Many Challenges Remain For Health Authority

The amalgamation of nine regional health authorities is off to a good start, but the battle is less than half won.

Long term care programs cost the province $536 million in 2015-2016, up 22% over the previous five years—even though the number of beds increased by only 2%.

In May, the Auditor General (AG) released his report on the oversight on Homes for Special Care by the Department of Health and Wellness. It was less than enthusiastic.

“Health and Wellness does not have an information system.”

“Health and Wellness does not evaluate how service providers are performing.”

“Health and Wellness has not provided written guidance to inspectors.”

“Health and Wellness does not ensure consistent enforcement.”

“Health and Wellness does not follow up deficiencies in a timely manner.”

The department agreed with all of the resulting recommendations and felt that two of them had been implemented since the audit began.

It is, nevertheless, not surprising to discover that the department’s oversight of the former nine health regions was equally weak. Productivity and efficiency varied considerably between regions, but there was not an effective process for identifying best practices in a particular region and having them implemented by others.

The advent of the province-wide Nova Scotia Health Authority (NSHA) allowed for direct management of this opportunity for savings. Seven hundred more Nova Scotians had hip and knee surgeries because better strategies were used to employ operating rooms suddenly available due to cancellations. The only additional cost was for the necessary prosthetics.

More than seven hundred Nova Scotians received MRI scans than in the previous year. Fewer people are waiting for home support services and long-term care.

The best part is that it’s typically less expensive to deliver good service (in this case, patient care) than it is to deliver bad service.

With so many moving parts, it is tricky to make comparisons—but the NSHA believes that savings of $70 million per year have been found, and that there are many opportunities for more.

At its annual meeting, the NSHA focused on a broader canvas. The NSHA has held 42 engagement sessions at which interested citizens contributed their thinking on the present system for care and how we can live more healthily.

CEO Janet Knox noted that Nova Scotians are less healthy than the Canadian average, with a life expectancy at birth (based on today’s conditions) a year less than the Canadian average.

She focused on wellness, noting that: “Good health starts at home and in our communities–at our schools and workplaces, playgrounds and parks. It requires the collective efforts of many… to focus more on wellness and the factors that really impact health–namely safe communities, a healthy environment, good education, jobs and housing.”

That is probably true, but those factors go far beyond the remit of the NSHA, or the Department of Health and Wellness. That list incorporates most of the responsibilities of the government in general and the premier in particular.

It is perfectly reasonable for the NSHA to draw attention to issues that impact wellness. But it is no substitute for getting it right on the very substantial agenda that confronts the health care system, including:

  1. Buildings: As the AG pointed out, the present array of facilities need to be rationalized. The rapid deterioration of the Centennial Building at the Victoria General Hospital represents a challenge, and an opportunity to centralize some services in a location other than downtown Halifax.
  2. Homecare and Long Term Care: The oversight of third party providers has been inadequate. Allowing the NSHA a more direct role in overseeing those contracts will facilitate greater integration with other parts of the system, making sure that support to patients is proportional to need, and that patients are exited from care programs when they are no longer needed.
  3. Cost Effectiveness: The easiest opportunities to extend best practices between different facilities will have already been realized, but there will be many more. A constant program—and culture—of process improvement can yield many more substantial savings.
  4. Information Systems: Nova Scotia is beginning to develop an electronic patient management system, which allows health care providers to see patient histories, including the results of diagnostic tests. In principle this is a great idea, but projects like these can go badly wrong. In 2013, the UK abandoned a similar project after spending about C$20 billion.

Governments frequently succumb to the temptation to micromanage choices in the health care system. It is almost always counterproductive.

The results of the first year of the NSHA are better than the McNeil government could have reasonably expected. It happened because the government mostly let them do their job.

It will need to continue that discipline as the authority deals with bigger challenges and opportunities. Correspondingly, the NSHA should stay tightly focused on the many issues it faces.

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