Sixteen months ago the Houston government was elected on a promise to reduce surgical wait times to meet national standards within 18 months of taking office.
But the health care leaders appointed to solve the problem now say it will take three years — until the end of 2025 — to deal with a stubborn backlog of patients.
Today there are 22,600 Nova Scotians waiting for surgeries. Most wait up to two years for hip and knee replacements and some types of heart and gynaecological procedures, according to the province’s wait time site.
The number of people waiting for surgery is only 2,000 fewer than it was almost three years ago, in February 2020, before the arrival of COVID, which provincial Health officials blame for continued pressure on hospital beds and hospital staffing.
Yesterday, both Nova Scotia Health CEO Karen Oldfield and Deputy Health Minister Jeannine Lagassé acknowledged during a meeting of the legislature’s Health Committee that these surgical wait times are “not acceptable” and “Nova Scotians deserve better.”
“We are making changes and we do have a plan to make sure the health system is ready when you need it and responsive to your needs,” Lagassé told the committee.
“Cross my heart, we will move these surgical wait lists as quickly as we possibly can and that is a promise,” added Oldfield dramatically, after first inquiring if there was a bible on which she could place her hand.
No bible was available. Oldfield will instead have to cross her fingers to deliver on that promise, given that wait times in Nova Scotia have been well above the national average in orthopaedics for many years.
We know about 250 hospital beds are often filled by people waiting for places in long-term care. We know Nova Scotia has vacancies for more than 1,500 nurses and signing bonuses haven’t worked.
Clayton Park West Liberal MLA Rafah DiCostanza described her recent conversation with a Halifax orthopaedic surgeon this way:
We are running operating rooms on the edge every day. First, we have to check if there are rooms, if we have enough nurses, whether we have the equipment — every morning. If the patient has come from ICU, sometimes by the time they make it to the OR, their condition has changed and they may not be able to have the operation.
NDP leader Claudia Chender asked why people waiting for knee and hip replacements have seen waits worsen by three months between the first quarter and the second quarter of 2022.
These surgeries are scheduled or “elective,” replied Cindy Connolly, the director of Clinical Networks at Nova Scotia Health. “Bed pressures and emergency department overflows lead to orthopaedic procedures being postponed.”
This confirms what Central Zone orthopaedics chief Dr. David Oxner told the Examiner back in April.
That lack of beds — which seems likely to persist until a new hospital can be built to replace the aging Victoria General — has fostered innovation and led to 800 people receiving new hips and knees through day surgery this year. But even a growing increase in outpatient volumes barely makes a dent in the wait list.
Brendan Maguire, health critic for the Liberal caucus, was quick to call out the Houston government for breaking an election promise to bring down wait times within 18 months.
“The Houston government has a pattern of not following through on commitments they made to Nova Scotians, and their promise to fix health care is a prime example,” Maguire said in a news release.
The broad strokes of the multi-year plan laid out by Lagassé and Oldfield involves “increasing capacity and improving efficiency while reducing demand.” Beyond those vague terms we learned the following specifics at yesterday’s meeting:
• Nova Scotia Health is committed to adding 250 full-time positions over the next three years to stabilize the surgical workforce (these could be physician assistants or other healthcare professionals).
• Dr. Philip Cyr, president of the privately-owned Scotia Surgery clinic in Dartmouth, is ready and willing to add a third operating suite to help reduce the surgical wait list, should the government make that request. Since the 1990s MSI has been paying Scotia to do less complicated types of orthopaedic surgery for adults and it has recently taken on doing orthopaedics and dental surgery for children.
• a single entry point for patient referrals to specialists (surgeons) will be implemented at the end of March 2023. The online platform called eReferral will be used by both family doctors and surgeons to schedule appointments for patients and keep track of diagnostic tests such as Xrays and blood work.
Imagine waiting months or years to see a surgeon for a heart condition or a painful hip and never knowing “who you might get in with” or if you are at the front or back of the line.
That’s been the status quo in Nova Scotia for years because each surgeon controls and manages their own wait list.
The Nova Scotia health system deals annually with one million referrals, mostly on paper, to specialists.
Cindy Connolly, who is Nova Scotia Health’s co-lead on the surgical access initiative, told the committee it’s not unusual for a patient to be on two or three wait lists simultaneously. And that patients can “ping pong” between specialists, each of whom may order bloodwork and x-rays, creating duplication and increasing wait time.
eReferral is an online program family doctors, nurse practitioners, and surgeons will be trained to use in the next three months.
It will allow family doctors to see and quickly access information about which surgeons have time available to see their patients. And patients will have more choice about where and when they want their procedure to take place. Connolly said they should no longer feel as if they are “lost in space.”
“A single-entry registry is not new but it is s new for Nova Scotia,” Connolly told the politicians. “In other provinces which have a single -entry model for referral, this has been shown to reduce wait times for patients.”
It’s depressing to learn that a single-entry registry was recommended in a provincial auditor-general’s report nearly 10 years ago.
It still won’t be a magic bullet to bring down wait times. Long-term solutions such as changing behaviours to reduce obesity and substance abuse will be needed to reduce the demand for operations, according to the president of Doctors Nova Scotia, Dr. Leisha Hawker. She also told the Committee:
In the short term, we need to recruit and retain more physicians and nurses and look at innovative ways to manage the backlog. The single entry pilot that is starting in the spring, I’m really hopeful that will have bring some significant efficiencies and I look forward as a family doctor to have that streamlined access for surgical services for my patients.
The committee was told the online registry needs to be user-friendly and make life easier, not harder, for health care professionals who are at the breaking point.
Oldfield acknowledged that the underlying IT infrastructure for health care needs an upgrade, even while more programs keep being added, risking the potential for a crash.
“With paper and faxing, we are really behind the times,” said Oldfield. “Our technology in the health care system is not where it needs to be, so there is a huge impetus to raise the bar there.”