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Want to eliminate queue-jumping? Then eliminate queues.
There you have it: seven million bucks worth of advice.
That is essentially the conclusion of the much-ballyhooed Alberta queue-jumping inquiry released last week.
This is not meant as a criticism of John Vertes, the former Northwest Territories Supreme Court justice who led what was officially called the Health Services Preferential Access Inquiry.
He carried out his mandate with aplomb, producing a report that was thorough (610 pages worth of thorough) and a set of recommendations that are entirely reasonable (if predictable).
But the reality is that this inquiry was never needed in the first place. There were never anything more than vague rumours of "fixers" and "go-to guys" who were supposedly ensuring "preferential or expedited care for prominent individuals."
Those politically explosive claims came principally from two individuals, Stephen Duckett, the ex-CEO of Alberta Health Services, and Dr. Raj Sherman, a former Progressive Conservative MLA who is now leader of the provincial Liberal Party.
In other words, they came from people with an ax to grind. They were seized upon and amplified by politicians eager to make headlines – namely by Alison Redford when she was running for the leadership of the PC party. When she won the leadership and became Premier she had little choice but to call a public inquiry, even though common sense dictated otherwise.
Not surprisingly, the claims, which were at best hearsay, never amounted to anything when subjected to the harsh glare of daylight.
As Mr. Vertes said in his report: "If a modicum of effort had been put into investigating these allegations when they were first made, their lack of substance would have become readily apparent."
This is reflected in his penultimate conclusion: "Improper preferential access is a minor component of the public health-care system."
So what's the head of an inquiry into preferential access to do when, pretty early on in the process, it was clear there was no preferential access?
Well, with reality out of the way, there's always perception. "Because of the public perception about the extent of improper access, this issue corrodes the public trust in the system," Mr. Vertes wrote.
Misconceptions about the public health-care system are commonplace. Many members of the public think, for example, that politicians have access to their own private hospitals. That's not true – though federal MPs did have access to National Defence health facilities prior to the 1970s. They think that the wealthy can buy access to better, quicker healthcare; they can't in Canada, but they can in the U.S.
The public perception is also that, when it comes to accessing health services, who you know matters. There is truth to that, but it's not always cut-and-dried. If you know the system, you can game the system, which means physicians and nurses can sometimes finagle family members to the top of a wait list, or extend "professional courtesy." When VIPs end up in hospital they sometimes get special treatment like courtesy calls from the CEO. And sometimes big shots (like hockey players) get bumped to the front of the line for their flu shots even if they don't ask. (When the fact that Calgary Flames' players didn't wait in line for their H1N1 shots is the most salacious queue-jumping scandal, it's not much of a scandal.)
But one of the more interesting points in Mr. Vertes' report is that there are a lot more opportunities for queue-jumping than there is actual queue-jumping. How very Canadian!
Nonetheless, Mr. Vertes came up with 12 recommendations:
- 1. Strengthen the queue-jumping provisions of the provincial Health Care Protection Act;
- 2. Expand whistleblower protection;
- 3. Clarify the scope and application of professional courtesy;
- 4. Reduce wait times;
- 5. Develop and implement wait list management strategies;
- 6. Develop standardized referral procedures and booking systems;
- 7. Consider creating the position of Health Advocate;
- 8. Develop a policy on courtesy calls;
- 9. Develop a policy on special accommodation during a pandemic;
- 10. Develop policies for the private health path;
- 11. Strengthen access, triage and booking procedures;
- 12. Develop a policy on preferential access.
Provincial Health Minister Fred Horne said the government essentially accepted all the recommendations. And why not? It's mostly motherhood and apple pie, with a dollop of sensible management.
It's also nothing that a small group of patients, health professionals and administrators couldn't come up with on the back of a napkin during a coffee klatch.
But politicians in this country too often fail to realize that not doing something (like calling a useless inquiry) is a much better way of showing leadership than merely going through the motions for the sake of appearances.
André Picard is The Globe's health columnist.
André Picard