The Health System Leadership Team appointed by Premier Tim Houston to replace the CEO and entire Board of Directors of the Nova Scotia Health Authority is looking at every possible option — including the increased use of private clinics — to “blitz” the backlog of 27,000 people waiting for surgeries.
That’s the highest number of people on wait lists in the past five years.
Solutions could include sending patients to privately owned surgical clinics outside the province or using public money to pay for more orthopedic procedures at Scotia Surgery — as the government is now doing to reduce the pediatric wait list at the IWK Childrens Hospital.
“We have to look at every single possibility to attack the waiting list,” Karen Oldfield, CEO of Nova Scotia Health told the legislature’s Public Accounts Committee yesterday. (Oldfield replaced Dr. Brendan Carr, who was fired September 1 with $400,000 severance.) “It would be irresponsible not to look at very possible scenario to serve people who are in need.”
Oldfield said it has been impossible to extend Operating Room (OR) hours as Tim Houston promised during the election campaign because the province doesn’t have enough people (especially nurses) to staff surgical teams. Oldfield told the committee the ORs are “very close” to returning to 100% capacity but the impact of COVID-19 means there are still 460 health care workers across the province unavailable to report to work.
That explanation did not sit well with NDP Dartmouth North MLA Susan Leblanc. “That response concerns me,” said Leblanc. “No one would say we shouldn’t be attacking the wait list… there’s lots of evidence that expanding private health services only lengthen the public wait times by siphoning the (human) resources. The resources are finite. I would say now is the time to bolster our public system and not undermine it with private services.”
Oldfield has asked for “an inventory” of all public and private providers of surgical services but insists that no decisions have yet been made.
“We need people to staff ORs… we are in throes now looking for someone who will serve as vice-president for ‘people, culture, and belonging,’” said Oldfield. “This isn’t just traditional HR (human resources). This is someone focused on training, development of leaders, equity and inclusion, succession planning — every aspect to do with people, including change management because there will be change coming to the system.”
Gang of four
Houston was elected promising to “fix” health care. A fresh start was needed, he said, and his new broom replaced the entire board of the Nova Scotia Health Authority with one administrator— Janet Davidson, a veteran health leader who has worked in several provinces, headed up the Canadian Red Cross. Davidson replaced Janet Knox as interim CEO of the NS Health Authority.
Houston appointed Karen Oldfield, a member of his Progressive Conservative transition team after the election, to replace Dr. Brendan Carr as CEO of Nova Scotia Health (the re-branded Nova Scotia Health Authority). Oldfield is the former president of the Halifax Port Authority; she earns $244,000 and six weeks vacation.
Rounding out Houston’s Health System Leadership Team is deputy Health Minister Jeannine Lagassé and Dr. Kevin Orrell, who heads up the Office of Healthcare Professionals Recruitment.
This group of four has the authority to make most of the daily decisions affecting health care workers, patients, and the system as a whole. Nova Scotia Health and the Department of Health are no longer working in separate silos. “Integrated decision making,” as described by Oldfield has reduced some of the red tape that frustrated staff. As an example, she said she once had to approve the purchase of a desk and chair for a doctor, something she considers well below her pay grade and symptomatic of larger problems.
Vesting authority in fewer senior managers has led to changes that include expanding virtual care to everybody in Nova Scotia without a family doctor or nurse practitioner, opening urgent treatment centres in Parrsboro and North Sydney, and setting up a “command centre” at the Halifax Infirmary to tackle lengthy wait times for ambulances and improve patient flow. According to deputy health minister Jeannine Lagassé, making these type of changes used to take far longer.
“We all come from our individual organizations and accountabilities but we are making decisions as a system,” Lagassé told the politicians. “That’s a big change and that is something I haven’t seen previously.”
While the group of four has sped up decision-making and cut red rape, it has also raised red flags for politicians concerned about the lack of transparency around how decisions get made involving a $1-billion dollar annual budget. It took several years under the McNeil government before the meetings and minutes of the former Nova Scotia Health Authority were opened up to reporters and citizens. That access has disappeared.
“I hear you saying its not just four people meeting privately but the perception is it is just four people meeting privately because we don’t have that transparency that allows the public to understand the decision making process,” noted Dartmouth South MLA Claudia Chender.
Oldfield said she agrees their processes should be “open shop and not closed” and “we will work to get there.” Apparently, under the legislation that created the Nova Scotia Health Authority, an annual general meeting must be held this summer. Administrator Janet Davidson will both organize and chair this meeting, whatever that may look like.
Chender also voiced concern that the wholesale firing of the board of directors of Nova Scotia Health had eliminated the ability of representatives from African-Nova Scotian and Indigenous communities to influence decisions affecting health care as it affects their communities.
“That’s the work of our new equity and engagement division (set up within the Department of Health and Wellness in 2021),” said deputy Health minister Jeannine Lagassé. “To remove systemic barriers for all staff within health care. To engage with communities and hear their voices and hear what they need. So that we can build that into the decision-making.”
“The criticism is that decisions should be being made by people who are affected by those decisions,” countered Chender. “So without a board, frankly, that doesn’t happen. We had school boards that had Mi’kmaw and African Nova Scotian representatives who were in decision-making positions and now we don’t. They had representation and we lost that leadership.”
Where’s the plan, Tim?
Liberal MLA for Fairview-Clayton Park Patricia Arab reminded the witnesses the premier had promised a multi-year plan to fix health care would be ready by March 31. When is it coming? she asked. Both Oldfield and Lagassé said that news was the premier’s to deliver but indicated the plan is “very close” to being presented to the public.
Lagassé was an impressive and inspiring witness who believes current challenges will be overcome:
Our health care system has not kept pace with changing technology, our aging population, and workers’ desire for work-life balance and better facilities. We heard that first hand during the Speak Up For Health Care Tour last September. Their deep frustration was palpable… We can’t nibble at the edges to solve long standing problems. We need to focus our energy on improving population health, providing clear and quick access to services, attracting and retaining our workforce…and always challenging the status quo through research and innovation.
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We are all seeing the “wonderful” benefits of privatizing the power company…exorbitant raises for CEOs and higher power bills for all, including seniors and other folks on fixed incomes. Privatizing the provision of health services is likely to have the same result…exorbitant salaries for CEOs and a restriction of access to essential services by those on fixed incomes and those who may need those services because they are older or in poor health. Folks with supplemental health insurance and/or high salaries already have ways to get surgery and medical care when they need it. But those who are too ill to work , who are receiving disability or retirement benefits will not be able to access these private health systems. Services that are essential to living, water, electricity and health should not be privatized. Privatization is certainly not more “efficient”; it just means that it is more exclusive.
Outsourcing to private health clinics is ok in the short term, but I am concerned we may never get past/over that short term and it will become a permanent non-solution. Do I understand that NS Health will pay for this private care? Or are the patients expected to pay?
Adding private clinics is a vicious circle. Those who can pay support private clinics for faster surgery, and demand tax cuts since they are not using public services. Public funding goes down, forcing even more people in private care, despite the high costs. A few clinic owners make lots of money, while large numbers of people suffer poor health care and/or high health care costs.
The numbers quoted above suggest downplaying the effects of COVID is part of the problem, but there is no getting around the costs of providing health care. The only decision is do we provide good health care to all, with all sharing the costs, or do we provide health care to the lucky and/or wealthy, and ignore the rest.
I watched and listened intently to these two women speak during this Public Accounts meeting. I was very impressed with the two of them. Karen Oldfield could be the first CEO who will do what they promise. In NS we are our own worse critiques. Health Care in NS is showing improvements already. Just my opinion.