Nova Scotia's doctors and health
policymakers are getting hot and bothered over something
called "transformational system-wide realignment." Trouble
is, no one can agree on quite what that means.
A divisive new government-commissioned
report, penned by a private health management consultancy
firm and released to the public late last month and
packed with over a hundred recommendations, has sparked
a contentious healthcare debate in the Bluenose province.
The only thing everyone can agree on, it seems, is that
healthcare in the small province — which is in
the throes of a funding crisis that's led to critical
physician shortages and repeated ED closures and other
service cancellations — stinks.
The ruling Progressive Conservative
government and the MD association Doctors Nova Scotia
like the report. "Certainly we believe it's past time
for�change and modernization of the healthcare system
in Nova Scotia," president Dr Don Pugsley told NRM.
Critics, however, have complained
of the vagueness of some integral elements of the reforms,
the timeline for those changes and the vision for a
healthcare system as a whole. "Really, what is missing
from the report is it doesn't say — and this is
pretty critical when it has been described as 'transformational
reform' — it doesn't say what [the government is]
going to say, when, how or how fast," says NDP opposition
leader Darrell Dexter.
ACUTE
CONTROVERSY
Of the 103 recommendations made by the report, entitled
Provincial Health Systems Operational Review (PHSOR),
one set has attracted by far the most attention from
policymakers and physicians in the trenches. Recommendations
#25-31 suggest the system can be more efficient by asking
community clinics to take on some acute care responsibilities
from small hospitals and centralizing a portion of emergency,
specialist and subspecialist services.
Critics have bridled at what has
been seen by some as a cost-cutting, budget-slashing
measure. Mr Dexter says he worries the recommendations
may result in rural hospital and ED closures. The government
supports the idea to "consolidate infrastructure" but
denies it plans to close EDs.
"What [the recommendation] is not
going to mean is that we won't have acute care services,"
says Dr Brendan Carr, the Capital District Health Authority
vice-president of medicine. "The report doesn't undervalue
acute care services — it simply recognizes we have
had an overemphasis on acute care. It's speaking to
the need for balance of resources."
Dr Dexter calls that "disingenuous."
"They say 70% of people who came in didn't have to go
to the emergency room, but the problem is that is retrospective.
If you come in with chest pain, you don't know until
later if you should have seen your family doctor," he
says. "And what happens to the 30% of people who did
need it?"
OTHER
RECOMMENDATIONS
Most other recommendations have been less controversial.
"Aside from access to rural and speciality care," says
Dr Pugsley, "most of the recommendations support improvement
in primary care delivery." For instance, Doctors Nova
Scotia was pleased to see an effort to encourage collaborative
care models and electronic medical records use.
The spectre of privatization, however,
has reared its head again. The government has eagerly
accepted a recommendation urging more public-private
partnerships, citing predictions of the healthcare budget's
growth. One Tory MLA, Pat Dunn, in a moment reminiscent
of last year's funding alarmism in BC (which was roundly
blasted for its "Chicken Little" logic) told the Pictou
County News, "The system, if it were to continue as
it is, would consume the province's entire budget within
20 years."
"That's a false comparison and
an inaccurate extrapolation from what are, in my view,
faulty data sets," says Mr Dexter. "In part, it seems
they use this [warning] to try to hive off parts of
the healthcare system they can place in private hands."
But Dr Pugsley says today's crisis
means "the public can't afford to wait for that debate
to reach a natural conclusion.... In 20 years somebody
will say 'I told you so' but we have to find innovative
ways to improve access now."
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