This is the undertaking of the current government as described in the article by Barbara Simpson and published in the TJ on April 23, 2025.   The phrase takes its roots from the Budget Speech of the Minister of Finance as he delivered this government’s first budget in the Legislature in March of this year.

In that speech, and in subsequent discussion in the legislature, the Minister was pressed on government’s platform commitment to balance the budget while projecting a serious deficit in their first year in power.  As to the huge health file, which constitutes nearly half of government expenditures, he stated that government will “do business differently”.  His speech had a whole section on the topic of Transformational Change.

To advocates for the health and long-term care file, the use of that language was music to our ears.  For many years, we have been trying to push government to acknowledge the need for transformation, not just the simple promises of change that have been part of the governmental and bureaucratic language for too long.  As McKenna found in the 1990’s, deep change requires Transformation, changing the way business is done.  Changing the way business is done involves, at a minimum, laying all the cards on the table, not just those cards that are safe and convenient.

Transformation is not for the faint of heart; those who do not have either the willingness or the courage to engage, with the serious risks that are involved, should exit stage left right away.
“Looking under the hood” is a phrase used often by those who create and direct serious transformation.  In health care, the early 1990’s was the last time we saw serious transformation in New Brunswick.    Actually, New Brunswick and Saskatchewan were the leaders and every other province has followed our example.  But not until these two provinces paved the way and absorbed some hits in order to get the tough issues of transformation kick-started!

Hats off to the Holt government for initiating more collaborative clinics and getting the approach to licensure of foreign-trained physicians producing tangible results.  They are apparently acting with some swiftness to commence reforms that have been needed for decades.  Health Minister Dr. Dornan seems to be off to a good start. 

Finance Minister Rene Legace sent the first signal from government that I have heard since 1992:  he used the language of reform in referring to the health portion of the budget.  Previous governments have avoided using the language of reform.

The discouragement that tens of thousands of New Brunswickers have experienced for the last two decades has been deep seated and justified.

The feelings of discouragement have been equally palpable when persons in need of emergency care describe their challenges with the full waiting rooms and corridors filled with sick people.  One of the root issues there has been the hundreds of beds occupied by persons awaiting proper long term care placement.  These have all had volumes written about them in these newspapers.
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Over 40 years ago, in the late 1970’s and the 1980’s, health economists and public health leaders made a simple and profound observation:  if you think things are tough in health care now, just wait until the Baby Boomer generation hits the system.  The system has had 4 decades to prepare for the level of distress that was forecast at that time. 

The health and long-term care systems in New Brunswick have been left so long without firm vision and direction that Minister Dornan, Minister Miles and Premier Holt have a monumental strategic challenge in order to get the pieces moving in tandem to provide the essential results of reform.

By now, the public is well aware of the need for Primary Care Reform and Reform of Emergency Departments.  The term “unattached patients” or “orphan patients” is an unnecessarily degrading term to describe taxpayers who have simply not been able to get through the long list of thousands of people waiting for a regular slot on the list of one of New Brunswick’s terrific physicians.  And it gets worse when they, or anyone else, has occasion to visit the Emergency Department in one of New Brunswick’s larger hospitals, only to be met with uncomfortable waits of up to 24 hours “to be seen”.

The most recent example that was brought to my attention was a person who actually suffering from a serious cancer requiring prompt diagnosis and treatment.  Under the circumstances described, sitting in an Emergency Department waiting room for seven hours was tragic at best.  I am not in a position of any executive authority nor with any particular influence, but I have heard those stories for far too long. 

In my own case, just in the last year, I experienced serious cardiac symptoms for weeks before eventually giving in to call the ambulance.  I was fearful of the long waits because mine were not the classic acute chest pain symptoms.  I was confident the EMTs would get me to the care required and they did!

It was 6 years ago that a newly elected premier and his colleagues called for reforms in the health sector, amongst many other things they had on their agenda.   For two decades prior to that, a number of serious health and long-term care issues had been accumulating:
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1. Wait times in Emergency Departments were becoming unmanageable with tales going back nearly 20 years to the distress caused for the public with long waits. 
2. The long waits for elective surgery (hips, knees and other orthopaedic procedures) were also a large concern for an aging population but not a new issue.
3. The growing number of residents without access to appropriate primary health service.
4. Governance and structure of the health authorities.
5. Health Human Resources issues ranging from impending vacancies by the carload to workplace morale, organization and structure.  Those themes have been frequently expressed for so long that I expect a certain numbness may have set in.
6. Wait times for access for long-term care growing at an alarming level that compromises the service that the acute care hospitals are supposed to provide.
   
   

The aging population has contributed to increasingly long waits for long-term care resulting in an embarrassing number of acute care beds being occupied by persons requiring long-term care capacity, which most mistakenly interpreted simply as need for more nursing homes.  This shortage and pressure have been forecast for decades and has never been taken seriously.  A succession of governments have mistakenly thought they were doing something significant by building a few new nursing homes and renovating existing stock.  Those have been great initiatives but have not resolved the issues.

In the power and decision-making structure of the New Brunswick government, the legislature has been for generations the centre of serious activity.  That is where legislation is approved, legislative changes are solemnized, legislative committees and officers are legally bound to demonstrate accountability to “we the people”.

The Opposition parties play, in our democracy, a serious role in presenting questions that technically are supposed to provide opportunity for government to hear the voice of the people, consider other perspectives, enable the government to explain their proposals for public consumption.  The public can connect by webcast to the sittings and we can, as well, actually go to the legislature to hear the questions and government’s defense of its position on whatever is the issue of the day or session.

The opposition raised a pertinent question on Thursday, June 6, 2024 that has received little coverage and follow up with media and government choosing to focus, instead, on the Auditor General’s report on Travel Nurses.

June 26 was a day to be remembered for one of New Brunswick’s foremost and successful business leaders, Jim Irving, was honored at a funeral at Saunders-Irving Chapel in Sussex.  His 4 children gave articulate and moving commentary on the impact of this great man not only on the business community but on the family, the province and beyond.  Robert, Mary Jean, Judith, and Jim all described the qualities of Mr. Irving that contributed to the huge impact that he has had in business, the province, local society and so much more.

Robert Irving, who directs significant businesses as part of the family business empire, described much of the business style that Mr. Irving demonstrated, emphasizing that central to his successful leadership was his commitment to Management by Walking Around!  He described the level of his commitment to speaking with employees and consumers.  He observed that it has been a commitment to that process that has kept new ideas and directions flowing for years.

Those who have known the Irving Family, personally or as employees or customers, know that to be true.  I have heard stories told by employees in various positions who experienced Mr. Irving’s walk-abouts as he often would arrive, unannounced, pulling up a chair and asking for opinions and insights.

On May 7, 2024 the Minister of Health released a plan entitled New Brunswick Primary Health Care Action Plan.  He said that it re-iterates the government’s commitment to improving access to health care services. 

Since its release, it has been faced with criticism from the Medical Society in which its President, Dr. Paula Keating, said that she had not seen the plan prior to its release.  Other groups that should have perspective have not exactly been too vocal thus far.

The plan consists of 26 pages of description of issues in the current primary care system with ideas for implementation to create a primary care system in a province in which, as the plan states, has primary care provided by a group of “moving parts” that are not organized in any “cohesive system.”  That lack of organization has been more than a little apparent in the past two decades as family physicians have retired requiring sometimes three physicians to take over their practice. Worse still is the something over 60,000 New Brunswick residents that have no access to essential primary care services.

He was a young man in his prime, gainfully employed in business, then was overtaken by what turned out to be a congenital heart issue requiring open heart surgery.  With the success of the surgery combined with the clinical history, careful monitoring on some regular basis would be normal.  Yet he is one of those persons, not defined as a senior, who has no access to primary care.  Family physician closed practice with records somewhere, cardiologist retired.  What is a person to do for follow up?

Another man with history of heart disease following a very active life involving service in health care and public service; family doctor retired so access to primary care is a 90-minute drive to see a terrific nurse practitioner.

Another lady with serious dementia, managed for a considerable time at home by the husband until recent admission to nursing home, whose family physician left the province with no transition arrangements for continued primary care.

The media has covered Travel Nurses and Health Authority Collaboration well and the Auditor General is asking questions.  What did you know and when did you know it? Then in classic New Brunswick fashion, the fingers come out in pursuit of where blame can be ascribed; anywhere but government!  There is a lot of blame to go around and government should refrain from over-reacting.

Travel Nurses?  The need was created because the issues in the nursing profession have been allowed to fester untreated for twenty years.  The pandemic was the tipping point with the enormous pressure placed on direct care workers by a Public Health crisis of unprecedented proportions.  This,  combined with the distress caused by the politics of Covid, was unlike any public health crisis in this lifetime.  Public health officials and government at all levels were inventing solutions that were created in an environment in which there was pitifully little factual, tried and true information.

The public was scared to death with the publicity and the response taken by various levels of government, based on information that they accepted, in good faith, from the World Health Organization and the federal authorities.  The media kept the sense of panic going with the incessant news coverage; they, also, were learning for the first time.

Don’t be put off by reading more about the Lamrock report!  If you feel that enough is enough, that is ok, but the key problems in health and long-term care do not get resolved in New Brunswick without some visionaries being very persistent.  The public has to say “enough is enough”!  No more tinkering with technology or solutions that give great photo ops and sound bytes.  Particularly in an election year, beware of solutions intended to placate or offset public expression of concern. 

Media exposes some of the issues that impact long-term care with those issues often disguised in other forms.  Nothing in health and long-term care is simple nor do simplistic solutions tend to yield sustained, satisfactory results.

The Lamrock report represents the opportunity for public policy in this very significant area to be put on the table and brought into line with current needs, issues, trends, and demographics.  Lamrock makes the point more eloquently than has been done in the recent past:  long-term care is a hodgepodge of services organized in a manner that does not encourage integration, consistent quality, consistent financing, nor many of the other relevant public policy goals.  The Nursing Homes Act was originally proclaimed in 1982 with a financing mechanism that has not been systematically brought up to date since that time.  The Family Services Act, under which the majority of long-term care services are regulated, was proclaimed in 1980 for a purpose other than long-term adult care.

“Is this the one or shall we wait for another…. if I live that long…?”  So asked a prominent, articulate senior of 90 years of age who has seen the dark underbelly of New Brunswick’s senior and long-term care system.  She is one of thousands who have been waiting to see the system modernized and brought into sync with the current age.

The TJ editorial, “The Gospel According to Kelly” seemed to pan the Lamrock Report as did the quotes attributed to the Premier.

Both, on the surface, seem insulting to any New Brunswicker who has had experience of managing in the system or attempting to effect change and improvements.  Not in the last three decades has there been an effort by government to create any plan for this sector despite many volumes of reports on seniors’ care done.

One of the huge problems in health and long-term care services is that typically decisions get made regarding services, the organization of services, the timing of services, who delivers the service by persons occupying positions of authority.  Decisions at a high regulatory level are made by government officials who may or may not, usually not, have had training and experience in the area of concern by the regulation.  This phenomenon is not uncommon in governmental regulatory agencies.

At a clinical or direct service level, decisions get made by staff who are engaged, as is the case in nursing homes, to provide direction for administration, care, activity and such.  Decisions are influenced by government regulations, national and provincial best-practices, and collaboration between service providers including physicians.  Often equipment suppliers play a role as they introduce the best of technology at “trade shows” and communicate new technology to service providers.

Did you find it odd that the most joyous season of the year had to be tainted with cries from the hospital authorities for people to stay away!  In the messaging, the situation at emergency departments was described as chaotic.  It was not a time that instilled confidence in what is definitely a distressed health care system.  Government raised hopes during the last election that this would all be fixed.  In fairness, the promises and raised expectations took place prior to the Pandemic and that was yet another tragedy for which the province was seemingly ill-prepared.

Marg Melanson, the Interim CEO of Horizon, who has given stellar leadership since the major government intervention on July 20, 2022, came out on Saturday with the promise to fix the problems.  I do believe that she is sincere, committed, heartbroken about the public discomfort.  But the issues causing the Christmas, and other elements of Chaos, date back long before her time, long before Dr. Dornan’s time, long before the time of Premiers Higgs, Galllant, Alward, or Graham.

Melanson inherited an organization that was struggling before the pandemic for reasons cited earlier in these columns.  Cyclical and unplanned leadership change and political intervention do not make for superb organizations to thrive.

The Op Ed by Dr. Paula Keating, published on December 17 by Brunswick News, was refreshing.  It was a delight to see the President of the NB Medical Society strongly advancing the concept of integrated, multi-disciplinary primary health care.  It was refreshing because it is a concept, well developed in other areas, that has been advanced in New Brunswick for nearly 20 years yet the traction has been slow to realize.  In recent years some innovation has been sparked not because of government innovation or direction but out of sheer common sense when physicians themselves take the bull by the horns to create models that better serve the public in 2023.

The medical society itself, a very influential body, has advanced models in the past that seem tentative and not filling the definition that Dr. Keating articulates.  The Department of Health has not been able to get serious vision cast regarding integrated and multi-disciplinary primary care.

For years New Brunswick has had this public policy tug of war at the expense of patients who suffer from issues requiring sometimes even minor surgical correction.  The tug of war is:  lots of Operating Room Space and getting much better with new construction, specialist surgeons who could and would love to do more work but cannot get surgical hours in the Operating Room.

In the middle of the pack is the patient whose gynecological issue really needed repair or the acutely painful joints that could be fixed in a flash or the vascular challenges that would benefit from repair in a few days not a few weeks.  In tugs of war, it is always the patient in the middle in health care and, for them, not only is it not pleasant but it is often unnecessary.

For decades in New Brunswick, the typical discussion of surgical wait times and access to operating room time has degenerated into “shortage or nurses and shortage of anaesthetists.”  That theme was carried again in Andrew Waugh’s article on November 29, 2023 dealing with Hip, Knee Surgical push…

Premier Higgs is a professional engineer and engineers and accountants have one thing in common:  numbers and formulae.  And it is good that they do or the world would be in a bigger mess than it is.
 
What was eye-catching, however, was the headline on Wednesday, November 8, 2023 that said:  No Politics in Hospital Decision.  According to the article, he was referring to his meeting with doctors in Fredericton who had expressed frustration that the new, multi-million-dollar Surgical Suite project at DECRH would not include state of the art imaging equipment.  Apparently, the equipment that makes it a hybrid Operating Room will be going to Saint John Regional instead even though the Chalmers Foundation is interested in raising the funds to purchase the equipment required to create the hybrid status.
Does that sound familiar? ​

“NBers unhappy about health system, survey suggests”; so, said the headline in the Fredericton Daily Gleaner on Saturday, October 14, 2023.  The article was based on an Angus Reid national poll that interviewed 5,010 Canadians of which 285 were New Brunswickers.
I presume statisticians may consider those numbers are “statistically significant” but I would doubt that any serious business would make expansion or re-structuring decisions based on survey samples that are a tiny fraction of 1% of the population.  But where there is smoke there is fire.  Even with a small sample size, those in charge of program delivery need to pay attention because the poll at least indicates a need to dig further.  It did suggest, for instance, that those who responded had little confidence in government to deliver on its promise of reform.

One of the dangers of polls and headlines is that the great people in the system who perform with skill and compassion get swept up in the broad assessment of the health system.  The truth is that when you need emergency (life sustaining) treatment, some key elements of the system are there with great efficiency.

“NBers unhappy about health system, survey suggests”; so, said the headline in the Fredericton Daily Gleaner on Saturday, October 14, 2023.  The article was based on an Angus Reid national poll that interviewed 5,010 Canadians of which 285 were New Brunswickers.

I presume statisticians may consider those numbers are “statistically significant” but I would doubt that any serious business would make expansion or re-structuring decisions based on survey samples that are a tiny fraction of 1% of the population.  But where there is smoke there is fire.  Even with a small sample size, those in charge of program delivery need to pay attention because the poll at least indicates a need to dig further.  It did suggest, for instance, that those who responded had little confidence in government to deliver on its promise of reform.

One of the dangers of polls and headlines is that the great people in the system who perform with skill and compassion get swept up in the broad assessment of the health system.  The truth is that when you need emergency (life sustaining) treatment, some key elements of the system are there with great efficiency.

Disclaimer:  I am not affiliated with any political party; in my career I have tried to stay in my lane of administering hospitals and long-term care facilities.  It has always been wise to maintain great working relationships with persons in all major parties, sharing with them all that I know which is health and long-term care excellence.  Beyond that, who gets elected is up to the public as far as my involvement is considered.

With that in mind, and since I have been so visibly passionate about health and long-term care reform in the past several years, it goes without saying that anything that slows down what should have been a clear reform process is irritating to me.  In my commentaries, in the past 4 years, I have outlined issues around long waits in Emergency, Primary Care Access (or not), workplace culture and health manpower issues and ever so much more.