Premier Blaine Higgs's on-and-off preoccupation with the province's two health authorities — and his desire to see them collaborate more — is on again. 

Higgs has recently renewed complaints he has made intermittently since becoming premier in 2018 about the Horizon and Vitalité health networks operating in isolation.

He raised it in question period last month, raised it unprompted with reporters and also mentioned it in his state of the province speech in January.

"New Brunswickers will never have access to the health care they deserve as long as our two health authorities, Vitalité and Horizon, compete against each other," the premier said in the January speech.

A single, centralized provincial lab for non-urgent tests had been "attempted many times," he said, "but it's failed because of lack of co-operation."

But the premier's own health minister, and the two authorities themselves, say they're making progress on closer collaboration.

Health Minister Bruce Fitch says plans are moving forward to create a single entry point system, which will require collaboration between the regional health authorities. (Roger Cosman//CBC)

Bruce Fitch said last week his budget includes funding to create "a single entry point" that will offer patients a choice of hospitals for surgery, allowing them to pick the one with the shortest wait time.

"People can go on that list and they can see, is it quicker to go the Miramichi?" Fitch told reporters, using the example of a regional hospital that often has shorter wait times.

"Same thing goes for MRIs. Is it quicker to go to Miramichi for a non-urgent MRI? So those are some of the things that we're working on in collaboration that will make it better overall." 

Wait times for various procedures can vary dramatically from one hospital to another or even from one surgeon to another.

Giving a patient who is able to travel a choice of hospitals would shorten their wait and reduce the wait list at the hospital where they usually get care.

That already happens within each health authority. But Horizon and Vitalité did not provide any data that CBC News requested on how many patients have been able to move between the two authorities.

   Dr. France Desrosiers, CEO of Vitalité Health Network, says the health authority aims to 'continue to build on our collaboration with Horizon Health Network.' (Gilles Boudreau/Radio-Canada)

That kind of flexibility is precisely what Higgs was talking about in question period last month when he sounded off again — with a frustrated, impatient edge to his tone. 

"We have to find a way for both Vitalité and Horizon to work together, build our health-care network together and deliver services, no matter where in the province," Higgs said.

"If you can't get it here in Fredericton, maybe you can get it in Bathurst. … If we are going to continue to pretend that we can isolate each other in our capacity, we will limit our ability to deliver the best service to the citizens of this province."

No one is actually arguing that the two authorities can, or should, operate in isolation — though Vitalité CEO Dr. France Desrosiers said any collaboration must respect "the autonomy and agility of each authority."

Horizon and Vitalité both say they are already working together in many ways.

The Saint John Heart Centre, for example, has long been operated by Horizon but serves patients provincewide from both health authorities, a model Higgs wants applied more widely.

In a statement, Horizon CEO Margaret Melanson said the two authorities are "in close communication every day."

Margaret Melanson, CEO of Horizon Health Network, says collaboration between the health authorities is already happening. (Horizon/Zoom)

She said that in Miramichi and northern New Brunswick, they work together to get patients access to X-rays, ultrasounds and MRIs at the hospital that can book them the soonest.

And in Moncton, she said, the two authorities co-operate in areas such as mental health, addiction and sexual assault examinations. 

Desrosiers said they also collaborate there on other services, including ophthalmology, plastic surgery and vascular surgery. 

"We aim to continue to build on our collaboration with Horizon Health Network and other healthcare stakeholders, in order to offer the best available care to all New Brunswickers," she wrote.

Premier unhappy with duplication

It's at least a partial realization of what Higgs has been pushing for since becoming premier.

Early in his tenure, he complained about duplication between the two health authorities, which were set up in 2008 to reflect New Brunswick's two linguistic communities.

His comments stirred fears among francophones that he might merge the two.

Horizon serves primarily English-speaking areas, and Vitalité serves French-speaking areas. While both are obligated by law to provide services in both languages, francophones see a health authority focused on their minority-language needs as a right.

The premier eventually ruled out a merger and instead pitched the centralization of particular services at particular hospitals to reduce duplication. 

"So if I need an MRI, I'll go to this hospital, and if I need something else I'll go to your hospital," he said in November 2020.

The following year, he suggested that the combining of some services, particularly in Moncton, would help address the shortage of nurses overworked and burnt out by COVID-19 — an idea supported by the New Brunswick Nurses Union. 

At the time, Higgs seemed content to let the health authorities sort out the details themselves, and the government's health plan, rolled out that fall, contained few specifics.

"I don't know how it's going to be proposed at the end of the day, but I'm just excited they're working on solutions to provide the service," he said in 2021.

"I'm not prescribing what that should look like."

CEO fired, boards replaced

By July 2022, however, the premier's impatience returned with a vengeance.

After a man died waiting for emergency care at the Dr. Everett Chalmers Hospital in Fredericton, Higgs fired the CEO of Horizon, replaced his health minister and replaced the partly elected boards of the two health authorities with trustees.

"I'm prepared to do whatever is necessary to protect and improve the health-care system in our province," he declared. 

The housecleaning led, a year later, to new, all-appointed health authority boards and a new structure called the Health System Collaboration Council, established to give a new impetus to the two organizations working together. 

It's been operating since last summer, yet Higgs's question period comments last month, in response to Opposition Liberal Leader Susan Holt, implied there's still been little progress.

"Does she agree that our two health networks should be working hand in hand, both in French and English, to deliver better health care to the citizens of this province?" he asked.

"Does she agree with that, or does she agree that we should just stay in isolation?"

Left unsaid was that the premier has been raising that question throughout his five-plus years in office without, it appears, being able to resolve it.

Fitch was reluctant to comment on Higgs's remarks.

"I don't want to speculate on some of the words that the premier said," he told reporters.

"I know things move at different paces and folks want to see things happen faster sometimes. … I think that's where we are."