Graham Steele: Health shake-up touches on urban-rural divide
Legislation to collapse the 9 district health authorities into one coming
The biggest issue being tackled by the McNeil government is reorganization of the health-care system. It’s double trouble, really, because of the government’s decision to reform health-care collective bargaining at the same time.
The legislation to collapse the nine district health authorities (DHAs) into one will be the centrepiece of the House of Assembly session that starts on Sept. 25.
With health minister Leo Glavine at the wheel, the Liberal government is doing nothing less than taking the health-care system apart and putting it back together again, while still trying to provide health services to almost a million people.
It’s a little like trying to strip a bus and then rebuild and repaint it, all while barrelling down the highway with a bus load of opinionated passengers. In the rain. Without a map. This kind of reform is not for the faint of heart.
The toughest part of the health re-organization will be that it touches on the most fundamental tension in Nova Scotia politics.
Many places have a central tension that drives politics. In the United Kingdom, it’s class. In the United States, it’s race. In Canada federally, it’s language. In Quebec, it’s sovereignty.
It’s a little like trying to strip a bus and then rebuild and repaint it, all while barrelling down the highway with a bus load of opinionated passengers. In the rain. Without a map.- Graham Steele
Little Nova Scotia, which has less than a million souls clutching to the edge of a continent, should be all-for-one and one-for-all, but it isn’t.
It has two very different economies, one operating at high speed and the other at low speed, and that’s only the most obvious part of the urban-rural divide.
Outside a radius of about 100 kilometres of downtown Halifax, there is deep, deep resentment of Halifax’s advantages and its arrogance.
That’s why—to give only one small example of how this tension plays out politically—it is almost impossible for someone “from” Halifax to be premier. Going back as far as Angus L. Macdonald, our premiers have all been “from” somewhere else, even if, as a matter of fact, they represented a Halifax-area riding (Angus L., Connolly, Regan, Buchanan, Dexter). John Savage, alone, could not play up his rural Nova Scotia roots, because he was born in Wales.
Leo Glavine’s health-care reform may founder, in the long run, for the simple reason that it runs afoul of this basic tension.
The current DHA structure has been in place for less than fifteen years, but people in Amherst, Bridgewater, and Yarmouth, among others, have gotten used to health decisions being made locally.
Far more questions than answers
Having served in the provincial cabinet and on the Treasury Board, I can tell you that DHAs really were, to a large degree, independent. We would at times be driven mad by our inability to get them to follow our wishes, even though they were spending billions of provincial dollars.
Despite Glavine’s musings in June to the contrary, it is absolutely inevitable that the headquarters of the unified health authority will be in Halifax.
For any government, that’s dangerous. Any problem in the system, anywhere, will be blamed on “Halifax.”
That’s why, this past Wednesday, the health department released a map of four “management zones,” unimaginatively named Western, Northern, Eastern, and Central.
People in Halifax won’t care. They basically have their own zone, and life will carry on much as before.
But the point of the map, I presume, is to reassure people outside Halifax that there will still be some local control.
Will it work? Unfortunately for the government, there are still far more questions than answers:
- How will work be divided up between Halifax and the zones?
- Will each zone have its own headquarters, or will it be run out of the Halifax office?
- If there is a local headquarters, where exactly will it be?
- Where exactly will jobs be lost?
By the time the legislature resumes, in two weeks, Leo Glavine will need answers to those questions.
There’s one more question to which Glavine will need an answer. The last Liberal majority government, under John Savage, undertook almost exactly the same reform in the mid-1990s, only to see it undone when John Hamm swept to power in 1999 with the promise of more local control. What’s to stop Jamie Baillie from making headway by promising the same thing in 2017?