Editorial: A worthy first move only, Mr Dalley

Horace Dalley is to be commended not only for the speed with which he moved to fire hospital governors at the heart of the scandal over the deaths of 19 preterm babies, but for the quality of the boards with which he replaced them. In both cases, they are being led by men of substance with reputations for getting things done.

That notwithstanding, we do not believe that the new health minister has gone far enough. There is more firing to be done. And the earlier he gets this messy part of the business out of the way, the better. It will be easier to accelerate the necessary reform of the health sector.

The proximate cause for the removal of Mr Dalley's predecessor, Fenton Ferguson, may have been the outbreaks of klebsiella and serratia bacteria at the University Hospital of the West Indies (UHWI) and the Cornwall Regional Hospital (CRH), with fatal consequences.

But an equally substantive driver of public anger was the revelation of the fetid state of several institutions, for which neither policy nor the admitted shortage of financial resources could bear the entirety of blame.

Indeed, any failure of contracted cleaners to provide their staff with mops or appropriate buckets can't be appropriated to policymakers. Nor can be a lapse by medical staff in insisting on the highest level of occupational hygiene. Or if solutions are not properly labelled, or available space not efficaciously utilised.

This highlights a collapse of operational management, which was the declaration of the audits.

Dr Ferguson's culpability lay in his failure to hold those who were responsible for the oversight of the institutions to account for their underperformance and for being less than candid about the state of the public health-care facilities when he became aware of the truth. Indeed, while that may not have been what actually happened, the state of the hospitals would have made them more susceptible to nosocomial infections.

Be wary

But worse, on Dr Ferguson's part, in the face of public criticisms, he allowed those who bear a large portion of the responsibility for the mess to form themselves into a kind of Praetorian Guard around him, which may be interpreted as an attempt, on their part, at self-preservation. For that alone, Mr Dalley should be wary of his inherited boards.

He also has other reasons to cut them loose. The crisis revealed in the audit was not limited to UHWI - which, though semi-autonomous, falls under the monitoring of the South East Regional Health Authority - or Cornwall Regional, which is part of the Western Regional Health Authority (WRHA). The problems are in all four regional authorities.

The appointment of new boards at UHWI and WRHA, therefore, is only a start - and a good one at that, with businessmen Jimmy Moss-Solomon and Tony Hart as their respective chairmen. The other boards must now go, and, perhaps, too, some of the technocrats who may have failed to properly advise Dr Ferguson.

As he is at it, Mr Dalley should look around for top talent to run, even on a short-term basis, some of the operational entities in health. R. Danny Williams and Douglas Orane, for instance, might be appointed as his principal secretaries to drive the overhaul of his ministry.