Recent hospital ER hour reductions a reminder of scrapped health-care reforms

The ghost of health reforms past is haunting New Brunswick hospital emergency departments this summer.

As health officials are forced to close some emergency rooms after hours because of staff shortages, there's an eerie familiarity to the difficult decisions.

They're just what those officials warned of in February, 2020 when they announced a reform plan that would have seen ERs close at night at six smaller hospitals.

"Too often, our facilities are facing decisions on whether to temporarily close beds and units," Horizon Health CEO Karen McGrath said at the time. "This is not the way health care should be delivered."

But that is how it's being delivered this summer.

The Higgs government cancelled the reform plan within days of its release, but elements of it are now being adopted by administrators who say they have no choice and who insist the changes are temporary:

• At the Sackville Memorial Hospital, the emergency department is closed on Friday, Saturday and Sunday nights.

• In Perth-Andover, the ER at Hotel Dieu of St. Joseph closes from 6 p.m. to 8 a.m. every day.

• Also at Hotel Dieu, inpatient beds have been converted to transitional beds for patients waiting for long-term care placement. That change was another part of last year's plan for the six small hospitals.

• The Caraquet and Stella-Maris-de-Kent hospitals, also part of last year's reforms, are among five Vitalité hospitals redirecting non-emergency patients who show up at the ER to primary-care appointments outside the hospital.

Sackville Mayor Shawn Mesheau says seeing a cancelled service cut make a comeback has been disconcerting.

"It's definitely brought some concern to our community and the outlying areas," he says . "Are we just revisiting something that's happened previously?"

Former Horizon Health board chair John McGarry, who advocated publicly for years for cuts to small hospitals, says this summer's forced reductions were inevitable.

"A year and a half ago … when we were proposing some changes, it was just to try to get ahead of the game,  rather than have it happen and have us try to regroup on the run. That's what's happening now."

McGarry says the short-term closures were unavoidable in a province that is urbanizing and that is seeing more and more health-care professionals choose to work in larger hospitals.

But "it should ideally be done in a planned fashion rather than in an urgent, immediate fashion." 

No one from Horizon or Vitalité would do interviews with CBC News for this story.

Opposition politicians say the summer closures amount to a broken promise by Premier Blaine Higgs, who promised in March 2020 and during the subsequent election campaign to keep emergency departments open.

"Why has he not kept his word with respect to rural ERs, to keep them open through the night for rural New Brunswickers?" Green Party leader David Coon asked in the legislature last month.

Health Minister Dorothy Shephard insisted that the changes are temporary and will only last until September. 

"This is an action taken to support the summer staffing shortages that are certainly going to happen," she said. "It is proactive so that all the important measures can be put in place to help mitigate any concerns during the summer months."

The minister said Wednesday that increasing enrolment in nursing programs and the recruitment of international nurses should help.

But Stéphane Robichaud, CEO of the New Brunswick Health Council says the province already has 1,041 nurses per 100,000 people, more than the Canadian average of 811. "We have to do better with the numbers that we have," he says.

Shephard held consultations earlier this year to develop what she calls "a really good plan" that will address the sustainability of the health system.

But eventually there's going to be more of this. It's just going to happen.- John McGarry, former Horizon Health Network board chair

But McGarry questions how realistic that plan will be if it hews to Higgs's promise to spare small-hospital ERs.

"ER closures are off the table, but we've got two ERs closed now on weekends," he says. "So they're on the table. But they're on there because we don't have control of the situation." 

McGarry believes if the Progressive Conservatives hadn't abandoned the reforms last year, it might have helped delay some of the staffing crises unfolding now.

"But eventually there's going to be more of this," he says. "It's just going to happen." 

Like McGarry, the New Brunswick Nurses Union has been warning for years that retirements from an aging workforce would lead to a crisis. 

But president Paula Doucet isn't sure the 2020 reforms would have made a lot of difference.

"All the change can happen, but if you still don't have enough human resources to carry out service, there's going to be an interruption, and that's what I think we're facing right now." 

Robichaud says it's not "a clear-cut thing" whether the cancelled changes would have made a difference because data on human resources in the health–care system remains difficult to measure and compare.

"Those changes of last February may have been the right thing to do. Maybe they were. We don't have proof that they were. We don't have the proof that they weren't," he says.

But he agrees Shephard's upcoming plan needs to adopt a new approach.

"The status quo is not sustainable, that's for sure, because the status quo is a system that has evolved by default, not by design." 

In Sackville and neighbouring communities, a local committee has been working with the Department of Health and Horizon to analyze the challenges at the local hospital.

Mesheau says that has given him a better grasp of those difficulties and the need for changes than he had at the time of last year's reform announcement.

"All I know is ultimately we will have to make change and sometimes it's hard to embrace change," he says.

"But we also have to be able to communicate that change and the benefits from it, and help people understand where they can get the care they need when they need it."

Asked if the February 2020 reforms will need to be revived some day, McGarry says that's already happening by necessity this summer. 

"They're coming back, aren't they? It's inevitable that some of this is going to happen. So yeah, I think some of this should come back.

"The fact is things are happening and someone has to manage the situation."