Time to reorganize the Nova Scotia Health Authority

Pioneer House, March 4, 2017.

Pioneer House, November 4, 2017.

Pioneer House, June 18, 2018.
Pioneer House has been abandoned by the management of the Nova Scotia Health Authority. Note the upstairs windows haven’t been touched. A can on a window sill remains in place in all three photos. Curtains hang partially closed in all photos in all seasons. The note in the front door window has not been changed. And what is the status of the white shipping container sitting in the drive? Does the health authority own it or rent it? Why? Judging by the undisturbed weeds the container has not been opened in months, maybe years. What is its purpose, why is it there, what does it cost? (Allan Lynch Photos)

Directly behind Valley Regional Hospital in Kentville, at the entrance to the executive parking lot sits Pioneer House. It is 100 metres from the back of the VRH and 50 metres from the hospital maintenance department.

Pioneer House, the VRH heating plant and the brick Provincial Building next to the hospital are the last remnants of the former Nova Scotia Sanatorium in Kentville. Pioneer House had been home to the Sanatorium’s head surgeon and the medical director. It was quality construction. It has hardwood floors, a fireplace, basement garage and a large deck has been added in the last decade. For a while Pioneer House was used as a clinic. But for the last several years it has been empty. It hasn’t been heated in winter and the upstairs windows are left open year round. For at least the last 17 months the upper drive has been filled by a white shipping container. Since March 2017 I have not seen indicators, like footprints in snow, disturbed leaves or a shoveled walk or anything to suggest anyone has been inside this house.

The open windows indicate either a lax attitude towards the property or a plan for it to deteriorate to a state where executives can justify demolishing it.

Because I publish helphealthcare.ca last March a hospital worker came to my door on behalf of a surgeon wondering if I could help find accommodations for medical staff and nurses when they are storm-stayed at VRH or prevented from returning for their next shift because of the weather. Staff and patients are frustrated that surgeries and procedures are cancelled because of weather.

For the sake of patient care and to prevent weather-related cancellations Pioneer House would seem to present a ready-solution to stranded and exhausted staff. It may not house everyone, but it could at least be a resource for the surgical team. In summer, it could provide accommodation for medical students and those filling in for staff vacations. If neither of these solutions are doable, it could be converted into a medical museum. The Government of Nova Scotia is trying to build trade with and encourage investment from China. China reveres Norman Bethune. The fact that Norman Bethune came to the Nova Scotia Sanatorium to be treated for tuberculosis before he went to assist in the Spanish Civil War and to help Mao Zedong’s revolutionary forces would elevate China’s interest in the province. Opening a house that Bethune might have been a guest in, surrounded by woods he may have walked, as a medical museum would help accomplish some of the political and economic goals of the Government.

Leaving a substantial property like this to rot is an unacceptable waste of a public asset. It is disrespectful to the people of Nova Scotia. An NSHA executive should be held accountable for this neglect. But, sadly, there is no accountability in health care for poor property management or anything else.

Across rural Nova Scotia employers complain that a lack of housing hinders their ability to hire. We have seniors and young families, as well as people fleeing abusive domestic situations who need a place to live. That a property like Pioneer House is left to deteriorate is unconscionable.

Why should we expect executives, who trained to be doctors and nurses, to be competent at managing real estate? Where in their courses did they learn about construction or building and systems maintenance? Given their other responsibilities, isn’t it too taxing to expect them to hire and monitor staff, keep abreast of medical changes, deliver prompt health care and oversee a property portfolio that has 99 hospitals, clinics, medical centres and office complexes across the province?

Since winning election in 2013 and 2017 the Government has initiated bold changes in provincial health care. First, they merged nine health authorities into one unified authority, the NSHA. Then, in preparation for developing a replacement for the Victoria General Hospital the Government is investing over $125 million in expanded facilities throughout HRM and as far away as Windsor. Last month the Premier announced the closure of two Cape Breton hospitals and the expansion of services at two others.

These are all preparatory moves for what will be a seven-to-ten-year time frame to demolish, design and redevelop the VG. Currently cost guestimates for a new VG are in the $2.5 billion range. But given Nova Scotia’s propensity to be late and over-budget on capital projects, it wouldn’t be surprising for a new VG to become the most expensive building in Canada. Do we want to hand such an expensive project over to in-experienced executives?

Nova Scotia hasn’t a good track record on capital projects. That dates back to the construction of Government House. In 1800 Whitehall gave Governor and Lady Wentworth £10,000 to build a governor’s mansion. The Wentworths spent £30,000. A 2009 refurbishment of the mansion took longer and cost twice what was budgeted. More recently the 2017 repair of the Legislature steps was 55 percent higher than the consultant’s estimate and three weeks past deadline. The Bluenose II restoration was 70 percent over the estimate and two years late. In the 215 years since Government House was built I have found no capital project which has come in on budget or to schedule, and yet, century after century bureaucrats and politicians express surprise when every project doesn’t come in as projected.

Our history with hospital construction and maintenance is equally troubling. In 1978 the new Yarmouth Regional Hospital opened with doorways that were not wide enough to accommodate hospital beds. It cost $400,000 to rectify. In 1987 the new Camp Hill Hospital became known as the sick hospital. It took two years to realize the problem was the side-by-side placement of exhaust and intake fans. Then when the QEII Health Sciences building opened we had to spend $1 million correcting a problem with the laboratories, which were designed without input from the lab technicians.

Simpson Landing at the Nova Scotia Hospital in Dartmouth opened five years late and was 48 percent over budget. And then there was the two-year-delay in opening the Colchester East Hants Health Centre, which was 78 percent over budget. That prompted the Auditor General to lament that the hospital project was overseen by executives with no construction experience. In an understated damning observation he also said that information provided to Cabinet should be factual.

Meanwhile, the health authority pays $1.2 million a year to maintain the empty former Colchester Regional Hospital in Truro. The authority is waiting on an action report that is four years late. In total, health executives and Department of Health have had 12 years to consider what to do with the hospital and failed to do so.

The problems with hospital construction seem systemic across Canada. For example, the new $1.3 billion McGill University Health Centre in Montreal opened with 14,000 deficiencies! It is being sued for $172 million for cost overruns and the former CEO fled the country to avoid charges of conspiracy, money laundering, fraud and accepting $22 million in bribes.

In Ottawa, the new Heart Institute is wrapped in controversy after it was revealed that a health executive accepted“luxury fishing trips”from a contractor who was later awarded several $100 million contracts. Lawsuits were launched.

In addition to our construction problems, were the on-going maintenance issues at the VG. For 30 years the water was so toxic it couldn’t be used for more than flushing toilets. No other building would have been allowed to remain open under those conditions. The Department of Health and NSHA say the VG must be torn down, but various letter writers to The Chronicle Herald have questioned that assessment. People with engineering backgrounds have asked if the shell can’t be preserved and the buildings gutted and rebuilt. There is a lack of trust by the public in assessments of properties that bureaucrats clearly don’t want. Pioneer House is a modest example of that.

In Ontario, an agency of the government called Infrastructure Ontario, handles all construction projects. Infrastructure Ontario’s focus is overseeing construction vs our habit of taking civil servants away from their daily work to dabble in multi-million-dollar projects.

Given our poor history with new hospital design, construction and maintenance I believe it is more efficient and effective to separate the real estate holdings from the NSHA. I propose a Nova Scotia Health Trust to own and maintain health care facilities. The NSHA would become the NSHT’s tenant. The Trust would also oversee construction projects.

The NSHT would be run by executives with real world experience in construction trades, contract negotiation and an understanding of what are reasonable project delays and cost overruns. They could also hold the lid on expensive, last-minute wish-list additions. The Trust executive positions could be tied to meeting specific performance targets.

Removing the burden of project oversight and facility maintenance would lighten the load on health executives and let them focus on delivery of care vs reacting to broken pipes and the myriad other problems buildings can have.

History shows us that public officials haven’t got a good handle on construction or maintenance costs. The example of Pioneer House shows how easily health executives mismanage our holdings. Meanwhile, older, large, high-traffic properties like The Westin Nova Scotian and Lord Nelson Hotel, both built in 1929, are shining examples of how well private sector expertise is at maintaining properties and extending their life spans.

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One Response to Time to reorganize the Nova Scotia Health Authority

  1. ausca says:

    What an comprehensive list of systemic project mismanagement in Nova Scotia!

    I’ve also noticed spectacular screw ups like the Bluenose II, the Washmill Overpass, the Yarmouth Ferry, what looks like another in the Halifax Convention Centre – and now Halifax City Council is seriously entertaining overtures about their (our) involvement the construction of a large football stadium! Yet both Dalhousie and St. Marys offer courses in management right here. (Surely their graduates can’t be practicing here?). It seems to makes sense that large construction and maintenance of health care projects should be overseen by construction and project management experts, the best of whom (with successful track records) might more likely be found in the private sector than the NSHA.

    Your point about what could well be the negligent or deliberate neglect of a public asset in Pioneer House is well taken. This is an irresponsible waste in a cash strapped province. I’ll bet few are even aware of this building in HRM. Like some of your other posts this one deserves being passed along.

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