Houston’s health care fix: another Hail Mary pass into a Grand Canyon of crises?

Nova Scotia’s healthcare system is hurtling past hell in a runaway, overcrowded, broken-down gurney.

Some recent dispatches from its front lines:

Consider this from a Canadian Press story last week.

Nova Scotia’s health unions say long-standing staffing shortages in emergency rooms are a key reason two hospital managers last week warned that some patients may be “dying” from long wait times…

[Janet Hazelton, the president of the Nova Scotia Nurses’ Union] says it’s possible the strong language in the email from managers at Dartmouth General Hospital is being driven by fears that Nova Scotia’s ERs will follow the pattern in New Brunswick, where two people are reported to have recently died in hospital waiting areas.

“If you have 30 or 40 patients waiting, you can’t expect a single triage nurse to both initially assess and keep an eye on those people,” she said. “They could deteriorate quickly, and someone ought to be responsible for checking on the waiting room.”

The overcrowding in hospital emergency rooms, of course, creates a torrent-down, knock-on effect on the rest of the system.

Here’s the opening of CBC reporter Preston Mulligan’s report about one walk-in clinic, which appeared on the same day as the Canadian Press story:

There are about 20 people lined up at 7:30 a.m. outside the Clayton Park Medical Clinic in Halifax. It’s a mid-week morning…

“If you’re not here two hours before, then you’re not getting in,” [Danita Collicutt, a support worker for people with brain injuries, said.] “It’s really common where they have to physically turn people away because they don’t have the space. So, it happens quite frequently,” she said…

After a few minutes, a woman from inside the clinic walks out with a handful of cards. She tries to console all of those who’ve been waiting, but she only has so many cards to hand out.

If you don’t get a card, you go home.

The pressure on the limited number of walk-in clinics, like the numbers of people stacked like cordwood in ERs, reflects the reality that 125,278 Nova Scotians — another month, yet another record number — don’t have a family doctor. Between November 1 and December 1, the net number of Nova Scotians looking for and not finding a family doctor grew by 4,868.

The government’s latest attempt to stick a finger in that dyke — VirtualCareNS — isn’t holding back the tide. Theoretically, 83,000 of those on the looking-for-a-doctor list are eligible to use the virtual care option, but the untheoretical reality is that the system can only accommodate 150-200 appointments a day.

Foreign-trained doctors could help ease this squeeze but, as the Globe and Mail’s Atlantic correspondent, Greg Mercer,  reported last week from an international doctor recruiting fair in Dublin, Ireland:

Some 5,135 foreign doctors became permanent residents in Canada between 2015 and 2020, according to figures from Immigration, Refugees and Citizenship Canada. Only a portion of them, about 37 per cent, are working in their field…

Canada’s system for assessing and integrating physicians who were trained outside of the country is plagued by barriers and chokepoints, and the country is increasingly losing physicians to other places as a result.

In this topsy-turvy world, even good news becomes bad news. After decades of population decline, Nova Scotia is becoming a magnet for immigrants from within and outside Canada. Halifax is now one of Canada’s fast-growing cities — second only to Ottawa — and predictions are that our population will top 500,000 within the next five years.

Good news? Yes, but…

Remember those 125,000 Nova Scotians currently crowding our doctor waitlist. Well, 53,100 of them call HRM home. If we add 40,000 more newcomers by 2028, imagine how many more of them will be wandering the medical maze, looking for a family doctor? Trying to line up an appointment through VirtualCareNS? Waiting in line at a dwindling number of walk-in clinics? Further overcrowding already overcrowded ERs?

It is almost possible to feel sorry for Premier Tim Houston.

Almost.

If you recall, he ran his 2021 provincial election campaign on the strength of his laser-like focus on health care and his promise that he alone could fix it — and he won a majority government.

The reality is that there can be no single, simple fix to the all-systems failures plaguing our healthcare system. It’s been building since long before Tim Houston.

Notes Janet Hazelton of just the ER crisis: “We kept saying, ‘If you don’t address this, we’re going to be in a crisis,’ and it never was addressed by multiple governments.”

Multiple governments, multiple decades… many more multiples of collapse and calamity.

That’s one reason why Houston’s announcement last week that the much-delayed redevelopment of the Halifax Infirmary will finally be put to the shovel beginning this spring, but with construction staggered so the most urgent needs can be operational sooner is welcome news.

In total, projects announced Thursday would add 423 beds to the system in the Halifax Regional Municipality.

Along with the work at the Halifax Infirmary, officials announced plans to expand the emergency department at the Dartmouth General Hospital and spend $13.9 million to buy the East Coast MediCenter Building, home of Scotia Surgery. The province has a partnership with the private clinic in Dartmouth to perform certain surgeries.

There are also plans to expand the Cobequid Community Health Centre in Lower Sackville, adding a site on adjacent property owned by the province to create 36 in-patient beds where right now there are none. The emergency department there will also be assessed for expansion or replacement.

“Nova Scotians,” Houston told reporters, “deserve better than to be told to wait a decade or more. That’s not good enough for them, and it’s not good enough for me.”

And yet, it all still felt like another Hail Mary pass into the Grand Canyon of healthcare crises.

For starters, Houston is continuing with the discredited Liberal plan to make the public health project a public-private partnership. You don’t have to look far — Nova Scotia’s schools — to see how badly that has worked for taxpayers in the past, or to have questions about the lack of transparency and accountability in the hospital plan.

To make matters worse, there isn’t even a second bidder for the Infirmary project; we will be at the mercy of a private sector that inevitably does very well by P-3 projects.

And worse than worse, Houston, the accountant, says he doesn’t know how much any of this will cost and, frankly, my dear, he doesn’t give a damn.

“We’re not trying to save money on health care,” he offered when asked about costs. “We’re trying to get it right. Whatever it costs, it will cost. We’re going to get it done.”

While many of us will sympathize with that sentiment, we also know how quickly political leaders can pivot from let’s-get-it-done to hold-on-not-so-fast-not-so-much.

Usually, it just takes one election cycle.

The cynical realist in me sees Tim Houston campaigning for re-election in 2025 on the basis of hopeful shovels in the ground rather than actual beds in the wards.

Let me finish the job, he will tell us.

If he wins, he will have to deal with a multi-billion-dollar, no longer un-costed bill of sale.  Since he won’t have ever tackled the real elephant in the room — the unfair and unequal tax system that starves public services so corporations and the wealthy can benefit — he will, as politicians before him, discover fiscal prudence, we can’t afford that, remember the debt, our credit rating, and, and, and…

We’ve been here before. And, it seems, we will be again.