Devils in the details

On March 1st, Nova Scotia’s Minister of Health and Wellness, the Honourable Maureen MacDonald, announced modest cuts to health care overheads.

The cuts were pretty tepid. The Minister allowed those in charge of the health authorities to direct the study. Are we surprised that no one looked at reducing the number of health authorities?

It doesn’t make business sense that authorities which claim to be so cash-strapped would only look at six areas in which to save money, instead ALL 13 areas.

I don’t know why we are afraid of change and innovation. The Minister says she wants to avoid chaos. Chaos by whose definition? Is it chaos as defined by people in the executive suites?

Whenever we talk about health care in this province we never let the people speak. They never consult the front line workers or patients or patient families. At a meeting in Berwick last week there were three retired nurses who had real, practical ideas on how to fix the system. You want ideas on helping health care – ask the retired nurses and doctors, people who don’t have to fear retribution. They’ll speak a truth the minister never hears because she’s placed in a bubble by her department and the health authorities.

If the minister shows up in a hospital, she’s escorted by executives who make sure no one says an unscripted word, and that the Minister is shielded from anyone who might not have pleasant things to say.

A better health care system isn’t only about cutting waste and duplication. It’s about helping sick people get better. We don’t talk about that. Where are the performance results?

I’ve had people say to me that health care is a sector that navel gazes looking at process – not results. This is an example of that. It’s an exercise in looking busy.

How can you talk about cost savings and not discuss drug costs? That’s where there are some real savings. Reducing drug costs was one of the objectives of the 2004 federal Health Accord. Eight years later our many administrators haven’t moved on that. Every health authority knows what they budget for drugs, why not negotiate volume discounts? That’s business 101. Hell, as a single payer system, why can’t the province tell drug companies this is what we will pay?

Instead, one of the areas they’re cutting is laundry. Is this a new saving or merely announcing an old, on-going way of operating? If you’re a patient at Valley Regional Hospital in Kentville you’ll often find johnny shirts and linens stamped with other hospital or health authority names. That must come from sharing some laundry facilities. And with gas constantly going up, how much will you really save when you factor in transportation costs? You’re talking about saving pennies when you have the option to save tens of millions.

The Minister says she takes no joy in knowing people will lose their jobs. I believe her. I’ve been in management. I know the hell of having to fire or lay people off. She would do less harm cutting at the top. My guestimate is that for every CEO/President laid off, she could save about 14-16 or more jobs. Executives are more mobile and have greater career options than a rural-based laundry worker.

Real savings – and better health care outcomes – would come from having consistent standards and administration across the province.

So many of the details are fuzzy. In interviews the Minister says projected cuts of senior executives might be 10-20 positions. That might mean a 4 – 7% cut in the executive ranks. Might. There seemed to be some wiggle room in the description of “general administration”, whatever that is.

These merged services are to be administered by a “shared-service organization”. That sounds like more bureaucracy. Where are those people coming from? Are we just moving people sideways? Is this where the cut executives land?

How many of these projected reductions in the executive ranks are real cuts? Or will they be handled by attrition or clever accounting? In other jurisdictions we’ve seen executives resign or retire, collect a severance package or pension, and come back within 30 days as a consultant at a 50-70% increase over their previous salary. But as a consultant they don’t show up on the books as a salary expense so authorities can pretend to streamline.

Let’s not forget there have been advance layoffs already. Capital Health eliminated 30 positions in February. In January, Annapolis Valley Health (AVH) laid off 11 lab technicians and on Monday (February 27th) they cut two food services positions, cut another person by 20%, expanded shifts from 8 to 12 hours and are reducing the hours of operation for the kitchens in Kentville by three hours which means patients have to eat earlier. That’s to save $100,000. But the subsidized executive lunch program survives. (See the Complex Costs article below.)

Why is everything with this Health Department on an 18-month time table? Has someone decided that’s the length of the public memory? The department gave health authorities 18 months to produce a list of all employees earning more than $100,000 annually. Why so long? Don’t people know what they earn?

Now they have 18 months to implement these changes. Is this for political purposes? 18 months takes us to the end of the government’s mandate. Is this part of the platform for the next election campaign?

It’s interesting that while six areas are identified for merged services, AVH have told their employees that only four are going to “proceed with detailed design and implementation: Supply Chain (purchasing and distribution), Finance/Payroll, Laundry and General Administration.”

AVH told their employees: “The detailed design work for the services of Human Resources and Information Technology/Telecommunications will also be done during this period; however there won’t be implementation at this time.”

Why are these areas not proceeding? One business person suggested IT can’t be implemented now because of a lack of uniformity of systems, forms and protocols within so many different health authorities. HR can’t be implemented because we have so many union contracts. We have 50 nursing contracts in Nova Scotia and another 50 contracts with workers in other departments. Why do we have this? If we have a uniform pay for teachers, liquor store workers and MLAs, why not nurses and other health care workers? Not having to negotiate 100 contracts would save time and money and improve employee morale.

You would think that an NDP government would go for wage parity across the province. The only reason to keep it complicated and fractured is to provide job security for the executive ranks.

In an October interview with CBC’s Information Morning, the Minister said that in Opposition she opposed this health care structure. I don’t know why she supports it now.

It seems that her advisors have gone out and hunted for bad examples to make the case against change. If this were an innovative system, it would look for both successes and failures and learn what did and didn’t work in other jurisdictions and begin working from there. You don’t go looking to duplicate failure. But the Minister believes any change can only guarantee chaos. I think there are a lot of front line workers and patients who believe we’re there now.

Ontario’s health authorities serve a million people each. If they can do it, why not us?

The administrative status quo is unsustainable and harmful to patients. Nova Scotia’s 10 health authorities have had over a decade to solve problems and they haven’t. They’re a hindrance to change, innovation and better health.

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3 Responses to Devils in the details

  1. Tina B says:

    Do you send your posts to Maureen MacDonald? Or anyone else with the power to make change? Everything you write seems so sensible and logical to me. I’m not being facetious, I really hope you are read by the “people in charge”.

    • Thank you. I don’t know if the Minister reads me or not. I used to write her letters, but that got nowhere and took months to get a reply. I did suggest changes to her and the Minister of Justice. Nothing. I have suggested where the Auditor General look. No response. And when we were in hospital and no one would listen to me, I wrote letters to the administrators which were basically ignored.

      If you’re not a cheerleader for the system, they attempt to marginalize you and tune you out. So I speak to Nova Scotians and Canadians via this blog. I do know that both Opposition parties read it regularly.

  2. Spc says:

    Six months ago, PCHA created about 6 positions: VPs and directors. I still have not learned their names nor have I seen them and I worked in the building. These are the sacrificial lambs who took high paying jobs, newly created positions after the last ones left. They are in positions that were never there before that time.

    As far as chaos goes, she means chaos in her world not the general public or heath workers because it is already there.

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