Big Decisions Rarely Emerge From Consultation Processes
Posted July 6, 2018
Some decisions are bigger than others. Paradoxically, big decisions are less amenable to community consultation than small ones, but they often represent the focal point for voters when they cast their ballots.
The implementation of the Goods and Services Tax was a choice around which the 1993 federal election was fought. The Liberals campaigned against it, but stuck with it when elected.
In the 2013 provincial election, the Liberals promised to consolidate health boards and balance the province’s budgets. The voters gave them a mandate to do so.
The Liberals won the 2017 rerun despite their many missteps in the first mandate. They had the clearest message on fiscal management and took a strong position on public sector wage restraint to make it happen.
Their health care platform was focused on mental health, reducing wait times for surgeries and continuing care alternatives, and improved access to primary care through expanded collaborative care facilities.
In 2017, the auditor general observed that having four hospitals in Cape Breton Regional Municipality (population 90,000) did not make sense.
On Tuesday, the Liberals announced that two of the four—in North Sydney and New Waterford—would be replaced by community health centres and new long-term care facilities, while the Glace Bay and Sydney facilities for emergencies and surgeries will expand.
It is understandable that people in North Sydney and New Waterford would be disappointed and upset. It matters not to them that their distance to emergency care and major surgery will still be comparable to many parts of the province.
Apart from that, most people found it difficult to understand the details of what was being proposed. Premier McNeil made that worse two days later by incorrectly stating that the only changes would be to emergency services.
Hospitals, like schools, are very important employers and elements of the community fabric. Losing them is both a result and a cause of population loss. That is an issue of economics, not health care.
None of those opposed to the decision have provided a cogent argument about why the changes are bad for care. Greater concentration of facilities for both primary and secondary care should help with doctor recruitment and retention.
Most of the visits to the emergency facilities in New Waterford and North Sydney have been for non-emergency situations. The planned collaborative care centres will be able to handle most of them, and the most serious emergencies would always be better off going to the better equipped Cape Breton Regional.
People should not have been surprised at the government’s decision. It is consistent with the Liberal direction on both fiscal responsibility and health care delivery.
Those who were concerned were given oxygen by the over-the-top reactions from opposition politicians.”This is Black Monday for health care in Cape Breton,” said NDP Leader Gary Burrill. Eddie Orrell, a Cape Breton MLA and the Tories’ health critic, said the changes will bring chaos, and do nothing to improve access to care.
Much of the hand-wringing was around the lack of consultation with either health-care providers or the community at large. Given the disinterest of opposition politicians and others in either detail or nuance, such a consultation would have produced more heat than light.
A period of consultation now can be useful both in determining needs at a more detailed level and improving public understanding of what is proposed. But the discussion is about how the plan is to be implemented rather than whether.
In principle, the choice the Liberals have made is a good one. The long-term perception will be determined by how it works in practice. Successful implementation of their good ideas has not been a hallmark of the Liberal government.
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