Mr. Higgs’ remarks to Brunswick News as reported on August 14 is right on the money. For decades that has been a message echoed by some of the most qualified leaders in the system in New Brunswick. Indeed, as the system has stumbled since the initial reforms of 1992, the issue of politics in the system has come up over and over and has been a source of major discouragement to many wonderful clinicians and administrators. When you have trained for anywhere from 4 years to 15 years to become the best you can be, the last thing you want to see is inconsistent direction, over-concern for photo-ops and tactics that respond to symptoms without solving real problems.
Many seasoned observers describe the Canadian health system as the third rail in Canadian politics; that is, the politics of the system is so powerful that governments deal with issues very gingerly. That was ever so obvious in the 1990’s when the great work initiated by the McKenna government became the target of would-be politicians who wanted to get elected. Changing the direction of anything in health care is challenging and cannot happen by issuing edicts or policies or election promises. Once the announcements are made, the hard work begins, work that involves responding to angry people, professionals or the public, showing people a better way when they didn’t know a better way was necessary.
The system in New Brunswick, at this time, does not enjoy the level of respect that it should enjoy. The recurring issues of Primary Care, Long Term Care, Nursing and Human Resources Issues, Rural Health Care, Emergency Transport and Management, excessive wait times for everything cause cynicism and frustration. These, combined with questions around patient focus, have many professionals, the public, the unions, and caregivers in such a state that the need for making a case for reform is academic; they all know it. What is not commonly agreed on is how to fix all the elements that people know are broken.
Mr. Higgs is correct in calling for some mechanism that will bring the major political parties together on a path forward. There are so many issues whose roots run so deep that almost any solution put forward looks good; at least it would be better than years of inaction by all governments. Whether Tories, Grits, or anyone else is in power, the issues are the same and require immediate solutions. Neither party has had a corner on wise direction on the health and long-term care file for 25 years. So, the professionals and the public are saying to the politicians of all colors: stop, get in the same room and fix the issues that you have created! Just do it!
So why is it all so political? And why do substantive decisions keep getting kicked down the road?
First, there is the power and influence of interest groups. Each profession and vocational group in health and long-term care services has a body that is said to represent the interests of their sector. The Medical Society has, for years, been powerful and highly influential. The group that they represent is not at all homogeneous by virtue of training, specialty, compensation models and more. Family doctors in 2021 are trained in a manner quite different from the family doctor trained in the 1970’s. Similarly with surgery in which, unlike the old days, there are many surgical specialties and subspecialties. There are some specialties that tend to lend themselves to “regular office hours” while others require many hours per week, long days, and elaborate call schedules.
All physicians are not compensated similarly, either, which creates a whole level of complexity. Some hold the conventional fee for service method of payment as the holy grail while others prefer the more regulated salary system that may also involve attractive fringe benefit packages and retirement plan. The Medical Society, in participating in discussions of fixing broken health systems, has to be careful about how to proceed and how aggressively to proceed. The wrong words wrongly interpreted can anger many loyal members.
Much can be said about nursing with the evolution of its specialties and hundreds of vocational directions, including supervision, management, teaching and research, taken by its members.
Then there is the issue of unions, very huge in New Brunswick. Strong unions represent nurses, lab and all diagnostic services workers, cleaners, maintenance and more. In both the acute care and nursing home sectors, the unions are a dominant force and have influenced the course of events in more ways than can be described in these paragraphs.
And all the people who feel passionately and have loyalty to their union or professional association are all voters with influence.
On the governing side, we have people elected by their constituencies, aware that to get elected initially, in addition to their party support, they need to be hearing the messages of voters and make it appear that, if elected, they will attend to the concerns expressed. Once elected, however, they soon learn that the combination of government and legislative complexity, party discipline and other priorities of the day place much restriction on what the member can and cannot do to respond to the wishes of the constituents. The major concern becomes ensuring that those who voted for you believe you are in their corner representing their interests. This is best done by news coverage, photo ops, now social media and lots of visibility in the riding and with party leadership.
The legislative game goes on until a year before the next election when there is a scramble to create good messages of reassurance to constituents. If you are a candidate in waiting, that year involves making sure that you get more visibility in the riding than the person elected last time. In all of this there is little time to really get to understand what the real issues are in health and long-term care and how to seriously influence them. All the while the priority is on getting elected and staying elected. That is simply how it works.
Making a dent in the complex and challenging issues of health care reform requires a premier who has no ambition to be premier for life, one that is strong and listens to sources of knowledge and expertise, who knows how to distinguish between symptoms and real issues, who will invest sufficient political capital to ensure that cabinet and caucus thoroughly understand the “why” of health care reform and are prepared to function as boots on the ground.
So, if members and leaders are primarily focused on the “got elected, now stay elected” mentality, they will perpetuate the mediocrity that has become so prevalent in the NB health and long term-care system. On this file, that represents 50% of the spending and 80% of the political lightning capacity, the major party leaders must, with their caucuses behind them, work through the process of compromise required to restore the excellence that New Brunswickers need and that will be attractive in recruiting and retaining great professionals and those immigrating to New Brunswick.
Say it after me: We can have service excellence, we need service excellence, it is not all about new spending but about leadership and focus!
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News, and author of Health Care Reform in New Brunswick; he can be reached at email@example.com.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.