This Wednesday marks one year since Tim Houston was elected premier of Nova Scotia on a promise to “fix” health care.
Nova Scotians handed the Progressive Conservatives a majority government to try and do just that. The government has undertaken many initiatives, creating separate offices to focus on the recruitment of more health care professionals as well as to improve mental health and addictions services.
In February, continuing care assistants (CCAs) got a 23% wage increase. Paramedics now have better equipment to reduce workplace injuries, doctors got a new payment scheme, and contract negotiations with registered nurses are also on the horizon.
Tenders have been awarded to upgrade old nursing homes or build new ones, but fall well below the Progressive Conservatives’ four-year goal of adding 2,800 beds to relieve some of the pressures on the health system.
Plans to build a new super hospital to replace the crumbling Victoria General Hospital facility in Halifax have been delayed to ensure it will be adequate to serve the growing population.
Houston told voters that fixing the health care system “wouldn’t happen overnight” and would require both time and money.
But the question for many Nova Scotians nearly a year after the election is whether access to health care is better, or has it gotten worse?
The Halifax Examiner did the following health care system “check-up” using information provided by communications advisors with the Department of Health and Wellness and Nova Scotia Health (NSH).
One new tool the government has developed to improve reporting to the public is a weekly online report with current information about hospital occupancy, long-term care admissions, and wait times for ambulances. It provides excellent information in a clear format and you can find it here.
How full are the hospitals?
The weekly online report cited above shows that as of last Thursday, August 11, hospitals across the province were, on average, at 98.5 % capacity. The Western region — which includes Valley Regional and South Shore Regional hospitals — were overflowing with patients.
Beds at the Digby General Hospital were at 125% capacity, and Yarmouth Regional Hospital reported 120% — this may or may not be partly because the emergency department at the hospital in Middleton has been closed overnight since last fall and emergency beds at the Annapolis Community Health Centre are closed indefinitely.
Hospitals in New Glasgow and Truro were at 100% of their capacity, the QEII Health Sciences Centre was at 93% last week, and Cape Breton Regional Hospital was at 105%.
Hospitals where emergency departments are frequently closed due to a lack of staff (like Twin Oaks in Musquodoboit Harbour and Hants Community Hospital in Windsor) help bring down the provincial average.
How many hospital beds are occupied by seniors waiting for care?
There are 226 hospital inpatients currently waiting for placements in long-term care homes across the province.
That’s down from 300 earlier this year. Last week, 58 people were admitted to nursing homes.
There are currently between 800 and 900 people waiting for full-time or part-time home support (what used to be called home care) so they can continue to live on their own.
How long are ambulances waiting at emergency departments?
The Department of Health’s public reporting website shows the response time or wait time for an ambulance averaged 28 minutes in every region of the province last week, including in HRM.
The volume of calls has been growing over the past month when compared to earlier in 2022. Last week, paramedics responded to 2,651 calls.
The average wait for paramedics to offload patients at emergency departments is still one hour and 24 minutes, despite the fact the target or standard set by the Department of Health is to discharge 90% of patients within 30 minutes.
What’s the plan to tackle the surgery backlog?
Five months ago (in March), the federal government gave the province $51.8 million to reduce the number of people waiting for operations, a backlog created by COVID-19 cancellations.
According to Khalehla Perrault, a communications spokesperson for the Department of Health and Wellness, the wait list has about the same number of people waiting for surgery today as it had prior to the pandemic.
“As of July 31, 24,982 patients are on our overall surgical wait list, this compares to 24,624 pre-COVID (February 2020). As of July 31, 6,702 patients are on our orthopedic surgery wait list, this compares to 7,140 pre-COVID (February 2020),” Perrault said in an emailed statement.
These numbers tell only part of the story.
“It is important to note that these figures represent patients who have been added to our wait lists following a consult with a surgeon,” NSH spokesperson Krista Keough said in an email. “We do not have data on the number of patients who have been referred for a surgical consult and are waiting to see a surgeon to determine if surgery is required.”
That means the wait list is actually much longer. The number of surgeries performed so far in 2022 is 97% of the volume surgeons did during the first seven months of 2019-20.
That was three years ago.
So how does the province intend to spend the federal money allocated in March to reduce the number of patients waiting for procedures?
“We are working on a plan to use the federal funding and address the backlog,” Keough said, adding that the federal money must be spent this fiscal year.
“Our goal is to build the system’s ability to complete surgeries more efficiently so that more can be done. We intend to focus on those patients whose need is greatest and who have been waiting the longest. We also want to improve pre- and post-surgical care so that patients recover faster, have better results, and as much as possible, don’t need repeat surgeries.”
Opposition leaders have said this is not a plan, although the government is promising to develop one.
Staffing shortages of nurses and doctors are likely making it difficult to ramp up capacity, and private clinics — like the one that recently opened in Dartmouth — siphon off already scarce human resources from the public system.
How many Nova Scotians without a doctor are signing up for virtual care?
Not as many as you might think.
In December, Virtual Care Nova Scotia expanded from a pilot project to a service available throughout the province.
So far, only one out of three people contacted by NSH have agreed to sign up for online visits with a doctor or nurse practitioner. That’s despite the fact over 100,000 Nova Scotians now have their names on the province’s “Need A Family Practice” registry.
“As of August 1, 2022 74,500 people on the Need a Family Practice Registry have been contacted to participate in VirtualCareNS and 23,700 people have signed up for the program,” Keough said.
“This information can be found online in the latest Finding a Primary Care Provider report (page three). By the end of this month, everyone on the registry will be able to access VirtualCareNS.”
To date, 19,800 virtual visits have occurred since the program began in May 2021.
There are 48 primary care providers who currently deliver care through VirtualCareNS (39 family physicians and nine nurse practitioners); and more providers are being recruited to participate.
What are the most common reasons patients provide for not accepting online visits with a nurse practitioner or medical doctor?
“We are continually evaluating patients (and providers’) experience with VirtualCareNS,” Keough said.
“From our evaluation, we know that of those who received an email to register for VirtualCareNS, but have not signed up yet, over 50% of respondents indicated it was because they didn’t need the service at the moment. Other reasons included: a preference for in-person care, no mobile device / computer and/or internet access, or they didn’t feel comfortable using virtual care (or don’t have the technological know-how to do so).”
The demographics of an aging population may make switching to online visits challenging, particularly if it isn’t easy to use. (Full disclosure: I can’t personally comment on that because I have managed to find a family doctor who recently immigrated to the province).
Perhaps some Nova Scotians are signing up for the registry in advance of their doctor retiring. NSH said by the end of this month, Virtual Care should be accessible to everyone who is eligible.
Who is running the Office of Healthcare Professionals Recruitment?
A month ago, journalists confirmed that Dr. Kevin Orrell was no longer working as CEO for the Office of Healthcare Professionals Recruitment. Repeated questions to the Department of Health about the reasons behind his departure have been met with no response.
Two weeks ago, Houston said that as far as he was aware, Orrell was still the CEO and was continuing as part of the four-person health leadership team that Houston had appointed last September.
The Halifax Examiner has asked to speak with Department of Health and Wellness Minister Michelle Thompson to set the record straight regarding Orrell’s past and future role and received the following response from DHW spokesperson Perrault:
“We understand your frustration, however, there are no updates to provide at this time. Minister Thompson has committed to speaking with media when there is news to share,” Perrault said.
Nova Scotia saw a net gain of 95 physicians in 2021-2022, and every Canadian province is competing to hire health care workers.
Are hospital patients who test positive for COVID-19 sharing rooms with patients who haven’t had the virus?
Although Nova Scotia hospitals no longer have separate units to care for patients admitted with COVID or those who contract COVID while in hospital, people who test positive are placed in rooms with other patients who also have the virus or with those who have recently recovered.
“Patients with COVID are allowed to leave their rooms only for necessary tests and procedures and are required to wear a mask when outside of their room,” Keough said.
Last week, the province reported five deaths due to COVID-19. While those on the front lines continue to provide good care, the system itself could use some strong medicine.
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It sounds like the Huston government is indeed taking first steps to deal with public health care issues that already had a very long history and were intensified by the pandemic.
One that seems to be all over Canada is that hospitals are routinely run at near 100% capacity in the best of times. In the worst of times (like covid-19) they had nothing in reserve, were not able to deliver the care they would have preferred and achieved what they did only by demoralizing and burning out staff, some of whom are leaving the profession as a result.
Hospitals are very expensive to run.
Running at close to full capacity most of the time may look ‘efficient’ on the books, but it’s clearly not sustainable. Operating at 120% of capacity makes no sense, suggests management failure to anticipate (or decisions to wilfully ignore) further needs and I could only imagine it happening in short bursts. I don’t see an alternative to hiring more doctors, nurses, personal care workers and people who can enable seniors to live at home. It also likely means construction of additional facilities unless we can find better ways to use what we have.
This all means more money as far as I can tell – not good news for a financially challenged province like ours. Huston has taken first steps but this ship cannot be turned around quickly. So long as it is actually turning, that’s something worthwhile I guess. I didn’t vote for Huston but I’m willing to be patient and see what he can do.
Thanks for keeping us up to date on this Jennifer.