In the lead up to Christmas during the legislative session of the Province of New Brunswick, the Minister of Health re-affirmed her commitment to consultation with the public relative to health care reform. She is an honorable person who will always do as she says; I know that.
The challenge will be to engage in consultations that are truly meaningful to the population being served and who pay taxes. They are the customers and, in the end, the customer is always right! The customer knows when a great product is being delivered but most often the customer is not sufficiently aware of all that it takes to get a quality product to market, a product that can be sustained in quality and price in changing times.
On the other hand, government officials working in offices with desks and computer screens in Fredericton, Bathurst, or Miramichi, or elsewhere, often have their thought processes directed by their own set of experiences, their own educational background, the experiences and backgrounds of those around them and the very culture of government and the civil service itself.
So out of that we had the perfect storm in February 2020! With the drama of Covid-19 taking over the news and social media wires in March, perhaps we have forgotten that what really was being announced, in the absence of any consultation with intelligent people in rural communities, was a serious reduction in essential health care services. Call it by any other name but that is what it appeared to be.
People in the rural communities were told that a ride by ambulance and service in an urban emergency department in the middle of the night was somehow better for them than what they had. The conversion of acute care beds to long term care beds in rural hospitals was not the explosive issue; that could be accomplished with little or no fanfare on a good day. It was replacing what worked with something that, according to reports they see, does not appear to work.
New Brunswick is known as the only officially bilingual province in Canada, a wonderful characteristic often causing public policy challenges. An equally challenging issue in health care is the rural/urban divide. The province must learn and learn fast that health care services cannot be administered in small, rural communities in the same manner that takes place in the urban centres. They are different worlds and not simply annoying cost centres for health authorities. Some provinces and jurisdictions have learned that and have adapted accordingly. The Ontario government, for instance, developed the Rural and Northern Physician Compensation model many years ago that makes it attractive for physicians to practice in rural communities without the necessity of running “all night Emergency Departments.” They also have taken some additional steps relative to the recruitment and retention of nurses and other great health professionals. True enough, the geography dictated some bold action but the principles and thought process could be adapted to New Brunswick.
The rural people (I have been one) and the public (I am one) do not want to waste time with more conventional government consultations. In the classic model, repeated over and over, the announcement goes out, the location and time are set, the projectors, screens and sound systems are put in place, the Minister gives an introduction, the facilitator gives instructions about process. Too often the default is to “break up in small groups and discuss ….” That is after a guest presenter has spoken as to what is the message government wants the public to hear. After two hours, the Minister thanks all for coming and please help yourself to the coffee and donuts; usually there is a promise of serious follow up, decisions to be taken, bold action. This is typically followed by a photo-op, press story, and limited, if any, result visible to attendees.
This is not what is wanted nor needed. Rural people know that times are changing, they know that they cannot have advanced, quality surgery in every hamlet. But for the most part they are not going anywhere, they have no great desire to move to the urban areas because they have farms, logging, fishing, tourism businesses, mining to do. They need to hear first that those who write the rules and regulations totally understand that and what it is like to fear for the well-being of one you love at 3 a.m. and they want to hear that the service they can rely on will help them not serve to delay them.
They need to hear that the provision of this local emergency response is possible without operating a full-blown emergency department and without risking a long ambulance drive to an urban centre to face another wait. They need to hear that the planners and administrators understand the value of providing good service, appropriate to rural communities, not duplication of urban health care.
How will this take place? Government, having raised expectations about consultation, needs to invent a process that blends consultation and engagement. The great U.S. military General Patton was quoted as saying: “They won’t battle the plan if they have planned the battle.” This is not some academic exercise that is to be done for a Masters degree term paper; this is all about getting to where people live every day and fixing real issues, not the issues that are believed to be issues in Fredericton.
For instance, the Covid-19 outbreaks in the northern part of the province were initially linked to the traffic between Quebec and New Brunswick. One physician was singled out as the carrier of the virus. In gathering further information, it soon became clear that communities in the northern part of the province are quite reliant on physicians and other care providers making the trip regularly from Quebec to serve in the Acadian Peninsula, Cambellton, and elsewhere. And why not? The natural relationship between French speaking health service and training facilities (e.g., University of Sherbrooke) has been a superb part of the health system in New Brunswick for decades. Similar patterns have existed, for other reasons, between Houlton/Woodstock/Waterville and Presque Isle/Perth-Andover/Plaster Rock. Then we learned that in Calais/St. Stephen there have been somewhat similar traffic patterns with people working on one side of the border while living on the other.
Meanwhile, there have been endless newspaper articles, meetings, and promises about health manpower planning! Resulting in what?
Moving to get stability and affordability in health care services in rural areas is not simply about cutting! Government has a duty to seriously engage in resolving real issues. It may be that the structure of services needs to be changed along with compensation models for health care providers. If that is the case, then it needs to be handled strongly but with every effort being made to avoid huge collisions. This is where real engagement, Patton Style, comes into play.
A place to start is for government to acknowledge that there are many issues that need to be resolved, none of which can be done overnight by dictate. Rural Health Care Service is one but equally so are the huge issues of Primary Health Care Services, Urban Emergency Departments, Long Wait times for Specialist Services, and more. I am no card player, but I think the rural folks have a right to see the full hand being played.
Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News and author of Health Care Reform in New Brunswick. His email address is firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.