Auditor General calls for more and better health communications

Policy and procedures remain a patchwork across the province

The provincial government did not have a good day Wednesday.

Auditor General Michael Pickup lifted the lid on problems in the Nova Scotia health care system and laid bare findings that confirmed the suspicions of opposition politicians, and caught others, including Doctors Nova Scotia, by surprise.

Three performance audits were conducted earlier this year, on physician recruitment, mental health, and home care services, and found – in corresponding order – confusion, inequity and a lack fundamental financial management.

Even Pickup seemed perplexed by the Liberal government’s poor communications with Nova Scotians on critical health issues.

“I shouldn’t be here telling you this,” he said at a news conference, talking about physician recruitment and the future of primary care, instead the government should be doing it.

The auditor general has statutory power to look at pretty much whatever he wants to across the provincial public sector, but Wednesday he lent his powerful voice to those calling on the government to talk openly and honestly with all Nova Scotians about health care.

He may also have provided some ammunition to the growing chorus of voices demanding that the Nova Scotia Health Authority lift the veil of secrecy that shrouds its governing board, when he noted that staff at the authority would report recruitment results more fully to the board.

The auditor general is an advocate of public accountability and believes that kind of information – especially results – belongs in the public domain.

Nancy MacCready-Williams, CEO of Doctors Nova Scotia, which represents all 2,400 practicing physicians in the province is concerned that DNS only learned of the existence of the Nova Scotia Health Authority’s (NSHA) recruitment strategy in the auditor general’s report.

Doctors have been offering to help the province develop a recruitment-retention strategy for physicians for years, but were not consulted by the NSHA on its strategy, which MacCreadyWilliams suggested is half a plan if it’s only about recruitment and ignores the retention of doctors already here.

Others were taken aback that the strategy is only months old, given that doctor recruitment has been a significant issue in the province since before Stephen McNeil’s Liberals were elected.

In fact, during the 2013 election campaign, the Liberals promised that every Nova Scotians would have a family doctor, but it wasn’t until the spring of 2017 that the health bureaucracy they created put a strategy in place to attract doctors.

Both Opposition Leader Jamie Baillie and NDP leader Gary Burrill said the auditor general’s report confirms what the government refuses to admit. There is a crisis in Nova Scotia’s health care system.

For his part, Health Minister Randy Delorey spent 45 minutes Wednesday trying to put a brave face on the report, but his vague answers failed to blunt any of the criticism inherent in its findings.

Nova Scotians who registered with the NSHA in hopes of finding a family doctor got cold comfort from the report’s disclosure that doctors don’t necessarily look to the registry when they take on new patients.

That prompted Tory leader Jamie Baillie to call the registry a “sham” that gives the appearance of action, but solves nothing.

Other issues raised in the report have been festering for a decade. In 2008, then Auditor General Jacques Lapointe told the Health Department it needed to verify that the 20-odd companies paid to provide home care services in Nova Scotia are actually performing those services.

Pickup repeated that recommendation in this report, adding that the Health Department’s own risk assessment identified a high risk of fraud in the home care sector because of the lack of proper procedures to verify that services billed are services provided.

The health authority is still wrestling to bring consistent mental health services to Nova Scotians. Policy and procedures remain a patchwork across the province, and in some areas emergency mental health services are a long distance away.

Many of the problems identified in the report are of the government’s own making. Through its obsession with message control, that results in lousy communications; through confusion and possible conflict between the health authority and the health department; and by not following up on past recommendations from the auditor.

If the McNeil government only takes one message from Michael Pickup’s report it ought to be that Nova Scotians not only deserve a full and honest assessment of their health care system, but it’s in the government’s interest to provide it.

One thing about government and political spin. It’s circular. It’s doesn’t take you in any direction.

“Many of the problems identified in the report are of the government’s own making.”

Jim Vibert consulted or worked for five Nova Scotia governments. He now keeps a close and critical eye on provincial and regional powers.