Health Authority opens the door a crack

For the first time since the McNeil government dismantled nine regional health authorities and created one provincial agency to run hospitals four and a half years ago, the Nova Scotia Health Authority opened a portion of one of its Board meetings to the public. Yesterday’s meeting took place in the town of Liverpool. Doors opened at 8:25am. Only 10 citizens and three journalists showed up.

“We are committed to engagement and transparency,” announced Frank van Schaayk, the chair of the Nova Scotia Health Authority Board of Directors. Well, a very limited amount of transparency as it turned out.

While citizens and journalists may now observe the public portion of four of the Authority’s six meetings a year (thank you, that’s a significant change that was broached in the Legislature by NDP leader Gary Burrill more than a year ago), journalists are not permitted to record the proceedings.

“It’s too disruptive,” explained Van Schaayk,“and we have a lot of business to get through”.

I’ll accept the second part of that statement but not the first, especially when you consider journalists are permitted to use tape recorders or cellphones to record the proceedings during murder trials in courtrooms as well as most at most other public meetings. Recording helps with accuracy.

So too would having a copy of the report prepared and distributed to Board members by the Health Authority’s CEO, Janet Knox. Considering the CEO’s report provides a regular update on the operations and annual spending of $2.1 billion of public money, transparency could be greatly improved (as well as the reporting on the discussion of that undisclosed document) if the Board shared the CEO’s report, if even at the start of the meeting, with reporters and citizens who cared enough to attend.

Here’s Frank van Schaayk’s response to that idea:

We won’t make materials public beforehand. We will publish the minutes. I can say we will consider it but I certainly wouldn’t promise it. You’ve got the ability to make notes while you are here and that’s the way we will be doing it for the next little while.

Let’s not give up. The door is open a crack.

Here’s what we did learn yesterday at the open portion of the meeting before the legal, personnel, and juicy bits were discussed behind closed doors.

The Health Authority recruited 26% more physicians in 2018-2019 than the previous year. They included 58 family doctors and 72 specialists. “We are making some progress but our vacancies still remain high,” acknowledged Carmelle d’Entremont, vice-president of People and Organization Development, what once was known as Human Resources.

d’Entremont told the Board members there are about 200 vacancies for physicians across Nova Scotia at this time. Fifty-one doctors have signed offers indicating they are prepared to come but that process often takes eight to nine months to complete. d’entremont said the Health Authority is hiring a sixth recruiter (two years ago it had only one). She said the involvement of more communities which are stepping up to help find their own physicians and nurse practitioners is a positive development that the NSHA believes will pay off.

In the Western zone, which stretches from Lunenburg County around the tip of Yarmouth and up through the town of Middleton in Kings County, there are two vacancies for anesthesiologists that have increased wait times for knee and hip replacement surgeries.

Tim Guest, the NSHA’s vice-president of health services and Chief Nursing Officer, said longer wait times for those surgeries in the western zone with nearly 200,000 residents wiped out gains made in reducing surgical wait times in other parts of the province. The national benchmark for getting  hip and knee surgery after having visited a specialist is 182 days (six months). That compares with 417 days for hips in Nova Scotia and 504 days for knees. Another reason for longer wait times may be because demand for joint replacement went up 9% last year.

The other domino threatening to fall in Yarmouth was that pregnant women would have to drive a couple of hours to deliver their babies. CEO Janet Knox told reporters after the meeting that anesthesiologists working on short-term contracts or “locums” will be brought in to maintain surgical services at the Yarmouth Regional Hospital for at least the next couple of months — by which time it is hoped the vacant positions may be filled.

“It’s a big challenge recruiting doctors to small rural communities,” said Knox. ‘We need new models for delivering health care because the old ones are worn out.”

That’s the same conclusion 50 people reached at a public meeting or “engagement session” the Board held the previous evening in Liverpool. Frustration over long wait times and the difficulty in finding family doctors had many people talking about the need for more collaboration among health care professionals such as nurses, physiotherapists, dieticians, and pharmacists who could provide some of the medical services most required where they live.

Last but not least, the 13 Board Members received information from vice-president Tim Guest about a new policy designed to help unblock clogged Emergency Rooms and get ambulances back on the road sooner. “It’s a system-wide problem,” said Guest, “and we don’t have the ability to fix issues that are not in our control.”

Guest seemed to be referring to an undisclosed percentage of hospital in-patients who are waiting for a bed to open up in a nursing home or a residential care facility. Or “at risk” people who show up regularly in the Emergency Room because they have addiction or mental health issues and their hostel or group home won’t let them in when they have a crisis. Guest said meetings have begun with both the Department of Community Services and the Department of Health to find alternative housing arrangements to relieve the pressure on overcrowded Emergency Rooms.

Meanwhile, the first week of June will finally see the new ER policy roll out at Emergency Rooms in Halifax, Dartmouth, Sydney, Kentville, and Truro. Guest says in a few locations more nurses may need to be hired as part of “transition teams” that will allow paramedics to hand off patients so ambulances can leave Emergency 30 minutes after arrival. After June 3, people who arrive at Emergency are supposed to wait no more than 12 hours  before being admitted. (This also means the families of patients will need to be told upon admission they must also be ready for discharge).

Guest spoke of the need to hire “external supports” or consultants “to help managers manage the culture of change.” There was no discussion of costs.

“We have a good foundation on which to build but there are still some gaps and it will take some time to work out the kinks,” Guest said about the implementation of the new Emergency Room policy to improve the flow of patients.

Janet Knox retires this summer. The Board has hired a Toronto firm to line up candidates to interview but van Schaayk says a new CEO may or may not be in place by the time Knox goes.