Okay, Stop: Ministerial Edition

One thing I feel absolutely no compulsion to print is op-eds by sitting politicians.

My job is not to help elected officials get their carefully crafted messages to the electorate. My job is to hold elected officials accountable.

So when I received a healthcare op-ed “written” by Energy and Mines Minister (and MLA for Sydney-Whitney Pier) Derek Mombourquette, my first instinct was to consign it to the round file.

But then I remembered my patented method for disrupting the transmission of messages and I decided instead to play a round of “Okay, stop” with Mombourquette’s op-ed.

Enjoy it. I doubt I will ever be on the receiving end of one again:

 

Mombourquette:

There are many elements in my role as MLA for Sydney-Whitney Pier that have brought me significant pride. Being elected – and re-elected – to represent my community is an encouraging and often eye-opening experience.

Okay, stop.

Shorter version: “I only won my seat by 160 votes in 2017!”

 

Mombourquette:

Whether it is through my constituency work, or in my capacity as a cabinet minister, I’ve been involved in many important initiatives in Cape Breton,

Okay, stop.

This would be the place to checklist those “many important initiatives.”

No?

Okay, I’ll help: the one that comes to my mind immediately is the CBRM Charter — an initiative you championed for about 10 minutes in 2018. You got people excited — there were consultations and presentations during which interesting, progressive ideas were discussed (including the idea of striking a charter commission that would involve people other than councilors), then the CBRM Council struck an Charter Ad Hoc Committee made up of five councilors, it met twice (the last time seven months ago), and then…crickets. And in the meantime, you left Municipal Affairs for Energy and Mines.

In fact, as Minister of Municipal Affairs, your record of accomplishments for Cape Breton seems limited to amending the Municipal Government Act (MGA) to allow the CBRM to sell port lands (or lease them for 99 years) in support of a container terminal project led by a man who is now literally — I cannot say this often enough — climbing trees in Florida.

 

Mombourquette:

…but none as transformative and groundbreaking as the redevelopment of Cape Breton Regional Hospital.

This isn’t a temporary bandaid solution. It’s one of the most significant investments Cape Breton has ever seen, and one that will redefine healthcare delivery in our community for decades to come.

Okay, stop.

I think expanding the cancer clinic and the emergency department at the Cape Breton Regional Hospital has the potential to make life better for staff and patients, but I don’t think making an existing facility larger counts as “transformative” (although I give you points for knowing better than to call it “innovative.”)

I also don’t think it will “redefine healthcare delivery” in our community for decades to come. I think it will simply double-down on the hospital-centric way we North Americans already deliver healthcare.

“Redefining” the way we deliver it could well mean acknowledging factors like poverty and poor housing as healthcare issues, focusing more on prevention than treatment and adopting treatments and therapies that don’t even exist today. There’s really no way of knowing ahead of time what will constitute a “transformative” change in a system.

Still, props for expanding an overcrowded facility.

 

Mombourquette:

I was proud to recently take a seat at the standing committee on health to hear expert testimony on the redevelopment project. As a Minister, I don’t have a permanent seat on government committees, so I’m grateful to my Liberal colleagues who graciously stepped aside to allow Geoff MacLellan and I to sit in on the proceedings that morning, as representatives of our communities.

Okay, stop.

I can’t believe you went there.

How nice for you that your Liberal colleagues allowed you to attend the committee meeting during discussion of one of the few healthcare-related matters your party has permitted the healthcare committee to discuss.

Too bad they weren’t equally gracious to the opposition Tory MLAs on the committee, who wanted to discuss doctors’ working conditions, or the NDP MLAs, who wanted to discuss emergency room overcrowding.

And while we’re on the subject of limiting discussion, where was that sense of gallantry when your party decided to cut meetings of the public accounts committee to once a month, limiting the time opposition parties have to question government policies and projects?  CBU Political Science professor Tom Urbaniak argued that move was an overreach of your government’s authority:

One of the ancient rights of parliament is to fully scrutinize the executive and a key tool in that scrutiny is the public accounts committee,” he said. “It is a generally acknowledged principle that the public accounts committee can range widely in its topics in its agendas and should be able to meet very frequently as well. Recent developments have compromised that principle to the point that I think there should be an intervention by the speaker of the house.”

So again, nice that your fellow Libs let you and Geoff sit in but how about asking them to spread the love?

 

Mombourquette:

Let’s be clear. There is no doubt there are challenges with healthcare delivery in Cape Breton. We are seeing and feeling those challenges firsthand, every day.

Part of the problem is our aging healthcare facilities, and I’m excited that the Cape Breton Regional Hospital is being expanded and transformed into a state-of-the-art hospital that will play a pivotal role in doctor recruitment to Cape Breton. Doctors want to work in modern facilities with advanced technology. Our government is making that possible, right here at home, while expanding vital healthcare services to all Nova Scotians.

Okay, stop.

I saw a commentator on Facebook refer to this as the “Field of Dreams” approach to doctor recruitment — “If you build it, they will come.”

I can believe facilities are a factor in physician recruitment but a “pivotal” factor? I’m not so sure. And you’re not offering any evidence to convince me.

Mombourquette:

The Regional’s emergency department will double in size, with 12 additional exam rooms to be added. Patients will immediately notice the difference with this improved layout and expanded space that will allow ease of transfer between departments. New x-ray and ultrasound services will be added, and a larger ambulance bay will mean quicker ambulance off-load times.

Okay, stop.

I think everything in that paragraph seems grounded in fact, although I’m not sure ambulance off-load times are a big problem at the Regional — from what I’ve read, the problem is that paramedics are stuck waiting with patients who can’t be admitted because the emergency department beds are occupied by people who need hospital beds but can’t get them because they’re occupied by patients waiting for long-term care beds.

Increasing the number of emergency department beds could help — provided sufficient additional staff is hired (that’s not my opinion — Chris Milburn, emergency doctor and emergency services chief for the Nova Scotia Health Authority’s eastern zone said the expansion of the EDs would require additional physicians and nurses).

Although John Malcom, the former CEO of Cape Breton District Health Authority, isn’t convinced:

Building bigger ERs won’t solve staffing issues facing CBRM hospitals.NSHA needs to update recruitment status & outline steps being taken to address patient flow ,rather than using ERs as an inpatient unit.Big thanks to staff working in these conditions https://t.co/CZVXgmCSD7

— john malcom (@johnmalcom18) April 17, 2019

Solving the problem will also mean adding long-term care beds at the other end of this chain, which your government has said it will do. The Liberals’ healthcare plan for Cape Breton includes 120 long-term care beds in new facilities in New Waterford and North Sydney for a net gain of 74 beds.

This raises two issues: first, according to Dr. Margaret Fraser, president of the Cape Breton Medical Staff Association, the additional beds won’t be enough to solve the problem. She told the Post in March:

It will accommodate the people that are in the dedicated nursing home floors, but it will not accommodate the people who are in other parts of the hospital waiting because there are more people than the beds that they have dedicated, unfortunately.

Fraser said her understanding was that while the beds are needed today, they will not be needed in 10-20 years, due to “the coming demographic shift.” But she had an interesting idea:

She suggested the current and future needs of the province could be addressed by designing nursing home buildings in such a way that they could easily be converted to another use, such as for low-income housing, once the demand for long-term care beds decreases.

Still, even if the government were promising to provide adequate numbers of beds, there remains the issue of staffing in long-term care homes. In fact, the very first recommendation of the Minister’s Expert Advisory Panel on Long Term Care, which issued its report in December 2018, was “Invest in human resource capacity and enhance staff mix.” The report states:

We heard over and over from residents and their families that staff do not have the time to provide appropriate care because they are “working short.” Shortages increase staff responsibilities, with more residents to provide care for, resulting in overstressed staff, high rates of injury and sickness, and many unfilled vacancies across the sector. It was most profound to hear from staff and many of the sector representatives about the guilt and shame they feel not being able to provide adequate care. These challenges highlight the urgency to invest in human resources to alleviate the unsustainable workload and untenable physical and mental fatigue of staff.

Mombourquette:

Our cancer centre is renowned for its effective and compassionate care. The redevelopment will see a new cancer centre constructed that will nearly triple in size, with an additional eight exam rooms added, and a doubling of the chemotherapy seats. As Dr. Kevin Orrell, senior medical director for the redevelopment project, mentioned at the health committee meeting, the services at the cancer centre can and need to be improved. It goes without saying that our loved ones battling cancer deserve nothing but the best treatment available, in a facility that offers compassionate, family-focused resources and comfort. Our new cancer centre will allow more supports like education, nutrition, psychology, and social work to be offered, holistic therapy, a sunshine and volunteer room, and audio-visual equipment so patients can virtually include their families in their treatment process.

The critical care department at the Regional will be expanded as well. We currently have the second-largest intensive care unit (ICU) in the province, but the new facility will house the ICU, coronary care unit, and intermediate care unit in one department, and will be three times the size of the existing critical care units combined. This will serve our community well by creating larger rooms that provide more privacy for patients and families.

Okay, stop.

I know (as most of us do) how good the work of the cancer centre is. It’s the one aspect of the Cape Breton healthcare system that you really don’t hear people criticize. But a friend put it to me this way: if you’re very sick in Cape Breton, you get excellent care. It’s when you’re not very sick — just sick enough to need to see a doctor — that you can run into difficulties.

And the problem, of course, is that people who are sick enough to see a doctor (or a nurse practitioner or a nurse) but don’t have easy access to one either have to wait hours in emergency departments or go without, which is how not-very-serious complaints can become serious.

 

Mombourquette:

In the short-term, we’ve increased healthcare spending in our recent budget with more than $270 million earmarked to ensure Nova Scotians get the healthcare they need.

Okay, stop.

The CBC reported the increased healthcare spending totaled $200 million:

Overall, the Health Department budget is growing from $4.4 billion to $4.6 billion.

It also reported that much of the new spending “relates to previously announced programs.”

 

Mombourquette:

In the last year, we’ve recruited eight new family doctors and seven specialists to Cape Breton, as well as 25 new collaborative care positions, including nine nurse practitioners, 10 family practice nurses, one licensed practical nurse and five social workers. These efforts have played a fundamental part in matching 14,252 Cape Bretoners with a primary care provider since 2016. We’re also the only province to add more residency spaces to train doctors, introduce a new Nurse Practitioner Education Incentive, and offer an emergency shift premium to hard-to-fill ER shifts.

Okay, stop.

To put these numbers in context requires other numbers.

Take the statement that 14,252 Cape Bretoners have been matched with a primary care provider since 2016. I’m guessing the source of that figure is the Nova Scotia Health Authority’s (NSHA) Need a Family Practice (NAFP) registry, launched in November 2016.

The most recent numbers available for the registry show that 13,843 Cape Bretoners had found a primary care provider as of 1 March 2019. (The total for the Eastern Zone of the NSHA is 14,356, but that includes Antigonish and Guysborough.)

The total number of Cape Bretoners still looking for a primary care provider, as of 1 March 2019, was 3,863. Breaking down those numbers further, the doctor shortage is most acute in New Waterford, where 6.3% of the population is without a primary care provider and least acute in Cheticamp, where 0.1% of the population is without one.

To evaluate the importance of the new hires, I’d have to know how many family physicians, specialists, nurses and nurse practitioners had left Cape Breton since 2016 and those numbers are not provided. (As I write, the Doctors Nova Scotia website is showing 47 openings for medical personnel in the Eastern Zone).

And speaking of the NSHA, it’s not mentioned anywhere in Mombourquette’s op-ed.

Could it be because the centralization of healthcare in this province has not exactly met with rave reviews? When asked recently to comment on Ontario Premier Doug Ford’s “plan” to restructure Ontario’s health system, Dalhousie Poli Sci professor Katherine Fierlbeck (author of Nova Scotia: A Health System Profile) told the CBC:

“I really get the feeling that nobody in Ontario is tracking Nova Scotia’s experience at all.”

Her advice to Ontario’s policy makers?

Take a closer look at Nova Scotia’s dismal outcomes.

“Take an afternoon, go through the newspapers, understand why the doctors are pissed off, understand why the nurses are unhappy, understand why patients are crying about the poor service that they’re getting,” she said…

“My perspective is that health-care restructuring is generally done because it reconfigures political power relations, not because it provides better health care.”

I really don’t have anything to add to that.

 

Mombourquette:

At yesterday’s committee meeting, Dr. Orrell mentioned he felt the CBRM healthcare redevelopment project was about leaving a legacy. I could not agree more. The renewal of the Cape Breton Regional Hospital is being led by Cape Bretoners for Cape Bretoners, to ensure we receive the utmost in quality of healthcare services.
We shouldn’t accept anything less. And we won’t have to.

Okay, stop.

Legacies are funny things. You don’t necessarily get to decide what yours will be. It could be an expanded Regional hospital — or it could be the “dismal outcomes” of your attempt at centralization.

Only time will tell.