VIHA: time to ‘out’ a failing institution?

The Vancouver Island Health Authority’s announcement of the return of fixed-site needle-exchange services (“service hubs”) to Victoria, after five years of false starts and delays, raises some important questions.

Why is VIHA taking so long to reintroduce this basic harm-reduction service? Does this failure point to deeper leadership problems at VIHA? Will these prevent or delay other components of health policy, such as supervised consumption services or drug and alcohol maintenance programs? What can we do about it?

Five years is a long time for a health authority to fail to provide services mandated by the province. As early as 2009, a VIHA briefing note to the board of directors pointed out that “without a fixed site NEX [needle exchange] the health authority is not consistent with either its own or with provincial policy,” and acknowledged that “failing to establish a fixed site NEX as part of a distributed harm-reduction model puts the health authority at risk for spread of HIV, hepatitis C and other blood-borne diseases.”

Five years is also a long time to wait for a basic health service, particularly for people who lack the financial resources to find support elsewhere. When it comes to fixed-site needle-exchange services, it’s not just access to clean supplies, but access to health care and referrals for people who would not otherwise have contact with these services.

So these five years can be measured, not only in terms of infections and diseases that could have been prevented, but also in terms of improvements to people’s health and well-being that could have been provided and encouraged.

Policy implementation sometimes moves slowly, but there are reasonable grounds to question whether VIHA has exercised due diligence in implementing these services in a timely and appropriate manner.

A scant two months following the policy brief above, VIHA disbanded its needle-exchange advisory committee and stopped speaking publicly about needle-exchange services, making an abrupt shift toward a “distributed model” of supplying needles through existing service-providers.

In a letter to VIHA dated Nov. 19, 2009, the advisory committee expressed its concern about a policy it believed “hamper[ed] the successful search for a needle exchange site” and re-stated VIHA’s own findings that a distributed model could not replace the range of services provide by a fixed site.

On what grounds were decisions to disband the needle-exchange advisory committee and to shift toward a distributed model made? This remains unclear.

More than a year later, the City of Victoria passed motions urging VIHA to form a working group to ensure fixed-site needle-exchange services would be reintroduced. In a letter dated March 4, 2011, VIHA agreed to form such a group as long as there was agreement “between the city, the police and VIHA on the benefits of harm-reduction services based on best practices, including the reduction of public consumption of drugs and improving public order.”

Why was the city forced to prompt the provision of services VIHA recognizes as part of its provincial health mandate? Why is VIHA putting public order and other policing issues before it’s health care mandate? This also remains unclear.

We know enough, though, to make a reasoned judgment that changes are needed to prevent similar implementation failures when it comes to other components of health policy, such as supervised consumption services or drug and alcohol maintenance programs. But do the directors at VIHA have the will to make these changes?

VIHA’s record so far isn’t good, and the problem seems to be at the very top, with a political leadership that appears more interested in avoiding public attention than backing the health services recommended by their own health experts. In Victoria, this has created a vacuum regarding health policy that is being filled by the only other major player in town: the police force. We’ve seen the results of this over the past 5 years, and it isn’t pretty.

What do you do when a public institution such as VIHA goes bad? The Ministry of Health likely has a good sense of the internal mess at VIHA is in, but isn’t likely to act without loud public demand. Our guess is that there’s a fair number of VIHA employees that may be tired of seeing their front-line work limited, or reports and recommendations ignored or blocked, by an overly centralized and politicized leadership — it would be great to hear from you.

Anonymous leaks of information are always a good way to kick off a flurry of public discussion — submit here!

[note: a shortened version of this post was printed as a Times-Colonist Op-Ed (Dec 13, 2012)]