Nova Scotia’s Health Plan Must Specify The Calendar For Improvements

The Action for Health plan was released on April 22nd, four weeks later than promised. That could have made sense if the document had lots of new content and a clear statement of goals. It had little of either.

Most of the substance had already appeared in the Progressive Conservative platform, the government’s budget documents, and the numerous press releases about items done so far.

Perhaps it was convenient to deliver it just before the legislature concluded its spring session, minimizing the opportunity for the opposition to ask questions.

It is instructive that the technical briefing was provided entirely by senior officials from the Department of Health. Of course, the management of the IWK and the Nova Scotia Health Authority were among those consulted as part of the process, but the overall leadership and accountability is clearly with Minister of Health and Wellness Michelle Thompson and her department.

To be complete a plan needs to have measurable high-level goals and a date by which they should be achieved. The plan’s “actions” do not fit that requirement. They include a mixed bag of statements:

  1. Plans to make a plan: “Develop a provincial health workforce strategy to ensure community health needs are met in the short and long term,” “Develop a multi-year virtual care strategy”, “Put a plan in place to guide sustainable investments in health infrastructure over the medium and long-term.”
  2. Gathering information to guide choices: “Explore opportunities to increase the number of clinical associates practising in the province,” “Review existing workflows for opportunities to reduce the amount of time spent on paperwork.” “Collect the data needed to better understand and address health inequities.”
  3. Providing direction but not a destination: “Support and expand Youth Health Centres in high schools”, “Explore alternative levels of care in long-term care to complement existing programs”, “implement digital solutions to improve processes.”
  4. Actions that have targets, and one that has a date: “Work with Dalhousie Medical School’s Family Medicine Clinics to take 3,500 more people from the Need a Family Practice Registry”, “Implement One Person, One Record (OPOR)”, “Renovate and build more than 2,500 single-bed rooms over three years.”

There is not much to quarrel with in the various initiatives, but patients will not rejoice when told that a workforce strategy has been developed, or that digital solutions are improving processes.

They want to know when care will be better and more accessible. The questions the government must answer are about outcomes that patients experience.

What is viewed as the acceptable maximum number of people waiting for a doctor? What is the target date for reaching that limitation, and where does the government expect to be at the end of 2022 and the subsequent three years?

What are the projected annual results for reducing surgery wait times?

Having one record for each patient will make for better care and lower costs. When will it be ready, and what will the record contain?

Taking into account the province’s ambitions for population growth, what staffing levels are to be achieved by the end of 2022 and each of the following four years?

Nova Scotia currently has the second highest per capita health care spending after Newfoundland and Labrador. What is the target for the plan?

The government advises that “in early summer it will provide an initial set of indicators that will track progress on outcomes. These will help us, and Nova Scotians, monitor the effects of the changes we are making to the health system.” That will be useful, but will not give us a clear view of the future.

There are two reasons why the early summer report should forecast the pace of improvements in patient outcomes. First, it will remind readers that it is a multi-year journey, while taking accountability for progress in each year.

Second, there is a need to manage expectations. The potential demand for health care is nearly infinite. That is especially true of mental health.
In the Canadian single payer model the only way to limit spending is to limit supply.

Nova Scotia is already forecasting deficits for the next four years. It needs to restore the fiscal discipline earned during the McNeil years. Failing to do so will threaten our credit ratings and increase borrowing costs.

Health care already represents more than a third of all departmental expenses, and the Action for Health document will push that higher. So could federal initiatives on dental care and possibly pharmacare.

Nova Scotia has the highest tax rates in Canada. Going even higher would seriously threaten our goals for population growth.

A ceiling on spending for health care must be identified this year, and act as a discipline on which health care initiatives we can afford.


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