Three in one: New health Regions

FTLComm - Tisdale - Friday, September 6, 2002

Since the beginning of this web site in 1998 health care and the related issues around it has been an ongoing theme. As this site was getting going the province of Saskatchewan had a budget problem and one of its ways of solving that problem was to cut the budgets of those services that Saskatchewan people had come to rely upon. The premier was reluctant to take the heat for cutting the budget for medical services so he concocted some thirty-two health regions to run the medical system. They were given budgets, not based on the numbers of patients that came for service, but arbitrary allotments that of course fell far short of meeting the needs.

There were a series of commissions and studies, most of the health regions fired their directors at least once, rules were set up to have the budgets approved by the government but were never followed, health region went broke, there was a strike of the nurses and several workers strikes and yet another one set aside only this morning.

The provincial government without accepting any blame for the mess closed hospitals, more than fifty and still things are worse than ever. Waiting lists longer, hospitals understaffed, nurses and doctors grossly overworked and many feel, underpaid. The most recent solution proposed by yet another expert (Ken Fyke) was to close down the hospitals (most of them) this would indeed save money and when you are doing a study, saving money is the keyword, dying patients and horrible hardship to the aged and sick is never mentioned.

The latest solution came into effect the first of September. Saskatchewan's thirty-two health regions have been scrapped in favour of twelve larger health regions.

Most health workers, both professional and otherwise suggest that there will be no reduction in staff with this new measure. Same number of offices, officials, cars and equipment will be needed.

It is impolite to refer to politicians and the confusing jumble of health care administrations in the province "boneheaded" but clearly their problem solving procedures and solutions are a matter of public ridicule.

The process we have seen in Saskatchewan and commented on in this web site seems to be this. When a problem arises:

  1. there is first a series of strongly worded denials that a problem exists

  2. then when it can no long be denied some way is found to blame the federal government

  3. a commission is set up to study the problem

  4. the commission is usual made up of accountants and business people intent upon destroying publicly funded medical care

  5. the commission recommends not spending any money but closing facilities and laying off workers

  6. politically unacceptable solution is rejected and the same system that caused the problem is reorganised and renamed and the problem declared solved

  7. there is denial that the problem is not solved

  8. when it can no longer be denied there is blame placed on the federal government

well this is were we write and so-on and so-on.

I began my exploration of the most recent move this morning by going to see the CEO of the Regional Health Authority #8 which comprises the former Pasquia Health region centred in Tisdale and the Health region for Melfort and the one for Nipawin.

Mr. Gordon Denton is the CEO and he was not in today, he will not be in Monday and he will not be in Tuesday. On Monday he will be in Regina.

Mr. Denton was hired by the newly appointed Board which under the former regions had been elected, but is now an appointed authority.

Mr. Denton has hired his executive assistant Donna Dobson, the position of his second in command is vacant. Six Executive directors have been hired with one still to be chosen. Each of these have long lists of responsibilities such as management, risk management, utilization management, capital asset management and all the details that one would expect to be looked after by people on the job and in the location. His organisation chart looks like the hospitals and other service units are all centrally controlled by these Executive directors.

As an example, look at the work responsibilities of Rennie Harper, Executive Director of Corporate Planning:

  • Strategic planning
  • quality assurance
  • client advocate
  • accreditation
  • communication
  • annual reports/ public reports
  • needs assessment
  • research policy
  • risk management
  • utilization management/Q.I
  • capital programs
  • program evaluation
  • health status
  • community advisory groups

Just imagine the remarkable efficiency and streamlined economics of having a group of executives handle the management for say fifteen farms. Then when they do badly, we increase the number of farms they have to manage. I realise that you might suggest that that is hardly a fair comparison, but if you think about it, most farms today are operating with similar budgets to many Saskatchewan hospitals, with the same kind of capital expenses.

Some years ago one of the many commissions established to study health care called the Dorsey commission decided that there were to many bargaining units and the provincial government decreed that with in each of the health regions the hospital workers (not counting doctors, nurses or other professional staff) must be in a single union.

As of September 1, 2002 these thirty-two health regions are now being restructured into twelve regions and each of the twelve regions must have only one union for the nonprofessional staff. The Pasquia Health Region had all of its people as members of the Canadian Union of Public Employees, Melfort has a different union and the hospital workers that were part of the Nipawin region are members of yet another union. All three of these unions are members of Saskatchewan's Federation of Labour. So since these unions are all part of the same group, I called up the Federation of Labour and the director told me that it was a real problem as it was causing dissension between unions which have to cooperate with one another.

I dropped into the CUPE headquarters that has been set up here in Tisdale to focus the campaign because that is what is now in progress. The three unions are campaigning, attempting to get 51% in an election concluding on September 20th.

The question that struck me was what about the Charter of rights. Under the charter every Canadian is guaranteed the right of association to become a member of a union or not to join a union. Is the charter being violated by the government decreeing that the workers be members of a single union? So far no challenge in the courts has occurred but it sure seems strange. The idea of a union is that it be a collective representation of its members who delegate their bargaining rights to the union, this must be a very member responsive and democratic process, what is government doing interferring in the process?

I am hoping to get a chance to talk to Mr. Denton and find out if he has any ideas about just how this new Region is suppose to be better than the ones it replaced and what is the purpose of this massive level of administration which could be as high as 20% of all people involved in health care are not involved in health care but in managing it.

Timothy W. Shire