A12

Stephen Campbell

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Of all the issues affecting the goal of self-sufficiency, there is nothing more critical than the delivery of health care. It is New Brunswick's largest government expense, and at current growth rates will consume 50 per cent of the provincial budget within 10 years. Despite millions of dollars being thrown at the system, wait times are long, emergency rooms are overcrowded, and a chronic shortage of medical staff persists.

I spoke to numerous health professionals. I asked for an assessment of the current state of affairs and recommendations on improving the system. Virtually all those I interviewed described the current status as a crisis.

The myth is that we have one of the best health-care systems in the world. In a study released this year by the Health Consumer Powerhouse, the Canadian system was compared to 29 European countries. We ranked 23rd, alongside countries such as Slovenia, Romania and Lithuania. In the category of value for money, we were ranked 30 out of 30. Within Canada, New Brunswick is ranked near the bottom on many key benchmarks.

We have more than 100 doctor vacancies, a huge nursing shortage, and no catastrophic drug plan. There is only one vascular surgeon to service the entire province, and the government can't even say what a simple blood test costs. With the shortage of physicians, the fact we are the only province enforcing a billing cap is moot. What we do seem to have, is catastrophic leadership.

Pandering to regional politics, the Liberals promised in the last election to keep a number of hospitals open. Although local politics shouldn't trump the provincial need for effective and sustainable health care, all too often it does. They played this card, and it worked.

A city with a population of 750,000 would normally have three, maybe four hospitals. On that same population base, we are supporting 24. That's a hospital for every 31,000 people. This also does not include the other facilities maintained by the province, such as community health centers. In Regional Health Authority B, New Brunswick maintains a total of 49 health-care facilities for a population base of 600,000. In that same region, we currently have a shortage of 210 nurses, which is projected to grow to 450 by 2014.

The government is spending millions to maintain, heat, and service physical premises, which we cannot adequately staff with health-care workers. What good is funding a facility, if patients can't get proper treatment?

With great fanfare, the government announced it was reducing the number of regional health authorities from eight to two. I have heard from people in the system that it has made little difference, except that we have introduced another layer of bureaucracy.

In theory, the decision to reduce the number of health authorities makes some sense if you can achieve greater operational efficiencies. In this case, however, the plan has turned out to be a fiasco. For starters, it introduced the ugly topic of duality, and has led to unhappiness within both linguistic communities.

These concerns seemed to be confirmed in the controversy surrounding the implementation of a provincial trauma system. Dr. Andrew Trenholm, a New Brunswicker from Riverview, was strongly endorsed by health professionals to lead the provincial trauma team. Trenholm was, by all accounts, bilingual. Yet, despite his overwhelming credentials, the government chose to not acknowledge his application, expanded the search, and raised the French language qualifications after the job had been posted. In the end, Trenholm withdrew his name, and the government ended up hiring a 65-year-old doctor from Quebec.

Many also complain about the government's confrontational style and the slow pace of reform. On style, one only has to look at the results of negotiations with the doctors. They signed a tentative agreement in December 2008, and as late as March still thought they had an agreement. Legislating a freeze on the wages of doctors followed soon after. There is already an acute shortage of qualified ER doctors, and this move has only compounded problems at New Brunswick's sole tertiary care facility.

An area where real efficiencies could be realized is in the enhancement of e-health. Yet we are years away from achieving any meaningful progress. A simple thing like having a universal system of drug monitoring is still not implemented, despite the Department of Health having a director designated to achieve this for more than a year. Ironically, right now there are New Brunswick companies implementing paperless e-health systems in Third World countries. Belize, for example, now has electronic health records which contain a patient's medical background, treatment history and health status, from birth to death - all thanks to a technology company based in Fredericton.

Even in areas where the government has boasted of achievement, there are serious issues of credibility. Not long ago, the previous minister of health proudly announced wait times had been reduced by 65 per cent. Nobody I have spoken to believes that. They tell me the only way this could have been calculated, is if the government assigns a specific date for a procedure, and then removes the patient from the list. The patient's date could be eight months away, but according to this method, the delay would no longer be classified as waiting. I challenge the new minister of health, Mary Schryer, to come clean on how wait times are calculated.

The people of this province must demand that politicians raise the debate to a higher level, with the foremost question being what serves patients best. This has to occur in an atmosphere of trust and competence, something the current government is sorely lacking.

Business as usual is no longer an option. Delivering a sustainable health care system, one that puts patients first, requires both leadership and a plan. Sadly, we seem to have neither.

Stephen Campbell is a freelance columnist based in Saint John. He can be reached at telegraph.Campbell@gmail.com. His column appears on Saturday.