New Brunswick

Privatization of extramural nursing an 'erosion of care,' union says

The New Brunswick Nurses Union responds to government's decision to privatize management of extramural nursing and Tele-Care.

Many unanswered questions about 2-tiered system created by Medavie takeover, nurses' advocate says

Paula Doucet, president of the New Brunswick Nurses Union, says extramural nurses have been looking for work elsewhere because of the uncertainty surrounding the province's home health care service under private management. (CBC News)

Privatization doesn't belong in New Brunswick's health-care system, the New Brunswick Nurses Union says.

The New Brunswick government announced last week that it is moving head with privatizing the running of the extramural program and Tele-Care services.

Medavie Health Services New Brunswick, the same company that runs Ambulance New Brunswick, will take over the home health-care program and 811 health advice line in January under a 10-year contract.

​"That creates a two-tiered system and we don't believe that's what we want here in New Brunswick," said Paula Doucet, president of the New Brunswick Nurses Union.

The estimated cost of the first year of the 10-year contract, which was awarded without a tendering process, is $4.4 million.

The aim of the "primary health-care integration initiative" is better co-ordination and collaboration among health-care providers, said Victor Boudreau, who was health minister when he announced the privatization of management would go ahead. 

Boudreau, who was dropped from cabinet on Monday, said the Medavie-run program would allow people to stay in their homes as long as possible, get more help navigating the health-care system, and experience greater continuity of care, although he didn't explain how this would be different from the current system.

Patients will still see nursing and Tele-Care paid by medicare.

Quality of care 'eroding'

The union was notified of the decision about 18 months ago that privatization was a possibility and had consultations with stakeholders. But there needed to be a broader public discussion, Doucet said.

"Moving this quickly with so many unanswered questions is just creating some turmoil," she said.

Victor Boudreau, who was health minister until Monday, and former New Brunswick premier Bernard Lord, the CEO of Medavie, announced Friday that Medavie will run extramural services starting in January. (Kate Letterick/CBC)

The government has promised nurses they will remain public employees and will not lose their jobs, benefits, including seniority and pensions, but Doucet said the union is worried the quality of care will decline when they report to Medavie.

"This now becomes a private entity, it's no longer Department of Health," she said. "Although the minister is saying, my nurses will remain public employees, the reporting system is different. They no longer report to the [regional health authorities]."

I think the research shows that privatization and health care in any country is not the route to go.- Paula Doucet, New Brunswick Nurses Union

She said extramural nurses have already been looking elsewhere for work, either returning to hospitals, public health or long-term care.

The departures have created a high number of vacancies, and the uncertainty has made it difficult for extramural to attract nurses in anything like the numbers it once did, Doucet said.

"I think the research shows that privatization and health care in any country is not the route to go," she said.

Expects higher quotas

She suggested that with the latest decision, Medavie could bring a private-industry metrics system to health care, such as requiring nurses to see more patients a day than good health care would allow. Employees might be less skilled as well, she said.

"Currently, a nurse may see seven patients a day," she said. Under Medavie, "they may be expected to see upwards of 10, 12, 15 who knows. You're timed with the amount of patients you'll see."

There's possibilities of improving … if we were provided with the opportunity and financial support … we feel we could've done a lot better and a lot faster. Unfortunately we sort of hit dead ears.- Gilles Lanteigne, CEO, Vitalité Health Network

Doucet said the union will hold both Medavie and the provincial government accountable and will try to ensure quality isn't diminished.

But the union still has a lot of unanswered questions, she said.

Although their collective agreement rights are still in place, the labour transfer agreement for nurses in the extramural program is not. The union is still working at it and will meet with government at the end of the month.

"I'm very hopeful that my nurses won't be losing any of the benefits that they currently have now under their collective agreement," she said.

"We're watchdogs of health care. One of our core values is providing quality healthcare to New Brunswickers."

No advantages to privatization

Vitalité Health Network president and CEO Gilles Lanteigne said the change extramural "dismantles" a service that has been highly appreciated by patients and communities.

"It's one of the critical areas Vitalité Health Network wants to provide more options to the elderly and people with complex care to not stay at the hospital any longer than they need," he said.

Vitalite Health Network president and CEO Gilles Lanteigne called the announcement a sad day for New Brunswickers. (CBC)

Although it's still too early to know the long-term impact of Medavie, Lanteigne said he expects short-term disturbances in the system.

"We're not convinced from any angle that there are advantages in privatization of these services," he said.

"New Brunswick is paying a lot and will pay more with these services and results simply aren't there."

In June 2016, the board of directors of the Vitalité Health Network suggested to government that services be kept under the regional health authorities and since then, the network has proposed improvements in the home care services program that were refused.

"There's possibilities of improving … if we were provided with the opportunity and financial support … we feel we could've done a lot better and a lot faster," he said. "Unfortunately we sort of hit dead ears."

A warning to government

New Brunswick's commissioner of official languages is also calling out the provincial government for moving extramural into Medavie's hands.

Katherine d'Entremont said she doesn't want the same kind of trouble she saw at Ambulance New Brunswick, which continues to experience "many challenges" in delivering bilingual services more than 10 years after its creation.

As a result, d'Entremont said, she is reminding the Liberal government that its obligation to provide services in both French and English does not end when a third party takes control.

Katherine d'Entremont, the province's Official Languages commissioner, wants to know how Medavie has guaranteed that patients will get service in the language they speak. (CBC)

Government retains responsibility for ensuring a third party complies with the Official Languages Act, and d'Entremont is asking government to "spell out" what it intends to do so Medavie respects the language rights of all citizens, she said.

"I have concerns about how government will ensure that Medavie will put in place appropriate measures to guarantee the respective citizens' language rights," said d'Entremont.

She wants to know if the government will require Medavie to develop a comprehensive plan for providing service in either language throughout the province at all times.

She also wants to know what measures are planned to guarantee employees will continue to be supervised and receive services in the language currently used in their health network.

Right now, d'Entremont said, she doesn't have enough information to determine whether the extramural service in both official languages is adequate but her office has not received a lot of complaints.


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