HEALTH CARE CRISES: ARE WE MAKING ENOUGH PROGRESS?
The splurge of recent health ministry announcements sound impressive but reveal major shortcomings. Government seems to respond only after significant negative media exposure. Within weeks of Merritt Council withholding tax because of ER closures, millions were suddenly found to prevent these. The outcry from patients forced to have their cancer treatments out of province/country was exacerbated by being forced to pay their travel expenses. This generated a widespread sense that the government didn’t care. Weeks later, travel money was announced.
Within weeks of the news that patients admitted from the ER in Nanaimo Hospital might not have physician coverage, a 300-bed chronic-care (CC) facility for Nanaimo was announced. Also ‘a new model of nursing care in acute care facilities including establishing ideal nurse: patient ratios’ (as part of the new federal transfer package) was initiated.
Ministry officials will self-congratulate. Politicians will make hay of these announcements during the next election. Will Nanaimo patients start to fare better? Will their health care staff feel a surge of relief? Unfortunately not. The facility won’t be operational until 2027. That’s at least three more years of CC in-patients filling up hospital beds, preventing ER admissions for acutely ill patients. Everything will worsen. The government has known about this building-up crisis for years and but they ignored their own data.
What about the ‘new model of nursing care/nursing ratios’. Sound exciting? This is gobbledegook to hide the fact that they have allowed our nursing numbers to plummet to dangerously low levels. Forget the ‘model’ and ‘ratio’. Ideal nursing ratios are already known. Get more nurses pronto. There are 2400 acute-care nursing vacancies in BC. There are 4500 total nursing vacancies in BC. BC trains 1400 nurses per year. Go figure!
Surrey Memorial Hospital standards fare worse than Nanaimo. Its data are frightening. Its number of beds are less than half of the Canadian average. It has about 20% of the acute-care beds that Vancouver has (corrected for population). 80,000 patients were diverted to the ERs of other Fraser Valley hospitals last year. It is the busiest ER in Canada. It is a national disgrace. That Fraser Health Authority has allowed such a discrepancy between health facilities in Vancouver and Surrey is inexplicable and an appalling reflection of how our funding agencies operate Other than racial mix, both cities are virtually identical. All Board members of these agencies are government appointees. Therefore allocations of resources are reflective of government policy which may or not be in patients’ best interest. Public input into these decisions is virtually non-existent.
We electors have no idea how these funding decisions are made. Low public trust prevails. Countless health reports demonstrate that transparency is essential to building confidence and an understanding of rights. A recent report from Ontario has even recommended an independent body to ensure accountability in health care administration. BC Health operates on a different wavelength. It trundles along at its own pace, seemingly oblivious to demands for change until it has no choice. Allowing Nanaimo and Surrey hospitals to decline to grossly substandard levels of care is negligence. To be the last province to employ Physician Assistants shows a lackadaisical attitude to measures that should have already led to increased access to primary care.
I would be seriously remiss if I did not praise some government successes. The recent funding model for family practitioners has been widely accepted. It is worth noting that considerable public pressure was probably a factor in getting this agreement. Two deficiencies mar this agreement. It does not cover maternity work. Nor is there any incentive for doctors to form group practices, widely accepted as the essential future of primary care
Several examples demonstrate the government’s arrogance. A recent op-ed (TC 22 Oct) described the rejection by a MOH official of a request for research funding to expand the number of multidisciplinary specialty clinics because it had “not been demonstrated that there is a demand for such clinics”. But that official was fully aware that this researcher already had 40 applications from specialists across BC to help set up such clinics! The government has refused to respond to any request BC Health Care Matters has made in writing for a meeting. Not even a proforma letter acknowledging receipt of letter. Similarly, zero response obtained from my MLA (M.Rankin). Have we been unjustifiably blackballed? Is meeting with patient care advocates now a crime? The government has never directly responded to the hundreds of media posts describing unacceptable shortfalls in medical care.
Lastly, should we be optimistic that increased Federal monies will ameliorate our multiple shortfalls? Canada already spends more on health care than most countries so it’s not just dollars. The Feds are demanding data on performance progress (number of new professionals, access to family doctor, surgery backlog etc) but given their previous track-record of allowing most provinces to fail catastrophically in providing health care according to the Canada Health Act, I would not hold my breath.
Adrian Fine MD, FRCP (retired medical specialist), a director of BC Health Care Matters