by Kathy Hamer (Edwards)
Probably everyone in rural New Brunswick knows that our access to health care is likely to require some travel, even for routine appointments with a family doctor. We are not so naive as to think the full range of medical care will be available in every community of any size. We’re nothing if not fairly realistic. Living here has made us that way.
But there are limits to what we are prepared to accept. The premier urges us to examine the details of proposed changes to hospital services. We would if we could: however, at this point, we have more questions than answers, especially given Horizon Health CEO Karen McGrath’s preference for avoiding a main-door exit from the Sackville hospital where she would have faced an anxious public on Thursday.
We are told that acute-care beds in Sackville will be converted to beds for the long-term care patients now accommodated in the larger hospitals. Can anyone at Horizon Health explain the logic of moving these patients to Sackville or Sussex, further away from family and friends, while moving acute-care patients to Moncton, and thus also further away from familial and social “safety nets”? Will the shuffle of patients meet the needs of those in long-term care? Will it release enough beds to accommodate all acute-care patients in the regional hospitals? We know that currently at least the three largest hospitals are operating at or well beyond capacity much of the time.
We are concerned about added travel time, especially in emergencies. Ms. McGrath has cited St. Joe’s (Saint John) and Oromocto hospitals as evidence that the proposed changes work. She neglects to add that each of these facilities is within little more than 10 or 15 minutes’ drive from full-service hospitals – the Regional in Saint John and the Chalmers in Fredericton. How do these distances compare with travel from Cape Tormentine to Moncton?
Both the NB Medical Society and the paramedics have expressed concerns about the fragility of existing ambulance services and the risk of adding new demands to an already stretched system. When and how will ambulance services be adjusted to ensure adequate service delivery? Will rural patients be forced to shoulder the additional financial burden of ambulance or taxi costs to receive ER service?
Ms. McGrath has claimed that doctors will now be able to see many more patients during the day, since ER services will be closed at night. Can she explain just how they will accomplish this in the face of already full-to-bursting patient loads? How exactly are nurse practitioners to be integrated into the current system?
Has Ms. McGrath considered the potential impact of the proposed changes on the Amherst hospital, which provides service to many residents of the Sackville area? That facility was blindsided by Tuesday’s announcement, just as were our own municipal councils and medical community. How will Amherst accommodate any increase in demand for services in its already overcrowded hospital?
What of the more than 2,000 university students in Sackville who rely on hospital access as much as our full-time citizens, and who, moreover, are unlikely to have spare funds to pay for ambulance or taxi travel to Moncton or Amherst? What timely access to needed services can they expect? After all, as one student commented on Thursday, “we die too.”
What about recruitment and retention of medical professionals? The medical programs training doctors in New Brunswick were created with two objectives in mind: to offset the likely rate of retirements among doctors, and to ensure better access to physician care in rural areas. How likely will new doctors be to come to communities where, among other potential limitations, they can’t even admit their own patients to a local hospital and oversee their ongoing care? How easily will nurses be able to move to positions elsewhere, especially if a move means uprooting a whole family?
Has anyone considered potential “downstream” effects of the changes? Sackville has welcomed a number of newcomers from more urban areas of the country; one factor in their decision to move here has been the presence of a hospital providing a good range of basic services and care. The attractiveness of this community and many others in New Brunswick risks being seriously undermined if access to health care is perceived as insufficient.
The communications fiasco that has accompanied the roll-out of these changes provides an excellent case study in how not to develop and announce challenging new directions. The word was out informally by Monday, February 10, and Sackville town council discussed it that evening; the formal announcement was made on Tuesday; a full-page ad appeared in local papers only on Wednesday; and not until Thursday was Ms. McGrath available to meet our local hospital administration and staff, the medical community and our municipal and university representatives — though remaining invisible otherwise. Her defense of the changes, published only yesterday in the Telegraph-Journal, is as detail-free as the ads featured earlier in the week.
Rural New Brunswickers understand that our fiscal ship has been listing badly for some time, and that changes to high-cost services may well be inevitable to ensure continued access to quality health care. We know finding effective long-term solutions is a challenge. Yet we now face what has been presented as a done deal, out of public view, with less than a month to prepare for and implement what clearly will be a major shift in service provision. Were no alternatives considered?
There is now so little time to put the required supports in place that patient care and public certainty are both likely to be the victims of a poorly-communicated, top-down, unconvincingly presented fait accompli, developed and announced without consultation and seemingly without consideration of alternatives or likely or unintended consequences. Ms. McGrath, Minister Flemming, and Premier Higgs, can expect much more blowback from skeptical voters.
Kathy Hamer (Edwards) came to New Brunswick in 1971 and worked as a Professor of French at Mount Allison University. She held various administrative posts at Mt. A before spending five years as Vice-President at the University of New Brunswick in Saint John. With the exception of those five years, she has called Sackville home. She and her husband Peter Edwards are now retired here. She is a member of the boards of the NB Youth Orchestra, Symphony NB, the NB Museum, and Sackville’s Festival of Early Music, and is a past president of ArtsLink NB.