Tuesday, August 12, 2008

New Brunswick provincial health council to hold government, RHA's accountable.

This is from the Times and Transcript.

This looks like more centralisation plus smoke and mirrors about accountability. Nothing is said about who is to serve on the new health council or how it is accountable to the public. There will be much less local control with only two RHA's. This will make the system much less accountable to local needs. This is probably the whole idea. It will be experts and professionals who will determine what localities need. The centralists will explain that this will ensure that the interests of the system as a whole rather than particular interests are served and will also avoid pesky locals trying to upset the smooth running of the bureaucratic system! Given the powers of the health council they will not be able to hold the government responsible or the RHA except through public pressure and as mentioned it is not clear that the council is accountable to anyone. The process of appointment to the council is not mentioned. Most reforms nowadays would be better described simply as changes! Reform used to mean a change for the better. Now it means a change that a government wants good or bad.

Provincial health council to hold government, RHAs accountable
By Jesse RobichaudTimes & Transcript Staff

FREDERICTON - Amid a series of health reforms which include the transition from eight health authorities to two, Health Minister Mike Murphy believes the soon-to-be-appointed New Brunswick Health Council will emerge as the "dark horse."
"It will be holding the government's feet to the fire to ensure New Brunswickers are getting what they pay for," said Murphy.
"There will be days where I wake up and wish I never appointed a health council, and that's the reason I am appointing it, because it will focus on some issues that might slip through the cracks . . . that may be overlooked by the minister of the day or the regional health authorities."
Murphy believes a seat on the health council will eventually be the most sought-after position in the province's revamped governance structure. That is because he says the arm's-length council will wield considerable power as a mix between a public advocacy forum and an auditor.
While that power will not allow the council to legally order the Department of Health or the two new regional health authorities to act, Murphy says it will be able to use public pressure to prompt action.
"The health council will have the power of public influence. They don't have any direct authority over the regional health authority, shared services, or any other sphere of health," said Murphy.
"The health council, I have said repeatedly, is the dark horse of this whole reform."
Murphy stressed that the council's voice will be a powerful commodity in the new system if it manages to articulate public opinion.
"We can put ourselves in a tight spot by ignoring the health council," he said.
While the reshaping of the province's eight regional health authorities into a seamless partnership of two authorities within a standardized health system has grabbed headlines, Murphy believes the health council's profile will grow as New Brunswickers realize just how different the new governance structure will be with the health council providing the forum through which citizens can express their hopes and concerns for the health system.
"People paid attention to the regional health authorities believing that the regional health authority were just large replicas of the previous health authorities," he said.
"The regional health authorities are now for clinical delivery within budget. The health council is the advocacy branch of this reform."
The council, which will initially be run by chairman Rino Volpé and CEO Stéphane Robichaud, will be able to address either the minister or the regional health authorities directly.
"They are not going to be hamstrung by bureaucracy and paths of reporting. But they will be reporting to the media and public on a variety of issues."
The council will measure fiscal and clinical performance of the health-care system, and it will also investigate areas of the system that it believes may be under-performing. It can act on requests from the public, or its own councillors, on aspects varying from wait times to the availability of bilingual services, the minister, and it will publish an annual report and make direct recommendations.
"It will look into things here and there, it will also look in to my requests, and will make an annual report," said Murphy.
"Its mandate letter is going to ensure the applicability of the official languages act throughout the health-care system."
The citizen engagement component of the Health Council cannot be overstated, said Murphy.
If there are concerns being voiced in an area of the province, the council will have the discretion to decide how best to gather public opinion, and what recommendation to make to government.
That discretion extends over contentious debates in which two or more communities could be asking for a new service, said Murphy. He said the council will have the discretion to decide which what option will strengthen the province's health system more effectively, and it will maintain that discretion in its recommendation to government.
"The health council has complete discretion as to whether they feel that they should come down on one side of an argument or not," he said.
As for accountability of the independent committee, Murphy said there are some ways to keep tabs on its operations beyond its annual report.
For example, Murphy said the Minister of Health will be able to summon the health council before the legislative committee that examines operations of crown corporations, but he said he will careful not to "awaken a sleeping beast."
While the council will have general orientations, such as a mandate to ensure health care is delivered effectively to all citizens of the province, it will also have the freedom to set the agenda
"The fact is they will have, I'm sure, some concerns about policy development," said Murphy.
He expects the health council to develop a position on issues like smoking in cars where children are present or the sale of candy-flavoured cigarillos that are alleged to be marketed towards youth.
Murphy said he expects the council will focus its attention on a few areas of interest at a time.
"There is the old expression that if you have too many priorities you don't have priorities at all."

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