Friday, September 22, 2006

A better way for klds in care

VICTORIA - Life is tough for children in the care of the government.
That’s not a slag on them, foster parents, social workers or the Liberals or New Democrats. It’s reality. Children in care have a tough time. Their lives - in care and after - are typically a struggle.
A new report from provincial health officer Dr. Perry Kendall and child youth officer Jane Morley confirms the problems and suggests useful areas for more research.
Most importantly, it suggests things that we can do now to start fixing the problems.
The report is groundbreaking, which should give you satisfaction that it was done and frustration that it’s taken so long. The study looked at the lives of more than 12,000 children in care between 1997 and 2005 and tracked their health-care records.
It was grim. Children in continuing care were five times as likely to commit suicide. They were 10 times as likely to end up in hospital as an assault victim. They were four times as likely to die.
Girls were four times as likely to become pregnant. Ten-year-old boys were 10 times as likely to be on Ritalin or other behaviour modification drugs.
Stop and reread those last two paragraphs and consider the odds for a little five-year-old boy starting his school years in the government’s care, toting his possessions in a cardboard bos as he starts his life with strangers.
This all shouldn’t be surprising. Children don’t just suddenly end up in the government’s care. They tend to come from troubled backgrounds. They suffer from malnutrition, fetal alcohol issues, neglect and all the illnesses and disadvantages that poverty brings. Messed-up parents have messed-up kids.
But so what?
If our own kids have problems, we don’t write them off. We work harder to do whatever it takes to give them the best chance.
These children and youths, whether we like it or not, are our responsibility too. They don’t have anyone else; that’s why they are in care. We, as a society, said we’d look after them.
And we do a bad job. We’re cheap, inattentive and callous. The Children’s Commission final annual report, in 2002, found that half the 9,700 children in the government’s care didn’t have the required care plans to provide direction and stability to their lives. At the same time, we watched as the government cut the ministry budget to save money. A tax increase worth 50 cents a week per British Columbian would change everything for these children, but the goverment has calculated that we don't think it's worth spending the money.
So what do we do? For starters, press the government to accept all 13 recommendations from the report. Children and Families Minister Tom Christensen seemed supportive, but ministers almost always do. Action does not necessarily follow.
For a specific test, watch to see what Christensen does about the report’s recommendation that the government come up with new funding for a cross-ministry plan for “post-majority supports for youth leaving care.”
Right now, children who have spent their lives in foster care and considered fully capable adults as soon as they turn 19. They get $700 and are sent out into the world to find a job and an apartment and make a life. "There's really no post-majority programs in place with the ministry of children and families," Morley said as she and KEndall released the report. Basic support, like counselling and help with budgeting or looking for work or considering school options doesn’t exist.
That’s cruel and stupid. The study followed who had been in care until they were 25. Unsurprisingly their problems continued and their risks of suicide, injury and mental health issues remained high. So did their pregancy rate. Young women barely able to care for themselves were much more likely to end up trying to care for bay.
Shamefully, the government is now appealing a B.C. Supreme Court ruling that it couldn’t arbitrarily cut needed support the day someone turns 19.
Christensen is new in the job. If, in the next 60 days, he can announce new funding to provide the needed support for children in care - as the report recommends - you can be optimistic that perhaps things will begin to get better for these children.
The first steps forward have been set out. Now we’ll see if the government is interested in improving the lives of these children and youth.
Footnote: There was good news in the report. While things may be bleak, in a number of areas - including mortality rates - there has been a steady improvement over the last two decades and a narrowing gap between the prospects for children in care and their peers in the rest of the population. It's important to celebrate successes.

Thursday, September 21, 2006

NDP’s patronage charge falls short

VICTORIA - The agency that produced the Liberals' election campaign ads was pretty steamed when the government decided to hold an open competition for a $150,000 contract to prepare anti-smoking ads.
Wait a minute, the people at TBWA/Vancouver said. No fair. We won the right to be the health ministry's ad agency. That's supposed to be our work.
Managers in the health ministry and the government's purchasing branch disagreed, pointing to government policies that they said called for open competition for all contracts worth more than $100,000.
TBWA/Vancouver started complaining to the health ministry as soon as the call for proposals was listed on the BC Bid website in late August 2004.
And eventually, after much confusion, internal panic and considerable wasted time and money - on behalf of taxpayers and the companies competing in good faith for the work - the bid was pulled.
TBWA was awarded the contract, over the spirited objections of some of the people involved in directing the anti-smoking campaign.
The NDP, brandishing almost 300 pages of documents obtained through a freedom of information request, this week accused the Liberals of political favouritism in awarding the contract. TBWA hadn’t hadn't just prepared the Liberal ads in the last two elections, the NDP noted. President Andrea Southcott was part of a small group of senior campaign advisors. The company had also prepared the “Best Place” government campaigns run in the lead-up to the election that looked much like Liberal campaign ads.
The government broke its own purchasing rules and over-ruled staff to reward its favoured ad agency, charged NDP finance critic Bruce Ralston.
Nope, said Finance Minister Carole Taylor. It was a mistake to call for competing bids and the government fixed it. Case closed.
So who to believe?
It’s confusing. Government policy, driven in part by a Canada-wide agreement on trade, does call for competitions for all contracts worth more than $100,000.
But the policy also allows for exceptions when there is a “corporate supply agreement.” If a government has signed a multi-year agreement to buy all its vehicles from one supplier, it doesn’t have to seek bids when it’s time to buy a batch of new heavy duty trucks worth more than $100,000.
Or, as in this case, when it wants to spend more than $100,000 on an ad campaign.
The concept of an agency of record is fading, but still convenient and popular in government. The idea is that you hold one contest and pick an ad agency that will get the ministry’s work for the next two years. The theory is the agency develops some expertise and the ministry is saved the time and trouble of seeking bids every time it wants to run some ads.
And there’s no suggestion that the selection process for agencies of record was faulty; it was endorsed by an internal audit.
On balance, the government did a pretty good job of rebutting the NDP charges.
But it didn’t emerge unscathed. If the policy of not seeking bids was in place, a lot of fairly senior people in the health ministry and the government’s purchasing department didn’t know about it.
And if the case was so clearcut as Taylor maintains, the government’s response to TBWA’s complaint was baffling.
The call for bids wasn’t cancelled for six weeks, until until after it had closed. During that time staff were involved in answering questions from bidders and setting up the assessment process. (And in trying to get clear answers about the pressure to cancel the whole thing.) Two other ad agencies were shortlisted for the work. The process finally stopped the day before they were to be interviewed by the selection committee.
The confusion and disorganization wasted a lot of time. The government’s public affairs bureau said it would take responsibility for compensating the two agencies for their wasted efforts, though it’s unclear if they actually got money.
The favouritism charge wasn’t proved. A charge of bungling would have stuck.
Footnote: In a strange twist, the NDP revealed the freedom of information request was made by NOW Communications, which was snarled in its own scandal over its dealings with the Harcourt government.

Tuesday, September 19, 2006

Minister's MRI answers just create more questions

VICTORIA - It started to feel like a "Yes Minister" episode as Health Minister George Abbott attempted to explain just what he's doing - and not doing - about paid queue-jumping in B.C.
Reporters caught up with Abbott on his way into a Liberal caucus meeting Tuesday, looking for an update on the latest case of a public hospital selling special access for people who didn't want to wait in line.
The issue has kept Abbott off balance for almost two weeks, since NDP health critic Adrian Dix revealed that patients were paying to jump the waiting list for MRIs. A private company, Timely Medical Alternatives, cut a deal with St. Paul's Hospital in Vancouver. Pay the company up to $1,400 and you could avoid the average four-month wait for a non-urgent MRI.
Abbott first doubted the reports. But once a patient came forward and described making the payment, he denounced the practice, which violates  the Canada Health Act, provincial law and government policy. He asked his deputy minister to investigate and then offered assurances that St. Paul's was alone in violating the policy.
Until this week, when news broke that Mount St. Joseph Hospital, also in the Lower Mainland, was cutting the same deal for CT scans and other diagnostic tests.
So how come, Abbott was asked, he didn't know about this second infraction? Did the hospital or health authority not know about the provincial policy, or were they concealing the information?
No, no, said Abbott, nothing like that. But the deputy minister likely just asked the health authorities if they were selling access to MRI machines - not CT scans or other equipment. And they didn't volunteer the information.
So the deputy minister wasn't asking the right questions then?
"I think that one always builds on one's understanding of these issues and one is able to ask more, further questions that further illuminate the situation," said Abbott.
Yes, minister.
One of the themes of the British political sitcom was the usefulness of keeping the minister out of the loop about unpleasant issues. That seems much like what has happened in this case.
And it sounded much like ministry officials and the health authorities have been playing some strange game, a combination of 20 Questions and Catch Me If You Can. The deputy ministry asked if patients were paying to jump the waiting lists for MRIs. The health authority said yes, or no, without feeling it necessary to add that they were paying for speedier access to CT scans or other tests.
Which led, naturally, to another question for Abbott. How do you know that health authorities aren't also cutting deals with private companies to let people jump the queue for surgery? Is the deputy asking the health authorities that question?
"I don't believe he is pursuing the issue of surgeries at this point in time," said Abbott.  "What we do is that where issues are raised or complaints are made then we pursue,  through either the ministry or through the Medical Services Commission or through the College of Physicians and Surgeons, whether in fact the complaint exposes something being done outside of policy."
"I don't believe that either I or my deputy or his team have unfilled days to go and look for issues that we don't know exist," Abbott added.
But how would the ministry know if the Canada Health Act or its own policies were being violated? The health authority making money by selling access wouldn't raise the issue. Neither would the private broker. And most patients who could afford the prompt treatment would likely pay and keep quiet.
"Are we sure that there are no surgeries that are going on," Abbot asked himself. "I don't believe that in as large a health-care system, as we have in British Columbia that we can be 100-per-cent certain of that."
Just don't expect much of an effort to find out if the practice is happening, or how widespread it has become. Footnote: Abbott also said the Vancouver Coastal Health Authority hasn't explained why it was violating the policy, which was set out in 2002. As well as barring two-tier care, the policy requires the health authorities to check with the health ministry if there's any doubt about a planned practice or charges. The authority won't say how much it charged the private company for the service.