Nova Scotia Citizens Health Care Network Meeting
With the Minister of Health
Hon. Angus MacIsaac
Thursday, December 5, 2003
Good morning Hon. Minister. My name is Debbie Kelly, Chairperson of the Nova Scotia Citizens Health Care Network. We are pleased to have the opportunity to meet with you face to face and discuss some crucial issues still facing us as Nova Scotians. Our brief submission is inclusive of the Network members who worked on this brief, and comments will be limited to summaries of each presentation.
We direct you to view the many years of dedication and hard work our Network has dedicated to building a true coalition of members and organizations across this province and to the many achievements and struggles we faced and continue to face by standing up to save and improve medicare in our province and in our country.
The members of the Nova Scotia Citizens' Health Care Network are concerned as consumers of health care and as health care providers over the status of health care in this province. We are here today to meet and discuss a few of our issues:
ü Privatization, Romanow Report, National Health Council and staffing concerns by Ian Johnson, Vice Chairperson
ü Pharmacare/Catastrophic Drugs and Long Term Care by John Ryan, Seniors Representative
ü Home Care by Peggy Brown, DIAL
ü Lack of Beds and wait lists by Debbie Kelly, Chairperson
There are many equally important issues, but these concerns are the priority at this time. These issues are also connected to one another in some form or another. Our concerns require governments immediate action to stop further deteriorization of our front line acute health care and to drastically reduce wait times for beds, operations, diagnostic testing and to help Nova Scotians to get affordable drugs. While the Romanow Report of November 2002 is a panacea, a breakthrough, it is facing major problems with implementation and accessibility. Governments are too slow to accept and implement the Recommendations. The very Recommendations the majority of Canadians demanded.
We emphasize again, the Department of Health should be working with the community organizations and health care unions to plan, organize and strategize to administer the "best" health care in Canada. At the same time, supporting the five (5) Principles of the Canada Health Act, and ensure "dignity" for the people of this province while living and in dying.
There are a number of ways to achieve reductions of wait lists and affordability of long-term care. We believe that the government must take its responsibility seriously and halt private MRI clinics. We are adamant that the solution to the wait lists is in the increase in beds. We have heard from various emergency room nurses that the lack of beds is the number concern. One nurse said she was so frustrated because she knew of many empty beds and rooms upstairs but were not allowed to use them.
Recently, government announced 80 million dollars from federal funding would be given to Nova Scotia. Media reported that the government and our Network agreed on two areas to address: reducing wait times and catastrophic drugs. Both of these are vital to reducing patient suffering. However, the CHA CEO said the budget cuts will further increase wait times which are already unacceptable.
We strongly recommend no further cuts to DHAs and put the 80 million dollars where it is needed most TO REDUCE WAIT LISTS AND CATASTROPHIC DRUGS. Nova Scotians are losing patience and confidence that government will address these two particular serious concerns. They must be reassured that budget cuts will not be forthcoming in health care, especially frontline, acute care which includes waiting lists and drugs. The problems can also be address by increasing beds across the province, which are desperately needed.
Since approximately 1993, we have lost about 2000 beds, 1600 under the Liberal government and 337 under the Conservatives. The number of nurses we lost was shameful and we will be lucky to ever replace them. We have and are also losing Technologist and Technicians. In about 8 years, there will be very few blood Technologist left and since Nova Scotia no longer trains them, where will we find them? Recruitment is crucial now!
Front line health care is the number one priority. It is truly sad to see hospital rooms and floors turn into administration offices. The priority is beds, then reduce wait lists to be no more than one month either for diagnostic testing or surgeries.
If we can get the number of beds increased back to the 1992/93 level, there would be no waits for people in emergency that require hospitalization, nor would day surgeries be held up or other emergencies be declined.
The government promised to hire/sponsor 400 new nursing positions, yet the media recently reported the layoff notices of 28 nurses. To lose one of these experienced nurses is unacceptable. Bottom line is if you dont have enough RNs, you simply cant provide adequate health care. It is the patient who suffers most from shortages. There are studies that confirm that patients do worse with fewer nurses.
The goal must be to increase accessibility to health care by increasing beds, reduce wait times, ensuring accessible health care treatments to rural areas, increasing home care to patients and treat long term care residence equal with the rest of Nova Scotians room and board only.
It is important for government and territorial leaders to implement the Romanow Recommendations without further delay and to set up the National Health Council as an arms-length committee.
We need a significant improvement in Home Care and to see Long Term Care Residence pay for room and board, not health care and to see rural areas have decent access to acute care.
Under the Canada Health Act, we are ensured access to health care regardless of the ability to pay, but patients are required to pay for parking to get medically necessary treatments. Not only is this a hardship on many patients, but it is in violation of the Act. Patients should not have to pay parking charges to get treatment, yet this continues today. Ironically, we pay for ambulance service, it may be a good service but only if you can afford to pay for it. But last week while at the Dixon Centre for treatment myself, I noticed an ambulance leaving the parking area and he took out a special key on a stick, put it in a special box and he drove out. Why are we allowing a for-profit company to get free parking yet patients have to pay? I have polled many patients, hospital staff, doctors and nurses and most agree that patients shouldnt have to pay parking charges. There must be another way. I suggested that the patient be given a slip upon leaving their treatment centre to give to the parking attendant so the charges would be void.
Publicly delivered and publicly funded health health with a significant increase in beds, as well as the logistics that go with the beds will answer many concerns and eliminate or reduce some of the other concerns through a natural process.
I realize that much of what you are hearing and what you will hear may appear as pipe dreams on our part, but I can assure you Mr. Minister, these are the needs of Nova Scotians and the bottom line is the loss of lives. We cannot continue to tolerate the uncaring for the many who need health care. We are tired of bandaid solutions, we need real solutions now.
Thank you, now we will go to our next presenter.
Peggy Brown, Disabled Individuals Alliance
Nova Scotia Citizens Health Care Network Meeting
With the Minister of Health
Thursday, December 5, 2003
Good morning, my name is Peggy Brown. I would like to repeat my concerns from my last meeting with the then Health Minister, Jamie Muir, regarding the provincial home care program based on my own experience and that of other persons with disabilities.
When the program was first announced, it appeared to be a good one. However, my experience has shown it to be otherwise. In fact, further reductions in home care are happening with little or no concern how it is affecting the patient and their families.
In my first encounter with it, there were not any homemakers in place.
I did finally get the services of a homemaker but fifteen months later, the number of hours I received was cut in half, from 16 to 8 hours. I also started to hear stories from people being cut off from home care services altogether for no apparent reason.
In addition, persons with disabilities have clearly told me that they are not getting all the services they need. This includes light housekeeping such as cleaning, laundry and changing of sheets.
We are now hearing that there are even longer waiting lists for people wanting to get services. I am receiving reports every day from the disabled how their home care has been completely cut.
There are four recommendations I still recommend to make home care improvements:
· The program needs to be improved, not cut back or de-proved.
· More services by homemakers and home support workers are needed, not less.
· More money should be put into home care to provide the services we need in order to allow everyone receiving these services to live comfortably.
· The recent logs of services being provided that have been required by Home Care Coordinators seem to be more paper work and a waste of money.
· Home care must be improved to help keep people out of nursing homes.
No more downloading of costs of this Program on Seniors.
Examine Recommendations of the Romanow Report regarding Prescription Drugs
and commence implementing them.
Reference is continually being made to obtaining cost savings on the price of
prescription drugs. What is the status?
The establishment of the N.S. Medication Awareness Committee is a step in the right direction. The next step is to allocate funds for education programs for seniors. 0.5% of the Pharmacare Budget should be considered.
Mandate Medication Reviews by physicians/pharmacists at least annually.
Promote vigorously a Trial Prescription Drug Program.
Examine the costs of Administration of the Program.
Evaluate the N.S. Prescription Drug Formulary System. Consider adding a lay person to the Formulary Management Committee.
As of July 1st. 2003 there were 130.000+ (statscan) seniors in Nova Scotia. The views of grassroots seniors need to be heard concerning the Pharmacare Program. Members of Group of IX should be afforded the opportunity to present drafts of their recommendations to the members of the organizations they represent prior to appproval by the Minister of health and Seniors should have the opportunity to see and comment on any planned changes.
It is 10 years since the last review of the Program, it is time to conduct another.
1. There is evidence that not all of the Recommendations of the PRWG (93/94) have been fully implemented the Department should consider conducting a new Review of the Seniors Pharmacare Program. 2003 marks the tenth year since the last review was conducted and much has changed during that period. The review should also take into account the Recommendations of the Romanow report relating to Pharmacare.
2. There is ample evidence that one of the contributing factors to the increasing costs of the Pharmacare Program is the increasing costs of drugs. There is also evidence that changes in the Patent Act of 1992 contributed to these rising costs by delaying the entry of lower priced generic alternatives to the market. The Patent Medicine Prices Review Board in its 2000 Annual Report stated, Sales of patented drugs have increased steadily from 43.9% in 1995 to 63.% in 2000". It is recommended that the recommendations concerning Pharmacare in the report of the Romanow Commission be examined carefully to determine how they can be addressed.
3. There is evidence that the Nova Scotia Prescription Drug Formulary is being used primarily as a Drug Benefit List. The PRWG clearly indicated the Formulary was to be much more than that, It stated To assist the physician in providing cost effective pharmacotherapy it is proposed that the Formulary be divided into three sections or lists based on compparative clinical value and cost. The physician will normally initiate treatment wiith a medication from the first section (Green Lisst-first line therapy) of mmedicines wiith proven efficiency, acceptable side effects and lowest cost for the consumer or third party. Recently studies have been released that indicate that some of the older, less expensive drugs may be the best choice. It is recommended that the Department of Health initiate a survey to determine whether the use of the Formulary is consistent with the Recommendation of the PRWG. If the survey indicates it is not, the use of the Formulary should be made mandatory. The original intent of the PRWG was that its use be voluntary initially but that mandatory use was an option.
4. The Commission on the Future of Health Care in Canada, in its publication on
Pharmacare, reports that the cost of administering drug benefit programs in Atlantic
Canada is 13% compared to 2% in Ontario. It is recommended that this claim be investigated and Nova Scotians be provided with a breakdown of the these
administrative costs. Nova Scotia is the only province where administration services
are provided by a private agency according to Maritime Medical Care Inc. which administered the Program for more than 25 years. It is also recommended that consideration be given to establishing criteria for the administration of the Pharmacare Program and a call for tenders be initiated to obtain the best possible deal. Funds for Pharmacare should be allocated to providing benefits to seniors not to cover excessive charges for administration. A year ago the Deputy Minister of Health indicated that the Department would consider calling for tenders to administer the program. If the 13% figure is correct we are paying $6.5 million for every $50 million paid for benefits by the DOH.
5. The Federation of Senior Citizens and Pensioners recommends, doctors should be urged to prescribe generic and/or drugs currently in use except for a trial period to determine that the newer drug is actually more beneficial for the user There is abundant evidence that there is considerable wastage of drugs in Nova Scotia in general and that some of these drugs are paid for by Pharmacare. There is also evidence that Trial Prescription Programs have been effective in other provinces in reducing the problem of wastage of drugs. It is recommended that the Department of Health investigate the possibility of enhancing the Trial Prescription Drug Program in Nova Scotia. The development of a pilot project to determine its effectiveness should be considered.
6. There is evidence that despite the best efforts of the members of the Group of IX that the Minister of Health has not responded favourably to some of their recommendations and has not provided reasonable explanations for not doing so. This past year a number of the representatives of the Group of IX expressed their concerns, some in the media, in addition the organizations represented by the Group of IX also expressed opposition to changes in the Pharmacare Program.
It is recommended that the role of the Group of IX be examined with the objective of allowing the Group of IX the opportunity to consult with members of the organizations they represent prior to reaching any endorsement of further changes to the Seniors Pharmacare Program. It is further recommended that the Group of IX have the opportunity to consult with physicians and pharmacists to obtain their position re proposed changes to the program. There should also be at least 3 seniors on this Committee whose only insurer for drug benefits is Pharmacare. These 3 seniors should be chosen from applications from the public at large. Some members of the Group of IX have private insurance and Pharmacare is their payer of last resort. Powers and responsibilities and administrative arrangements for the Committee should be assigned by the Minister of Health similar to the way the Pharmacare Board of Directors operated until it was dissolved in 2000.
7. The PRWG recommended a number of strategies to address the cost of drugs, among them were the following:
(a) negotiate with pharmaceutical manufacturers a rebate on medications similar to the Medicaid rebate Program in the U.S.
(b) Extend prices available to hospitals in N.S. to Long Term Care Facilities such as Homes for Special Care, Nursing Homes, etc.
(c) Adopt the Patent Medicines Prices Review Boards Guidelines for price increases on existing medications whether patented or non patented.
(d) Consider alternative reimbursement models for all pharmacists services. There appears to be little to no progress with this recommendation and this has hindered the implementation of programs such as DUR, Disease Management and Medication Reviews which contribute to improved patient care and can result in significant savings in other areas of health care. Presently responsibility for any charges for these services is that of the patient. As a matter of interest Pharmacists maximum professional fees have only increased from $8.30 to $9.35 since 1992, an increase of only 12% over 10 years.
(e) Evaluate models for the delivery of pharmaceuticals and pharmacy services to Long Term Care Facilities.
(f) Negotiate prices with manufacturers of generic medications to achieve a defined percentage less than single source medications.
It is understood that there is movement toward a bulk purchasing system to lower cost of drugs but this is proceeding very slowly and implementing some of the above would serve as a good interim measure.
It is recommended that Pharmacare Management provide a report on the progress with these recommendations along with an explanation as to their status and reasons for the failure to implement those on which no action has been taken.
8. Some hospitals in Nova Scotia and New Brunswick have initiated Seamless
Care projects to improve communication among health professionals and between hospitals and the community to reduce and/or eliminate Drug Related Problems. Some successes have been reported and it is hoped these programs can be expanded throughout the provinces. Funding has been a problem for those providing this service and this deficiency must be addressed. A local researcher reports that Drug Related Problems cost the Canadian Health Care System $10,995,363,216.86. A breakdown of these costs is available. It is recommended that the DOH investigate the incidence of Drug related Problems in Nova Scotia and further that the DOH provide financial assistance for proposals aimed at correcting these problems.
9.The Federation of Senior Citizens and Pensioners of Nova Scotia includes in its recommendations for 2002 The price of drugs is reaching a point beyond the ability of many people to afford. Doctors are furthermore prescribing newer drugs which are more costly.The changes in the Pharmacare Program implemented April 2002 have had a significant impact on many seniors in Nova Scotia. It is recognized that very low income seniors benefitted from the changes made but 40,000 seniors had to deal with a 60% increase in their premium. There is evidence that increasing copays and premiums has a negative impact on compliance by seniors. A number of researchers have reported on this problem. Another problem which has become apparent is that with the ever increasing costs of prescriptions the 33% copay is becoming a problem as well. It is recommended that the fee structure imposed in April 2002 be re-examined and that the recommendation of the Group of IX that the payment for Pharmacare be split on the basis of 75% Government, 25% Senior be implemented. It is further recommended that consideration be given to implementing a maximum co pay for each prescription and that the maximum co pay of $350 annually remain unchanged.
10.The following quote is from a 1996 Editorial in the Halifax Chronicle-Herald and refers to the First Annual Report of the Seniors Pharmacare Board of Directors, Unfortunately, Mr. Salsmans first annual report gives short shrift to the other great goal of Pharmacare Reform-------fostering the health of seniors it goes on to say,Forget finances for a just a moment. The medical goals of Pharmacare were getting seniors off drugs if possible and TEACHING THEM ABOUT SENSIBLE DRUG USE, the Pharmacare programs first annual report gives us pages and pages of statistical and financial detail and ABOUT 50 WORDS ON EDUCATION.Very little has changed since 1996. It is acknowledged that the Department of Health has established a Medication Awareness Committee as recommended by the Group of IX and others. It is further acknowledged that the Senior Citizens Secretariat has provided excellent support to the Committee. To really be effective the Committee requires funding to undertake educational activities. Some of this required funding can be obtained through the private sector. This task could be made easier if the DOH would make a commitment to funding. It is recommended that the Department of Health allocate up to 0.5% of the Pharmacare Budget to Medication Education Programs for Seniors in Nova Scotia. Progress has been made with education programs for physicians and pharmacists now we should direct funding to more education programs for seniors. Perhaps this could be one of the responsibilities of the new Department of Health Promotion and Prevention.
11. One of the most effective means of monitoring appropriate medication use is through a system referred to as Medication Reviews. Patients medication is reviewed at least once each year in an attempt to provide better patient outcomes and reduce or eliminate Drug related Problems (DRPs) The provision of this service was recommended by the PRWG in 1993 and is only one of many of their recommendations not fully implemented by the Department. This service is still not funded by the program and this presents a barrier to its use. It is recommended that initiatives be taken to introduce this service in the Pharmacare Program without any further delays. This is perhaps one of the most important issues to be addressed.
SENIORS PHARMACARE PROGRAM COSTS 1989/90-2003/04
YEAR TOTAL COST COST TO GOV. COST TO SENIORS % G %
1989/90 $72.400M $72.400M ZERO 100
1990/91* $76.150M $68.960M $7.190M 90.6
1991/92 $80.245M $68.451M $11.794M 85.1
1992/93 $82.112M $70.643M $11.469M 86.0
1993/94 $77.774M $64.955M $12.819M 83.5
1994/95 $86.213M $73.554M $12.659M 85.3
1995/96** $82.294M $64.100M $18.194M 77.9
1996/97 $83.218M $60.286M $22.932M 72.4
1997/98 $88.903M $64.567M $24.336M 72.6
1998/99 $98.800M $73.670M $25.130M 74.6
1999/2000 $100.900M $78.100M $22.800M 78.0
2000/01 $104.160M $73.624M $30.536M 70.6
2001/02 $113.270M $83.110M $30.160M 73.4
2002/03(est) $123.500M $87.174M $36.730M 70.6
2003/04(fore) $134.530M $97.500M $37.230M 72.5
* first copay introduced.
** Premium introduced.
Total Cost of Program increase from 89/90-03/04 $62.13M (14 years)
Total Cost to Government 89/90-03/04 increase $25.10M
Total Cost to Seniors increase 89/90-03/04 $37.23M
The total cost of the Program increased approx 4.4% per year
total cost to Government increased approx 2.5% per year.
The total cost to Government increased approx 2.5% per year.
Nova Scotia Citizens Health Care Network
The issue of payment for Health Care continues to be a major concern for Nova Scotians and families of Nova Scotians who require admission to Long Term Care Facilities. It is recognized that recently some changes were made to address issues related to Financial Assessment and the Province of Nova Scotia provided some assistance to help cover the costs of Long Term Care. Regrettably increased daily rates have reduced the value of this assistance. We are also aware that the province has promised to pay the costs of health care in Long Term Care Facilities by 2007. Presently the cost for residents ranges from $110.75 per day to $205.42 per day, with the average daily cost $151.84 (N.S. Department of Health). The Government has not provided any detail on what the costs per day will be for the room and board portion of the cost when it assumes responsibilty of the health care of the residents. Veterans at the Veterans Building at the QE2 pay a maximum of $25.00 per day for room and board.
The changes to the Financial Assessment system have not been totally fair giving definite advantages to home and property owners and not to those who choose to rent their accommodations. A resident may have a home valued at $300,000 and a cottage at $100,000 all of which are exempted from their assets while a resident who lived in a rental accommodation having the equivalent $400,000 in Investments from which he/she must receive income has no exemption. This is not fair. An alternate system would have been to exempt all Assets to a maximum amount.
One of the concerns most frequently expressed to us by those residents who are entitled to the monthly personal allowance is that it has not changed in 10 years. Immediately prior to the recent election the Premier indicated this would be changed. After the election he claimed no change could be made until the 2004/05 Budget dashing the hopes of hundreds of residents. In addition it has been recently brought to our attention that some residents being moved from double to singe rooms have had to pay a $1.50 per day premium, leaving them only $65 a month. We ask that someone look into this right away.
Concern has also been raised regarding products and services not covered by the Daily rates like prescription drugs, over the counter drugs, incontinence supplies, eye glasses, hearing aids, wheelchairs and transportation to medical and hospital appointments. We are asked what is the difference in service levels in the higher cost homes than in those with lower cost. Also what rate does government pay for those residents who cannot pay the full daily rates, is it different than those who pay their own costs? Some families and or caregivers are concerned about the care they have to provide which is not provided by the staff in the facilities. Others are concerned about the complaint process and ask if there could be an opportunity to present these complaints to other than the staff in the facilities.
Recently it has been reported that the province does not plan to add any additional long term care beds other than those just announced for Grand View Manor in Berwick. Is this correct? Would it not be appropriate to add more long term care to reduce the strain on active treatment beds in hospitals presently being occupied by some awaiting admission to Nursing Homes.
Finally what measures are being considered to provide more assistance to families who would prefer to keep their loved ones at home? We understand that some families prefer to do this if support is available to them. With the increase in the number of older persons in the population and the fact that they are living longer it is imperative that this issue be addressed sooner rather than later.
Shelburne County Community Health Board
Recommendation for Immediate Action and
Application for a Proposed
Lockeport Community Health Centre
Before the last election, the Nova Scotia Citizens Health Care Network sent out a survey to all candidates. We asked whether you agreed or disagreed with taking steps to ensure rural and remote communities have an appropriate mix of skilled health care providers to meet their health care needs. Mister Minister, you graciously responded, Yes, I agree.
That was encouraging to those who live in rural areas where, over the past decade or so, services have been eliminated, health professionals have been terminated, and bed numbers have been drastically reduced. 24/7 access to essential services is sporadic as recruitment and retention of doctors and nurses becomes increasingly challenging.
most Nova Scotians, rural residents contribute generously to the economy and the tax base.
For example, Shelburne County is known as the lobster capital of Canada with landings
valued in excess of a hundred million dollars annually. Our taxes and donations built a
hospital that held 51 beds, now reduced to 19. Our surgery and medical wards repaired and
restored thousands of patients a year who must now travel hours to crowded and
overburdened regional and tertiary hospitals. Our advanced obstetrical ward once welcomed
more than 120 newborns each year; in the past decade, two have arrived - unexpectedly.
Emergency care that was once efficient and affordable now depends on referrals, and
expensive ambulances which some cannot afford.
Like most Nova Scotians, rural residents contribute generously to the economy and the tax base. For example, Shelburne County is known as the lobster capital of Canada with landings valued in excess of a hundred million dollars annually. Our taxes and donations built a hospital that held 51 beds, now reduced to 19. Our surgery and medical wards repaired and restored thousands of patients a year who must now travel hours to crowded and overburdened regional and tertiary hospitals. Our advanced obstetrical ward once welcomed more than 120 newborns each year; in the past decade, two have arrived - unexpectedly. Emergency care that was once efficient and affordable now depends on referrals, and expensive ambulances which some cannot afford.
As we have drifted from Health Care Transition, to Reform, to Renewal, each stage has led us to more losses and more expense. And now were even paying for parking which isnt a service at all.
is a quote from the Department of Health publication
This is a quote from the Department of Health publicationYour Health Matters Working Together Toward Better Health Care:
On October 21, 2003, the Nova Scotia House of Assembly, by Resolution 505, commended the vision of members of the Shelburne County Community Health Board, wishing them every success in staffing and planning a health clinic in the Town of Lockeport. Mister Minister, the plan is feasible and affordable, and we request that you give it your kind attention.
After thorough consultation, surveying, and compiling data, the Shelburne County Community Health Board prepared a detailed Health Plan, a Community Profile, and a Resource Directory on August 25, 2003. All of these reports are relevant and comprehensive, and we commend them as a supplement to the following presentation.
The Shelburne County Community Health Plan identified several key issues, such as:
The high cost of medical services prevents economically strapped individuals from achieving and maintaining health because of inequitable access to services. In addition, the geographical location of Shelburne County results in higher transportation costs to travel to receive medical attention/services.
And Shelburne County does not have enough health professionals and services to meet the needs of its residents.
On these issues, it is apparent that our County is going from crisis to crisis first Shelburne, then Barrington, now Lockeport.
Traditionally, the Town of Lockeport and outlying area has required the services of two doctors to provide health care to many surrounding communities and to a separate population of seasonal residents.
The recent partial distribution of an estimated 1,000 of Dr. Peter Robbins patient files to other physicians indicates the size of the practice. Add to that figure: those who are currently without a doctor, and those who are unable to travel.
Lockeport Mayor Huskilson and others have been contacted about the current status of
1. physician recruitment activities, and
2. a proposed Community Health Centre.
Dr. David Wilson, in semi-retirement, made a proposal to attend Surf Lodge and Lockeport patients on a regular but not full-time basis.
Prior to her recent vacation, Dr. Chaloner was available to Surf Lodge and Lockeport residents on a regular but not full-time basis. She accepted approximately 500 of Dr. Robbins former patients into her Shelburne practice. She has expressed interest in a Community Health Centre model for Lockeport.
To continue to provide accommodations for this infrequent and inadequate use, the Town of Lockeport would be required to pay a monthly rental of $500. for Dr. Robbins former office space.
PROPOSED COMMUNITY HEALTH CENTRE :
Attracting physicians and other practitioners to the Town of Lockeport will require an accessible building with adequate space for offices.
The Town owns a building which would offer the quickest and easiest solution. Costs of renovations, interior and exterior, have been estimated at less than $35,000. , subject to further study.
It is anticipated that the Roseway Hospital Charitable Foundation could contribute to equipment and furnishing needs.
With a Health Centre appropriate to the needs and resources of Lockeport and area, there would be renewed incentive and ability for the eastern Shelburne County Physician Recruitment Committee to attract practitioners to serve the community.
We recommend that Cathy Blades, Vice President, Community Health, South West Nova District Health Authority, proceed with all necessary application(s) for a Community Health Centre to be located in the Town of Lockeport, and we request open consultations with our Board throughout the process.
Ian Johnson, Vice Chairperson
Nova Scotia Citizens Health Care Network
Waiting Times and Privatization
Probably the most single most important issue in health care for most Canadians and Nova Scotians is waiting times for diagnostic and treatment services. The Nova Scotia Citizens Health Care Network is concerned about many aspects of this issue. They include access to all insured services, especially in rural and outlying communities, access to MRI and other diagnostic services, and the rise of for-profit clinics and services.
Our starting point is the five basic principles of the Canada Health Act (accessibility, universality, comprehensiveness, portability and non-profit or public administration). In our view, all possible efforts must be made by governments, district health authorities, health care facilities and health providers to ensure that all citizens are able to obtain the health services they need without any barriers. Unfortunately, over the last ten to fifteen years, we have seen successive budget cutbacks and reductions in health services across the province. This has meant that many services such as hospital emergency services, obstetrics and surgeries are no longer available or much less accessible than they were in rural and outlying communities. This does not mean that everything should stay the same but what we have seen over and over again is that services have been cut in the name of health reform without ensuring there was a proper transition period to move from one form of service delivery to another.
The most recent national survey by the Fraser Institute in October 2003 suggests waiting times have increased in the last year and have actually reached an all-time high. They report total average waiting time has increased in all but three provinces, including Nova Scotia. Considering that we have among the lowest levels on a broad range of health status indicators, this is very disturbing news.
We are troubled by the impacts
of recent budget restraints by the government. The
Minster of Finance has suggested that there has been no direct impact on the funding for
the direct care of patients in need of direct hospital care. We beg to differ, especially after the release of
the October 10 letter from the President and CEO of the Capital District Health Authority
to the Assistant Deputy Minister of Health in which he apparently indicated that wait
times will increase in light of the funding provided to them. We also disagree with the major restrictions on
overtime and sick time replacement which will also directly reduce needed hospital care.
We are troubled by the impacts of recent budget restraints by the government. The Minster of Finance has suggested that there has been no direct impact on the funding for the direct care of patients in need of direct hospital care. We beg to differ, especially after the release of the October 10 letter from the President and CEO of the Capital District Health Authority to the Assistant Deputy Minister of Health in which he apparently indicated that wait times will increase in light of the funding provided to them. We also disagree with the major restrictions on overtime and sick time replacement which will also directly reduce needed hospital care.
We have also been very concerned about the limited access to diagnostic services such as MRIs. We are aware of your recent announcement on November 18 about increased access to MRIs being an important part of your governments plan to reduce wait lists. We are also aware of the work group that has been established to make recommendations on standard definitions, needed information and the monitoring and reporting of wait lists.
However, we are concerned about the length of time that it has taken to get these initiatives underway. When we met with then-Minister Muir about this problem in July 2002, it clearly seemed to us that the government was scrambling and had no plan in place to deal with this serious issue. Moreover, we have heard increasing concerns about this problem from our own members and growing numbers of Nova Scotians since that time. We are not against study and research but we also believe some short-term and longer-term actions are needed now.
We see the problems with this issue as giving rise to for-profit services such as the private MRI clinic in Halifax and private blood collection services. They promise easier access if people are willing to pay without dealing with the fundamental problems of why waiting times have increased or how they can be resolved. Based on the research about the impact of for-profit services done by many sources such as Romanow Commission and the Canadian Health Services Research Foundation, we believe that they will only make waiting times worse and they represent a fundamental departure and threat to public health care that must be stopped. Worse still, the research suggests they offer lower quality of care and less accessible care.
On these serious issues of
waiting times and the rise of for-profit services, we recommend that the government:
On these serious issues of waiting times and the rise of for-profit services, we recommend that the government:
· Entrench the five basic principles of the Canada Health Act in provincial legislation (including the sixth principle suggested by Mr. Romanow of accountability) as has been done in other jurisdictions.
· Investigate fully the loss of service in rural and outlying communities and its impact as a result of continuing budget restraints over the last ten to fifteen years.
· Develop a comprehensive wait list management strategy as has been done in Western Canada with the Western Canada Waiting List Project and the Surgical Wait List Management Strategy in Saskatchewan, beginning with the appointment of broad range of representatives from health providers, DHAs, the public and government. The governments own election commitments identified other elements of such a strategy including a Provincial Wait List Information Service , common measurement tools and standards, and expanding the Hospital Information Management System.
· Investigate fully all possible ways in which waiting times can be reduced such as extended hours of operation, use of alternative rooms or facilities, other diagnostic or treatment modalities, better information management systems, and the need for additional staff resources.
· Take all possible legislative and regulatory measures to regulate the development of private, for-profit clinics as Ministers of Health committed in September 1994 at their meeting in Halifax.
· Investigate fully the extent of private, for-profit health services in the province.
· Initiate discussions with the Nova Scotia Federation of Community Health Centres and DHAs about the development and expanded use of community health centres for more diagnostic and treatment services building on the announcement last week for funding to train health professionals to work together in community-based clinics.
· Produce an annual report(s) on waiting times.
Health Human Resources
Despite major technological advances, health care remains a person-to-person, hands-on service involving direct contact for patients with health providers. The largest proportion of its costs is related to the employment and utilization of health care workers. The overall quality and success of public health care is therefore largely affected by the health human resources available to it.
Despite the obvious importance of these human resources, very little consideration has been given until recently to the understanding of and planning for health human resources. It frankly seemed to us as though if there was overall assumption that if funding was available, facilities open, equipment and supplies provided, they would pretty much operate on their own.
The recent release of the report of A Study of Health Human Resources in Nova Scotia represents a major departure and provides invaluable information about 31 health occupations that should have been collected years ago. While this report provides important background and baseline information, it does not identify the extent of possible shortages not is it a substitute for devoting major efforts to ensuring a vibrant health workforce. As stated in Your Health Matters: Working Together Toward Better Care report, having enough doctors, nurses, and health care providers is key to shortening wait lists and building the quality of health care (p. 17).
We are very concerned about the future supply of needed health providers from a wide range of disciplines and fields (including but not restricted to doctors and nurses) such as x-ray technologists, respiratory therapists, therapeutic counsellors and home support workers to name a few examples. We are aware that the government has launched various initiatives to recruit and retain physicians, nurses, medical laboratory technologists and paramedics. However, frontline workers, their unions and their professional associations for these groups clearly tell us that these initiatives are insufficient to prevent major shortages in the near future. In addition, we are told that at least the same range of initiatives is needed for all other health disciplines and support staff as well if we are maintain and hopefully enhance our overall quality of care.
On this neglected issue of health human resources, we recommend that the government:
· Develop a comprehensive a comprehensive health human resources plan or strategy as recommended by the Nova Scotia Royal Commission on Health Care in 1989 and by the Blueprint Report in 1994. As recommended by the Royal Commission and still to be fulfilled, that plan or strategy should be based on the health needs of the population and a review of the present and future roles of all health professionals to determine [at a minimum](our addition) appropriate entry points to the health system, numbers, mix, training, scope of practice and distribution of health professionals in Nova Scotia (p. 65).
· Ensure this plan or strategy covers all health occupations including assisting, support, clerical, administrative staff as well as volunteers and family caregivers.
· Move to fully implement the final report of the Canadian Nursing Advisory Committee from August 2002 as a model set of actions for such a plan or strategy.
· Investigate fully compensation and benefits for frontline health care workers and how they will affect future supply and working environments.
· Involve frontline workers and their unions fully (and not just on a token basis) in all stages of health human resource research and planning processes.
Implementation of the
Implementation of the Romanow Report
On November 28, 2002, Commissioner Roy Romanow released his long-awaited report and plan for protecting and sustaining public health care over the long-term. It was the culmination of 18 months of the most intensive public consultation and exhaustive research ever conducted by a royal commission. In our view, there can be little doubt that Mr. Romanows final report reflected the voice and mind of Canadians about how to protect and enhance Medicare.
For example, one strong indication for us of the importance of the implementation of the Romanow Report to Nova Scotians was the 65,000 signed postcards from concerned Nova Scotians that we presented to the Prime Ministers Office a year ago. No other recent health care report such as the Kirby Senate Committee Report can make such a claim to breadth of research or extent of public support.
The 47 recommendations of Commissioner Romanow included:
· Ensuring stable, accountable federal funding for health care with a Canada Health Transfer that provides at least 25% of public health care expenditures.
· Setting up five targeted funds during the next two years for rural and remote access, diagnostic services, primary health care, home care and catastrophic drugs.
· Establishing a new Canadian Health Covenant.
· Creating a Health Council of Canada to foster collaboration and cooperation at the national level.
· Modernizing the Canada Health Act.
· Stopping private, for-profit delivery of health care services by such means as improving access to medically necessary diagnostic services and managing waiting lists more effectively. In fact, he neither received nor found any evidence in support of for-profit health care delivery.
· Developing a comprehensive plan for Canadas health workforce.
· Instituting major primary health care initiatives.
· Making home care a publicly funded service.
· Setting up a National Drug Agency.
· Integrating aboriginal health services.
· Protecting Canadas health care system from potential challenges under international law or trade agreements.
While at least two-thirds of
Canadians have enthusiastically endorsed these recommendations, federal and provincial
governments have not been very supportive at all. At first, all governments talked about
how committed they were to implementing the Romanow Report.
But it quickly became clear to us in the response of governments was a lack
of federal leadership and hard-nosed provincial attitudes. To date, the Health Accord
worked out in early February has only meant a modest increase in federal funding for
health care, home care and prescription drugs and no direct challenge to for-profit
services by those provinces already supporting them including Nova Scotia. In other words, very few recommendations of the
Romanow report have been implemented and the will of the Canadian people have been
rejected by governments that were supposedly elected to serve it.
While at least two-thirds of Canadians have enthusiastically endorsed these recommendations, federal and provincial governments have not been very supportive at all. At first, all governments talked about how committed they were to implementing the Romanow Report. But it quickly became clear to us in the response of governments was a lack of federal leadership and hard-nosed provincial attitudes. To date, the Health Accord worked out in early February has only meant a modest increase in federal funding for health care, home care and prescription drugs and no direct challenge to for-profit services by those provinces already supporting them including Nova Scotia. In other words, very few recommendations of the Romanow report have been implemented and the will of the Canadian people have been rejected by governments that were supposedly elected to serve it.
We have been especially disappointed in the response to governments to establishing a National Health Council. In the Health Accord, governments committed to setting up the
Council by May 5. That date has come and gone and we are still waiting for this commitment to be fully honoured. We thought there was finally some agreement among ministers of health when they met in Halifax in September but we have yet to hear of a firm date by which the Council would be established. While we have appreciated your efforts to receive nominations for up to four public and expert provincial representatives for the Council, we wonder if they or any other representatives will ever have the opportunity to begin the important work of the Council. We think it is important to remember that Mr. Romanow labeled government action on the National Health Council as the litmus test of their commitment to implement his report.
On the very important issue of implementation of the Romanow report, we recommend that the government:
· Publicly commit itself to the full implementation of the Romanow Report and not just its funding recommendations.
· Lobby extensively as the current Chairperson of the Conference of Ministers of Health for the commitment of all governments to doing so in accordance with the expressed will of Canadians.
· Launch a joint campaign with all Nova Scotians to help pressure all other governments to support the full implementation of the Romanow Report, and not just as your government suggested for all MLAs ands parties in this Falls Throne Speech to get the federal government to accept greater responsibility for supporting health care.
· Continue to actively work for a firm date by when the National Health Council will be established.
· Work with us and many other Canadians for a national moratorium on the spread of for-profit health care.
· Help to lay the foundation for the long-term goal of establishing a truly national health care system and not just a patchwork of provincial and territorial systems.
Thank you for your time and attention to our concerns and recommendations. We would appreciate a detailed response. We have tried to offer positive and constructive recommendations for action by you and your Department. We look forward to meaningful consultations with you in the future including being part of the regular stakeholder consultation sessions your Department has been holding over the last year or so. We again appreciate this opportunity to meet with you.