Ken McGeorge: Why true health reform fails to happen: political or systemic intervention?

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He was a young man in his prime, gainfully employed in business, then was overtaken by what turned out to be a congenital heart issue requiring open heart surgery. With the success of the surgery, combined with the clinical history, careful monitoring on some regular basis would be normal. Yet he is one of those persons, not defined as a senior, who has no access to primary care. Family physician closed practice with records somewhere, cardiologist retired. What is a person to do for follow up?

Another man with history of heart disease following a very active life involving service in health care and public service; family doctor retired so access to primary care is a 90-minute drive to see a terrific nurse practitioner.

Another lady with serious dementia, managed for a considerable time at home by the husband until recent admission to nursing home, whose family physician left the province with no transition arrangements for continued primary care.

In New Brunswick there are tens of thousands of such stories and, frankly, in 2024, the excuses are getting a bit lame. Government has seen this coming for 20 years; it is a public policy, public service systems issue. Resolution of such complex issues is not given to political photo-ops, expressions of political anger in the moment, promises of solutions that do not materialize, arguments about how many nursing seats are to be funded, criticizing medical schools for numbers of trainees in the programs.

Whatever is the current accurate number of New Brunswickers who do not have access to quality, comprehensive primary care, the current situation is not at all good enough. Having heard suggestions that the number might be much higher, but assume for now that the current number is 60,000. These are New Brunswickers who pay huge taxes (federal and provincial), live in a province of a country that guarantees access to “medically necessary health care” to all residents of Canada under the Canada Health Act. They typically are law-abiding citizens who love New Brunswick but ever so many are not receiving what they are paying for.

Some will, when distressed, resort to the emergency department in a crisis, which is not even close to a good solution. Some are actually afraid to go to emergency based on the publicity of long waits and worse.

And, of course, one of the factors contributing to the large issues in emergency are the unresolved issues of increase in patients with drug-related problems before you get to the difficulty created by the arrival of numbers of frail elders in crisis.

With an election coming at both federal and provincial levels one should beware of the typical array of promises of more cash, more recruitment, more of anything that will interest the voter. Better access to primary care will not be resolved by promises of training more nurse practitioners or recruiting more physicians. Nor will the answers to fixing the pressure on hospitals caused by persons in need of long-term care be found in promising more nursing home beds. Nice statements on the stump, but empty and devoid of direction and commitment to reform.

Solutions to such issues based strictly on political headlines or promises have caused lots of problems in the past. Remember when it seemed politically sound to reduce the numbers of training slots in medical schools a few decades ago? What did that do for us?

Remember when the numbers of funded seats in some nursing programs were apparently increased? And that accomplished what?

In consultation recently with a seasoned and experienced “organizational turn-around specialist,” we had a very interesting chat about how governmental policy over recent years has dealt with many things while failing to deal with systemic and structural issues that lead to many of the problems that impact those who actually need service.

The core of these complex issues is public policy, and good public policy in health and long-term care cannot possibly be formed on the election stump, social media, mainstream media. It is a serious business that requires detailed digging into carloads of facts by a team of persons who are highly informed and not given to the conventional parochialism of unions, professional associations and such. These organizations need to be involved, but development of sound public policy and repairing public policy where it shows need of change requires people with ability to “take the long-view”, unencumbered by tradition and four-year election cycles.

Half a century ago, the Llewellyn Davies Weeks Report was convened by the New Brunswick government which outlined the way forward for hospitals. That became a blueprint for reform action commenced in 1992. Prior to that, the Department of Health commissioned a major study leading to the development of the extramural hospital system which has served the province exceptionally well.

The Finn Report was created in 2008 as a blueprint for re-structuring municipal government yet it took years for the follow up to be taken.

In the current context, the Lamrock Report, if studied and dissected by informed people with the goal of creating excellent long-term care, thus relieving the emergency departments and hospital beds of much congestion, could be the basis of the way forward for issues that have stymied government and the health and long-term care system for decades.

Members of the public from whom I hear, as do others who play various roles as advocates, have no idea of the complexity of “fixing” what, to them, seems so obvious. My doctor retires, I have no doctor nor do I know where the records are…. should be a simple fix in a system that technically is a government-regulated system. You would think so, eh?

My friend has been on the wait list for nursing home for months while living in a hospital room. The fix should be simple when there are unprecedented numbers of nursing home beds and serious numbers of other long term care beds that are vacant. Simple to fix?

Getting serious change requires insight by political leaders along with strength of character and willingness to lead change. Then there is the issue of ensuring that the public service team is on side with the change, understanding the changes needed and the difficult people challenges of implementation.

But the rewards for seeing the change through are enormous; actually, getting a visual of better service, better care, more efficient systems are worth the investment and the personal risks involved. I’ve seen it myself in my career in other venues and it can happen here and it must happen here.

Ken McGeorge, BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook.com or www.kenmcgeorge.com