Former health ministers speak out on privatization of extramural nursing

If it's not broken, why fix it? 

Former health minister Ted Flemming has added his voice to others asking that question about planned changes to what he calls the "crown jewel" of New Brunswick health care — the extramural program.

This was one of the crown jewels of health care and somebody says, 'You're doing a terrible job I'm going to give it to somebody else to manage.- Ted Flemming, former health minister

"It's a system that works well, people have confidence in it, people trust it," said Flemming, Progressive Conservative MLA for Rothesay and a health minister under the David Alward government.

The Liberal government announced last week that it is moving ahead with privatizing the running of extramural and Tele-Care services. 

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Medavie Health Services New Brunswick, the same company that runs Ambulance New Brunswick, will take over the home health-care program and 811 health advice line in January under a 10-year contract.

"When I was minister of health, of all the things I had to look at, goodness knows this was the least of my worries … it went to people's houses instead of having them in the hospital."​

The estimated cost of the first year of the 10-year contract, which was awarded without a tendering process, is $4.4 million.

The aim of the "primary health-care integration initiative" is better co-ordination and collaboration among health-care providers, said Victor Boudreau, who was health minister when he announced the privatization of management would go ahead.

The government turned the services over to Medavie without a request for proposals or tendering process.

Flemming said he isn't sure why the province is making the changes, how they will better serve the public, or how they will save money in the long run.  

"People have faith and they have trust in the extramural system," said Flemming. "It's one of the things government did well … if it ain't broke don't fix it."

But former Liberal MLA Mike Murphy, who as health minister in Shawn Graham's Liberal government presided over the outsourcing of the ambulance service, applauded government for moving to privatizing extramural and Tele-Care.

The controls within government are very lax and you can't be everywhere … you don't have to own all the buildings, you don't have to own all the employees.-Mike Murphy, former health minister

The trial lawyer called the changes "evolutionary."  

"It's not an Americanization of health care," he said. "It's just an evolutionary thing and I think it's a good thing."

He also encouraged the province to outsource the administration of medicare, which he said would save $50 million a year.

Murphy said the latest changes should not have any effect on standards and protocols should stay the same.

"The controls within government are very lax and you can't be everywhere … you don't have to own all the buildings, you don't have to own all the employees."  

Response to nurses union

The loss of extramural management to Medavie has drawn criticism from nurses, Vitalité health network and the official languages commissioner.

Paula Doucet, president of the New Brunswick Nurses Union, said extramural nurses have already been looking elsewhere for work, either returning to hospitals, public health or long-term care.

Flemming was sympathetic.

"This was one of the crown jewels of health care and somebody says, 'You're doing a terrible job, I'm going to give it to somebody else to manage,'" he said. "It's kind of a slap in the face and a kick out the door."

Murphy, however, said the nurses would still have their union and would be paid by government.

"This is a matter of the administration of health care, it's not about the provision of health care," he said.

Restructuring elsewhere

The extramural change was the latest affecting how New Brunswick provides health care. The government has also been criticized for plans, announced in August, to restructure the Office of the Chief Medical Officer of Health. Some of its daily operations are moving to other government departments.

The work of public health and agri-food inspectors will now be looked after by the Department of Justice and Public Safety.

Meanwhile, the public health practice and population health branch will become part of the Department of Social Development. And the healthy environments branch will be integrated with the Department of Environment and Local Government.

Both Murphy and Flemming agreed the restructuring office of the chief medical officer of health was a mistake and don't agree with the spreading of the services available under the chief medical officer.

Independence important

Murphy and Flemming worked with New Brunswick's former chief medical officer of health, Dr. Eilish Cleary, saying she worked independently from government.  

"You don't want a politician putting their fingers into whether we're inspecting this level of service or these restaurants or whatever," said Murphy.  

Flemming said the move was "ill-conceived and improper."

He said the office should be independent without political interference and people need to have confidence in the independence when it comes to health care and safety.

"Why would you take health and disease out of the Department of Health and give it to public safety?" he said.

"People need to know their drugs are of a particular standard, that health care is of a particular standard … we don't need people sitting around scratching their heads getting the manual out saying, 'Health has done this for decades. I wonder what they did?'"