Nova Scotia·Analysis

McNeil's major move: Reorganizing health care

One of the most significant decisions by the Liberal government during its first term was to merge the district health authorities into one provincial body.

Grits merged 9 district health authorities, consolidated contracts, promoted collaborative care

Reform of the health-care system was a major item in the Liberals' 2013 election platform. (John Panella/Shutterstock)

The first term of Stephen McNeil's Liberal government was punctuated by a series of big moves that led to big fights. In some cases, the consequences of those decisions — and the ensuing reactions — are already becoming apparent. For others, it will take some time to tell.

With that in mind, here's a look at one major move from the Grits during their mandate and what the fallout has been.

Reorganizing the health-care system

The biggest plan pitched by the Liberals in the last election was to merge nine district health authorities into one, creating a provincial entity.

The rationale at the time was to reduce administrative spending, redirect it to front-line care and provide provincewide access to the system. If someone in Amherst could get something done sooner in Yarmouth, they should be able to go there, went the logic.

Along with that came a protracted fight with health-care unions as the Liberals worked to reduce 50 collective agreements to four and a fundamental shift in primary health care toward a collaborative model involving doctors, nurses and other providers.

Sound in theory

While contract talks continue between the employer and the unions, and it's far too early to judge the shift to collaborative care, the merger was mostly successful from a purely process standpoint, according to health-care consultant Mary Jane Hampton.

It makes sense to look for these kind of efficiencies in a province this size, said Hampton, but she's concerned the system might be overly centralized and contain too many new bureaucratic steps that could create encumbrances.

"The theory behind a single health authority is actually a sound theory. What we've not yet seen is the ability of the organization to translate that theory into an improved health-care experience for patients and many would say an improved work experience by providers in the system."

A spokeswoman for the health authority said in its first year (2015-16), administrative savings totalled $14.5 million through the reduction of district health authority CEOs and vice-presidents, bulk purchasing and other efficiencies. Numbers for the 2016-17 fiscal year are not yet available. 

More work to do

Despite those savings — and to Hampton's concerns — promises made by the Grits to reduce wait times for things such as hip and knee replacement and increase access to family doctors have made little, if any, progress.

McNeil said now that the foundation is laid through the merger, those improvements should be easier to facilitate. He noted the wait lists for home care have been pretty well wiped out. And the budget the Liberals tabled last week included money for additional orthopedic surgeries and more seats in the family medicine residency program at Dalhousie University's medical school.

"Are there challenges? Of course," he said in an interview. "Is there more work for us to do? Of course there is, and we're doing that."

Too soon to pass judgment

McNeil pointed to increased surgical capacity that will come through new operating rooms in Dartmouth and Windsor as well as people's ability to go where treatment would be most timely. Those changes should also help target procedure wait times, said McNeil.

Hampton said it's simply too early to say for certain if the merger was a success or a failure, but that it's time to prioritize same- or next-day access to primary care, paperless record-keeping and other steps to modernize the system.


Michael Gorman is a reporter in Nova Scotia whose coverage areas include Province House, rural communities, and health care. Contact him with story ideas at