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, Senior’s 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 government’s 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 don’t have enough RNs, you simply can’t 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 shouldn’t 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
For
Nova Scotia Citizens’ Health Care
Network Meeting
With the Minister of Health
Thursday, December 5, 2003
9:00 a.m.
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.
RECOMMENDATIONS
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 Board’s 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. Salsman’s 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 program’s 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 %
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
Nova Scotia Citizens Health
Care Network
December 2003
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
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.
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.
PHYSICIAN RECRUITMENT:
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.
Thank you
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.
· 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 government’s
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.
· 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.
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. Romanow’s 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
Canada’s 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 Canada’s health care
system from potential challenges under international law or trade agreements.
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.
· 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 Fall’s 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.