Despite claims from the provincial government that improvements have been made, and they are committed to continuing to work on it, facts on the ground are showing that the health care system might be getting worse.
Because of the many problems in the system, Minister of Health and Wellness Michelle Thompson told The Reporter recently that it will take money and time to fix health care.
The health minister said one priority is to address primary care needs which will be helped by the creation of an urgent treatment centres and the reopening of emergency departments.
To increase training opportunities, the province has entered into a Memorandum of Understanding with the Michener Institute and is working with the Canadian Resident Matching Service, the Antigonish MLA said, noting the province is looking at different models surrounding the duties of pharmacists.
For those who don’t have a primary care provider, whether a physician or a nurse practitioner, Thompson said it is important they enter their names on the Need a Family Practice Registry so they can access virtual care, and if the primary care provider that you speak with feels there is a need, patients can be seen in a clinic.
The health minister said adopting new ways of doing things can drive better care for patients and help doctors put down roots in communities.
One example of innovation in health care is the mobile primary care unit which was put on the road in the Cape Breton Regional Municipality after Hurricane Fiona, Thompson noted. She said people were able to access care outside of the “usual environment” and even those with urgent treatment concerns were navigated through the system.
Thompson will join Deputy Minister Jeannine Lagassé and Nova Scotia Health CEO Karen Oldfield for a series of community conversations across the province.
The Antigonish session will take place on Oct. 27 from 7 to 9 p.m., then on Dec. 2, the consultations will visit Inverness from 2 to 4 p.m. and Port Hawkesbury from 7 to 9 p.m.
Thompson said she wants talk about some of the initiatives happening in the Strait area. Given the challenges around recruiting nurses and physicians, she said there is a need to look at different ways to deliver care.
Thompson said improving the system so it’s reliable and responsive will take time. She said physician training is a long-term goal, more specifically a 10-year investment, in the medium term are issues like internationally educated staff, and hiring 180 transport drivers is an example of a short-term goal where the province has reduced low acuity ambulance transfers.
Sometimes recruiting a physician can solve a number of needs in one community, but Thompson said another community might need a “more complex approach.”
Also on Oct. 12, the province announced in a press release a $6.3-million investment over the next four years to help new graduates and new doctors to the province establish practices, starting at Dalhousie family medicine clinics.
But during the regular monthly meeting of Inverness Municipal Council in Port Hood on Oct. 4, District 4 Councillor John MacLennan said visitors to the emergency department at Inverness Consolidated Memorial Hospital “are coming from all parts of Cape Breton,” and as far away as Truro.
After MacLennan noted that staff and taxpayers are worried about what’s going to happen if they have to close the emergency department, District 5 Councillor Lynn Chisholm said these same concerns are “coming from everywhere.”
Commenting that “we’re all worried, absolutely,” Warden Bonny MacIsaac recommended that the issue be discussed further, and council agreed to a suggestion from CAO Keith MacDonald to have a representative from the department of health attend a future council meeting.
Then in a press release issued Oct. 12, Nova Scotia Health said it was experiencing high patient volumes at hospitals in all zones.
And on the same day that officials toured the newly renovated Strait-Richmond Hospital, administration and provincial officials were responding to rumours of more cuts to the facility.
On Oct. 18 at the Riverdale Community Centre, officials with Nova Scotia Health, the Strait Richmond Healthcare Foundation, and Strait-Richmond Hospital hosted a public meeting.
Strait-Richmond Facility Manager Rose MacIsaac said the future “is looking bright, maybe not exactly what it always was, but definitely we’re staying focused on the direction and building back up to our former level of service.”
Glen Cox, Executive Director for Community and Rural Health in Nova Scotia Health’s Eastern Zone, took time to “address any rumours about the hospital’s status.” He said “there are no plans to permanently close the hospital or its emergency department.”
Cox said Nova Scotia Health contributed $650,000 to the renovation project at Strait-Richmond and is “making other investments in the site.”
Nova Scotia Health (NSH) funded the overhaul of the air handling system, increased hot water capacity, and are looking to enhance diagnostic services such as laboratory and diagnostic imaging, Cox said.
The first person to address the meeting, businessman Joe Shannon, said they are renovating two rooms in the hospital to include a bedroom with a television to attract more specialists.
Currently, there is one emergency department physician who works eight hours at a time and the department is open based on his availability, Cox said, noting the hope is that two family physicians in the Practice Readiness Assessment Program (PRAP) will be able to provide emergency coverage once they their emergency department competency is completed.
Last June a temporary model of care was introduced at the hospital which included a patient capacity process, Cox noted. Under this process, once all the beds in the emergency department are filled, the department has to close, he explained, and once the patients have been treated and beds are available, the department reopens and remains open until it reaches capacity again or reaches the end of the scheduled hours of physician coverage.
Cox said 10 in-patient beds are used for medically stable patients awaiting transfer to other facilities, as well as for palliative care patients.
Recruitment is underway for additional staff, Cox stressed. He said one full-time advanced care pharmacist has been hired to work at the hospital, a clinical nurse lead is in the process of being hired, Continuing Care Assistants have been added to the staff, there is increased security, and a Registered Nurse (RN) and a Licenced Practical Nurse (LPN) are expected to start in the spring of 2023.
Noting they are engaging in the ongoing recruitment of emergency department physicians, Cox said they are recruiting RNs and LPNs, using travel nurses to cover vacancies, and are reviewing requests from allied health professionals who want to work in the facility.
Cox said they are constantly evaluating the temporary model of care, “to get back to where we were in the past with an in-patient model that works.”
After officials spoke, there were questions from the crowd of approximately 60 people.
Former Richmond Warden Steve Sampson asked for more information on recruitment efforts, specifically for the emergency department.
Cox said NSH has been working closely with recruitment advisors, noting they are hoping the two PRAP physicians can help keep the emergency department open more often.
However, Cox said the NSH is “facing a health human resources crunch across North America,” noting that “every other organization in every other jurisdiction is offering those same incentives.”
When asked by Sampson how long it will take for the PRAP physicians to be available, MacIsaac said they need to complete their program before they can work in the emergency department. She explained that it takes at least a year before they can write an exam, then they need to be mentored in the emergency department.
In response to a question from Port Hawkesbury resident John MacLeod Langley, MacIsaac said the PRAP physicians are under a three-year commitment, but one year has passed already, and they can leave after the third year.
This could leave the Strait-Richmond emergency department with coverage and expanded hours for a short time, but over the long-term, noting is guaranteed.
And according to the NSH, they are offering similar incentives and recruiting against almost every other jurisdiction in North America for a limited pool of health care professionals.
This comes as emergency departments in places like Inverness swell with visitors, as more Nova Scotians continue looking for a doctor, as this province deals with a shortage of health care workers, and as ambulance wait times continue to be unacceptably high.
Transport operators might be able to fill some of the gaps in the emergency health care system, and virtual care might help some people, but they aren’t long-term solutions to what appear to be growing problems.
It’s conceivable that the system is in such bad shape that things will have to get worse before they eventually get better, and that could be what is taking place right now.
But during this time of widening cracks, how many Nova Scotians will fall through, and how long will the public continue to accept this reality?