​New Government; New Hope: Now What?

It was 6 years ago that a newly elected premier and his colleagues called for reforms in the health sector, amongst many other things they had on their agenda.   For two decades prior to that, a number of serious health and long-term care issues had been accumulating:
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1. Wait times in Emergency Departments were becoming unmanageable with tales going back nearly 20 years to the distress caused for the public with long waits. 
2. The long waits for elective surgery (hips, knees and other orthopaedic procedures) were also a large concern for an aging population but not a new issue.
3. The growing number of residents without access to appropriate primary health service.
4. Governance and structure of the health authorities.
5. Health Human Resources issues ranging from impending vacancies by the carload to workplace morale, organization and structure.  Those themes have been frequently expressed for so long that I expect a certain numbness may have set in.
6. Wait times for access for long-term care growing at an alarming level that compromises the service that the acute care hospitals are supposed to provide.
   
   

The aging population has contributed to increasingly long waits for long-term care resulting in an embarrassing number of acute care beds being occupied by persons requiring long-term care capacity, which most mistakenly interpreted simply as need for more nursing homes.  This shortage and pressure have been forecast for decades and has never been taken seriously.  A succession of governments have mistakenly thought they were doing something significant by building a few new nursing homes and renovating existing stock.  Those have been great initiatives but have not resolved the issues.

As Lamrock’s report (“What We All Want”) so eloquently noted, the issues in long-term care are way more numerous and complicated than simply adding a few beds or recruiting a few staff.  The central issue is that there is not now, nor has there ever been, a plan for long-term care.  A plan for nursing homes that does not include home care and special care homes along with many other long-term care issues is planning for one segment only.  Plans presented in the last 20 years have not been long-term care plans at all.

Nor, for that matter, has there been a plan for the orderly development of health care.  One of my mentors often said:  “If you have no plan, any old road will do.”  Health and Long-term care suffer, as do those who staff those services.  Working in an environment that lacks clear vision and direction must be a struggle.

What would a plan for Health and Long-Term Care look like?  What would be the essential ingredients?

1. A clear analysis of the present state, strengths, weaknesses, challenges.  There needs to be more public dialogue on the reality of the present state across the province.  This needs to include Human Resources, Workplace Culture, and more.
2. Clear understanding and documentation of service needs….not service dreams or aspirations but real needs
3. Realistic forecast for future development
4. Realistic summary of the role of the private and public sectors.  It is more than evident that the public sector, for many valid reasons, cannot respond quickly enough to meet real public need.
5. Clear assessment of the resources required in order to achieve the plan
6. A clear definition of things that need to change in order to get to the point of correction for the serious issues noted above.
7. And so much more
   
   

The previous government, to their credit, managed to get some things started.  MyHealthNB is one such initiative.   The creation of e-visit was a good idea.  And the development of a few urgent care centres was a start.  The conversion of the Health Authority Boards was necessary but seemed to be pretty quiet.

Apparently, there has been improvement in access to hip and knee surgery; wait times for other surgery seem to be unchanged.

The issues that are in need of urgent focus and direction did not happen overnight nor will they be corrected overnight.  Measurable progress can be made soon but not without courageous strength and determination.  The steps required will not make everyone happy any more than regionalizing the hospitals made people happy in 1992.  But it was the right thing to do and every province in Canada followed with their own versions.  People wiser than I have noted that all politicians start out with a certain level of political capital and start investing it with the decisions they make.

Such is the case in fixing health and long-term care.  Reform requires a level of courage, commitment and vision that goes far beyond change. 

A good deal of political capital will be required if efforts to fix the issues described above are to be successful.  Some elements of essential change will include:
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1. Regulatory and legislative change
2. Re-design of the organization of clinical programs that the public holds dear
3. Defining Rural health and long-term care services
4. Re-defining the roles of regional facilities and the services they provide
5. Overhauling workplace culture and labor relations
6. Re-defining compensation methods
   
   

On this file, Health and Long-Term Care, I have great respect for any new government.  There is so much to learn, most of what they need to know is not in any briefing books or files, there is a naïve public belief that once sworn in they can snap the finger and make things happen because they “now have authority”.  And as we have seen on many occasions in health and long-term care:  decisions made in the heat of the moment often create more problems than they resolve.

What the public often does not understand is the complexity of getting change make in such a complex environment.  I would hope that the public would resist the temptation to simply insist that government just pour in more money.  We need to insist that the government take the time to create viable plans so that resources are invested in a responsible manner.  It has taken primary care 30 years to get to its current state; it needs more than patchwork.  Similarly with Long-Term care…. engaging nursing homes, special care homes, home care to their maximum and challenging their leaders to be creative….so much potential to be harnessed.  Government cannot do it all alone.  Emergency and Urgent Care also need systematic and well-considered planning, perhaps some external resources to advise.
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New Brunswick still has the opportunity and potential to become a model for the country.  Small enough to be manageable; great cohort of professional staff
 
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