Not enough heads have rolled at NSHA

Merger failed to free up funds for front lines

Your Nov. 25 front-page headline read: “N.S. Health Authority cuts VP positions.” The article explained that three vice-president positions have been cut.

Whether those former vicepresidents go or stay in some other capacity, it isn’t enough. The NSHA has not lived up to its mandate. I can say that because merging the province’s nine health authorities under one umbrella organization was my idea.

In 2009, my mother had a small stroke while having blood work done at Valley Regional Hospital in Kentville. Another health problem occurred and over nine months of daily visits to VRH, I saw and heard many things that didn’t make sense. As a former newspaper publisher/ business owner, I saw ridiculous organizational and communications problems.

Prior to our family’s exposure to the system, I used to believe everything would be great if only government gave health care enough money. I have since learned that no one in health care has any idea of how much money is enough to make the system work.

Doctors and nurses at Valley Regional told me their problems and issues, then connected me to their colleagues across the province. I discovered the universality of their issues. One issue was how medical talent and assets were underutilized. While Halifax

surgeons couldn’t keep up with the need, operating rooms in Windsor, Middleton, Pictou and other hospitals were dark. Surgeons were leaving the province because they couldn’t get operating room time.

In 2010, I started writing about health care for a blog and The Chronicle Herald. I proposed merging the nine authorities into one to reduce duplication of management, streamline delivery of care, redirect CEO and VP compensation to front-line workers and use all provincial assets to speed up the delivery of care to produce better patient outcomes.

In February 2013, long before the writ was dropped for the October election, the former leader of the opposition, former health critic and a member of the Liberal party office met me in a Wolfville coffee shop to discuss a vision for a merged health authority. Meanwhile, former health minister Maureen MacDonald and Premier Darrel Dexter rejected the concept and repeatedly said they weren’t going to import chaos into Nova Scotia’s health-care system.

When the Liberals took office, they were astonished to learn how advanced the Department of Health’s planning was for a merged health authority. While the NDP publicly decried a merged system, behind the scenes, they’d been working on the very idea.

Over the last six months, I have been at two public meetings in the Valley where people have wistfully mused about returning to more responsive local health authorities. They forget how poorly served we were under the previous nine health authorities.

The problem with the NSHA isn’t the system; it’s the management. We hired the same people who frustrated us when they managed the smaller health authorities to run a much larger organization. And perhaps stung by Opposition criticism of her spendthrift ways at the Annapolis Valley District Health Authority (AVDHA), where administrative expenses were 8.3 per cent of a budget that was 60 per cent above the national average, the NSHA’s CEO, Janet Knox, kept a tight rein on information about provincial health. So tight was the information flow that the NSHA executive offices are constantly referred to as Fort Knox by Valley Conservatives and front-line medical workers.

Staffing is one of the great NSHA secrets. The NDP government introduced the Nova Scotia Public Sector Compensation Disclosure Act, which requires publicizing the name and compensation figures for anyone receiving $100,000 or more from the taxpayer.

The purpose of the compensation disclosure act was to give taxpayers a type of public oversight of expenditures.

Originally, most of the health authorities, universities and other organizations covered by the act listed the names, titles and compensation of the province’s one-percenters. Even the AVDHA provided this information. However, when the NSHA was formed, job titles were dropped from the compensation report.

Retired Halifax physician and Dalhousie Medical School lecturer Dr. David Zitner often says: “You can’t manage what you don’t measure.”

Without job titles, there is not real transparency in management of the NSHA. Without job titles, the compensation disclosure is merely a prurient act. Having job titles would allow us to see if organizations, like the NSHA, are top-heavy in managers and executives. It could provide insights into problem areas in staffing and help the public understand how our money is spent.

This year’s public compensation numbers are a prime example of this transparency failure by the NSHA and government.

In fiscal 2017-18, the NSHA filing listed 884 names. However, fiscal 2018-19’s filing contains 2,699 names! This wasn’t a massive, across-the-board pay raise, but the distribution of public service awards, which for senior executives ranged from $49,441 to $132,183. For privacy reasons, this isn’t detailed in the filing.

If we can read an individual’s name and compensation, how is it more invasive to know that part of the package was a onetime payment? This level of secrecy doesn’t make sense.

The NSHA has a spreadsheet — which they provided — showing the names, job titles and amounts paid to these thousands of staff. John Gillis, director of content and media relations wrote in an email: “Regarding inclusion of titles in the reporting, the audited document posted complies with what’s directed in legislation, but acknowledging the value of understanding the roles of the people identified, we have always made available on request a version that includes that information.”

What is troubling is that of the 2,699 people paid over $100,000 this year by the NSHA, 725 were vice-presidents, directors, managers, co-ordinators, consultants, advisers, analysts, and some other managerial title holder. Other managers and executives earning $99,999.99 or less aren’t listed.

The raison d’être for merging nine health authorities into one organization was to streamline management and direct money from the executive suite to frontline care. These executive numbers show the NSHA is not keeping with the vision for merging health authorities. Not enough heads have rolled at the NSHA.

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