It was only a small slip, of information, Mr. Editor, but it struck me as a possible tell. In the throes of the dispute over furlough days, the BPSU declared that they had been threatened with a 19 per cent hike in health insurance premiums. Around about the same time, the rest of us were put on notice by the Finance Minister to expect (his words now) a tough Budget in a little over a week’s time.

Inquiring minds begin to wonder; no, not wander, wonder. It has been some time since we have heard how the Bermuda Hospitals Board is managing with the cost of operation of the new Acute Care Wing, and with KEMH generally for that matter. On the other hand, we not only hear a lot about rising costs in health care, we experience it first hand.

Budget-time is typically when we learn about new rates for the KEMH and they almost never, ever, go down. Only up. This is quickly followed by upward increases in health insurance rates, for everybody. While I could be wrong, and I hope I am, brace yourself people for a possible shock, assuming the proposed 19 per cent increase for civil servants is any indication.

I readily concede that I am only guessing that two plus two will once again equal four. We have not actually been given a lot of information on how our hospital has been doing financially. For example, I believe that the Hospitals Board is behind in publication of as many as three financial statements, and counting.

The absence of information stands in stark contrast to the promises that were made a year and a half ago when the Board through its chairman promised us greater transparency and accountability in an advertorial entitled “An Open Letter from the Bermuda Hospitals Board to the Community”. This was back in June 2013 and Board members had only just been appointed in January of that year following the December 2012 election.

“Prior to joining”, read the Open Letter, “we were acutely aware of the many serious concerns the community had regarding the BHB, including the quality of care, financial stewardship, leadership, transparency and accountability. We are in the process of developing a scorecard of clinical and financial data that will be shared regularly with the community beginning in July.” There was even mention of quarterly press conferences and an annual public meeting.

Correct me if I am wrong but there hasn’t been that much sharing since.

Meanwhile, Government is now on its third Minister responsible for health and by extension the hospitals. We may or may not learn more about hospital financing when Government funding comes up for vote in the Budget Debate. That will depend in part on how much time is set aside for examination (and the allocation of time is in the first instance something the Opposition determines) and then on how forthcoming the Government is prepared to be.

Sad to say but that parliamentary process doesn’t always produce the kind of detailed examination that is merited.

I have written on the subject before, I know. This is just one of the things that needs changing up the Hill: the way our annual Budget debate is conducted. The Board and hospital management only get to respond to questions, and to provide answers, by handing up hastily handwritten notes to the Minister who may or may not answer, and then only if there is enough time. This method of parliamentary scrutiny leaves, shall we say, a lot to be desired.

But there is a more direct way to proceed and we wouldn’t have to wait twelve months for the Budget Debate each year. There is again a role here for the Public Accounts Committee (PAC) — or for a specially struck committee of the Legislature — whose members can, through public hearings, ask questions of, and seek answers from, those in charge.

The need to keep a close and current eye on hospitals’ finances by an active PAC has, pardon the expression, never been more acute. Aside from the ever-pressing need to keep down costs in the current economic climate, and the burden this could potentially mean to Government and mounting public debt, taxpayers ought to know how one of the community’s most important public institutions is managing economically.

The need to know is even that much more pressing, post-completion of the new Acute Care Wing under a public private partnership (PPP). The model of financing warrants closer public examination even more especially now that Government has decided that a PPP is the way to make a new airport fly; financially, of course.