Houston government announces emergency care changes; opposition asks about recruitment

Health Minister Michelle Thompson and Nova Scotia Health president Karen Oldfield say there wasn’t anyone in the room on Tuesday during the health care summit who failed to get Premier Tim Houston’s message about health care in Nova Scotia.  

“The premier said we need fast action, and it must be bold,” said Thompson, noting that some actions announced earlier Wednesday would be effective immediately and others would take weeks and months. 

Two recent deaths of patients who visited emergency departments at Cumberland Regional Health Care Centre in Amherst and the Cape Breton Regional Hospital in Sydney have underlined the urgency. 

“Our actions today focus on two areas,” Thompson said. “The first, improving emergency room care and safety. The second is diverting lower-acuity patients away from the emergency room to the right provider at the right time.” 

Improving emergency department care 

Here’s a list of the improvements for emergency departments announced Wednesday: 

• Regional hospitals will get money to pay a designated doctor to supervise the triage of patients arriving by ambulance to reduce wait times. 
• Starting this Saturday, every regional hospital will have a patient advocate to provide blankets, drinks, and comfort to patients in the waiting room. Additional care providers, as they can be recruited, will help with reassessing patients. 
• Regional hospitals will hire physician assistants and nurse practitioners with the power to admit and discharge patients from emergency departments, reducing the pressure on doctors. 
• Patients with fewer urgent needs will be offered a visit with an online emergency doctor. 1,300 patients at three hospitals have used virtual care while at emergency; two more hospitals will use this virtual system by March. 
• A new app being used in Halifax that provides real-time data on where beds are and what tests are needed to get patients home faster will expand to other areas. 

No announcement of a recruitment plan

Liberal leader Zach Churchill was supportive of the changes to improve emergency care but told reporters they lack one key element. 

“We can be hopeful that this is going to improve outcomes and ease people’s anxiety and support our health care workers, but we do not know where these new workers are coming from,” Churchill said. “The government did not announce a recruitment plan and we have very high vacancies, up to 80% in some hospitals.” 

Cumberland North MLA Elizabeth Smith-McCrossin said she was disappointed by what she heard Wednesday. Smith-McCrossin said the Houston government has yet to respond to many of the suggestions put forward by the family of Allison Holthoff, who died after a several-hour wait at the emergency department in Amherst.

The MLA claims the government has only promised to provide the family with recommendations and not the full report, which will result from a quality review into the circumstances around Holthoff’s death.      

Smith-McCrossin said the bureaucracy moves too slowly when it comes to hiring nurses. She cited the example of a nurse who applied through Nova Scotia Health to work at the emergency department in Amherst where there are several vacant positions.  

According to Smith-McCrossin, the nurse received an offer from a private agency the government uses to provide “travel nurses” at Amherst before the applicant heard back from Nova Scotia Health, which does the hiring for all regional hospitals.  

Giving patients access to care to divert them from emergency

Thompson and Oldfield announced other measures so people without family doctors and with non-urgent medical problems can get help. Those measures include: 

• Expanded funding for 37 collaborative care family practices and 14 new ones so more people can be seen and treated
• Expanding to more communities the services provided by pharmacists such as prescription refills and dealing with tick bites, urinary tract infections, and contraception
• Providing more mobile primary care, mobile respiratory care clinics, and urgent treatment centres
• Making more appointments available through Virtual Care Nova Scotia  

NDP leader Claudia Chender praised the initiatives to improve access to primary care. But she noted more rural emergency departments are closing for longer periods of time because of staffing issues, and no action was taken to offer bonuses to retain workers.

She also questioned whether the province can deliver on its promise to provide more online appointments with family doctors. 

“There is a privatization creep happening,” Chender said. “When they say they are going to expand virtual care, we know that most people trying to access virtual care right now can’t. And we know there is an option where they can pay. We’re not sure that Maple is operating within the bounds of the Canada Health Act. We know there is a push for privatization in Ontario. We don’t want to see that here. 

“I heard a story yesterday about an elderly man trying to access a walk-in clinic. They said, ‘We will text you on your cellphone. You can’t wait here.’ And he said, ‘I don’t have a vehicle and I don’t have a cellphone.’ He was refused care. I think we have a big issue when we look at digital solutions to what are sometimes analog problems.” 

In a media release, Hugh Gillis, the first vice-president of the NSGEU (which represents 15,000 members who work in the the acute health care sector) agreed retention of health care staff needs to be addressed.

“Today’s announcement does not address that concern,” Gillis said. “The employer must provide incentives that will allow them to effectively keep experienced health care professionals in areas of high turnover and specialized need, such as the emergency department.”

Earlier this month, the NSGEU provided the government and employer with a letter and comprehensive list of 59 suggestions from its members working at the Halifax Infirmary emergency department. Two of those suggestions, including adding care providers in the waiting room, were adopted.

Addressing ambulance wait times 

Here are some of the announced changes for paramedics and ambulance services:

• Two additional paramedic training courses will be added at Yarmouth and Pictou community colleges this spring and fall to respond to hundreds of vacancies
• A tuition rebate of $11,500 will flow to paramedics who agree to work in the province for three years
• Emergency Health Services is planning to lease or purchase a fixed-wing aircraft to handle routine transfers for tests and treatment between Sydney and Halifax and Yarmouth and Halifax, allowing ground ambulances to stay in communities more often
• More funding for volunteer fire departments to train medical first responders who sometimes arrive at an emergency scene before paramedics

A senior manager with the government’s emergency health services department said adding another aircraft capable of transporting two hospitalized patients from either end of the province to Halifax could keep an additional four paramedics on the ground, available to respond to emergency calls around the province, every day.  

EHS currently has one Life Flight helicopter deployed when there is a health emergency. It also has one fixed-wing aircraft. EHS manager Jeff Fraser estimated the annual cost for this second plane at $4.5 million a year. Fraser suggested the province could be ready to launch the service as soon as mid-April.  

“For us, the health system is changing at break-neck speed,” Oldfield told reporters. “We have the right ingredients to succeed. We have the funding, the experience, and the political will to make it happen.”