Vague sound bites effective on campaign trail, less so in government

Opinion

Hey there, time traveller!
This article was published 02/01/2024 (645 days ago), so information in it may no longer be current.

One of the first things former NDP premier Gary Doer did after taking office in 1999 is consolidate the number of regional health authorities across the province.

He claimed during the election that year that a bloated health-care bureaucracy was compromising patient care.

Regional health authorities, which act as planning and managerial bodies that oversee the operation of health-care facilities, diagnostic testing, ambulances and other aspects of public health care, were relatively new at the time. They were set up by the previous Tory government in the late 1990s as a way of finding efficiencies in the system and improving co-ordination among hospitals.

Some of those objectives were realized. But like most aspects of government operations, empire building took over quickly. Within a few years, regional health authorities — including what was then known as the Winnipeg Hospital Authority — grew into oversized bureaucracies whose role became increasingly disconnected with patient care.

Doer said Manitoba’s health-care system needed fewer vice-presidents and more front-line workers. It was a good sound bite. And while the NDP government at the time did reduce the number of regional health authorities and cut back on the number of vice presidents they employed, the overall size of the health bureaucracy continued to grow.

The Winnipeg Hospital Authority merged with what was then called the Long-Term Care Authority, which became the Winnipeg Regional Health Authority. But over time, the WRHA grew larger than the two previous health authorities combined.

That dynamic played out right across the province.

It got worse under Brian Pallister’s Progressive Conservative government, which added another layer of bureaucracy to the system called Shared Health. In addition, the Tories created the Diagnostic and Surgical Recovery Task Force, which became another layer of bureaucracy in the system that did little to improve patient care.

Like Doer, NDP Premier Wab Kinew says he plans to cut back on the health-care bureaucracy and make it more responsive. He wants a “patient first” culture.

Those, too, are nice sound bites. But they’re meaningless without concrete change.

Nearly three months after winning the Oct. 3 provincial election, Kinew isn’t any more clear about how he intends to shrink the bureaucracy and “change the culture” of health care than he was during the campaign.

“There is a real need to improve the culture in health care, and the current status quo with the service-delivery organizations is just not something that is supportive of us improving things on the front lines,” Kinew told the Free Press in a recent interview.

That’s as vague as it gets in politics. It is utterly meaningless.

To its credit, the NDP wound down the Diagnostic and Surgical Recovery Task Force. But it committed a huge error by also eliminating the task force’s out-of-province surgical options for those on long wait lists. Allowing patients to get surgery outside of Manitoba, including hip and knee replacement procedures (paid for by Manitoba Health), was one of the few things the task force got right. The NDP could have kept that component while shutting down the rest. It chose not to.

Kinew and the NDP have provided no details on plans to shrink the bureaucracy and make it more responsive to patient care. Manitobans have been told only that there will be a review of the existing structure.

There is a real possibility the NDP will do little more than tinker with the system, as Doer did in the early 2000s. Without a clear set of criteria and objectives on what role a bureaucracy should play, empire building in Manitoba’s government-run health care system would surely continue.

Vague announcements will do nothing to change that.

The NDP has been in office less than three months. No one expects the new government to “fix” health care overnight, including reducing the size of the bureaucracy. Structural changes need to be made carefully and thoughtfully to mitigate service disruption.

But at some point, sooner rather than later, Kinew will have to make his plans clear.

tom.brodbeck@freepress.mb.ca