Amid local and provincial attempts to fight problems in the health care system, it was very disappointing to learn that two emergency departments in the Strait area were closed a total of 1,664-hours during 2018-19.
According to the annual Accountability Report on Emergency Departments, published by the Department of Health and Wellness, in the Eastern Zone, there has been a dispiriting 58 per cent increase in closure hours over the previous year.
According to the report, which was released in December, in Zone 3 (the Eastern Zone), there were a total of 22,116.5 emergency department closure hours, including 12,843 scheduled and 9,273.5 temporary closure hours. Temporary closure hours within the zone saw an annual increase of 119 per cent.
Emergency departments with no scheduled closure hours saw the Strait-Richmond Hospital in Evanston with 906 temporary closure hours, St. Anne Community and Nursing Care Centre in Arichat had 758 temporary closure hours, Guysborough Memorial Hospital recorded 96 temporary closure hours, and Eastern Memorial Hospital in Canso dealt with five temporary closure hours.
Nova Scotia’s New Democrats responded that emergency closures have increased every year the Liberals have been in power but the premier “sits by and does little to nothing.”
When the Liberals took office in 2013, there were eight Collaborative Emergency Centres (CECs) that had been opened, which the NDP said helped reduce ER closures. Instead of using this model, which was developed in Nova Scotia and is now used in other jurisdictions, the NDP said the Liberals cancelled planned expansions of CECs in Cape Breton and Lunenburg County.
Under Darrell Dexter’s government, emergency room closures went down every year because the NDP invested in health care. Some of the solutions they propose include opening new CECs, building new long-term care beds, allowing physician assistants to practise in hospitals to reduce congestion, and creating same-day/next-day mental health services to take the pressure off emergency rooms.
Progressive Conservative leader Tim Houston said the increase in emergency room closures is further proof that the McNeil Liberals are making things worse, maintaining that since Stephen McNeil became Premier, there has been a 213.6 per cent increase in closure hours, comparing the numbers in the 2013-14 accountability report to the numbers released last month.
Claiming the province “is putting people’s health at risk,” the PCs said too many Nova Scotians do not have access to primary care, and that coupled with more ER closures, is a “dangerous situation.”
Houston added that because the province is in a “health care crisis” and people are “terrified,” Nova Scotians can no longer accept “minimal action” by this government.
The Department of Health and Wellness said in the report that it is “working hard” with the Nova Scotia Health Authority (NSHA) to address problems in the health care system.
Barb O’Neil, Eastern Zone director of emergency program of care, said temporary emergency department closures may occur due to physician, nursing, or paramedic availability.
O’Neil said the NSHA works with its teams in the local area to “achieve coverage” when faced with a scheduling vacancy. If coverage isn’t found, a temporary closure may be “unavoidable.” She pointed out that nurse and physician recruitment is ongoing.
O’Neil explained that Collaborative Emergency Centres were developed to enhance day time access to primary care and support night time access to the broader integrated network of emergency care. By having a nurse and paramedic, or two nurses, available overnight in the CECs – with oversight from a physician by phone as part of the team – family physicians are freed up during the day to provide primary care when there is more demand, and respond to emergencies when they arise, O’Neil said.
O’Neil said the NSHA is evolving toward a provincial emergency system that will include various levels of emergency departments with varying response capacities, connected through tele-medicine and the high quality ground and air ambulance system. At the same time, they are working to strengthen the primary health care system with collaborative family practice teams that are “health homes,” where family physicians, nurse practitioners, family practice nurses, and other health care providers work together to meet patients’ needs.
It is encouraging that work is being done to modernize and improve the emergency care system, but the fact is that emergency department closures have more than doubled since last year, and it doesn’t seem this trend will reverse immediately.
While groups, governments and agencies in the Strait area and around the province have done yeoman’s work in trying to attract and retain doctors and other health care workers, clearly not enough have been recruited, and unless more come to Nova Scotia and soon, ERs will continue to close.
That doesn’t mean the situation is hopeless.
There is room for more integration, the use of more technology, coupled with increased investment by the province to help fill these gaps, and while that work is being done, if more health care professionals decide to locate in Nova Scotia, these trends can be reversed over the long-term.
It does not mean that emergency departments will not close years down the road, but this can become far less frequent, and that is a glint of hope in a hopeless situation.