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Commentary – John McGarry, President and CEO

Health care: Does the NB Budget make the grade?

Budget day has come and gone and now it is time for New Brunswickers to assess the plan. As CEO for Horizon Health Network I have had many people ask me what I think. Did the budget solve our problems? Did we get what we felt we needed to do the work we are required to perform? As usual, the answers are qualified. Initial budget speeches, at least as far as I am concerned, are more political instruments than informative documents to even those who should be in the know. And this one is no different - but there a couple of good omens.

First, the announcement about discussions to "strengthen community-based primary care" is really quite positive. Extra-Mural Program, Ambulance New Brunswick, and 811 TeleCare have a great number of common patient touch-points in the population. It is logical to take advantage of any opportunity to optimize and leverage the professional care that is being given to thousands of patients in a manner that is seamless and completely connected. One might expect that to be the current reality; sadly it is not. The potential inclusion of Medavie EMS as a co-ordinating body is really quite exciting. This organization is not your old notion of a simple health insurance provider; this is a very significant player within Canada in health insurance, health services and, very importantly, technology [read this as connectivity]. The fact that it is a private organization is a complete red herring thrown up by idealogues to the notion that any private involvement is heresy. Most physicians are private business people who have medicine as their business. Quality health services that people receive in our community pharmacies, physiotherapy and nutrition businesses, psychology offices, etc., are private. I look forward to Horizon taking part of in these discussions.

Secondly, the involvement of the New Brunswick Medical Society (NBMS) in a new effort to provide more comprehensive off-hours coverage in a team-based environment is equally positive. It finally appears that New Brunswick physicians are being made a partner in a model where, to date, they seem to have considered themselves a scapegoat or target. Details are unclear, but I am optimistic that with government and physicians working on a model together - and, hopefully with the participation of our Regional Health Authorities - they will succeed in delivering what the population needs.

So, good marks for two major elements of government's budget relative to health care. But, both of these are still intentions and discussions - not definitive actions ready to take effect. New Brunswickers need to push both government and NBMS to keep their feet to the fire so this is not simply a good idea that breaks down in the details. 

What about the here and now? Not much, truthfully. Although I appreciate the 2.6% funding increase provided to the Department of Health, I'd prefer it buy more change - not to preserve the status quo.  Personally, I am disappointed with government's message that there will be no changes to hospitals. I know there have been many statements made that leave room for interpretation but that absolutely is the message people are receiving. I am especially disappointed in government's commitment that there will be no bed reductions anywhere. Beds are tools to get the job done - they are not the objectives we seek to achieve.  Would any industry commit to maintain the same number of old tools as the market changed? We do need program adjustments. 

We do need to allocate more of our resources to the new needs of this aging population (think cancer, cardiac, mental health just for starts). In more than one dozen Community Health Needs Assessments communities told us they need better youth mental health, improved services to chronic illness in the community and transportation improvements. We, in Horizon, intend to continue discussions consistent with our legislated mandate to assess needs, set priorities and allocate resources to deal with those priorities. 

I constantly remind people of the changes in population health needs that are around us now and coming full force in what is almost the immediate future. Please look at our five year plan called Horizon Health Network and Partners: A Healthier Future for New Brunswick. You will find it on our web site at . Our four priorities are patient-focused care, developing advanced models in selected areas, redirecting resources, and advocating firmly. 

This series of opinions is proving to be a most effective tool within that last priority. I won't say it makes us feel entirely comfortable but it certainly has resonated with staff and the public (not all in support, mind you!). But, we are hopeful it is, in at least a small way, contributing to the discourse and eventual solutions that we all seek. 

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