Medical professionals call for extra $600M in N.B. budget to transform health-care system
Joint report identifies 6 priority areas, makes recommendations to Higgs government
New Brunswick medical professionals have come up with their pre-budget prescription for the ailing health-care system, which they say needs an extra nearly $600 million and urgent action from the government to stabilize and transform.
On Tuesday, the New Brunswick Medical Society and the New Brunswick Nurses Union unveiled the 2024 Pre-Budget Health Stakeholder Forum Report, which identifies six priority areas and includes 23 recommendations ranging from preventative care for school-aged children to long-term care, as well as the estimated costs.
They say the system is in crisis, with tens of thousands of New Brunswickers who don't have a primary care provider resorting to visiting already-overcrowded emergency departments, hospital beds tied up with seniors and others awaiting long-term care placements, overworked and underappreciated health-care providers either scaling back or leaving, and few incentives for new graduates to choose to practise here.
"The current state is the result of a series of short-sighted decisions made by the provincial governments over many decades, up to and including the current government, consistently favouring a focus on the acute-care sector instead of preventative and primary-care options," said Dr. Paula Keating, president of the New Brunswick Medical Society.
"We simply cannot continue to starve the system and then blame it for its poor organization and outcomes. We must change it," she said during a news conference in Fredericton.
Among the report's recommendations:
1) Re-engage with health-care professionals to support informed decision-making ($150 million)
This includes reinstating "true" pre-budget consultations and advance notice of changes that will affect them, said Keating.
"We agree that the health-care system must put patients first, but the needs of the people working within that system must also be considered," she said.
The government hasn't had any "meaningful conversations" with stakeholders for "many years," according to Paula Doucet, president of the nurses union.
"You've just gone off and made recommendations and investments where you think it's a good place to do it," she said, directing her comments to Premier Blaine Higgs, Health Minister Bruce Fitch and Finance Minister Ernie Steeves.
That's why the medical professionals held their own pre-budget health stakeholder forum in Fredericton on Jan. 18, with 17 health-care organizations representing about 25,000 professionals, said Doucet. They invited Higgs, Opposition Leader Susan Holt and Green Party Leader David Coon to present their visions for health care and to answer questions, then produced the report.
In addition, they're calling on the government to remove Fitch as chair of the Health System Collaboration Council and replace him with someone "apolitical."
"The whole concept behind this body was to take the politics out of health care, and yet there's a politician in the chair. This is a bit ironic," said Keating.
The health-care professionals also want to see more transparency in decision-making, she said.
2) Create multidisciplinary team-based primary-care clinics ($70 million)
Keating wants to see at least 50 clinics across the province in rural and urban areas in 2024-25.
These should include more than just doctors, nurses and nurse practitioners, but also possibly occupational therapists, dieticians, physiotherapists, pharmacists, psychologists, and social workers — depending on the unique needs of the communities in which they're located.
About $50 million would go toward required improvements to spaces and infrastructure, administrative supports and allied health salaries and ongoing operational costs.
The other $20,000 would see at least 250 non-clinical employees hired to help health-care professionals with paperwork, so they can see and treat more patients.
3) Prioritize the retention of health-care professionals to ensure continuity of service ($192 million)
New Brunswick needs to invest in remuneration, incentives and benefits, said Doucet.
Many health-care professionals have "reached the breaking point" and are leaving the province for other jurisdictions where they are "properly acknowledged and fairly compensated for their hard work and dedication," she said.
The report recommends $32 million to offset inflation and match the primary-care stabilization funding given to primary-care providers in other comparable jurisdictions, pending contract renewals, and another $90 million to align nurses' pay with neighbouring jurisdictions.
The government should also present job offers to all New Brunswick students in high-demand health-care fields of study and adopt tuition, tax or student loan forgiveness models tied for those who agree to work here, it says.
4) Prioritize healthy living and preventative care ($60 million)
The majority of this — about $50 million — should be allocated to provide a nutritional school food program, said Doucet.
"It's time to get serious about our children. They're our future. That's our population health," she said.
The governments should also invest in new and existing programs, including physical education; mental health education on topics such as bullying and stress management; and education about the detrimental impacts of smoking and vaping, said Doucet, and explore partnerships with local governments and non-profit organizations to develop new infrastructure and programs that promote healthy behaviours throughout society.
"Investment in these areas today will lead to a significant reduction in acute-care costs in the future, laying the foundation for a better health-care system for future generations of New Brunswickers as well as [a] sustainable health-care budget."
5) Fix the root causes of issues in the long-term care system ($65.5 million)
Many seniors, including those waiting in hospital beds for long-term care placements, could age in place "safely and affordably" in their own homes with access to proper support and care, according to the report. Recent Canadian Institution for Health Information (CIHI) data suggests 13 per cent of new long-term care residents in New Brunswick in 2022-23, could have potentially been cared for at home, instead of taking up a bed in a long-term care facility, it says.
The report calls for an extra $20 million per year to support community initiatives that provide additional support and options for home care, plus $8 million to have patient discharge teams at hospitals work seven days a week to reduce delays and the backlogs they create in emergency departments and admissions.
"Finally, the most obvious answer to address the pressing issue is to build — but also staff — more long-term care beds and ensure they are accessible and affordable to people who need them as soon as possible," said Doucet.
"We have been pretending this problem can be solved through other solutions for far too long and we are falling short as a result."
The report calls for the creation of 500 long-term care beds, with a one-time capital investment of $160 million.
6) Invest in the digital transformation of the health-care sector ($60 million)
"Health-care professionals and their patients must have access to patient records to ensure quality, efficient and safe care that takes everyone's medical history into consideration," said Keating.
While health-care professionals acknowledge the government has identified this as an important area to focus on, "progress on this initiative must be accelerated," she said.
The government should commit to fully funding electronic medical records systems for every primary-care provider in New Brunswick.
Similarly, the government should commit to fully funding the implementation of a province-wide clinical information system within the province's hospitals, said Keating. "We are 10 years overdue for this."
Estimated costs represent 5% increase in budget
"While some recommendations entail long-term planning and investment, others could be swiftly actioned, leading to tangible improvements in the near-term," according to the report, which was presented to the government on Feb. 28, in advance of the budget, scheduled to be tabled on March 19.
The estimated $597.5 million required for these "generational transformations," represents a five per cent increase in the provincial budget.
It's still about $400 million short of the $1 billion investment needed to catch up with Nova Scotia, the report notes, but it's "a start."
"The reality is we've known the solution for primary care for 25 years. … We've just never put the money to the solution to make it a reality," René Boudreau, CEO of the New Brunswick Medical Society, told reporters.
"We create pilots, they work amazingly well, they have amazing results, and then we stop because somebody looks at the numbers and says, 'Whoa, we can't afford to roll this out.'"
Boudreau noted the commitment for the transformation of primary care in the last provincial budget was $2.5 million — or about 0.1 per cent of the health-care budget, "defined narrowly."
"What we're saying today is that if we're going to plan to fail, then let's be honest about it, but if we're going to plan to succeed, we need these types of investments going forward."
Health Department reviewing report
The Department of Health thanks the group of health-care professionals for their report and is reviewing it, said spokesperson Sean Hatchard.
The department has had "several discussions" with the medical society about its ideas, including a meeting on Feb. 15, according to Hatchard.
"We look forward to continued discussion with the society and our other partners as we work to tackle the ongoing challenges within the province's health-care system," he said in an emailed statement.