Health care’s new demographic dilemma

Demography is the scientific study of human populations.

According to best-selling demographer David Foot (his book, Boom, Bust & Echo was on the best seller list for over 100 weeks) demography is the key to understanding the past and forecasting the future.

Health care hasn’t shown itself adept at understanding demographics. Otherwise they wouldn’t have failed to plan for our greying population.

In Nova Scotia we have a shortage of doctors. We have a shortage of nurses. These current shortages will grow due to a tsunami of retirements.

What we do have is an abundance of older Nova Scotians. There is never a conversation about health care that doesn’t reference Nova Scotia having one of the oldest populations in Canada. As I have said before, the population didn’t suddenly get old overnight. Demographers have tracked and issued reports about our aging population, but health care didn’t plan. Instead it waited decades to react.

Well, a new labour shortage may torpedo our health care plans.

Currently, everyone is hot to trot to build a new hospital to replace the VG. Graham Steele told the CBC that when the NDP took office in 2009 his cabinet colleague, Health Minister Maureen MacDonald found a file on her desk that said a new hospital would cost $1 billion. The government didn’t want to deal with such a large expenditure, so December 2011 MacDonald held a press conference at the VG to announce $1 million to fund a request for proposals for how best to allocate Capital Health’s facilities. The project was given a five-year time line. Studies, as Steele tells us, are out of the political playbook. They make it look like you’re doing something without having to face an uncomfortable reality.

Fast forward to April 2016, more money was advanced to plan for a VG replacement. The current timeline is for a five-to-seven year planning process with demolition to start in 2022.

That 2022 target is a starting time for demolition, it’s not when a hospital would open or even when construction would start. First we have to tear down what’s there, the whole site has to be cleared then an environmental assessment conducted and any required mitigation done before construction can begin. We don’t know how long it will take to build a hospital. Since no public project in this province has come in on time and on budget, we may be looking at late 2020s or 2030 before there’s a ribbon cutting.

Here’s where this leisurely time line hits a new demographic snag. On Thursday, BuildForce, the organization which represents Canada’s construction industry, said Nova Scotia will lose over 8,000 construction workers over the next decade!

Rosemary Sparks, executive director of BuildForce Canada, told Localxpress, “Nova Scotia is basically the second-oldest age profile in the country. And to lose almost a quarter of your workforce over 10 years is a significant challenge for the industry.”

Just as we have a shortage of younger people to take medical positions, we have fewer younger people to enter the construction industry. These workers not only build things, they manage and repair them. They’re in demand.

This means that construction of a new VG may be further hampered or delayed by a labour force shortage. Costs could rise because a labour shortage means a bidding war over wages. We knew a new hospital was going to be very costly. Last year estimates were $2.5 billion. But with overages on capital projects, like the Truro hospital and new access ramp in Metro, averaging 70-80 percent, we’re probably at $3.5 billion and realistically headed to $4 billion, before we factor in inflation and additional labour costs. We might just end up with the most costly building in Canada.

Maybe this time those in charge were paying attention to demographics. Looking at the average age of the CEO and top VP, they will reach the traditional retirement age in the next four or five years. So costs and construction becomes someone else’s problem.

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2 Responses to Health care’s new demographic dilemma

  1. ausca says:

    I’m sure that when I first moved here in the early 90s demographers were very visible (thanks to Meech Lake) and there was occasional mention of the increasing median age in the Maritimes warning of long term challenges for government revenues and public health care.

    “Long term” of course could be 10 years to decades. I feel this is a systemic problem with the way our democracy works in NS. Political lifetimes are usually measured in 4 year terms. The temptation for cash-pressed governments to kick the can down the road for some other government to manage 2 or 3 future terms away must be irresistible for huge expenses like a VG replacement. Perhaps that’s what Maureen MacDonald did (or was directed to do from above) and maybe it might be argued the Liberals are dragging their feet likewise, I really don’t know. (However, you certainly wouldn’t want to rush management of building such a massive asset and botch it).

    Because of the long time frames, big money and lives on the line, I’ve argued with MLAs that we should reform the way we manage public health and wellness via some sort of all-party mechanism. That way, whichever party is governing doesn’t get sniped over the latest health horror story, and all three of them get the public kudos for good ideas, well implemented.

    So far, nobody seems interested. How do you get the tacit agreement of the leaders of all 3 parties (especially one running a majority government) to do something like this?

    Also, I wonder what happened to the notion of replacing one big structure with cheaper extensions or re-purposing of existing assets? I think this has been raised in this column before. Do we really need all the services and facilities with the VG inside one physical location?

    • Good points. With regard to how existing assets are being and to be used, that is still progressing. It’s not reported on regularly because so many other things compete for headlines.

      Work on Dartmouth General is, as I understand, proceeding. Two vacant floors are being made usable. They may finally be. There is to be an expansion to add surgical suites. The QEII is also getting more surgical suites. Part of the reason for dialysis in Kentville is to relieve pressure on Halifax. Getting the QEII, Dartmouth General and Infirmary up to speed is step one. Dartmouth will look after a number of cases of rural residents which otherwise would go to downtown Halifax for care. The QEII is going to specialize in certain illness and treatments. Then all three hospitals – Dartmouth, QEII and Infirmary – will be assigned temporary roles for the duration of the VG reconfiguration.

      The idea is still to change the patient mix at the VG and have it focus primarily on cancer care. The idea is that the VG and QEII become specialized centres of excellence for certain illness. More general care will go to the other facilities. Dartmouth will play a bigger role for non-Metro residents. It’s thought this will be faster for patients to reach, more convenient and cheaper for families and friends than having to navigate downtown Halifax.

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