Robin McGee is worried about the fox getting into the hen house.
McGee, a clinical psychologist who also does patient safety advocacy work and served as a member of a working group tasked with addressing wait times, is worried about changes at the Health and Wellness Department that would see more patient oversight being passed on the provincial health authority.
“Monitoring should be done by people other than the clinicians who are actually doing the program,” she said. “It needs oversight and that oversight needs to be independent.”
Several weeks ago the government announced changes within the health department that will impact about 100 people; some will be transferred to other departments or the health authority, some will be laid off.
McGee, who has herself been the victim of medical error, said there is a risk of expertise being lost with the changes. She is particularly concerned about what will happen with the work being done to help reduce wait times and streamline service availability for patients requiring treatment or evaluation by specialists.
“I’m concerned that that program might go by the wayside,” she said. “Even if the Nova Scotia Health Authority does operationalize that kind of a program, my question is: Who monitors it? Who monitors the success of the program?”
But Health Minister Leo Glavine said the work McGee is citing will continue and it should happen without interruption.
Glavine said most of the structural changes are about reducing duplication between his department and the health authority, something recommended by officials in New Brunswick and Alberta where mergers have already happened.
Responsibility for improving quality on the front lines will rest with the health authority, said Glavine, but “it will be the department that will have a final oversight.” To that end, the department is working to create a quality health council.
“The Health Department needs to be the one that makes sure that standards are in place across the province (and) that these standards are in fact measured.”
The minister said the focus for his department is shifting to creating policy and programs that will be delivered by the health authority. The department will provide oversight as to the success of that delivery, said Glavine. He anticipates new roles within the department to provide “much stronger analytics of the data that we do get back.”
“That will be a major role,” said Glavine.
“Lots of time we collect data but we don’t really do the deep analysis that I think can lead to, again, those kinds of improvements that we need to see in the coming decade.”
Tory health critic Chris d’Entremont said he thinks the restructuring is more about the department being able to reduce its administrative budget “when we all know they just transferred everything over to the health authority.”
Transferring any responsibility for oversight should not happen, he said.
“In this particular case, the patient experience and patient safety, I think, is a regulation piece that should remain really close to the department, close to the minister, so that they know whether the health authority is doing their job.”
Acting NDP leader Maureen MacDonald said it probably makes sense for some structural changes, now that there is one provincial health authority, but she agrees with d’Entremont about who should be responsible for oversight.
“I think that it’s so important to have strong accountability in the minister’s office for the delivery of services,” she said.
“The devolution of the quality piece into the health authority, in my mind, creates one of the largest risks of lack of accountability around infection control, around medical mistakes, around any number of issues around the quality and the fact that we need to prevent bad practices.”
There needs to be “as arm’s-length as possible” monitoring of quality and safety, said MacDonald, and right now she isn’t seeing evidence that it exists.
McGee is supportive of there being a single health authority, but said “I just think that oversight of the health authority has to be outside the health authority.”
“I don’t think the health authority can police itself; I don’t think any serious institution can really police itself.”
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CHANGES WITHIN THE HEALTH DEPARTMENT BY THE NUMBERS
39 positions transfer from the Health Department to the provincial health authority or IWK (one from active living; eight from acute and tertiary care; eight from mental health and addictions; two from primary healthcare; one from physician services; 13 from public health; and six from health system quality).
23 positions (all from the active living branch) will transfer to the Department of Communities, Culture and Heritage.
20 layoffs (10 are executive positions and 10 are administrative support staff).
43 (approximately) vacant and term positions will be eliminated over time.
25 new positions will be created, including executive staffing positions and project leads in areas including advanced analytics and stakeholder relations.
(Source: Department of Health and Wellness)