Higgs’ adoption of Nova Scotia’s health playbook is a ‘huge gamble’
A tragic death in the ER, a health care crisis — and a prime minister firing top health officials while promising to fix the system in a hurry.
It happened in New Brunswick this summer, but a remarkably similar series of events unfolded around the same time last year in Nova Scotia.
On July 22, 2021, Bedford man Keith Harker died while awaiting treatment in the emergency department at Cobequid Community Health Center in Sackville.
The province was in the first week of an election campaign where health care was already the main issue.
“There was a feeling that things weren’t going well, that there were multiple failures in the system and that something had to be done,” says Katherine Fierlbeck, a political scientist at Dalhousie University who specializes in politics and policy. health.
“The Conservatives mounted a campaign very much based on ‘fixing’ health care, and I think that’s what people responded to.”
The day after he was sworn in, new Progressive Conservative Premier Tim Houston replaced the CEO of the provincial health authority, appointed a new deputy minister of health, and replaced the provincial health authority’s board of directors. by an administrator.
The new team was able to make “an immediate difference” in the system, Houston said.
“I think sometimes you just have to press reset. It’s time to press reset at the Nova Scotia Health Authority.”
Now, Premier Blaine Higgs has adopted a similar playbook in New Brunswick, appointing a new minister and new CEO for Horizon Health this month and appointing administrators to replace the boards of Horizon and Vitalité. . Earlier this summer, he replaced the Deputy Minister of Health.
“We recognize this is a crisis and I’m not going to give up,” Higgs said, days after a man died while awaiting emergency treatment at Dr. Everett Chalmers Hospital in Fredericton. .
“I am prepared to do whatever is necessary to protect and improve our province’s health care system.”
The Prime Minister has called for the two health boards to be replaced by temporary administrators, but it is unclear what exactly “all that is necessary” will look like.
He wants more latitude for patients to travel to other hospitals if they can get services there more quickly and called for greater cooperation between Horizon and Vitalité.
He spoke of “structural change”, and while he ruled out the merger of the two entities, he did not rule out the possibility of putting them both under the same board of directors.
Fierlbeck said eliminating advice from health authorities allows governments to “control [decisions] more closely. … You are effectively signaling the end of this arm’s length relationship with the people who run the system on a day-to-day basis, opening the door to political decision-making.
A new governance structure would risk sparking controversy at a time when the PC government is already suffering in opinion polls.
But this is the first time Higgs has had both a majority government and a less acute COVID situation to deal with. Two years from the elections, he has a window to implement his own vision of health governance.
He has already tried other approaches.
In February 2020, his government passed a proposal from Horizon and Vitalité to close the emergency rooms of six small hospitals at night and divert their staffing resources to provide more primary care during the day.
But within five days the PC minority government abandoned the plan in the face of protests and the risk of losing a vote of confidence and being forced into an election.
Higgs said he was caught off guard by the lack of an implementation plan by health authorities, although Karen McGrath, then CEO of Horizon, told a committee of MPs that the Prime Minister had been knowledgeable about what to expect.
“We are behind schedule”
The government’s second attempt at a health plan last November avoided closures in favor of more consultation with local communities about the services they need.
But the Conservatives have already missed some of its targets. The Patient Connect list of people waiting to find a family doctor has grown from 40,000 to 63,000 names.
For a second consecutive summer, emergency rooms and other services closed sporadically for days or weeks due to a lack of staff.
“The plan itself is good but it needs to be implemented,” Higgs said during his July 15 press conference.
“He has goals to implement during our tenure. We’re not on that schedule. We’ve fallen behind schedule, but we’ll catch up.”
The prime minister blamed a “bureaucratic stalemate” at health authority level, although ousted Horizon board chairman Jeff McAloon said the system was “on a really significant path to change”.
Higgs did not provide a timetable for achieving what he says are clear and measurable goals for improving the system, although Fierlbeck said expectations for improvement will now be very high – as they are in Nova Scotia .
In this province, “the situation has gotten much worse”, despite the September 2021 housekeeping in Houston, she said.
The “interim” CEO appointed last year and the trustee who replaced the health authority’s board remain in place.
But the number of people without a family doctor is “climbing quite high,” and the province has seen long ER waits and sporadic shutdowns this summer, much like New Brunswick.
“When you make extraordinary promises, you’re expected to deliver, and if you don’t, there will be accountability,” Fierlbeck said.
“With a government-appointed administrator taking over the leadership from the highest level, there is absolutely no doubt where the accountability ends. Whatever happens now, the prime minister himself will have to bear it. So the stakes are quite high.”
She points to a difference between the two provincial cleanups: Houston made his on his first full day as premier, while Higgs made his moves midway through his fourth year in office.
“If you’ve been in the job for three or four years and you haven’t even monitored the effectiveness of performance measures, what exactly have you been doing?” she says.
“By firing both the health boards, the CEOS and the health minister, you are in effect admitting that your government has made a complete mess,” which Fierlbeck says could haunt PCs at the polls in 2024.
“Can a government really transform health care in two years, so that the electorate forgets and forgives this particular episode? That’s a huge gamble.”