A tale of two health authorities; what’s the best way forward for healthcare in New Brunswick?

NEW BRUNSWICK – Dorothy Shephard says merging New Brunswick’s two regional health authorities is no prescription for what ails the province’s health-care system.

The possibility, long pushed by the People’s Alliance leader Kris Austin, isn’t on the table as the majority Progressive Conservative government puts together a five-year plan for the two authorities, the province’s health minister told the Courier.

“It’s not something we’re considering,” said Shephard. “What’s we’d like to do is have a heightened sense of collaboration between the RHAs (regional health authorities). That’s the direction we’re going in.”

Asked if her party has done an analysis of the pros and cons of combining anglophone-managed Horizon Health Network and francophone-managed Vitalité Health Network, Shephard said, “The last thing we need is to be distracted with other people’s agendas.”

An annual savings of $40 million to $60 million is the figure that’s been bandied about over the years, but merger skeptics say the estimate is overblown and a minuscule amount compared to the province’s ballooning overall health-care budget of roughly $3 billion.

Austin said his party hasn’t conducted any research or contacted consultants to get a sense of the possible cost-savings. “I don’t think the government even knows how much it would be,” he said. “They say it’s minimal, but I find that hard to believe. Anytime you run two, it’s going to cost more than one…We don’t have two Department of Transportation’s.”

Just as important as cost savings, which he characterizes as low-hanging fruit, Austin said combining the authorities would eliminate competition between Horizon and Vitalite for doctors, nurses, equipment and supplies and provide uniform care in the province. “There’s an opportunity here for taking the good parts of both health authorities and seeing (them) used throughout one provincial health authority,” he said.

“The fact is that New Brunswick is determined to have these dual health authorities just based solely on language,” said Austin. “There is no other reason for it. Back when they had eight health authorities, the report clearly stated it should go from eight to one. But the government decided to go with two with a linguistic makeup.”

Green Party leader David Coon is opposed to a merger, saying a combination would further centralize management of a healthcare system that’s already too centralized.

“The centralization that’s already occurred has not, in many ways, been positive,” he said. “We need to decentralize decision-making in healthcare, so that it actually reflects the needs for health services for people in the communities where they live.”

Retired hospital CEO turned health administration consultant Ken McGeorge said the consolidation from eight to two health authorities in 2008 hasn’t fixed any of the long-standing problems, including a shortage of primary care physicians, backlogs for surgeries and specialist care, long waits in emergency rooms, shortcomings for long-term care, and growing costs.

“I know it’s politically sexy for some people to think that if we just get rid of the two health authorities and have one big one and get rid of the linguistic divide then everything will be fine,” “Rearranging the chairs on the deck of the Titanic makes not a whit of difference in the things New Brunswickers care about.”

McGeorge said combining the two authorities would be a distraction and likely wouldn’t deliver much in short-term savings, particularly by the time merger fees and expenses were factored in. He said a merger could cost at least $10 million and take two years to implement.

“The real issue is what will it take to create the health system that we need and deserve in this province,” he said. “One problem with the authorities is not that we have two, one French and one English, it’s that neither is organized structurally for success.”

The board chairs and the CEOs are appointed by government, creating the potential for them to be unnecessarily political, said McGeorge. “If a board doesn’t have the authority to hire, fire and manage the performance of the CEO, then the board has nothing. Why have a board at all?”

McGeorge also criticizes the previous consolidation of health authorities for taking the most basic decisions out of the hands of hospitals. Now decisions are often vetted in Miramichi, the home for Horizon, which is responsible for the province’s southeast English-language hospitals, or Bathurst, the home of Vitalité, which oversees northern New Brunswick’s French-language hospitals.

Premier Blaine Higgs appeared in favour of combining the authorities when he was finance minister between 2010 and 2014. In a televised CBC roundtable discussion with other political party members, including Austin, Higgs said the combination was recommended at the time of the eight-to-two consolidation and made sense operationally, but wouldn’t past muster politically.

His attempt at health-care reform last year blew-up in his face after six rural hospitals were blindsided with a cost-savings plan to shut overnight emergency services.

Higgs now has a new strategy to try and implement reforms. Shephard has embarked on a listening tour – virtually because of the COVID-19 pandemic – to get input from communities around the province to develop a five-year plan for healthcare.

Shephard said closing rural ERs or reducing their hours won’t be part of any five-year plan.

“I’ve made it very clear in my engagement sessions that there isn’t a defined plan here yet,” she said.

Her engagement sessions are expected to wrap up in mid-April and she hopes to have a health plan for the government to endorse and deliver to the health authorities to implement within a month or two. “I’d like to see us getting on a real trajectory,” she said.

McGeorge said he’s encouraged that Shephard “seems sincere” and is looking for “a rural health strategy.”

“The lesson they learned is you don’t go into these rural communities and take them by surprise, unless you have the doctors and the nurses who are supplying the care onside with your plan,” he said. “Invest the time and the energy it takes and then it will go down well with the local community.

“Forget about going into these small communities and carving and chopping and transforming beds. Don’t use that language,” he said. “Understand that you can’t use urban health care organization methods in Plaster Rock or in St. Stephen. It’s different.”

McGeorge said he still “the scars to show” from the first half of the 1990s when he helped then Premier Frank McKenna try and sell small communities and their doctors on a massive overhaul and restructuring of the hospital system.

“People were really upset about healthcare, and McKenna risked losing his seat,” he said. “Every government after that has been very timid about what they do with healthcare. The easiest thing to do is play with the boards and health authorities. The public doesn’t care about that.”

McGeorge said better fixes than band aids can be found to fix New Brunswick’s health-care system and its escalating costs as the population ages.

He said the rural hospital in Red Lake, seven hours north of Thunder Bay, Ont., that he led for five years delivered better healthcare than downtown Fredericton.

“With a small population of 10,000, there’s no way we could afford to pay doctors to wait around in emergency,” he recalls. “So we put them on a call roster and we had nurses who were on duty with sufficient training to do the first-contact care. It worked like a charm. We were in mining, logging and fishing, so we had some pretty brutal accidents that didn’t happen from 9 to 5.”

Hospitals in Sussex, St. Stephen and other small communities could seek out similar strategies, he said. “In Ontario, the rural strategy was to get doctors away from the conventional fee for service. That’s the holy grail.”

Janet Whitman