At no time have the challenges for health care been so striking. The Coalition of Concerned Citizens sees this as a time when New Brunswick must face these pressing problems.
Health and Long Term Care constitutes nearly 40% of the province’s annual budget, or $3.6 billion dollars. The high and rising cost of this complex system means it’s vital to ensure the maximum amount of timely, quality service is received for such a large public expenditure. We must ensure faster help for people who are ill and prevent rising health care costs from adversely affecting other important public services. Since the province’s population is aging and the volume of acute and chronic illnesses is increasing, the need to make the best use of all available resources is urgent.
Adding more and more without improving system services and efficiency makes no sense. The fact that the current system does reasonably well at responding to life-threatening situations tends to disguise its shortcomings in many areas. The status quo regarding how the system is organized and operated simply cannot address the many service problems that need attention. We need an improvement plan and we need to stick to it.
PRIMARY HEALTH CARE
A glaring system failure is that we have roughly 40,000 people without timely primary care access. One reason is that the new generation of doctors don’t have the high patient load that the previous generation did. Many older doctors took anywhere between 3,000-5,000 patients. We hear that new doctors are taking 500-800 patients with some up to 1,200. It can take up to 3 or 4 doctors to replace one who is retiring — a major change. Doctors provide essential services and perhaps there should be a minimum standard for how many patients they have. In theory, if each primary care doctor took on another 50 patients, the list would be eliminated. However, this seemingly simple solution wouldn’t solve the province’s primary health care difficulties. Primary health care is the foundation of the system so it must be modernized.
Necessity is the mother of invention. Covid-19 has forced us to find new ways to help people. Theoretically, people can call a walk-in clinic, but it can be very difficult to get through due to the large number of calls and limited hours of operation. Also, there are large differences in the number of clinics that are available from place to place and they exist at the whim of the doctor(s) involved. For example, Moncton has over 20 clinics, whereas Fredericton has only 2 or 3. Many areas have none, so they are not a reliable system component. Many people are now talking with their doctor by telephone or video, which seems to work well for some problems. Others use online services such as Maple (www.getmaple.ca) where you have a choice of talking with a doctor or a nurse practitioner. They can
diagnose some problems and provide prescriptions as necessary — for a price. But then you may still
have to try to connect with the regular system for necessary follow-up care. So that’s not a viable long-
term solution either. The current approach to primary health care is archaic, rickety and in need of a major overhaul.
On a per capita basis we have sufficient number of doctors compared to many other provinces in Canada. To just keep hiring more and more doctors hasn’t and won’t work. What the Province needs is a new approach where professionals work together on a collaborative basis — including physicians, physician assistants, nurses, nurse practitioners, dietitians, pharmacists, etc. This could offer a much better array of primary services across the province, including a good alternative to ERs in smaller communities being kept open 24/7. Communities need to be included in the discussion and explanation of such a new model.
We are not making the best use of our 22 hospital buildings. In smaller population centers hospitals can only offer minimal active treatment care. If there is something serious wrong, they have to transfer you to a larger center. Some facilities could be re-purposed to provide a wide range of primary health care services along with initial urgent care and coordinate other important local services like chronic disease management and palliative care.
A few of the related issues we face are:
Health services in smaller communities and rural areas are inconsistent in terms of availability, quality and comprehensiveness. This must change.
Professionals often operate independently, even in competition, when integration and coordination is what is necessary for continuity and timely care, and therefore overall effectiveness and efficiency. Health systems are always influenced by many advocacy groups representing professionals, labour and patient/disease groups that naturally place priority on their particular interests and preferences.
The NB Nurses’ Association estimates there will be about 2,000 nurses retiring over the next 10 years. At least 200 new nurses are needed every year just to maintain the current supply. Fortunately, the provincial government has recently announced more funding, since nurse training is expensive due to it’s clinical and lab components. In addition, there is the geographic factor. Not everybody wants to move to/work in a smaller community. Achieving a suitable distribution of nurses and other health care personnel around the Province is a continuing challenge.
HA Boards are advisory only with no real authority or accountability for results. There is no clear, relevant performance management and review system for Boards and their CEOs. The CEOs of Horizon Health and Vitalite report directly to the Premier through the DM of Health. Political involvement in what should be
evidence and patient safety based clinical decisions such as service location is not uncommon.
We have too many ALC cases in acute care hospital beds. They are often referred to as “bed blockers” because of the effect their presence has on wait times for diagnostic and treatment services. Regulations and standards should be reviewed to determine if more special care beds could provide the needed services, as well as increased use of home or ambulatory care options.
ACUTE CARE AND LONG-TERM CARE
System responsibility is divided between two separate government departments (Dept of Health and Dept of Social Development), which makes system planning, management and service coordination more difficult and both time and energy-consuming than necessary.
NB doesn’t have an electronic information and communication network with a comprehensive patient record and digital I.D. to connect system components in a timely manner and support service provision as well as system performance analysis and evaluation. Patients should have secure access to results of blood and other diagnostic tests by simply going on line.
We are encouraged by Minister Shepherd’s announcement that she will be conducting a consultation process and subsequently formulating a long-term vision. The Coalition of Concerned Citizens has submitted a Health Services Planning Guide and Framework for New Brunswick to the Minister for her consideration.
In the second part of this “op-ed” we will discuss The Desired Situation and How to Get There.
Daryl Branscombe, President
Coalition of Concerned Citizens Inc.
For more information on the Coalition, please refer to our website or contact us at email@example.com