Critics voice concerns

Future of collaborative emergency centres questioned

Critics are worried Nova Scotia’s Liberal government might be backing off a promise to add to the roster of collaborative emergency centres established in some community hospitals.

Former health minister Leo Glavine previously said the centres would be going to hospitals in North Sydney, Glace Bay, Lunenburg and Shelburne, but the NDP says no new ones have been established since the Liberals took power more than four years ago, and there are signs the government is shifting its emphasis to existing family practices outside of hospitals.

The first collaborative centre was established by the former NDP government in Parrsboro, Cumberland County in 2011, and seven more have opened around the province, using oncall doctors, nurses and paramedics — and in some cases midwives and mental health workers — to cover non-urgent or non-emergent care and relieve the stress on smaller emergency rooms.

“The Liberals have promised them in a lot of rural communities, but that hasn’t happened,” said NDP health critic Tammy Martin, the MLA for Cape Breton Centre. “And I have heard from the medical professionals, from doctors, that a collaborative practice will not help them at all.

Instead, said Martin, doctors have told her the province should recruit more family physicians.

The government and the Nova Scotia Health Authority have both said that recruitment is ongoing and more doctors are on the way.

“Tell that to the 107,000 Nova Scotians that are without a family doctor,” said Martin.

John Malcom, retired CEO of the former Cape Breton District Health Authority and one of the early advocates for collaborative emergency centres, said shifting the burden of care onto already overworked family practices would be a mistake.

“To me, it’s like a $20 bill that’s only printed on one side,” he said. “You need both.”

Malcom said there is plenty of evidence that stronger access to primary care improves people’s health by treating problems before they become crises.

That means having collaborative teams available in family practices and at community hospitals.

“The collaborative model is an exceptional model,” he said.

“I think it’s a great thing, but I also think there’s nothing wrong with having nurse practitioners working in a group or having family doctors working solo. The key is you get access when you need it. It’s not the type of access. Once everybody’s got access when they need it, we can talk about how we improve the quality of service.”

Emergency rooms across the province are shut down for thousands of hours every year due to unplanned shortages of doctors or nurses, something that also occurred when Malcom was CEO of Cape Breton health care.

Scheduling and staff recruitment are difficult, he said, but that is one factor that diminishes health care and health outcomes.

Progressive Conservative health critic Elizabeth Smith-McCrossin, whose Cumberland North riding includes a collaborative emergency centre in Pugwash, with another in Springhill in a nearby riding, said the centres work well, when they aren’t hit by temporary closures due to staff shortages.

“If they’re staffed, they work perfectly,” she said. “But it’s really hard on communities when they’re open half the time. It’s inconsistent. When there’s a real emergency, they need to know that that emergency room is open.”

The Nova Scotia Department of Health and Wellness website does not seem to list the locations of collaborative emergency centres, and information pages on the site mostly refer to collaborative teams rather than centres.

And last September, Premier Stephen McNeil announced new money for nurse practitioners and family practice nurses for existing collaborative teams, seeming to mark a shift away from emergency centres.

A 2014 study by an independent consultant found collaborative emergency centres in Nova Scotia offered improved access to primary care and a reduction in unplanned emergency room closures, and McNeil has since reiterated his support for collaborative care.

“One of government’s top priorities is to improve access to primary health care for Nova Scotians,” Health Minister Randy Delorey said in an emailed statement late Tuesday.

“The focus of our current planning is in establishing and supporting more collaborative teams of health professionals.”

“We know this flexible approach supports recruitment, retention and work satisfaction of health professionals, and directly improves access to care and quality of care.

“There is detailed planning underway to invest further in collaborative care teams, with a focus on improving access to primary care.”