The Progressive Labour Party’s more than two-to-one majority in the House of Assembly represents a great political opportunity to make the radical changes Bermuda needs.

That is the view of Philip Butterfield, chairman of BermudaFirst, the advisory group which has proposed sweeping changes to address the island’s challenges in areas including healthcare, education, living costs and immigration in its Future State report.

Among the recommendations are an independent education authority, regulation of medical professionals amid a healthcare system overhaul and immigration policies to spur economic growth.

The report was commissioned by David Burt, the Premier.

The apolitical group drew on the work of eight working groups and 90 participants to make its proposals for the island’s future socioeconomic success.

Asked whether he thought the will existed to enact the politically challenging raft of proposals, Mr Butterfield said: “I’m an eternal optimist.

“Given that the Premier asked for transformative solutions, he’s already at the place where he recognises that this isn’t going to be an easy objective to accomplish.

“With a 25-11 margin [the PLP’s majority in the House of Assembly], that’s a political capacity that should be taken advantage of.

“I recognise that this is not a light-switch experience, that what we’re trying to accomplish can only be achieved over a period of time.

“We’re trying to get people to recognise that there’s an opportunity for a greater level of success, if we embrace some of the recommendations we’re talking about, as opposed to the tinkering that’s been done in the past. I believe that if you can convince people that these recommendations make sense, then there would be a level of broad support for getting those things done.”

In an interview, Mr Butterfield, the former chief executive officer of HSBC Bermuda, said he and his BermudaFirst colleagues were “ready to talk with anyone” to help further the case for the recommendations.

The status quo was not the way to success, he added, and he spoke of the urgency for action, especially in education and healthcare.

The public education system had underperformed for the past two or three decades, he said, and now was the time for radical change.

“The most substantive proof of that is that there are fewer students in public education today than in private; about 52 per cent of students are in private education,” Mr Butterfield said.

“That was very different from my experience growing up and it’s very different from any other place on the planet.

“All the tinkering around the edges that well-meaning people have engineered over the years hasn’t produced the desired results. So it’s time to do something radical.”

Accountability was the key to improving public education, he said, and an independent authority would be the best way to achieve it.

“Today, there’s no penalty for the shortcomings in the system,” Mr Butterfield said. “We need a performance management system that allows us to hold people to account.

“That’s how it works in the private sector and we see no reason why it shouldn’t work that way in education.”

As well as ensuring that teachers meet international standards of competence, managerial skills to deal with matters such as allocation of resources are needed.

“There are decisions we have to make about consolidations or school closures, which tend to get wrapped up in politics, as opposed to the underlying issues,” Mr Butterfield said.

“We have declining birthrates and a flow into the private sector, so in the 21st century why do we need 18 primary schools?

“I think we could be more effective with a smaller, more focused number of institutions.”

On healthcare, the BermudaFirst team came to the conclusion that an holistic approach was needed to a complex challenge, including a national wellness programme to address the chronic, lifestyle-based diseases driving Bermuda’s healthcare price inflation.

“We know through medical practitioners that there are 800 pre-diabetic Bermudians,” Mr Butterfield said.

“There are about 200 people using dialysis today, between the hospital and the centre on Front Street and that is costing in the range of $20 million a year.

“Left unchecked, in ten years that number could be $40 million to $50 million. To me, that’s a crisis and requires the kind of proactive debate and dialogue that demands a real solution.”

BermudaFirst was critical of the Government’s approach to healthcare financing reform and Mr Butterfield recommended an approach tackling “the full spectrum of activity” rather than focusing on one part of it.

“When you pick one element and it has the potential to be more disruptive than any of the others, then that raises a level of angst that is not in our best interests,” he said.

“I think we need to have a transparent debate about single-payer systems and I know that is an objective of the Government.”

BermudaFirst recommends an outcome-based healthcare system to reduce the overutilisation of services, as well as regulation of medical service providers.

Mr Butterfield said much technology now existed to monitor our health, producing data that could help doctors to intervene to prevent more serious problems.

“I’m of the view that we should be more proactive in healthcare and I’m sure that the several physicians in my family would say that it’s in the interests of patients to take a more holistic view of their health requirements,” Mr Butterfield said.

The right expertise would be needed for regulation, he stressed.

“I don’t know how you can have a non-medical person regulating doctors; it’s like plumbers running the Pentagon; it doesn’t make sense,” he said. “I think we’ll get a better result if we get a medical professional overseeing medical practitioners.”

Bermuda should leverage relationships with overseas institutions to tap expertise to help make informed healthcare reform decisions, Mr Butterfield said.

Immigration arose as a topic of concern among all of BermudaFirst’s eight working groups, Mr Butterfield said.

“It is the most emotive issue,” he said. “So we looked at how we could find a methodology to lessen the emotive content. If we look at it through a talent lens, then we can do that.

“We suggested to the Government that they should lead the way, and with the Premier agreeing to conduct a talent assessment in the Civil Service to see if the right people are in the right jobs, and to identify people who can be sent abroad for appropriate career development and return to Bermuda and make their contribution.

“If that same approach were consistently applied throughout the private sector, then over time we’d have a more constructive viewpoint of immigration.”

Immigration’s relationship with job creation and a healthy economy needed to be made clear, he said, as did an open discussion of why the subject is so emotive.

“The history of immigration in Bermuda is one that needs to be addressed, not in whispered tones, but in an adult fashion,” Mr Butterfield said.

“I think it’s fair to say that, in the past, immigration practices were nefarious and principally used to attract more white people to Bermuda to perhaps balance the politics, as opposed to being used to attract the right talent to Bermuda to allow us to be successful in the long run.”

BermudaFirst has also identified the high cost of living as a priority issue, with the price of energy and food causing particular concern, as well as the plight of seniors.

“Bermuda’s kilowatt per hour charge is among the highest in the world and that has an impact on households and businesses at all levels and it’s an impediment in the hospitality sector,” Mr Butterfield said.

“So we have to work out a long-term solution that results in a more reasonable charge.”

He saw a role for entrepreneurs in addressing cost of living issues, and possibilities for vertical, hydroponic farming to make the island less reliant on food imports.

“We’d like to stimulate the thinking across the community,” Mr Butterfield added.

• To view the BermudaFirst report, click on the PDF link under “Related Media”