This was the first op-ed of the citizen committee formed on the public accountability of the B.C. Minister of Health

Eight people from Greater Victoria have established a citizens’ accountability group on health. They have written this to explain their position.

The BC Citizens’ Assembly on Electoral Reform showed that citizens brought together can do a remarkably useful service for citizens as a whole. Given a consequent 58% approval vote in favour of the single transferable vote for BC elections, citizens can reasonably require the Premier to explain why he insisted that the 60% threshold (no significant difference) be kept and why he is keeping it for the re-run of the vote in 2009.

Exacting this explanation from the Premier is called holding fairly to account. We can approximate the citizen assembly approach by forming citizen accountability groups for important government responsibilities.

During Health Minister George Abbott’s recent “Conversation on Health” forum in Victoria, citizens at one discussion table (partly in view of the risk of the Ministry “cherry-picking” citizens’ reported views) decided to ask the Minister personally for his response to questions and proposals they had raised at their table. This they did, and to help guide the Minister’s response they added as an appendix to their letter a definition of public accountability supplied by the Citizens’ Circle for Accountability.

Public accountability means that governments and other authorities have the obligation to explain publicly, fully and fairly, before and after the fact, how they are carrying out responsibilities that affect the public in important ways.

This means explaining before the fact their intentions and reasons — what they intend to achieve, for whom, and who would bear what costs and risks. It also means that governments will explain their intended performance standards, which includes reporting how they inform themselves for their decisions.

Full and fair public reporting provides information that citizens would not otherwise get. But even more important, the fact that it is public produces a beneficial self-regulating influence on authorities’ decision-making. Validated public explanation subjects authorities’ intentions to the “Dracula Test” (i.e., once brought out, intentions leading the wrong way tend to self–destruct).

To his credit, Abbott replied to the citizens’ group’s letter within a month. But the group saw it as a stock Ministry response that ignored the definition of public accountability and left important questions unanswered.

The Minister did not give useful responses to the following questions.

The group asked him:

• whether he agreed that Medicare, as a resolute Canadian national policy, should be legislated in BC as a human right.
• what the Minister meant in his use of the terms “sustainable” and “public-private sector partnerships”
• whether the Minister thought improved Medicare in BC, if administered effectively and efficiently, was sustainable.
• how the Minister, as the health Regulator for BC, informs himself on the safety, efficacy and value for money of the drugs his government intends to fund. (edited out: the Minister replied that he relied on an Ottawa recommending body called the Common Drug review.)
• what the Minister thinks is the level of health care in the community that citizens have the right to see met. (An obvious example is the staffing reductions sought at Mt. St. Mary’s Hospital. In building the Hospital, the government endorsed its new construction design, meant to improve care. If the Minister and the VIHA Board members now seek to lower the hospital’s level of care in staff hours to something “adequate,” they have the obligation to explain publicly, fully and fairly exactly how this would impact care.)
• overall, whether the Minister would deliver on the premiers’ collective commitment that they would each report to their citizens their province’s “health system performance.” In common sense, this would mean they would produce annually a one-stop, user-friendly report, tailored for citizens, that would state:
  • what the Health Minister intended to achieve and why he intended it,
  • the performance standards set for the Ministry and those it oversees (such as VIHA), and
  • whether the Ministry met performance and management control standards that BC citizens are entitled to see met
  • whose needs or wants would be honoured through each intended program (e.g., health care programs and P3s) and whose would not, and why.

Given the Minister’s response, the Table 7 participants formed a citizens’ accountability group for health, and on June 27 sent a follow-up set of requests back to the Minister. This time the group was more specific in asking for full and fair accountings.

The accountability group is not lobbying for something or telling the Minister how to do his job. It is simply asking for explanation that ministers in a democracy cannot refuse, especially when the request and obligation to account are fair and non-partisan.

As a pilot, the Group’s requests are perhaps a first in citizens themselves holding the executive government fairly to account. However, to the extent that a government majority in a legislature supports an executive’s refusal to account fully and fairly, the media will be needed to publicly support citizens asking fairly for accountings.

Society will work properly only if citizens have valid trust in their governments. The only way citizens will learn their governments’ intentions well enough to deal with them sensibly is if the government accounts to the standard of public explanation that citizens are entitled to see met. This means that elected representatives locally, provincially and federally can be held fairly to account for installing this obligation in the law. We need to form citizens’ accountability groups across the country.