Analysis

McNeil's hospital shuffle won't kill health care. He just needs to convince Cape Breton

Monday's announcement that two hospitals in the Cape Breton Regional Municipality will close and two others will be expanded didn't come out of nowhere. It's been a long time coming.

Deeply personal connections to hospitals persist — even when it's in a community's best interest to close them

Premier Stephen McNeil had to shout over a crowd on Monday as he rolled out changes to Cape Breton hospitals. (Tom Ayers/CBC)

It wasn't a new idea.

While word of the planned changes to hospitals in the Cape Breton Regional Municipality sent shock and anger through many parts of the community on Monday, the reality is this didn't come out of nowhere.

In fact, the former district health authority had examined the possibility prior to the creation of the Nova Scotia Health Authority in 2015.

From there, the blanks are filled in by five people either involved with or aware of the process leading to Monday's announcement, and who spoke on background with CBC.

They say the provincial health authority spent its early days reviewing whatever work each of the district health authorities had been doing to see what could be continued.

From there a document called the health resourcing plan — a non-political look at how health-care resources could be improved and made more efficient — was developed.

Not long ago, Health Minister Randy Delorey, health authority CEO Janet Knox and several other senior officials brought the plan to Delorey's colleagues in the Liberal government. Northside General would close, replaced by a modern health centre without an emergency room but retaining all other services. Same for the hospital in New Waterford. Services would be expanded at the Cape Breton Regional and Glace Bay hospitals. And for the first time in their mandate, the Liberals would build new long-term care beds — 50 spread across two new sites.

Despite the obvious political concerns that go into the notion of closing a hospital, people in those meetings say support for the plan was almost immediate and universal. Premier Stephen McNeil pitched it as a generational opportunity to modernize and improve health care in a part of the province desperate for an upgrade.

Plan about more than just hospital closures

There are obvious challenges ahead for the government. McNeil was booed the way New York Yankees fans boo the Boston Red Sox when they come to town.

Many people heard hospitals were closing and stopped listening. It will be the government's challenge to overcome that.

It is difficult for people not from Cape Breton to understand the mindset behind that booing, but there are deeply personal connections to the hospitals being closed. They were built by the communities, with coal miners and steelworkers pitching in portions of paycheques to make it happen.

Then there is the pervasive view that Cape Breton's needs have been overlooked for years at the expense of the growing beast that is Halifax Regional Municipality, and the (unfounded) concern some have that provincial equalization — which isn't what a lot of people on Cape Breton think it is — also shortchanges the island.

It might not make sense to everyone, but it does to people on the ground and they're the ones who right now need to be convinced. For all the responses Monday, there was little nuance. Opposition parties and at least one union argued the government is ripping health care out of communities — it isn't — and that a tidal wave of chaos is about to crash on the island.

But health care on Cape Breton is already in dire straits, so clearly something has to give.

These will become increasingly tricky political times for the Liberals in a part of the province where they're already challenged to win seats.

But there are also the facts.

Often, the emergency departments are serving as people's go-to site for primary care. Medical professionals will tell you that makes neither medical nor financial sense and it's not the best way to deliver care.

So many ERs so close a 'historical anomaly'

Dr. Chris Milburn, a family and emergency physician in Cape Breton, called it a "historical anomaly" to have so many emergency departments so close together.

"That doesn't exist anywhere else in Canada that I'm aware of," he said Monday.

The proposed changes would likely improve primary care, he said, as opposed to seeing people head to emergency departments for situations that can be handled by a family doctor, nurse or paramedic. The savings could go toward other primary care initiatives.

It's also probably the island's best chance to recruit much-needed doctors and other health-care professionals.

The nurses union was cautiously optimistic, saying they'd wait for more details but it looks like a step in the right direction.

Maintaining 4 aging hospitals not feasible

There is also the physical condition of the buildings to be considered.

Northside General was opened in 1954 and New Waterford Consolidated was opened in 1963. Considering there are also complaints about Glace Bay, which opened in 1986, and the regional hospital, which opened in 1995, it's no surprise the two oldest sites would be targeted for replacement— an idea reinforced by a government infrastructure team that evaluated the sites ahead of the proposal.

Nova Scotia Auditor General Michael Pickup also touched on this in a 2016 report:

"Staff noted that Northside General Hospital, the oldest of these three community facilities, does not have adequate heating and ventilation systems, and many other significant repairs are required. We were also told that New Waterford Consolidated, the second-oldest facility, requires electrical upgrades, a sprinkler system, and conversion of the 40-year-old boiler plant."

There are many questions yet to be answered, including timelines and cost. Government officials said all of that would come, with one comparing Monday's announcement to the initial announcement of the hospital revitalization project in Halifax: A high-level process that will soon narrow down on detail and include extensive consultation as site planning happens.

That may not be enough to satisfy everyone, but people in the medical community have, for years, said the current model of health-care delivery in Nova Scotia is broken and outdated.

Monday's announcement is the government's first major attempt to try something new.

Time will tell if it works.

Read more stories at CBC Nova Scotia