GNWT will keep closer tabs on health boards
Two of Nunavut’s three health boards made major changes without considering how they affect patients, a team of GNWT bureaucrats say.
IQALUIT Senior health board staff in Nunavut failed to plan adequately for changes in the delivery of medical services.
That’s one message contained in a bureacratic review of the Baffin and Keewatin health boards tabled in the legislative assembly last week by Health Minister Kelvin Ng.
Now that those changes are underway, patients in both the Keewatin and Baffin regions face disruptions in medical specialist services, a territorial government review has concluded.
The review was prepared for Ng by five senior bureaucrats under the supervision of deputy health minister Dave Ramsden, and made public last week.
The report recommends that the NWT health department monitor more closely the operations and programs of health boards.
“The department should also play a key role, along with other stakeholders, in addressing the serious situation of recruitment of physicians in the NWT,” the report states.
In general, investigators found that doctor recruitment in the Northwest Territories is currently handled on a “crisis basis” by senior health board staff.
Little consideration for patients
And although the authors of the review stopped short of assigning blame, their investigation into recent controversial health board proposals found that neither board gave thorough consideration to the effects of these changes on patients.
The Keewatin board ended its contractual relationship with the University of Manitoba’s Northern Medical Unit last April and is currently trying to recruit its own general practitioners. The Baffin board voted unanimously on Sept. 23 to move its contract for medical services from Montreal to Ottawa.
In the case of the Baffin Regional Health Board, for example, the authors found that “no documentation exists that explains how the board decided to make the move [to the Ottawa Health Insititute], what the move involves or what the exact services will be.”
The report also questions the capability of the Ottawa Heart Institute to provide Baffin residents with specialist services, the range of hospital services, boarding home services and patient-travel management that they used to receive in Montreal.
No transition plans
Although the Baffin health board intends to enter into an agreement “with some form of not-for-profit corporation to provide the services,” the report found that this corporation has not yet been formed, nor has any transition plan been put into place.
In the Keewatin, investigators found “no documented contingency plan… in place to a address current or future physician shortages.”
The report predicts, furthermore, that Keewatin residents will experience a shortage of general practitioners that is expected to last three to four months.
“The shortage of general practitioners in the region will mean an increase in medical transportaion of Keewatin residents,” the report concludes.
Relations between KRHB and NMU broke down
In the case of the Keewatin, the report’s authors suggest that strained relations between the health board’s executive director and the director of the Northern Medical Unit (NMU) contributed to the collapse of negotiations for a long-term physician services.
Despite being close to a settlement with NMU, the health board decided to start its own physician recruitment program, according to its 1993 Keewatin regional health services plan, prepared by the consulting firm Resource Planning Group Inc.
“While negotiations were still going on, the board had been trying to hire other doctors to work in the Keewatin under contract with the board,” the report says.
Although “no documented plan exists to bridge the services provided by NMU to those to be provided by the board” the authors of the review acknowldege that the board is working toward putting these services in place.
On the basis of these findings, the department recommends that each health board:
submit to the health department by the end of October a schedule of visiting specialist services in their respective region;
prepare and implement immediately a communication plan that informs residents and caregivers of the board’s intentions and actions;
draw up a transition plan for new service arrangements.
In addition, the department has urged the Keewatin Regional Health Board to advise the health minister on how many general practitioners are currently available to Keewatin residents.
The report has further recommended that the Baffin Regional Health Board not enter into any arrangments with the Ottawa Heart Insititute until completing a cost-benefit analysis of the proposed change in services.