Merging Health Regions

The Liberal platform promised to merge the regional health authorities (other than the IWK) into a single unit. It’s a big job.

An important benefit of that choice is streamlined collective bargaining. There are a total of 50 different collective agreements with four different unions: Nova Scotia Government Employees Union, Canadian Union of Public Employees, Nova Scotia Nurses Union, and Unifor. The particulars of which union represents which employees differs by region.

The employees can be generally categorized as Nurses, Other Health Care Professionals, Clerical, or Service and Support. The wage and benefit packages for any particular category do not materially differ between regions nor between the unions that negotiate them.

Achieving that similarity has been expensive. The first union to settle for a particular category sets a benchmark for others. Typically, the next group to bargain would take that as a minimum and seek to add extra benefits, sometimes by forcing arbitration. If successful, the first union would then be brought up to the same level. Nevertheless, minor differences remain in contract terms for people doing the same work but represented by different unions.

The minister indicated that he would like to see one contract for each category. The unions replied that they would form a bargaining association for each employee group to negotiate at one table, but not one agreement. 

It would have to be a very long table. All of the minor contract terms that vary would have to be negotiated separately. Different grievance processes would exist for similar employees in different parts of the province. Geographic boundaries that will disappear for every other purpose would be retained for union purposes.

Flexibility is lost. Nurses from the QEII cannot easily go to the Dartmouth General (and vice versa) when clinical work dictates the need, because different unions are involved. Discussions with unions about changes in process would have to be done two or three times. 

Unions fight to preserve territory as well as the minor differences in contract, because without them the illogic of multiple representations is more clearly exposed. 

The union proposal is in fact a proposal to maintain the status quo. The government is right to reject it.

The union promises to cooperate are similar to what we hear from municipal politicians when the topic of merging comes up. The 41 councillors in the six municipalities of Pictou County (population 46,000) talk cooperation but have not been able to agree on a study of service sharing or possible restructuring. The problem is that a decision to amalgamate would eliminate most of their jobs.

Likewise, there would be far less work for union officials if there were only four collective agreements to discuss rather than 50. Of course that should result in reduced union dues for members, and corresponding savings in the Department of Health for taxpayers.

The minister highlighted the issue at an early date and invited the unions to make a proposal. The contents of the response do not serve the interests of union members or taxpayers.

The right result is to have only one bargaining agreement with each of the four categories of employees. The government has guided the discussion to that conclusion. Good.

The province wants to maintain local clinical and operational leadership in the consolidated health care structure. To do so it will be creating four management zones to provide operational oversight of  programs and services. This is also a good idea. The consolidation of health authorities in Alberta has gone poorly because too many decisions ended up in Edmonton. It will be crucial to a successful transition in Nova Scotia to get the right level of authority delegated to the zones.

In June, the minister mused about basing the new board in Truro, but with a staff of less than a dozen people. Fortunately government has now concluded that the right location is HRM. New CEO Janet Knox will have a tremendously difficult job. She will need a substantial staff supporting her in areas such as legal, finance, infrastructure planning, and human resources. It could not possibly help her to be physically separated from most of them.

On the other hand, opportunities should be sought for activities that can be concentrated at regional hospitals. Truro is a particularly good candidate because it would be an easier trip than Halifax for many Nova Scotians. Perhaps it could be a centre of excellence for standalone procedures such as eye surgery. 

Similar possibilities for other regional hospitals should be examined. The opportunity to concentrate specialty care-giving resources based on zonal or province-wide considerations may present substantial additional opportunities for savings, even more so if it happens in some of the regional hospitals.

Finally, the new organization is to have a real governance board with substantial decision-making authority. That can greatly improve the quality of oversight and decision making.

The Liberal promise to consolidate regions highlighted savings from reduced executive ranks. In fact there can be much broader benefits from the other choices being made. Bringing the regions together is a complex and difficult process. It is off to an excellent start.

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