On April 4th, with
much fanfare, Prime Minister Stephen Harper announced his government had hammered
out new wait times guarantees for every jurisdiction in the nation. "None of my
ministers had a tougher assignment," he said. "Today I'm proud to announce that
Health Minister Tony Clement has succeeded in his mission. All 13 provinces and
territories have committed to approving the first patient wait times guarantees." Getting
the feds and all the provinces to unanimously agree on anything is quite a neat
trick but critics like Michael McBane, the national co-ordinator of the Canadian
Health Coalition, say Mr Harper's plan is mostly sleight of hand. "It's cynical,"
says Mr McBane bluntly in an interview with NRM. "The whole approach is
flawed. It's meaningless but politically loaded." THE
BREAKDOWN
Mr Harper's plan is, in essence, to offer $600 million in
extra funding, divided up among the provinces, that must be used to help achieve
a maximum wait time in a clinical area of the provincial government's choosing.
In exchange, the PM gets to appear as though he's fulfilled campaign promises
to create wait times guarantees and improved the healthcare system. But critics
in the healthcare sector have called the guarantees ineffective, politically motivated
and lacking in substance. Most provinces chose to focus
their efforts on radiation therapy for cancer. The exceptions were Newfoundland
and Saskatchewan, which tackled CABG queues; Ontario, which chose to concentrate
on access to cataract surgery. Quebec, distinct as always, already had four guarantees
in place: tertiary cardiology, cataract surgery, joint replacements as well as
radiation oncology. FALLING
STANDARDS
With six out of 10 provinces committing to wait times guarantees
for radiation oncology would it be safe to assume the docs performing these treatments
would be pleased as punch? Not by a long shot. "We have issues with these benchmarks,"
says Canadian Association of Radiation Oncologists (CARO) president Dr Tom Pickles,
a BC-based oncologist. "First, the profession feels the maximum acceptable wait
time for receiving radiation therapy is two weeks and the federally-appointed
Wait Times Advisor's Final Report came up with recommendations — that were
adopted nationally — that said the maximum wait time is four weeks. So what
was recommended by the profession was doubled by the government. Now in the newly
announced guarantees it's been increased to eight weeks — except in Manitoba,
where it's four weeks." "We're concerned that all this
might lead to slippage of the benchmark itself to eight weeks." THE
HARM IN WAITING
The provinces themselves have been getting some heat
for pledging to meet such easy wait times targets. Still, even premiers like Dalton
McGuinty of Ontario — whose relationship with Mr Harper is famously icy —
publicly defended the plan. "What I like about the guarantee is that it will drive
change," Mr McGuinty told the National Post. EASY
PICKINS
If it's such a flawed plan, why would the provinces and their
health ministers agree to the deal? They'd be crazy to pass up such low-hanging
fruit, critics admit. "You can't blame a province like Nova Scotia for accepting
money for radiation therapy," says Mr McBane. "I place the blame with the government
for playing politics with wait times guarantees." "These
are not really great benchmarks," agrees Dr Pickles. "If you're currently treating
patients within two weeks — as we're currently doing in BC — and then
to have a benchmark to treat people within eight weeks, that's not very much of
a guarantee at all," he says. "It's a very soft target." While
Dr Pickles practises in BC, which has relatively short radiation wait times, he
frequently speaks with oncologists in areas with more serious queue problems,
like in the Maritimes. But he feels they're equally ill-served by the plan. "Most
of these guidelines don't kick in until 2010 which does absolutely nothing for
the patient now who's sitting and waiting more than eight weeks," he says. PLAYING
POLITICS
"I think there must be a lot of politics involved because of
the timing and the pressure to get all the provinces to sign on," says Dr Pickles,
alluding to federal election rumours. "And from the provinces' point of view,
if someone comes up to you and says, 'Here's $76 million, all you have to do is
agree to achieve this,' and you're already achieving what you're agreeing to,
it must be awful tempting to sign." If this was truly
just an exercise in crass politicking on the federal government's part, was it
well executed? "I think it backfired," says Mr McBane. "They've been getting an
awful lot of criticism." And indeed, media outlets from coast to coast have slammed
the wait times guarantees. Even in the heart of Harper Country, the Lethbridge
Herald savaged the deal in an editorial entitled "A cunning promise." A
BETTER WAY?
Mr McBane thinks that the Prime Minister's $600 million
would have been more wisely spent on areas he feels are in need of federal leadership
— like training new doctors, which would also lessen wait times. He feels
the PM ignored some good counsel. "If Mr Harper is truly serious about addressing
wait times he wouldn't have thrown Dr Brian Postl's report in the trash last Canada
Day weekend," he says, referring to the Federal Advisor on Wait Times' Final Report
published last year. Dr Postl's report questioned the utility of using wait times
guarantees. Dr Postl, now ex-Wait Times Advisor, refused
to answer any questions about Mr Harper's latest queue commitments and how the
PM seemingly ignored his recommendations. His spokesperson said, "Since Dr Postl
no longer holds the post of Federal Wait Times Advisor, he doesn't feel it would
be appropriate to comment." | 
