Will Reform of the New Brunswick Health and Long-Term Care systems actually happen?

For years, the public has been expressing its disapproval of horrific long waits in Emergency Departments along with frustration and anger when their doctor retires or leaves the practice only to be left with either the Emergency Department or an After-Hours Clinic as their source of primary health care services.  In recent years, the media has carried a seemingly endless stream of articles and commentaries on topics ranging from hospital staff absenteeism to violence in the workplace toxicity.  We have heard the cries from gifted specialists in various surgical disciplines who claim to have access to no more than one day per week in the Operating Room for elective and urgent surgical cases.
 
The stories are endless and the public has been growing increasingly restless.  The professionals, on whose work the reputation of our health care services depends, are getting increasingly restless.  The Minister of Health has recently spoken about the Department of Health taking over the recruitment of doctors yet it is difficult to envision recruitment and retention success until some major shortcomings of the system are cleaned up.

Most recently physicians at the Dumont Hospital were expressing concern about the huge number of frail elders occupying acute care beds while awaiting long term care.  The group with whom I met were more than chagrined to learn there are over 1000 special care home beds vacant, a fact known to government for over two years.
 
The health and long-term care systems are well beyond the need for putting fingers in dikes!  It is well beyond band-aid fixes and announcements that make headlines and give photo-ops.  The system is creaking badly because a succession of governments has done just that:  short term, band-aid solutions.  There has been no serious health care reform since 1992.  People will recall the merger of 7 health authorities into two in 2008, but that was, in public policy terms, tinkering around the edges.  That initiative did very little to resolve the issues of concern to the public.  If it had, why would we be dealing now with such serious, if not tragic, system failures?
 
It was in 1992 that Premier McKenna, armed with a strong legislative majority and a very strong cabinet, took the action that had been called for over a 30-year period by external consultants.  Fifty-five Hospitals and health centres were in bad shape financially and government was struggling to figure out how to respond to so many voices, each with compelling cases.
 
With no notice to the public, hospital boards were discontinued, the Minister of Health became the “one board for the province” for three months, and the reform game was on!  It worked but not all were happy by any means.  Each hospital and health centre had a loyal community that supported it and played a key role in helping to keep doctors engaged and contented.  Suddenly they were threatened and lost control to a regional board and CEO and the next 2-3 years of adjustment were very traumatic.  But it was necessary.  Since that time, each province in Canada has replaced local hospital governance with regional or provincial boards and we could write for pages about why that had to happen.
 
Following a few years of reform, the population got accustomed to the new governance model although it did not stop the competition between regions for programs, staff, equipment, and capital funding.  Hence, the creation of the two health authorities.
 
In provincial change management, the 1992 initiation of reform goes down in history as a success story and there has been nothing like it in health care in New Brunswick since that time.  It is instructional to examine why that initiative was successful and it must always be born in mind that health care services constitute one of the largest single political lightning rods in Canada and its provinces.  It is said that more elections have been won or lost based on health issues than any other single issue.
 
In consultation with some former colleagues, including Bonny Hoyt-Hallett, who was Executive Director of Strategic Policy and Legislative Development, and accountable directly to the Deputy Minister, we identified key elements required for success in health care reform:

1. There was enormous documentation of the need to regionalize the health system; 30 years of study by some of the foremost health consulting firms in the world laid it out.
2. A strong Department of Health that had a strong, seasoned, knowledgeable Deputy Minister with much experience and education federally and provincially in public policy.
3. Around the Deputy were officials who had been successful in leadership in health care prior to joining the civil service:  hospital administrative personnel, Provincial nursing leadership, Accounting and finance.  There was a full team of about 12 such people who played key roles in advising and setting the legislation and regulations.
4. A Minister of Health who was a respected family doctor, totally a-political, a strong personality, visionary, very supportive of all who were taking the pressure on the front lines.  He knew the health system very well.
5. Senior health executives who, for the most part, were well trained, experienced, understood good governance and had courage and ability to absorb pressure.  These people knew that there needed to be several stages to reform with the most difficult stage being regionalization of hospitals.
6. A premier and cabinet who understood the need for deep change and the inevitability of investing some serious political capital to make it happen.  With a commanding majority in the legislature, legislative approvals were possible without the need for political points to be scored by opposition.
7. Consensus of the medical society, nurses’ association, hospital association in advocating for regionalization of health care.
8. A distinguished panel (McKelvey/Levesque Commission) that recommended implementation of what the consulting reports had said for years.

 
The current government has indicated a desire to proceed with health care reform.  Elements of their plan have not yet been outlined; they did try to initiate some steps in February 2020 which backfired politically.  The great lesson learned in the 1992 reform was that when intruding into rural New Brunswick, walk collaboratively and don’t carry a big stick!  The rural communities, physicians, nurses and others are more than ready for essential change but they want to be engaged to ensure that their communities retain essential health care services.  They know that rural services cannot and should not include MRI’s, major reconstructive surgery.  But they do need good primary care, good eldercare, access to specialist consultation and service, and access to efficient transport.  None of that was part of the February 2020 initiative, as far as the mayors could tell.
 
So, the consultations promised by the premier are complete, the stage is now set.  What the public does not want to see is a glossy 5-year plan.  You could paper a wall with such documents created by the Departments of Health and Social Services in recent decades, yet the issues persist.  Government would do well to figure out what are the key elements that need focus, examine the ingredients of the success of 1992, then assemble a strategy to move the reform agenda accordingly.  Simply recruiting some doctors or some Nurse Practitioners to the province is does not constitute reform.
 
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 protected].  His columns appear on his website www.kenmcgeorge.com