The final week of the Nova Scotia provincial election has taken on American overtones. The leaders of the Progressive Conservative and New Democratic Parties are pushing Liberal leader, Premier Stephen McNeil, to say that health care is in a crises.
In a leaders’ debate the Liberal leader said health care has challenges. The PCs and NDP have formed a united front to get the Premier say health care is in crises. Then what? Does that change anything? Does it impact their platforms and plans? Beyond throwing money towards health care, have they real measurable plans to improve the delivery of care? We’ve had decades of simplistic solutions, like tossing more money at health care, that haven’t resulted in better outcomes for patients.
Focusing on a phrase is what happened in the U.S. presidential campaign. Donald Trump focused his election campaign about the refusal of then President Obama and candidate Hilary Clinton’s to mouth the phrase “radical Islamic terrorism”. Saying the phrase doesn’t stop terror attacks.
Focusing on a phrase instead of a plan is what drags our provincial election to the level of what we saw in the United States. Do we want that?
I’ve long been critical of our health care system. And my frustration began long before this government was formed. I started this blog as far away from an election cycle as possible because I wanted us to have a substantive, sustained discussion about the problems, issues and concerns around the delivery of quality health care in Nova Scotia and hopefully share actionable ideas to improve it. I did that because the traditional election conversation about health care is to see who is prepared to toss the most money at it.
Study after study has said that more money isn’t a panacea for better health care. More money means solutions are more expensive.
Public memory is short. Our hospitals have been falling apart for decades. During 2009-11, I was told of 37 doctors who quit their practices in two communities. These weren’t retirements, they were physicians fed up with their working conditions. Later I met mayors and wardens who appealed to their local health authorities (under the nine-authority system) and the Department of Health to fix their hospitals and hire more doctors and nurses. Before the last provincial election a Valley mayor told me he was so fed up he refused to speak to the president of his local health authority. In 2012 I attended a meeting in Berwick where an Annapolis Valley District Health Authority board member told those complaining about care they “didn’t know what they were talking about.” The idea that local decision makers are more responsive is fantasy. At least as it was managed in this province.
In thinking about how to help health care, I realized the problem is two-fold.
First, it’s the executives who, whether they sit in communities around the province or a health headquarters in Halifax, are too embedded in old thinking. We built a new system around cooperation, coordination and collaboration, but put it in the hands of people who have a history of being unresponsive. They drape themselves in a pretense of consultaion, but as doctors, nurses, surgeons and others have told me, meetings are called not to listen to concerns and ideas, but present top-down measures from people who haven’t been on the front lines in decades. These executives don’t recognize that change and innovation are about action, not simply peppering conversation and memos with the management catch phases du jour. Health executives have not shown themselves to be innovative or collaborative.
The second problem is the revolving door of health ministers. In the last 14 years we have had eight ministers of health and/or health promotion. Some have been responsible for multiple ministries at the same time. Here’s the list:
Rodney MacDonald – Minister of Health Promotion (2003)
Barry Barnet – Health Promotion and Protection, African Nova Scotian Affairs and Communications Nova Scotia (2006)
Chris d’Entremont – Minister of Health and Acadian Affairs (2006)
Pat Dunn – Health Promotion (2009)
Karen Casey – Minister of Health (2009)
Maureen MacDonald – Minister of Health (2009)
David Wilson – Minister of Health (2012)
Leo Glavine Minister of Health 2013 to present.
Health is the biggest single file the government has. It deserves a minister’s full attention not just photo ops. As President Donald Trump learned, “It’s an unbelievably complex subject. Nobody knew health care could be so complicated.” Certainly the solutions presented in this provincial election seem pretty simplistic.
In Nova Scotia the average term of a Minister of Health is 21 months. The issue is this: when a new minister comes in it takes at least a year to come to grips with the file. Then, when they have begun to grasp the basics of it they focus on a pet project. That announced, there’s a cabinet shuffle and a new minister takes over. The cycle starts again and about the time the new minister understands the file we’re in an election campaign. More promises, more dashed dreams.
The other problem is that each new minister is advised by the same bureaucrats and health executives as his political opponents. Whatever party is in power, the status quo remains because the advice comes from the same people. Many years ago a senior bureaucrat in Newfoundland told me they had three people in their department whose job it was to talk the minister out of things. No doubt each health minister is surrounded by multiple advisors explaining why something can’t be done. Based on that we delude ourselves when we think we’re voting for change.
Perhaps the best thing we could do to help health care is to vote for consistency. The current Minister of Health, Leo Glavine, has been minister for the entire duration of this government. That hasn’t happened in Nova Scotia in over 40 years. Before he was minister he was health critic. No one has a better grasp of the file than him.
Glavine is not a flashy personality, so the public probably isn’t aware of all the heavy lifting done in health care in the last three-and-a-half years. There was the merging of the health silos to create better cooperation and use of resources and people and work done to prepare for a reorganization and replacement of the VG. Instead of a focus on the next election, health planning has been done for what’s best now and in the long term, so that in 10 years we won’t still be complaining about the same things we complain about now and complained about in the year 2000.
The radical idea to better health might be keeping a Minister of Health in place for eight years instead of 21 months. A long-term minister would have the confidence to take the lead in health care change and not have to rely on guidance by vested interests.