Province hands extra-mural, tele-care management to Medavie – Times & Transcript – 1 Sepember 2017

article by: Tom Bateman
photo by: Tom Bateman

It’s a bad day for health care in New Brunswick – David Coon

A controversial new agreement that will see a private, non-profit company take over the province’s home care and tele-care programs was unveiled in Moncton Friday.

Health minister Victor Boudreau announced Medavie Health Services New Brunswick will assume responsibility for the province’s extra-mural home care and Tele-Care 811 programs in January. Medavie has operated Ambulance New Brunswick since 2007.

The current Ambulance New Brunswick board will be folded, and a new board with representation from the two health networks and the province will govern the three programs, Boudreau said.

The deal, heralded as the first of its kind in Canada by Boudreau, was roundly criticized as privatisation by opposition parties and one of the two regional health authorities impacted by the move.

The 10-year contract sets performance-based incentives on 15 indicators for Medavie. They include goals like reduction in emergency room visits, more home visits, less hospitalizations, less variation in extra-mural programs and faster intake to extra-mural programs across the province.

Should Medavie hit its targets, incentives will be paid out by the government to a maximum of $4.4 million annually.

The approximately 700 employees affected will remain government employees and all pay, benefits and pension benefits will remain the same, Boudreau said, adding Medavie will honour all collective agreements.

About 32 senior managers now employed by the province will become employees of Medavie Health Services, the Dartmouth-based sister company to Moncton-based Medavie Blue Cross. It runs 12 subsidiary companies in Canada and Massachusetts that employ nearly 3,500 health care professionals.

The minister said there won’t be savings found within the change, and that there may be additional spending up front. The current Ambulance New Brunswick board will be folded, and a new board with representation from the two health networks and the province will govern the three programs, he said.

Boudreau and Medavie CEO Bernard Lord, the former Conservative premier of New Brunswick, were careful to note the deal doesn’t represent the privatizations of services because there will be no additional fees for services.

“What’s key here is the funding remains public, the standards remain public,” Lord said. “There are no user fees here. Those who want to use the word privatisation – it’s really used to scare people when this is a form of insuring there is greater collaboration.”

Boudreau also noted the services will remain bilingual. When an MOU on the deal was made public in February, New Brunswick’s Commissioner of Official Languages Katherine d’Entremont expressed concern the transfer of the programs would mean bilingualism wouldn’t be respected.

Lord said the province is “ahead of the curve” on a demographic shift that in the past 15 years has seen the population of New Brunswickers older than 70 double while the general population has only grown by two per cent. This is creating additional demands on the health system to provide care to New Brunswickers in their communities, he said.

Lord said efficiencies will be found because the three entities now managed by Medavie are so closely related.
Currently the extra mural program, which has a $78-million annual budget, depends on a hand-written system that is “not very IT compatible,” Boudreau said.

“Medavie has invested a lot in their software, hardware capacity to support the programs they had. They’ll be able to use that to enhance the extra-mural program today,” he said.

The transfer got support from the Horizon Health Network and the Nurses Association of New Brunswick. Dr. Pamela Jarrett, a Horizon Health geriatrician said the deal will help seniors remain in the home, “where they tell us they want to be,” she said at the announcement.

“This is not privatisation,” said Horizon Health president and CEO Karen McGrath. This is an “existing partner of Horizon and we will continue to work with them on this file.”

‘The accountability is gone’
McGrath’s counterpart at the Vitalité Health Network, president and CEO Gilles Lanteigne, didn’t share her sentiments.

Lanteigne said client satisfaction rates in his health network have been good, and emergency room visits have been going down already, thanks to internal initiatives by Vitalite.

“Splitting the provincial health system up into several components will make it increasingly difficult for us to achieve expected results, namely in terms of quality, continuity of care, effectiveness and efficiency,” he said in a statement released Friday morning, before the official announcement.

Vitalité board chairwoman Micheline Paulin said the Vitalité leadership team was “deeply disappointed” and “puzzled” by the announcement. Paulin said the transfer “involves the fundamental responsibilities of the regional health authorities, as described by the Regional Health Authorities Act.”

McGrath disagrees.

“I believe we all have enough to do in providing health care to the citizens of New Brunswick,” she said.
Paula Doucet of the New Brunswick Nurses Union also came down against the move, which she only learned of on Friday.

“We’re concerned about the quality of service that is being delivered to the patients in New Brunswick … as well as the benefits for my members that work in EMP,” she said.

Ralph McBride, a representative of the Canadian Union of Public Employees, also objected strongly to the decision.
“The biggest item for us is that we’re taking the management cycle outside of health care and putting it into a private corporation’s hands. We’ve got concerns about private entities having control over public health care,” he said.

“Honestly, I think there’s a bigger picture in play here. I think there’s a move to take and offload as much responsibility out of the government into private entities which I think is bad for the public because we lose control of our public interests. The accountability is gone.”

Donald Savoie, the Canada Research Chair in public administration and governance at l’Université de Moncton, called the arrangement “one heck of a damning comment on the ability of government to deliver services.”
Savoie said if the new deal will both cost more and provide better services, “then perhaps we should look at everything government does.”

Boudreau said he doesn’t shy away from the fact that government doesn’t have all the answers.

“If you’ve got a particular expertise you can go get and help the overall situation, overall services … what’s wrong with that?”

Political backlash

All three political parties were also quick to question the government’s decision.
Conservative health critic Brian MacDonald noted the move wasn’t mentioned in the Liberal government’s election platform.

“Had [the Liberal party] honestly campaigned on the HST hike, seniors asset grab, tuition rebate cut, privatising extra mural, firing the Chief Medical Officer and now gutting the Chief Medical Officer’s office, they likely wouldn’t be the government,” he said in a statement.

MacDonald said Medavie has proven to be a good manager, but said the move is “clearly a form of privatisation … in the same way that they have privatised other health services” like the controversial deal to turn over the hospital food and cleaning services to Sodexo.

“My concern is there’s a lot of pieces in the health care system that need to be fixed, but extra mural was doing well,” he said.

“It’s a bad day for health care in New Brunswick,” said Green Party leader David Coon. He is worried about the loss of public accountability in the deal, and about potential mobility restraints on health care professionals affected.

“Who do New Brunswickers go to if they don’t get the type of care they have been accustomed too?” asked Jennifer McKenzie, the new leader of the provincial NDP who was at the announcement.

“Do they go to their MLA or do they go to the private company? It really fuzzies the line.”