The
Nova Scotia Citizens Health Care
Network
Medicare..
Need NOT Greed!
Opening Remarks
To The
First Aid for
Medicare:
A Forum on Access to
Health Care
By
Ian Johnson
Vice-Chairperson
Nova Scotia Citizens
Health Care Network
Keshen Goodman
Library
Halifax, N.S.
Monday, February 9,
2004
7:00 p.m.
Put
the Heart Back in Medicare - Keep Profits Out!
c/o 3600
Windsor St. Hfx NS. B3K 5G8 (902) 455-9164,
fax 455-0400
email:healthnetwork@hfx.eastlink.ca,
website: ns-medicare.tripod.com
Introduction
Thank you Andrew and
good evening, everyone. I am pleased to
have this opportunity to participate on this
panel this evening and look forward to your questions and comments.
My background: Community Health Centres, Canadian Health
Coalition, N.S. Health Coalition and N.S. Citizens Health Care Network, Senior Policy
Analyst with the Provincial Health Council and for the last seven years, Policy
Analyst/Researcher with the Nova Scotia Government and General Employees Union, half of
whom work in health care.
During the last year or
so, there has been almost continuous coverage of news and stories about Medicare,
especially during the public hearings and after the release of the Romanow Commission
report in November 2002.
The topic for this
evenings forum is very appropriate because I dont think there is much doubt
that the most single most important issue in public health care for most Canadians and
Nova Scotians is access to health care, especially waiting times for diagnostic and
treatment services.
We with the Nova Scotia
Citizens Health Care Network are 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.
The significance of this issue is shown when it is one the top items
on the agenda the first meeting of the National Health Council two weeks ago in Toronto.
We want to see immediate action to stop further deterioration of our front line acute
health care and to drastically reduce wait times for beds, operations, diagnostic testing
as well as to help Nova Scotians to get affordable drugs.
When I first thought
about what I was going to say this evening, I was reminded of a story I heard about our
current Minister of Health, Angus MacIsaac just after he became Minister last summer. He had been in a rush that morning to get to the
office and by the afternoon, he realized he had left his watch home. So he called a local
radio station to ask what the correct time was. The
person who took his call replied that the answer depends on who he is. He was quite irritated and he wondered what
difference that would make. The person at the
other end said Well, if youre with the Health Council of Canada, the time is
14:00 hours, if youre with the QEII Emergency Department, it is 2:00 p.m., and if
youre the Minister of Health, the little hand is on the two and the big hand is on
the twelve.
Time and timing is very
important to public health care and it is long overdue that federal and provincial
governments to understand what Nova Scotians have been saying for years about our health
care system. We want to keep it public
and we want to make a number of long overdue changes to deal with serious issues such as
access to health care.
History
Health and health care
fundamental values: WHO and 1964 Royal
Commission
The enjoyment of
the highest attainable standard of health is one of the fundamental rights of every human
being without distinction of race, religion, political belief, economic or social
condition. (Constitution of WHO, 1960)
that as a nation, we now take the
necessary legislative, organizational and financial decisions to make all the fruits of
the health sciences available to all our residents without hindrance of any kind.
(Final Report of the Royal Commission on Health Services, 1964).
Medicare not given to
us on a silver platter, history of struggle from the beginning and since then. And a broad range of groups and organizations have
been part of this struggle all across Canada including Medicare Now Committees in Nova
Scotia.
History in
Saskatchewan: 40th Anniversary, 1947 and 1962 with insured hospital and medical
care services including the Doctors Strike in July 1962
History in Canada: 1957
and 1966 with the Hospital Insurance and Diagnostic Services Act and the Medical Care
Insurance Act
History in N.S.: 1958 and 1969
Benefits of Medicare:
Improved accessibility, gradual broadening of insured services, relatively cost-effective,
competitive advantage and cost-saving for businesses, major employer and spin-off
benefits, and model public service.
Since the mid 1970s,
public services including Medicare have been under attack and there has been a struggle centered around funding and changes to
federal-provincial funding arrangements: 50-50, EPF, CHST (single most devastating piece
of fiscal and social policy ever conceived).
Major struggles at each
point e.g. from which we achieved 1984 Canada Health Act and 5 basic conditions or
principles: accessibility, universality, comprehensiveness, portability and public
administration.
Our Analysis of Wait
Times
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. In
particular, since CHST in 1996, the impacts were swift, widespread and worse still,
ongoing e.g. hospitals being closed, downsized and merged, hospital beds being closed or
phased out with almost a 40% reduction between 1992-93 and 2000/01 (5.3 to 3.3 beds per
1000 population), long-established medical services being de-insured or scaled back,
co-payments or premiums being increased, and major job cuts e.g. 24,000 between 1994 and
1996 nationally and over 2,000 between 1993 and 1996 in N.S.
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 Medical
Laboratory Technologists left and since Nova Scotia no longer trains them, where will we
find them? Recruitment is crucial now!
All of 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, especially 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 said 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. The situation has further worsened with the crisis
at the QEII ER which has really been a serious problem since 1997 when it opened.
We have also been very
concerned about the limited access to diagnostic services such as MRIs. We were aware of the governments
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
and its recent first report.
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. The governments recent 10-Point
Plan and additional 58 beds announcement are only a start in what should have been done
several years ago.
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.
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 one concern. Nurses at the QEII have been very frustrated
because she knew of many empty beds and rooms upstairs but were not allowed to use them.
The government is new
expecting to receive $60 additional million dollars in federal funding. We strongly recommend no further cuts to DHAs and
put the $60 million dollars and any additional federal funding where it is needed most
TO REDUCE WAIT LISTS. Nova Scotians
are losing patience and confidence that government will address this serious concern. The problem can also be address by increasing beds
across the province, which are desperately needed and providing the appropriate staffing
levels for them.
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 has
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.
Furthermore, 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 recently while at the Dixon Centre for
treatment myself, our Chairperson 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. She 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.
Recommendations
On these serious issues
of waiting times and the rise of for-profit services, we recommend that the government:
·
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. Front-line workers such as ER staff must be
directly involved in exploring all possible options
·
Increase the number of
acute care, in-patient beds back to the 1992-93 level
·
Increase the number of
long-term care beds immediately to reduce the strain on acute care beds in hospitals
presently being occupied by at least 160 people seeking admission to nursing homes.
·
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.
·
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.
·
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 with at least updates when the situation is especially critical
is as the case right now with ER wait times.
·
Support the launching
of a joint campaign involving all parties and all Nova Scotians to help support the full
implementation of the Romanow Report.
·
Support whistleblower
legislative protections to intimidate and prevent workers and their unions from bringing
forward their concerns and suggest alternatives as the CDHA is now doing.
Conclusion
We emphasize again, the
Department of Health should be working with concerned individuals, community organizations
and health care unions to plan, organize and strategize to administer the "best"
health care in Canada. Publicly delivered and publicly funded 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 that 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 band-aid solutions, we need real solutions now.
Thank you for this
opportunity. We welcome your questions and
comments.