Patient First Review: Saskatchewan Health refusing to release consultant Tony Dagnone’s Scoping and Planning Project document

Dagnone's services in May 2008 agreement

Dagnone's services in October 2008 agreement

Patient First Review Terms of Reference

The Saskatchewan Party government is refusing to release a report submitted by the consultant it hired to review the province’s health care system that contains information on the study’s framework and methodology.

On Nov. 5, 2008, the Brad Wall government announced that the former head of Saskatoon’s Royal University Hospital, Tony Dagnone, was appointed as the commissioner to lead the “Patient First Review” of the health system.

The review will have two parts. The first part of the review will focus on issues and challenges in the health care system from the perspective of patients. The second part of the review will examine administration in health care and identify efficiencies, constraints and opportunities for improvement in the regional health authorities, their affiliates and the Saskatchewan Association of Health Organizations.

Dagnone was initially retained by the government in the spring to assist in setting the terms of reference and make recommendations on the study’s framework to Health Minister Don McMorris.

An access to information request dated Nov. 7, 2008, was submitted to the health ministry for copies of the government’s contracts with Dagnone, the framework report he delivered to health officials and the terms of reference for the Patient First Review.

The ministry’s Dec. 10, 2008, response disclosed the contracts and the terms of reference but not the report. According to the ministry “the information contained in the Scoping and Planning Project document is exempt” because it “contains advice and recommendations to the Ministry of Health’s Executive Government; and… information pertaining to the deliberations of Executive Government and Senior Government employees within the Ministry of Health.”

There are two agreements between the government and Dagnone for his services: May 14, 2008 to June 30, 2008; and October 21, 2008 to September 20, 2009.

Under the first agreement Dagnone’s services included, but were not limited to, the following:

1. Engage in discussions with Ministry of Health officials, direct Deloitte project staff and others as may be necessary to ensure: a) The preparation of Terms of Reference for a Patient First Review; b) The development of a scoping framework and methodology for the Ministry, reporting to the Deputy Minister of the Ministry of Health.

2. Participate in meetings and other consultations associated with the proposed mandate identified above.

3. Prepare documentation and written reports which contain options and recommendations for consideration of the Ministry.

4. Complete other related assignments that may arise as a result of activities detailed in #1 and/or #2 above.

Under the second (and current) agreement Dagnone’s services include, but are not limited to, the following:

1. Act as a Commissioner for the Patient First Review of the Saskatchewan health care system that includes two components: the Patient Experience Component and the Administrative Review Component.

2. The mandate of the Commissioner is: a) To undertake consultations with patients that are focused on the patient experience with health care. Using a range of mechanisms, the consultations will solicit information on what is and isn’t working well in the health care system;

b) To undertake consultations with health care providers and stakeholders, which examine the feedback from the patient consultations and identify opportunities to improve patient experiences across the continuum of care;

c) To provide a report to the Minister that includes findings from the consultations with patients, providers and stakeholders, and makes recommendations on changes needed; and

d) To complete an administrative review of the Regional Health Authorities (RHAs), affiliate organizations, and the Saskatchewan Association of Health Organizations (SAHO) to assist in determining the overall effectiveness of resource use in the health sector, by identifying the current base of administrative, operating efficiencies, constraints and opportunities for improvement, and to provide a report on findings and recommendations to the Minister of Health.

3. Provide oversight and management for both components of the review which includes:

– Participate in selection of suppliers to conduct the review;

– Engage in discussions with Ministry of Health officials, direct supplier project staff and others as may be necessary to ensure the administrative review and patient experience component of the Patient First Review is completed in accordance with the approved methodology and within defined time frames;

– Participate in meetings and other consultations associated with the mandate of the Patient First Review.

4. Engage in the preparation of documentation and written reports, which contain identified issues in health care, options and recommendations for consideration of the Ministry.

5. Complete other related assignments that may arise as a result of activities detailed in #1 and/or #2 above.

The agreement indicates that Dagnone’s progress will be reviewed on December 15, 2008, January 30, 2009 and March 15, 2009.

The Patient First Review is being sold to the public as an “independent” review, which should mean freedom from political and administrative interference.

If this is the case then why does Dagnone’s framework and methodology report contain “information pertaining to the deliberations of Executive Government and Senior Government employees within the Ministry of Health”? Why would this be relevant? Did the government impose conditions upon or give Dagnone direction that it does not want the public to know about?

Who specifically did Dagnone meet and consult with while developing the framework and setting the terms of reference?

What is so sensitive about Dagnone’s advice and recommendations that they must be kept secret from the public?

Dagnone is to consult with health ministry officials “to ensure the administrative review and patient experience component of the Patient First Review is completed in accordance with the approved methodology.” But, again, the public is forbidden to know what that is.

The one-page terms of reference notes that the review process will be transparent and “open to public scrutiny, and the results of the review will be available to all Saskatchewan residents.” Unfortunately, the Wall government had decided that the very document that lays the foundation for the review is not open to the same level of scrutiny. This does not instill confidence in the review process.

In the article Unions seek assurance there is no hidden agenda (Leader-Post, Nov. 13, 2008) Dagnone appeared to dismiss labour union concerns with the possible privatization of the health-care system and public sector jobs as a result of his work.

“The unions are getting ahead of themselves,” Dagnone said, explaining the review was only announced last week and over the coming weeks the commission will release details on how it will be conducting the review.

However, it’s now been more than seven weeks since the review was launched and there has been no word from the commission on how the review will be conducted – even though it’s well underway.

In the same article Dagnone said, “What is really critically important in this methodology is that we really want to harness the knowledge and imagination of the patients who experienced health care and then turn to our health-care givers and leaders to identify what I would hope would be made-in-Saskatchewan solutions.”

“I just don’t want to be distracted by a lot of rhetoric that might be out there right now.”

The concern is that the public is being denied access to his report that explains the review’s framework and methodology, not to mention the mysterious “deliberations” of executive government and senior health ministry officials. As long as this kind of secrecy continues Dagnone’s work will likely be met with skepticism.