Cost-cutting agenda degrades health care

Opinion

Hey there, time traveller!
This article was published 22/09/2021 (1227 days ago), so information in it may no longer be current.

Last week a young neurosurgeon informed me he was leaving Winnipeg for greener pastures.

When I first met him, he was thrilled to be recruited to run an epilepsy surgery program. That was five years ago. The program was never funded and he finally had enough of waiting to do the work he came here to do.

Thousands of Manitobans suffer from epilepsy, and medications provide reasonable control for most. For hundreds of others, surgical intervention offers life-transforming relief and functional independence while clearly reducing long-term health costs. It literally pays for itself. Virtually every other province has an epilepsy surgery program.

The young doctor’s departure comes on the heels of a 40 per cent turnover of academic neurologists in Winnipeg in the last three years. These doctors look after patients with epilepsy, stroke, multiple sclerosis and neuromuscular diseases.

Last summer, the shortage of neurologists forced the discontinuation of stroke and neurology consultation services at St. Boniface Hospital. Soon we will be forced to reduce outpatient EEG testing at Health Sciences Centre owing to a shortage of technologists. Waiting lists for multiple sclerosis patients continue to increase because of inadequate staffing.

These events have unfolded despite two years of warnings and proposals for practical remedies. If challenged, Manitoba Health officials will cynically claim they have committed resources for a new stroke ward and an epilepsy monitoring unit as a bridge to a surgery program. Funding for renovations and equipment were announced as pre-election promises, but operating budgets have not been approved.

Without doctors, nurses, technologists and therapists, they will remain empty showrooms. We can point to other medical services that have suffered similar fates over the last few years.

Without doctors, nurses, technologists and therapists, [units] will remain empty showrooms. We can point to other medical services that have suffered similar fates over the last few years.

Why is this happening? The Manitoba government has systematically stripped health-care decision-makers of autonomy in order to reduce costs, at the expense of patient care and the integrity of our health system.

Let me provide a brief historical perspective. The Winnipeg Regional Health Authority (WRHA), formed in 1998, created city-wide programs for each major discipline, including surgery, family medicine, internal medicine, pediatrics and several more. Each had its own budget and management team, including a physician, nurse administrator and a financial analyst.

These teams had considerable autonomy and a mandate to improve service through innovation, process improvement and resource redistribution to address service gaps. Regular open venues were established for teams to engage each other to co-ordinate care and establish priorities.

The process was messy, but ensured a high level of transparency and accountability. Questionable proposals, either from government or the teams themselves, could be challenged, debated and adjusted.

The WRHA was certainly imperfect, but it was an essential first step in establishing a professional health-care management culture that was accountable, collaborative and transparent. Strong management teams were able to make significant health-care improvements. Planning for natural disasters was based on sharing of information and analysis and the broad engagement of program teams.

Five years ago, the current provincial government created a new organization, ironically called Shared Health, to largely replace the functions of the WRHA. The pretext was to improve efficiency and planning; however, transparency and accountability were largely excluded in the new management model.

Decisions are no longer debated or challenged. They are handed down by edict or, more often, interminably delayed by endless reworking of proposals.

Regional teams that previously planned and managed clinical services are now only expected to manage the expectations of their health workers. Most of the administrative personnel at Shared Health are competent and knowledgeable people recruited from WRHA, who were probably attracted by the prospect of more streamlined decision-making.

I suspect many are realizing that they have become politically directed intermediaries delivering a cost-containment agenda rather than health-care improvement.

Any informed and successful businessperson will confirm that a pure cost-cutting agenda degrades service quality and eventually costs more. Improving quality and efficiency first invariably leads to lower costs.

Any informed and successful businessperson will confirm that a pure cost-cutting agenda degrades service quality and eventually costs more. Improving quality and efficiency first invariably leads to lower costs.

And so, our young neurosurgeon departs after years of broken promises and disappointment. Hundreds of Manitobans with epilepsy are destined to needlessly suffer gradual deterioration and dependency. A few will be accepted by other centres for surgery, but for many, access will remain elusive.

From experience, I can guarantee that no one will accept any responsibility for this sad outcome, or any of the other fiascos that we’ve learned to tolerate, or those failures that are certain to follow.

Dan Roberts is an intensive care physician currently working as co-section head of neurology in Winnipeg.