Improvement for patients or window dressing?

In today’s contested, turbulent public opinion environment, governments increasingly use carefully selected words as a way to shape positive public beliefs about proposed legislation. The public needs to look beyond the symbolism of political language in bills in order to understand what will actually happen as a result of proposed policies.

Bill 27, The Declaration of Principles for Patient Health Care Act, is a showcase bill of the Kinew government in the health-care field. Bill 27 was promised in the throne speech in November last year, and is now before the legislature for debate and potentially for public hearings before a legislative committee.

The intention of the bill is to improve the patient experience, which is a laudable goal. My concern is how much positive change its provisions will produce. The throne speech promised a “charter of patient safety” and in an article on Dec. 2, I raised concerns about whether that phrase might lead to the public belief that the intention was to create legally enforceable rights for patients in their interactions with the different parts of the health-care system.

It is now clear that it does not go that far.

Provision 5(1) of the bill declares it does not create rights or remedies under any other enactment or the common law. Provision 5(2) indicates that a failure to comply with any provision of the proposed law cannot be the basis for legal action in court or before any other body/person having decision-making authority.

Reading further, Bill 27 gives rise to ambiguity and uncertainty about the extent to which it will, in practice, promote and protect patient rights and patient safety beyond the multiple mechanisms that already exist throughout the health-care system.

The preamble to Bill 27 declares a commitment to the principles of the Canada Health Act ( such as comprehensiveness, universality and public provision) and to patient-centred care. This seems intended to reinforce the long-standing NDP defence of medicare and its suspicion that the PCs will engage in privatization of health care by stealth.

Section 3 of the bill sets forth a lengthy list of principles/values which patients can legitimately expect in their encounters with the health-care system, such as: respect, timely access, safety, privacy, clear communication, participation and the opportunity to raise concerns. The health department, Shared Health, Manitoba’s five health authorities and the many front-line health-care delivery organizations are required to post the list of patient expectations online and in a prominent location within their institutions.

It is unclear whether such postings will make much difference in helping patients who encounter difficulties in their interactions with the health system. Such aspirational statements already exist in different locations, such as the Charter of Patient Rights and Responsibilities that exists at St. Boniface Hospital. Most health institutions also have “safe to ask” and/or “speak up” programs meant to encourage patients to raise their concerns.

To assist patients, Section 4 of the bill would require that the health department, the five health authorities and each health-care delivery organization establish a patient advocacy office and publicize its existence.

It is unclear what is entailed in function of patient advocacy. Here are some fundamental questions about the role that will need to be asked and answered.

Will advocates understand their role as doing everything possible to resolve patient concerns but stop short of taking sides in disputes? Or, to redress a real or perceived imbalance of power between patients and health professionals/administrators, will advocates see their role as defending the rights and concerns of patients?

At a minimum, one might expect advocates to ensure patients know their rights, help them to navigate in a complicated system and commit to conveying their concerns to health professionals/ administrators. If they are also expected to mediate disputes between patients and health officials, they may face a real or a perceived conflict between their commitment to patients and their loyalty to their employers.

These are not abstract issues. All hospitals in Winnipeg used to have a position called the patient representative. Based on a concern that the title implied the patient representative would always champion patient rights or concerns, a switch was made to the title “patient relations office.” It was also argued at the time that patient rights and concerns were everyone’s business.

It is unclear where the proposed advocates will be located within hierarchy of health-care organizations, and how closely they will work with the existing patient relations offices and with the risk management officials whose job is to mitigate legal liability arising from unwanted events happening in the health-care system.

The anticipated role of the advocate position seems to most resemble the traditional ombudsman functions of informing, investigating and recommending, but stopping short of being able to issue binding orders.

Currently Manitoba has a general ombudsman, but not a specialized health-care ombudsman like that which exists in Ontario and Quebec. Manitoba’s ombudsman can investigate complaints within institutions that are part of the province’s five regional health authorities. However, few patients know that this service exists and, as a consequence, relatively few cases arise in the health-care fields. If advocates become active more cases might be brought to the ombudsman.

As the minister of health probably knows better than anyone, enshrining high-minded principles in legislation will not address the severe strains on the health-care system. Hopefully, Health Minister Uzoma Asagwara will explain in the second reading debate and in a public hearing before a legislative committee how the positive words of Bill 27 will translate into tangible improvements in patient experiences.

Paul G. Thomas is professor emeritus of political studies at the University of Manitoba.