Time to Decentralize Health Care Decision-Making

I am hearing from more and more people that care seems to be a dwindling resource in our health care system compared to a decade ago.   

Despite the $1.3 billion that we spend on the delivery of hospital services every year our city hospitals are stretched to the limit, operating at full capacity with inadequate levels of staffing. Staff are feeling disrespected by the administration. Burn out is a real concern. Those who chose the caring professions are frustrated with a system that gets in the way of good care. Patients suffer.

It doesn’t add up. We have a nursing shortage, but newly minted nursing graduates cannot get permanent full-time work, so they leave the province. Emergency departments are operating at 100 percent capacity without a single ambulance delivering a patient in urgent need of emergency care. Wait times are putting patient safety at risk, but ER’s are not being adequately staffed. Nurse practitioners can’t get sufficient work to keep their licenses, so they are leaving the province. Surgeries get cancelled for lack of beds. Patients are in hallways for lack of beds. And if you need treatment for a mental illness in Fredericton, psychiatrists are a scarce resource, limited by an inadequate number of billing numbers.

Physicians and nurses are venting their frustration in the media, and in letters circulated to MLAs. Patients and family members of patients are doing the same. What could account for this deplorable state of affairs?

The past decade has seen government after government obsessed with what euphemistically is called efficiencies. We have had a fiscally-driven health care system, rather than a patient-centred system of care. As a result, our front-line health care services lack the money they need to meet the demand. On the flip-side of this, nowhere near enough has been done to reduce the demand for health care in the way of health promotion and prevention, an approach that is central to the Green Party’s agenda for health care reform.

The other big change to health care in the past decade was centralization. In 2008, Shawn Graham’s government collapsed four health authorities into one called Horizon. Four others were folded into Vitalité.  The objective was to save money and improve the health of New Brunswickers. Ten years out, the verdict is in. It didn’t work. Centralization has become the problem, not the solution. Nurses are now even scheduled centrally, out of Saint John. A nurse calls in sick in Miramichi, and a decision is taken in Saint John about who to replace them with.  

It’s time to move back in the other direction, creating smaller health districts with local advisory councils. Interestingly, Vitalité never fully consolidated the four health regions it encompasses, leaving some local decision-making authority in each.

A more decentralized system would be better equipped to deliver health promotion and disease prevention, responding to local priorities rather than a one-size fits all approach from a central authority. The New Brunswick Health Council has carried out community health assessments across the province, but the health care system is too centrally organized to make effective use of their findings.

Greens believe that decisions should be made as close to the people who will be affected by them, as is practical, whether it is patients, health professionals or communities.  This means those at the centre of government must be prepared to relinquish some of the power and authority that has been handed them in the rush towards the centralization of decision-making.

Whether it is health care, economic development, or forest management, it is time for a provincial government that is committed to empower our communities and regions to be able to shape their futures.  This is an essential part of the Green vision for New Brunswick.

David Coon is the Leader of the Green Party of New Brunswick and the MLA for Fredericton-South.

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