Joint Ministerial Council 2013 - Progress on ...

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Joint Ministerial Council 2013 - Progress on Implementation of Agreed Actions 1 Completed By: Cayman Islands Date: 31 October 2014 The political leaders and representatives of the United Kingdom and the Overseas Territories agreed to report on the progress made in implementing the commitments made during the 2013 Joint Ministerial Council meeting in December in London. The Cayman Islands progress report is as follows. Economic Diversification Commitment Progress 1 Promote globally the investment and trade opportunities in the Territories, including through cooperation between Territory investment agencies, UK Trade and Investment (UKTI) teams and UK Embassies, High Commissions and other Posts. As of June 2014 all companies incorporated in the Cayman Islands can take advantage of the Overseas Market Introduction Service (OMIS). This service assists companies to access the right international contacts or partners, find the best way to do business in a market, and help to penetrate new markets. United Kingdom Trade and Investment (UKTI) Miami visited the Cayman Islands in October to discuss business opportunities and to explore how UK companies can partner with local firms to successfully submit tender bids. 2 Inform UK companies of investment opportunities in the Territories and encouraging them to explore the opportunities. Action principally for UKG The Cayman Islands Government (CIG) highlighted Government tenders to UKTI mostly in relation to key infrastructure projects, such as the airport and the integrated waste management system. There was significant interest from UK companies as a result. 3 Promote Territory exports and service industries, including in emerging markets and in countries where the Territories are not currently recognized. Action principally for UKG 4 Explore further opportunities to boost inter-Territory trade and investment and the sharing of best practice. The CIG continued to establish medical tourism as the fourth pillar of the economy, with the launch of Health City Cayman Islands (HCCI), a joint venture between US-based Ascension Health and Dr. Devi Shetty from Narayana Health in India. The first phase is open and offering tertiary care in cardiology and orthopaedics. Regional UKOTs may find this more cost-effective than sending patients to the United States. During Pre JMC, OT Leaders visited HCCI to learn

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Joint Ministerial Council 2013 - Progress on Implementation of Agreed Actions

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Completed By: Cayman Islands Date: 31 October 2014

The political leaders and representatives of the United Kingdom and the Overseas Territories agreed to report on the progress made in implementing the

commitments made during the 2013 Joint Ministerial Council meeting in December in London.

The Cayman Islands progress report is as follows.

Economic Diversification

Commitment Progress

1 Promote globally the investment and trade opportunities in the Territories, including through cooperation between Territory investment agencies, UK Trade and Investment (UKTI) teams and UK Embassies, High Commissions and other Posts.

As of June 2014 all companies incorporated in the Cayman Islands can take advantage of the Overseas Market Introduction Service (OMIS). This service assists companies to access the right international contacts or partners, find the best way to do business in a market, and help to penetrate new markets.

United Kingdom Trade and Investment (UKTI) Miami visited the Cayman Islands in October to discuss business opportunities and to explore how UK companies can partner with local firms to successfully submit tender bids.

2 Inform UK companies of investment opportunities in the Territories and encouraging them to explore the opportunities.

Action principally for UKG

The Cayman Islands Government (CIG) highlighted Government tenders to UKTI mostly in relation to key infrastructure projects, such as the airport and the integrated waste management system. There was significant interest from UK companies as a result.

3 Promote Territory exports and service industries, including in emerging markets and in countries where the Territories are not currently recognized.

Action principally for UKG

4 Explore further opportunities to boost inter-Territory trade and investment and the sharing of best practice.

The CIG continued to establish medical tourism as the fourth pillar of the economy, with the launch of Health City Cayman Islands (HCCI), a joint venture between US-based Ascension Health and Dr. Devi Shetty from Narayana Health in India. The first phase is open and offering tertiary care in cardiology and orthopaedics. Regional UKOTs may find this more cost-effective than sending patients to the United States. During Pre JMC, OT Leaders visited HCCI to learn

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more about available services.

CIG amended its Health Practice Law to provide a legislative framework to oversee the development of Medical Tourism, to allow for a vetting and due diligence process to screen potential providers and facilities.

5 Publish Territory investment policies setting out clearly the offer to inward investors.

CIG has created a number of long-term residence categories for investors and persons of independent means such as: –

o Residency Certificate for Persons of Independent Means; o Certificate of Direct Investment; and o Residency Certificate (Substantial Business Presence).

6 Commission independent advice on enhancing competitiveness, strengthening resilience and reducing vulnerability

The CIG commissioned Ernst & Young (EY) to review its public sector with a view to reforming public services and asset base. The aims of the reforms are to free up government finances and create opportunities for public and private investment in infrastructure development. This in turn will stimulate economic growth, enhance competitiveness and strengthen resilience. The EY report and recommendations are currently under consideration by the Cabinet. The Deputy Governor has established a unit to oversee and support the implementation of the recommendations agreed by the Cabinet.

7 Promote entrepreneurship and the development of small businesses, including through the Caribbean regional EU-funded Small and Medium-sized Enterprises project.

CIG is working with the Chamber of Commerce, the Small Business Association and the EU consultants on Small and Medium-sized Enterprises project funding opportunities.

CIG gave an official definition of small and micro businesses for the Cayman Islands.

Micro businesses are to receive a discount of 100% of their Trade and Business License Fees. Small businesses will benefit from a similar discount of between 50% - 75%.

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Employment and Education

Commitment Progress

8 Share good practice on workforce planning, skills training and addressing the specific needs of young people, older people and the disabled.

In late 2013 representatives from the Ministry of Education met with a delegation from Turks & Caicos Islands, that included the Minister and Permanent Secretary of Education, Youth, Sports & Culture. The meeting was to share good practice on the following:

o The Strategic Plan for Education; o The use of technology to enhance teaching and parental involvement; o Use of a database for record keeping; o Responding to challenges of violence in schools; o New school structures (Clifton Hunter High School and new primary

school buildings)

In February 2014 a similar meeting was held with a delegation from Bermuda which included representatives from their Ministry and Department of Education.

The Cayman Islands Further Education Centre (CIFEC) has approximately 265 students. All CIFEC students take part in a robust internship programme. Each student spends three days in lessons, and two days in the workplace. The students have the opportunity to resit English and mathematics and take three Business and Technology Education Council (BTEC) subjects, including the mandatory Deloitte employability course. Optional subjects include business, beauty therapy, construction, health, ICT and more.

The internship in many instances links closely with one of the student's BTEC subjects. The Careers department at CIFEC has close links with employers throughout the Island. Many of the Island’s most prestigious firms take student interns each year. Some of the job placements have led to full-time employment

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or scholarship opportunities for students. To help this process the Careers department organizes a Careers Fair at the beginning of every school year.

Recognizing that the solutions to addressing the challenges related to unemployment are found across Government, the Ministry of Education, Employment and Gender Affairs (EE&GA), through Cabinet, established an Inter-Ministerial Committee on Employment (IMCE) in July 2014. The broad purpose of the committee is to promote better collaboration between Government agencies on matters related to the challenges of unemployment.

EE&GA is currently developing a proposal, for presentation to Cabinet, for the establishment of a National Workforce Advisory Council (NWAC). It is proposed the NWAC have industry and public sector representation, to ensure the engagement of employers and industry as stakeholders in human capital development efforts. The Council will provide guidance, feedback and support to EE&GA and the National Workforce Development Agency (NWDA).

To better prepare prison inmates to re-enter society, the NWDA Training and Development Unit, in partnership with Her Majesty’s Cayman Islands Prison Services, offers a City and Guilds qualification in Employability and Personal Development – Preparing for Employment. The Training and Development Unit also offers Career Ready 101 assessment and career planning for inmates at the beginning of their sentences.

The Sunrise Adult Training Centre delivers quality vocational training programmes and therapeutic support services for adults with disabilities. The Sunrise Vocational Department partners with local businesses and the Government to identify opportunities for internship and/or employment for its clients.

The Sunrise Adult Training Centre Vocational Department facilitates training both onsite and off to develop work ready skills in those clients identified for supported employment. The Sunrise Centre continues to provide therapeutic

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support services through the Life Skills Workshop projects which highlight the creation of products by clients using crafts or produce grown at the Centre. Through these projects the Centre continues to develop programming which will facilitate tracks which emphasize interaction, inclusion, and socialisation.

To ensure that the citizens of the Cayman Islands are positioned to access, maintain and progress in employment, the NWDA engages in a number of initiatives: -

o Delivery of free training and development opportunities that develop soft skills, job search skills, and specific technical skills (delivered since January 2013);

o A National Internship Programme designed to provide Caymanians with experience in the world of work, by facilitating internship opportunities whereby persons are able to gain valuable knowledge and hands on experience in a structured format (launched May 2014);

o The National Employment Passport Programme, Passport2Success (P2S) Programme is currently running its 15th cohort. Over 50% of graduates secure employment within one year of graduation. This programme targets two demographics: men and women aged 17-20 and unemployed mothers.

The framework for the National Apprenticeship Programme is currently being developed in collaboration with the private sector. Its objective is to ensure there are adequate training opportunities for Caymanians who are engaged in studies locally and abroad, and who are interested in gaining the requisite technical and applied skills and experience to access the labour market.

9 Develop efficient and professional public employment services.

The NWDA is focused on creating effective mechanisms for connecting job seekers with employment opportunities while supporting the facilitation of transparency in the work permit process. This objective is being accomplished through:–

o an Online Job Portal that connects job seekers with employment opportunities while encouraging independence in job-seeking activities

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(launched June 2014); o a Department of Immigration interface connected to the Online Job

Portal that provides information that facilitates transparency in the work permit process (launched February 2014);

o an interface designed for the offices of elected public officials, which provides information on available jobs, and supports elected officials as they assist constituents with accessing employment (launched June 2014);

o a comprehensive intake and assessment process includes the identification of barriers to employment and an appraisal of skills, interest and abilities. It connects job- seekers to activities and service providers that can support them to overcome barriers (launched June 2014); and

o Fresh Start, a voluntary community programme which identifies paid or unpaid employment opportunities for offenders eligible for Release On Temporary License (“ROTL”) or Parole.

10 Develop immigration policies that take into account the interests of local people and businesses, and minimise risks for the UK.

The “Key Employee” designation was abolished and CIG instituted revised Permanent Residency requirements in October 2013.

Review of the work permit regime is expected to be completed during the first half of 2015.

11 Explore further how the people of the Territories can access vocational training in all parts of the UK and in other Territories;

Action principally for UKG

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Links with the Wider World

Commitment Progress

12 Strengthen Territory engagement with international partners with support from the UK’s network of diplomatic posts.

Progress on this commitment continues to be hampered by a lack of a Memorandum of Understanding. The OTs and the UKG have committed to including this issue on the 2014 JMC agenda to further discuss details.

13 Make full and effective use of new trade opportunities with the EU and increased EU funding streams including the European Development Fund and its regional programmes

While the Cayman Islands does not qualify for a territorial allocation of the EDF, it does and can benefit from the regional allocation. For example, along with other Caribbean OTs it is benefiting from the EDF10 project on developing SMEs. It is also participating in the OCTA Territory Strategies for Innovation. Like all other Associated Territories it can also access the ERASMUS Plus education mobility programme, HORIZON 2020 and other selected EU horizontal funds including the Development and Cooperation Instrument.

Under the 9th European Development Fund (EDF) the Cayman Islands received an approved amount of €4,500,000 for the establishment of a digital early warning station on the Cayman Islands. The Kearny Gomez Radar project was successfully completed on 31 December, 2013. The radar system will be included into the 2007 “Strategic Framework for Disaster Risk Management for the Cayman Islands”. Furthermore, the Caribbean Meteorological Organisation (CMO) will ensure that the station is integrated into the existing radar system for which they are responsible, in close co-operation with CARIFORUM, fulfilling the EU’s mandate for regional early warning stations throughout the Caribbean region.

14 Encourage the Commonwealth Secretariat and the chairs of Commonwealth fora to invite the Territories directly to participate in relevant meetings and programmes, particularly the Commonwealth small states meetings.

Action principally for UKG

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Green Energy and Environment

Commitment Progress

15 Increase the use of renewable energy sources, including enabling production and removing barriers to use.

Following discussions with CIG and power provider Caribbean Utilities Company Ltd, a private company, OTEC International, is set to commence an EIA for a project that proposes the phased implementation of 25mW of power, produced through ocean thermal energy conversion technology. The proposed first phase is a 6.25 mW floating power platform with an anticipated operational date of 2017.

Renewable energy components and materials remain “duty-free” as an incentive for private and commercial uptake of renewable energy technology.

16 Establishing workshops in order to assist Territory Governments in capacity-building, technical assistance and renewable energy financing

Action principally for UKG

17 Promote the development of, and investment in, sustainable fishing industries, particularly in Territories where potential resources are underutilised or illegally exploited.

Given the extremely narrow coastal shelf of the Cayman Islands, the resulting limited fisheries resources, the already significant fishing pressure from recreational and subsistence level fishing, and the value of healthy fish populations to our economically important coral reef systems, this is not an area that the CIG sees as a priority for further development.

Despite these obstacles, a pilot programme for a tilapia farm was launched at Her Majesty’s Prison. It currently supplies the local supermarkets and there are plans to expand the operation.

18 Publish road maps by end of May 2014 setting out plans to implement our environmental commitments and demonstrate our contribution to the UKOT Biodiversity Strategy.

The Department of Environment is actively working on the roadmap.

A major milestone for all biodiversity conservation actions in the Cayman Islands was the approval of the National Conservation Law by the LA in December 2013.

The CI National Biodiversity Action Plan (2009) remains active, and species action plans have been or will be updated in the near future, e.g. Sister Islands Rock Iguana, Nassau Grouper, Marine Turtles, sharks etc.

19 Ensure the continuation of relevant funding programmes for Overseas Territories environment, conservation, biodiversity and climate-related projects.

Action principally for UKG

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International Financial Services Regulation

Commitment Progress

20 Explain the contribution of well-regulated international financial centres to the global economy.

CIG is supporting industry’s most recent effort to quantify our jurisdiction’s contribution to the global economy, via a commissioned report that will be published before the end of 2014. Through adherence to recognised and practiced global standards, well-regulated IFCs such as the Cayman Islands promote investor confidence; uphold the parameters for local and global market innovations; and facilitate international commerce, which stimulates economic growth and job creation.

21 Promote the application of high regulatory standards to deliver conditions in which legitimate financial services business can flourish.

The Cayman Islands signed both US and UK FATCAs in late 2013. We were the first Overseas Territory to sign the UK FATCA.

As of early September, more than 19,000 Cayman-based financial institutions had registered on the US FATCA’s GIIN (Global Intermediary Identification Number) registry. At that time, there was a total of nearly 100,000 registered financial institutions.

The Cayman Islands was rated 'largely compliant' following the Global Forum's peer review and rating process. The ratings were based on the forum's Phase 1 assessments of member countries' legal and regulatory frameworks, and Phase 2 assessments of their practical implementation of the global standard for tax information exchange.

The OECD/Council of Europe Convention on Mutual Administrative Assistance in Tax Matters was extended to the Cayman Islands on 1 January 2014.

The Cayman Islands Monetary Authority (CIMA) regulates the local financial services industry. Its knowledge and understanding of global regulation, and its ability to communicate the benefits of this regulation to industry, facilitates the promotion of, and adherence to, these standards. CIMA therefore creates and maintains an environment for legitimate financial services through regulatory

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policies that are appropriate, responsive, cost effective and efficient.

22 Discuss evolving standards in the provision of financial services and actively engaging with international standard setting bodies.

The Cayman Islands is now one of the vice chairs of the Peer Review Group, and it has retained its position on the Steering Group of the Global Forum on Transparency and Exchange of Information for Tax Purposes.

The Cayman Islands is a member of the Global Forum’s Automatic Exchange of Information (AEOI) Group.

CIMA’s engagement, with both international bodies and its regulatory counterparts in other jurisdictions, allows it to stay informed regarding current developments and future trends. Among other groups, CIMA holds memberships in the following organisations:

o Caribbean Financial Action Task Force (CFATF) o Offshore Group of Banking Supervisors (OGBS) o Working Group on Cross Border Banking o Caribbean Group of Banking Supervisors (CGBS) o Association of Supervisors of Banks of the Americas (ASBA) o Group of International Insurance Centre Supervisors (GIICS) o International Association of Insurance Supervisors (IAIS) o Offshore Group of Collective Investment Scheme Supervisors (OGCISS) o International Organisation of Securities Commissions (IOSCO)

23 Challenge other jurisdictions to match our commitments to transparency and tax information exchange.

Action principally for UKG

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Governance

Commitment Progress

24 Engage in peer review processes to improve regulation and get rid of red-tape, and further strengthen procurement, public financial management frameworks and codes of conduct and integrity.

CIG has not engaged in peer review but has undertaken a number of initiatives to improve governance of the public service. Including establishing a Central Procurement Unit and sponsoring a new Procurement Law.

Also a Public Authorities Law is near to being passed that provides consistent governance, financial and human resource arrangements to improve the accountability of public authorities to Parliament and citizens.

The Standards in Public life Law has been passed to promote and preserve the integrity of public officials.

A rationalisation review has been completed. The recommendations cover suggestions for performance improvement, for merging and restructuring, as well as options for sale, privatisation, outsourcing and engaging in public-private partnership (PPP) projects.

25 Increase secondments between the Territories and the UK where appropriate including through reviewing the effectiveness of the UK Government’s Jubilee Programme.

Action principally for UKG.

The Portfolio of the Civil Service (PoCS) has hosted delegations of HR professionals from other jurisdictions to demonstrate the HR reforms applicable in the Cayman Islands civil service. PoCS welcomes the opportunity to second key employees to the UK and other Territories, in order to increase their exposure to international best practice and to expand their professional networks.

26 Extend to the Territories international treaties on tackling corruption, bribery and the financing of terrorism and of organised crime (the UN Convention Against Corruption; the OECD Anti-Bribery Convention; the UN Convention on Suppression of Financing of Terrorism; and the UN Convention on Transnational Organised Crime)

To date the OECD Anti-Bribery Convention and Convention on Transnational Organized Crime have been extended to the Cayman Islands. The Cayman Islands requested the extension of the UN Convention Against Corruption in 2014. Some work has also been ongoing in the UK on the extension of the UN Convention on Suppression of Financing of Terrorism, so it is anticipated that these Conventions would similarly be extended within the near future.

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27 Fulfill our commitment to extension of the core human rights conventions1 where these have not been extended already.

Footnote1: the International Covenant on Civil and Political Rights; the International Covenant on Economic, Social and Cultural Rights; the Convention on the Elimination of all forms of Racial Discrimination; the Convention Against Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment; the Convention on the Rights of the Child; and the Convention on the Elimination of all forms of Discrimination against Women.

All of the core human rights conventions with the exception of the Convention on the Elimination of all forms of Discrimination against Women (CEDAW) have been extended to the Cayman Islands. Further to our initial request in 2004, the Cayman Islands has formally requested the extension of CEDAW and the Ministry of Education, Employment, and Gender Affairs has been heavily involved in this process. The UK Government Equalities Office is currently reviewing the Cayman Islands’ December 2013 submission. It has moved to the ‘evidence gathering phase’ in order to analyse evidence of compliance.

28 Strengthen the work of audit bodies and public accounts committees or their equivalents, with the support of the UK National Audit Office.

Steps were taken to functionally separate the Internal Audit Unit from the political directorate. The Internal Audit Unit now reports to the Deputy Governor as Head of the Civil Service. This is a key change as it impacts the operating environment of the Internal Audit Unit. The move has also enabled appropriate access to senior management to ensure the implementation of audit recommendations.

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Security

Commitment Progress

29 Enhance support provided by the UK Association of Chief Police Officers, UK College of Policing and the newly formed National Crime Agency.

Action principally for UKG

30 Enhance support for judicial and prosecution services, building upon the relationships already established with the Ministry of Justice and UK Crown Prosecution Service.

The deployment of a Criminal Justice Advisor on secondment from the UK Crown Prosecution Service is at an advanced stage. The advisor will assist in capacity and competence building by providing training in appellate level advocacy, prosecution of money laundering offences and the enhancement of case management systems. The ultimate aim is to improve the delivery of justice, improve security and reduce the threat of crime to the Cayman Islands and wider region. Terms of Reference have been settled and funding identified. Project implementation date is January 2015, subject to final sign off by the CPS.

31 Implement disaster risk reduction initiatives; robust and effective disaster preparation and response planning, including exercising and engagement with regional and international disaster response agencies.

Disaster Risk Reduction initiatives undertaken by Hazard Management Cayman Islands (HMCI) include: -

o Forming new Community Emergency Response Teams (CERTs). A total of four CERTs exist with two covering entire districts (North Side and West Bay). Approximately 100 persons have been trained in CERTs. Extensive work has been conducted in Windsor Park as precursor to establishing a CERT in that community.

o Training for first responders in Mass Casualty Management and Incident Command Systems. This was conducted by local certified trainers. PAHO assisted with access to manuals. HMCI also trained in Electrical Safety for First Responders and Hazwoper.

o Coordinating the Cayman Islands’ participation in the regional Lantex14 tsunami exercise and conducting the annual hurricane exercise.

o Raising awareness of International Day of Disaster Risk Reduction by coordinating local activities to recognize the day.

o Coordinating and delivering several public education programmes, including displays at major exhibitions and shows. The agency has also conducted extensive hazard disaster risk management awareness talks with the Health Services Authority (over 150 persons participated).

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o Conducting hazard awareness and disaster risk management educational talks with schools, incorporating earthquake drills in some cases.

o Participating in Overseas Territories Disaster Management Seminar Miami, Florida hosted by FCO.

o Hosting the British Overseas Territories Disaster Managers meeting. The goals of this meeting included developing strategies for strengthening disaster plans and sharing best practices.

o Strengthening the capacity of the office, through participation in certified Disaster Risk Management course. Emergency Management Accreditation Programme (EMAP).

o Assisting Turks and Caicos Islands' Department of Disaster Management in an assessment of their communications capability and also demonstrating WebEOC software operational use.

o Completing the installation of a Tsunami Gauge in George Town with the assistance of Department of Environment, Lands and Survey and Port Authority. The instrument will assist the departments mentioned and the National Weather Service with data regarding tides and wave heights.

o Continuing management and maintenance of the National Radio Communication System.

o Continuing the use of social media to deliver disaster risk management messages.

32 Take advantage of the expertise of the UK Ministry of Justice, National Offender Management Service and HM Prison Service to progress alternatives to custody, prison reform, restorative justice and protection of vulnerable witnesses.

Her Majesty’s Inspectorate of Prisons (HMIP), through networking with the Ministry of Justice, conducted an external inspection of Prison Service in July 2012, and is due to conduct a follow-up inspection in January 2015 to evaluate progress to date.

In addition, the Prison Director has implemented the Release on Temporary License (ROTL) scheme (NOMS based) as part of prison reform process and to promote rehabilitation of offenders & improve re-entry.

The Department of Community Rehabilitation (DCR) has expanded their Victim

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Services Unit, which provides a wide range of services and programmes. Victim Impact Statements are now considered by the Parole Board as part of the decision making process prior to release, victims are contacted by the DCR & provided with support.

33 Put in place robust and reliable extradition arrangements, including through extension of the 2003 Extradition Act;

Reform of extradition arrangements between the Cayman Islands. and the UK is in progress. The proposal is to make certain provisions of the UK Extradition Act of 2003 applicable to the Cayman Islands and Overseas Territories, to provide an updated and uniform approach to extradition across the Overseas Territories. Preparatory work and consultation have been ongoing. Final revision of the draft Order In Council is scheduled to be undertaken throughout October, with the aim of having the Order into force by the end of the year.

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Health [carried over from 2012 Communiqué]

Commitment Progress

34 Improve treatment and care for people suffering from chronic non-communicable diseases:

improve the sharing of information on UK health strategies and practices to the Territories;

share expertise on the audit and review of healthcare standards;

improve treatment of the mentally ill, building on work carried out by the Royal College of Psychiatry.

Action principally for UKG.

The Ministry of Health is partnering with PAHO this fall to start work on implementation planning for the National Health Policy & Plan 2012. This NHPP was shared with the Ministers of Health from the UKOTs at a recent meeting at PAHO.

The Health Practice Law & Regulations were reviewed and significantly amended in 2012. This legislation governs registration of health care facilities and providers.

CIG recently reviewed and overhauled its mental health legislation, including the introduction of a new Mental Health Commission which has started meeting this past year

The Ministry of Health and Mental Health Commission have partnered with PAHO to undertake the WHO AIMS survey of mental health services. This important survey will provide a baseline on incidence, existing service provision, and associated costs of mental health care in the Cayman Islands.

Work is currently being done to explore the feasibility of establishing a long-term residential mental health facility to allow CIG to bring our people who suffer from mental illness home to a therapeutic environment focused on the continuum of care.

35 Use telemedicine and other distance support arrangements where this can improve healthcare in the Territories

Action principally for UKG.

The Cayman Islands Health Services Authority has “Sally Robot” - a telemedicine tool donated to the hospital by a local NGO. This has been primarily used to treat stroke patients, but has expansion capability.

36 Address gaps identified by situation analysis of International Health Regulation compliance

Action principally for UKG

CIG is working with PAHO to get technical assistance regarding some aspects of IHR compliance/ implementation. At the same time CIG is largely compliant and has amended various pieces of legislation in accordance with IHR.

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37 Improve representation of the Territories and linkages with the work of global and regional health bodies

Action principally for UKG

CIG has a good working relationship with PAHO, however a recent meeting of UKOT Ministers of Health at PAHO headquarters highlighted the need/ opportunity for enhanced dialogue between the UKOTs and the UK, as the UK is the “member at the table” for the UKOTs and it may be beneficial to formalise the way that the UKOTs concerns/inputs are sought and fed into the PAHO Directing Council (for example).

CIG also has good working relationship with CARPHA.

38 Review health care support for the people of the Territories including the NHS quota arrangement, assistance for the cost-effective procurement of medicines and professional training.

Action principally for UKG.

CIG would welcome any assistance in these areas.