15 October 2009

If only they’d read their briefing materials…

While health minister Jerome Kennedy busily backs off decisions he took only a few weeks ago on health care, there is something obviously haphazard and chaotic about the way the current administration is approaching virtually everything they do.

Your humble e-scribbler has noted this before in other policy areas. Equalization is the most obvious subject and, as it turned out, that was a post that was extremely popular.

But in the case of health care, word of the on-again and possibly off-again review of some services makes one want to turn back the clock to 2002.

That’s the year a provincial government with no cash to speak of - and certainly far less than the billion dollar surpluses Jerome! and his buddies have turned up – laid down a simple set of practical guides to health care delivery across the province.

Healthier Together (2002) was touted as a strategic health plan for Newfoundland and Labrador. It’s still available on the health department website. Read together Along with regional profiles produced the following year, you get a very good picture of the health issues in each part of the province and the solutions needed.

If you want to get a sense of how the document could help the government of today, take a look at the section on the organization of the health care regional authorities:

Newfoundland and Labrador is a large geographic area with a highly dispersed population where regions often have different circumstances and needs. This is partly the reason why the province has 14 health care boards.

It is not possible to compare the diversity of this province to the relative uniformity of Winnipeg or Edmonton, where populations which exceed that of Newfoundland and Labrador are serviced by a single health authority. However, if the number of health boards in this province create barriers to proper patient care, then re-examination is needed.

One of the problems both the Premier and the current health minister pointed to was a lack of accurate information they had when making decisions.

Well, the 2002 approach affirmed that decision-making authority on delivery of service belonged to the regions, not to people far removed from where the service was delivered. It also noted that the number of boards allowed gave a system that could take into account the local issues that could get lost in a larger system.

But when you turn to the section on where services would be located, there’s a simple model for health care that could work very easily today. After all, this thing was drafted only seven years and and, as it notes, the health care system currently in place goes back 20 and more years:

Primary health care sites will be the common denominator of service for the whole province. These sites will provide a cluster or network of basic services, plus public health and social services consistent with the mandates of the health and community service boards. Each site will serve a defined geographical region designed to ensure the right number of health professionals to service the population. For example, a minimum of five family physicians will be needed in a primary service site so that coverage can be provided 24 hours-a-day, seven days-a-week. Therefore, a region should contain no less than 6,000 people and the site should be located so that 95 per cent of the population within that region are within 60 minutes driving time to the site. Depending on the geographic shape of a region or the remoteness of some communities, additional facilities may be located outside the main primary health care site to be serviced by a small complement of staff or by providers who make routine visits to the area.

Doesn’t that sound just a wee bit like Lewisporte?

All this makes you wonder if the turn-over at the senior levels in the current administration has served to rob the government of much-needed corporate memory, the kind of memory that would serve a cabinet well in tough economic times.

That turn-over didn’t come as a result of retirements and normal job changes-over. Rather there seems to be some other force at work producing a parade of ministers in some departments and the ping-ponging of others (finance and justice) while at the public service level there is an equally high level of change. All of it must surely make it very hard to implement a coherent and sustained set of policies over time.

And when people making decisions don’t have a clue about what happened relatively recently or when it is official policy to denigrate everything that occurred before October 2003, it makes the job of running government all that much more difficult.