In the power and decision-making structure of the New Brunswick government, the legislature has been for generations the centre of serious activity. That is where legislation is approved, legislative changes are solemnized, legislative committees and officers are legally bound to demonstrate accountability to “we the people”. The Opposition parties play, in our democracy, a serious role in presenting questions that technically are supposed to provide opportunity for government to hear the voice of the people, consider other perspectives, enable the government to explain their proposals for public consumption. The public can connect by webcast to the sittings and we can, as well, actually go to the legislature to hear the questions and government’s defense of its position on whatever is the issue of the day or session. The opposition raised a pertinent question on Thursday, June 6, 2024 that has received little coverage and follow up with media and government choosing to focus, instead, on the Auditor General’s report on Travel Nurses. The question raised by Liberal Leader Susan Holt was insightful and generated a response that was, in itself, concerning. She had learned that the Premier and wife had hosted senior health executives and health authority leaders at Larry’s Gulch for a time of relaxed discussion. When asked about the purpose of choosing the exclusive resort location, the premier responded that he wanted to explore with them the issues of getting the health authorities working more closely together. In government-speak, that typically means: “how can we save money, cut out perceived duplication of services?”
And on the surface, it is a good question. In light of the serious issues of providing essential health services to New Brunswickers, it is the wrong question at the wrong time. Of course, any rampant and unnecessary duplication of services and inefficiencies needs to be routed out and fixed. Heaven knows, government structures seem to be awash in stories of duplication and inefficiency in several departments. But with the issues of the cost of travel nursing also dominating the headlines, eleven percent of the New Brunswick population with no access to effective primary health care, the continuing ALC crisis, the chronic, long wait times for essential care, the public would prefer priority and energy in issues that matter to them. Getting two health authorities to eliminate duplication would not be understood nor a matter of priority to the people. Getting serious about health and long-term care reform requires that priority at the highest levels be fixed on the issues of government inefficiency and health human resources. Those words flow off the tongue fairly simply. But do not be confused; these are the essential, core issues of health reform and the fact is that true reforms cannot happen in the absence of a clear strategy built around them. To the issue of government inefficiency many experienced health professionals could write volumes describing issues that have been identified for many, many years, government after government, that demonstrate obstacles to getting obvious issues dealt with. At the heart of the inefficiencies seem to rely core, structural issues in the public service that seem best represented as “elephants in the room” in many high-level discussions of reforms. Health human resources is a broad heading that has needed fresh thinking, analysis, collaboration, new directions for many years. The changes and new directions are not topics that lend themselves to conventional collective bargaining with all the drama that normally in involved in that process. Government normally is represented at those tables by lawyers and labor negotiators whose mandates are, as they need to be, bound by legislation and government direction. It is a process that typically leads to much drama, threats of strike, public claims that are intended to influence the outcome of classic contract bargaining. That is not what we are speaking of in describing the Health Human Resources issues in Health and Long-Term Care. With the system at the crisis level that has now been described for over a decade, a new and different level of dialogue needs to be invented between government, its agencies, and the leaders of the professions. Simplistic responses to the crisis of the day simply make matters worse. As mentioned, several times in these columns and the writings of other contributors, health professions have been changing before our very eyes for decades; the challenge for public service is that public policy has yet to catch up with that level of change. Great and effective health and long-term care services are provided by skilled, caring, talented professionals who have been attracted to medicine, nursing, psychology and the other great professions who have entrusted their minds and hearts to leaders of educational programs to prepare them for service in their chosen field in the future. The professional associations are charged, by law, with ensuring that people offering service are properly registered in a process that effectively assesses their training and certifies them to be safe practitioners for future. In the public interest, regulatory processes must be carefully structured with approval and sanction of government. But over many years, the attitudes, motivation, environment of practice, social norms and ever so much more have been evolving. Medicine had been, for generations, a respected profession in which long work weeks, scarce personal time were the norm. And the thousands of professional nursing positions were filled primarily by university graduates with LPNs functioning largely in long term care and other supportive roles. Pharmacists performed with much knowledge but limited ability to engage their full knowledge in clinical situations. Many professions have struggled for decades to function at full scope of practice with interesting exceptions to that restriction along the way. The level of crisis that has existed in New Brunswick and reported by tens of thousands of New Brunswickers requires that most of the old thinking needs to be simply put aside with innovation occupying the place of prominence on the table that it deserves. Readers of these columns have shared with me their experiences in health care in Scandinavia, Spain, USA, the Netherlands and more…. always reciting how much better was the coordination, accountability, patient (customer) service in their experience in those jurisdictions. The International Commonwealth Fund is not too kind to Canada on rankings of 11 developed countries on issues of system performance. Canada and the US rank low while Scandinavian countries and the Netherlands rank at the top. So, if we want to fix the issues of health and long-term care in New Brunswick, I would be asking the same question I have asked for over 5 years: what is the plan? if the plan is to cut cost, wrong question. If the plan is to attach the minutia of micro-cost savings from perceived duplication, wrong question. Define the system you want and its performance goals. Then figure out what changes to the infrastructure and Human Resource base are indicated. Then the hard work begins. Anyone can save money; it is easy to just say “no”. The acid test of reform is in working with the associations, unions and regulatory authorities to re-shape how we deliver primary care, how we structure and administer long term care, how we manage change that creates a magnetic work environment. Larry’s Gulch, different conversation! Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com
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AuthorKen McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada. Archives
May 2023
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