Health care’s five-and-seven year timelines

Access to a family physician is always a hot topic in Nova Scotia. It heated up in October when the struggles the community of Weymouth had in recruiting a doctor became more public. For the first time in 150 years the community doesn’t have a resident physician. The community’s efforts to attract a new doctor have been thwarted by the Nova Scotia Health Authority (NSHA), which is reluctant to grant billing numbers to new solo practices.

The NSHA is focused on establishing Collaborative Care Clinics (CCC) across the province. The NSHA has discovered that new doctors don’t want to work in isolation as a solo practitioner. A study conducted by Dalhousie medical students and presented to a Liberal Party health policy day in January 2014 said new doctors want to share their practice with others so they have a better work-life balance than previous generations of doctors, and also have colleagues to consult. Fair enough.

I get that many doctors like to work together for the work-life balance. But what if there’s a lone-wolf medical maverick out there, an individual who prefers to or is at least willing to work on his or her own? Are we telling him/her “No, you can’t?” What if two or three friends from medical school are willing to open a shared practice? Are they also refused billing numbers because their willingness isn’t allowed under our tight-fisted regime? Why are the willing unacceptable? And why not recruit rural doctors now on the understanding that theirs is in interim practice which will be melded into a CCC in two-, three- or five-years? That interim measure would seem to deal with many of the problems people face now. It could cut costs by providing faster access to care, so diseases and other maladies don’t progress as quickly or at all, and could impact the level of extensive, heroic care provided to some. Two years ago a provincial cancer specialist told me that many of the cases he saw were too far advanced to help. The advanced progression of the disease was due to the length of time it took the patient to either see a physician and/or get a referral. High mortality rates arise from lack of access.

But NSHA is absolutely intransigent about change to their not fully-articulated CCC plans.

During the election and again last month Premier McNeil said a doctor for every Nova Scotian is a priority for this mandate. His office says there are 100,000 Nova Scotians without a family physician. Without a physician, people are forced to go to hospital Emergency Rooms or Out Patient departments for their medical problems and even simple things like a prescription refill.

While the Premier has made physician access a priority, it is less high up on NSHA’s to do list. In October NSHA VP of Medicine, Lynn Harrigan, admitted the authority doesn’t know how severe the doctor shortage is. She told Halifax media the only numbers known are physician vacancies, not the number of people without a GP.

On top of not knowing how many people are without a family physician NSHA president Janet Knox has said it will take five years to develop and staff all the CCCs the province hopes to build. That’s not exactly a sign of urgency and doesn’t recognize the concerns and fears people have at not having a doctor. Knox’s comment also raises the question that if you don’t know how many patients are in need of a GP, how do you know many CCCs you’ll need and how long it will take to build and staff them?

Given this new CCC focus, what happens to the practices of retiring GPs? Will replacement doctors be discouraged from coming in to assume that patient load? Or will new doctors be allowed to practice in some – not all, witness Weymouth – areas?

Another example of this preferred five-to-seven health care timeline arose in the fourth quarter of fiscal 2010-2011. It was a different administration, but it was discovered that Capital Health took up to 133 minutes (two hours +) to offload a patient from an ambulance instead of the provincial criteria to complete this in 20 minutes. Capital Health told the then NDP government they would improve by 10 percent per quarter to achieve the provincial requirement. For some unexplained reason, then Health Minister Maureen MacDonald allowed then Capital Health CEO Chris Powers to dictate to the ministry. Doing the math, this incremental quarterly change meant Capital Health/NSHA wouldn’t meet the provincial requirement for five years. The health authority’s self-imposed deadline was September 2016. In those five years, people in dire enough condition to be delivered to hospital in an ambulance could be left for hours in an ambulance without being seen by hospital staff. Allowing the authority to determine what would happen is insensitive, unresponsive and arrogant.

In September 2013, speaking about a replacement facility for the VG, Powers told The Chronicle Herald, “Any expansion would take at least five years to complete.”

Fast forward to April 2016, Knox told Halifax media the overall project timeline for a replacement facility for the VG “is between five and seven years”.

To reiterate, when the Premier expressed his wish for a doctor for all citizens ASAP, Knox gave herself a five-year term to complete this task.

Back-tracing to pre-merger days: former Health Minister Dave Wilson came to Kentville in November 2012 with a $1 million announcement for a new dialysis unit for Valley Regional Hospital. After the Minister had his photo opportunity and left, then VP Tim Guest (now a VP with the NSHA) told The Advertiser that it would take two years to design and construct a dialysis unit.

As of October 31, 2016, four years later, there is no new dialysis unit in operation. Nor has ground been broken for one. Considering the schedule health executives work to, this is another project that will exceed five years before it opens. Meanwhile, dialysis patients in South West Nova still have to struggle with transportation issues and costs to reach care in Halifax.

Another five-to-seven year project was Colchester East Hants Health Centre in Truro. In September 2005, provincial cabinet authorized $78 million for the construction of the new hospital. The community raised $26 million towards the cost. It opened in November 2012, seven years after it was given cabinet approval, five years after the designs were completed and 11 years after the launch of a campaign to build a new facility. These lengthy time lines don’t seem to suggest executives do extensive or complete planning. As everyone knows, Truro was behind schedule and over-budget. Among the problems the Auditor General identified with this hospital was oversight by people with no experience in capital projects and lack of consideration given to the additional operating costs for a building that was 100,000 sq. ft. larger than the building it replaced. (Nor, in all those years of planning for a new facility was any focus put on finding an alternative use for the existing hospital, causing the health authority to spend over $1.2 million to maintain an empty building.)

The commonality of this timeline raises the question of why everything requires five or seven years? Is it because health executives count on the public having a short memory so won’t be held accountable when they again fail to deliver on what they said?

Five years is also outside the mandate of whatever government is in office. Health executives can expect that a new government will cooperate with anything that discredits the previous government. If the same government is returned, then there’s probably a new minister who, for the sake of party unity, won’t say anything that could reflect poorly on his predecessor, even if it’s not the former minister’s fault that health executives failed to act.

And, given the age of many health executives, does a five-to-seven-year timeline now take them to retirement?

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3 Responses to Health care’s five-and-seven year timelines

  1. Bubbie says:

    If memory serves me correct, one CBC report stated that of 63 Dalhousie medical graduates only one made a solid commitment to remain and set up a practice in the province. The family Physician I had for over thirty years retired a few years ago. he started to look for another physician two years before actually retiring from his practice because he knew it would take that long to find a physician that would take over his practice. The physician he finally found was an older doctor practicing in Ontario that wanted to return to Nova Scotia. He agreed to take over the practice on the premise he would retire in five years.

    Needless to say, having some inside knowledge of how our health care system works I did not stay with the clinic and was lucky in finding a new, much younger physician in another clinic that was taking on new patients. My retiring physician told me young doctors do not want the old model of a family practice working long hours five days a week and on call on the weekends. Instead, they prefer to work a committed schedule five days a week or less with no weekend service and that is why it took so long for him to find a doctor willing to work the old fashioned way. The new physician I found works three days a week and dedicates one other day for the walk-in segment of the clinic for patients needing immediate medical attention. This duty is shared with the four other physicians in the clinic. In order to see my physician, I have to make an appointment at least two weeks in advance. It has been reported Nova Scotia has more physicians per capita than most other provinces but because of their preference for work/life balance and limiting their practice to a number of patients fitting to that schedule, approximately ten percent of the provincial population do not have a family physician. Within the Halifax Metro area, there are thirty thousand people without a family physician. A recent media report stated that anyone looking for a family physician should call 811 to have their name added to a waiting list. So, now do we not only have a waiting list for a long-term care bed, we, now have a waiting list for a family physician.

    As far as making plans for our health care system is concerned, plans since the reign of the Conservatives under Rodney MacDonald have been anywhere from a ten year Long Term Care Plan, a “Plan to have a plan within five years for a new plan,” a twenty-year plan for a new hospital, no plan, just cuts under the NDP, to a five to thirty year plan under the present Liberal Government revealed to our ACE Team during a recent meeting with the Department of Health on August 31 of this year. In other words, not one of the last three governments has made any real concrete commitments to improve patients centred care, long-term care, reduced wait times for elective surgeries and mental health care or the repair of the crumbling third world infrasturcture the people of Nova Scotia are experiencing. We will have to endure a ten-year wait for a bedless, Cobequid style hospital that will provide, “Take out Health Care.” Leo Glavine says, “We do not need a flagship style hospital to replace the old V.G. Hospital.”

    The Federal Government is negotiating a three percent reduction in health care transfer funding from six percent in a new national health accord. In the first decade of the history of our precious health care system, the feds provided fifty percent funding with the provinces kicking in the rest. After that, groups with vested interests have been convincing governments of all stripes to move away from public funding towards a private system based on the American system which has been proven to be one of the foremost causes of bankruptcies in the U.S. A recent Canadian Institute for Health Information report shows federal public health funding spending increasing every year from 1988 to 2014 where it take a .5% drop. Private funding, however, shows a steady increase to the point where private and public is nearing equal status. In my opinion, this indicates a very clear picture showing our health care system on the path toward privatization. The same report states that while Federal funding under the last ten-year national health accord was six percent from 2004 -2014, provinces were spending 7.2% between 2008 to 2011 where spending was slashed to 2.7% as the feds continued to provide six percent funding into 2016. Nova Scotia, during this time, shows a.5% drop. It was, for this reason, the Harper Conservatives using the “Flaherty Formula” decided to reduce spending to three percent and Justin Trudeau’s governing Liberals continues to follow. In other words, over the years our health care funding has suffered a 97% reduction, overall.

    We need to get back to, at least, the twenty-five percent funding suggested in the Romanow Report in order to get back to providing the health care the people in this province and all Canadians deserve.

  2. Bubbie says:

    Correction to the percentages given. At a Federal Service Retirees Association Health Accord Town Hall I asked Deputy Minister Dr Peter Vaughan to explain the National Health Care Funding. He stated the 3% funding offered by the feds accounted for inflation and the provinces receive 20.5% in actual dollars. He also stated that he is after the feds to increase it to 25% as stated in the Romanow Report. Despite all the rhetoric nothing much was offered for quality patient centred care or anything else that will improve our health care system. In other words, nothing but more fluff and no solutions. Just more planning to have a plan.

    • Planning to have a plan is considered action in our system. Graham Steele, in his book, said politicians like studies because everyone looks busy without having to commit to anything.

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