Monday, October 28, 2002

The perils of high speed health change
By Paul Willcocks
VICTORIA - It sounds pretty ominous, the threat of even deeper health care cuts in the north.
And it didn't come from some alarmist. It was the Northern Health Authorities acting CEO who passed the bad news on to doctors and staff. Costs were running over budget after the first four months, he said, and the changes that were supposed to improve things were taking longer than expected. "If we do not deal with our deficit now there will be major service cuts down the road," warned Peter Warwick.
NDP Leader Joy MacPhail confronted the Liberals with the memo in the legislature, charging that it showed disaster is looming in the north.
Health Minister Colin Hansen said it's no big deal, just a small financial problem.
So what's the real story?
Here's the facts. Warwick, who was replaced this month by a permanent CEO, reported the massive health authority had shown a deficit of $1.3 million for the first four months of this fiscal year, when it had planned on a surplus of more than $2 million.
Mr. Hansen was quick to point out that the deficit is less than one per cent of the authority's budget. They're simply responding to the problem quickly as any good managers would, he said. And they're allowed to run a deficit this year, because the government recognizes that restructuring the health care system will be expensive. Several of the authorities are in a similar position.
All true. But it's wrong to downplay the significance of the problem. Even on a big budget, missing the targets by $3.3 million over four months is a serious gap - as the CEO warned. Projected over the full year, and it's a $10-million problem. And cutting $10 million worth of services is bound to do damage.
The health authorities are all struggling to find ways to provide better care at less cost. The budgets, set by the province, are not adequate to allow them to pay for already negotiated wage increases and maintain current services. They need to make cuts and savings.
So they're re-engineering and re-organizing and restructuring like crazy. But those things always take longer than expected. "Cost savings that we intended to have implemented by now have not completely materialized, which is affecting our bottom line," Warwick said in his memo. And general cost control, over things like overtime and sick leave, weren't having the effect the authority had hoped.
Those are familiar problems to anyone who has tried to re-organize an operation, large or small.
And so are the solutions. The memo urges managers not to fill vacant or relief positions, and says that cost-cutting initiatives that had been planned for the next two years would now be rushed forward. It's standard stuff for a cost-cutting organization.
Except this isn't just another organization. I used to manage newspapers. If we decided not to fill a vacant reporters' job to save money, stories were missed. The stakes are a lot higher in health care.
The memo is a reminder just how much pressure the heath authorities are under, caught between the Liberals' desire to control costs and the public's desire for quality care. They got more money this year, though not enough to deal with the cost pressures they faced.
But next year and the year after their budgets will be frozen, while their costs will still climb. Nurses get a general wage increase of 1.5 per cent next year, but most will also move up through the salary grid based on their experience, bringing their increase closer to five per cent. The health authorities will have to find that money from cutting within their existing tight budgets.
And they'll have to do it on the run, the organizational equivalent of changing a tire on your car while you're driving down the road.
Consider the memo another warning of just how wild that ride will be.
Paul Willcocks can be reached at

Librals back-tracking on openness
By Paul Willcocks
VICTORIA - For people who claimed to value open government, the Liberals sure seem eager to promote secrecy.
Back in the old days the opposition Liberals were quick to attack government secrecy. They were big users of provincial freedom of information laws, ferreting out the information that the government wanted to keep hidden. And they promised to bring more openness. But since the election, they've done nothing to strengthen the public's right to know and taken several steps to make it harder for you to find out what's going on.
The latest attempt to curb your right to information is unfolding in a stumbling fashion in the legislature . Among the creations of the new government were government caucus committees on key areas like the economy and health, an idea lifted from Ralph Klein's Alberta. The committees -- chaired by a backbencher -- are supposed to review polices and budgets. It's a good idea.
Cabinet discussions are protected under freedom of information law. The theory is that ministers need to be free to debate ideas and consider options, and that freedom would be lost if their discussions were made public. That protection is traditionally extended to subcommittees of cabinet ministers, like Treasury Board.
But the government caucus committees weren't covered. Half the members are MLAs, not cabinet ministers. They don't meet the legal test required to allow the government to keep their discussions secret, according to the independent privacy commissioner ruling. Faced with that ruling, the Liberals could have just made the information public.
Instead they rushed to change the law to keep things secret. And they did it by introducing changes to the freedom of information law that would have let government hide almost any committee behind a secrecy barrier. The Liberals retreated this week, sort of. They amended their amendment, to make it slightly harder to shield information.
But the new version still makes it easier for the Liberals to deny the public information that up to now has been a matter of public record. All they have to do is make sure one-third of the members are ministers and claim the committee is doing the work of cabinet. But in fact, it's hard to see why the committees should be protected from the law.
When they were established the Liberals had trouble deciding how open they would be. But after some confusion, Premier Gordon Campbell pledged that any time an outside group presented to the committees the meeting would be open to the public. That happened once, when the oil and gas industry made its pitch.
But since then a succession of special interest groups have made pitches to the committees, from the arthritis society to the hotel association, all behind closed doors. The public has no idea when the committees will meet, or who will be there. The Liberals have a poor record on respecting the public's right to know. They've already given themselves longer to respond to requests, increased costs and chopped the budget for the information and privacy commissioner. And reports -- like the work of the energy task force, or the group reviewing Pharmacare payment policies -- stay secret long after they have been received by government. It's a shame.
The Liberals used to welcome the public's right to information. Now they want to restrict it.

Paul Willcocks can be reached at