What cost comfort?

This week the leader of the Nova Scotia New Democratic Party, Gary Burrill, called on Premier Stephen McNeil to apologize for the $250,000 purchase of furniture for the Nova Scotia Health Authority’s executive offices.

I understand the outrage, but it’s directed to the wrong person. The Premier didn’t spend this money, the health authority did. They took it from the money the province provides for the administration and delivery of health care. The person responsible for this expenditure is NSHA President and CEO Janet Knox. Public anger and frustration should be directed to her. It was her decision.

To blame the Premier is playing politics with health care. When the NDP formed a government, they didn’t apologize for the 30 percent one-year jump in the number of executives earning over $100,000 (that was in fiscal 2012), so its disingenuous to now be outraged by this $250,000.

Put blame were it is due.

Knox is not a budget hawk. She has a history of administrative extravagance. When she was president of the Annapolis Valley District Health Authority (AVDHA) in Kentville administrative costs were 60 percent above the national average. In an attempt at belt-tightening, AVDHA under Knox, reduced access to x-rays in clinics in Wolfville and Berwick; cut 2.5 ER nurse positions; and reduced two more nurse positions in other departments. The AVDHA also reduced the Valley Regional Hospital’s food services budget by $100,000. While cafeteria hours were reduced – impacting hospital staff and visitors – Knox continued a subsidized lunch program for 160 white collar staff at the health authority executive offices across town. Two snacks a day, plus two choices of lunch entrees, are trucked across Kentville from the hospital to executive offices. This also requires food services staff be on-site to dish out snacks, meals and drinks to these office workers.


Knox’s history is of executive indulgence, so it should be no surprise that in the week when people in Cape Breton complain about a lack of wheelchairs and other care, we learn Knox had authorized the purchase of $250,000 in office chairs, sofas and boardroom fixtures. We can rest assured that the NSHA executive team (seen here: http://www.nshealth.ca/about-us/executive-team ) aren’t inconvenienced.

So, rather than play politics over on-going gaps in judgment, blame the right person. Janet Knox has the titles, pay and perks and should wear the responsibility for her choices.

Of course it’s difficult to direct complaints to the NSHA since no phone number is listed for the executive offices. The NSHA website lists numbers for services and enquiries about hospitals, but not for the executives. They do give a mailing address:

Nova Scotia Health Authority Provincial Office
90 Lovett Lake Court, Suite 201
Halifax, Nova Scotia   B3S 0H6

And this laughable email address: wearelistening@nshealth.ca

Good luck complaining. Health executives don’t entertain public complaints. Instead they treat any contact as “feedback” which is then interpreted to fit their messaging.

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7 Responses to What cost comfort?

  1. Tim Segulin says:

    Point taken, but doesn’t Knox and the DHAs ultimately come under the purview of the Minister of Health and Wellness? With an election in progress it may be too late to jerk her chain now, but this is hardly the first management excess in our District Health Authorities. Why does Health and Wellness look on like disinterested bystanders while having to fend off legitimate complaints about wait times for joint replacements, poor elder care and lack of wheelchairs (for goodness sake!) in Cape Breton.

    Burrill is not Dexter. Many in their party were unhappy with Dexter’s priorities, including Burrill. My feeling is that he shows promise but needs better grounding in the financing of his policies or he will never get a shot at implementing them.

    The Liberals are rolling up all those DHAs into two. It remains to be seen if they actually save unwarranted administrative expense in the process, but if not it will be a huge opportunity lost.

    In the meantime it seems to me that Knox answers to the Minister of Health and Wellness who answers to The Premier. If Burrill calls McNeil’s attention to this, then surely the ball is then in the Premier’s court. Let’s see how he responds.

    Sure, we’re in an election now and everyone is ‘playing politics’. I’m inclined to feel McNeil has left Burrill a legitimate opening here. However it barely glances off the surface of the iceberg of reforming NS public health and wellness so it becomes sustainable and responsive. As usual, no party(so far) seems to have a plan for that, and none of them want to talk about it seriously. (Correct me if I’m wrong).

    • I disagree about this being the Minister’s or the Premier’s responsibility. Janet Knox and the heads of other Crown corporations and agencies and boards are hired and paid well to manage these institutions and organizations. You don’t pay someone over $340,000 a year and stand over their shoulder watching everything they do on a day-to-day basis. That’s impractical.

      No one runs every purchase order past the Minister’s desk or the Premier’s desk. Government would get bogged down and have to sacrifice the larger initiatives they oversee. Do we want Dartmouth General finished – after 40 of sitting half empty – and have QEII expanded and VG replaced and all of the other medical infrastructure we need done or do we expect the Minister to concern himself with the decor of Janet Knox’s office? Who would have expected her to be so cavalier with expenses when the government preaches restraint?

      The other problem with a Minister or Premier approving every purchase order is the charge of potential impropriety and influence and negatively impacting the work these executives, like Knox, were hired to do a job. If she can’t see the bad optics of decisions like this, then she may not be the person for her position. On the other side of the coin, maybe she could see the poor optics and wanted to sabotage the government with the leak of such an expenditure?

      For decades health executives have been unanswerable and unaccountable for their actions and decisions. The public gets mad at the government of the day and give the executives a clear path to do what they have always done.

      A new government works better for the health executives because they can waste half of a new government’s term bringing the party in power and new minister up to speed. Then just as the new minister starts to understand the health care system, the Premier of the day shuffles his cabinet and appoints a new minister. That second minister only gets up to speed in time for an election. Of the last five administrations, it’s only been this government that has kept the same minister for the duration of the mandate. Look at the political history and you’ll see that health ministers last an average of two years. The best thing we can do for health care is 1) hold the health executives accountable for meeting targeted outcomes and 2) have the same health minister for another four years so we don’t lose time breaking in newbies and we can move ahead in making the hard decisions. Those hard decisions shouldn’t include Janet Knox’s office decor.

      • Tim Segulin says:

        “If she can’t see the bad optics of decisions like this, then she may not be the person for her position. On the other side of the coin, maybe she could see the poor optics and wanted to sabotage the government with the leak of such an expenditure? ”

        What would be the point of the minister trying to micromanage Knox? That would not be a vote of confidence in her and could even be portrayed as unwarranted political interference. Left to her own devices, she is expected to run (and be seen to run) a lean, efficient DHA, delivering accessible, quality health care at a reasonable cost. This latest scandal calls her judgment into question. That makes it an issue for the minister, and were they to take serious action they might have to run it by the Premier.

        If your point is that the public don’t understand how the DHAs are largely to blame for much of out public health malaise, I agree. However if it’s not up to the elected government to configure them so they work optimally, whose responsibility is it?

      • It is the Minister’s responsibility. But he can’t be expected to contact the NSHA CEO on a daily basis and ask what she’s spending money on today. I have been a boss. You train staff, you give them guidance, you define the job, you give them autonomy to do it. Things get by you. Then you try to resolve it and ensure it doesn’t happen again. It that means dismissal, that’s what you do.

        But this purchase only became known during the election campaign. You can’t expect the Minister or Premier to act on it during a campaign. That looks political and shifts the discussion from serious issues around care delivery. And frankly, I would almost rather health care not be discussed during an election campaign. The history of health care discussions during a campaign is basically about opportunism. As I have written before it mostly boils down to who will throw the most money at the system vs who will make the hard decisions about care. Lazy voters want easy answers. They haven’t shown an interest in hearing anything involved, complicated, detailed.

      • ausca says:

        I think we may be largely in agreement.

        Where do non-lazy voters go to get information they can understand about the state of health care, and option for the future? Yes, there is this blog, but it goes back quite a way now and reading all of it would require a great deal of effort. How does a conscientious citizen concerned about health care make sense of this?

        Thanks for all the stuff you have written on this BTW. I read everything you send.

      • Thank you. I suggest when people visit they can try a subject search to see if it’s something I’ve covered or others have contributed.

        People might visit Doctors Nova Scotia to see what they have said about various topics. CBC do a fair bit of coverage of the health system. You’d have to go to their site and click in a subject. I’ve tried to include some links, but sometimes their web hosts have to pare what’s available to make space for new material.

  2. Mary McDaid says:

    Thank you for this insightful article. It is so easy to point fingers during an election but let’s be sure we understand the facts. You are entirely correct, we should look to the senior administration to use sound judgement and to be prudent with taxpayer’s money, they are hired with an assumption that this will be the case. The only issue we have is, unlike a CEO of a company who is not fiscally responsible, it is very difficult for the “shareholders” of the province to fire a civil servant.

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