The recent NDP policy proposal directed at our sector says “the government should study the best way to create a Community Care public agency to replace the myriad of agencies that currently exist so that it gives the province the accountability and transparency we need, creates uniform standards, and allows the workers in this industry to become public servants and earn living wages. We will implement such a public agency within our first mandate as government.”
“Finally, upon election we will apply pay equity legislation to this important sector so that, along with the announced introduction of an increase to a $15 minimum wage, the wages of those providing home care and community care services will be improved.
The New Brunswick government’s approach to the delivery of seniors and community care is to rely on patch work quilt of hundreds of agencies, some non-profit, some for-profit but all delivering services with inadequate standards and almost invariably at low wages with no benefits. This industry is plagued by high turnover and shortages.
It is perhaps not surprising that women are in the large majority in this sector.
This is in stark contrast to the excellent service provided by the government Extra Mural program which provides for medical needs of clients in their homes, and up until last year was run by our health care authorities as a public institution with union wages and benefits.”
Commentary:
This is the strongest policy statement of any party yet addressing the situation in our community based health and social services sector. The NDP and their leader should be commended in being so thorough and forthright in trying to think through and propose such a policy. As a thought experiment it is highly useful as it motivates a continuation of a discussion that some involved in the sector have been having over the past several years. My personal comments here are restricted to the three bolded portions of the statement and are for careful reflection and discussion purposes among everyone concerned and committed to the well-being of this service sector and the NBers who depend upon it, many as a matter of ‘life and death’.
- ‘To replace the myriad of agencies’ – with one public agency needs careful questioning. There are agencies that have been providing quality services for some time often under very difficult circumstances. I would suggest that rather than propose a blanket replacement, instead a coordinating authority be established that has some degree of authority over standards, training requirements, and wages and benefits, while leaving actual delivery to agencies that can operate effectively according to the general rules negotiated among government, agency organizations, worker organizations, and this public authority.
- ‘Implement such a public agency’ within our first mandate as government’. I refer to this proposal as a ‘useful thought experiment’ but unlikely to become government policy as stated anytime soon given that presently support for this line of thinking is running at best at about 9% of the electorate according to most assessments/estimates. Though the analysis of the sector problems especially regarding working conditions and worker turnover is on the mark in my view, the remedy proposed raises important questions and requires more discussion and constructive debate. There is the real question of whether a straightforward extension of the government bureaucracy is the best approach to restructuring this sector – would it be more cost-effective? Are there alternative ways of restructuring the sector that builds on the good things that already exist in this sector of which there are many?
- ‘The excellent service provided by the government Extra Mural program’ – Many of us have had direct experience with the extra-mural program and it is true that it is something we can be very proud of in NB. However, it is funded under an entirely different funding structure than community based health and social services, where generally the client has no responsibility to pay but instead costs are covered directly by medicare. I believe it is unlikely that community based health and social services can or will be brought under the same structure. Realistically, this issue involves deep matters of policy, programming, and direct practice that will require a significant political and economic consensus to change as is being proposed. As high quality as Extra-mural services generally are, it is also the case that there are questions regarding the efficiency of delivery especially in terms of meeting the growing demand for services which led to the ‘privatization’ move to Medavie. Though this move may need to be reversed, as is proposed, we must recognize that there are real issues of balance between effective and quality direct service delivery and complex issues of centralization and decentralization of management and control, which in my view is as crucial as any discussion surrounding the so-called public versus private debate.
Hugh Williams
Image from CTV News (https://atlantic.ctvnews.ca/video?clipId=1313658)
