Running the Ministry of Health used to be regarded with high status, now it’s where aspirational political careers go to die.
A commentary by Martin McMahon, a retired professor.
Only two years into a four-year mandate and Premier David Eby has called a provincial election.
All the talk seems focused on Eby’s political opportunism, his calculated call to seize political advantage from turmoil in the Conservative party.
While voters complain about the hard cost of running an election so soon, especially in a province running a structural deficit, many are oblivious to the indirect but more consequential cost: Turnover in the largest ministry, the Ministry of Health.
While Prime Minister Mark Carney focuses on labour reforms and changes to tax regulations to speed up private investment, the sector consuming almost 40% of all taxes remains insulated from change.
To understand why Canada is viewed as a laggard when it comes to creating the conditions for innovation, capital investment and efficient use of tax dollars, look no further than health care, the poster child for ossification.
Federal health expenditure is almost $360 billion, accounting for 12% of GDP. Health care consumes about 40% of provincial budgets.
By any measure, more is spent on health care than in any other government sector. Such scale, you would think, would merit serious scrutiny.
Yet, in B.C. alone, the province has had 10 ministers in 20 years. The average tenure for a minister of health both provincially and federally is just over two years.
The last major federal review of health was more than 20 years ago, and that dealt mostly with guarantees of funding while leaving the delivery model untouched.
In many ways, health care is a broader embodiment and symbol of the problems ailing Canada. Budgets growing at almost twice the rate of population growth while services creak and strain to meet demand.
Services in rural Canada, intermittently available, held together with a Band-Aid of volunteers and community-minded health-care workers.
Urban hospitals struggling to balance the demands for access to surgery and diagnostics, while emergency departments overflow with a mixture of acutely ill patients and the addicted and homeless who lack access to alternative streams of service.
The system, and the people working in it, are buckling under the pressure.
While the United Kingdom’s National Health Service might suffer from change fatigue, Canada’s health system seems frozen in a state of inertia.
Substantive structural reform is needed to address new technology, changing demographics and geographic inequities. We need answers to the big questions of who should get paid to do what and is funding getting us the results we want?
There is always talk of change, but nothing arrives. The gap between talking and doing feels cultural.
In the U.K., a triumvirate of entities from academia, the civil service and health administration work collectively to guide robust analysis of outcomes and costs.
These entities feed into an existing management and public-sector culture of accountability for performance. It can be argued the NHS has too many targets, but it cannot be argued the system suffers from stasis.
Each day in Canada, administrators and clinical personnel make valiant efforts to meet the public’s expectations, but without guidance from political leaders to tackle the big question of how health care should be delivered in the 21st century, health care will slide into deeper trouble.
The biggest obstacle to change is that we suffer from endemic short-sightedness, fuelled by a political culture where key ministerial roles are traded around like aging hockey players on an injury list.
Running the Ministry of Health used to be regarded with high status, now it’s where aspirational political careers go to die. The majority of British Columbians likely don’t know who the minister of health is, despite it having such significance for the fiscal health of the province and for their own health. To move forward we need to build bipartisan structures responsible for planning and oversight of health.
Structures that can give sustained attention to tackling the big issues confronting health and that exist beyond the tenure of a single period of office.
Finally, we need to build a culture of accountability to the public for performance and enshrine this into all aspects of public service. The more the public knows how their money is spent, the greater will be their advocacy for reform.
Hang around the hallway of a hospital or eavesdrop on a group of health workers and you will hear tales of a system near the breaking point.
If we want health care to be there for us all, we have to demand politicians step up, do their part and start answering the big questions. After all, isn’t that what we pay them for?