​Health Care Reform in New Brunswick: Issues for an Election Campaign

So, we are going to the polls!  Last week had drama leading to the fact that the parties will not agree to the plan placed before them by the Premier.  There are two vacant seats and, according to reports, at least three that want to be vacant!  

Those who are seriously interested in seeing the health system get fixed should now start to memorize some lines so that when candidates contact you, you can respond with good questions that will force some response.    In just how many elections have you heard the same promises?  No more cuts!  We will keep your emergency departments intact!  No, we will not close rural hospitals.  Yes, we will hire more doctors and nurses.  We will add more nursing home beds; why we will even put some in your riding.

One of the greatest that comes up in every campaign is:  We will place new resources into Health Promotion and Disease Prevention.  And sometimes that happens, yet the basic issues of the health system remain.

Our election mentality, as a population, is not helpful.  Somehow, as an electorate, we fall for the vague assurances and 4 years later, repeat the same cycle.  That is why chronic health services issues never get fixed!

For how many more cycles will the electorate tolerate lack of real action on dealing with senior care, for instance.  For well over a decade, informed health experts have pointed to the need for strategic steps to improve the organization of home care and special care as major elements of the long-term care system.  For 20 years we have looked at population forecasts that told us we were going to be exactly where we are:  the province with the highest proportion of seniors and not at all ready to respond to the needs.

On March 20, 2010 the Daily Gleaner carried an article that presented the basics of a strategy for making sense of senior care.  Have you noticed real progress?  Yet we have had at least three senior’s reports in that time.

How much longer will we hear the question from tens of thousands of people: “I don’t have a family doctor, what can I expect from your government?”  To which the standard response is an official promise to hire 50 new physicians or some such thing.  Have any of those previous promises fixed what is an inexcusable problem?  Of course not.  You can apply the same line of questioning to the nursing profession to which the responses have seemed to be quite similar………. hire more nurses; we will go to foreign countries to hire more nurses.  This noble profession deserves serious focus with real issues identified and dealt with, but not in the heat of an election campaign.

True Primary Health Care Reform has little to do with the absolute number of physicians or nurses in the province but has everything to do with organization, structure, ensuring that all possible resources are woven together in a truly integrated primary health care system.  We have great Physician Assistants, Nurse Practitioners, Advanced-Trained Nurses, Social Workers, Psychologists who can and should be integrated into a system that works for the best interests of the patient.

What about the huge wait times in hospital emergency departments?  This issue has been a feature of the New Brunswick Health System for decades and yet never dealt with in a strategic and systematic manner.  Consequently, the population gets accustomed to the 3-8 hour waits, sometimes longer, and MLAs continue to get elected, draw salary and benefits, and the public waits.  This is not rocket science!

To the discussions of healthy aging, age-friendly communities, and health promotion, the electorate needs to understand that those are incredible public policy goals.  There was a movie, a few years ago, entitled: “What Lies Beneath”.  What lies beneath the goals of healthy aging and health promotion are many issues which, if not recognized and thought through, will leave us right where we are.  First is that most of the issues that drive elders to long term care have their roots in genetics or simple frailty.  Second is that unhealthy living has billions of marketing dollars behind it and it is pretty hard to compete.  Many low to moderate income people tell me they struggle to pay for truly healthy foods, for instance.

Many of my friends wait for very long periods to receive surgical interventions that will relieve pain and improve mobility.  Many talk about 2-3 year waits for what now is fairly routine surgery.  Yet government after government for nearly 30 years has promised to bring relief to that problem.  When they get into office, they seem to think that improvement means huge cash outlay.

Who can forget the absence of anything resembling a rural health strategy?  The attempt to get health care reform kick-started in February 2020 should be a serious lesson.  There are larger issues at stake.

And often the topic of the health authorities comes up during elections with some insisting that if the two health authorities were merged into one health authority that somehow a ton of money would be saved and that would make things better.  WRONG!  Merging two organizations together that have performance problems into one organization simply create one oversized organization with problems that are really hard to imagine.

Here are some questions to give to those desiring your support.  First, since health and long-term care is such a huge part of the government funding envelope, and since all the problems that concern the public have been in existence in NB for nearly 30 years, what strategy will your government take to prioritize the issues and create a plan that makes sense?  Answer:  government cannot do it by itself; we saw that in February.  For the first time since the early 1990s, we need an entirely different way of administering health and long term care services in this province.  It starts with sorting out symptoms from real issues.  Many of the things that cause the public concern are mere symptoms of an underlying set of problems.

How will your government choose to bring the key professions to the table to join in creating meaningful strategy to move the system forward?

How might your government work differently with the public service than previous governments?  One answer is that there is serious confusion within the public service between service provision and service regulation.  Those lines are blurred in a manner that leads to many operating problems in health and long-term care.

What steps will your government take to conduct a high-level assessment of the effectiveness of health authorities and act on it?  Answer:  the health authorities have been in place for over 10 years.  During that time issues of concern to the public have deteriorated, even though the core programs such as Cancer and Cardiac Services function extremely well.  CEO turnover, recruitment, appointment, and performance management should be review topics.  It is time to ask some key questions about the structures and to take action aimed at creating and sustaining excellence.

Those who seek office need to hear from informed consumers, not simply those of us with perceptions of issues. 
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Ken McGeorge,BS,DHA,CHE is a retired CEO of 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. His email address is [email protected].