McGEORGE: Fixing health care, four years later

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“If you don’t know where you are going, any old road will do”, so says the oft-quoted quip from Lewis Carroll. I have attended many planning and strategy sessions in which that was used to get the audience to focus on clarity of vision and plans.

David Duplisea, the retiring CEO of the Saint John Region Chamber of Commerce, said it well in his Brunswick News article on Saturday, Oct. 28. Commenting on the lack of a visible plan for critical issues in the province, of which he named health as one important one, he said: “It’s time to put the cards on the table.”

His article went on to observe the great successes of fiscal prudence with surpluses and paying down debt, while issues of health care and others continue to dog our society and economy with no apparent plan.

In the same edition, commentator Dr. Linda LeBlanc, a prominent medical specialist in the field of cancer treatment showed clearly, with her interprovincial comparisons, how New Brunswick’s health system issues have more to do with leadership, vision and direction than with resources.

Analyzing her observations and applying them to the issues in New Brunswick, it is safe to conclude that fixing those awful issues is not so much about adding more money to the pot, but making intelligent and skilful use of what already exists.

There are many professionals in the health system, medical, administrative, diagnostic and nursing fields who can express problems and symptoms of issues. But few who take the time or have the ability to get beneath the surface to determine the difference between symptoms and underlying causes.

Then along came not one, but 12 respected medical specialists in the Fredericton region who decried, in a public letter, the lack of an apparent plan for reform. It takes a lot of time and resources to recruit and retain quality specialists, and their frustration seems well-founded in that there seems to be no known or apparent plan for the orderly reform of health care in New Brunswick.

If the Chalmers hospital in Fredericton is not in line for a hybrid surgical suite, why not? Was that a decision taken in the context of planning the array of surgical services in the province? In a normal planning process, this would have been part of the decision-making at the time of planning the major expansion at Chalmers.

Based on what was reported in their letter, I would wholeheartedly agree with the angst of the doctors. Key players must be involved in such decisions, not surprised by them.

What is concerning to outstanding physicians such as these, and others, is living with the unknown. The need for reforms and upgrades has been evident for a long time. The announcement of health reform being a priority set people’s expectations, four years ago, of a planning process that would engage the outstanding people who are left to perform services long after the ribbon cutting and the photo-ops.

That we have long waits in emergency departments, up to 40 per cent of all acute care beds occupied by people who should not be there, thousands of people without access to appropriate primary care (they often refer to it as “have no doctor”), inordinately long wait times for essential surgery are all known and have been documented, written about, complained about. And the only thing the public has heard, or those few who heard it on the news for a fleeting moment, is that the health authorities have new board members.

No talk of vision, goals, strategy, timeline. In short, no hope for those who need hope.

Accountants and many who seek to make improvements to essential public services always start with the assumption that there will be huge dollar cost additions associated with what is being proposed. That is the public service mentality and has been for generations. Have a new idea? Give us 50 more staff and we will fix it!

But it doesn’t have to be that way, nor should it be that way. The public service is good at what it does, which is to regulate and to manage the legislative process. As Dr. LeBlanc points out, haphazard fixes to create a photo-op or deflect a headline are usually quite ineffective and rob New Brunswickers of quality care.

What is aggravating to great professionals like her, and to informed people with experience in transformation, is to see the waste of time, money and energy in tilting at windmills when a serious focus on intelligently managing resources could yield results in fairly short order.

Dr. LeBlanc suggests an Ombud as an independent person with some authority to expose and influence some important issues. I would go a step further to propose that, as stated in my last commentary, neither the health authorities nor the government can do what needs to be done by themselves to “right the ship.” Some new thinking that comes from experience and knowledge, as well as experience with reform and restructuring, must be brought to the table for the purpose of instituting strategies that will have results in real time.

Our population has been waiting with bated breath for four years.

Dr. Michael Gardham, Associate Professor of Medicine at the University of Toronto, published a thorough analysis in the November 2023 Health Management Forum. As he traced the evolution of the health-care system in Canada, he outlined how the costs of pharmaceuticals and all that goes into health care have skyrocketed, despite the fact that conventional local volunteer boards have been largely replaced by governance creations, put in their place ostensibly to provide “better governance” over a system thought to be spiraling out of control. The issues have not been improving with more government intervention; in fact, they have been getting worse.

General Dwight D. Eisenhower said: “No battle was ever won according to a plan, but no battle was ever won without one.” Health and long-term care reform is a battle; New Brunswickers are, in fact, suffering, the worst being the seniors. It seems that so many who deliver care are asking: “What’s the plan, General?”

Ken McGeorge is a retired career health-care CEO, part-time consultant and columnist with Brunswick News. He is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook.com or kenmcgeorge.com.