Changing the health-care system is really hard. But describing change in a way that avoids sparking panic and political blowback, well, that is a real trick.
Premier Brian Pallister and Manitoba’s Progressive Conservative government are certainly learning about the inherent perils of changing health care while struggling with basic communication. And in doing so, Pallister is threatening to make his re-election plans in 2020 a bit more complicated.
First, it’s hard not to be impressed with the Pallister government’s breathtaking array of health-care changes.
A plan to close Winnipeg emergency rooms and reorganize all hospitals to perform different tasks has proven particularly challenging. Although most thoughtful people understand it is unrealistic to have a fully-staffed emergency department in every neighbourhood, the hospital reorganization has genuinely spooked large segments of the city’s population.
Health Minister Kelvin Goertzen and officials from the Winnipeg Regional Health Authority this week tackled the thorny issue of reassigning more than 500 nurses affected by the reorganization. Nurses remain both a key professional cog within the health-care system and a potent political force. Mess up the messaging on this part of the reorganization and there could be dire political consequences down the road.
For the most part, this time the government got the message right.
Contract obligations required that nurses be provided with “deletion notices” well in advance if there is a chance they could be reassigned to a different role or facility. For a government trying to fend off allegations that it is a reincarnation of a former, austere mid-1990s Progressive Conservative government renowned for laying off nurses, this was a delicate task.
This time, however, Goertzen and his people managed to work closely with the Manitoba Nurses Union to get past the awkward semantics and clarify the fact that no nurses will lose their jobs. Many nurses will have to take new jobs in new facilities, but none will go without a job unless it’s of their own accord.
However, this week’s success will do little to ease the long-term political pain that appears to be headed Pallister’s way. The government has painted itself into a difficult corner with its strategy of delivering significant organizational changes while, at the same time, cutting front-line clinical services.
The premier’s decision to pursue both streams of change — reorganization and austerity — could prove to be problematic in 2020 when Manitobans next go to the polls.
The suggestion that Pallister will not be easily, almost automatically, re-elected is heresy in the Tory ranks. Given both the Liberals and NDP are struggling through awkward leadership vacuums, it’s not hard to see why true-blue Progressive Conservatives feel their government is untouchable in the next election.
And yet Pallister is messing with the most volatile of all political issues. His political opponents, struggling to find a new brand along with new leadership, could not find a better lifeline than the image of a Tory government cutting the heart out of health care.
To be fair, that’s not really an accurate explanation of what Pallister is doing, particularly on the operational side of the health-care system.
The hospital and emergency room reorganization is long overdue and planning for it began years ago under the NDP’s watch. Other recent innovations — including most notably the creation of Shared Health Services to co-ordinate clinical practices and procurement — hold real promise for a more cost-effective health-care system.
On the financial side of the equation, however, Pallister has unleashed a wave of austerity that has nothing to do with making health care more cost-effective.
In last April’s provincial budget, regional health authorities (RHAs) learned they would get small increases in funding, but not enough to handle the increased demand from population growth and demographic changes. In simple terms, the RHAs were asked to provide the same amount and level of service to a larger population as they did the previous year, but with slightly less money than they would have normally expected.
It doesn’t sound like a big change in funding philosophy, but the impacts have been huge. In the WRHA alone, $82 million in overhead and front-line clinical services needed to be cut. Winnipeggers have heard about most of the decisions: elimination of outpatient physiotherapy for elective surgery patients; dismantling of the Mature Women’s Health program at Victoria General Hospital; cutbacks in the provision of some basic medical supplies, such as post-partum pads for new mothers.
What we are left with now is conflict between two competing streams of change. While the government tries to win the public’s trust on the potential benefits of profound but necessary changes in the way health care is delivered, it is also eroding trust by cutting back on programs on the front line of health care.
The Pallister government will only resolve this conflict if it can show measurable improvements in the performance of the health-care system before the next election. Given the scope of change unleashed, it’s a race against the electoral clock.
Provincial health-care systems are poked, prodded, measured and analyzed on an annual basis. Reports from the Canadian Institute for Health Information measure wait times for treatment in emergency rooms, elective surgery and major diagnostic procedures. The Pallister government’s tidal wave of change in the health-care system can only become a political asset if there is positive movement in those benchmarks.
If there is slippage, then there will be negative consequences for Tories in the next election. It may not be enough to defeat the Tories, but it will make election night a whole lot more interesting.