During the 2013 provincial election campaign the Liberals made three big health care promises. They were going to amalgamate nine district health authorities into one, improve wait times for hip and knee replacements and ensure a doctor for every Nova Scotian.

Since any one would be hesitant to argue against the latter two planks, the promise about replacing the DHAs with a single authority drew most of the fire from their opponents. Pointing to problems that had come from Alberta’s earlier move to a super board, the NDP predicted all sorts of chaos would ensue. But the amalgamation has happened and the NDP’s predicted scenario has not taken place, at least so far.

The other criticism levelled at the amalgamation promise was that the priority should be front line services, not reshuffling the health bureaucracy. That criticism has been borne out, in spades. The Liberal failure to make any progress on their other two key election promises is the evidence. In fact, not only have the Liberals failed to make progress on family doctors and wait times, by some measures they’ve gone backwards. In the case of family doctors, the evidence of regress is clear.

Doc situation worse

In 2013, when the Liberal platform promised “a doctor for every Nova Scotian,” Statistics Canada data show that about 9.1%, or 71,322 Nova Scotians aged 15 or older, were without a regular family physician.[1] That was up more than 30% from 2011 – the kind of negative growth that makes excellent fodder for opposition politicians.

Last month Stats Can released data for 2015. Although not strictly comparable (it surveyed population 12 or older), it is clear the percentage of Nova Scotians without doctors has increased significantly – to 11.3% in 2015 from 9.1% in 2013. In actual numbers, after two years of Liberal efforts to ensure a doctor for everybody, there were about 23,000 more Nova Scotians without one. That’s another 30% jump in two years. Broken promise #1.

Backsliding on wait times is a little harder to demonstrate. Last week the Canadian Institute for Health Information (CIHI) released one of its regular reports on wait times for five priority procedures, including hip and knee replacements. The report received little or no coverage in the local media, perhaps because what it had to say on Nova Scotia was old news. Thanks to the media and the auditor-general (not to mention first-hand accounts) we’ve become aware over the years that this province has a serious problem with wait times for certain procedures. Last week’s report simply confirmed that.

It is perhaps less well known that when it comes to lengthy wait times for hip and knee replacements, this province is in a league of its own. That was the case in 2013 when just 50% of hip replacements and only 36% of knee replacements in Nova Scotia were being performed within the recommended wait time benchmark of 182 days – six months. The average for all provinces was 82% for hip replacements within the recommended time frame and 77% for knees.

Still worst by far 

No other province approached Nova Scotia’s record for futility in 2013, and that was still the case in 2016, when only 56% of hip replacements and 38% of knee replacements in Nova Scotia were being performed within the recommended time. The all-province average was 79% for hips and 73% for knees. The 2013 Liberal platform promised to “meet the national standard of six months for hip and knee replacement.” Not even close: broken promise #2.

Granted, the Liberal campaign promise was an ambitious one. The target it set is one that no province is meeting – Ontario and Quebec were best in 2016 with over 80% of those procedures being done within the six-month standard. And to give the Liberals a bit of credit, Nova Scotia’s 2016 result was a small improvement over 2013.

                                                2013                   2016

Hip replacement                         50%                   56%

Knee replacement                      36%                   38%

Hip % below average                 -32%                 -23%

Knee % below average               -41%                 -35%

As the bottom four numbers show, for both hips and knees we are not as far short of the national average in 2016 as we were in 2013. We remained in a league of our own but – to continue the baseball metaphor – merely moved from peewee to bantam.

However, “we don’t suck as badly as we used to” is not an inspiring election slogan. And those modest gains for some on the wait list have been achieved at the expense of some others. CIHI has another metric, the 50/90th percentile. It shows that in 2013, 10% of Nova Scotians were waiting 21 months or more for knee replacement and 18 months or more for hips. In 2016, wait times for those long-suffering (literally) groups were even longer – 25 months or more for knees and 20 months or more for hips. That’s where the regression comes in.

The Liberals had better hope none of those folks show up on the TV news during the upcoming campaign. Their stories about waiting for two years or more would prove much more compelling than anything the Liberals might want to say about amalgamating health boards.


[1] CANSIM Table 105-3024

Red Tape Randy to the Rescue

The Nova Scotia election campaign hasn’t started yet but already the need for a BS detector is becoming apparent. The initial blip on my political malarkey tracking system came last week when reading about Finance minister Randy Delorey’s pre-budget speech to the Halifax Chamber of Commerce.

The lunch time event ($54.95 for members, $84.95 for “future members”) was billed by the Chamber as Delorey’s chance to convey “clear signals that Nova Scotia’s finances remain on track.” Delorey didn’t disappoint on that score, promising to table a balanced budget when the McNeil government – the priority job of reporting to the Chamber of Commerce out of the way – gets around to facing the Chamber of the House of Assembly in three weeks.

Aside from the commitment on the balanced budget and an equally predictable tweaking of the small business tax, media reports suggest there wasn’t much in Delorey’s speech worth the price of a soup and sandwich at the local diner, never mind the top ticket of $84.95. One tidbit the media did pick up on was Delorey’s claim that businesses will be better off to the tune of $25 million a year, thanks to “less red tape.”  That’s quite a claim.

The McNeil government has shown itself a bit preoccupied with slaying the red tape dragon. Together with the other Maritime Liberal governments they’ve set up the Joint Office of Regulatory Affairs and Efficiency – budgeted at $1.6 million a year – to carry the fight to all corners of the region. Last June the Office published its first annual report – 36 glossy pages devoted to the notion that regulatory reform is a key to economic transformation.

That first report claimed that all of $730,000 had been saved from just three initiatives, but told readers that this was just the beginning. “Expect these savings to grow,” the report advised. Clearly Randy Delorey shares that optimistic expectation, but all the way to $25 million? Pressed after his speech by reporters seeking details of how the millions of dollars in savings would occur, Delorey was mum.

His silence suggests a number of possibilities. It could be that Delorey has lots of detail but he wants to save some fresh material for his actual budget speech to MLAs. It could also be that the amount of red tape removal required to produced $25 million in business savings is so significant that the health and safety of workers and consumers could be called into question. The third and likeliest possibility is that the budget when presented will be an exercise in economic pipe dreams, featuring the red tape miracle as as centre piece. Because when it comes to hard economic facts, the McNeil government has very little to say for itself.

The latest piece of negative hard data was this week’s Statistics Canada report on Film Television and Video production. Not surprisingly in light of the Liberals’ handling of the film tax credit, the report showed that Nova Scotia’s share of the $4.85 billion industry has shrunk from 1.83% in 2013 to 1.15% in 2015. Total revenue dropped by 28%, from $77.1 million in 2013 to $55.6 million in 2015.

The operating revenue figures provide additional insight into the malaise that has overtaken the entire cultural sector in Nova Scotia. As I reported in February, average monthly employment in the sector dropped 15.6% between 2014 and 2016, making culture the hardest hit of any sector in the employment-challenged Nova Scotia economy. No wonder the McNeil government prefers to flirt with economic fantasy.