Friday, January 22, 2010

What Zwozdesky is Doing in Health Must Also be Done in PDD

Minister of Health Gene Zwozdesky first days on the job have been significant, and I have to say, reassuring. Stopping bed closures is one thing. Taking back control of the healthcare system into the government is even better. The bluster and bulling culture of the past years has done nothing to get those who work in the system to help the province accomplish the goals it has set out. Zwozdesky has not likely doing this without the support of the Premier.

I am wondering just how much the Whitemud Citizen’s Forum on Health Care rally a few days ago had on reversing the attitude of the government towards providing healthcare services. Dave Hancock had the largest margin of victory for any PC candidate in the last election. His constituents came out in droves to express their frustration and dissatisfaction with their government. So maybe, just maybe, the message got through that the bullying, intimidation and heartless approach to providing public services to citizens who need help is not winning friends. It was sure influencing people – and they are starting to show up and talking back.

So now we need the same Zwozdesky decisiveness and caring to infiltrate the Department of Seniors and Community Services. The last time this department was understood and had a champion in government was when Zwozdesky was the Minister. He understood the role of the department. He had compassion for the people it served and he was able to provide accountability for the taxpayer dollar too. He was well respected by the professionals in the field then too. In fact I have seen letters from Zwoz that he wrote to community based not-for-profit volunteer supported service provider agencies for persons with developmental disabilities that they have framed and on their walls. When was the last time you saw a politicians with that much respect?

I am working on a volunteer basis helping the service provider agencies who serve Persons with Developmental Disabilities stop the final quarter claw backs of fees for services to cover off projected deficits in the Regional Boards of PDD. How is it that these regional boards appointed by government and run by CEOs who work for the Department and allegedly report to both the boards and the Minister are running deficits? They know what money they get from the province. They determine who gets what services for how much so how is it they are in deficits?

The PDD service provider agencies have been bullied and intimidated by the province for years with these end of year claw-backs. But now the attitudes amongst service providers have changed. They are no longer willing or even able to cover the shortcomings of the funders. They do this work as a calling more than a job and have in the past spread out the services and pressed staff capacities thin to the point they can’t meet the safety, care, and dignity needed of the clients in their care. The services providers are standing up, demonstrating and asking questions of government – and insisting on answers. Over 1200 people in the PDD sector recently demonstrated in a church to demand that the government deal with the shortcomings in the funding of this sector and stop downloading bad regional and provincial management on the agencies.

The province wanted a “more business-like relationship” with the service providers and insisted on a contract – not a grant – relationship. Contracts were negotiated and signed but again in an atmosphere of intimidation, threats and bullying of the agencies by the province. I know, I helped the agencies in the negotiation of those contracts. The province however still seems to think that they can unilaterally at their whim single-handedly change a contract. That is not the law - and one thing for sure - the province is not above the law.

The intimidating and innuendo calls and comment to the agencies continue but the threat of a Court Injunction for anticipatory breach of contract has seen the province pull back. It no longer says they will just withhold the funds they demanded in the next payment. They are now threatening to cut back the claw back funds and more in the next contract rounds that are supposed to be in place April 1, 2010 for most agencies. That, of course is a matter for negotiation between the parties. If the province is not willing to pay not-for-profit community based volunteer local agencies what is needed to do the job, then the province will have to do the job of caring for citizens with development disabilities itself.

Let’s look at a bit of law to see who is really responsible for these vulnerable Albertans. The “Persons with Developmental Disabilities Community Governance Act of the Revised Statues of Alberta has a most enlightening preamble. Preambles are intended to set a tone, a spirit, if you will, and some context about a law. Let’s review this spirit of the law in the context of the intimidation actions and the bullying attitudes of the Government of Alberta in dealing with those who provide the services for the government to these citizens.

1 “Whereas the people of Alberta honour and respect the dignity and equal worth of adults with developmental disabilities;”

If this were true why is the province jeopardizing the safety, care and dignity of those vulnerable adults by not providing enough funds to meet their needs? Why the community based service agencies are only allowed to pay staff about 2/3 of government employees doing the same jobs and with fewer benefits? How can this sector attract and retain qualified trained staff with such uncertainty in working conditions and pay levels. So much for “equal worth” and “respect for dignity.”

2 “Whereas the Government of Alberta recognizes values and supports the ability of communities to respond to the needs of adults with developmental disabilities;”

Again if this were true why does the government strangle the ability of community based agencies to respond to the local needs with arbitrary funding cuts coupled with intimidation and bullying of agencies? Why are funding levels are so low that there are known risks being created that could threaten the safety of clients and put staff, volunteers and agency administration? Why are these people being asked to assume a risk of liability for possible contributory negligence because they can’t meet their legal duty of care for clients because of the low level of resources being provided?

3 “Whereas the Government has ongoing responsibility to ensure and oversee the provision of statutory program, resources and services to adults with developmental disabilities;”

Here is kicker for the Minister. She is the one ultimately responsible for all of this, the good the bad and the ugly. There is not much that qualifies as good these days. What is the function of the regional based community boards serve to meet the needs of the clients? They are appointed by the Minister, they get remuneration and expenses, and they get to recommend a CEO to the Minister. That CEO becomes a government employee not a regional board employee because the law says the community boards can’t have employees, can’t borrow money and have to be non-profit. That is the full extent of their powers – just stuff they can’t do. Why have them? They act as buffers between the community and the politicians and protect the Minister from the rabble called citizens. So much for responsibly “ensuring and overseeing” when the government has no intention of taking advice from its own community boards on PDD issues.

To be fair according to the Act the Minister “may” – not shall – give written direction to the community boards as part of her duty to “monitor and asses the community boards in the carrying out of their activities.” The role of the community boards is to provide services, determine community priorities, allocate funding, develop plans of delivery of services, oversee and evaluate the implementation of the plans, assess the ongoing needs of a region, manage the provision of services, ensure reasonable access to services and co-ordinate with other community boards, public and private bodies for the proviso in of services. With powers and responsibilities like that, if there is a regional deficit that is due to the management at the regional and departmental levels…not at the community based service provider levels.

The CEOs of the community boards have the power and ostensible responsibility to the Minister and the community boards. However the Minister pays them, so guess who they really work for. The appointed members are mostly inconsequential and either misinformed or uninformed. I expect they share that latter reality along with the Minister. I can’t believe the Minister is fully and appropriately informed about what is going on when these claw backs and bullying started to happen all over again. I could be wrong about the Minister but even so, it is about time she started asking some serious questions.

Here are a few questions ask her department and her regional CEOs and community boards.

1 How come there are last quarter deficits in the regions year after year? Can’t these people learn from mistakes?

2 Why does the money go? For example in 2006/07 of $508 million in the Budget only $404m went to the community based service providers but $104 stayed in the regions and the province to “oversight and direct delivery.” Why can’t we have a better breakdown of that $104m portion to see how much value we get for “oversight” and what the costs are for government provision of services? Rest assured if the community based service providers do not accept the provinces funding levels those services will have to be provided by the province in new institutions with unionized workers. That will not be cheaper.

3 Why are the Calgary Region Community Board expenses so out of line? Based on the government’s own audited financial statements in the seven years 2001 to 2008 Calgary community board “Supports to Delivery System” actual expenses have gone through the roof. These are the region administrative costs that do not provide services – just “supports to delivery.” In two words, administrative overhead! Here are some actual Supports for Delivery System costs numbers:

2001 12.0m 15.23 % of total budget

2002 13.8m 15.5 %“

2003 16.2m 16.9%

2004 19.5m 18.5%

2005 19.9m 17.5%

2006 22.0m 17.7%

2007 28.2m 22.1%

2008 31.0m 22.1%

By contrast Edmonton region spent $24.2m in 2008 in total Support for Deliver of System costs. Edmonton has a total budget that is $10m larger than Calgary yet spent $7m less on administrative overhead. The Calgary region 2008-09 budget for this cost was $31.6M a whopping 24% of total budget.

To add insult to injury the Calgary region board froze the administration and service delivery costs for community agencies for 2007 and 2008 even though they took on more clients.

There is something radically wrong with this picture and they still claim to be running deficits at the community board levels. This does not pass the sniff test as lawyers sometimes say. This is just one example of many I could bring forth but it makes the point. Service providers are in survival mode. They are not just playing hardball. They are meeting with MLAs and bringing their books with them to show them the facts not the spin that is coming to them from other sources. Service providers have nothing to hide and they are tired of being bullied and intimidated and misinformed.

All this information was provided to the Minister in a letter dated January 7, 2009. There has been lots of time to investigate and respond. I think that is exactly what has to happen, an independent investigation into the regional boards and departmental management and administration.

A request for a meeting with the Minister by the group that represents the community based service providers has not been responded to. A five page letter was sent to the Premier just before Christmas but no response has come yet. The letter outlined “Principles of Partnership” like accountability, independence, interdependence and dialogue. The service providers acknowledged that there are difficult choices facing the province but better decisions could be made in collaboration with service providers – not unilateral punitive actions. A recommendation for Principles Guiding Funding was made to the Premier that would take a long term sustainable approach that would provide stability and certainty for clients and the sector. There were Key Messages and Recommendations made for a Joint Solution to the challenges.

Gene Zwozdesky took the right path by re-engaging government directly in a hands-on way in health care. Minister Jablonski needs to do the same thing but the Premier has to give her the blessing to do that housecleaning and fact finding and verification in her department. The good news is this Minister’s heart is in the right place but she needs to make sure she has her facts straight from her department. I think an independent review of the PDD system internally and externally is in order. It is happening in Children’s Service and it is warranted here.