Stop politicizing health care

Universal health care is so important that it is considered part of Canada’s national identity.

It is the largest single expenditure of any government, consuming an average of 40 percent of provincial budgets.

I launched this website when I did because it was outside of an election campaign. I wanted us to have a reasoned, sustained conversation about health care that was more than the clichéd campaign race to see which political party can out promise the other on spending.

Until I became exposed to our health care system, I, like many Canadians, believed that health care would be fine if only it were properly funded. When I stopped grumbling about funding and started to listen and think I realized money wasn’t the answer. Otherwise we would have bought our way to good health. Over and over again, every study says the problems and issues with health care are greater than money.

Former TD Bank economist Don Drummond, who studied Ontario’s public service came up with a 100-item list for improving the province’s health care. He wrote, “Among those we talked to, none who manage parts of the system argued that more money alone is the solution to the problems of the health care system, including the ones they face. Indeed, some argued that the system is now well funded and that too much money would simply impede needed reforms. Certainly, the evidence of the recent past is that more money — political rhetoric notwithstanding — did not buy change, only more of the same, at higher cost.”

More recently, Dr. Danielle Martin, of Women’s College Hospital, Toronto, has written a book, Better Care, in which she agrees money isn’t the issue.

One of the long-term problems with health care is political opportunism. Political opportunism has cheapened the health conversation. It trivializes the issues around health care to a simple cheque-writing solution rather than making difficult decisions to address long-standing problems. Politicians have talked and campaigned as if they had no memory of what they or their parties did or didn’t do. In part, they can do this because the public memory is short and easily swayed by the headline du jour. U.S. Senator Strom Thurmond said, “If you say something three times in Washington it becomes a fact.” Many Canadian politicians operate on this premise, conveniently forgetting, ignoring or altering facts and history to their purpose.

The latest example of politicizing health care is a television commercial being aired by the Nova Scotia New Democratic Party. The new NDP leader, Gary Burrill, criticizes the current government’s austerity plans and says he believes “… there is a lot we can do. We can invest again in our hospitals, schools …”

The problem with this message is Burrill implies that the current government has done nothing by way of investment in hospital construction. His political message ignores the investments made by the current government in actual hospitals, in collaborative clinics and in realigning of the delivery of care throughout the province. Specifically, this government is mid-way through a major refurbishment and expansion of the Dartmouth General Hospital. Floors that sat unused for 30 years are being brought to use and a surgical tower is being added to the hospital. There is also a $6 million refurbishment underway of the Canso Hospital. Millions went in to the VG’s Centennial Building to repair damage done by flooding. There are more investments coming to the QEII, and a design team have been hired to plan a replacement for the VG. The final design will depend on the other metro medical investments. After 20 years, Valley Regional was given a timeline for a palliative care unit. And the current government is proceeding with plans for a dialysis unit announced by the NDP in 2012. Those are the tangible investments.

The current regime have made announcements for several collaborative care clinics. Now, Health care announcements are always dubious. In 2011, the NDP announced $1.5 million to study the future use and disposition of the VG. As we learned from former Finance Minister Graham Steele that study was to find a more palatable option than the $1 billion solution proposed in a study commissioned by the government before them. The NDP didn’t have the money and didn’t like the optics of such a grand plan, so they resorted to the safety of a study. The results of the study the NDP commissioned weren’t publicly announced, just quietly posted on a backpage on line. The plans, which no one was acting on, where shelved by the 2013 election.

On November 28, 2012, the NDP announced the construction of a new dialysis unit at Valley Regional Hospital. Only after the initial happy headlines was the public told it would be two years before the unit opened. That didn’t happen. Four years later the current government announced construction would start in 2017 and the unit would open in 2019.

Burrill’s suggestion that “we can invest again in our hospitals” ignores that when his party was in office no hospitals were built, refurbished, expanded or planned. The Truro hospital opened in 2012, but that project was done under a previous government and was two years late in opening, so should have had a Tory doing the ribbon cutting. Burrill’s message ignores what is being done now to fortify the bricks and mortar aspect of the health system.

As for doing anything for people, his predecessors reduced the number of teachers in Nova Scotia, cut $15 million in funding to classrooms, took 102 weeks to negotiate 104-week nursing contract, had a short health care strike (it only lasted a matter of hours, but caused months of disruption in scheduled care) and, according to Steele, twice legislated health care workers back to work.

On the subject of senior care, the Advocates for the Care of the Elderly (ACE) complained to the previous government about putting 600 new long-term care beds on hold. These beds were part of the previous government’s initiative for continuing care.

In January 2013 ACE wrote a letter to then Minister of Health David Wilson, which concluded, “In my opinion putting new nursing home beds on hold is placing a huge burden on the shoulders of caregivers without any thought of their well being, all in the name of the almighty dollar. I am beginning to believe that by not creating the new nursing home beds that it is a form of warehousing of the elderly in a hospital setting where they are forced to pay “rent” while waiting for a nursing home bed creating a source of revenue for the hospital. The government, in turn makes cuts to funding, as hospital revenues rise from other sources. This has been evident in the past two years where funding has been cut by hundreds of millions of dollars … Taking all what I have stated into account, it appears that our NDP government is probably the most anti-elderly government we have ever had.”

The two years of cost-cutting were done by the NDP.

Burrill seems like a nice man, but this message is disingenuous and disappointing because we’re back to politics as usual. Power for some, pain for many. Nova Scotians deserve better.

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10 Responses to Stop politicizing health care

  1. ausca says:

    Whether or not this or the previous government did or did not invest in hospital infrastructure is an important but secondary issue IMHO. Of course it’s important, especially given the disgraceful state of the Centennial Building – evidently neglected for a decade or more.

    Blame rests on the shoulders of all parties who have avoided facing scary public health expenses for years. This is especially true in the Maritimes where revenue sources have been declining for many years.

    I also believe it rests with the Federal government who solved their deficit problem under Chretien / Martin by reducing the Federal contribution to the funding of universal public health care from what was once around 50% to barely 20% today, leaving hard-pressed provinces to make up the difference just as revenues decline and young people leave. So IMHO it’s no real surprise that provincial budgets are struggling to deliver timely, quality public health care, not to mention education et. al.

    I was also not impressed by NS Premier McNeil’s breaking ranks in what had been a unified front by all provinces to fend off Trudeau’s continuation of the Harper policy to tie public health care funding to the increase in GDP with a 3% floor. In effect that means we’re about to take a lower rate of increase next year. McNeil seems prepared to take less at a time when elsewhere he insists he cannot fund teachers or home care workers or doctors and (shortly) nurses because he supposedly doesn’t have the money.

    I see a more serious issue than just the money though, and I think you do too.

    Funding increases of 5.2% p.a. or more may well be needed, but until we can reform the way we manage and deliver health and wellness in NS, just tossing more money at it is akin to treating a major internal hemorrhage by just transfusing faster. It just gets us through the current crisis, but the underling problems remain. I believe we may not be using our current funding efficiently.

    I’ve not seen any sign from the three major NS political parties that suggests any of them are serious about reforming the way we manage health care. (To be fair Gary Burrill tells me that “…a long-term plan for health care coherence and sustainability … is at the centre of our thinking…”, so I’ll have to wait until then). Nobody seems terribly concerned about the often unfairly long wait times or it being fiscally sustainable beyond noting the increasing share it takes in successive budgets. The few discussions I’ve had suggests government may well be intimidated by the sheer scale and complexity of it and dread the political repercussions from death and suffering due to failed attempts to fix it.

    One also wonders what sort of advice they can rely upon from their deputy ministers and their departments, if governments come and go like this and nothing ever change beyond putting out individual fires. Somebody who was a country lawyer 4 years ago and has now been appointed minister of health and wellness will likely know little about it and may well be intellectual hostage of the deputy and department. What if their thinking is outdated or they have their own agenda? Shades of “Yes, Minister”.

    That’s why I would like to see a cross-partisan initiative that involves the best and the brightest from all of them (supported by non-partisan experts) in longer term solutions for public health in NS. This would be an ongoing body which would be able to plan over longer terms than 4 year election cycles. Successful policies should attract credit for all parties. If something goes wrong, they might hopefully roll up their sleeves and deal with the matter at hand rather than just snipe at each other for partisan gain. We need a Medicare Party!

    • I think Ministers and Governments are not just held hostage to deputy ministers. In the past the health authority executives have been very effective in harnessing public anger against a Minister or a decision. When the NDP first formed a government they announced a freeze on spending. The health CEOs headed for the cameras and microphones to complain about government cutbacks which would make their work impossible.

      It wasn’t a cutback, it was a freeze for the status quo, but to people used to having cheques constantly written for them, that was a cutback.

      Yes, we should hold politicians’ feet to the fire, but they should be joined by those who oversee the day-to-day operations of the health system and who recommend the short-, medium- and long-term plans. For example, we complain about the state of the VG, but why isn’t everyone mad at the executives, who for 30 years, did noting to fix the problem and who allowed the building to deteriorate? CBC asked the previous six health ministers – Tory, Liberal, NDP – and not one of them had been asked for money for the VG. Let’s share our anger and frustration by including the executives for their on-going failures.

  2. ausca says:

    Correct me if I’m wrong here. Aren’t these health executives responsible for their actions to the DHAs, who in are responsible to the Minister of Health and Wellness who is responsible to the Premier, who is responsible to the electorate?

    If I am correct, what worries me here is that the Minister almost certainly is in charge of an enterprise they cannot fully comprehend. I wonder if any one person does, although some will know their part of it in some detail.

    I guess DH executives exploit that fact when they rush to the media to complain about freezes. This is not only a health issue – I believe we saw it with the Bluenose II restoration debacle and possibly the Yarmouth Ferry saga. Each involved a Minister relying on the advice of their Deputy, who in turn relied on the collective wisdom of their Department (and more frequently these days, hired consultants). Thus the Bluenose II ended up way over budget with a steel rudder and a hogged keel, to be replaced with a wooden rudder some time soon – all the responsibility of ministers who never claimed any knowledge of vintage sailing ship restoration.

    Can the public hold the DHA executives to account without in effect blaming a minister, who may well have been kept in the dark or simply failed to comprehend the byzantine complexities of our public health system?

    If a health Minister cannot reasonably comprehend their portfolio but by default must accept responsibility for it, does that not encourage them to obfuscate, to spin the current state of public health to save their own hide, that of their government and their party in the face of feckless voters who are even more bewildered by public health that they are?

    If that’s remotely true, we have a potentially disastrous lack of public control over a health system supposedly operated for the benefit of the public, don’t we?

    If so, how do we begin to fix that?

    • The health file is so large and so driven by disaster du jour there’s only so much the Minister can focus on in a day. He has a deputy and a department to assist, then the NSHA to oversee day-to-day operations. I think there’s failure all down the chain of command.

      As for neglected properties, NSHA and local authorities are acting like they always have. They ignore property maintenance. Look at the state of the VG. Look at how two floors at Dartmouth General were never finished. Look at Truro. They have had seven years to determine what to do with the old hospital and no one has come up with a plan. That’s after they struck a special committee to act quickly on it – that was three years ago.

      Drive around the province and look at the number of abandoned schools. Over near Walton/Cheverie, there’s a perfectly good, single-story brick school that has been empty for at least a decade. It costs to keep buildings empty. These are public properties and someone should be held accountable. Those in charge won’t do anything themselves, I believe most groups have a quiet plan to let things get so bad they have to be torn down. It’s up to the public to go to a meeting and ask questions or write a letter/email and put it on the record. The other thing we could do is pinpoint a building and ask your MLA (or MP if it’s Federal property) what is to become of it? And if everyone wrote the Auditor General (Michael.Pickup@novascotia.ca) he might investigate and quantify the loss to the public purse.

      If Annapolis Valley Health has opted to waste Pioneer House, then the public should demand it be turned over to a group to help with other social programs. We have homeless people in the Valley – this could help them. Do we know if the women’s shelter is in an overflow situation? Are there charity groups who need office or meeting space? It could have lots of uses.

  3. ausca says:

    If there’s failure all down the chain of command, why would anyone expect a change in government would fix it? No wonder nothing ever really changes, except to get worse.

    Really, this is very serious.

    We are saying the most expensive government program, one upon which lives depend, one which is fiscally unsustainable and yet unresponsive to many patients is ungovernable. Any newly elected government cannot just continue doing what they’ve always done.

    The whole way we manage public health requires radical reform, leading to a carefully considered step wise plan to implement change. That surely requires input from the medical, nursing, related technical professions as well as managers. It probably also involves bringing in outside advice, since the locals have brought us to this state, and may have matters they may prefer not to be aired. I would also guess that it must be removed from the usual political horseplay and short elections cycles by somehow getting all the political parties to buy into a common long term public health plan, being seen to put vital public interests before their own.

    So where do we begin?

    • It’s not ungovernable, it’s just poorly managed by people who are stuck in an old way of doing things. We have a new system, which they are overseeing as if it was just what they did before, but more.

      One doctor told me of attending a meeting which executives said they wanted everyone’s input. Then the executives talked so much that the medical professionals brought in to give their views had not time to speak.

      A Halifax doctor suggested a novel approach to managing health care, which would remove the politics from it. It’s something I am quietly researching.

      • ausca says:

        Glad to hear somebody who knows something about it is on the case.

        I’m not in the healthcare profession nor in government, but it’s obvious this is a looming threat to our fiscal survival, so many people are unhappy with it, it’s always in the top 3 priorities if you ask people on the doorstep and yet neither the government nor opposition parties ever want to discuss it beyond the latest patches here and there (yes, the VG is quite a ‘patch’). Trying to get interest in an election seems a doomed cause. All you hear is well intentioned, vague ideas and partisan sniping.

        Maybe the public has to believe health care has collapsed, or see its monopoly over medically necessary services struck down by the courts before anything gets done. (By then, of course there may be little left to do). I would hope we might be able to begin repairs before the whole edifice falls down.

        We have to get away from stupid partisan games and short election cycles. Can you see any way that oversight of health care could be taken over by a body that included a 3 parties irrespective of which one was in government?

      • I doubt we’ll ever see three-party cooperation because health care is the path to power for them. It’s always been about whoever makes the greatest promise. And the public has fallen for the pick-up line. That has been fortified by health executives who use budget as their excuse for any problem or cock-up.

        Health care gets better when the public focuses their annoyance and disappointment at the feet of the executives, not the politicians. Politicians only write cheques. Executives spend it.

  4. ausca says:

    Governments come and governments go: Tories, NDP, Liberals and almost nothing seems to change in public health and wellness, except perhaps to get worse. However I imagine key civil servants in the Department (indirectly advising incoming ministers) or DHA executives (operating the system) presumably stay for far longer. Is this why nothing ever changes, despite changes in government?

    Is there somewhere a concise list of failings over the years by DHA executives that illustrate your point? (Sounds like it might be a long list).

    How is it possible for an elected minister to rate the effectiveness and competence of these executives?

    How does one recruit such people?

    What is the process for replacing these executives? Is it the Minister’s prerogative, or must it be handled at arm’s length to avoid being seen to politicize DHAs?

    I have no idea how any of this stuff works.

    • The folly is that the public votes for change and gets the status quo. Only the Legislative face of government changes, everyone else remains in their positions. A new government comes in and relies on advice from the professionals – the same professionals who advised the people the new government defeated. Those in-house professionals give the same advice to the new government as a way to protect their reputations and positions.

      As for failure to perform, so what, no one beyond the Minister is held accountable. How can the VG operate for 30 years with toxic water and no one be held accountable? What other building in Canada would be allowed to operate? Health authorities would have closed it. No executive was fired or demoted. Same for all the other long-time, on-going problems with health care. The system has designed itself so there are no consequences for failure. So the Minister of the day wears it for the professionals.

      For a start on the list of failures you’ll have to read through the several hundred articles here.

      We recruit the people who are in charge by designing the job description so only the desired candidate qualities. The hiring process is theatre. And the executives hire from a small group of like-minded, like-trained professionals. They do not encourage new thinking or what we popularly now call ‘disruptors’.

      Their job security comes for public lethargy. The public looks to the Minister to carry all the blame. It’s always down to the belief that more money is the solution to any and every problem in health care. It isn’t, but it’s easier for the public to believe that than pay attention and question – and question the right people. The right people to question are those responsible for day-to-day operation of the system. And for spending the money given them by government.

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