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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:
- there is first a series of strongly worded denials that a
problem exists
- then when it can no long be denied some way is found to blame
the federal government
- a commission is set up to study the problem
- the commission is usual made up of accountants and business
people intent upon destroying publicly funded medical care
- the commission recommends not spending any money but closing
facilities and laying off workers
- politically unacceptable solution is rejected and the same
system that caused the problem is reorganised and renamed and the problem declared
solved
- there is denial that the problem is not solved
- 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
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