Higgs's adoption of Nova Scotia's health playbook a 'huge gamble'

A tragic emergency-room death, a health care crisis — and a premier firing top health officials while promising to fix the system in short order.

It happened in New Brunswick this summer, but a remarkably similar series of events unfolded this time last year in Nova Scotia.

On July 22, 2021, a Bedford man, Keith Harker, died while waiting for care in the emergency department at the Cobequid Community Health Centre in Sackville.

The province was in the first week of an election campaign in which health care was already the driving issue. 

"There was a sense that things were not going well, that there were multiple system failures and that something had to be done," says Katherine Fierlbeck, a Dalhousie University political scientist specializing in health policy and politics.

"The Tories mounted a campaign very much based on 'fixing' health care, and I think that is what people responded to." 

The day after he was sworn in, new Progressive Conservative Premier Tim Houston replaced the CEO of the province's health authority, named a new deputy minister of health and replaced the provincial health authority's board with a trustee.

The new team knew how to make "an immediate difference" in the system, Houston said. 

"I think sometimes it's just you have to hit reset. It's time to hit reset at the Nova Scotia Health Authority."

Now Premier Blaine Higgs has adopted a similar playbook in New Brunswick, naming a new minister and a new Horizon Health CEO this month and appointing trustees to replace the Horizon and Vitalité boards. Earlier this summer, he replaced the deputy minister of health. 

"We accept it's a crisis and I'm not kicking it down the road," Higgs said, days after the death of a man waiting for emergency care at the Dr. Everett Chalmers Hospital in Fredericton. 

"I'm prepared to do whatever is necessary to protect and improve the health care system in our province."

The premier called the replacement of the two health boards with trustees temporary, but it's not clear what exactly "whatever is necessary" will look like.

He wants greater latitude for patients to travel to other hospitals if they can get service there faster and has called for more co-operation between Horizon and Vitalité.

He spoke of "structural change," and while he has ruled out merging the two entities, he has not excluded the possibility of putting both of them under a single board.

Fierlbeck said eliminating health authority boards allows governments to "control [decisions] more tightly. … You're effectively signalling an end to this arm's-length relationship" with the people who run the system day to day, opening the door to political decision-making.

A new governance structure would risk controversy at a time when the PC government is already suffering in public opinion polls.

But this is the first time Higgs has had both a majority government and a less acute COVID situation to deal with. With an election still two years away, he has a window to implement his own vision of health governance.

He has already tried other approaches.

In February 2020, his government embraced a proposal by Horizon and Vitalité to close emergency rooms in six small hospitals at night and divert their staffing resources to offer more primary care during the day.

But within five days, the PC minority government abandoned the plan in the face of protests and a risk of losing a confidence vote and being forced into an election.

Higgs claimed he was caught off guard by a lack of an implementation plan by the health authorities, though Horizon's then-CEO Karen McGrath told a committee of MLAs the premier was well-briefed on what to expect.

'We've fallen behind on the schedule'

The government's second attempt at a health plan last November avoided closures in favour of more consultations with local communities on what services they need.

But the Tories have already missed some of its targets. The Patient Connect list of people waiting to get family doctors has swelled from 40,000 to 63,000 names.

For a second summer in a row, emergency departments and other services have closed sporadically for days or weeks because of a lack of staff.

"The plan itself is good but it needs to be implemented," Higgs said at his July 15 news conference. 

"It has targets to be implemented during our mandate. We're not on that schedule. We've fallen behind on the schedule, but we're going to get caught up." 

The premier blamed a "bureaucratic stalemate" at the health authority level, though ousted Horizon board chair Jeff McAloon said the system was "on a real significant path of change."

Higgs hasn't provided a timeline for hitting what he says will be clear, measurable targets for improving the system, though Fierlbeck said expectations for improvements will now be very high — as they are in Nova Scotia.

In that province, "the situation has gotten much worse," despite Houston's September 2021 housecleaning, she said.

The "interim" CEO appointed last year, and the trustee who replaced the health authority board, remain in place.

But the number of people without family doctors is "climbing quite high," and the province has seen long ER waits and sporadic closures this summer, just as New Brunswick has.

"When you make extraordinary promises, the expectation is that you will deliver, and if you do not deliver, there will be a reckoning," Fierlbeck said.

"With a government-appointed trustee taking direction from the highest level, there's absolutely no question where the buck stops. Whatever happens now, the premier himself is going to have to wear it. So the stakes are pretty high." 

She points out one difference between the two provincial housecleanings: Houston did his on his first full day as premier, while Higgs made his moves midway through his fourth year in power.

"If you've been in office for three or four years, and you haven't even been keeping an eye on whether there's effective performance measurements, then what exactly have you been doing?" she said.

"By firing both the health boards and the CEOS and the health minister, you're effectively admitting that your government has made a complete mess of things," something Fierlbeck believes could haunt the PCs at the polls in 2024.

"Can any government really turn health care around in two years, so that the electorate forgets and forgives this particular episode? It's a huge gamble."