Canada-NL Health Deal: Warning Signs #nlpoli #cdnpoli

Late Friday evening, the provincial government announced it had signed a deal with the federal government on health funding.

We don't know what the arrangement is on the annual increase in funds but if it looks like what New Brunswick bought into,  Newfoundland and Labrador won;t see anything significant.  Once we've got more details, we'll get back to you on that.

As for the money tagged for home care and mental health,  there will be another $160.7 million over 10 years.  That works out to $16.7 annually. Since we get $738 million annual now from both the Canada Health Transfer and the Canada Social Transfer,  that works out to an annual increase of  zero point two percent (0.2%).  New Brunswick's deal got them zero point three percent (0.3%).

These health transfers will be delivered based on the population.  Since the government's own optimistic forecast has the population shrinking over the next decade, we may well wind up with less money from Ottawa at a time when our demand for health care funding will increase.

-srbp-

HCCSJ operational review a decade later #nlpoli

Talk of financial problems at Eastern Health brought to mind an operational review of the former Health Care Corporation of St. John’s, completed by the Hay Group and released in May 2002.

Go back to the official record of the House of Assembly – Hansard – and you’ll quickly be struck by the similarity between the way the opposition approached the issue then and now.

Consider these comments by Ross Wiseman, the Liberal who crossed the floor to the Tories and later served as health minister:

The union says, once again nurses and other health professionals in this Province are holding their breath to see if their jobs are going to be lost.

Fear of lost jobs. Wiseman asking the minister if he will reject the report.

All too familiar.

Breasts: they’re not just for gawking at

This is important.

66 at 6 in 2: We need to get 66% of new mothers still breastfeeding their newborns at six months and we need to do that within two years of making the commitment.

And if you want to know how far the province has come since 2006, let’s just say that the numbers today likely aren’t remarkably better than they were back then.

If we wait for politicians, nothing will ever get done.

October 1-7 is Breastfeeding Awareness Week.

Don’t just stand there staring.

Lead by example in your own little corner of the universe.

66 at 6 in 2.

- srbp -

The Kings of Cuts

There’s something about Paul Oram that just seems so familiar.

Maybe it’s his similarities to the equally-perfectly coifed predecessor, Lloyd Matthews.

Yes the father of the Premier’s Chief Publicist occupied the health minister’s office until early 1997 when he was hastily shuffled out.  There was a massive revolt against the way government was handling health care. 

Take a second and read the old news releases from those days though, and you’ll find more than a few things that seem oddly familiar.  Stuff like reviewing health care in central Newfoundland with an eye to what could get “improved”:

Health Minister Lloyd Matthews will take the next 6-8 weeks to fully evaluate and consider the recommendations of the report into health services in Central Newfoundland. KPMG Management Consultants recently presented the final report to the minister following four months of consultation with individuals and organizations throughout the region.

"This review is a comprehensive analysis of current and future health needs for the entire Central Newfoundland region," said Mr. Matthews. "The report looks at the network of primary, secondary, chronic and community based care, and makes recommendations on how these services can be better organized and coordinated to meet existing health needs and to reflect the emerging health needs of residents in the region."

The minister stated he would now be presenting this report to Cabinet for consideration. "Once government has had an opportunity to consider the full report, I will be able to provide further details on health services contained in the report, as well as outline future directions for health services in Central Newfoundland," said Matthews.

The minister thanked all individuals who made presentations or submissions to the consultants during the period of review, for their interest in health service delivery.

Matthews released the review in March, 1997, after announcing it had been received in early January.  The project started the previous June.   It recommended a number of things, including renovations to North Haven Manor in Lewisporte to ensure it could provide service out to 2005.

There are a lot of things in Matthews’ ministerial past that seem oddly familiar to the current generation, as well as a few surprising differences.

Matthews didn’t have much money to play with either as minister or as a member of cabinet generally.  Paul Oram and his cabinet colleagues  - by stark contrast - have access to more cash than any cabinet in the province’s history.

Oram talks about health care cuts.

Matthews’ review of health care in central Newfoundland could note that since the creation of new health care boards (re-organized out of existence by Oram’s clan), day surgery had increased by 70% in Gander. Note, for example, the reference to demographic projections for 2005.

There’s a sense of planning and organization to the whole thing.  The re-organization started with a view to changing how health care money was spent so more could be pushed toward front-line service.   It may not have worked out exactly as intended, but there was a long-range goal based on the knowledge that by 2005ish, the population would be pretty much where it actually turned out to be.  That brought with it certain predictable consequences and government worked to organize a system that could provide needed care within the budget likely to exist.

Sometimes, the differences are startling.  Back in the 1990s, the health minister could commission a report, get it and then release it within six weeks.  When was the last time Oram and his colleagues managed to get a report on the street within six months of getting it in hand? 

Compare as well, Matthews’ language to that used in the past 48 hours or so.  The emphasis on changes in the 1990s was ensuring that the government could continue to meet health care needs despite limited funds and what was anticipated to be skyrocketing demand. 

There’s a decidedly less positive sound to the way Oram put it:

“Our government faces a difficult decision to make regarding the types of services we can offer in the long-term, how much we can continue to invest as a province and identifying how we can improve the quality in our programs and services across the province.”

Still through it all there are some common threads, ones that transcend the superficial nonsense Oram got on with the other day by referring to cuts in the 1990s. 

He might do well to check with some of his predecessors, people who had a real hard time running the department but who managed to get through it with their reputation intact.  Roger Grimes would likely give him a good pile of advice. So too would Herb Kitchen or Julie Bettney.   Lloyd Matthews wouldn’t:  if memory serves, he got into political hot water largely due to the way he presented himself publicly.

How Oram handles himself might determine who really gets remembers as being the Kings of Cuts: Danny Williams and his crew or the guy Danny used to call the King of Cuts.

-srbp-

Questions in search of answers

Just a few observations on announcements from the province’s health ministry lately.

1.  labradore points out that others – like the local news media -  are noticing the odd but telling similarity between the Lewisporte cuts announcement and the one from Eastern Health about breast cancer back in April.

So much for the story then and now that it was all up to the local health authority.

2.  During Cameron, every senior government witness insisted that all the decisions were made by the people at the health authority because that’s what they do; ministers of health and cabinet did not get involved in operational issues.

Like say, deciding whether to shut down laboratory and x-ray services.

Who decided on an operational issue in the Lewisporte case?

Hint:  it wasn’t the regional health authorities.  They found out about the cut the morning it was announced.

3.  And how many times will a cabinet minister refer to the recommendations of the Cameron Inquiry in trying to justify the operational decision made in Lewisporte?

4.  Then there’s the claim by no less a personage than the Premier that the cuts came from the health authorities and that it was aimed at improving the system.

He claims the health authority made a recommendation “to us” for services that should be cut.

He leaves out the important bit, of course, that the health authority didn’t come up with this idea on their own.   They suggested cuts  only when prompted by a request from the health department to suggest cuts in the first place.

And the cuts had nothing to do with either offsetting the cost of the health centre in Lewisporte (as the Friday release claims) or “improving” the system.

That’s plain from the letters released by government late on Friday.

But don’t take my word for it:  Read them for yourself.

5.  And since we are in the questioning mood:  why would a provincial government that is evidently flush with billions in loose change ask for recommendations on what to cut from health budgets in the first place, especially when the sum finally settled on by  - whom?  cabinet, the Premier, definitely Paul Oram – was such a measly, miserable amount?

And that’s based on nothing more than the general political principle that you just don’t go out and randomly shoot off a body part when you don’t need to. 

Cuts make people upset.

Cuts to health care make lots of people really upset.

Burn ‘em at the stake kinda upset.

And they don’t get un-upset easily.

Un-upsetting them will be costly either in blood and/or treasure:  cash or in political strips taken off someone’s hide.

Therefore, as the political wisdom would suggest:  do NOT cut health care unless it is absolutely necessary.

So why in the name of all that is political and therefore unholy would any cabinet in its right mind ask health regions to recommend a list of slashes, some of them valued at upwards of a million bucks.

6.   When did they make the decisions?  Observers of government will note the date on the letters released on Friday is from early 2009, well into the budget cycle and long after decisions would normally be made.  People will start asking hard questions about when all this was decided. Evidently it wasn’t in August.

7.  There is no plan. And when all that is done, ask yourself why a government department would release letters that show their initial talking points were more composed at the Mad hatter’s tea party?

Usually you release evidence that backs your claim, not further hints that – contrary to the Premier’s claims at the bored of trayed last week - people in the departments of government have no idea what they are doing.

-srbp-

Winston Smith: on health care

Shame this guy – we all assume he’s a male writing under a pseudonym – feels so constrained in sharing his views.

But there is a Parkway-sized pothole on the road to separatist health policy: it's a provincial jurisdiction. The many failures of health care in NL cannot be pinned on Ottawa. If the separatists criticized the running of health care, they would have to criticize DW, whose government has been running it for six years.

-srbp-

Tilley pulls pin

George Tilley resigned today as president and chief executive officer of Eastern Health authority, based in St. John's.

He will be replaced temporarily by Louise Jones, formerly the chief operating officer for acute care facilities in the St. John's area.

-srbp-

Government promises accounting in cancer scandal

Premier Danny Williams said Thursday his administration had a "moral responsibility" to investigate whether patient health was compromised in the way a regional health authority in the province responded to news that certain breast cancer screening tests had produced incorrect results.

Upwards of 300 women were steered away from access to the drug Temoxafen, based on the results of faulty hormone receptor tests.

Former health minister Tom Osborne, now the province's justice minister, admitted he was briefed on the scope of the problem in December 2006.

At the time, health authorities only publicly disclosed changes in treatment to over a hundred women. Information that tests were incorrect for almost three times that number of women was not made public until this week, as a result of inquires for lawyers representing some of the women.

CBC reported Thursday that:

...Health Minister Ross Wiseman told the legislature Thursday that Eastern Health — which is largely funded by government, but operates at arm's length — was aware of the inaccurate test results more than a year ago.

However, he said, government officials were not notified until last August, and that the then health minister was not personally briefed until three months after that, in late November.

Health Minister Ross Wiseman said Eastern Health has known for more than a year about the error rate of hormone receptor testing.Health Minister Ross Wiseman said Eastern Health has known for more than a year about the error rate of hormone receptor testing.
(CBC)

Court documents reported earlier this week by CBC News showed an error rate of 42 per cent in a large set of samples, several times higher than a public estimates.

Wiseman said Eastern Health still may not know what went wrong with hormone receptor tests done between 1997 and 2005.

In the House of Assembly, Wiseman said that the health authority became away of a problem with testing in May 2005 and began a review of tests and procedures.

There was no explanation for the delays in briefing the health minister in 2006 or why the provincial health department concurred with legal advice that appears to have recommended partial disclosure of information.

The premier told the legislature today that his administration would conduct a thorough review of the matter bearing in mind the issues of liability and confidentiality.

-srbp-