Over-centralization of health, education is recipe for failure

Bureaucratic franchises should not replace communities

My wife, Alison, or I sometimes accompany a friend to medical appointments. He is a senior with severe hearing loss, the result of an injury many years ago. Appointments at the Cape Breton Regional Hospital can be especially disorienting. Numbers and instructions are constantly called out in crowded, stressful waiting rooms.

In December, Alison e-mailed the Sydney-based employee of the Nova Scotia Health Authority (NSHA) who is designated to receive concerns and suggestions about patient services. Alison politely shared her observations and a few practical suggestions for how the hospital could be more accessible to hard-of-hearing people.

The official acknowledged the e-mail, noting that it would be passed on.

Alison replied with thanks and asked if she could be informed once staff decide whether or not to make any changes.

This would not be possible, Alison was told, because of patient confidentiality.

Alison clarified that she was referring to institutional protocols and visuals, and not any particular plan of care for our friend or other individual patients.

The NSHA official then advised Alison that the leadership takes all concerns seriously, but at no point was an actual answer provided, one way or the other.

Of course, this is a small example. And no one acted in bad faith. But it speaks to a highly centralized franchise system with local staff but no local governance. All lines of accountability ultimately run up to Halifax and not out to the community.

The province’s planned further centralization of the education system will fail, just like the centralized health authority.

Centralization can appear elegant in theory. In her recent report to the province, education consultant Avis Glaze decries “role confusion.” She calls for a cleaner model where all lines ultimately run to the minister of education.

Glaze’s proposed flow chart shows only one line running to “Nova Scotians”, and that is from the minister. In other words, only the minister would be directly accountable to citizens. But the minister cannot possibly be on top of how every school responds to unique community needs. Nor can the minister directly oversee local officials.

Thus, in practice, oversight falls to layers of senior bureaucrats – an obscure “leadership” that never deliberates in public.

Both Glaze and Premier Stephen McNeil contend that their reforms will “enhance” the local voice by putting more emphasis on “vibrant” school advisory councils (SAC).

But these idealized SACs will have no authority to make change. They truly are an example of role confusion. They are not responsible for any oversight of the principal. They have no mandate to approve directions for school excellence.

You can’t really draw any lines from the SACs. The principal and other selected staff are actually on the school advisory councils, shaping advice back to themselves or to the superintendents (regional executive directors). The SACs can “have their say” (Glaze’s words), but no one has to listen because the SAC members are not trustees and are not responsible to anyone. What to do?

The education governance reforms might start to make sense if the school advisory councils were re-imagined as school councils (not merely “advisory”) with some authority. Members would be drawn from the broader community. They could be responsible for the school’s improvement plan, the school’s engagement with the community (including field work and incommunity learning curricula), approving the school’s budget, and the selection and periodic performance appraisal of the principal.

Every school would have to meet provincial benchmarks, but there would be local flexibility, overseen by local trustees, to try different methods, formats and technologies to attain the goals.

This kind of oversight and innovation closer to the ground would allow for fewer managers and central support staff in the department and in the offices of the regional executive directors.

Shelters, arts centres, halfway houses, museums and clusters of libraries are run this way. They have to meet certain common standards, but groups of pro bono citizen trustees/boards of directors, usually elected at annual general meetings, try to keep things focused, fair and frugal. They can try new approaches and respond to public concerns. They feel directly responsible to their fellow citizens.

Premier, let’s pause before writing the text of the new education bill. It won’t fly in Cape Breton as currently envisioned. Let’s please give our communities some direct responsibility and accountability for education and health.

Bureaucratic franchises erode public confidence and damage our democracy.