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.

Watching the performances at the Public Accounts Committee of the legislature last week has given me cause to ponder.  How does NB continue to roll with public servants refusing to disclose essential information accurately to legislators?  Where did accountability ever go?  Is the legislature only an inconvenience in government?

I remember it well!  Impressionable university student, wanting to learn about business and organizations.  Business 101:  the beginning and introductory course aimed at instilling in young students the fundamentals of organizations.

Accountability was drilled into us.  For every person in the organization there must be clear accountability to someone; that someone on the organization chart used to teach us was the person who can hire or fire that person, as well as setting performance standards, expectations of performance and professional behavior.

Social Development Minister Dorothy Shephard has seen health and long-term care reform from the inside out.  She was the Minister of Health during the pandemic when times were crazy and she was trying to get the first steps of Health Reform initiated.  Given the context with a failed first attempt at health reform, prior to her term, combined with the insanity caused by the pandemic, she gave it her best shot. She was involved in the consultations that were promised, compromised again due to the necessity to do so much virtually with Zoom technology.  A poor substitute for face-to-face communication.

Now she is back in the Department of Social Development in which strong attempts are being made, with a superb team of senior civil servants, to get long-term care reformed.  The issues in the failure of long-term care in this province are now legendary with hundreds of empty long term care beds, challenges in recruiting and retaining skilled staff, little political or public understanding of the real issues that prevent the long-term care system from functioning like a well-oiled machine.

I remember his voice from 60 years ago when Prof. Arnold Cook lectured beginning business students, and I was one, on the principles of what makes for a good organization that grows and develops.  The principles of clear accountability, shared vision, strong leadership have been my guiding principles in large and small organizations that I have directed over the last half century.  The organizations that grow and survive have shown that Prof. Cook was absolutely correct, and some of them are outlined in Good to Great, the classic Jim Collins book that describes what it takes to take an organization from “good” to “great”.

Transpose that basic thinking then to health and long-term care in New Brunswick and think, for a moment, of the issues that have caused so much nasty public discussion in recent years, particularly the last three.

“But oh, we suffer, right? Yes, right!” So said Yente in the classic, Fiddler on the Roof! Families dealing with the Dementia journey suffer, often desperate for support. For years the challenges of getting a correct diagnosis followed by proper and helpful mechanisms and
supports for the patient, caregivers, and families has been the huge “elephant in the room” in
discussions of health care for the aging population. 

​With the greatest proportion of elders amongst provinces in the country and a population that has forecast its aging issues for decades, it should come as no surprise that emergency departments and hospital beds are distressed with elders in crisis.

Professor Richard Saillant, the noted Moncton-based economist and author of Over the Cliff, wrote a sobering article in the Brunswick News on March 4 in which he detailed the difficulty that the NB government seems to have with its fiscal projections.  The current government was elected on a platform of fiscal responsibility, attacking the provincial debt and reforming health and long term care, municipal government, education and other services.  Somewhat accurate fiscal projections are needed but are always elusive in the public sector.
At last count, according to Saillant’s summary, government was projecting a surplus in the current year of nearly $1 Billion.  And to staunch fiscal conservatives, that is incredibly great news.  This could not only stop the bleeding of expenditures but could also provide some capacity to actually reduce the public debt.

But not so fast.  Are you heeding what is really still happening in health and long term care?  Wait times for essential diagnostics are such that private clinics have been developed with the Federal government now “clawing back” over $1 million in health transfer payments.  Worse still are the continuing stories of people either not getting essential diagnostics and care on a timely basis, but still a disturbing number without access to primary care or on long wait lists for long term care.

In July 2022, Premier Higgs, having promised reform of the health system prior to election, fired the newly appointed Horizon CEO and disbanded the boards of the two health authorities.  Two trustees have served as surrogate governing boards and an interim CEO was appointed to replaced Dr. Dornan.

So now what?  Health and long-term care cannot be run from the Premier’s office forever.  Informed observers have been calling for a more relevant governance model for the health authorities for years. 

By all accounts, the Health and Long-Term Care System in New Brunswick appears to be in the state that was forecast many years ago when Llewellyn Davies Weeks was commissioned to create a plan.  The regional plan for hospitals, created by the Department of Health and introduced in 1992, was intended to be the first phase of a systematic development of the health care system.  The plan had not spelled out, in finite detail, what it would look like but the regional hospital structure then paved the way for merging difficult files such as long-term care, mental health, even public health into a vibrant system that had 7 functioning regions, fairly close to the people.

Since the inception of the system that we loosely call the Canadian Health Care System, in 1959 the federal and provincial dialogue has been a succession of squabbles over funding.  What was intended as a 50:50 cost sharing has grown far beyond that in scope and complexity.

So here we are, once again, with more federal/provincial discussion with the predictable scenario:  national consensus “the system is in crisis” with a federal response of “let’s pour more money on this troubled sector.”

Then in the public discourse in social media, conventional media, and advocacy publication, the public is, once again, treated to the usual arguments:  use the money to hire more doctors and nurses, use the money to build more nursing homes, give employees a respectable income that is attractive.

In 1995 when the government of the day was going to the polls and Hospital Regionalization was politically hot and risky, I was encouraged to move on from being CEO of the Region 3 Hospital Corporation.  For three difficult years, beds had been cut in rural areas, staff were laid off, and the atmosphere in rural New Brunswick was not ideal for an election.  Having been professionally trained and certified, and being still in the midst of a career that had been very successful in other provinces, I was happy when one of the strongest leaders in the province, Dr. L.D. Buckingham, invited me to work with him in Moncton.

I had admired him since we both were students in the early 1960’s so this was a great relief from the politics of health care reform.  But the job was not in health care, which had been my first love; it was in a Church in Moncton that had the reputation of being the fastest growing protestant church in Eastern Canada.  Indeed, under the leadership of Dr. Buckingham, the Moncton Wesleyan Church now had a reputation beyond Moncton and extending well into Canada and the U.S.

The Brunswick News Legislative Bureau published a front-page article on December 29 giving an assessment of the “rocky road to health reform” in New Brunswick.  In it they cited the major goals set by government and showed how Covid has been a set back to reform but how in the pandemic the province eventually was able to break down some silos to get things moving a bit faster.

It was noted, however, that some influential advocacy groups still express skepticism, particularly on the nursing situation.

A subsequent article by Sarah Seeley on January 3 observed the angst being felt by people waiting for access to primary care services including new residents in New Brunswick who have waited three years.  The technological measures introduced by government that largely revolve around “virtual care” are stop-gap measures at best and are no substitute for having a relationship with a Primary Care Service provider, be that a physician, nurse practitioner, or an integrated primary health clinic.

That our health services are in crisis is the understatement of the decade!  Much has been written and debated on the topic and some will suggest that “it is the same in all provinces!”  True only to a degree and a very lame excuse, at that.

Acute Care facilities in New Brunswick are under duress for many reasons.  One of the large ones is the pressure on emergency departments and on acute care beds in which elders “waiting for a nursing home bed” are said to be a huge problem.

Indeed, New Brunswick is one of the leaders in Canada for having the highest proportion of acute care beds occupied by such frail elders, according to the Canadian Institute for Health Information.  Ask a social worker, a discharge planner, a physician, and the family of the patient….” we could free up those beds for occupancy by really sick people if we could get the ALC patients to a nursing home.  But the nursing home wait list is huge and wait time for admission is months and months!”

Catherine Morrison’s account of the CanAge Report called attention to the poor performance in New Brunswick in dealing with Dementia, one of several diseases of aging that also impact many people under the age of 65!  Many of the issues causing much grief to the public and the health system stem from the inadequate manner in which care is administered and delivered to the vulnerable.

For generations, our planners have known that the aging bubble would be here now, as it is, and that with it would come all the health issues of aging:  reconstructive surgery, neurological challenges, diabetes, and ever so many more.  Dementia impacts a huge percentage of the aging population and, unlike many other illnesses, it impacts the entire family.  Suddenly the spouse is a caregiver with lifestyle entirely dictated by the symptoms and phase of the Dementia on the husband or wife.  Volumes have been written about how this disease is so life-altering for the entire family unit that it does not need further repeating here.