By Stephen Kimber
January 17, 2008
Later today, Health Minister Chris d‘Entremont is scheduled to release the results of a provincial health services operational review he commissioned two years ago. The purpose of the $1-million report, which was prepared by outside consultants Corpus Sanchez, was to provide “a snapshot” of the province’s existing health care system and offer, as d’Entremont explained at the time, “a number of recommendations to mull over on how to make our system much more efficient.”
Though the report is still officially under wraps, some of its more than 100 conclusions and recommendation have already leaked. The Chronicle Herald reported yesterday, for example, that Corpus Sanchez concludes “not all small hospitals should be providing emergency care.”
What was as interesting as that certain-to-be controversial recommendation was the government’s almost instantaneous and even-more-certain-to-be-political response to it.
“I can say with certainty there will be no ERs closing,” the premier’s spokesperson, Joe Gillis, declared flatly. “The minister has said that in the legislature, and again I can say that with certainty.”
Just so there can be no misunderstanding.
And that, in a nutshell, is our problem.
We have a problem — actually, plenty of problems — in our health care delivery system. Health care costs already gobble up more than 40 per cent of the province’s budget and an expensively aging population is only going to get older. There are too few nursing home beds, too-long wait times for too many critical procedures, not enough physicians in the rural communities where we desperately need them, the highest death rates from cancer and respiratory disease in Canada, and, of course, those seemingly never-ending closures at rural emergency rooms — a day at the Roseway Hospital in Shelburne here, a week at the Digby General there — usually because the local health authorities can’t find doctors to staff them.
In fact, the emergency room closures are really just the tumbling-into-turmoil end result of some of those other problems. That lack of nursing home beds, for example, too often transforms emergency rooms into overcrowded, temporary holding tanks for elderly people with no other place to go. And the shortage of rural doctors not only means too few physicians are available to keep ERs open but it also forces patients who can’t find family doctors of their own to turn to ERs for their primary health care.
All of that makes the notion of a comprehensive review of the sort d’Entremont initially described an important and necessary exercise.
Whether Corpus Sanchez was the right choice to conduct such a review is another matter.
As Liberal health care critic Dave Wilson pointed out in the legislature after the government first awarded the contract, Corpus Sanchez has a history of taking the easy cut-and-then-cut-some-more approach to whatever ails health care. On a previous contract for the IWK, for example, it “recommended that beds for children with cancer should be closed and wait lists for children's mental health services should be allowed to grow.” It also once advised Capital Health that “acute care beds should be closed at the QE II as soon as patients occupying them are moved to nursing homes.”
While it is too early to know for certain the overall thrust of Corpus Sanchez’s recommendations this time, the initial portents are not encouraging. One of the report’s other leaked conclusions is that putting more money into the current health care system is “not an option.”
In fact, some critics, like the Nova Scotia Citizens' Health Care Network, have suggested the government commissioned the Corpus Sanchez report to provide “a blueprint for systematically dismantling the public health care system in Nova Scotia.”
That may be harsh. The more likely scenario — given this government’s dithering track record — is that it commissioned the study when it did primarily to avoid dealing with what it knows is an un-winnable, hot-button political issue for Nova Scotians. In such a scenario, privatizing health care is just a side-benefit.
In the best of all possible Tory worlds, the next provincial election would now be history, the government would have been re-elected (in part by arguing it couldn’t discuss the contentious issue of health care reform because it was waiting for the consultants to report) and possibly with a majority of seats — this after all the best of all possible Tory worlds — which would then allow it to blame Corpus Sanchez for whatever unpopular decisions it decided to take, hoping no one would remember by the next election.
But in the real world, the Tory’s electoral prospects did not improve and the election did not happen so Rodney MacDonald’s still-minority government now has to make the political best of the sow’s ear of what will be an unpopular report.
No wonder the premier’s spokesman was so quick to dismiss even the idea of closing emergency rooms.
No wonder our health care system is in such a mess.
http://www.stephenkimber.com
Stephen Kimber is the Rogers Communications Chair in Journalism at the University of King's College. His column, Kimber's Nova Scotia, appears in The Sunday Daily News.
