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October 15, 2007

Health Authority Service Plans

On October 11th, 8 months after the provincial budget was tabled in the Legislature together with service plans for ministries and government organizations, the Ministry of Health boasted that BC's six health authorities posted their 2007/2008 service plans. In just 4 more months, most government entities will have to table their plans for 2008/09, but don't hold your breath waiting to hear from the health authorities, which happen to spend the largest chunk of your tax dollars. Submitted March 28Don't blame the health authorities for the late reporting. The service plans for the Coastal, Fraser, Interior and Northern authorities state that they were submitted to the Ministry of Health by March 30th or earlier. The service plan for the Provincial Health Authority doesn't have a date indicating when it was approved by its board or submitted to the Ministry, but a footnote refers to a Board vacancy as of April 15th so one might assume the report was finalized sometime after that. The plan for the Vancouver Island Health Authority is dated July 9, 2007. Why did the public have to wait until October 11th for the release of these reports?

Rather than providing links to the plans, the Ministry's news release said to look on each authority's website for their plan. In most cases the services plans are found on the pages the authorities set aside for their financial reports.

Section 13 of the Budget Transparency and Accountability Act requires the public release of service plans concurrent with the publication of the provincial budget. The plans must reveal goals, objectives and performance measures for the current year and two years beyond; however, health and education organizations are exempted. That exception was implemented by way of amendment to the Act in 2004, not through the usual step of a provision in a Miscellaneous Statutes Amendment Act but through an amendment included in Bill 5 (2004) Budget Measures Implementation Act. There is not one word in Hansard as to why that exception was introduced.

The 2007/08 Service Plan for the Provincial Health Services Authority (PHSA) reveals 18 performance measures. The first is the "adverse event rate". The plan is to develop a baseline and the long term target is "to be determined". The second is the "number of times the electronic health record viewer is accessed for clinical care across PHSA acute sites", in other words whether electronic health records are being used. The plan is to develop a baseline and the long term target is (you guessed it) "to be determined". The baselines and long term goals are "to be determined" for 10 of PHSA's measurements. The Authority appears to have given up on smoking, despite the Minister of Health's promise to launch a new tobacco strategy in 2008. Its measurement is the provincial smoking rate, the baseline is 13% (possibly a misprint) and the long term target is 13%. Is that a vote of confidence in the Ministry's tobacco strategy or not? Its measure of the percentage of the population considered overweight or obese has a baseline of 45% and a long term goal of 32%, a good step, but not exactly ambitious. The Authority doesn't have a baseline for staff vacancy rates or overtime, but it wants to reduce sick leave by 5%; perhaps it would be more likely to do that if it could reduce vacancies and overtime. The idea of a service plan is to provide goals and measures against which a government organization can be held accountable; the Minister of Health has to be held accountable for the state of PHSA's plan.

The service plans for the five regional health authorities differ substantially, but they share a common theme of baselines and targets to be determined. Nevertheless, the effort to measure whether goals are being achieved is proceeding in the right direction. A comparison of reports from year to year will eventually allow researchers to determine whether progress is being made for the enormous resources that are consumed. The Fraser Health Authority's plan includes a risk assessment for each of its measurements, indicating on a scale of 1 to 4 whether the target is likely to be achieved or not. Its plan states: "An estimate of risk is determined by the Executive Leader of the initiative based on factors that may represent barriers to implementation of the proposed changes which would cause movement towards the target. These factors would include available capital or operating dollars, available staff, change management challenges associated with complexity, attribution of the effort to the outcome, among others."

The Fraser Health Authority's plan is a cry for help. It clearly states that even after mitigation strategies are taken into account, the current capacity of 2,102 beds leaves a bed gap of 1,348 by 2020 of which 722 are required by 2010. The region's population is expected to grow by 27% by 2020 and its senior population is expected to grow by 81%! The Legislature sat from February 13th through May 31st, during which time the budget estimates for the Ministry of Health were debated. The Minister of Health might know whether the services plans, and cries for help, from the health authorities were withheld until his budget passed in order to stifle debate even though most of the plans were submitted to him before the end of March. Now that the information is out, the plans require careful review and the Campbell government needs to start answering questions.


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