July
20, 2005
Plans
from the Health Authorities
"There
are 1,233 persons with a mental illness in immediate need
of mental health housing and an additional 2,700 needing
addictions housing in VCH. To meet the most immediate needs
of these two clients groups, 1,568 new housing units are
proposed - 901 for mental health and 667 for addictions.
This represents 40% of estimated current need. 260 of these
units will be implemented in 2005/06 that addresses 6.6%
of identified demand."
Vancouver Coastal Health Authority (VCH), "Health
Service Redesign Plan 2005/06 to 2007/08", May
19, 2005, par 2.6.2, p. 19
Addressing
6.6% of identified demand per year means, if nothing changes,
that the full demand would be satisfied in just over 15
years, sometime in 2020. Some might be quick to criticize
the Vancouver Coastal Health Authority for moving so slowly
on what it has identified as demand for mental health and
addiction housing, but it deserves credit for publishing
a report that acknowledges the problem and its expected
rate of resolution. The report boldly accepts that the plan
may face "challenges" because:
"Tracking
and attributing changes in performance in related system
areas will be a challenge and it may be expected that the
housing interventions will have a variable impact upon access,
service levels and patient flow. It is possible that increased
system engagement by larger number of clients may put a
strain on existing community clinical services."
British
Columbia's five regional and one provincial health authorities
have standardized their financial reporting. None report
anything on a functional level, such as how much is spent
on mental health; all report expenditures in just four simple
and useless aggregate categories: salaries, supplies, contracted
services and depreciation. The authorities cannot be accused
of the same frustrating standardization when it comes to
their planning documents. The Vancouver Coastal Health Authority
arguably publishes the most detailed planning documents.
It's "Health
Services Redesign Plan" appears similar to service
plans required by the Budget Transparency and Accountability
Act.
All
of the health authorities publish planning documents but
they vary in how much they actually disclose to the public.
The Fraser Health Authority publishes its strategic
plan and a more detailed "operating
plan"; the Northern Health Authority also publishes
an "operating
plan" as does the Provincial
Health Authority; the Vancouver Island Health Authority
publishes its "Integration
Plan"; the Interior Health Authority publishes
its "Health
Services & Budget Management Plan".
It is
instructive to pick a particular service area, like mental
health, and compare how each of the health authorities specifies
what will happen to that service in its plan. In contrast
to more than 12 pages devoted to mental health and addictions
in the VCH document, Northern Health devoted one paragraph
(section 3.4) to what it previously accomplished plus one
paragraph (page 5) on its future plan:
"These
services have developed a service redesign plan focused
upon having a regional system of care with similar access
to services at the community level. Much work remains to
be done to achieve effective integration with other parts
of the health system. Like Public Health, these services
face staff shortages and have been under spent as a result.
Mental health and addiction services are not believed to
be sufficient to appropriately meet needs, but a more rigorous
needs assessment should be carried out as the redesigned
programs begin to operate. North Health should increase
its commitment of resources to this area in the period 2005-06
to 2007-08".
It is
concerning that Northern Health is redesigning services
without having completed "a more rigorous needs assessment".
The
six health authorities are responsible for over $7 billion
in spending, over 20% of the provincial budget. They should
be subject to scrutiny on how that money is spent, how they
specify their objectives and whether their objectives are
being met. It would help to be able to compare performance
between authorities, but that is difficult when their plans
bear few similarities, not because they are different communities,
but because no effort is put into standardized reporting.
The Minister of Health and the Premier, who are ultimately
accountable, need to insist on more transparency, consistency
and accountability from the health authorities.
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