Social Development Minister Dorothy Shephard has seen health and long-term care reform from the inside out.  She was the Minister of Health during the pandemic when times were crazy and she was trying to get the first steps of Health Reform initiated.  Given the context with a failed first attempt at health reform, prior to her term, combined with the insanity caused by the pandemic, she gave it her best shot. She was involved in the consultations that were promised, compromised again due to the necessity to do so much virtually with Zoom technology.  A poor substitute for face-to-face communication.

Now she is back in the Department of Social Development in which strong attempts are being made, with a superb team of senior civil servants, to get long-term care reformed.  The issues in the failure of long-term care in this province are now legendary with hundreds of empty long term care beds, challenges in recruiting and retaining skilled staff, little political or public understanding of the real issues that prevent the long-term care system from functioning like a well-oiled machine.

I remember his voice from 60 years ago when Prof. Arnold Cook lectured beginning business students, and I was one, on the principles of what makes for a good organization that grows and develops.  The principles of clear accountability, shared vision, strong leadership have been my guiding principles in large and small organizations that I have directed over the last half century.  The organizations that grow and survive have shown that Prof. Cook was absolutely correct, and some of them are outlined in Good to Great, the classic Jim Collins book that describes what it takes to take an organization from “good” to “great”.

Transpose that basic thinking then to health and long-term care in New Brunswick and think, for a moment, of the issues that have caused so much nasty public discussion in recent years, particularly the last three.

“But oh, we suffer, right? Yes, right!” So said Yente in the classic, Fiddler on the Roof! Families dealing with the Dementia journey suffer, often desperate for support. For years the challenges of getting a correct diagnosis followed by proper and helpful mechanisms and
supports for the patient, caregivers, and families has been the huge “elephant in the room” in
discussions of health care for the aging population. 

​With the greatest proportion of elders amongst provinces in the country and a population that has forecast its aging issues for decades, it should come as no surprise that emergency departments and hospital beds are distressed with elders in crisis.

Professor Richard Saillant, the noted Moncton-based economist and author of Over the Cliff, wrote a sobering article in the Brunswick News on March 4 in which he detailed the difficulty that the NB government seems to have with its fiscal projections.  The current government was elected on a platform of fiscal responsibility, attacking the provincial debt and reforming health and long term care, municipal government, education and other services.  Somewhat accurate fiscal projections are needed but are always elusive in the public sector.
At last count, according to Saillant’s summary, government was projecting a surplus in the current year of nearly $1 Billion.  And to staunch fiscal conservatives, that is incredibly great news.  This could not only stop the bleeding of expenditures but could also provide some capacity to actually reduce the public debt.

But not so fast.  Are you heeding what is really still happening in health and long term care?  Wait times for essential diagnostics are such that private clinics have been developed with the Federal government now “clawing back” over $1 million in health transfer payments.  Worse still are the continuing stories of people either not getting essential diagnostics and care on a timely basis, but still a disturbing number without access to primary care or on long wait lists for long term care.

In July 2022, Premier Higgs, having promised reform of the health system prior to election, fired the newly appointed Horizon CEO and disbanded the boards of the two health authorities.  Two trustees have served as surrogate governing boards and an interim CEO was appointed to replaced Dr. Dornan.

So now what?  Health and long-term care cannot be run from the Premier’s office forever.  Informed observers have been calling for a more relevant governance model for the health authorities for years. 

By all accounts, the Health and Long-Term Care System in New Brunswick appears to be in the state that was forecast many years ago when Llewellyn Davies Weeks was commissioned to create a plan.  The regional plan for hospitals, created by the Department of Health and introduced in 1992, was intended to be the first phase of a systematic development of the health care system.  The plan had not spelled out, in finite detail, what it would look like but the regional hospital structure then paved the way for merging difficult files such as long-term care, mental health, even public health into a vibrant system that had 7 functioning regions, fairly close to the people.

Since the inception of the system that we loosely call the Canadian Health Care System, in 1959 the federal and provincial dialogue has been a succession of squabbles over funding.  What was intended as a 50:50 cost sharing has grown far beyond that in scope and complexity.

So here we are, once again, with more federal/provincial discussion with the predictable scenario:  national consensus “the system is in crisis” with a federal response of “let’s pour more money on this troubled sector.”

Then in the public discourse in social media, conventional media, and advocacy publication, the public is, once again, treated to the usual arguments:  use the money to hire more doctors and nurses, use the money to build more nursing homes, give employees a respectable income that is attractive.

In 1995 when the government of the day was going to the polls and Hospital Regionalization was politically hot and risky, I was encouraged to move on from being CEO of the Region 3 Hospital Corporation.  For three difficult years, beds had been cut in rural areas, staff were laid off, and the atmosphere in rural New Brunswick was not ideal for an election.  Having been professionally trained and certified, and being still in the midst of a career that had been very successful in other provinces, I was happy when one of the strongest leaders in the province, Dr. L.D. Buckingham, invited me to work with him in Moncton.

I had admired him since we both were students in the early 1960’s so this was a great relief from the politics of health care reform.  But the job was not in health care, which had been my first love; it was in a Church in Moncton that had the reputation of being the fastest growing protestant church in Eastern Canada.  Indeed, under the leadership of Dr. Buckingham, the Moncton Wesleyan Church now had a reputation beyond Moncton and extending well into Canada and the U.S.

The Brunswick News Legislative Bureau published a front-page article on December 29 giving an assessment of the “rocky road to health reform” in New Brunswick.  In it they cited the major goals set by government and showed how Covid has been a set back to reform but how in the pandemic the province eventually was able to break down some silos to get things moving a bit faster.

It was noted, however, that some influential advocacy groups still express skepticism, particularly on the nursing situation.

A subsequent article by Sarah Seeley on January 3 observed the angst being felt by people waiting for access to primary care services including new residents in New Brunswick who have waited three years.  The technological measures introduced by government that largely revolve around “virtual care” are stop-gap measures at best and are no substitute for having a relationship with a Primary Care Service provider, be that a physician, nurse practitioner, or an integrated primary health clinic.

That our health services are in crisis is the understatement of the decade!  Much has been written and debated on the topic and some will suggest that “it is the same in all provinces!”  True only to a degree and a very lame excuse, at that.

Acute Care facilities in New Brunswick are under duress for many reasons.  One of the large ones is the pressure on emergency departments and on acute care beds in which elders “waiting for a nursing home bed” are said to be a huge problem.

Indeed, New Brunswick is one of the leaders in Canada for having the highest proportion of acute care beds occupied by such frail elders, according to the Canadian Institute for Health Information.  Ask a social worker, a discharge planner, a physician, and the family of the patient….” we could free up those beds for occupancy by really sick people if we could get the ALC patients to a nursing home.  But the nursing home wait list is huge and wait time for admission is months and months!”

Catherine Morrison’s account of the CanAge Report called attention to the poor performance in New Brunswick in dealing with Dementia, one of several diseases of aging that also impact many people under the age of 65!  Many of the issues causing much grief to the public and the health system stem from the inadequate manner in which care is administered and delivered to the vulnerable.

For generations, our planners have known that the aging bubble would be here now, as it is, and that with it would come all the health issues of aging:  reconstructive surgery, neurological challenges, diabetes, and ever so many more.  Dementia impacts a huge percentage of the aging population and, unlike many other illnesses, it impacts the entire family.  Suddenly the spouse is a caregiver with lifestyle entirely dictated by the symptoms and phase of the Dementia on the husband or wife.  Volumes have been written about how this disease is so life-altering for the entire family unit that it does not need further repeating here.

Minister Fitch announced in the Telegraph Journal on Saturday, October 22, 2022 that “doctorless patients” should register with Health Link.   It is a good interim approach to filling some voids in a primary health care system that is more like Plinko for over sixty thousand New Brunswickers.  If you don’t have a doctor and have an issue, seeing someone with medical training is better than a zoom call and certainly better than seeing no one at all.  It is a step above the after-hours clinics.

But a real reform with intentionality is well overdue for those on the waiting list “for a doctor.”  Speak with these people and you get the most bizarre stories and when I think I have heard them all, I hear another one!

Joe, a senior of about seventy-seven years, with a spouse of the same age, both needing some regular surveillance of issues of aging, thought they were secure; doctor was part of a group and suddenly decided to stop practice.  They assumed they would be assigned to another doctor in the group.  Simple, right?  Wrong, no such assignment made so they enquired about records.  Well, the records can be retrieved from a company in Toronto for a fee.

Municipal reform in New Brunswick, having been discussed and debated for 40 years, has finally gotten off the ground!  The Finn Report, published in 2008 and prepared by Jean Guy Finn, one of the outstanding minds in New Brunswick in public policy, finally got some traction with government.  Is everyone happy?  Not entirely.  Will the initiatives underway yield serious improvements in local government?  Undoubtedly so.  Are there major hurdles to be worked out?  Of Course.  That is the challenging process of changing structures that touch on the lives of New Brunswickers.

Are everyday New Brunswickers attentive to the issues that remain outstanding?  Not really because life goes on, the sun has been shining and moose season is upon us.  But the people most impacted, the mayors, councilors and officials of local government remain concerned about the details of funding, cash flow.  Their concerns, as I hear them expressed, are a repeat of the major, sometimes explosive, concerns of implementing health care reform in 1992. 

So, everyone wanted major change in health care, or so we thought!  People express disgust with long waits for finding a family doctor, for long term care, for treatment in emergency and ever so much more.  They say they resonate to the government’s promise for reform and government gets accolades for seemingly moving in that direction.

But not so fast!  In every attempt at even insignificant reforms in the last 20 years, resistance has come from interest groups, politicians of a different hue, advocacy groups, and more.  That’s the problem with health care….it is the third rail of Canadian politics!  Everyone wants to complain, to demand change, to express disgust, chide government for not doing more; and many of them say they are supportive of major reforms.

For well over a decade in New Brunswick, many informed professionals, some former senior civil servants, others former politicians, others informed nursing persons, have been sounding the alarm about the state of Health and Long-Term Care Services in New Brunswick.  Disgruntled nurses and an impending nursing crisis was foreseen two decades ago, for instance.  The overcrowded emergency departments have been a serious issue since the early 1990’s.  Primary Health Care Services and the issue of “getting a family doctor” has been an issue for nearly two decades.

Some of these bright people offered their help to the Gallant government but that was not acknowledged.  Then some of these folks, all feeling a sense of desperation, offered to support the current government, taking heart in the Premier’s commitment, nearly 3 years ago, to health care reform.

The early attempt by the government to initiate reform in February 2020 was ill-conceived and ill-informed and it did backfire in a big way.  Then after a cabinet shuffle, a new commitment to reform was made with virtual public consultations as a major element.  What was reported from the consultations seemed strangely similar to many of the messages that have been discussed by informed people for nearly two decades; that is, there was nothing new.

Some things never change!  In 1965, when Judy LaMarsh was Federal Health Minister, the provinces were already sounding warnings of the rapid increase in health care costs, even though the Canadian Federal/Provincial Health System, had only been in place for six years!  Years later, when Paul Martin was Finance Minister there was lots of federal/provincial debate about the costs as the federal government sought to slow down the growth by capping transfer payments. And so, it has gone with every government federally and provincially since the inception of the system in 1959 then Medicare in 1969.

So now they are at it again:  the provinces, with legitimacy, arguing that the system that was supposed to be a 50/50 cost sharing has drifted a long way from that with the provinces left holding the bag for way more than was intended in 1959.  The Hon. Dominic LeBlanc expresses the intent to have a resolution this fall while Mr. Higgs keeps pushing, as he should, for a larger fiscal presence by the Feds.
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But it won’t stop there!  

Tommy Douglas would be most disturbed at what he reads in the press this week!  Two headline stories on July 4 in Brunswick News:  Sinking Faster than the Titanic (Dr. Mark Waite) and Moncton Orthopedic Surgeons stop accepting referrals for elective surgery.  That was not the vision that Mr. Douglas had nor any of those political leaders who went to the wall at a time of intense national debate in the 1950’s.  Ours was to be a system that provided for essential medically-necessary care of all Canadians.

Fast forward to 2022 and the water gets really murky.  Those who have been carefully tracking the trends for decades have seen this day coming for years; those with their focus strictly on budgets perhaps not so much.  Much has already been written and said about how we have arrived at this place and this is no time to point fingers and ascribe blame.  It is a set of health and long-term care circumstances that simply do not respond effectively to the demographic of 2022.

At the age of 19, some incredible nurses, orderlies and interns taught me to do  much of what is conventional nursing practice.  Over 3 summers as a summer student, I honed skills that I did not know I had nor could I imagine developing.  Procedurally, I removed stitches and clamps after surgery, prepared patients for surgery, replaced dressings, inserted and replaced foley catheters, helped with application of casts under the careful tutelage of great doctors, did bowel care, helped with patient mobilization, went on the ambulance to retrieve people in distress either heart attacks, strokes, or motor vehicle accidents.  The list included all the basics of toileting, bathing, preparing for surgery, and more.  As a bonus, I got to work in the morgue as well, honing some other skills.

When employed for a fourth summer in another hospital in another province, I gave total care, except for drugs, to a person who was palliative then got assigned total care for others later on.  Never, for a minute, did I think this was work restricted to females.  As a matter of fact, I got much job satisfaction in seeing things done well, patient’s needs met, doctors and nurses happy with my care, and families who thanked me for caring for their loved one.

By now, there is no doubt about the provincial government’s commitment to health and long-term care reform.  Heaven knows, it has been promised with volumes written about it for 10 years or more.  To persons “on the street”, to ordinary physicians, to employees and their representatives the question remains:  What?  Where?  When?  How? Who?  By now, journalists should be seeing a pattern of change and the course of reform should be clear.  They are not!

I have searched for answers as to why so slow?  Why does the obvious require years?  The issues of the ALC patients in hospital have been obvious for many years yet there they are, occupying highly expensive beds needed to accommodate the huge backlog in surgical cases postponed largely due to the pandemic.   When you think you are seeing progress in moving a few to long term care, a new group come through the Emergency Department and back to square one all over again.