​Health Care Reform in New Brunswick: if not now, when? If not us, who?

It is hard to focus on the important when pre-occupied by the urgent.  Covid-19 is the urgent and has our collective attention:  the public, our institutions, our public servants, elected officials.  And while we all just want to get out of this mess, it will be over in a few months and we will be in a new normal, whatever that looks like.
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But please do not forget how angry so many in the population have been prior to the pandemic about the state of our health system.  Rural people were traumatized in February with talk of eliminating what they believed to be an essential service.  Urban people have been very angry about access to efficient primary care services, long waits for service, over-crowded emergency departments.

This government has made it clear that reform of the system is on their agenda and the Minister of Health has agreed to engage in consultations in order to hear the public.  Those consultations can wait until the pandemic is totally over and we can gather in meeting halls and church auditoriums.  Or they can commence now in some other fashion perhaps using technologies.

She needs to hear from the public.  As I have emphasized over and over in my columns and in my book, the current state of our system is sorely in need of fixing.  We have a wonderful cohort of great health care professionals across this province.  But the issues that lead to huge wait times, accessibility issues, huge wait times in emergency departments, long waits for diagnostic procedures and lack of access to family physicians are purely organizational.

Everyone with whom I have spoken in recent years about issues of health and long-term care reform has his or her one thing that government should do to fix the system.  The problem is that few of those “one things” are the same.  Even amongst great health professionals, there is little to no common views.  That is not surprising because we all are products of our training, our experience, our values, our own interactions with the system.

Government needs to get to it and show the leadership that the system has needed for a long time but there is no way in the world that the decisions they eventually announce will make us all universally happy!
The problem with many public consultations in the past has been that often the strongest voices come from union officers or members in attendance at public gatherings; when they speak they do so with emotion, some knowledge and passion.  The system is so complex that the public, for the most part, has a struggle discerning passion from knowledge. When someone says that health care workers are overworked and subject to much stress on the job, it engenders strong support and emotion….until you come to know that that is what working in health care services is all about. You have some days that are fine and everything goes well, then the next day there seems to be a flood of congestive heart failure or motor vehicle accidents or substance overdoses, then you have a brutal day.  Or if you are in management, you have to deal with a variety of staff problems, sudden absenteeism issues, discipline issues and you, too, have a very difficult day.  I have had them all!  But I still love the healthcare environment and would trade it for no other occupation.

The government needs to hear from a cross section of people who are keen to see our health care system get to excellence and stay there.  They need to hear from employees at all levels, seniors, young families, employers, caregivers, first nations, and the list is seemingly endless.

Having invested my life in the system and having written these columns for two years while consulting a bit, I want to lay out what people have said to me in response to the columns and in advance of the columns.

Great health care service commences with access to superb Primary Care.  Tens of thousands of New Brunswick residents still complain about lack of “access to a family doctor”.  That, in itself, is not superb primary care regardless of how great the family doctor.  Previous columns have underscored how antiquated is the idea that everyone needs to be registered with “their own family doctor”.  Increasingly, the concept of Integrated, multi-disciplinary primary care is gaining ground.  In the models springing up, patients are rostered in a primary care clinic where his records are kept and where he may or may not be assigned to one physician; but the routine visits involved in chronic disease management, acute care follow up, medication review and renewal can largely be accomplished by members of the primary care team leaving the MD to focus on more complex issues and clinic oversight.