Legislative overview: The Regional Health Authorities Amendment Act (Bill 10)

Publish date: Tuesday, April 23, 2019

MNU members

Politics & Government

Put Patients First

Regional Health Authorities

While the problems created by Phase I and Phase II of the WRHA’s cuts and closures continue to disrupt health care services in Winnipeg, the Pallister government has decided to introduce legislation that will bring about more changes to health care province-wide.

Many nurses are already aware of the newly created Shared Health Manitoba, and its growing sphere of influence. However, what is less clear is the government’s overall intent for Shared Health.

Bill 10, which was introduced on March 6th, 2019, outlines the intended role of Shared Health, its future responsibilities and sets forth a new health care governance structure for Manitoba.

In this new model, the regional health authorities will still exist, but there will be an addition of two more health authorities: the provincial health authority (Shared Health) and CancerCare. However, under Bill 10, not all health authorities are created equal – in fact, Shared Health will have greater influence and control over how clinical services are delivered by the RHAs.

Bill 10 proposes that Shared Health will assume considerable power over the RHAs. Some of the key responsibilities Shared Health would assume include:

  • Develop the provincial clinical and preventive services plan (PCPSP) which will direct “the delivery of healthcare services in Manitoba”
  • Establish clinical standards for healthcare delivery
  • Develop provincial health human resources plans
  • Prepare annual health capital plans aligned with the PCPSP
  • Provide administrative and support services to the other health authorities

These changes would put Shared Health in a leadership role in directing health care services and delivery.  Shared Health will also have oversight functions, and will monitor the other health authorities’ implementation of the PCPSP, compliance with clinical standards and construction of capital projects (when government is funding two-thirds or more of cost).

Bill 10 also politicizes the planning & delivery of health care services by severely limiting the ability of RHAs to make decisions about services that address local needs. All the health authorities will be required to follow the PCPSP, which is developed by Shared Health and approved by the Minister of Health. The RHAs ‘participate’ in the development of the plan, but will no longer lead the process. Therefore, the bulk of the decision-making affecting the services to be available in the regions will be made in Winnipeg, with greater input and influence from politicians.

The plan is touted as a way to provide consistency of service, but a one-size-fits-all plan runs the risk of drastically diminishing the flexibility needed to address local needs. Nurses know the challenges associated with moving decision making further away from the bedside, and into the hands of politicians.

The bill also contains a number of other troubling features.

First, requirements for consultation with the public are weakened in this bill, by moving from a system that specifies who, at a minimum, should be consulted, to one wherein the Health Minister exclusively determines who would be consulted. The Bill 10 language around public consultation simply states that it must be carried out “as directed by the minister.” This is wholly inadequate as a means of ensuring proper public input into plans that will impact the healthcare services available to Manitobans.

Second, many aspects of this bill reinforce the Health Minister’s authority and centralize power in their hands. Beyond determining the extend of consultation, the minister must sign off on many of the plans, including the PCPSP, provincial capital plan and provincial health human resources plan. No health authority will be able to “purchase, lease or accept by donation” any equipment that is deemed to increase operational or capital costs without the permission of the Minister. Therefore, regional capacity for health care planning will be removed and politicized by concentrating decision-making power in the office of the Health Minister.

Other troubling aspects of the bill include the addition of “accountability agreements,” which would force RHAs to not exceed their budget. The introduction of these agreements highlights the intent of the current government to prioritize fiscal restraint in healthcare. There are no aspects to these accountability agreements that have anything to do with quality healthcare or meeting patients’ needs – they appear to be strictly intended to address financial concerns.

A final concern for nurses should be the proposed establishment of “standards committees.” Although similar language can be found in other acts, the language in Bill 10 is overly broad and encompasses all regulated health professions. Essentially, it allows for Shared Health to establish standards committees to “review the professional competence of health care providers,” and recommend additional training for individuals, or recommend “actions or systemic changes” that should be made by other providers.

When establishing the standards committees, Shared Health is required to consult with the college responsible for the type of healthcare services under review. However, consultation does not guarantee that the committee would adequately consider the nature of the profession of the provider under review. We view these committees as redundant for nurses, given that the College of Registered Nurses of Manitoba or College of Licensed Practical Nurses of Manitoba already investigates when a nurse is suspected of not meeting the profession’s standards. It is also unclear whether, or to what extent, a provider brought before a standards committee would have representation. MNU continues to investigate this section of the legislation.

Overall, Bill 10 is concerning for a variety of reasons. It appears to lay the groundwork for further cuts and closures in health care throughout the province, and gives RHAs and communities little recourse to challenge the direction provided by Shared Health and/or the Health Minister. Concentrating power into Shared Health and the minister’s office, while limiting consultation with communities being served could create serious challenges for health care delivery in Manitoba.

Bill 10 has gone through first reading, but has not passed. In April, the Official Opposition (NDP) delayed the passage of Bill 10 until at least the fall session of the legislature. MNU will continue to study the potential consequences of this bill and keep members informed. In the meantime, Shared Health is expected to release their first Provincial Clinical and Preventative Services Plan this summer.

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