1. Biennium Budget 2008 - 2010 University Hospital of the West Indies

2. These plans are a continuation of the operational plan submitted in the 2006/2007, 2007/2008 budget and biennium estimates. It is predicated on the following critical pillars: The University Hospital of the West Indies Board of Management Five Year Strategic Goals and Objectives; The requirements of both the Caribbean Authority for Education in Medicine, and the International Standards for Accreditation; The proposed Service Level Contract between the University Hospital and the Ministry of Health. Major Influence on the Budget

3. The University Hospital Board of Management recognizes the pressures that have resulted from prior reductions to hospital funding. Namely; inability to maintain sufficiently a 50 year old plant inability to replace obsolete equipment inability to meet the demands of new services Unable to attract and maintain best talents Overview

4. Financial Concerns The drastic cut to the budget in prior years; The ambitious dependency on the collection of hospital fees to supplement the approved budget; The continued high inflation and devaluation of the Jamaican dollar; The mushrooming of a number of services that were not supported in the budget creates greater pressure on the budget, and on the ability of the hospital to ensure a high quality of service; The deterioration of the physical plant, and infrastructure, which give rise to frequent breakdown of the service often involving urgent funding that may not be provided for in the approved budget;

5. Key Issues for 2008/2009 Information Technology (IT) forms an integral part of the plan, as the operational and management systems and processes have to be driven by IT for greater efficiency the savings that can be realized by the reduction of time and labour to achieve the required outcome. The absence of this critical intervention is currently a major inhibitor.

6. Key Issues for 2008/2009 (Cont’d) There has been a growing demand for our services while our resources are shrinking. Areas, such as the Medical Programme, have been experiencing an increase in the demand for cardiology, diabetes and gastroenterology services. Dialysis service is under extreme pressure which will continue in the upcoming year.

7. Key Issues for 2008/2009 (Cont’d) There are also issues facing the Surgical Programme. These issues include the ongoing shortage of operating time and space for surgeries. The old operating rooms with chronic maintenance problems, along with the outdated structure give rise to inefficiencies in its operations.

8. Key Issues for 2008/2009 (Cont’d) Chronic shortage of professional staff, Nurses, Pharmacists, Radiographers, and Dietitians; Inadequate cash flows; Staff Retention issues; Deteriorated facilities;

9. U.H.W.I Funding

10. Achievements Over the last Three Year Period 2004/2005, 2005/2006, 2006/2007 (cont’d) Implementation of the Bachelor of Science Degree in Medical Radiation Technology; Increase in the intake of students to the School of Medical Radiation Technology (SMRT) Establishment of the Diabetes Programme for paediatrics; Establishment of the hospital wide Continuous Quality Improvement Programme; Services

11. Achievements Over the lastThree Year Period 2004/2005, 2005/2006, 2006/2007 (cont’d) The introduction of the Emergency Room Technicians (ERTs) as part of the emergency room health care team. 8 ERTs have been trained and an additional 9 will complete training at the end of March. Bring the total number of Emergency Room Technicians to 17; Establishment of the Community Mental Health Programme and the emergency response team; Development of the Therapeutic Community and Open Ward Policy; Services

12. Achievements Over the last Three Year Period 2004/2005, 2005/2006, 2006/2007 (cont’d) Administration Developed and implement the new nursing organization structure; Developed for implementation the new management structure that is complementry to and supports the new thrust for accountability; providing greater support to the clinical programmes and support services; Developed and implement the Policies and Procedures Committee; Development of the Staff Welfare Programme; Development and implementation of disciplinary code, policy procedure manual and grievance procedure;

13. Achievements Over the last Three Year Period 2004/2005, 2005/2006, 2006/2007 (cont’d) Administration  Developed and instituted the Audit Committee of the Board;  Developed and instituted the Education Committee of the Board;  Developed for implementation the Quality Council, as a committee of the Board;  Implementation of the weekly Senior Directors’ meeting;

14. Achievements Over the Three Year Period 2004/2005, 2005/2006, 2006/2007 (cont’d) Administration  Establish the Business, Marketing and Reimbursement division, which has realized an increase in user fees collection from an average of $33.0M monthly to $52.18M having achieved the highest collection of $58.3M in the month of July 2007;  The development and implementation of a fee structure for the Tony Thwaites Wing which results in the hospital payments from the Wing jumping from a monthly average of $0.96M to $9.46M;

15. Achievements Over the lastThree Year Period 2004/2005, 2005/2006, 2006/2007 (cont’d) Administration  Administration supported the hospital ophthalmology service and supplied the necessary resources, thereby, allowing that discipline in the Surgical Programme to re-start the DM Programme. It is now in a position to accommodate an increase in the demand for the training of the medical students.

18. Key Issues for 2007/2008 (Cont’d) Salaries and allowances Memorandum of Understanding (MOU) agreements with the Trade Unions, representing the professional groups, have not yet been finalised but it is expected to be in line with inflation which runs from 10% to 16%; Sessional allowances for the nurses have been restructured to include new rates for Saturdays, Sundays and Public Holidays.

19. Repairs & Maintenance Needed repairs to buildings including those accommodating scarce Professional staff to include Nurses and Pharmacists. Begin a phased rewiring on the campus to reduce the risk of electrical fires etc. The need to replace old equipment that have exceeded its useful life and is in the books as fully depreciated.

20. Medical and other supplies Additional supplies needed for : full time operation of new ICU. This is possible due to overseas recruitment of nurses from India. Increase uptime for operating theatres (95%); Reopening of two closed wards (2, & 10);

21. Service Contracts Expected costs based on current obligation to contractors – 16% in line with inflation.

22. Other Operating Expenses Improvements for communication system:- To increase and upgrade of IT staff; To purchase software licenses; To acquire new software; To integrate various systems – increase efficiency; To replace aging equipment;

23. Urgent - Additional Staff Request 78 Doctors $ 245 M 408 Nurses Recruited Overseas $496 M Grand Total $741 M

24. Major Considerations in Budget Upgrade and additional staff $923M Capital projects Building $568M Information System Upgrade $53M Equipment replacement $818M Recurrent expenses for 2006/7 $6.4B Annual increase in operating cost of at least 10% TO 16%

25. Consequences of previous inadequate Budgetary Provision 50 year old plant with high maintenance costs; Significant shortage of nurses and other professional groups (NB over 120 nurses are lost each year) Implication for accreditation of the UHWI; Deteriorated patient care quality; Inability to attract and maintain the best talents;

26. Manual and nonintegrated information systems; Accounts payable balances of approximately US$6.9M and the inability to get the best prices from suppliers. US$4.7M is over ninety days old. Consequences of previous inadequate Budgetary Provision (cont’d)

27. Conclusion The UHWI strategic direction has been clearly communicated in our budget for 2008-2010. We continue to achieve the primary goals and objectives as directed by our operational plan. Our focus on continuous quality improvement directs us to set targets and measure our progress to ensure that we accomplish specific tasks and achieve key objectives.

28. Conclusion (cont’d) We have made some important assumptions in setting the direction for the 2008/2009 fiscal year. These assumptions are based on a number of variables that impacted the budget in 2006/2007 and the first half of 2007/2008 fiscal years. The estimate of expenditure that is submitted has been thoroughly considered, based on the realities of the Jamaican economic state, and the critical needs of the hospital; the submission contains the needs that are critical and urgent. Efforts have been made to make this budget as lean as possible without compromising care to our patient.

29. Against this background, the University Hospital of the West Indies seeks the support and approval of The Technical Advisory Committee for this budget request requiring Government contribution of $7.1B for financial year 2008/2009 and to note the the budget for 2009/2010.

30. The End

31. Thank You