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Yukonomist: The accountability cloud

There is a legend about a Yukon minister of health in the 1980s. After winning a seat in the legislature and being assigned the health portfolio, the new minister retired to the Edgewater Lounge. After consulting friends, political advisors and the server, the minister obtained a pen and an Edgewater napkin and wrote the new ministerial health policy on it.

There is a legend about a Yukon minister of health in the 1980s. After winning a seat in the legislature and being assigned the health portfolio, the new minister retired to the Edgewater Lounge. After consulting friends, political advisors and the server, the minister obtained a pen and an Edgewater napkin and wrote the new ministerial health policy on it.

The next day, when the deputy minister arrived with an assistant carrying armfuls of briefing binders, the minister told them to sit down and produced the napkin. It contained just a few bullets, such as “hire more nurses.”

The legend goes that for the next few years, whenever the deputy minister appeared with briefing books, the minister would produce the napkin out of the ministerial desk drawer and ask things like, “How many nurses did we hire this month?”

Such stories grow in the telling. But this one contains an important truth about being a minister: you can do worse things in politics than stay focused on tangible achievements you can explain to a voter on a napkin.

The Yukon government was a fraction of its current size back then. Voters could, and did, just wander into ministers’ offices and give them a hard time about potholes or liquor store hours.

But government accountability does not depend on size. President Harry Truman was running the biggest and most complex government in the world when he put a sign on his desk in the White House saying “The buck stops here.”

Truman knew a thing or two about accountability, including, you may be surprised, government boondoggles in the Yukon Territory. As a senator, he led the Truman Committee investigating the omnishambles that was the Canol Project. His investigation concluded that $2.5 billion in today’s money was wasted on a pipeline completed years after the Japanese navy’s threat to Alaska was eliminated.

Flash forward to 2023. A slow-rolling crisis has engulfed the Yukon Department of Health and Social Services. In July, 3,402 Yukoners were waiting to be matched to a health-care provider, up from 3,341 in October 2022 (although down from 3,840 in March). This despite the government lowering the bar by changing the waiting list from “find a family doctor” to “find a family doctor or nurse practitioner.”

“Close to half of Yukon’s health centres have temporarily closed despite government’s efforts,” blared a News headline last week. The health centre in Ross River, for example, will be closed for a month until Aug. 29.

The Whitehorse and Dawson hospitals have both issued alerts about long wait times.

These issues are not new, as doctors and nurses will tell you. The “find a family doctor” matching service was launched with media fanfare in November 2019, although the News noted at the time the original launch date was supposed to be more than a year before.

The government points out there is a global shortage of health professionals. True enough, but that does not fully explain the problem. The Yukon has lots of transfer-payment money and our population is only 0.1 per cent of Canada’s. We only need to lure slightly more than 0.1 percent of the nation’s health-care workers here to solve our problem.

And the Globe and Mail, a newspaper in Toronto pointed out last week there are loads of fully trained Canadian health-care workers abroad who want to return home but are blocked by restrictive licensing provisions. The Globe cites a 2010 report saying that 3,500 Canadians a year were leaving to study medicine abroad, and that 90 per cent wanted to return.

What has the Yukon government achieved since the “find a family doctor” program was supposed to start in September 2018? As noted above, the waiting list is a stunning 3,402.

It’s too bad Harry Truman isn’t available to run a Senate commission to find out what went wrong and hold the relevant executives accountable.

In theory, in our system the minister of health is the member of the executive branch accountable to the legislature for the government’s actions on health, with the deputy minister of health in direct support.

The UK Institute for Government sums up ministerial accountability in our Westminster system as follows: “Being accountable to Parliament means that ministers have to explain and provide information on what is happening in their area of responsibility. It can also mean a duty to take remedial action or apologise for failures. Ultimately it also means an expectation that they should resign if something has gone seriously wrong.”

However, from an organizational performance point of view, the remarkable thing about our health system in practice is the lack of accountability mechanisms. With the Liberal-NDP alliance majority and question period being more about political theatre, the legislature has proven to be completely ineffective in holding the executive branch to account. There is no Yukon health board of independent citizens sitting overseeing the health bureaucracy. The federal auditor general visits only rarely and has many other departments to look at.

Instead we have a system characterized by a lack of rigour, transparency and clarity of responsibility.

The premier’s mandate letter to the health minister has 12 bullets of instructions, but contains no numbers or dates. At your workplace, you might expect your boss to give you a clear mandate such as “Get the ‘find a family doctor’ waitlist down to 1,000 by the end of the year.” But the letter doesn’t even mention the “find a family doctor” program specifically.

It does say “continue to work to connect every Yukoner to a primary care provider.” But readers with bureaucratic wiles will note that the premier’s direction is the vague and easily achievable “continue to work” rather than something more specific such as “achieve the target”.

The mandate letter does not mention the vacancy rate for government-employed community nurses. The government points out this has been improving, from 47 per cent last year to 32.9 percent at the end of July.

It is progress, but think what these numbers mean. Almost half the roles were empty at one point. And now we are supposed to be reassured that only a third of community nurse roles are vacant!

Meanwhile, accountability has been further muddied by the proliferation of committees. First there was the Putting People First working group. More recently, a Yukon First Nations chiefs committee on health was formed, according to the government press release, “to provide direction and oversight regarding the transformation of the health and social system of the Yukon.”

And two weeks ago another new committee was announced, the human health resources steering committee. This is composed of government, hospital, Yukon Medical Association, the Yukon Registered Nurses Association, the Yukon Medical Council, Yukon First Nations, the Yukon Employees Union, Yukon University and the Professional Institute of the Public Service of Canada.

These are on top of existing government committees, of which there is no shortage from cabinet to inside the health department.

Many successful organizations take a different view on how to organize for success. They often focus on clear chains of command, specific goals and clear accountability feedback loops.

One has to ask if the purpose of all these health committees is to get the needed actions done faster or to blur accountability into a cloud of committees, working groups and organizations.

If someone inside the health department did have an idea to, for example, accelerate foreign-based Canadian doctors and nurses moving to the Yukon, they now have to work it through cabinet, the chiefs committee and the human health resources steering committee.

Unfortunately, it is clear what all of this means for Yukon families: don’t get sick. Expect delays, waitlists and clinic closures to continue until some — unspecified — date in the future.

Keith Halliday is a Yukon economist, author of the Aurore of the Yukon youth adventure novels and co-host of the Klondike Gold Rush History podcast. He won the 2022 Canadian Community Newspaper Award for Outstanding Columnist.