Who really runs health care in Manitoba?

Hey there, time traveller!
This article was published 06/08/2024 (470 days ago), so information in it may no longer be current.

It’s an obvious fallacy and yet, politicians, the media and unions continue to mislead — and in many cases manipulate — the public into a perception that has always been wildly untrue.

For the past several decades, Manitobans have been led to believe that politicians are to blame for everything wrong with our health-care system. For example, we are updated with the latest health-care wait times data every month. If those times are higher than the previous month, the health minister is guaranteed to face tough questions from opposition MLAs and reporters, followed by scorching commentary from columnists and editorial writers.

If there is a staffing shortage for a particular shift on a particular hospital ward, a health-care workers’ union will likely tweet about it and, again, the minister will be grilled under the bright lights.

If an ambulance breaks down, an ER overcrowds at the height of flu season, or there is a nursing shortage on a long weekend, it’s almost always the health minister who bears the brunt of the complaints from the public, the opposition and health-care workers.

All of those things happen with clock-like regularity in Manitoba, based on the misperception that the health minister has iron-grip control of every single aspect of our health-care system. The opposite is far closer to the truth.

In Manitoba, our health ministers exercise very little control over a few aspects of the health-care system, and zero control over most of it.

They are largely big-picture figureheads who, because of the concept of ministerial responsibility, are forced to take the heat and scorn for the mistakes of bureaucrats and health-care workers they, in many cases, have never met.

Stating the obvious: the health minister has no control over how many nurses or health workers will be working the graveyard shift on a particular night on a particular ward in a particular hospital. And yet, when something goes wrong during one of those shifts, it’s the minister who is often attacked by opposition politicians, the media and the relevant unions.

Health ministers fight for as much money as they can get for the health-care system, and then hand all that cash to their department’s senior bureaucrats. It is those civil servants who really decide the areas of the health-care system where that money will be spent, and how it will be spent.

In my five-plus years working in the premier’s office, I attended dozens of meetings regarding important health-care issues facing Manitobans. What I saw and heard bore no resemblance to the spin Manitobans often see from the opposition, the media and health-care unions.

I observed first-hand that health ministers don’t freelance their decisions. Every decision they make is based upon the advice of experienced bureaucrats, as well as senior doctors, nurses and other health-care professionals.

The problem the minister frequently faces, however, is that there is often no consensus among those advisers as to what the true nature of the problem is, let alone the solution. In many cases, different doctors will have completely different perceptions of an issue, and passionately different opinions as to what the correct response should be.

Discussions on complex health issues often involve a clash of egos among highly paid senior health-care experts, with the minister observing the debate from the sidelines. The challenge for the minister is deciding which of those experts’ advice should be followed and which should be ignored.

The minister seldom possesses the specialized knowledge required to competently decide which expert is right, so the decision is almost always made based upon the advice of senior civil servants in the department, and hoping it proves to be the right choice.

If things don’t work out as hoped, as often happens, the minister and government are blamed for a decision they likely played little to no role in making, and had even less of a role in implementing.

That’s the unrealistic, unfair level of accountability and criticism that health ministers are subjected to in our province. They pay the price for the mistakes of others in their department and/or other health agencies.

Viewed from that perspective, it’s fair to ask how we can reasonably expect our health-care system to improve if the advisers, decision-makers and implementers really running the system aren’t being held accountable.

Deveryn Ross is a political commentator living in Brandon.

deverynrossletters@gmail.com

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