Auditor’s report calls out gaps in Nova Scotia’s health-care system

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In need of more than 500 new family doctors over the next decade, Nova Scotia is failing to communicate how residents can access primary care in the interim, says an Auditor-General's report released Wednesday.

The report calls attention to gaps in the provincial health-care system that have patients languishing on wait lists without updates as to when they can expect access to the care they need. The Auditor-General questioned whether the wait lists are even useful: Nova Scotia's registry of patients in need of a family doctor had 36,000 names on it as of Sept. 1, but no mechanism to prioritize people based on their health history or condition.

"That means anyone with a serious health condition is not placed higher on the list," Auditor-General Michael Pickup's report said. While the provincial health authority encourages doctors to use the list to obtain new patients, they are not obligated to.

Kirsten DeJong, pregnant with her second child, recently experienced the problems this creates first hand. Having moved to Cape Breton from Ontario, Ms. DeJong called – and was rejected by – more than 20 doctors who would not take her on as a patient, despite the fact that she was pregnant. When she called the health authority, she was told to go to an emergency room. A firefighter, Ms. DeJong was bewildered.

"I don't agree with being directed to an emergency room," she said. "I think emergency rooms are meant for emergencies."

She was 19 weeks pregnant when she heard her baby's heart beat for the first time after a doctor finally agreed to see her. Neither Ms. DeJong's husband nor her two-year-old have a family doctor; at times, the family has wondered whether it would be best to move back to Ontario.

The spotlight on the province's struggle to provide basic, timely access to primary-care providers comes at the same time as local governments are working hard to attract new residents and businesses, including Amazon.com, a long-shot bid but one that, if realized, would potentially flood Nova Scotia with thousands of new residents.

Mr. Pickup said he is "disappointed" with how poorly health officials rate at communicating with patients over solutions to the challenges at hand. "At the end of the day, this is about people. It's about how people are going to be served and the stress that people may feel as they wonder how they're going to get primary care today or in the future," he said.

Health Minister Randy Delorey said he has accepted the 21 recommendations for improvement outlined in the Auditor-General's report.

"We recognize that there is work to be done," he said, adding that efforts are ongoing.

Work to simplify health care in Nova Scotia began more than two years ago when a decision was made to merge the province's nine district health authorities into one body, now called the Nova Scotia Health Authority. Part of the health authority's mandate involves streamlining the delivery of services into a new, community-based care model while tackling doctor shortages and addressing wait times.

"Mergers … do create confusion and chaos and anxiety," said Janet Knox, chief executive officer of the health authority.

"We know that we need to spend more time talking internally within our organization and with the people of this province," she said.

Part of the health authority's mandate involves improving the consistency of mental-health services across the province. Discussions, the Auditor-General found, began in 2015, but there is still no cohesive plan in place. Mr. Pickup said the mental-health-care gaps must be remedied "without unnecessary delay."

"How services are delivered varies across Nova Scotia," reads the report's section on mental-health services, which highlights the province's patchwork offerings."There are no province-wide policies or guidelines, and there are inconsistencies in: wait times targets, intake methods and eligibility criteria."

At the fourth-largest hospital in the province, Dartmouth General, for example, there is no psychiatric assessment capability in the emergency room. Although the hospital recorded more than 1,400 mental-health complaints in 2016, patients must be transferred to Halifax for psychiatric assessments. In other communities, crisis-response services are only offered during daytime hours.

When asked if current mental-health services are adequate, the Health Minister, Mr. Delorey, pointed out that "we do have our emergency services, our 911 service … that does operate to bring patients in Nova Scotia to the care they need."