NDP MLA Maureen MacDonald speaks up for health care workers

September 30, 2014

Maureen MacDonald’s speech on Bill 1, which eroded the hard-won rights of health care workers:

I doubt very much if there is anybody here in this House of Assembly who would disagree with a more effective health care system, reducing health administration – streamlining health administration – but it’s how you go about doing this that has myself and the NDP caucus extraordinarily concerned.

As the previous speaker said, when we discuss second reading of a bill, we talk about the principles of the bill rather than going clause by clause. I look back on what now is becoming a much longer time in this place than I actually had contemplated when I first arrived here. When I was first elected in 1998, we had four regional health boards, and prior to that, each hospital in the province had its own board.

The Savage Government in the mid-1990s did something called regionalization. It was a very popular approach to managing health care systems right across the country and there were four regional boards, which I think are very much the zones that the current government have defined; they’ve reintroduced into their recycled plan for overhauling the governance model for our health care system.

That whole exercise was very controversial. It put the system in crisis for a considerable period of time. It took probably 10 years or more for our health care system to recover from that process and it was the focus actually of an election campaign when Dr. John Hamm campaigned on a promise that if he became government he would introduce district health authorities. In fact, Dr. Hamm formed the government and he came to this place and introduced the current governance structure that we have: nine district health authorities and the IWK.

When the NDP formed government, that’s the structure that existed in the health care system. I have said on more than one occasion, I really don’t know, frankly, what the right number of boards is for a province of our size. Is it four? Is it five? Is it one? Is it nine? I don’t really know. I’ve asked people from other provinces who have gone through a lot of these exercises. When I was Health and Wellness Minister I asked people, and the advice I got repeatedly from people in other provinces who had gone through this was that that wasn’t the right question to ask. How many boards should you have, is not the right question.

The right question to ask is about what is most needed in your health care system and how are you going to improve patient care on the front lines, and what can you do to set about achieving that? Those are the right questions to be asking, not questions about how many health authorities do you have and how many volunteer boards do you have – that kind of stuff. That preoccupation will not give you a better health care system. The preoccupation has to be about improving health care.

The Minister of Health and Wellness in his remarks talked about the importance of improving the quality of patient care, and we would agree with that. One of the things that we learned when we came to government actually was how little attention was being paid in our health care system to the whole question of quality. Nova Scotia is one of the few provinces in Canada that doesn’t have a quality control council to monitor the performance of the health care system.

We put in place a foundation that would allow us to move in that direction and I hope that the current administration will build on that foundation, because in the end this will result in not only quicker access to health care but better results – better outcomes. A better quality of patient care means better results and better use of our resources for those results.

Frankly, there’s no one better to lead that initiative than the deputy minister in the Department of Health and Wellness, Dr. Peter Vaughan, who is a leader in this area of quality of patient care. It’s unfortunate that Dr. Vaughan is having to oversee a merger of boards and focus so much on governance because this doesn’t necessarily use his talents in the best way, in my view, which is around the whole question of quality of patient care.

So we have in front of us today a bill that’s preoccupied with what is the right number of boards to have in the district health authorities, which is the wrong question. The question does need to be, what do we need to do to improve health care, to improve quality, to improve access. With the restructuring there is a loss of community input and the minster will say that community health boards will be given a greater role to have community input in health care planning. I and our caucus have the greatest respect for community health boards and the work they do, and an expanded role is always a welcome thing for the community health boards, without question.

The fundamental problem here is that community health boards are being corralled into looking at a particular kind of health – health promotion, health planning around improving the health outcomes of people more broadly in the community where, let’s face it, the community health boards want to focus, and that’s a good thing. Who at the local level is going to fill the vacuum that looks at the local needs in terms of the acute care system, the long-term care planning, and what have you? Those roles were being filled at a local level by the volunteer district health authority boards. These are the folks who put a lot of effort, volunteer effort, into understanding the local community needs and what was available in the system, locally, and what was required locally, to address this.

This government has dismantled that local voice, Madam Speaker, and that is being centralized in one board, located here in the capital area, and if anybody thinks for one moment that this is not going to have an impact on protecting health care in rural and small towns around the province, they are dreaming in Technicolor. This is the beginning of the end for any number of small facilities in parts of our province where communities have built their health care intuitions with dimes and nickels from fishermen, farmers, and coal miners; and don’t you kid yourself if you think that those facilities are going to survive in a centralized model of decision making, when they have to compete for resources in or health care budget-making process with the large tertiary centres, the regional hospitals, and any other number of needs.

I’ve been in the Department of Health and Wellness. We have all read the consultants’ reports over a long period of time and we know where this train is going, Madam Speaker, and so this bill that is in front of us today has way more implications for the people of this province than simply what this government is doing for health care workers. This bill has significant implications for the population of the province as a whole, and the implications for health care services from one end of this province to another.

We all agree we need to streamline administration, but I suggest to you this bill is about a lot more than streamlining administration. Madam Speaker, you can streamline administration without having a bill like this. I know that because we did it. When I became the Minister of Health and Wellness, the amount of the budget that was eaten up by health administration in the Province of Nova Scotia was above the national average – the third highest in the country. We brought that down below the national average and we did that without a Bill No. 1, we did that without any grandiose merger plan. It actually wasn’t that hard to do.

I’ll give you an example. We have the IWK and we have the QE II side-by-side, the Capital District – one’s in the Capital District Health Authority, one’s a stand-alone health authority. They’re both teaching hospitals, they’re both connected to the Dalhousie Medical School, an academic centre, so the specialists who work in these facilities are teaching, they are practitioners, they’re doing research, and one of the positions that both of these health authorities had was a VP of research, one in the Capital District Health Authority and one at the IWK. They got to talking among themselves and they said, really, do we really need two VPs of research? One of the VP of research was retiring and they decided it makes great sense to have a VP of research across these two entities.

No merger was required, no legislation was required, and stripping health care workers of their rights was not required. There were quite a significant number of VP positions that were eliminated through attrition and they were eliminated through collaboration across the district health authorities. People don’t always see what’s going on in the backrooms, how things actually work in a health authority or in a Department of Health and Wellness, but I’d like to give people a little look at some of that.

The district health authorities in the Province of Nova Scotia met every month with the deputy minister at the Department of Health and Wellness and they brought information about what was going on in their district health authority, but they also were working quite collaboratively on any number of things.

The Deputy Minister of Health and Wellness might go to one of those meetings with all kinds of data that his department officials would have prepared for him to show to the CEOs about the number – let’s say the mortality rates – and they would be able to look at morality rates across the DHAs and they would have discussions around why a DHA was somewhat higher or lower than the mean and they would talk about why that might be. They shared the best practices and the worst practices with each other, through that process. They worked on a variety of issues. They worked on things like the infection control and the high rates of C. difficile and those other super bugs that have plagued acute care facilities around the world and what they could do in collaboration with one another and with the Department of Health and Wellness to deal with that.

There is a lot of collaboration that went on. I listened to the Minister of Health and Wellness when he introduced the bill the other day, read the press release, listened to him this morning. You would think, to heavens, Madam Speaker, that nobody ever talked to each other in the current configuration. This bill is going to tear down the walls; it’s going to eliminate the barriers.

Well that’s hogwash; that’s complete and utter hogwash. These individuals between DHAs spoke to each other constantly and worked together constantly. Someone who lived in Halifax would get orthopaedic surgery in Bridgewater or in New Glasgow. This idea that the district health authority structure is an impediment to accessing health care is nonsense, complete and utter nonsense.

There may be very good reasons to streamline and reduce administration but whether or not this is the way to do it is very questionable. I would suggest that the approach this government is taking has other motivations in terms of how our health care system will change that go far, far beyond the management level. We have seen it before and I dare say, Madam Speaker, we will see it again.

That’s a little bit about my concerns around this bill with respect to the health reorganization. This bill, as we know, also contains significant provisions to change the face of labour relations in the health care system for a very, very long time. Now as someone who has also been there through rounds of collective bargaining that sometimes were very challenging, to say the least, Madam Speaker, I do not disagree with the government’s position that it would be preferable to have fewer rounds of bargaining and fewer collective agreements. If that can improve labour relations, that is something that should be bargained with the health care unions.

I’m not at the table, I don’t know all the details, but as I understand it, the health care unions went to the government and said, we know you’re going to amalgamate the boards – you’re going to merge the boards, and this is going to have implications for who our employer is, so we want to work with you, we want to understand what your objectives are, and we want the opportunity to present a proposal to you to meet those objectives. The government said, right on – that’s great, we want to work with you; we want to see what we can work out.

For a number of months now, there has been a lot of effort between the government and the health unions to work out a set of arrangements that would achieve the objectives of the government with respect to fewer collective agreements, but also respect the rights of health care workers to remain with their current bargaining units, and also prevent the incredible upheaval and chaos that ensue in the health care system when the preoccupation becomes something other than front-line patient care.

Earlier, the Leader of the Official Opposition talked about approaching this in a way where you would get things right. This government had an opportunity to approach this in a way that could get this right, could do things differently than the choices that have been made. They’ve chosen the absolute worst possible approach – the approach that will have a damaging impact on the health care system and on people who work in the system.

This is not hyperbole. I’ve been reading – first of all, I’ve received many – probably more than on any other issue that I’ve experienced in my time in this House. I’ve had a few campaigns that I’ve lived through – Liberation therapy, for example. I’ve received many – and I know that the members on the other side are receiving many letters and phone calls from members of their constituency.

Quite often these are long-term health care workers – nurses, for example, who have worked in the health care system for more than 25 years. Some younger nurses. But by and large, I’m hearing mostly from people who have been in the system. They have considerable experience and expertise and specialization. They’re nurses who work in specialized areas and fields – on specialized wards, on stroke units, on cardiac units. They are distressed and distraught about what this government is doing, and they feel betrayed. There is no other word to characterize the feelings. They are talking about how betrayed they feel.

What disturbs me is the politics of this. We live in a time where union bashing is fashionable. It’s popular. It earns you a lot of brownie points with columnists and interest groups.

The labour movement worldwide has been hammered for the past 30 years by the forces of globalization. The wages of working people have stagnated, and the benefits that working people have previously enjoyed are disappearing. Our kids are a generation who are going to be worse off than we were because of that. And what does this government do? It jumps on that bandwagon. It attacks the very middle-income, middle-class earner in this province and makes them responsible for the financial situation in the province and the financial future of the province – a province whose economic prospects need to improve.

We all get that. We get that our economy has grown more slowly than any other provincial economy in the country for the past 20 years. That’s why we need a government that doesn’t sit on its hands. That’s why we need a government that will do things and have an action plan to ensure that we have a more prosperous future. But to focus on one sector – our health care workers – and make them responsible for the financial situation in the province is wrong, and it’s very, very short-sighted, Madam Speaker.

You know, if there is one thing I’ve learned around health care in the time that I’ve been in this place, it’s how significantly competitive we have to be with other jurisdictions. We have a very, very short road between ourselves and health care opportunities throughout the United States and throughout western Canada. If we as a province fail to maintain a competitive place in terms of pay and benefits and conditions of work and respect for health care workers, we will lose health care workers to other jurisdictions.

It has happened before. It happened under the last Liberal Government. It took more than a decade, and it took huge injections of funds to undo the problems that that created under the last Liberal Government, who did this very thing – a reorganization of the health care system in this way.

If we, on this side of the House, are unable to support this kind of approach (Interruption) I hear the member for Halifax Chebucto saying that I wouldn’t support anything. Well, I think the member for Halifax Chebucto should go back and look over the record of myself and this Party in the 17 years we’ve been here and the times that we have indeed co-operated with the government on any number of initiatives that have resulted in positive change for the people of this province. I’ll make him a little reading package. We’re going to be here a while so I’ll have time to do that. As he’s meeting with people to explain the bill, I can meet with him as well and explain the impact of this bill.

Madam Speaker, this bill may make good politics in terms of the kind of union bashing, the kind of contributing to or feeding into popular sentiment about big labour and greedy unions. We need to remember who make up these unions. They are regular men and women who work in our health care system and they perform the vital work of delivering health care to people. They are technicians, and social workers and people who clean the halls and the washrooms and change the beds and care for patients. They need and they have a right to have a voice. First of all, a voice of their choosing; and secondly a voice that is a collective voice, a place for them to speak collectively. Without that, they definitely are at the mercy of a government that has no respect and doesn’t really understand what it means to provide that front-line patient care, the importance of good morale, the importance of going to work every day and feeling like you’re valued.

This is a concern that we have, that this bill will result in an erosion of local input into health care. It will result in the removal of health care services from local communities; that it will throw labour relations and the morale of health care workers in our health care system into chaos, which it already is; that it will result in people leaving the profession and leaving the province, which is not a good thing; and that it doesn’t result in the health savings that people would imagine – in fact it often costs more money to do these things. We’ve seen quite a few amalgamations and mergers in all kinds of different ways around the province that really have not produced the kind of savings that people anticipated.

When I look at HRM, the amalgamation of the municipalities here in Halifax, I doubt very much that there are very many residents, property owners, taxpayers in HRM, who will tell you that that saved much money – not to mention the commercial property owners and the small business community who continue to see their municipal taxes and their assessments just go through the roof. This has not made things more efficient or more affordable.

We’re in this situation where the Minister of Finance and Treasury Board hasn’t really been able to give us any documentation, any evidence, to support her claims of what savings there will be. I tabled earlier today a document, an open letter in The Chronicle Herald back in the election where they said that one board would result in $13 million in savings – on an annual basis, they would be able to invest $13 million.

I saw the Minister of Health and Wellness on television one evening saying that was an oversimplified understanding; that was based on an oversimplified understanding of what a merged health authority into one would look like. The next time we heard from the minister in terms of any numbers he said it would be about $1 million; then yesterday I think it was $5 million, we would get $5 million – in the millions, in the millions – and now we have $5 million. It has been a big of a moving target.

We know other provinces have gone through this – I think most notably Alberta, where they literally have spent millions of dollars. Their system, especially their emergency care system, has been a complete disaster and crisis ever since that process. They, in the Province of Alberta, have a new Premier, Jim Prentice. One of the first things he announced, and I think in his leadership bid to become the Leader of the Alberta Progressive Conservative Party he indicated that the one super board in Alberta hadn’t worked that well. It particularly hadn’t worked – surprise, surprise – for rural health care. Now, as Premier, he has announced a review of rural health care delivery in Alberta, so all you rural MLAs on the government side take note.

I would ask those other members, all of those rural members, to take note of the plan in Alberta by their government to review rural health care and the impact that having one centralized health authority, no doubt in Edmonton or Calgary – Edmonton, I believe – the impact that has had because it hasn’t been a positive one.

I remember as Health and Wellness Minister being at a meeting of health ministers about health care delivery in general and the Minister of Health from Alberta at the time – Minister Horne, a very thoughtful, knowledgeable individual – was very concerned that what they had initially perceived to be a way to reduce administration had actually resulted in an increase in administration, an administration that was more costly, an administration that spent a great deal of time focusing on reducing access to front-line care, especially in the rural areas, and it was a disaster. So let’s hope that this does not happen here, Madam Speaker, but I don’t have great confidence in how we have started this off.

The Leader of the Official Opposition says that their Party also supported the idea of reducing the number of district health authorities even though it was Dr. Hamm who set the current system up from what the Liberal plan was of the previous four regions. They now think that wasn’t the best thing to have done and they are in support of dismantling that system and going to one. Presumably, if my colleague, the Leader of the Progressive Conservatives, were in charge, they would do it differently and they would get it right. Their plan would be to separate out the labour issues from the merger issues to deal with later.

Ironically, I was thinking when I saw the bill that was tabled – Bill No.1 has an interesting history in this Legislature. I think the Bill No.1 that was tabled the last time the Progressive Conservatives were in power was, in fact, the bill that would take away the right to strike from all health care workers in Nova Scotia, everybody who worked in the health care system, everybody who worked in the district health authority.

So you may have been somebody who was a maintenance person and you no longer would have the right to strike. Or you may have been somebody who worked in one of the cafeterias, you no longer would have the right to strike. If I remember correctly, when that Bill No.1 was introduced by this Party, that Party didn’t support it. The Premier, who would have been over here in the Third Party position at the time, was not in support of Bill No.1, was not in support of eroding the rights of health care workers.

Those were back in the days when the Premier wanted to project a very different image than the one he wants to project now. When he was here he wanted to project a very labour-friendly image I suggest, Madam Speaker. And now that he’s on that side, he would like to project a very tough-on-unions image and get onboard that kind of 35-year trend of blaming the organizations that represent working people for all of the ills of the world and for being the greedy people in our society.

It’s interesting how that shift occurs in just a few feet and in such a short period of time. I think that Bill No.1 was introduced in the last session that the Progressive Conservative Government were in power, before that government fell, and it was during a minority government and the Third Party, the Liberal Party, held the balance of power at that time. So the Premier was, at that time, on the side of labour and the health unions, but things certainly have changed in that regard.

I’ve tried to touch on the three aspects of this bill that I’m concerned about, that my caucus is concerned about, that I think all Nova Scotians should be concerned about. That is essentially that, while we do need to reduce health administration, it can be done without this kind of disruption and massive reorganization, that what’s at the heart of this reorganization is not simply the reduction of top management, that what will really be the motivation for this massive kind of reorganization is a significant centralization of health services in each of those regional zones here in metro, an eroding of local community voices and control, and that the labour relations piece is both financially motivated in the absence of a government that has demonstrated no plans to do anything about the state of the economy except ride on the investments of the previous administration and take advantage of the very conservative politics of union-bashing that have been so effective in seeing a growing gap between the rich and the poor and an erosion of the standards of living of many middle-class households and families. This legislation is just part of continuing that trend and jumping on that bandwagon.

With those few remarks, I think I will take my place, Madam Speaker. I know I will have an opportunity to discuss this bill in a clause-by-clause basis when the bill returns to the floor of the House after it has been through the Law Amendments Committee process.

You know, I want to say a few things about the Law Amendments Committee process. We’re very lucky here in the Province of Nova Scotia that we do have a process where we allow the public – or I shouldn’t say we “allow” the public – where the public have an opportunity to come and make presentations to members of the Legislature based on what legislation is going through this House.

We have been through two very difficult pieces of labour legislation already. As I said, there is only one part of this legislation that is labour legislation. This legislation has scope that goes far, far beyond the interests and the concerns of people who are looking at this legislation from the perspective of the rights of workers.

We have not seen such a massive reorganization of our health care system since Dr. Hamm introduced the Health Authorities Act back in – I would think, I don’t know; I didn’t have time to check with the Legislative Library, but I would think that bill probably was introduced around 2000, and came into effect maybe – maybe it was introduced in 1999 and came into effect in 2000, but it was introduced quite early in the majority Hamm Government.

It has been quite a long time since we’ve had a piece of legislation with respect to our health care system that is so significant and what is this government doing? They are racing this really important bill about this really important health care system, that takes up almost half of the provincial budget, that is the number one priority and concern for Nova Scotians, they are racing this bill through this Legislature, into the Law Amendments Committee where no doubt they will want to limit public opportunity to speak on this bill. They sure don’t want to give the public an opportunity to understand the bill.

The bill was introduced last night and we were out of here. We are back here this morning because the government wants to race the most important piece of health care reform that this province has seen for more than a decade. I would suggest, Madam Speaker, that members of the government Party will have some explaining to do with respect to why they are so anxious to keep the public from having an opportunity to have their say on this bill.

What is it about this bill that is different than any other piece of legislation we do in here that commands this kind of process? I have not heard a good explanation from anybody on the government side with respect to that and I genuinely would like to know what lies at the heart of trying to prevent the opportunity for Nova Scotians to learn about this bill, to understand what is in this bill, to have input into what is in this bill. What’s that all about?

This is not only about bad process when it comes to health care workers and the health unions that represent them, this is bad process for Nova Scotians more generally. This is a really crummy process for people who are concerned about a strong health care system. This is a government that crows and a minister that crows about the consultation he did, this big consultation, by invitation, he did in terms of developing this approach.

Apparently they are interested in hearing from Nova Scotians who they invite to hear from but they are not all that interested in hearing from Nova Scotians once people get a look at the bill and start to understand its implications. They are not really that interested in that.

How does that happen? How does it happen that you have a government that says you know we really want to hear from people and then their actions don’t demonstrate that there’s anything behind those words? Those words are empty, those words are completely hollow.

I have a lot of skepticism about this bill. As I said, there are things that I could certainly get behind – quality care, improving the quality of care, reducing health administration and streamlining our system. All of those things sound great, but they’re not represented in this bill and that’s unfortunate. This is an opportunity that this government has blown. Thank you.