Nova Scotia Citizens’ Health Care Network Presentation

To The

 Nova Scotia Liberal Round Table on Wait Times

Westin Hotel

Halifax, N.S.

Thursday, January 29, 2004

7:00 p.m.

Introduction

Good evening Mr. Wilson and members of the Round Table.  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 wait times and how critical they are to us as Nova Scotians. 

 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, especially with respect to wait times.  Our concerns require government’s immediate action to stop further deterioration 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. 

 Our Analysis of Wait Times

 The most single most important issue in public 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.   The significance of this issue is shown when it is one the top items on the agenda this week of the first meeting of the National Health Council.

 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, 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 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.  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 are aware of your recent announcement on November 18 about increased access to MRIs being an important part of your government’s 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.  The government’s 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 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.

 The government is hoping to receive $60 additional million dollars in federal funding.  Media reported that the government and our Network appear to be 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 $60 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 Medical Laboratory Technologists 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 recently 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.

 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 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.

·        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.

Conclusion

 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. 

 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.