A Manitoba health super-agency could be in the works, as power is consolidated at Shared Health at the expense of regional authorities.
In April, the Opposition NDP delayed proposed legislative changes — which would give provincial authority Shared Health a hand in much of what regional authorities do, from procurement to oversight — until after September’s election.
Meanwhile, it has become standard for hospitals and regional health authorities to include language in bid opportunities warning Shared Health might take over contracts at any time.
"The province of Manitoba is presently undertaking a transformation of its health-care system. As part of that transformation, responsibility for delivery of some programs and services may change from a regional responsibility to a provincial level responsibility. A provincial health organization, called Shared Health Inc. (formerly Diagnostic Services Manitoba Inc.) has been created to provide centralized clinical and business services for all of the regional health authorities and other health-care entities. Some programs or services associated with the Winnipeg Regional Health Authority may transition to Shared Health Inc.
"The purchaser under this RFP is St. Boniface General Hospital (SBGH). The implementation of the strategy is out of scope for this RFP."
"It doesn’t surprise me at all. I would say what’s behind (Shared Health), eventually, is probably the dissolution of the regional health authorities," said Manitoba Health Coalition board member Colleen Bytheway. The coalition, which includes current and former health care professionals, was formed in response to the province's health-care reorganization under the Tories.
"I wouldn’t be surprised if they do away with RHAs, but they’re not saying that right now, and I don’t anticipate that they will be very transparent about it."
A recent St. Boniface Hospital request for proposal to build a new wayfinding system states during the "transformation" of Manitoba’s health system, "some programs or services associated with the Winnipeg Regional Health Authority may transition to Shared Health Inc."
Those types of clauses are now standard on bid opportunities, the province said.
A RFP seeking computer software (Cisco Systems products) for the WRHA is deliverable straight to the "purchasing department of digital health, Shared Health."
However, "There are no plans to consolidate the Winnipeg Regional Health Authority into Shared Health," a spokesperson for the province said, referring further questions to the Health System Transformation Blueprint for Change.
The 2018 report promises more clarity about Shared Health’s role is coming, as it becomes involved in everything from procurement to emergency medicine to the operation of Winnipeg's Health Sciences Centre.
Other provinces have consolidated regional health authorities in recent years: Prince Edward Island, Nova Scotia, Alberta, and just last year, Saskatchewan. Ontario is cutting 400 jobs as it consolidates 20 local health authorities and agencies such as CancerCare Ontario.
"They might be doing something similar to what the Ford government in Ontario did, which is to set up a giant super-agency, a giant RHA," said Manitoba Liberal Leader Dougald Lamont. "It still means that a whole bunch of decisions are going to be made by an organization that has real accountability problems."
If elected, the Liberals would merge regional health authorities into Manitoba Health, with the ultimate goal of more local control at hospitals, clinics and care homes, he said.
Bytheway said regional health authorities were supposed to put decision-making in local hands and save on bureaucracy, but they haven’t been effective at either. Neither has Shared Health, she said.
"I think what (Shared Health) has done right now, unfortunately, has added another level of administrative people to the system, which we don’t need," Bytheway said.
Consultation has been a problem throughout the health-system changes, said Manitoba Nurses Union president Darlene Jackson.
A law revamping Shared Health's role was introduced in March; among other changes it would allow the provincial health authority to directly run hospitals in any health region. The NDP blocked the bill from passing this spring.
"It really centralizes power in the hands of the minister of health and Shared Health," Jackson said of the Regional Health Authority Amendment Act. "It really takes away from the role of the regional health authorities."
"The fact that they’re proceeding when (this law) hasn’t even been passed by the legislature is also a big concern," added Lamont.
Jackson noted rural and northern communities have unique needs that are difficult to address from Winnipeg.
"The farther decisions are made away from the beside, the less they are about actual patient care," she said.