Month: May 2017

Yes we can: Revoke pols’ hospital privileges

drawing
Architectural drawing of an upgraded hospital building in HRM

For far too many Nova Scotia politicians, the interests of their party outweigh those of the people who vote for them. This is why citizens hold them in such low regard. So, if we want see the Halifax’s hospital and outpatient services upgraded to modern standards, we will have to wrestle the project away from our political class.

An independent authority would do, but not the NS Health Authority, which was born wearing the political stink of 2013 campaign politics. Problem is, the task of creating the authority would fall to partisan politicians, who hate to put distance between themselves large amounts of money or power.

A case in point is the Efficiency Nova Scotia Corporation, which lost its legislated independence and revenue stream shortly after the Liberals took over in 2013. The money was about $45 million a year tacked on to electricity bills, where government couldn’t get at it. The corporation’s short-lived independence was the result of consultations in which the public was clear that ENSC should be free of politics.

ENSC had its own Act because, the thinking was, it would be too embarrassing for a government to repeal it. Turns out it wasn’t a problem for Stephen McNeil’s Liberals, who killed the law six months after they were elected and seized control of ENSC.

ENSC’s other problem was that it was an NDP creation and thus inherently unacceptable to Liberals, just as the NDP loathed the Conservative-crafted Environmental Goals and Sustainable Prosperity Act. What saved that act from repeal was its unanimous passage by a House that wasn’t really paying attention. It’s harder to repeal an act you voted for.

The QEII redevelopment project involves hundreds of millions, which presents both an opportunity and a problem for Nova Scotia partisans. The opportunity is obvious: the  budget estimate starts at around $714 million, according to a 2009 Capital District Health Authority PowerPoint you can find here. The problem is, no sane politician campaigns on a promise to spend that kind of money in Halifax. You would win more votes by promising a mandatory puppy-cull.

Oh, and all the rooms would be private and have big windows, something proven to pay for itself in shorter recovery times, but nonetheless hard to explain to a certain class of voters.

Why am I so cynical about this? Because all three major parties have had a crack at the  project since 2009 and all three have dropped the ball after an election. And self-serving political parties are the reason. In a better world, new governments would pick up important projects where their predecessors left off. But not in NS.

To wit: the PCs got the 2009 plan just months before an election and turned a blind eye. The NDP appears to have ordered the project cut by half (see below) just before the 2013 election, although unlike the other parties, they did consult the public on the plan. The Liberals won’t even discuss the cost, preferring to add up all the bits sometime in the future and THEN tell us. Or they don’t want to be accountable for it. Or it wouldn’t fly in rural NS. Or they have no idea.

And don’t think the Liberals jumped on the job right after they were elected. They announced “their” plan in April 2016, borrowing heavily from earlier work, after wasting 2.5 years amalgamating nine health authorities.

Just for example, this is an excerpt from the “final report” the NDP had in front of them in May 2013. If you’re a lover of detail, here’s the full version, but prepare for a long download.  It’s worth your time, though, because it’s the standard we should be aspiring to. (I expect, as with the NDP, whoever is in power will prefer something much cheaper.)

For a quick fix, here is a single page from the report illustrating with a photo of the concept the planners had hoped to emulate, with some explanation.

Or, here’s a cropped version of the picture:

photo
Banner Page Hospital in Arizona, an example of what the defunct CDHA aspired to.

This could have been ours by 2015, if the NDP or Conservatives had been interested.

What happened, you ask? Here’s a clue — just a clue — from a subsequent draft report dated August 2013, two months before a general election, but likely never seen.

"To develop cost reduced scenarios within a fixed budget assumption, several major potential space/ bed capacities were explored ... Project budget is $360m."

In other words, Capital Health had been told to slash the project cost. To see the impact of that budget cut, you can look here. Of download the full document.

What to do? Well, the groundbreaking Environmental Goals and Sustainable Prosperity Act was passed by a Conservative minority government. The power dynamics of such governments often produce creative results. The job of citizens is to persuade the party holding the balance of power that it’s in their partisan interests to force the winners into de-politicizing the hospital project if they want to stay in power.

Yes we can.

 

Did a police dog eat SiRT’s homework?

Tomorrow, May 16, the Serious Incident Response Team (SiRT) and the Halifax Police Service will reach the 11-month mark in their suppression of the name of a 41-year-old man who died in a Halifax police cell.

That means it will have been 11 months since SiRT supposedly began investigating the death of CR, as I call him.

I have several theories about the delay. One is that SiRT Director Ron MacDonald has been too busy helping the NS Bar Society put Lyle Howe in his place to move the CR investigation along.

Another theory is that, for the dullest of reasons, SiRT is never going to release the results of its investigation and, consequently, you will never know whether the victim simply died from misadventure, was killed accidentally through negligence, or was murdered.

A third theory is that a police dog ate MacDonald’s homework.

It’s difficult for bloggers to dig into these issues because we don’t have the thousands of followers enjoyed by mainstream media. A communications flack once told me: “I really don’t have time to give a high priority to questions from bloggers.”

I completely understand and even sympathize. But the media don’t seem interested, which means I’ll have to put on my amateur reporter fedora and begin calling CR’s family and friends to confirm his identity.

They won’t like it and neither will I, but I’ll do it because the police and SiRT are being undemocratic. And, unfortunately, it seems to be catching on.

If you know something about CR, you can email me at gpike@eastlink.ca. I’ll do my best to honour a request for anonymity, but I don’t have the resources to resist a court order demanding your name and I don’t want to go to jail. A pretty good solution is go to a library or internet cafe you don’t routinely visit, set up a phony gmail account, send me the email, and then kill the account. It’s not bulletproof security, but it requires a lot of effort to learn who you are. Whatever you do, don’t send it from work.

If you feel your information is so hot that organizations will indeed go to extreme lengths to find you, then give it to the CBC, which has a secure drop at https://securedrop.cbc.ca.

 

NS has the most doctors per capita in Canada

Canada physicians per capita

The 261 number is about the same as the United States, but much lower than France (330) or Italy (420)*, two of the top-rated health systems in the world.

However, there are subtleties to this that will never be discussed in an election campaign, if ever. For example, Doctors NS argues the high ratio here is driven by the need to treat patients from other Atlantic Provinces. Perhaps, but other provinces will have unique challenges, too, such as vast territories to cover.

The detail-oriented among us are invited to see the Physician Resource Planning report submitted to the Dept. of Health and Welfare.

*OECD (2017), Doctors (indicator). doi: 10.1787/4355e1ec-en (Accessed on 05 May 2017)

VG fix starts at $714 million

Slide 16 CDHA w border smaller
Presentation for Treasury Board, April 22, 2009

Two days into the election, no one seems to want to talk about the all-in cost of bringing hospital services in Halifax up to contemporary standards. In fact, about a year ago, the premier said it would be “irresponsible” to speculate about that.

But at Turpin Labs Irresponsible R Us. So I say the cost starts at $714.1 million, as of 2009, and rises with inflation.

My source is a PowerPoint deck by the Capital District Health Authority intended for presentation to the Treasury Board on April 22, 2009 — the waning days of Rodney MacDonald’s Conservative government.

It’s fun to imagine what the reaction to that must have been. The Tories were going to call an election in two months and no sane Nova Scotia politician would go to the polls with a plan to spend that kind of money in Halifax, even if many of its specialized services are used by all Nova Scotians.

And yet the $714 million number is in the ballpark. By comparison, a new 172-bed hospital slated for completion in Grande Prairie in 2019 looks like it will come in around $740 million. (I don’t know why Albertans tell taxpayers the cost of their hospitals. They’re just wild and crazy, I guess.)

By contrast, my information comes from a document obtained through the province’s tedious and execrable freedom of information process. You can download the deck below. The red circle on Slide 16 is mine.

TL Treasury_Board_Master_Plan_Presentation_April_22_2009.

You may hear that the 2009 and subsequent proposals that each of the previous three governments have seen were too expensive because of “frills” such as single-patient rooms with large out-facing windows. But research shows these features accelerate healing so much that they pay for themselves in reduced patient-load.

The deck says the earliest feasible target for vacating the Centennial and Victoria wings at the VG site is 2015. Yep, that’s right. It could have been done by 2015.

When Darrell Dexter’s NDP took over in June of 2009, the CDHA asked for a meeting the same day. But the Dippers appear to have sought minded-boggling budget cuts that in the end rendered the project moot.

Next up, Stephen McNeil’s government in 2013. They wasted maybe two years amalgamating the province’s nine health authorities, accidentally neutering Halifax’s in the process.

Finally, in April 2016 they announced a “plan” that was mostly cherry-picked from previous proposals. Hell, the Terms of Reference weren’t prepared until a month after the announcement. You can download that below:

Terms of Reference QEII Steering Committee May 25 2016

For an irresponsible comparison, here’s a TOR template:

TOR template-download

Here are some excerpts from the 2009 proposal:

  • An aggressive “push down and out” of hospital services into robust, interdisciplinary and highly integrated community health services centres.
  • Less about architecture, more about interpersonal networks and relationships in a wide array of services – i.e. community health centres and family health teams 
  • Strategically located throughout our communities in locations that respond to community needs. 
  • A mental health master plan.    
  • And Phase 2 – 2018 to 2026:
    A menu of alternatives based on projected needs with flexibility to adapt to: 
  • changing priorities and funding opportunities 
  • Fitness, wellness & commercial building on VG campus 
  • Expansion of Cobequid Health Centre 
  • Freestanding, comprehensive suburban ambulatory centres 
  • Comprehensive community health centres on new sites 
  • Further expansion at HI, VG and DGH sites 

Will the next government follow through this time?

Here’s something George Moody, a health minister in the 1990s, said to the late, lamented Halifax Daily News around the turn of the century: “We’ll never get the health system working right until all the political parties agree on a plan that goes beyond a four-year mandate.”

So, my advice for voters is be cynical, be very cynical.