Two decades of big govt management jeopardising British Columbians’ access to healthcare
The primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers, according to the Canada Health Act.
After two decades of big government management in British Columbia, through the five health authorities, many British Columbians are finding that they don’t have reasonable access to health services, particularly in rural and remote areas of the province.
Not a week has gone by this summer, when there hasn’t been at least one ER closure in Northern Health, despite assurances that the health authority was working to solve the issue. A closed ER in northeastern BC means that not only do residents not have reasonable access to emergency health care, but they often have to travel unreasonably long distances to find an ER that is open.
“I sure hope we don’t see closures here, Fort Nelson and Dawson Creek, because it’s a long trip after that."
Fort Nelson-Northern Rockies Regional Municipality Mayor Rob Fraser
For example, BC residents who live north of Fort Nelson, where the nearest hospital is located already have to travel great distances for health care.
“If our emergency room goes down, we have to come here,” Fort Nelson Mayor Rob Fraser told participants the recent Rally for Better Healthcare, organized by MLA Dan Davies in Fort St. John.
“You spend three and a half, four hours just getting to Fort Nelson to find out that the emergency room is closed, and you have to make another four-hour trip to here, if that emergency room is closed it’s another hour (to Dawson Creek).
“I sure hope we don’t see closures here, Fort Nelson and Dawson Creek, because it’s a long trip after that,” Fraser said.
While there has been a shortage of doctors in northeastern BC since the 1990s, Fraser believes the problems we’re experiencing today with ER closures and a chronic shortage of healthcare staff across the board, really began in 2001, when then-premier Gordon Campbell and his Minister of Health Planning Sindi Hawkins, reduced the 52 health boards down to a mere five health authorities.
The move was designed to “minimize the duplication of administrative services that are adding to confusion and cost,” Fraser said. At the time, the 52 health boards between them had some 600 people in administration. There probably were too many health boards and administrators, Fraser acknowledged, but those 600 people were those who were there to do their best for their communities and the system.
“One of our fears, back in 2001, was that the geographic regions were going to be too large, because they went from 52 to 5,” said Fraser who was on the North Peace Health Board in the late 1990s.
“The loss of local influence over the system, the loss of understanding of what the local cultures were – was it good to work there, did it feel good to work there? We were acting as healthcare governance back then; we could interact with the people in our communities who would tell us what the culture was within our facilities. If it was going bad, we could have a discussion at the board table with the leaders and let them know that things were going sideways. They were responsive to us. That’s not happening anymore.”
Nothing has changed for the better since 2001. There are still unpredictable and unacceptably long waits for treatment, and inconsistent quality of care in the province.
“All they’ve done is take the locally elected community people out of the system – the new structure was supposed to eliminate duplication and costs. That’s why we’ve asked for the audit. We want to see exactly what the administration of healthcare, particularly Northern Health looks like,” he said.
“They don’t represent you or the region. They represent Northern Health.”
When the NDP came to power in 2016, they took 15 years of bad healthcare policy and made it worse.
“Basically, they took governance and policy underground, communication was silenced. Regional Health Authorities were not responsible or accountable,” Fraser said. “You couldn’t talk to them about what was happening in your area, and there were no representatives from our area because those representatives that were being appointed from here were being told that they were representing Northern Health, not the people.”
On top of that, authority for recruiting foreign-trained healthcare workers was passed from the province to what Fraser called gate-keeper organizations, who made it nearly impossible to get anyone foreign-trained into BC’s system. What has that resulted in? Nothing more than ever-increasing shortages of doctors, nurses and other vital healthcare workers.
The impact on healthcare, particularly in the North has been profound. Fort Nelson, for example, used to have a full-service hospital. Now, expectant mothers have to travel all the way to Fort St. John to deliver, or Dawson Creek if the Birthing Unit at Fort St. John Hospital is closed as it was recently.
By centralising services like addiction treatment and recovery in Prince George, residents of the North are being denied reasonable access to healthcare. Fort St. John has an Overdose Prevention Site, and some day services for people with addictions and mental health issues, but the nearest proper facility is a five-hour drive, and weeks on a waitlist away.
“The decision was made without warning or notice, to pull our ambulance from Hudson’s Hope to cross-cover in another community.”
Hudson’s Hope Mayor Travous Quibell
There’s also the need for more senior’s housing. Peace Villa, Fort St. John’s only long-term care facility has been full since it opened in 2013. The business plan for a third house at Peace Villa has been approved, but two years later there’s no indication if or when it will be built. Meanwhile, dozens of seniors have to wait for a fellow senior to die, in order to get moved up the waiting list.
Fort St. John Mayor Lilia Hansen, says that the community has come together to improve the situation where it can, such as by advocating for the Northern Baccalaureate Nursing Program through Northern Lights College and UNBC.
“We appreciate the successes that have happened, but we’re not seeing the changes that we need,” Hansen said. “We need to have the care, whether it’s to bring a beautiful young baby into this world, or to help seniors as we age in place. I am asking for the provincial government to listen to our voices, listen to our actual examples and what happens to us. If we don’t have the healthcare that we need, we need to have those tools and resources to support our healthcare workers for when we need that help.”
Hudson’s Hope is another example of Northern Health and the provincial government failing to provide health services to residents. According to Mayor Travous Quibell, Hudson’s Hope is the only community in the region with a part-time BC Emergency Health Service station. The community’s health centre is also closed on weekends. So, if there is an emergency, residents rely on the ambulance to get them to an open ER. But on several occasions, when there’s been an ER closure, the ambulance was taken to support other communities in the region, leaving Hudson’s Hope with nothing.
“Imagine not having an ambulance available and have to drive yourself, broken and bleeding,” said Quibell.
That was very nearly the case a couple of weeks ago during Hudson’s Hope Rodeo. Chetwynd’s ER was closed. The closest available emergency care was in Fort St. John, an hour’s drive away. The ambulance was off serving another community.
“The decision was made without warning or notice, to pull our ambulance from Hudson’s Hope to cross-cover in another community.”
When a Code 3 emergency call came in, the ambulance returned. What Quibell said should’ve been a 5-minute response time, was over an hour. When the ambulance arrived in Fort St. John, two people were injured at the rodeo with severe broken bones. Two ambulances and an advance life-saving unit were dispatched.
“Luckily for the two individuals, broken bones are serious, but not life-threatening,” Quibell said. “It should’ve been minutes to see the attention of a professional EMT, it became hours. If Fort St. John had been closed, if the ER was on diversion, it would’ve been Dawson Creek or further.
“These are serious issues and they dove-tail into the overall picture of health in the northern region. Our rural areas all suffer from the same issue. We don’t have a hospital on every street corner, we are hours and in some cases hundreds of kilometres away from help,” he said.
“Regional health board governance is too isolated from the needs of the public. That needs to be changed.”
Mayor Rob Fraser
As the speakers emphasized several times, the problem is not the doctors, nurses, technicians and other healthcare workers in the communities. The problem is the way Northern Health, and indeed the province’s entire healthcare system, operates.
Davies organized the rally in order to get the government’s attention and illustrate the urgent need for an audit to find out where and how things can be improved. Denying access to vital health services, such as emergency care, is unacceptable to local politicians and residents alike.
“When there are ER diversions, that deeply impacts communities, and we’re hearing from our residents the frustration, the anger, the fear – this can be a life and death situation. Having access to quality healthcare is imperative to a community for its vibrancy, and its sustainability,” said Hansen.
A large part of the problem, is that the health authorities are way too big, Fraser said, and suggested breaking Northern Health up into three operational areas; northwest, central and northeast.
“Bring those budgets back here, appoint local representatives for a local health board. There’s an opportunity for all of us, the public, to get back into the system,” Fraser said.
Regional health board governance is too isolated from the needs of the public. Taking local, community input out of community healthcare has compounded the problems that were already there.
“These results are a symptom of a deeper problem, and that problem is poor provincial leadership; health authorities are too large and slow to react, they’re no longer nimble; and they don’t report to the public. Regional health board governance is too isolated from the needs of the public. That needs to be changed,” Fraser said.
Everyone is worried about healthcare, and the ability to receive it. The Canada Health Act says the provinces must provide it or lose their federal health payments.
Northeastern BC is a region that sends a lot of money to Victoria through the resource sector, says Davies, but we hardly get anything in return when it comes to services such as healthcare.
“We have some of the best doctors, nurses, healthcare professionals anywhere, we’ve got a lot to be proud of. I have deep gratitude for their service and their dedication. Not only to their patients, but to this community,” said Hansen.
Yet those same doctors, nurses and other staff are hard to recruit and retain in northeastern BC. Local politicians have been calling for an independent audit for years, only to be told that the government does its own audits. Residents, such as local lawyer Tyler Holte, have taken matters into their own hands and started a petition calling for an independent investigation into the repeated hospital emergency department closures.
“The government just keeps going on about how good things are in healthcare in the province, but all of us know that it is not good. Previous government was not perfect, it made mistakes, but prior to this government we were leaders in healthcare,” said Davies. “We need to get back to making healthcare about the patients, about people, not the Health Authorities. Patients needs to be at the centre.”