Health care: what’s in a name?

A CBC Information Morning interview on Tuesday, July 29 set me thinking of Shakespeare’s comment, “What’s in name? That which we call a rose
 by any other name would smell as sweet.”

The interview was with Barbara Hall, Vice-President of Person Centred Care at the Capital Health District in Halifax. The subject was the growing wait list for physiotherapy at the Cobequid Health Centre. In a happy, gee-willikers tone Hall attributed the increasing delays, which have grown from six months to eight months to 10 months to a year, to the popularity of the place, great staff and easy parking. Oh, and our aging population.

Every failure and delay in health care is about our aging population. Essentially, our bad health outcomes are our fault for growing old. And because we, the public, are so thoughtless as to live, we have stressed the system. Those in charge of health care – and this goes right into the Department of Health and Wellness – treat our aging population as an excuse for their failure to act. It’s not as if anyone didn’t have notice that the population is aging. This isn’t an epidemic which swept ashore on a ship or landed on an airplane. Those in charge should have better prepared. Sadly, they have shown a predilection for procrastination.

Annapolis Valley District Health has spent 14 years talking about building a palliative care unit in Kentville. Their failure to act has seen the cost of any such unit double.

Capital Health gave itself six years to introduce and implement the goals outlined in their Promise and Milestones documents (from 2007 to 2013). In 2011 Capital Health, which failed to meet provincial targets for off-loading patients from ambulances within 20 minutes (they were at 133 minutes), promised then health minister Maureen MacDonald to improve their performance by 10 percent a quarter. They allowed themselves until September 2015 to meet provincial targets. For some reason the government allowed Capital Health to continue not meeting provincial targets. But then successive governments have allowed Capital Health to operate a building with water so toxic it’s barely fit to flush toilets. If it were a privately owned building, the health department would have closed it or forced the owners to fix the problem, not Capital Health. They’ve been allowed to put patient, public and staff health in jeopardy for 30 years with no indication of a solution. This is a serious issue because in 2011 Capital Health admitted if they could get staff to properly wash their hands hospital infection rates could drop by 30 percent. It’s hard to be clean when your water supply is toxic.

Politicians have also shown a significant level of procrastination. In February 2003 they agreed to save money by participating in a bulk drug purchasing program. That hasn’t happened.

And while the population ages, that growth hasn’t happened in isolation. Health care isn’t working with the same budget it had a decade ago. The public money poured into health care has more than doubled in a decade ($1.7 billion to $4.1 billion). And when you factor in the private money paid into health care in Nova Scotia the financial increase has tripled (final total is in excess of $6 billion). That bought an explosive growth in CEOs, Vice Presidents, Directors and other managers. The short score is over 526 health care executives earning over $100,000 a year – the bulk of whom never see a patient.

One RN in Nova Scotia told me, “our organizational chart has so many Managers on it we don’t even know who they are.” And added, “There is no manager. Just a person who goes to meetings and posts motivational quotes on her office door when she leaves every day at 3.”

The complaints about the aging population are offensive because it ignores the contribution of those people to society in general, and in taxes and donations which fund the system, pay the comfortable salaries of the bloated army of administrators and, for many, also subsidized their education.

Our system is fat in executives with meaningless titles whose only outcomes are increased wait times in all disciplines.

I am bored by the aging population excuse. If this natural progression caught executives in health care and the Department of Health off guard then why should we trust that they are up to the job ahead?

And what have we gotten for the money? We get executives who excitedly talk about a “patient-centred focus to health care”. I want to gag whenever I hear this. What they hell other kind of focus would health care have? I can’t decide if this is a PR slogan or a reminder to those so far removed from actual patient contact.

Hall’s job title is equally gag-inducing. “Person-centred care”!?! What the hell is that? It’s nonsensical, which is worrying. And words are important. In a conversation among a group of Canadian newspaper publishers one colleague observed “Countries with names that include: “the people’s republic of” or “the democratic republic of” usually aren’t.”

This, I believe, can be transferred to ‘patient-centred health care.’ Meaningless platitudes.

In her CBC interview, the host asked Hall, who urged as many patients as possible to use private services “Doesn’t that fly in the face of a public system?” Hall replied, “I don’t think that public health care ever meant to include everything.”

This is a key statement because I believe the public – remember them, they foot the bill – do believe that our idea of universal health care is to include everything for everyone. At election time that’s the implication. If this isn’t true, then the Minister needs to redefine what is meant by universal/public health care. If care for everyone for all things is what is meant, then the Minister has to restate that to all those involved in health care delivery; especially, it seems, to those in the executive suites.

You can hear Hall’s interview here (her comment about public health is at the 5:30 mark):

For a history lesson on universal health care in Canada, go here:


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4 Responses to Health care: what’s in a name?

  1. ghjkl says:

    “But then successive governments have allowed Capital Health to operate a building with water so toxic it’s barely fit to flush toilets. If it were a privately owned building, the health department would have closed it or forced the owners to fix the problem, not Capital Health.”

    I guess that in NS there is a license needed to operate a hotel. Is there under this license something about the necessity for the hotel operator to provide basic services to the public/clients and does this includes “clean water”?

    There is a pamphlet in CDHA given to patients with cancer or immunodeficiency which directly or indirectly result in the patients being unable to fight infections, so a pamphlet warning them not to use tap water for drinking and to refrain from taking showers inside the hospital (Victoria General site).

    The fix provided by management is not to fix the water supply, but to warn the patients. If the patient gets an infection, then it is him/her fault… not the fault of management.

    • Indeed. In May 2013 a friend was there for surgery for pancreatic cancer. He was in hospital for a week. Not one of us who stayed in Halifax with him was given a pamphlet, warned verbally about the water, nor was there any warning in his washroom. And to reduce the possibility of infection, we all judiciously and constantly washed our hands. We insisted that visitors also wash their hands. Many times staff saw us come out of the washroom drying our hands from washing them and still no one mentioned the dangerous water.

  2. ghjkl says:

    I found the pamphlet. The exact title is “Water Rules”, the version I have is dated April 2007 (picked up in 2013). It says that the pamphlet is updated every 3 years… (why in 2013 there are still 2007 pamphlets to be distributed?)

    The opening paragraph is about Legionella pneumophilia, basicly it develops in plumbing systems of old buildings, it can get in the lungs of patients through small droplets of contaminated water released in the air when filling a tub or a sink, when taking a shower or washing hair and inhaled by the patients.

    Healthy people are not affected, but people with immunosuppression either from their own condition or resulting from chemotherapy are at risk with respect to this bacteria.

    The name came from an outbreak which occured in the US during an American Legion meeting, the infectious origin of the death of several veterans attending the convention was difficult to prove as the bacteria is extremely small and difficult to grow in lab. The origin of the contamination was the air conditioning system in the hotel.

    Another story around this bacteria occured in Paris in the latest hospital built by AP HP (the Parisian public DHA), Hôpital Georges Pompidou. The project went significantly over budget and in order to cut the cost, the decision was made to change the copper pipes of the hot water system to plastic pipes. Unfortunately, there were dead ends in the pipe system with portions where the water was not running. There were roughly 10 persons who died of Legionella infection contracted during their hospital stay. The irony was that the treatment for the water system which was recommanded was to run boiling water through the whole pipe system, but… this was not possible because the plastic used for the pipes would have melted.

    • Thank you for this. And yes, if materials are updated every three years, why are six-year-old pamphlets still being distributed. Obviously, Capital Health made no effort to change the water situation or their materials since that would just highlight their inaction.

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