Reopening of Nova Scotia's health system will take months, says health authority CEO

When it comes to ramping up the province's health-care system, the head of the Nova Scotia Health Authority says the pace will be more like the changing of seasons than moving from one day to the next.

Elective surgeries, procedures, clinics and other non-urgent cases were cancelled in recent months as the health authority rolled out its pandemic plan and prepared for the worst in anticipation of COVID-19's arrival.

But the primary- and acute-care systems have avoided any real stress related to the disease, with the number of hospitalized cases never exceeding 13 at any single time for the entire province.

With the daily number of recovered cases now oftenoutpacing the number of new cases, Dr. Brendan Carr, the health authority's CEO, and other officials are turning their attention to the reopening of the system.

It will be a gradual process, with the immediate focus on the patients who were displaced as a result of COVID-19 preparation, said Carr, and all of the work will happen in consultation with Chief Medical Officer of Health Dr. Robert Strang and public health officials.

"The best case will be that over the next period of months, we're going to be able to advance along a very careful plan that Dr. Strang and his team will outline," Carr said in a telephone interview.

That work includes an acknowledgement that a second wave of the disease is anticipated at some point, and so the system must maintain a level of capacity to deal with that possibility, while also protecting patients and staff in the meantime.

"From my point of view, we are still very much in the middle of this thing," said Carr.

"While the numbers are going down, as a community this is still present.We don't have immunity [and]it could at any moment in time rise up."

Carr and his colleagues with the IWK Health Centre acknowledged that cutting into a surgical backlog that existed even before the pandemic required putting off cases is going to take time.

Dr. Doug Sinclair, the IWK's vice-president of medicine, said the emergency department at the children's hospital is currently split between infectious and non-infectious areas and that has required taking over some clinic space. The site's COVID-19 assessment unithas also taken over clinic space and so making transitions will take time. Like Carr, Sinclair said it would take months to try to cut into the backlog.

Carr said taking advantage of efforts to streamline the system that have stemmed from the pandemic shouldhelp.

Those efforts include more of a reliance on virtual medicine where possible and appropriate, co-ordinating appointments so people don't have to make multiple trips to the hospital and triaging people with the help of 811.

Carr sees big potential for building on the way people have used 811 to schedule appointments for COVID-19 assessments. The same approach could be used to prevent people from going to an emergency department and waiting for hours to be seen by instead giving them an appointment, or keep them from going at all if it's determined they would be better suited byseeing a different type of provider, he said.

"Other countries are already doing those kinds of things and we could be doing those kinds of things here," he said.

Dr. Gary Ernest, president of Doctors Nova Scotia, said the increased use oftelephone and virtual conferencing to treat patients has gone over very well. At least 1,200 doctors are using some sort of conferencing system and even more are using the phone.

For years, doctors and the province have tried to get some type of system in place, but it was never very successful. In the lead up to COVID-19, the two sides quickly reached an agreement on an approach that worked and compensated doctors the same as if they were physically seeing a patient in their office.

Ernest and others are hoping the temporary payment agreement becomes a permanent part of the system. Being able to see patients in ways other than traditional office visits is often as helpful for the patient as it is the doctor, said Ernest, because it reduces the need for people to take time off work or find a way to get to the appointment.

Health Minister Randy Delorey, who is working with Carr on the reopening efforts, said the way virtual care has been used and its effectiveness is being evaluated. Adecision will then be made about what changes become permanent.

"There's a definite interest," he said in a telephone interview.

"What it's going to look like is too early to say."

Delorey acknowledged the change has been a long time coming, but he said few systems are as complex as health care. Carr said sometimes it takes everyone focused on a single issue like a pandemic to create a sense of urgency and action.

"Immediately, we are all galvanized by that in terms of needing to respond and a sense that it's going to require a collective response," he said.

"The barriers kind of go away and people are highly motivated to kind of advance."

Delivering better value

All of this work to begin restoring services will happen within the context of natural limitations, such as the number ofsurgeons and anesthesiologists, and the availability and number of operating rooms. For patients requiring home care and continuing care resources after they leave a hospital, there are only so many resources available.

But even within those limitations, Carr said he believes the experience of dealing with the first wave of COVID-19 and the cohesive way the system responded proves there are ways to improve the delivery of care with the system's existing resources.

"I think that we can be smart and we can be efficient and I think that we can deliver better value for Nova Scotia with the resources we have," he said.

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