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JIM VIBERT: Bureaucrats need to come clean or fail on health reform

Published on July 20, 2017

There’s something wrong with the system. That’s where unanimous agreement on health care starts and stalls.

Take the start, leave the stall.

The government, health bureaucrats, the medical community, caregivers, patients and potential patients agree. It has to change. The big, troublesome, devilish details — what, how, when, and sometimes who and where — are in dispute.

Take it a step further. Most folks concede that cost control is vital, while the quality of and access to care must improve. Which element of that compound deserves more emphasis splits opinion again. Never mind. There is broad consensus that each is a component of success.

Here’s the thing: System survival depends on sweeping and successful reform. It has to be done without undue disruption to day-to-day operations. Like the blues, it don’t come easy.

There is a surefire road to failure and the Nova Scotia Health Authority is on it. Defeat and chaos are certain unless the health bureaucracies come clean.

Some folks at the health department actually get that.

Leadership at the NSHA tortures us with a mix of messages, from “don’t worry, be happy” to the more muted “you can’t handle the truth.” It’s your choice whether being patronized or disrespected is more cloying.

Conversely, top staffers at the department are stepping up and out. In interviews this week they acknowledge reform is a fragile work-in-progress, complete with road hazards, high hurdles, certain and legitimate frustrations, but progress nevertheless.

Refreshing candour and unvarnished truth, respecting that Nova Scotians as owners and users of the system have the inherent right to know the big picture, the troublesome details, and everything about their personal health, earns them the credibility to move to proposed solutions.

Last week a key component of the integration and use of information technology as an enhancement to care suffered a major setback. One of its pioneering users and champions said she had to disconnect from MyhealthNS because of its inordinate expense and demands on time.

Two senior departmental officials with unruly titles but well-cultivated outlooks on health care’s future didn’t default to the usual, circular government talking points to address the setback. The decision of Dr. Ajantha Jayabarathan (Dr. A.J.) was the most predictable topic on the table but there was no attempt to spin it away.

Senior executive director, investment and decision support Christine Grimm and Angela Purcell, director, fee for service and master agreement, were disappointed but understood A.J.’s decision. Nor did they dispute the need for improvements to MyhealthNS.

Nothing less than changes to the doctors’ fee structure — one of the system’s tougher needles to thread — can correct the deficiencies that Dr. A.J. identified. Officials in the health department, even senior ones, can’t get that done so they can’t say if the flaws that forced A.J. to withdraw can be corrected. However, they did reveal the road map to make that happen, suggesting there is a plan to try.

These are troublesome details alluded to above. They are manageable, but exist within the context of complex and competing interests. Compromise, time and money are all elements of the fix.

MyhealthNS is a piece of a big, ambitious plan that culminates with something called One Person, One Record. Oversimplified, that’s a secure IT platform by which players across the system are permitted access to patients’ medical records as required for treatment.

All of the above is a lot of detail and too much context preceding the crux.

The health bureaucracies — the NSHA and the department — can hold their cards close to their vest and guarantee another failure, and perhaps put the final nail in the coffin of dependable public health care in Nova Scotia.

Or, they can open up to Nova Scotians with the hard truths and give themselves a fighting chance at winning the public patience they need to get the job done. There are encouraging signs the department is moving in that direction.

“Trust us, this will be better,” is neither usable information nor an explanation. It asks Nova Scotians for a leap of faith they will not take, nor should they. The government and its mammoth delivery structure over at the NSHA can either lay all their cards on the table or fold. Their call.

 

Jim Vibert spent 10 years as a political reporter and editor with the Halifax Herald; and 14 years with the Nova Scotia government where he set up Communications Nova Scotia.