Former Nova Scotia Health Authority CEO Janet Knox’s rebuttal (“Counterpoint: Health bureaucracy hardly bloated,” Aug. 31) to Ralph Surette’s Aug. 24 column (“N.S. needs to upchuck health bureaucracy hairball”) exposes the culture of unaccountability that she can take credit for.
Contrast Knox’s response to the performance of Nova Scotia Power’s CEO, Karen Hutt, following hurricane Dorian. As we witnessed uprooted trees entangled with power lines leaning dangerously on homes, a crane precariously entwined with a building, and rooftops and vehicles laid open to the elements, she was immediately present to give clear account to the public.
Help from federal, provincial and municipal governments coalesced into a logically prioritized, urgent response. News Radio 97.5 offered information, connection and comfort as the hurricane ravaged the province. MLAs like the NDP’s Claudia Chender analyzed mishaps such as the failure of cell tower generators to kick in, causing loss of cellphone access, that led to people making the dangerous choice to drive during and after the storm to reach those who needed assistance. She called on federal Public Safety Minister Ralph Goodale to intervene and change policy to ensure private companies responsible for delivering essential services had effective backup systems in place, in the interests of citizen safety.
What if the health-care crisis was actually a weather phenomenon, like a hurricane? How would we forecast it to warn people?
From 2005 to 2010, with both the population and health-care workers aging, it was like a tropical storm building toward a category 1 hurricane; from 2010 to 2012, the then NDP government put up innovative solutions, only to see them taken down by the next (Liberal) government. The storm was growing, but the new Liberal government decided the immediate priority was to take two years to plan the deconstruction of the Department of Health and Wellness and amalgamation of nine health district authorities into just two, including the NSHA.
In 2015, the government put a stranglehold on how many doctors could practise in Nova Scotia and where they would be allowed to work. It refused to innovate and develop urgent solutions, to ask for help from the military and federal government or to invest in long-term care beds. It refused to address the need for more staff or its use of pink slips or tight offload times in emergency departments. This all fed the gathering storm, much like the warm waters around the province had fed hurricane Juan.
The health-care storm is now category 2 and developing into category 3. The resulting damage is plainly visible across the province.
Waiting on the winds of change
Demand for care is surging at emergency rooms, doctors’ offices, walk-in and outpatient clinics. Patients face wait times of four to eight weeks to see their family doctors or nurse practitioners. Paramedics talk people out of going to hospital, pointing out the terribly long wait times. Patients in hospital are subject to medical errors committed by overwhelmed staff. The tight offload rules imposed on emergency departments, without creating new beds in long-term care, has passed on that stress to hospital wards.
Can you imagine being 80, with fractured bones, and being moved into the hospital corridor to make room for someone else? Can you imagine using a bedpan, while an LPN holds up a sheet to give you privacy? Can you imagine being given a painkiller, that causes you to hallucinate, because staff did not have time to check the alternative ordered by the doctor? All this has happened.
Unlike Karen Hutt sharing the actual number of people without power, the NSHA continues to lowball the actual number of people without a doctor.
In 2015, then health minister Leo Glavine said that 95 per cent of Nova Scotians had a family doctor and the remaining five per cent did not want one. The NSHA website indicates 104,633 patients were placed with a “provider” of primary care between August 2018 and August 2019, while 51,980 more waited on a list. This shows that last year alone, at least 104,633 people — 10.8 per cent of the population — needed a doctor, while five per cent of the population are still waiting.
Since April 2018, 171 doctors (67 family docs, 104 specialists) have been recruited. There are now 175 vacancies (81 family docs and 90 specialists). Adding the number of family docs recruited to current family physician vacancies totals 148. Using a conservative estimate of practice size of 2,000 suggests 296,000 people (31 per cent of the province’s population) need or needed a family doctor at some point. Again, the NSHA’s estimate of people without access to primary care does not add up.
How can we trust the health authority’s numbers, let alone feel sympathetic to the protestations of its former CEO? Janet Knox bears responsibility for the culture of obfuscation that she oversaw and supported. Meanwhile, we are being battered by a health-care hurricane that is growing to a category 3.
Using baseline population information collected in 2016, the estimation of people waiting for access to primary care ( family doctor or nurse practitioner) , broken down by “zones” and “clusters” extends from 0% ( Cheticamp) , 0.1% ( Inverness) to 15.8%( Annapolis Royal) , 20.2% (Middleton).
51,980 people are registered on the health authority’s waiting list as of Aug 1,2019. As of Aug 1, 104,633 people are listed as having found a “provider”.
Figure below identifies the number of people in Nova Scotia who have found a primary care provider who were on the NAFP registry or identified through other routes as tracked by NSHA since November 2016. Figure 1: Total Provincial Volumes - Found a Primary Care Provider by Month
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