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No ‘crisis’ but no lapdog either: Barefoot

Fraser Health Authority board chair Gordon Barefoot denies the health region faces a looming crisis due to inadequate funding – a claim his predecessor Keith Purchase made as he resigned last month.

“No, I don’t think we’re in a crisis,” the new chair said in his first interview since stepping in Jan. 26. “A number of things have actually changed since Keith had characterized things that way.”

Purchase protested the government’s announcement of a 7.1 per cent budget increase for Fraser Health in the new fiscal year, warning it would mean hospital overcrowding will “only get worse” and the situation threatens to take the region “rapidly backwards.”

Barefoot, an FHA director since last summer, said the province now won’t make health authorities plan around a three-year funding allocation and will instead set only a one-year budget and look for health reforms flowing from the Conversation on Health to guide budgets in later years.

Victoria has also added an extra $100 million fund for innovation, he noted.

But he would not say whether the new budget with a 7.1 per cent increase is adequate.

“I’m still looking at that,” Barefoot said. “Between now and sometime in early March we’ll come to a determination on that.”

And he revealed that he has not yet signed the “letter of expectation” demanded of him by Victoria that commits the board to deliver required service levels within the set budget.

“No,” Barefoot said. “I have no intention of doing that until I understand exactly where we are in the budget.

“I told the minister when I signed onto this task I’m not signing anything until I understand the situation. We’ll deliver on a budget based upon what we believe we can deliver. Hopefully that’s going to line up with the expectation.”

Barefoot said there are daily if not hourly discussions underway over the budget, adding he will take Fraser Health’s position to Victoria after he has a firm grasp of what’s needed.

He also countered one criticism – that health authority boards are essentially government-friendly lapdogs who will do Victoria’s dirty work on cost control while insulating provincial politicians from most of the ensuing flak.

“Anybody who knows me knows I’m not a yes man,” Barefoot said. “I’ll give the best advice that I can and look somebody in the eye – the minister or the premier – and if they don’t agree with me I will press very hard.”

Asked what he will ultimately do if the money from Victoria doesn’t come close to meeting Fraser Health’s needs, he said:

“Rome wasn’t built in a day. And a war isn’t one battle. So one has to take a view over time. Sometimes your victories are small and incremental. I fully intend on being here for the duration of my appointment. But you never know.”

Was it difficult to step in as chair after two other board members resigned over the province’s hard line?

“Quite frankly, I thought it would be a disservice not to step in the breach and continue the work that had been done,” he said. “When the flag-bearer goes down, someone’s got to pick up the flag. It’s best that somebody picks it up that even knows a little bit about it.”

Asked whether Fraser Health faces bed or service cuts this year – another warning from Purchase – Barefoot said that would be “inconsistent” with the goal of retaining quality patient care.

He confirmed FHA hospitals are running at about 120 beds over budgeted levels – equivalent to being short one mid-sized hospital.

Barefoot said his top priority is to hire a new chief executive from a short list of candidates to replace acting CEO Keith Anderson who has served since former CEO Bob Smith was terminated just over two years ago.

“It’s critical to have stability in leadership roles to go forward,” Barefoot said.

His other top goal is to convince the province to agree to the long-term bed requirements for the region the FHA has laid out in its Acute Care Capacity Initiative, which was sent to Victoria in December but remains under wraps.

It’s expected to make the case for several hundred more beds over and above the roughly 1,900 now funded in Fraser Health to meet future demand. It will also lay out when and where hospitals should be built or expanded.

Barefoot won’t reveal details, but he says he wants health minister George Abbott to release the document quickly.

“I’ll be urging him to do it sooner as opposed to later,” he said. “I think it’s important for everyone to understand the situation to make the Conversation on Health a meaningful discussion.”

The initiative is the product of 18 months of intensive research on what bed levels are needed in each part of the region over the next two decades.

“Everyone has an opinion – there’s no shortage of opinions,” he said. “I’d like to get some additional facts on the table.”

Victoria’s response is critical, he said, because if it signs on to the FHA’s bed master plan, it will be accepting new costs and funding pressures.

Fraser Health staff who are “doing an exceptional job under some very, very tough circumstances” need to see evidence of progress, he added.

“What they need to see is there’s light at the end of the tunnel in terms of the proper capacity at the right places,” Barefoot said. “We have to keep the pressure on.”

Meanwhile, Barefoot confirmed the board is still sparring with Victoria over $43 million in committed capital funding that had been promised in the 2006-07 budget but removed when the grant arrived last July.

“It’s a concern of mine and we’re in discussions around that $43 million at this point,” he said. “I’m hopeful we will resolve that issue shortly.”

Also up in the air is exactly how a new outpatient hospital in Surrey will be built.

Barefoot said it will be a P3 – a private-public partnership – “in some form.”

But he said the board has only recommended a design-build model – not other variants that would put a private firm in charge of financing and possibly running the facility.

The final choice will be up to Victoria, he said, because a full design-build-finance-operate P3 amounts to a long-term arrangement for which only the province can guarantee funding.

A management committee had previously recommended against a P3 approach.

Barefoot came to the FHA after retiring as chief financial officer for Terasen Inc. He’s also a chartered accountant who was a partner at Ernst and Young. He’s also president of Cabgor Management.

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