Premier’s ‘innovative thinking’ won’t improve health care

It is a political truism: there is no better time to do something controversial than on a lazy Friday afternoon, especially if it falls in the middle of another pandemic summer, marked by war, inflation, and ongoing reminders of the climate emergency.

Taking advantage of the tragic death of a man who waited for hours in ER without getting help, Premier Blaine Higgs announced July 15th some important changes to the Vitalité and Horizon Regional Health Authorities (RHAs), firing respected Horizon CEO Dr. John Dornan and replacing the elected boards of the two RHAs with political operatives directly responsible to the premier.

Any mention of the ongoing pandemic’s effect on the health care system and the growing burden of long COVID patients was strictly off the table as a rationale for the changes.

Premier Higgs is a firm believer in “innovative thinking” and consistently uses management jargon to describe ways to lead the provincial government so that it continues to function more or less adequately to the public’s needs while cutting expenses, especially on public sector workers.

The premier’s strategy for dealing with hospital wait times and staff shortages draw heavily on his belief in management’s ability to solve problems by moving bodies around. As he told CBC’s Khalil Akhtar on Information Morning July 18th: 

“I would like to see someone in every hospital that owns the activity in every hospital. Right from the emergency door, the admission door, right through to their release, and the timeline that they need to be in for based on the seriousness of what they are in for, is clear, and doctors adhere to that, there is someone that’s controlling it, so you don’t have someone just come in, they don’t know when they are going to leave, they don’t know when they are going to be committed, they don’t know when they are going to be triaged, we have a process…”

While the Premier’s approach is entirely process-driven, health care professionals have been saying for years that the province needs to do more to recruit doctors and train nurses—which successive governments, including the Higgs Conservatives, have failed to do.

More funding for health care systems is not in the cards, despite surpluses totalling more than $900 million over the last two fiscal years.

“Funding by itself will not solve the problem,” the Premier said, “we tried throwing money at the problem and it didn’t work.”

However, as the New Brunswick Medical Society points out, New Brunswick makes do with the lowest per capita and per patient expenditure in Atlantic Canada. 

Doctors have been drawing attention to the lack of resources for decades, as Liberal and Conservative governments prioritized tax cuts and balanced budgets above investing in health care infrastructure and staffing levels.

Instead of improved funding, Higgs wants to apply statistics and force hospitals to improve their metrics. But these stats will also make hospitals more comparable amongst one another, facilitating ranking and privatization of services. Moreover, metrics and rankings—already common in the university sector—take time and resources to compute. In short, it expands managerialism, with no guarantee that the beans being counted will actually improve care.

The changes at the top come in the midst of a seventh wave of a seemingly unstoppable COVID-19 pandemic that continues to wreck the province’s hospitals and emergency room capacity.

Over the last six months, hundreds of health care workers have had to isolate at any given time due to COVID-19 infection or exposure, reducing hospital capacity. Other health care workers have left the profession—a wave of retirements that was predicted by the NB Nurses Union years ago. 

In order to keep more health care workers on the job, the Health Department changed isolation requirements, reducing the amount of time workers had to isolate. But that meant some workers may have returned to work while still contagious.

Whatever management improvements can be made by consolidating health care decisions, Friday’s announcement does little to address the province’s rampant COVID transmission, which the government’s libertarian, “survival of the fittest” approach has only made worse.

The government has no intention of bringing back an indoor mask mandate, nor of requiring people infected to isolate at all. Premier Higgs has gone full Bolsonaro on the pandemic, with so much still unknown about how the virus interacts with our immune systems, and whether an “immunity wall” will ever enable the virus to become “endemic” (for a primer, see here and here).

More important for the Conservative Party agenda is the eventual fusion of Horizon and Vitalité RHAs, a long-term goal of Premier Higgs, which is deeply unpopular with francophones in the province’s North, but which will help consolidate his party’s base on the anti-Acadian right of New Brunswick politics.

The Conservative fusion with the People’s Alliance last winter appeals to the belief among some anglophone New Brunswickers that the province’s “dual” health care system is at the root of health care inefficiencies. 

Of course, in a system starved of resources, even the meager (if any) gains that might be made in this regard (and at what cost?) appear enticing to a manager’s ambition of rationalizing service delivery. But fusing the RHAs will not help hire more nurses. 

As a bellwether of where the province is going in the denialist phase of the pandemic, it seems health care reform has left huge elephants in the room. Given attrition of staff, and closing of ERs, the New Brunswick government’s “innovative thinking” on the pandemic may actually enable us to save health care costs this year.

But in no way does that mean better care for New Brunswickers.

Matthew Hayes is a professor of sociology at St. Thomas University and an editorial board member of the NB Media Co-op.