Details that will guide the Yukon government’s comprehensive health care review were made public Monday, coming complete with an extension that will see a final report given to YG in March 2020.
That’s despite the government saying last November and as recently as last month that a final report was expected to be in the Department of Health and Social Services’ (HSS’) hands by October 2019.
That five-month extension was requested by the independent expert panel, a Monday release noted, “to ensure the panel has the time to do its work and to hear from Yukoners, partners and stakeholders.”
The chair of that panel is Bruce McLennan, who joined HSS deputy minister Stephen Samis Monday afternoon for a briefing in the wake of minister Pauline Frost tabling the terms created by the panel in the legislature.
McLennan appeared via video conference from Nanoose Bay, B.C.
While the extension request was granted, he noted, HSS will still have something in their hands via draft recommendations in December to guide the next fiscal year’s budget.
“So that will give the minister at least some preliminary indications of where we’re going with the review and some preliminary recommendations so that she can plan as she goes into the future,” McLennan said.
Work of the panel is split into five phases: it starts with collecting internal information, past reports and reviews, which has been completed.
Phase two is the panel sorting out themes (also completed) and looking at best practices of other jurisdictions, and will run until about June of this year.
The third phase includes public engagement and will be July to September of this year.
After that, YG will share a “What we Heard” report between September and December and see draft recommendations delivered to HSS (this is what McLennan was referring to).
Between January and March 2020 is when there will be a draft report and final report tabled to YG.
“I think if you want a better product, given the commitment of the panel members to this assignment, I think stretching it out an extra three months is good value for your money,” McLennan added.
The health care review has been a popular topic in the legislature, and may be rightfully so. An HSS spokesperson clarified Monday that while it was a health care review, it could bring forth recommendations for a number of different bodies.
That means HSS may not be the sole group accountable to the suggestions.
Other groups that could be under the microscope include Emergency Medical Services (which falls under the Department of Community Services), the Yukon Housing Corp. (a portfolio also held by Frost) and the Yukon Hospital Corp.
Meanwhile, McLennan, who also chaired the steering committee for YG’s 2008 health care review, referenced that in his remarks Monday.
“There are things even there that the panel is aware of that may not have been fully implemented,” he said.
“It’s a very complex area, and to make changes does take some time because it involves people and involves changing systems.”
Examples of what the panel could be looking at include different primary care models in the light of changing demographics.
“The 2008 review ... it was more looking at an economic type of review,” he said, likening it to focusing on “overall fiscal sustainability.
“This review, I would say, is a little broader in that regard, in the sense of we’re not just looking at health, we’re looking at the social services side as well.”
Samis spoke to this too, pointing to one of the 14 efficiencies that was found by an internal team within HSS dubbed the tiger team.
“One of the things that we could do is identify alternative payment mechanisms for people in social assistance,” he said.
Right now, those getting financial assistance are paid via cheque rather than direct deposit, like other jurisdictions may do.
“We’re not able to do that because we have a regulatory system which doesn’t enable us to do that – so we actually have to create a regulatory change to be able to pay people differently,” Samis said.
He added the department will be making the 14 efficiencies, some of which have been referenced in the legislature, public.
The review itself will be guided by six themes, including the co-ordination of care in and out of territory, structures of systems to help those with multiple layers of needs, aging in place, and social supports.
McLennan said the exercise’s intention was not to say the department is too small or too big, but suggestions could come out of it that would point the government in that direction.
From there, it would be left up to the government to prioritize where to focus in finding efficiencies.
“Some recommendations will probably direct for future changes to the department and how they deliver services and what resources they use to deliver those services,” McLennan said.
He later added that indirectly, changes in staff levels could be an outcome if the panel finds a certain program doesn’t work anymore, for example.
But he maintained it wasn’t a focus of the group. “We’re not looking at staffing models, we’re looking at deliverables.
“It’s dealing with things at a 1,000-foot level, I guess.”
HSS tends to be one of the biggest cost drivers to the government. The 2019-20 budget shows it makes up about 30 per cent of total expenses in the territory, while the next-highest department makes up about 18 per cent.
On the flip side, HSS brings in the third-highest revenue for YG, at about three per cent of total revenues.
“We’re not doing an audit of the department (HSS) per se; we’re looking at fairly high-level recommendations in terms of programs and services,” McLennan added.
This overall health care review comes as the department wrapped up its internal review of NGOs over the last year. That included looking at the clientele the groups serve, their scope of practice and the like.
Samis added there was no report to be shared from that review: “There’s nothing to be made public about that; that was just work we were doing in due diligence as providing public funds to our NGO partners.”
Another one of the review’s five themes is reconciliation. That calls for a valuing of traditional health practices and looking at the impact of colonialism on the health and wellness of Indigenous people.
“There’s a recognition that in terms of involvement of First Nations people, especially in the Yukon, where most of them have self-government agreements, that there is a need to ensure that we look at any inequities ... as they affect First Nations,” McLennan said.
Samis agreed, noting that was a theme to guide the work rather than a focus on a specific issue.
Adding that governments have the ability to take on some services as per their agreements, he said that would be left up to them, “and we (HSS) would work together to operationalize that – but we don’t download to First Nation governments.”
Samis was asked whether Yukoners can expect a formal response from YG to the draft recommendations (which it will see in December), laying out, for example, how they were being met or any changes ahead of the unveiling of the 2020-21 budget.
He said it’s too early to say at this point.
“I don’t want to commit us to doing a formal response in December,” he said. “This is a tight agenda to get done, a review of all health and social services systems.”
That’s also since the the suggestions will go through the minister and cabinet, so the department is still figuring out how to respond to the suggestions beyond the acknowledgment of them, he added.
As for the immediate next steps, the government hopes to come out with its public engagement through an online survey in early May.
That will come after it publicly shares the 14 efficiencies that were found by the tiger team by the end of this month.