Opinion: Where do the strategic decisions of health get debated? And decided?
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And decided?No evidence of the really important issues of health care being addressed in public policy termsPublished Aug 18, 2026•Last updated 1 hour ago•4 minute readYou can save this article by registering for freehere. Orsign-inif you have an account. Columnist Ken McGeorge writes after years of working, consulting, and writing commentaries he can still see no evidence of the really important issues of health care being addressed in public policy terms. PEXELSIt would be foolhardy to assume that all is well in our health system. Listen to lived experiences of people, watch social media conversations and posts, read the news, speak with some of the reporters who are paid to listen. Take a walk through the DECRH emergency department to see the overcrowding. Look at 42 per cent of beds occupied by people who should not be in hospital based on care requirements. Subscribe now to read the latest news in your city and across Canada. 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Create an account or sign in to continue with your reading experience. Access articles from across Canada with one accountShare your thoughts and join the conversation in the commentsEnjoy additional articles per monthGet email updates from your favourite authorsI invested a few years early in the 1990s as CEO of the DECH, then as CEO of the newly-created Regional Hospital Structure, then a very few months in the Department of Health before returning to Ontario in 2000. When I returned to New Brunswick in 2006, I had the delightful experience of providing leadership in a major long-term care facility and since retiring from that I have continued to try to help various organizations with their issues. I thought I understood our health and long-term care system and have been enjoying writing commentaries for the media on the issues of health care reform. The enjoyment comes from the research required and the feedback from readers across the province, as well as sharing over a half century of experience!I remain mystified, however, because I keep asking “where do the real issues that impact health care actually get fully debated?” And I am no closer to an answer now than when I first posed the question years ago. Plans that go public in the public arena are always expressed as aspirations, not real plans. A clear and concise roundup to start your weekday morning. By signing up you consent to receive the above newsletter from Postmedia Network Inc. A welcome email is on its way. If you don't see it, please check your junk folder. The next issue of Morning Email Telegraph-Journal will soon be in your inbox. We encountered an issue signing you up. Please try againIt would be naïve to think those difficult issues get fully debated at caucus or cabinet. Just not possible. At the AGMs of interest groups like unions and medical society? Not. Would that level of important public policy be discussed at the board meeting of the health authorities? Probably not. The NB Cardiac Centre and Heart Program is a system that represents what was intended with the reforms initiated in 1992. How that came about is no secret. In a province known for competitiveness on many lines, the heart centre and provincial cardiac program developed from the vision and perseverance of a few physician leaders who could see the value of collaboration and excellence. Excellent care and service yield incredible benefits, not the least of which is a more satisfied patient and family population. That program did not just happen nor was it done deliberately by government. The leading professionals, supported by a strong administration, did the leg work of selling vision and creating relationships required for serious change. That success, while not planned specifically in the reforms of 1992, is certainly consistent with the public policy goals of the hospital restructuring that did, at the time, raise eyebrows and concerns in rural New Brunswick. The reforms of 1992 were intended to set a public policy framework that would enable truly integrated and excellent clinical programs to develop. According to reports, the public service is larger than it ever has been, the province seems to be in a bit of shock with the issues of deficit and credit agencies sounding the bell. Engagement of consultants to try to find ways to save money… again! Health authority budgets are huge and often showing serious operating deficits. This is not nickel and dimes time; it is time for the re-structuring that has been given only periodic lip service since the 1990s. I would look no further than in the approach to health care that governments have long abandoned: a health and long-term care system that is structured provincially with coherence and integration as its hallmarks. That is what was intended in 1992! But we are not there by a wide margin. Back to basics!That requires restructuring with purpose… that takes knowledge, vision, strength, spine. In making the essential realignments, not everyone will be happy and some vocal opposition always emerges. Some just don’t get it; some are wedded to the status quo however mediocre that may be. But the advocates of excellence need to stand strong because at the end of the day, the value of excellence will be seen and sought after. The cardiac centre illustrates that. Our experience at York Care Centre illustrates the same principle on a smaller scale. Setting centre of excellence as the goal and vision, the board and staff worked through a change management process that has positioned York Care Centre as one of the premier long-term care facilities in the province. Did they have opposition? Yes. Do the critics now understand? You bet they do. Where does that strategy get developed? After all these years of working, consulting, and writing commentaries I can still see no evidence of the really important issues of health care being addressed in public policy terms. Being a true centre or program of excellence is more than slogans! It is hard work requiring vision, knowledge, discipline, courage, and adherence to the dream. A new, time-limited entity, NB Health, could be created as the vehicle to fill this void as long as it is literally at arm’s length from government. This could lead to a new era of excitement and enthusiasm in health care. I can say with confidence that working in a centre of excellence program is much more satisfying and professionally rewarding than working in programs that are ordinary and often mediocre. Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook. comJoin the ConversationNew BrunswickNew BrunswickMoncton to MiramichiMoncton to MiramichiNew BrunswickThis website uses cookies to personalize your content (including ads), and allows us to analyze our traffic. Read more aboutcookies here. By continuing to use our site, you agree to ourTerms of UseandPrivacy Policy.