30 Jan Column: Decoding Corpus Sanchez

Wednesday, 30 January 2008

Decoding Corpus Sanchez
By Kyle Buott, Coordinator, Nova Scotia Citizens’ Health Care Network

*This article was printed in the Chronicle Herald on January 30th*

The provincial government endorsed all 103 recommendations in the Provincial Health System Operation Review written by Corpus Sanchez. The report’s readers will surely be impressed by the number of task forces, committees or feasibility studies to be commissioned – likely to more consultants for more millions of dollars.

Readers will also be impressed by the number of euphemisms in the report designed to dupe the public into believing we need to downsize, privatize, outsource, and right-size our health care system.

To help understand some of these euphemisms the Nova Scotia Citizens’ Health Care Network has put together the following decoder.

Number 1 – Changes and Transformations
The report calls for “change” and a “transformation” of our health care system. By change they mean reductions in the hours of service at rural ERs. By transformation they mean redefining hospitals as regional sites or community centres so they can make the argument that such sites do not need laboratory, diagnostic, surgical or even ER services.

Number 2 – Communities will decide
The provincial government says communities will decide the future of their health facilities. Great! Unfortunately, when the government says communities they mean the District Health Authorities, who are not accountable to the public as they are appointed not elected. They also close some of their meetings to the public and there is a general lack of transparency. The only part of the health system with any accountability is the Department of Health, headed by a democratically elected minister. This is the same department that now wants to abdicate its responsibilities and turn everything over to unelected officials.

Number 3 – Sustainability and Fiscal Imperatives
The study begins with the assumption that health care spending is unsustainable. This myth has been pushed by Fraser Institute (a right-wing think tank) and, using some questionable methodology, argues health care spending is increasing dramatically. A report by Marc Lee, an economist with the Canadian Centre for Policy Alternatives, called “How Sustainable is Medicare?”, shows spending on public health care, as a percentage of the Gross Domestic Product (GDP), has stayed relatively stable since Medicare was created. The issue is that provincial budgets are shrinking as a percentage of GDP due to tax giveaways to large corporations and the wealthiest Canadians.

Number 4 – New sources of funding
The Corpus Sanchez report instructs the District Health Authorities to look for “new sources of funding” for health care. This means looking to the private sector. One example would be private, for-profit delivery of care like the private MRI clinic in Halifax where patients pay out of pocket for this procedure. It also means looking at public-private partnerships, or P3s, for new infrastructure projects. Nova Scotia has a disastrous record with P3s, with cost overruns for P3 schools of over $32 million. Other provinces have seen dramatic cost overruns in health P3s, most notably in Ontario where costs for 5 current P3 hospitals are estimated to be almost $1 billion more than expected.

Number 5 – Confirm Staffing Ratios
There are recommendations throughout the report that look at staffing issues. In reality, “confirming staffing ratios” likely means what is called right-sizing the workforce. The government will attempt to reduce costs by hiring staff with less training. So a Licensed Practical Nurse may be doing the work of a Registered Nurse, a technician may be doing the work of an Anaesthesiologist. Instead of looking at training new professionals, the government is threatening the level of care Nova Scotians will receive.

Number 6 – Citizens Engagement
The government claims Corpus Sanchez spoke with over 1000 Nova Scotians about what was to be done with the health care system. It is curious then that out of over 35 new task forces, feasibility studies, committees and other initiatives, not one of the actions has a meaningful role for citizen engagement. One recommendation goes as far as to suggest that community involvement be include in the final implementation plan, once the decisions have been made so the District Health Authorities can explain how the local health system will work when ER services are reduced.

The Corpus Sanchez report is full of countless examples of euphemisms and plans to take our public heath care system apart, piece by piece. Interestingly, the research on the solutions has already been done and seems to have been ignored in this report. Dr. Michael Rachlis in his book “Prescription for Excellence” outlines many of the solutions to the problems in public health care. All of which must be done in the public system.

Public sector solutions include travelling physician teams, drastically increasing the use of Nurse Practitioners, using new queue management techniques and increasing the number of health practitioners we train locally. Many of these strategies have been tried in other provinces like Ontario, Alberta, Quebec and Saskatchewan.

The provincial government needs to bring in proven, public sector solutions. The first step in this direction will be shelving the Corpus Sanchez report and all its euphemisms