A worrisome timeline for change

A regular reader of this blog wrote expressing their concern over the questionable, feel-good promises being made about the upcoming realignment of Nova Scotia’s health care.

They directed me to this article:


The contributor says “Yes, we all want the same perfect state of healthcare for all Nova Scotians. But … there will never be the same levels of healthcare for all Nova Scotians. … We operate with a tertiary system so that you can move up the ladder to more specialized and intense care as needed. It doesn’t mean that if you live in rural Guysborough county you will have access to the same immediate care that you would have if you lived in Halifax. Neither would you have access to simple physio, speech therapy, or whatever. My issue is with the silly message and the ridiculous platitudes to address the changes coming in the system. Assuring Nova Scotians all will have the same healthcare throughout is unrealistic.”

The contributor’s email ended with the comment from a friend who suggests “perhaps we ARE all getting the same level of healthcare – it’s down to the level of what you would find in an unserviced rural area.”

There are a lot of troubling statements in this article. Janet Knox, CEO of the new provincial health authority, is quoted saying, “I have a lot of love and pride for health care in this province, but we are at a point where it’s costing us more and more for less results.” Ironically the Annapolis Valley District Health Authority (AVDHA), which she has run for years, has had higher than average administrative costs. A point the then health care critic, now Minister of Health, Leo Glavine repeatedly made.

She says, “Why should health care be different for different people depending on where they live?” Again, it’s an odd comment given that residents in one part of the AVDHA service area had limited ER access because of closures caused by policies which paid ER doctors at Soldiers Memorial Hospital in Middleton less than ER doctors at Valley Regional Hospital in Kentville. Doctors rightly refused to work for less than their colleagues, resulting in a series of ER closures at Soldiers Memorial. The Authority never explained the pay imbalance.

She then says, “It’s time to pay attention to our people and listen to what they are saying.” I agree it is time to listen to the people – both front line workers (the bulk of whom in Nova Scotia hospital accreditation surveys say they don’t trust their management) and patients. But why didn’t they listen before? The realigned system is being run by the same executives who have been deaf to the public, so why should we believe they will suddenly change their way of working?

The article ends with the comment, “The transition won’t be without its anxiety, but it has the potential to make a huge difference. I hope we let this change force us to be healthier in five or 10 years from now.”

That time frame is worrisome. Worrisome because those in power in the province know how poor public memory has been when it comes to recalling the promises and failures of the past.

And our executives have become accustomed to make everything seem ponderous. Canada has participated in two world wars, involving tens of millions of people on multiple continents, which were successfully completed in less time than the project and performance schedules Nova Scotia’s health care executives set for themselves.

For example, for 15 years the Annapolis Valley District Health Authority has talked about building a palliative care unit in Kentville. Their failure to act has seen the cost of any such unit double. And that doesn’t take into consideration the pain and suffering of those in need. Keeping to AVDHA, on November 28th, 2012, then Health and Wellness Minister David Wilson pledged $1 million to fund a new dialysis unit at Valley Regional Hospital.

Explaining the fine print, AVDHA VP Tim Guest told The Advertiser (December 3, 2012) it will take two years before the unit opens because AVH hasn’t determined where they will build the new unit. Two years and three months later no unit has opened.

In 2007 Capital Health gave itself six years, the same duration of WWII, to introduce and implement the goals outlined in their Promise and Milestones documents. That is a way of working, it didn’t involve construction, so six years seems beyond generous.

Then 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 to fail to meet provincial targets. We have recently seen how critical this failure continues to be.

For 30 years successive governments have allowed Capital Health to operate a building with water so toxic it’s barely fit to flush toilets. Allowing Legionnaire’s bacterium to exist in the water supply of the province’s leading hospital is scandalous. What timeline were the executives working with to resolve that problem?

Capital projects have been an on-going issue in health care. For 23 years Capital Health executives couldn’t figure out what to do with a vacant floor at the Dartmouth General Hospital. A short drive down the TCH, Truro’s new hospital came in 78 percent over-budget and nearly two years behind schedule, leading the Auditor General to conclude the original budget was insufficient and the local health authority was inexperienced in large construction projects.

In a press release dated December 14, 2011, Capital Health President & CEO Chris Power said, “the province today announced that it will be funding a planning and design study for the future of Capital Health’s infrastructure, which will include vacating and eventually demolishing the Centennial Building at the Victoria General site and concentrating inpatient specialty services at one Queen Elizabeth II Health Sciences Centre site.”

Well, whatever became of that study? The shelves of this province groan under the dust-gathering studies which were “received with interest” then fell victim to “the iron grip of the status quo”, a phrase repeated often in Graham Steele’s book What I Learned about Politics, which banishes innovation to an ideas and recommendations graveyard.

The political class aren’t exempt from failure. In February 2003 Canada’s health ministers agreed to save money by participating in a bulk drug purchasing program. That hasn’t happened. As a result we experience increasing drug shortages and paid, and continue to pay, billions more than would have been charged through a centralized purchasing system.

Health care shouldn’t be allowed to set vague targets that are five-to-ten years out because a) in the meantime people suffer and b) they consistently fail to do what they say they will. Long deadlines shift attention from failed performance to political point-scoring in a future election. It’s also about the right time frame for when many executives will be retirement age.

We are 16 days from a realigned health care system and people are rightly worried.

This entry was posted in Uncategorized. Bookmark the permalink.

5 Responses to A worrisome timeline for change

  1. woof says:

    And you can be assured the title “realignment” will be used for many years to defer any criticism (“it takes time!!”).

    Agreed, the same rose is a rose is a rose executives who accomplished nothing except creating new titled positions and studies are in charge. Their explanations for delays and accountability and incompetence in their assigned tasks get really, really, really boring.

    Pity, we do have ample moneys to have more than a successful system. Call it politics … as usual.

  2. Bubbie says:

    There have been more reports, studies, presentations conventions, and seminars then you can count. There have been lots of bubbly town halls and announcements like this one with promises of making our health care system better, but all I have seen over the past decade are funding cuts by all levels of government with care for the elderly taking the biggest hit. In every announcement the first reference is made to money and the astronomical costs of health care. Shortly after each announcement cuts are made leading to more inefficiencies for patient centred care.

    Even with this announcement $5,000,000.00 isn’t a huge amount with the almost billion dollar amount it cost our provincial health care system, but, as always, it will be “patient centred care” that will be affected. The cuts to long term care are not even figured into this amount. My biggest fear with all of this, is that it will lead to complete privatization of our health care system such as what is happening with our longterm-care system.

  3. Ken says:

    Status quo has to go.

  4. Well, whatever became of that study?

    Well, why don’t you actually check out the CDHA website to find out?

    Or is it more satisfying simply to complain?

    • It’s interesting that Capital Health opted not to issue any public announcements about this, but then I can understand how they may be embarrassed since it’s only taken 24 years to think about doing something at Dartmouth General. (That was driven by the Minister’s intervention.) It’s been over 30 years for the toxic water situation in Halifax, as well as dodgy wiring in the Centennial Building.

      You ask is it more satisfying to complain? Well, if people had actually performed there wouldn’t be the need to complain. But Nova Scotians have endured decades of indignities, broken promises and under performance. I don’t know how long you have practiced at Capital Health, but while a floor sat empty in Dartmouth I’ve seen patients lined up in hallways on both sides of the harbour because of space shortages. And they have been there for days. It is heartbreaking for families to see their loved ones left so exposed.

      And how long does it take to off-load an ambulance? The public has been mislead by TV to believe that every ambulance is met by a curbside medical team waiting to spring into action, when the reality is that Capital Health, by their own admission, took an average of 133 minutes to off-load a patient from an ambulance. They gave themselves five years to meet the provincial standard. Using Capital Health’s deadline they will down to 20 minutes in September 2015.

      It’s only been thanks to social media that Nova Scotians have gained a voice when it comes to health care. When we have questioned care we are told we don’t understand or that it’s a one-off, that mistakes happen. Everyone felt isolated. With social media we can connect, share experiences and confirm that we aren’t mistaken and that there are systemic problems and those problems are far greater than the legion of PR people employed by the health authorities would admit. For decades there were only two news streams out of health care. Either we heard of chronic underfunding or cheerleader-type stories usually released in conjunction with a fundraising campaign. Think about how often health authorities use photos of happy, pretty patients to shill for cash?

      While study after study across Canada has confirmed the problem with health care isn’t money, health executives kept up the pretense, engaging in a type of election coercion that encouraged politicians to out-bid each other for votes. The conversation has changed. Show us performance, show us better patient outcomes.

      In the last few months as the march towards a realigned health care system was focused on which union represented which group, I know of a 140 surgeries which have been expedited because of a greater level of cooperation between hospitals and professionals. For example, 20 people on a two-year wait-list for knee surgery in Kentville had their surgeries done in Amherst. That saved them two years of pain, saved the system money and frees front line workers who won’t be seeing these people because of worsening conditions. Why couldn’t/wouldn’t the executives under the previous system arrange that? They were too busy defending their turf and competing for money. Instead we had a series of silos which meant a Halifax surgeon had a 13-year wait list, while a surgeon in Pictou moved to Ontario because he wasn’t busy enough here. It’s absurd and highlights the failure of management.

      Before health care professionals criticize the public for wanting better, try being a patient and seeing how it works from our side of the bed.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s