Friday, February 05, 2010

Children's ministry shunning recommendations to help kids

The ministry of children and families is a competency test for government. The Liberals, like the NDP before them, are failing.

They bungled the ministry in their first four years. As the scandals mounted, the government asked Ted Hughes to review the problems.

He blamed botched restructuring and budget cuts, in part. And he made 62 recommendations, including restoration of the independent oversight the Liberals had eliminated.

Premier Gordon Campbell promised to adopt them all. He appointed Mary Ellen Turpel-Lafond as Representative for Children and Youth. Oversight and advocacy and complaint resolution were important for children in trouble, the government conceded.

But four years after the Hughes report, the ministry is ignoring the office. And Children's Minister Mary Polak looks badly out of touch.

Turpel-Lafond reports to a legislature committee, which met this month for an update. She told the MLAs most ministries had responded to her recommendations in two reports from last year.

But not the children's ministry, which had by far the largest role. Polak told reporters she was "perplexed." Not once, but 11 times in a 16-minute scrum. ( has video.)

"We have been regularly meeting with her," Polak said. "She's aware of how we intended to be responding. Some of the reports, of course, have yet to be responded to. Some we have responded to."

The representative was clearer.

She told the committee about Kids, Crime and Care: Health and Well-Being of Children in Care, released last February. It found children in the government's care - some 9,000 this year - were more likely to be involved with the criminal justice system than to graduate from high school.

We claim responsibility for these children and then fail them. The report, delivered to the government a year ago, remember, had sensible recommendations.

Take one. After studying the factors that snared children in crime, the representative recommended that each time a child was involved with the justice system, the plan of care would be reviewed within 30 days to include steps to deal with the criminal behaviour.

If your son or daughter got in trouble, Turpel-Lafond told the committee, that's what you would do. You would look at their stresses, their friends, whether drugs are a problem. You would do everything to get them back on track.

And children in care need the same help.

The recommendation called for the ministry to have the first step - a plan to report quarterly on children in care involved with the justice system - by last November.

But a year after the report, the ministry hasn't responded to the recommendation.

It doesn't have to adopt the measure. The ministry could judge the recommendation not needed or impractical. "It's perfectly fine," Turpel-Lafond said, "to say we reject your recommendation."

But some response is required.

"In order for oversight to work and for change to happen when we do major pieces of work like this, there has to be engagement," she said.

And in her view - not really refuted by Polak - there has not been.

The second report, completed last July, dealt with the terrible story of a baby taken from his parents because they couldn't afford housing. He was injured and permanently disabled while in care. Now he is back with his parents.

The representative's first recommendation said that by Jan. 1 the ministry should have a policy for front-line staff that every effort should be made to avoid taking children from their parents because of poor housing. (Children need their parents and it's cheaper to help with housing than to pay for foster care.)

The ministry, Turpel-Lafond said, has not responded.

Something has gone wrong. If the process were working, Polak wouldn't have been perplexed.

Even days later, when the Public Affairs Bureau released its written statement on the problems, there was nothing about the ministry's actual response to the recommendations.

Polak is to present at the committee's next meeting on March 3. She needs to have real answers.

Footnote: It's unclear why the process has broken down so badly. But Polak or the committee is going to have to find a way to get it back on track.

Wednesday, February 03, 2010

Once more, the Danes provoke us

We are, once again, on the brink of conflict with the Danes, this time over shrimp.
It does seem a little odd that a country that destroyed the East Coast cod fishery is claiming the high ground on conservation.
But it does give me an excuse to post this column from 2005, when Hans Island loomed as our own Falklands.

A father’s advice, on the eve of war with Daneland

VICTORIA - Son, I know you’re ready to serve your country.
Art school is fine. Perhaps you’ll go back there some day.
But right now, it’s important to stand up to the Danish war machine, before they launch a sneak attack from Daneland and crush the non-existent inhabitants of Hans Island.
No, that’s not near Saltspring. Don’t you students watch the news?
Hans Island is in the north somewhere between Greenland and some Canadian cold place. Defence Minister Bill Graham angered the war-mongering, cheese-loving Danes when he flew over the island in a helicopter and, in a rare carefree moment, said ‘Hey, let’s land on that rock and take some pictures.'
Provocation, the Danes whined, scoffing their fancy open-faced eel sandwiches. Eel sandwiches, son. These people are barbarians, who have never even grasped the concept that a sandwich requires two pieces of bread.
Now the Danes are ready to do battle to try and take away an important Canadian rocky outcrop, which they falsely claim as their own.
Sure, Hans Island is nothing special. A flat rock in a cold ocean, about 100 metres wide and 3,000 metres long. Even birds aren’t dumb enough to live there, and based on that penguin movie they are not picky.
But darn it, son, Bill Graham says it belongs to us. And if we aren’t willing to support a man who has spent a lifetime travelling the world preaching the Gospel in overheated arenas, can we really be Canadians?
Yes, it’s a useless lump of rock today.
But wait a few centuries and global warming will turn Hans Rock into a strategic must-have, our government says. Cruise ships and oil tankers will be booting it through the Northwest Passage as if it was a police-free shortcut home from the bar on Friday night.
Hans Island could be our toll booth, or help us protect the environment, or something. And maybe there’s oil, or kryptonite, waiting to be discovered.
Anyway, that’s not the point, son. This is about sovereignty, and national pride.
Those Danes are laughing at us, an insult made more cruel because of their normal melancholy. They’re taking breaks from watching their beloved women’s handball games to sneer at our way of life, wandering around with their freakishly large dogs, munching their beloved Danish pastries, telling each other Canadian jokes.
They’ve been tormenting us for years, those Victor Borge loving lowlanders.
Consider Ole Kirk Christansen, his company supposedly making ironing boards, stepladders and wooden toys, flying under the radar. In 1955 Christansen struck, unleashing Lego. Three generations of Canadian parents have spent the best years of their lives on their knees each evening, picking up hundreds of tiny plastic blocks, inevitably missing the ones that will later stab into their heels.
The coming conflict won’t be easy, son. It took Germany less than four hours to conquer Denmark in 1940, but we aren’t Germany. Denmark has about twice as many tanks as Canada, and air and sea forces are evenly matched. (Although we outnumber them six to one in population.) We need to negotiate rules of engagement that allow some sort of time-out if anybody gets hurt or one of our submarines catches on fire.
I know what you’re thinking, son.
Is this really your fight? How come I’m talking so tough for somebody who never fought anyone? Where is Daneland? What don’t Graham and his Danish counterpart fight this out on the island, with an appropriate split of the pay-per-view money? What’s with all the question marks?
But ultimately this is simple. The enemy isn’t just trying to take our freedom, or extract some revenge because Aqua was a global one-hit wonder. (Though Barbie Girl was catchy.) No, they hate our freedom, and our liberty.
It’s tough to go to war.
It’s especially tough when the whole conflict would have been ignored if it wasn’t summer and the media desperately short of real news stories.
But life is cruel. Good luck, son. Bring us back some cheese.
Footnote: The Danes have a secret weapon - “hygge.” Hygge is a Danish term for a happy life, suggesting a "warm, fuzzy, comfortable feeling of well-being," a life of good food, good company, wine, nice furniture, good music. The risk, of course, is that our brave young warriors may end up lounging on an oiled teak chaise, knocking back Aquavit and herring. Be strong, son.

Tuesday, February 02, 2010

Tough decisions on rationing health care

A Vancouver Province news story last month indirectly raised one of those health care issues no one wants to talk about.

Cutbacks would mean 2,450 fewer surgeries in the Lower Mainland, the article said. The excuse was the Olympics, but really it's a cost-cutting measure. (Otherwise, the lost surgeries could have been made up during the rest of the year.)

The reporter found people to put a human face to the story.

One woman said she urgently needed a new hip. "I'm in pain, but the medications they give me for pain make me sick," she told the reporter. "I'm confined to a wheelchair when all I need is hip replacement surgery."

She hasn't even been given a possible date for surgery because of the "Olympic slowdown."

Here's what stopped me. She was also 91.

Health care remains affordable; governments have just been reluctant to allocate the needed money, judging lower taxes a bigger priority. With good management and system reform, it will remain affordable. (Though we're lagging on both counts.)

But rationing care is part of the reality in the near term, longer if we don't improve efficiency.

And the notion of a hip replacement for a 91-year-old raises questions about just how we're going to decide who gets care.

Right now, it's informal. Specialists and committees make judgments about who should be treated first based on urgency and other factors.

Some people are constantly bumped down the list. It's tough to have confidence in fairness. (And of course, people with money pay for private care - supposedly illegal - to avoid rationing.)

We need to talk about the process honestly, to improve fairness and cost-effectiveness and to allow informed decisions about the current level of rationing.

The issue is sensitive. But better to discuss the criteria for rationing than to allow it to happen without any public input or assessment.

It doesn't need to be - shouldn't be - entirely arbitrary, based on age, for example.

But take a person of 91 in the queue for a hip replacement. A new hip can last 25 years. So spending the money on a 40-year-old buys many more years of benefit. The risks of complications or an unsuccessful outcome also rise sharply, according to recent studies.

Ideally, we decide both deserve timely surgery so they don't suffer and live shrunken lives.

But if that won't happen, we should be upfront about how and why the decision was made.

The discussion alarms people. For instance, should people who are seriously overweight have the same access to knee and hip replacements?

It's not a moral judgment. The surgery is riskier, outcomes poorer and the artificial joints don't last as long. A few years ago, some British National Health managers faced a budget crunch and quit doing knee and hip replacements for anyone with a Body Mass Index over 30. If you were five feet nine inches tall and weighed 205 pounds, no new hip until you lost weight. (Some doctors in B.C. take the same approach, but the system doesn't.)

The British National Institute for Health and Clinical Excellence looked at one of the most controversial rationing questions. What if the patient's illness is self-inflicted?

Should a child who needs a liver transplant wait in line behind someone whose illness is caused by years of alcohol abuse? After all, addiction is a disease.

The institute decided that what mattered was not past behaviour, but future prospects. A child with a new liver thrives; an alcoholic, statistically, is at high risk of returning to drinking.

This all started with the 91-year-old waiting for a hip transplant. But there are two issues. When do we want to say no treatment for you. It's not worth the money.

And how will make those decisions.

Right now, we pretend they aren't being made. That's cowardly, and it's keeping us from a serious health care discussion.

Footnote: Here's one of the most interesting numbers. Of all the health care costs you occur in your life, 35 per cent will typically come in the last six months. And then you'll die. Beyond efforts to improve your comfort, it hardly seems smart spending.

Monday, February 01, 2010

B.C. Lotteries woos mayor with free Games tickets

Good Michael Smyth column in The Province on what's happening to some of the Games tickets purchased with public money - specifically by the B.C. Lottery Corp.
It has offered free Games tickets and hotel accommodation from mayors in towns with mini-casino gaming centres and casinos. That's money that comes out of the pockets of losing gamblers and comes out of the profits that flow into provincial revenues. And the value is easily in the thousands of dollars.
Chilliwack Mayor Sharon Gaetz said no. It seemed wrong, and it also seemed illegal, she said. Municipal politicians aren't allowed to accept gifts under the Community Charter.
That raises a good question. B.C. Lotteries seeks lots of favours from mayors and councillors, from support for gambling expansion to support for eased liquor regulations (drinking gamblers lose more).
So how is this not an improper attempt to secure future favours, or at the least an effort that raises the appearance of impropriety?
And if B.C. Lotteries doesn't expect any future benefit, why is it giving away taxpayers' money?
Read Smyth's column here.

Class-size ruling means more stress on schools

This was already going to be a tough year for schools in B.C.

School districts have been closing classrooms and cutting costs for years now. Collectively, they estimate that they will be $300 million short of what’s needed to keep education quality at the same level after the March budget.

Trustees, of course, tend to be advocates for education.

But the government’s own numbers indicate a big problem for education in the province.

That was made more complicated by an arbitration award this month on the way class size and composition limits are handled by school districts.

At a time when districts are likely going to be looking at more oversize classes, the ruling means they will be paying more to teachers as a result.

Which will, in turn, lead to more oversize classes.

This all goes back to 2002. The teachers’ union and school districts had negotiated contractual limits on class size, with some flexibility.

The Liberal government used legislation to strip the provisions from contracts in 2002 and made it illegal for teachers and districts to negotiate any class size limits in future.

That turned out to be a mistake. Class sizes jumped in schools across the province. Parents weren’t happy.

In 2006, the government acknowledged the stumble and introduced legislation setting limits on class size and on the number of students in a class requiring special assistance.

It was a reasonable solution. For teachers, class sizes are a workplace issue. Unions usually deal with those in bargaining.

But the appropriate class size and composition decisions are also questions of educational effectiveness. Those decisions shouldn’t be made as a result of labour bargaining. Elected school trustees and MLAs have the responsibility and can be held accountable.

The government’s effort was flawed though. It didn’t give school districts enough money to comply with the law.

While the legislation allowed schools to have oversize classes, or more special-needs students in classroom, after consultation with the teacher, the process was poorly defined.

And there was no provision for enforcing the law.

So it didn’t work. In the 2008-09 school year, 3,336 classes had more students than the limits called for. Almost 11,000 classes had more than three students with special needs called for in the legislation.

Not all those were a problem. In many cases, teachers, principals and superintendents agreed the extra students could be accommodated, as the legislation envisioned.

But the arbitration award found that in many cases that wasn’t the case. Teachers weren’t really consulted and the class sizes violated the law.

The districts were ordered to give the teachers paid time off as compensation, which will mean higher costs.

The decision was based on small number of test grievances. The B.C. Teachers Federation said thousands more cases will now go forward.

This all comes as school districts are set to receive a funding increase of well under one per cent; at the same all costs are rising. Teachers, for example, are set for a two-per-cent base pay increase.

The Education Ministry’s response to the ruling has been dismissive. Not our problem, it says. School districts should sort it out.

But arbitrator James Dorsey didn’t see it that way. He noted that when the class size legislation was introduced, the government said it was needed to move toward the first of the province’s five great goals by making B.C. the “best educated” jurisdiction in North America.

If it’s that important, and if government took away school districts’ right to negotiate class sizes, then the government must provide enough money to meet the standards. Or it could change the law.

In short, the government can’t make a big deal about the importance of class size in education and then make it impossible for school districts to comply with the law.

It’s a useful ruling. Or it will be if the Education Ministry takes its responsibility seriously.

Footnote: The arbitrator’s judgment offered a reminder of the relevance of legislature debates. His interpretation of the law and its meaning was based in part on the explanation cabinet ministers provided in the legislature.