Tough questions and answers required to meet evolving health care expectations

Life has become burdened with anxiety, society is in a perpetual ‘fight-or-flight’ heightened alert level approaching three years (rolling covid waves, supply chain disruption, conflict in Europe, natural disasters, food security, accommodation affordability, job satisfaction, etc). We observe these impacts daily in our human resources and recruitment conversations. No person is immune.

One of many subjects inducing fatigue is “health-care crisis.” Yes, we have challenges; and we must adapt. “We” must adapt, no system can conform to expectations. I am increasingly hearing of the duress of health access from employers, employees and the public at large.

Health care is transforming. It ‘will’ look different than it has in the past, we cannot resist change and must become more self-reliant, unfortunately. We all expect a system that is accessible when needed – and by measure the system does still work when triaged on severity, but we do not have the access we feel we deserve.

Frustration mounts as access recedes. Closures at extremes of the province become structural in Montague and Alberton. Losses of specialists in Summerside and Charlottetown reverberate through a fragile system and cascade to unrelated services that are symbiotically associated in an ever-connected health continuum.

What no political leader will ever admit – we will not have the services we enjoyed in the past; we may not even maintain the services we have today. This takes courage beyond a popularity contest successor. Thus, bureaucrats that are not afraid to conceal themselves are admonished, such as the short-term Health P.E.I. CEO (a position that traditionally rotates with equivalent frequency to a Health Minister). The messenger is not the issue. A lack of planning and decades of denial is the villain.

The P.E.I. community, not the west, nor the east, or the apparent benefactor centrists, need to come together and be honest. Our services are declining. We are already deficient in necessary services. We need to channel resources where best deployed; regardless of location.

We have wonderful infrastructure which needs to be correctly utilized, and a $30 million investment in infrastructure replacement needs to be critically appraised (Montague is budgeted for $13 million, but no recent government projects have remained on forecasts several years aged).

Is this a crisis? Yes. It is a crisis if we allow it to escalate and although challenging, we still are empowered to act.

Health care has now exceeded a $1B total burden to Islanders for the first time, or 47 per cent of our total annual expenditures as a province – growing at 13 per cent annually. Obviously unsustainable.

Are we willing to consolidate services before being forced, or before physicians relocate unexpectedly as has recently been the case at the Prince County Hospital? Can lost services be restored? Are we willing to consider trade-offs? Would we defer Transportation and Infrastructure’s investment for several years to bolster the health system? These are considerations we must be willing to make. Our income for investment is finite, health care complexity and costs are not finite.

Health professionals are members of our community and struggle with the same life challenges as all. If health consumers’ lifestyles have changed (ie: work from home), why would you expect your health access providers not want the same. Society needs a recalibration of priorities and expectations.

We are burdened with overlapping structures administering our health care. Devolved, wisely, to avoid political interference. We have long since passed the point where this structure was practical. Should we consolidate administration, reduce duplication of effort, and streamline operations? We need empowered leadership to make active decisions. Functions devolved through evidence no politician can ‘ever’ make difficult decisions on health care. Bold vision with leadership is required, a plan as to where the health system will be in twenty-five years and the path to get there.

In the 2023-24 budget, government is anticipating a continued 3.6 per cent annual population growth rate (presented as an unsubstantiated projection based on current trajectory). We need to determine if we have the infrastructure to service a projected 200,000 – 250,000 people.

Our service structure and expectations need to change. Is infrastructure sprawl the solution, or do we need to consolidate around a smaller number of centers with a denser footprint to improve efficiency and resource allocation?

Crisis is so overused in our vernacular it is meaningless. Crisis is an excuse for ineffective planning inducing anxiety to stall. Frontlines are not immune to the increased pressures of system sprawl. What we need to articulate is a plan to remedy the challenge; this is achievable in the right time horizon and necessary for effective recruitment.

If we need more health workers, bolster what we have by changing the workflow and system management. Consolidate recruitment and work with external professionals; not increase incompetence at the rate of 12 per cent per annum. Be progressive in assessing foreign credentials. Streamline immigration and licensure; but learn from neighbouring poor implementations. Empower the Colleges to process and accept candidates then applied where most appropriate in the system. Invest in technology and continue expansion of scope for allied services.

Although uncomfortable, we need to assess expectations, methods of delivery and responsiveness. There is no solution acceptable to all; maybe we need to take some hard medicine today in advancing to a cure tomorrow. Honest messengers need not be vilified because we do not wish to accept harsh realities.


Blake Doyle is a business columnist with SaltWire Network in Prince Edward Island. (@blakedoylePEI)