Today’s editorial is the third of five on the main issues confronting Premier Christy Clark and her new B.C. Liberal government. Last Sunday, we looked at energy policy. Today, health care is the focus.
Clark and the Liberals are getting what few politicians in office ever get — a second chance. And rarely was a government more in need of one, especially when it comes to health care.
From the outside at least, it appears as if our public health service revolves around two solitudes. On one side of the gulf, the line agencies which actually deliver medical care are doing a first-class job.
Our hospitals have 25 per cent less overhead than the national average, yet their mortality rates are second best in Canada. Our cancer program gets as good results as any in the world.
B.C.’s population has the best health status in Canada, yet only Quebec among the provinces spends less on health service delivery.
There are indeed areas that need closer attention. Our mental health program is inadequate by almost every measure. And far more attention should be paid to home care for the frail elderly.
Yet the people who manage and deliver our health service are doing what they should: providing generally high quality care at an affordable price.
On the other side of gulf, the central agency responsible for planning and funding — the provincial health ministry — is in dire straits. Most of the reason is political.
The Liberals have spent years trying to stifle independent drug research in B.C. Last summer, amid allegations that patient medical files had been mishandled, the government terminated all funding to arm’s length drug researchers, and fired most of the in-house staff involved.
There may indeed have been carelessness on the part of some employees, though none of the allegations has been proved. But by intervening so crassly in a field that should be free of political interference, the government has brought vital research projects to a grinding halt.
There are also major internal challenges. Over the last two decades, the ministry’s staff complement declined from 5,000, to 1,300, as services were devolved to regional health authorities.
That contributed to the gulf between the centre and the field, as most in-house program managers left, and took their expertise with them.
The ministry is now trying to reshape itself around a planning mandate. But without the day-to-day feedback that comes with actually running services, the “centre” can easily become a cocoon.
The dangers of such a model have been shown in other jurisdictions. Targets are set for care providers that cannot safely be met. Process is given more weight than outcomes.
Some local examples: Hospitals on Vancouver Island are being offered $100 for every low-risk patient they move through the emergency ward in less than two hours. Bonus money is paid for increasing throughput in operating theatres and diagnostic imaging facilities.
Time, of course, is money. Yet the real question is whether patients are better off after receiving treatment.
Despite its reduced size, the ministry still retains a core of dedicated managers and program specialists. If given a chance, they will make the necessary adjustments.
And that is the challenge facing the premier and her colleagues — to give the public service a chance. In the simplest of terms, the government must stop using the ministry as a weapon in its ideological or political crusades.
Relationships with the research community must be rebuilt. The atmosphere of crisis must be ended. The issue here is not management or funding, but one of stewardship and trust.
Whether the premier and her colleagues understand this will soon enough be seen. But a beaten and downtrodden health ministry doesn’t have to be Clark’s legacy.
She has a second chance. Hopefully she will use it.
