N.S. health-care plan good start to long trek

My advice to the premier is that “fix” has become the F-word in health care, and he should stop using it.

Much of the Nova Scotia Progressive Conservative health platform that got them elected was dangerously simplistic, and didn’t give much confidence that they understood well enough how the system works to have the foggiest idea how to make it better. Then, after getting elected on the strength of that platform, they fired the people who might have been able to explain what was going on, and thought that someone with no experience managing health care would do a better job than a doctor with an MBA. To be frank, I was feeling pretty nauseous about what the next few years were going to bring.

But since then, this government has taken some tough issues head on and seems able to get good advice. The premier, the minister of health and a couple of key deputies hit the road last fall to listen to health-care workers throughout the province. Tim Houston said they’d release a plan for the health system based on what they heard by the end of March, and we got it just over a week ago.

The first thing I like about the plan is that there is one. That sounds like a very low bar, but let’s be honest; there hasn’t been any strategic plan for the health-care system since 1994 (I know, because I wrote it). It even became law in 2014 that the Department of Health and Wellness was responsible to produce one, and they never did. Whether people like this plan or not, there can be no accountability without one, and that’s been a perennial problem for every government led by every political party for the past 25 years in Nova Scotia. The Liberals didn’t produce a plan. The NDP didn’t produce a plan. The previous PC government didn’t have one, either. This plan wasn’t “three weeks overdue.” Just saying.

As for the document itself, despite being panned by critics before the ink was dry, I think it’s a really good start. It covers all the major issues that challenge the health-care system and seems to commit to solutions that learn from the past but are forward-looking. There’s a heavy emphasis on recruitment, but it’s not physician-centric. It talks about shoring up the supply of providers, but also speaks to the need to address demand for health services. There’s the need to improve efficiency with a commitment to modernize. Ways to make more sensible use of resources have been identified — and there’s even tolerance for risk.

For those who criticize the plan for being short on new ideas, I’d point out that what we’ve been short on is a commitment to implement the many, many good ideas that have been talked about for years. If anything, this plan is vindication of all the reports, studies and commissions that have set out what needs to be done to fix health care, but that sat on shelves for decades. In many ways, this plan is a compendium of work whose time has finally come.

That’s the good news. There are also parts of this plan that will trip the premier up if he doesn’t do some quick manoeuvring.

First, this is absolutely not a four-year plan (and if anyone in leadership really thinks it is, I’m still worried they haven’t learned as much as they should have). It’s probably not even a 10-year plan, but at the very least it should be regarded as that. What we need is disciplined, determined focus on a long-haul effort, not a start-andstop. Pretending this can be done in four years, and then predictably failing by year three to a resounding “told you so,” just doesn’t seem very strategic.

Second, they have the title wrong. This isn’t an Action for Health, it’s a plan for the healthcare system. That’s not just splitting hairs, it’s really important. Every dollar we spend on health care is a dollar not available for some other area, like schools, roads, services for persons with disabilities, the courts, child protection, tackling climate change, tourism, etc., so how much the health-care system should take up of the provincial budget remains a huge issue. We can’t throw an extra $400 million at it every year, but there’s no connection between this plan and the budget that was just passed. There are some very significant transition costs — crumbling infrastructure, modernizing our health information systems, addressing wages and the extraordinary backlogs in care, just to name a few.

We need a 10-year financial plan to see how all these ideas actually get implemented, in what sequence and what that means for the rest of government. And failing to invest upstream in things like early child development will make downstream costs spiral — so saying that decisions will be “evidence-based” means we’ll need the courage to actually make them.

Finally, we have to start counting the right things to measure the performance of the health-care system — and today, we don’t. The number of health-care professionals recruited is less important than the number who stay. How many Nova Scotians are attached to a family doctor is less important than how easy it is to get the right service from the right health-care professional when you need it. Health information systems that connect providers to each other, but not patients to the health system, are incomplete. The rate of handwashing by hospital staff is less important than the rate of infections, and the number of days rural emergency departments have unplanned closures matters far less than how quickly patients receive emergency care that saves them.

My advice to the premier is that “fix” has become the F-word in health care, and he should stop using it. Tell us instead what taxpayers should be expecting to get from a high-performing, publicly funded health-care system that Nova Scotia can afford, and give us the tools to understand if it’s doing the job. This plan is a good starting point for a journey that’s going to be long and arduous.