In the midst of a crisis in frontline health care, the Yukon government is embarking on a costly multi-year top-level reorganization of our health system.
I am worried it will distract the top managers of our healthcare system for years, and end up with minimal — or even negative — effects on health services to First Nation and non-First Nation Yukoners.
Let’s hope I’m wrong.
Before I share my concerns, here is some background.
Health authorities are common organizational set ups in larger jurisdictions (the N.W.T has one, too). The idea goes back to Britain’s original National Health Service in 1949, which had 14 regional boards and 146 local health authorities.
The idea for one for the Yukon comes from dueling government reports. The Putting People First health report recommended one. Premier Silver’s Financial Advisory Panel did not, saying “institutional reorganization can take many forms from moving around senior civil servants and reorganizing departmental mandates to consolidating (and then decentralizing) stakeholder boards in areas such as health care and education.
“This is the easiest change to undertake and the least likely to increase efficiency or effectiveness in the operations of government (…) this is otherwise referred to as ‘rearranging the deck chairs’.”
Bill 38 to rearrange the deck chairs was recently tabled in the Yukon legislature.
Pretty much everyone agrees something has to change. Longer waiting lists. Unequal outcomes for First Nations people. Yukoners paying to go Outside or to the U.S. for surgery. A crisis in morale and working conditions among nurses, doctors and frontline workers. The list goes on.
But any off-the-record discussion with healthcare professionals or local policy experts reveals that not everyone agrees on what the fixes are.
Bill 38 is trying to solve two problems: first, better include First Nations people in the system and, second, improve frontline health service for Yukoners.
Think of the new health authority as the Yukon Energy Corporation of health. It is supposed to be at “arms length” from government, with its own board directing a separate management team to operate efficiently and effectively. It will have a board of seven, with four appointed by the Yukon cabinet of the day, three by Yukon First Nations and none elected by the public.
On the first objective, Bill 38 is sure to solve at least part of the issue around First Nations involvement in the health system. In addition to the three First Nations board members, there will also be involvement of the Yukon First Nations chiefs’ committee on health. This ensures First Nations perspectives at the very top.
But that is not the same as improving frontline health system performance for First Nations citizens. More on that in a minute.
On the second objective of improving frontline performance, Bill 38’s prospects are much less clear. A government press release says that “a health authority is an arm’s-length agency that supports a system-wide perspective that enables better planning, improves efficiency and allows for innovative healthy system delivery methods.”
This sounds nice, but raises the question of what the Yukon Department of Health has been doing. Isn’t its job to have a “system-wide perspective” that enables better planning and so on? If the Department of Health can’t do this now, how confident are we that mostly the same people with new job titles will do a better job?
Bill 38 is hazy on what will actually change in your doctor’s office, at the hospital or at your community health clinic. It has to be hazy, because the whole point is that the new board, CEO and management team will have to be hired and then given months or years to come up with their plan.
Consider a small Yukon community with a clinic that serves First Nations and non-First Nations Yukoners. If it is understaffed or staff are not treating First Nations patients with respect, why not solve that problem right now? At the frontline now, instead of spending a proposed one to three years reorganizing the high mucketymucks in Whitehorse and then telling them to start working on the problem.
I have worked on my share of major reorganizations over the years. They are all consuming. Senior management’s bandwidth will not be focused on that underperforming community clinic. They will be asking who the next CEO will be. Who will get the senior vice president jobs? Who gets to decide what? Should we benchmark those salaries not against Yukon assistant deputy ministers but big-city health authority salaries?
Renegotiating the union agreements, dismantling the hospital corporation and putting in place new financial systems will burn up huge amounts of time and money.
The government has budgeted $9.4 million for this fiscal year for reorganization activities. Not counting what has already been spent on planning in previous years, tens of millions more will probably be required over the multi-year implementation period.
Even when implemented, I have questions about effectiveness. Yukon health system decision making is not known today for speed.
Now we are adding new overhead, decision and consultative bodies. The finance minister will still control the budget. The minister of health and the department will still control health policy. Now you will have a CEO, a board and various consultative committees added to the Whitehorse meeting merry-go-round.
Furthermore, the original British system was for a country of fifty million people. It makes a lot of sense in a big province to have a central health ministry and decentralized implementation. But here in the Yukon, we will have one minister accountable for one health authority sitting on top of one hospital. How fancy does the organizational chart need to be?
I wonder if it might not be better to keep the new First Nations involvement at the top, freeze the reorganization and cut the Department of Economic Development to give money to a couple of new task forces focused entirely on improving frontline health care at the hospital and in the communities right now.
If Bill 38 passes, I also wonder whether a client of that community health clinic will notice any difference in the next five years.
Keith Halliday is a Yukon economist and the winner of the 2022 Canadian Community Newspaper Award for Outstanding Columnist. His most recent book Moonshadows, a Yukon-noir thriller, is available in Yukon bookstores.