NAM revives the mullet

Like ugly fashion trends, bad ideas often rise and fall in cycles.

So it’s to be expected that sooner or later somebody would resurrect Nunavut’s public policy version of the mullet: regional health boards.

Enter the newly-revived Nunavut Association of Municipalities. In a resolution this past May, the organization called for their reinstatement. Later in the summer, Ron Mongeau, the SAO of Pangnirtung, and Paul Quassa, the mayor of Igloolik, talked it up in radio interviews.

They defended the idea by pointing to all the usual longstanding complaints about health care in Nunavut: the increased use of agency nurses, the territory’s terrible health indicators, and lack of transparency within the Government of Nunavut.

Most of these problems are real. But there’s not a shred of evidence to support the idea that a new layer of bureaucracy could ever fix them.

Take the agency nurse issue. Short-term contract nurses, who work for employment agencies, are replacing full-time nurses at many community health centres. Most patients don’t like this. They say short-term agency nurses don’t understand their health needs as deeply as full-time nurses understand their health needs.

But government policy is not the root cause of this issue. The root cause is the changing labour market for nurses. Since the mid-1990s, there have been more job vacancies for nurses than there are nurses.

This is a global problem afflicting numerous countries. In Canada, the Canadian Nurses Association estimates that this year, to fill all nursing jobs that are available, the country may need 70,000 more nurses than we now have.

As a consequence, many nurses have decided to use their bargaining power to get more money and freedom. They’ve decided that it’s in their financial interest to quit full-time jobs with the GN and sign up with employment agencies to work as short-term contractors.

In 2008, the GN responded to this by increasing its recruitment and retention bonuses for nurses and beefing up its nursing program at Arctic College.

Perhaps the GN should do and spend more. But creating new regional talk-shops for professional meeting-goers and local honorarium collectors will not change the global labour market for nurses.

Besides, an inexperienced health board, dabbling for the first time in complex human resource issues about which they know nothing, could do serious damage to the morale of health care workers and drive even more of them out of their jobs.

Another claim NAM makes is that health boards would provide “transparency and accountability.”

This is risible. All the available evidence, especially the sorry record of dysfunction produced in the 1980s and 1990s by regional health boards and other regional bodies, points to the opposite conclusion.

Mongeau ought to recall this. He worked on the creation of the Baffin Regional Health Board while serving as executive director of the Baffin Regional Council, which in 1993 collapsed under the weight of a $250,000 deficit, then sank without a trace.

In October 1997, Dave Ramsden, then the deputy minister of health for the Northwest Territories, produced a report for Kelvin Ng, then the territorial health minister, that showed health boards in Baffin and Keewatin operated with little regard for patient services and bungled numerous files, especially the recruitment of doctors.

Transparent? A typical regional body of that era was about as transparent as a granite wall: little financial reporting, no reporting on health care outcomes, lots of in camera meetings and other forms of secrecy.

In the Keewatin, health care delivery descended by early 1998 into a Third World nightmare: no doctors and a grave nursing shortage. At a meeting in Rankin Inlet in January 1998, Ng admitted to local leaders that the GNWT erred in giving regional health boards too much autonomy.

The GN is no paragon of accountability. But in Nunavut, at least people know who’s accountable when things go wrong: Nunavut’s 19 elected MLAs and cabinet ministers, the health minister especially.

So when the Nunavut government, after receiving a consultant’s report on this issue, decided in 2000 to pull the plug on the dysfunctional regional health boards inherited from the NWT, the people of Nunavut gained a health care system that is easier to understand and falls under the direct control of a democratically elected legislative assembly. This is as it should be. JB