The Nova Scotia Citizens Health Care Network

The Nova Scotia Citizens Health Care Network

Medicare.. Need NOT Greed!

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

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 evening’s forum is very appropriate because I don’t 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 you’re with the Health Council of Canada, the time is 14:00 hours, if you’re with the QEII Emergency Department, it is 2:00 p.m., and if you’re 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.

“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: 40^th 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

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 1970’s, 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 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 government’s 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 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 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 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 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.

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 shouldn’t 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.

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.

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.

regulate the development of private, for-profit clinics as Ministers of Health committed in September 1994 at their meeting in Halifax.

� 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.

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.