The Targets For Improving Health Care Capacity Are Too Low
Posted January 20, 2023
Nova Scotia’s health care system, which includes long term care, is not keeping up with the need. Recent deaths of patients waiting for care in emergency departments are just one symptom of the problem. There are not enough doctors, not enough nurses, not enough facilities. This week’s “summit” had health care leaders discussing short term responses.
The province’s strategy for the long term is captured in its Action for Health plan. Unfortunately the key goals are vague and incomplete.
We are no closer than two years ago to the target of 135 family physicians per 100,000 Nova Scotians. The 32,566 new Nova Scotians added in the 12 months ending in October require 45 additional family physicians. The current rate of training and recruitment is inadequate.
Surgical wait times are lengthening and the percentage of Nova Scotians seeking a primary care provider is increasing.
The net increases in registered nurses and nurse practitioners are shown, but there is no estimate of how many are needed. The offloading times for ambulances are deteriorating.
Initiatives are planned to make care more efficient, more effective, or more culturally sensitive; some of these are still being defined.
Most advanced are long term and home care, where multiple facilities are being added, waiting lists are shortening, and staffing ratios are being enhanced. This can reduce pressure on hospital rooms, which will in turn provide some relief to emergency departments.
The problems long preceded the Houston government and are not easily resolved. Forecasting future need for health care staffing and facilities, informed by prudent demographic forecasts, has not been a part of budget planning.
On December 15th the government announced a smaller version of the Infirmary expansion, which would add up to 216 new beds, 16 new operating rooms, and a new emergency department. A separate building for cancer care will follow.
As well, they will expand Dartmouth General Hospital to include a new emergency department and more beds, add new in-patient services at the Cobequid Community Health Centre in Lower Sackville, and build two standalone care centres in HRM, including one with 195 beds near the Bayers Lake Community Outpatient Centre.
Some of these builds will enable gradual exiting from the deteriorating Victoria General building.
As well, planning will begin for a new mental health and addictions campus, a new Nova Scotia Rehabilitation and Arthritis Centre, and a new Heart Health Centre of Excellence.
Dividing the construction into multiple smaller parts was a good choice. Usable facilities will appear more quickly, and diverse locations will be more accessible for staff and patients.
Premier Houston acknowledged that the costs for all these is not yet known but will be in the billions. He is right to commit to building them before cost estimates are finalized. Many of the secondary pieces will be subject to competitive bidding, which should achieve some price discipline.
The announcement trumpeted a series of benefits, claiming that it “Reflects the needs of our growing population, both across the province and within Halifax Regional Municipality, which could grow by 29% by 2043.” That estimate would have HRM growing by 7,500 people per year for the next two decades.
Memo to premier: The population of HRM grew by 20,000 people in the most recently reported twelve-month period. At that rate its population will grow by more than 40% by 2033, half the time.
It is likely that 2022’s torrid pace will weaken, but it will still be well above 7,500. Let’s assume that over the next decade yearly provincial growth averages 25,000, of which 16,000 are in Halifax. That is consistent with the premier’s goal of reaching 2 million people in 2060. In that scenario health facilities and staffing will need to grow by 24%, in addition to what is needed to make up for today’s shortcomings.
That means many more facilities than currently contemplated. The same is true for health professionals. Today, Nova Scotia Health has 195 vacancies posted,117 of those are in family medicine. As well, retirements need to be replaced: 25% of practicing family physicians and 23% of practicing specialists are 60 years of age and older.
All that needs to be dealt with, plus supporting anticipated growth. As advocated by NS Health, primary care teams of health professionals who collaborate to meet patient needs can be part of the solution. So can broader scopes for nurse practitioners, pharmacists, and other health professionals.
The good news is that the growing population reduces our average age, adds considerably to the province’s tax revenue, and increases its share of federal health transfers and equalization payments. That plus good discipline on other spending will make it possible to afford the many billions that will be necessary to bring the system up to scratch.
A realistic picture of the shortfalls in people and facilities will not be pretty but is essential. Otherwise, today’s unsatisfactory delivery of health care will never be fixed.
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