KPMG review of HSA published - CIG promises action plan in six months

What have been presented as significant first steps on a pathway to ultimately improving the administration of the Cayman Islands Health Service Authority (HSA) have been outlined in a comprehensive government-commissioned report into the agency’s operations.

Presenting the 51-page report compiled by the accounting firm KPMG, Hon. Min for Health, Environment & Sustainability(MHES), Katherine Ebanks-Wilkes, stressed that “we had commissioned an independent external review of how the HSA is governed.”

Issues surrounding the management and oversight of the government’s health agency have been in the public domain for some time now and were even addressed during recent sittings of Parliament.

Outlining that the scope of the KPMG review focused on how decisions are made, how the board is structured, and ‘how accountability works’, Min. Ebanks-Wilks went to great lengths to emphasise this point: “I want to make it clear that this is not a review of clinical care or quality of treatment that patients receive. That’s a separate piece of work,” she stated.

The Health Minister pointed out that: “This was specifically about governance; the structures and processes that sit behind the health system.”

CHALLENGES AND OPPORTUNITIES

The report details what it refers to as “11 identified challenges and 47 improvement opportunities” resulting from its consultation, which involved nearly 700 stakeholders, including members of the public.

According to Min. Ebanks-Wilks, “The opportunities in this report are intended to strengthen the HSA’s governance and performance so that actions taken across the system lead to real, measurable improvements in health outcomes that matter to the People of the Cayman Islands.”

Among the key observations in the report, described as phase one of a corrective process, was that ‘stakeholders consistently highlighted governance challenges within the HSA, including a legacy governance system characterised by slow decision-making, limited accountability, reactivity, and inconsistent engagement with staff, patients, and partners’.

The report concluded that these were identified as problems that have caused ‘diminished trust, elevated risks, driven inefficiencies, and compromised timely, high-quality care’. It recommends that ‘timely action would help address these challenges to avoid further escalation of problems’.

Speaking to the validity of the findings in the KPMG report, Alanis-Linwood Amor, Senior Policy Advisor in the MHES, outlined that the findings were not based on a single source. “This review involved extensive engagement with a broad range of stakeholders…This simply was not a best-case review. It was informed by direct engagement with the people and organisations close to the HSA.”

Exie Tomlinson-Patton, Deputy Chief Officer in the MHES, explained that KPMG organised their review of HSA around five areas of governance. “Together these cover how HSA sets directions, how decisions get made, how performance is tracked, how it communicates internally and externally, and its organisational culture.”

In giving a direct comment on the outcome of the review, Min. Ebanks-Wilks stated: “The report’s findings reflect the breadth of those perspectives and demonstrate the value of engaging widely in matters of public importance. Commissioning this independent review reflects the National Coalition for Caymanians Government’s commitment, and my own as Minister responsible for Health, to accountability, transparency and evidence-based decision-making in the governance of our public healthcare institutions.”

She also admitted that while important steps have already been taken to strengthen governance since December 2025, “this report provides a clear roadmap for further improvement”.

ACTION PLAN IN SIX MONTHS

Min. Ebanks-Wilks gave a commitment that an implementation plan will be finalised within six months, setting out how the Ministry, the HSA Board and the Authority’s leadership will respond to the report’s recommendations. She said progress will be communicated transparently, with a formal public update published following completion of the implementation plan.

As part of the next phase of this work, it was explained that an independent clinical and operational review will be commissioned to provide an objective assessment of the Authority’s clinical services and operational performance, complementing this governance review.

It is expected that together, these reviews will provide a comprehensive foundation for strengthening the HSA and ensuring it is equipped to meet the healthcare needs of Cayman’s growing population. “As the public is aware, the HSA operates in a challenging environment shaped by rapid population growth, cost-of-living pressures, capacity constraints and the realities of delivering healthcare in a small country comprising three islands,” the Health Minister said.

​“Meeting these challenges requires clearly defined roles and responsibilities between the Board and management, effective Board oversight, strong leadership and clear priorities at every level.”

Stating the decision to publish the full KPMG report, rather than a summary, Min. Ebanks-Wilks said it is important that the public can see the recommendations for themselves and understand the basis for the actions that will be taken in response to the report’s recommendations.

“The Ministry is working closely with the HSA Board and the Authority’s leadership to deliver these reforms so that the HSA meets the standard the people of the Cayman Islands rightly expect, both now and for future generations. I have every confidence that the Board and Authority’s leadership will approach this work with the seriousness, professionalism, and commitment it demands.”