Monday, 01 June 2009
The Four Parties’ Positions on Health Care: Disappointment and Doublespeak
Founded in 1996, the Nova Scotia Citizens’ Health Care Network is a coalition of community groups, labour unions, health charities, faith groups, student organizations, local committees and individuals. Our goal is to protect, strengthen and extend the public health care system.
This report is designed to provide some guidance to Network members, supporters and the general public about the four parties’ position on health care issues in this election campaign. The report does not amount to an endorsement of any party’s political agenda as the Network is non-partisan.
For more information about the Health Network, or on health care issues in the province, visit our website at www.nshealthcoalition.ca.
Overall, the four parties’ election platforms on health care are extremely disappointing. No party has scored well on all of the 8 issues our research committee identified.
The Green Party has received the highest grade in this report, a C-. The Greens would have received a higher mark if they had properly costed their platform.
The Conservatives, NDP and Liberals all received a D.
No party presented a clear vision for our public health care system. Instead they each presented a very small number of public policy ideas, most of which simply tinker around the edges of larger problems. What is clear from this evaluation is that regardless of which party forms government after the June 9th election, supporters of the public health care system will need to pressure politicians of all stripes for action.
Of particular note is that only the Greens openly stated that they oppose private, for-profit health care in both acute care and long-term care. The Conservatives openly support for-profit health care in their platform through their support for the Scotia Surgery clinic and the privatization of the Telecare service. Neither the Liberals nor the NDP make a specific mention of for-profit health care in their platforms.
This trend is quite alarming. All the parties should publicly affirm their support for a single-tier, publicly-funded and publicly-delivered health care system.
Marking System and Methodology:
The Heath Network struck a committee of health researchers and activists to rank each of the platforms.
Our committee created the following marking system:
A – The platform seriously considers and takes action on all public policy options presented by the Health Network
B – The platform contains several recommended policy options
C – The platform contains one of the recommended policy options or an equivalent
D – The platform contains none of the recommend policy options but does contain some action on the area of focus
F – The platform makes no mention of the area of focus
The Problems and Recommended Policy Options:
|Area of Focus||The Problem||Best Public Policy Options|
|ER Closures||10 ERs around the province have faced closures
in 2008/2009. These closures have had major effects on the
health of rural communities.
|- Follow the Colchester East Hants Health Authority’s lead and negotiate with physicians to get them off the fee-for-service model and on to alternative payment
plans.- Integrate nurse practitioners into rural communities, including in ER settings.
|Privatization||The provincial government allowed two private,
for-profit health clinics to open, one of which is suspected
to be in violation of the Canada Health Act. The government
also gave a contract to the for-profit, wholly US-owned
subsidiary, McKesson Canada to run the Telecare services,
despite a bid from the not-for-profit Victorian Order of
Nurses. This case also raises concerns around the
implications of NAFTA.
|- Bring the existing private, for-profit
clinics into the public health care system.- Cancel the Telecare contract and build Telecare in the public system
- Enshrine the principles of the Canada Health Act in
|Infrastructure||Nova Scotia has a huge health infrastructure
deficit, including hospital construction and renovations,
upkeep for long-term care facilities, and the building of
community health centres in rural areas.
|- Implement a legislated moratorium on Public-Private Partnerships (P3s)- Develop a clear plan for re-building and renovating hospitals around the province. Stop using health care dollars for political purposes.
- Create an investment fund for long-term care
|Health Human Resources||Nova Scotia does not have an all encompassing plan for training new health care workers. The provincial government has also chosen to pick fights with health care workers by trying to take away their Right-to-Strike instead of focusing on the real issue – recruitment and retention.||- Pull together a stakeholders meeting consisting of front-line workers, government, labour unions, post-secondary institutions, and patients to plan an all
encompassing health human resources strategy- Do not
reintroduce Bill 1 which would take away the Right-to-Strike from 32,000 health care and community service workers.
|Continuing Care||The provincial government gave all of the
contracts for new beds in the last round of bidding to for-profit providers. The evidence shows that for-profit long-term care facilities have higher death rates, lower
levels of cleanliness and lower food quality. There are also major concerns that for-profit long-term care facilities in
Nova Scotia are not meeting the legislated care guarantee of 3.5 hours per patient.
|- Stop giving contracts to for-profit
companies- Enforce existing standards, including the 3.5
hours care guarantee
- Create a legislated role for resident and families
councils in long-term care facilities
- Improve home care by looking at the Manitoba model
|Models of Care||Nova Scotia has not integrated a range of
health care workers into the system. This is especially problematic when looking at midwives and nurse practitioners which are not being used effectively in the province.
|- Integrate allied workers into the health care system, including midwives, nurse practitioners, mental health workers and social workers- Continue Nova Scotia’s
leadership role in alternative payment plans for physicians
- Move towards a province-wide Network of Community Health
|Pharmacare||The Family Pharmacare Program and the Senior’s Pharmacare Program are totally inadequate. Both programs involved up-front costs and co-pays, limiting people’s access to necessary prescription drugs.||- Demand action from the federal government on
building a National Pharmacare Program that would provide
first-dollar coverage for all Canadians with no up-front
|Governance||The current District Health Authority model is not accountable to the communities they serve and are only accountable to the Minister of Health.||- Review the current DHA/CHB governance model with the goal of giving more powers to Community Health Boards and local hospital boards- Create elected District Health Authority Boards
- Re-start the appointment process for the Provincial Health Council
The Parties’ Platforms:
|Area of Focus||What’s in the Platform||Grade|
|ER Closures||- Implement the Corpus Sanchez Report (Which
calls for reductions in the hours ERs are open and hints at permanent closures)- Platform says the goal is zero ER closures
|F, The Conservative have had 10 years to fix ER closures but took little action. The Corpus Sanchez report is the biggest threat to rural ERs.|
|Privatization||- The platform brags about the deal with the
for-profit Scotia Surgery- The platform also brags about the for-profit contract for Telecare
- At the same time, the current Health Minister claims these action are “not privatization” while her predecessor agreed that the day the deal was signed with Scotia Surgery was “the day private health care came to Nova Scotia”
|F, The Conservatives appear committed to continuing their privatization agenda if they form government again.|
|Infrastructure||- Fund an upgrade at the Aberdeen Hospital in
New Glasgow- Add “Rapid Access Clinics”
|Health Human Resources||- Continue pushing Bill 1 to take away health
care workers’ Right-to-Strike- Train 200 more nurses each year
- Create bursaries for Medical Lab students and
- Fund a rural nursing program
- Better integration of health are workers trained abroad
- Create an Integrated Learning Centre in cooperation with Dalhousie University
|B, with the exception of Bill 1, the Conservatives plan on health human resources is good. The creation of the Integrated Learning Centre is a very important development that should continued regardless of who forms government after the election.|
|Continuing Care||- Re-announcement of the $260 million over ten
years for long-term care beds
|Models of Care||- Integrated Learning Centre||C-, while the Integrated Learning Centre is a good step, the platform says nothing about allied workers|
|Pharmacare||- Continue the Family Pharmacare Program-
Leave the co-pay and premium at existing rates
|C, the Family Pharmacare program is inadequate
because it creates up-front costs.
|Governance||- No mention||F|
|Area of Focus||What’s in the Platform||Grade|
|ER Closures||- Create 17 new beds in Halifax- Open the
Cobequid ER 24/7
- Protection fund to hire physicians
- Provincial Advisor to lead ER recruitment
|B-, While the NDP plan will have a positive affect on the ERs in the province, unless they are willing to move physicians off of the fee-for-service model, rural ERs will still face major problems|
|Infrastructure||- Opening the Cobequid ER 24/7||C|
|Health Human Resources||- 13 new nurse practitioners||D, The NDP plan is totally inadequate in addressing health human resources. There is no mention of training or of recruitment and retention. We assume, because of their public stance, that they will not re-introduce Bill 1|
|Continuing Care||- Create a home adaptation fund- End security
deposits for seniors in long-term care facilities
- Self-managed care allowances
|C, the research on self-managed or informal
health care is inconclusive and the best way of helping
seniors stay in their homes longer is to improve the home care system
|Models of Care||- Create a pre-hab program- Hire 13 nurse practitioners
- Develop targets for acute and chronic disease
|Governance||- Approve health budgets in a more timely
|D, while this move will help DHAs with long-term planning, it does not address the lack of accountability to local communities|
|Area of Focus||What’s in the Platform||Grade|
|ER Closures||- Centralized database to track and warn of ER
closures- Train more physicians
|D, while we agree with the Liberal plan to train more physicians by offering free tuition, this is a longer-term plan that will not result in immediate changes
for rural ERs
|Health Human Resources||- Pledges physician for every family- Train
100 new physicians under a free tuition for service plan
- Create a central website for all health care jobs
- Improve licensing for health care workers trained abroad
- Encourage workers near retirement to stay in the system
|C, the Liberals have the best plan for training new physicians, however they have failed to look at other shortages in other areas like Lab Techs|
|Continuing Care||- Keep care giver allowance in place- Work
with DHAs to improve home care
- Hire a director of Palliative Care
|D, while we are pleased to see some attention toward Palliative Care, the platform doesn’t look seriously at long-term care facilities|
|Models of Care||- Increase the number of collaborative
practice agreements- Create family care teams
- Create senior’s care teams in long-term care facilities
|B, the Liberals seem to be the only party that
understands the need to move towards a team-based approach
|Pharmacare||- Return the senior’s co-pay to $30- Create a
drug recycling program
|Governance||- Create a health care sustainability council||D?, this policy is very unclear and they have not defined sustainability. In BC, the term sustainability was used to promote privatization in the Conversation on Health.|
|Area of Focus||What’s in the Platform||Grade|
|ER Closures||- Implementation of overcapacity protocols for
|Privatization||- Opposed to existing privatization projects-
Full and open disclosure on P3 projects
- States that they support public health care
|C, while the Greens say openly that they support the public health care system, unlike any of the other party’s platforms, they do not say they would reverse existing privatization|
|Infrastructure||- Green infrastructure for hospitals||D, when we are facing a major infrastructure
deficit, a simple mention of Green infrastructure is
|Health Human Resources||- Re-examine method of paying physicians-
Additional financial incentives for physicians to practise in under-serviced areas
- Funding for informal care workers
|B-, the Greens are the only party to support a review of how we pay physicians, though the platform falls
short because it does not look at other health care workers
|Continuing Care||- Develop multi-level long-term care facilities so couples are not spilt up- Develop incentives for community-based long-term care facilities||B, the Greens are the only party to reject profit as a motive for long-term care facilities|
|Models of Care||- Create multi-disciplinary clinics- Increase
funding to EHS and informal caregivers
- Integrate mental health care workers into community health centres
|B, the Greens get points for looking to integrate mental health workers|
|Pharmacare||- Launch research studies into a provincial
pharmacare program and a provincial formulary
|C, we don’t need any more studies. Provinces must push the federal government to create a National Pharmacare Program. The provinces cannot afford to run a pharmacare program on their own. Also bulk-purchasing cost savings will only be successful on a national level|
|Governance||- Ensure composition of health boards adequately represents health care workers||D|
|Final Grade||C-, The Greens would have received a C+ however we are deducting points because the platform is not
The Green Party of Nova Scotia has received our highest mark in this election, barely. It is clear that regardless of who wins the provincial election the people of Nova Scotia have their work cut out for them. It will require a lot of pressure from below to push the provincial government to take real, concrete measures to protect, strengthen and extend the public health care system.
None of the parties have presented a clear plan to keep ERs open. While the ER situation is slightly different in each community, a major problem is how physicians are compensated. The fee-for-service model creates conditions where physicians can earn more money by working in their own practice than in an ER, especially at small, community hospitals. The Colchester East Hants Health Authority has shown leadership on this issue, by responding to a year and a half long campaign by the North Shore Citizens’ Health Committee, a local committee of the Health Network, and negotiating with their physicians to put them on an alternative payment plan.
Nova Scotia is a national leader in alternative payment plans. Indeed a full 30% of our physicians are not on the fee-for-service model. Nova Scotia should continue this national leadership role and move more physicians off fee-for-service. Also, integrating nurse practitioners into our health care system will create some relief in our ERs.
When it comes to privatization, no party has promised to bring the two private, for-profit clinics back into the public system or to cancel the contract with the for-profit company on Telecare.
This is alarming for several reasons. First, it threatens Nova Scotia’s federal funding on health care. The Federal government has the ability to withhold funding if the province does not enforce the Canada Health Act and stop for-profit health care. Second, there are no regulations in place to govern for-profit clinics, meaning health and safety standards are unclear.
When Nova Scotians vote on June 9th, health care will be one of the issues on their minds. No party has presented a clear vision for the public health care system and the Health Network will be continuing our campaign to protect, strengthen and extend the public health care system.