Newfoundland and Labrador’s health-care system is in desperate need of transformation
Winston Churchill once said a “good crisis should not be wasted.” Indeed, a crisis is an opportunity to make transformative change, and our health-care system is in dire need of reform.
The Newfoundland and Labrador Health Accord report has presented a 10-year blueprint for transformation, after a thorough process of research and consultation.
Good health requires not only reform in our health system itself but also improvements in our social programs. The Accord’s focus on the “social determinants of health” shows how improved incomes, housing, food security and more attention to the complex problems of children and youth, can make us a healthier society. A healthier population has less need for health interventions.
The Health Accord, led by Sister Elizabeth Davis and Dr. Pat Parfrey, does not dispute the need for reforms in health care, but says they must go hand in hand with better social programs. Reform of social programs must be undertaken concurrently with transformative change in health. Indeed, improvement in our social programs will require that we find savings in our health-care system which can be redirected to these social programs. This will lead to better health outcomes and reduced health-care costs.
I’d like to build upon the Health Accord report’s recommendation for a Newfoundland and Labrador Council on Health Quality and Performance. This council would examine the costs and outcomes of our healthcare system and benchmark our performance, not only in comparison with other jurisdictions, but also to track our progress over time. It would provide information, not only to government, but to all citizens as health-care consumers. It would improve outcomes through evidence, so that health-care decisions are based on facts, and not on politics or bias.
LESSONS FROM MUSKRAT FALLS
This council could be modelled on similar entities in other provinces, but I suggest that we go even further and build our own bespoke process to enable all citizens to participate more fully in all health-care decisions. All major decisions would be open to public review through a public hearing process modelled on the Public Utilities Board. Such a process was recommended by Commissioner Richard Leblanc in his report on the “misguided” Muskrat Falls hydroelectric project.
Leblanc concluded that the Muskrat Falls project was misguided because of political bias and through a failure to consider all the options and to engage with the public. The execution of the project was also misguided because of the project’s poor governance, lack of oversight and by what Danish megaproject expert and professor Bent Flyvbjerg described as “optimism and political bias.”
Recommendation No. 1 from Leblanc was that there should be “robust review, assessment and analysis” of any major project before a decision is undertaken and that this should be combined with “well-designed oversight.” The council proposed by the Health Accord can be the mechanism to ensure that all major health-care decisions are subject to a robust, transparent, public process.
Health economist Dr. Michael Doyle has advanced a review process modelled on the operation of the Public Utilities Board, which is mandated to review projects and proposals for change, and which assesses evidence from a wide range of stakeholders, including consumers.
Decisions on major healthcare projects — new facilities, treatments, hospitals and clinics — are now made without a public review process and rely too heavily on political discretion and too little on evidence. Decisions should be based on an assessment of need as well as medical efficacy and cost.
It is vitally important that citizens, as consumers, be empowered in these health-care decisions and that the PUB model enable intervention by consumer groups, along with the appointment of a consumer advocate.
The provincial government should embrace the proposals advanced by Davis and Parfrey and it should act immediately to create a council with a broad mandate to conduct hearings on all major health-care decisions as a vital component of its blueprint for transformative change.
“All major decisions would be open to public review through a public hearing process …”
David Vardy, a Princeton-trained economist, has held a number of executive positions in the Newfoundland and Labrador provincial government, including Clerk of the Executive Council, president of the Marine Institute, deputy minister of Fisheries and chair of the Public Utilities Commission. He was also a member of the Muskrat Falls Concerned Citizens Coalition. He lives in St. John’s.