​Health Care Reform in New Brunswick: Stabilizing Health Care, An Urgent Call to Action

The Higgs government was elected on promises of reform within government.  The Premier has no patience for deficits so paying down provincial debt has been a huge priority.  He has turned his attention, equally, to the long-standing call to reform local government which Jean Guy Finn identified, in his landmark report, as long overdue in this small province struggling to grow and develop.  Education has been another area targeted for reform and there have been, Covid notwithstanding, some inroads apparently.

Health has been, as Jeffrey Simpson pointed out in his book Chronic Condition in 2012, the area fraught with incredible political minefields.  In February 2020, government released its initial plan for Health Care Reform.  To financial people, it made sense:  cut the loss leaders, a first principle of successful business.  But health and long-term care is not about financial logic but about providing what the population believes to be efficient, safe, quality service within reasonable driving distance.  The plan, as announced, backfired and was one large embarrassment to government.

Minister Shephard, a person seriously devoted to making a difference, conducted the promised consultations across the province, albeit with the constraints of zoom as opposed to in-person conversations.  Having received and analyzed the feedback from the consultations, she then set about a process of creating a plan for health care reform.  One of the hazards of this style consultation is that electronic meetings tend to present a warped sense of communication.  Being in the same room, listening attentively, observing body language, allowing a good exchange of information and perspectives is ideal.
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Having worked successfully in both the acute and long-term care systems as well as in rural health care, and having heard from many people across the province in response to these columns, health care professionals and general public, I start by saluting government for getting something out of the gate.  With respect to all who have gone before, the “system” has been in need of hands-on shake-up at many levels for years, so say doctors, nurses, long term care operators and service providers, caregivers, the public generally.

In 1992 there was a plan; it was tough to introduce but it was a plan; people knew the deliverables but did not necessarily agree on all the terms.  But there was a plan.  Since 2000 there has been no serious plan and services have developed in the absence of a blueprint.  The Graham government introduced the two Health Authorities with hopes and intentions that would lead to a better order.  Instead, it has led to perceived competition and duplication.

And Long-Term Care, that which has needed direction for 30 years, has suffered seriously without a plan despite loud calls for attention from various quarters for decades.  Over the last 20 years there have been a series of Health Plans and Seniors Plans published, each with glossy cover, each affording photo-ops, each used to defend some course of action.  But none of them have been plans at all but marketing documents.
So, the release of Stabilizing Health Care on November 17, 2021 gives some hope and I, for one, am prepared to give government the opportunity to use it as a tool for action.  But since previous plans have resulted in so little, what is it that gives hope.

First, it identifies the key topic areas that have been troubling the population and the system.  The skeptic will say, as they should, “we’ve seen all this before!”  And they would be right.  Never a week has gone by in recent years that we have not seen headlines decrying lack of access to primary care, essential surgery, addictions and mental health, and access to long term care.

Secondly, the headings of People and Technology are huge.  In neither section will we find the answers but they are there as key strategies to be worked out.

Thirdly, for a government known for cost-cutting, the funding section is a first.  The idea of the need for funds to bridge from the old ways of doing things to some new ways is encouraging.  I have made the point for years that the system is in such need of overhaul that some seed money is needed to create new models of care and service, allowing older models to serve out their lifespan and eventually disappear.  The idea of pilot projects is rather novel in the sense that many ideas for reform have been put forward in the last 20 years only to be met with lack of interest or support.  Some of those ideas represented care models already up and running successfully in other provinces!

What gives me hope is that unlike previous “plans”, government is forming a Task Force to oversee and lead reforms.  The Terms of Reference for this entity have not been released and always the devil is in the details.  But as we said with the Aging Council Report in 2017:  government needs to bring people to the table who have good track records of achievement along with a rock-solid understanding of the health and long-term care system to work with them and service providers in finding innovative ways to bring people and ideas together in real time.  That did not happen with the Aging Council Report and consequently many of the priorities contained in it still languish.

The Co-Chairs of the new Task Force are impressive:  Gerald Richard is a superb, recently-retired Deputy Minister with experience in Education and more recently as DM in the Health Department.  Notwithstanding the misfire in February 2020 with health reform, he has been at the helm throughout the pandemic providing a calming influence.  Dr. Suzanne Johnston is a superb health service executive whose career commenced in nursing in New Brunswick and who won real recognition for her leadership in Northern British Columbia and the Hamilton/Niagara Health Network.  I know that area very well and fully understand the complexity of the environment in which she provided system leadership before retiring to her native New Brunswick.

How the Task Force will unfold is yet unknown and it will be interesting to watch how it is constructed.  Certainly, having it populated simply by officials of the affected departments, health authorities, and representative groups will not get the desired and essential results, guaranteed.  Progress on the key files will require issues to be tackled as never before, conversations to be had that are difficult, issues of compensation models, regulatory and practice methods squarely on the table for debate.  If everyone has to go back to a constituency for direction, nothing will happen.

If I were directing the strategy, I would look for and drive some early wins!  Grab some low-hanging apples!  There are so many issues that drive professionals and service providers mad that early wins could send some very encouraging signals to a health and long-term care system desperately in need of good news.  Many early wins do not need to cost a fortune!  Indeed, some may save money or be cost neutral.

Join me in watching carefully as this unfolds.  I, for one, will be pretty discouraged if some tangible system improvements are not in evidence by the summer of 2022.

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 is the author of Health Care Reform in New Brunswick, available at www.kenmcgeorge.com;  His email:   [email protected].