Columns and Letters

Column: Health care: Looking forward may require looking back

September 22, 2021

-by Frank Macdonald
    Nova Scotia’s new premier, Tim Houston, and health minister, Michelle Thompson, are currently on a ‘listening tour’ of the province to hear how health professionals think the new government should prioritize Nova Scotia’s serial health care crises. At the end of the listening tour, perhaps the people of the province will be surprised by the insights and policies enacted because a premier listened. But don’t bet any of your vital organs on it.
    The first act by the new premier was to reenact one of the first steps by former premier, Stephen McNeil. That was to show an absolute contempt for volunteers. McNeil had rid himself of the province’s nine volunteer district health authorities, replacing them with the Nova Scotia Health Board (a.k.a. the Halifax Health Board). Premier Houston’s first volley against a previous government’s structure was to rid the province of the dozen or so remaining volunteers who made up the Nova Scotia Health Board.
    So they are touring, the premier and his health minister, and they will try to stay awake as they listen. They will return to Halifax, have minions compile notes taken while they were listening, and maybe something will even come of it, such as a measurable improvement in Nova Scotia health care and professional recruitment.
    There is an alternative that Premier Houston could explore.
    There is rarely, if ever, one good word a political party, newly elected to govern, has to say about its predecessor. New governments are more apt to be demolition crews in the beginning, undoing the good and the bad. A new government seldom has the confidence in itself to adopt and improve on existing initiatives of a different coloured government.
    But what if the Houston government, along with the dog-and-pony show of listening to complaints they have already heard, and ideas and suggestions they have already heard, incorporates a bit of hindsight into its health care strategies for Nova Scotia? This would not even involve other political parties. It would mean listening, assessing, and where possible, adopting policies of two previous Progressive Conservative governments.
    When Premier John Hamm came to power in 1999, he initiated changes, some of which were working. For example, creating district health authorities to attempt to address to health various health concerns and needs of this diverse province.
    Hamm also contracted an international health auditing firm, Corpus Sanchez, to conduct a five-year audit of the province’s health finances to identify where there was financial waste. The premier was adamant at the time that was this not an effort to pull away wasted money from the health care system, but to find better uses for it inside the system.
    Two years into its five-year contract, the Corpus Sanchez auditors met with the premier and informed him that they had learned enough in that time to predict that their audit would not find $10 million of waste in the province’s $2 billion health budget. The audit found there was virtually no waste. That did not mean the money was being best used, and the remainder of the contract focussed on better, financially efficient, strategies for delivering health care. Corpus Sanchez searched the rest of the country and other parts of the world for “best practices” that were showing good results in health care.
    When the report was delivered (Provincial Health Services Operational Review Final Report: Supplementary Reports (December 2007) with 102 recommendations, the premiership of the province had changed. The leader now was Premier Rodney MacDonald. MacDonald, with the support of all district health authorities and other health organizations, accepted the report in its entirety. District Health Authorities began implementing some of the recommendation with successful outcomes.
    Perhaps it was one of Nova Scotia’s misfortunes that the MacDonald’s minority government was defeated a short time later, and the NDP came to power. Little or nothing of the report upon which the MacDonald government attempted to base substantial and positive changes in Nova Scotia health care ever saw the light of day. The NDP, like other parties, came in with all the answers, answers that might have been more helpful on Jeopardy than in the province’s hospitals.
    The NDP were followed by another new government, one in which Liberal Premier Stephen McNeil proved to be a bull in the tuck shop. He, too, never gave a glance at what a previous department of health had been trying to achieve with a blueprint that might have mattered enough so that more than a decade later, the crises Nova Scotians are currently facing in health care might have been minimized.
    I would advice the premier and the health minister to look back as well as ahead, as they take on the challenges Nova Scotians are facing in their health care.
(Disclaimer: I served on the Cape Breton District Health Authority for a decade until the concept of local health authorities was dissolved by former premier Stephen McNeil.)




























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