Kudos for primary health care efforts

Here’s the Atlantic news we’re tracking this week, including some positive developments in primary care, a fight over fixing the Chignecto Isthmus and the latest in oil exploration.

Primary care

Dr. Jane Philpott, former federal health minister and current director of Queen’s University’s School of Medicine, sat down with PPF’s WONK podcast to talk about her recent book, Health for All: A Doctor’s Prescription for a Healthier Canada. She had some interesting points to make about reforming primary health care, and some nice things to say about Nova Scotia’s approach, which other Atlantic provinces are pursuing as well.??

Philpott contends that Canada’s health-care system was designed mostly to ensure we had national health insurance — a single payer, in other words — and was built around hospitals and doctors. It was not focussed at the community level, and when it comes to primary care, Canada wound up with a patchwork of family practices and local clinics.??

“It was not done with any clarity around how we would ensure that everyone would have access,”?she said. That’s how Canada can have one of the world’s most expensive health care systems and some of the poorest outcomes when it comes to access to primary care and family physicians.??

Philpott believes primary care should work like public education. Every child has a right to a spot in a public school, and if a family moves the kids are simply assigned to a spot in their new city or neighbourhood. A number of European countries do the same with primary care — they have legislated the right to primary health care and assign people to a primary health team as needed. No one sits on a wait list for a family doctor.??

Nova Scotia’s Need a Family Practice Registry is an ambitious first step in getting a handle on the problem, she said. Rather than depending on surveys to estimate the numbers of people without access to primary care, Nova Scotia has developed an actual list, mapped out the shortages and is promising to address the gaps in primary care. And the gaps are considerable. As of June 1, there were 160,000 Nova Scotians ?on the registry, up 6 percent over the last year. The province has taken some heat for not having updated the number since June, but it’s chosen to spend the summer on a concerted effort to contact everyone on it to confirm their status and let them know different ways they can access care.??

Nova Scotia has also been among the most aggressive in Canada at developing collaborative care teams that include doctors, nurses, nurse practitioners, dieticians, social workers and other health-care practitioners. These are the kind of community-level care centres Philpott is talking about, and Nova Scotia had 107 family practice teams in place as of July, up from 95 last May. This summer has seen a new one announced for Antigonish , a new one open in Port Hawksbury and a number of clinics announcing new doctors joining up and new services being made available.??

Newfoundland and Labrador is also hurrying to create family-care teams . As part of its blueprint to revamp health care two years ago, the province vowed to build 35 such teams. It has 23 in place, but only six are fully staffed. The province recently announced?it would offer doctors already practising in the province a?$75,000 incentive ?to join a family care team and stay with it for a year.?

New Brunswick announced this spring it would put collaborative care clinics at the centre of its effort to meet its primary care goals. The province earmarked $20 million to establish the clinics in this year’s budget, and is hoping to see 30 clinics opened or be shifted to fit the model. With an election campaign underway, the issue promises to be top of the agenda. Liberal Leader Susan Holt ’s first promise was to open “at least”?another 30 collaborative health-care clinics in three years should she win power.??

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Growing pains

The growing pains involved in converting to renewable energy were felt again last week when the federal government announced it was negotiating a $500-million loan for Nova Scotia Power Inc. to cover costs incurred due to delayed deliveries of electricity from the massive Muskrat Falls hydroelectric project in central Labrador.??

N.S. Power did its part for Muskrat Falls, helping to pay for the 180-km undersea Maritime Link that carries its electricity from Newfoundland to Nova Scotia. It was finished on time and on budget but pretty much every other part of the project suffered delays and massive cost overruns.??

When the electricity failed to arrive in 2022, N.S. Power had to boost production from existing generating stations, which meant buying more fossil fuels at a time when Russia’s invasion of Ukraine sent costs soaring. That added some $352 million in additional fuel costs, and if the utility had to pay it all back now ratepayers would see a 19-percent jump in their electricity bills. Nova Scotians already pay the second highest rates in Canada.??

“Reasonable folks know that stacking such additional costs on top is not feasible at a time when cost of living pressures are already significant,”?said Federal Natural Resources Minister Jonathan Wilkinson at the announcement in Halifax. The loan will let N.S. Power spread out the rate increases associated with the delays.?

Protection racket

Federal/provincial co-operation was in much shorter supply last week on the issue of protecting the Chignecto Isthmus linking Nova Scotia and New Brunswick. Millions of dollars in trade pass through the corridor every day along rail lines, highways and telecommunications systems, and the aging dyke system protecting it is considered increasingly vulnerable to extreme weather caused by climate change.??

Fixing it up would cost $650-million, and the two provinces have begun work on it, but they want Ottawa to pay the full shot. Ottawa has offered to pay through its Disaster Mitigation and Adaptations Fund but Nova Scotia and New Brunswick aren’t budging. They’ve launched a court challenge asking the Nova Scotia Court of Appeal to rule that funding key infrastructure connecting parts of Canada is a federal responsibility, citing examples like Montreal’s $4.2-billion Champlain Bridge.??

Last week, two Liberal cabinet ministers released letters they’d sent to the premiers telling them to take the $325 million now or it would be spent somewhere else. New Brunswick’s Dominic LeBlanc and Sean Fraser from Nova Scotia said the premiers were jeopardizing critical work on the isthmus and called the court case “frivolous ,” saying it “only served to delay action on this urgent matter.”?

Things got a bit heated.??

“Why are the Liberals threatening us? Why don’t they just do what’s right?”?Nova Scotia premier Tim Houston said to reporters. If the province had to pay for infrastructure that should be a federal responsibility, he said, it would have less to spend on provincial commitments like health care.?Fraser took umbrage, particularly at the health-care linkage, saying “there is no good justification to threaten a reduction in health-care spending, particularly when so many Nova Scotian households live with real anxiety over health needs that continue to go unmet.”?He even reminded the premier that federal transfer payment helps pay for health care, and suggested he could use some of last year’s $143-million provincial surplus to meet its commitments. ?

Both provinces have, in fact, applied for funding through the disaster fund, though Houston said that was done “as a placeholder”?in the hopes that the federal government would change its position. By week's end, New Brunswick premier Blaine Higgs wrote back saying he would happily take the money now, but had no intention of dropping the court challenge. Houston said he wasn’t sure Ottawa even had looked at Nova Scotia’s application, but likewise was “confident that the courts will determine that the federal government is responsible for key infrastructure connecting our country.”??

Both provinces said the squabble wouldn’t prevent work from continuing, and late last week announced they’d hired Colliers Canada as a project manager.

Coming up empty

Hopes that the Orphan Basin might be the next great opportunity for Newfoundland and Labrador’s oil and gas industry took a hit last week when ExxonMobil Canada confirmed its Persephone C-54 exploration well had come up dry . The basin has been magnet for exploration since 2016, when seismic survey results showed it may hold as much as 25 billion barrels of oil. The Persephone was drilled in an area thought to hold up to three-billion barrels, but ExxonMobil couldn’t find it, at least not in commercial volumes.??

Country manager Kerry Moreland had cautioned this summer that the success rate for frontier exploration wells like Persephone, in deep and sometimes angry waters some 500 kilometres east of St. John’s, is roughly one in 10. BP came up dry there last year with its Ephesus well, and Woodside Energy abandoned plans to drill there two years ago.??

Persephone was the second unsuccessful offshore well drilled this summer. In early September, Equinor said it failed to find commercial volumes of oil at its Sitka site in the Flemish Pass, near the company’s Bay du Nord discoveries. It’s planning a second prospect well nearby in hopes of improving the economic case for his massive Bay du Nord project, which is on hold pending a final investment decision, likely two years away.??

ExxonMobil hasn’t given up on the Orphan Basin either. It’s called for expressions of interest for seismic work and the supply of a drill rig for a potential 2025 drilling program.??

In more positive news for the sector, Cenovus has contracted with a Polish shipbuilder to deliver a new support vessel for its White Rose operations, 350 kilometres east of St. John’s. To be delivered in 2027, the 110-metre Seadragon will provide for crew change, drilling support, emergency towing and ice management. The next generation vessel will also have one-megawatt battery packs on board and (ironically?) the ability to burn biofuel.??

Meanwhile, the company’s West White Rose project passed two milestones this summer. Its massive concrete gravity structure, under construction in Argentia, reached its full 145-metre height. It will form the base on the platform onto which the topside structure, which finished construction in Texas in July, will be bolted. Once interior work on both is finished, they’ll be towed out to the Jeanne d’Arc basin 350 kilometres east of St. John’s and put together. Dredging at the Port of Argentia to make way for the gravity structure got underway last week. First oil is expected in 2026, with production expected to reach 80,000 barrels of oil per day.

Robot dos and don’ts

Unions at the Port of Halifax have decided that automation is their enemy, and that plans to install more robotic systems over the next decade is a threat to their jobs .??

The International Longshoremen’s Association (ILA) is fighting back with a public awareness campaign carrying the tag line, “Robots Don’t. Port Workers Do”?— as in, support families, pay taxes, employ the next generation of workers.?

Kevin Piper, president of ILA Local 260, said Singapore-based PSA Halifax told the unions it planned to quadruple the container volume it handles at its two terminals at the port, and to do so it would be installing semi-automated gantry cranes that can be operated remotely. “It’s the slippery slope or the sharp edge of a wedge that you’re dealing with,”?Piper told Saltwire . “If automation is allowed to occur at this scale, all jobs at the port in container handling will be eliminated over time.”

The port’s three ILA locals have 750 members, including stevedores, checkers and maintenance staff. PSA Halifax decline to comment on the matter.??

The Port could well be getting busier soon with news last week that shipping giant Zim Integrated Shipping Services is reworking its Latin American routes to connect Halifax, giving the port its first direct connection with the west coast of South America. Nova Scotia exporters will get direct shipping access to some countries they haven’t had before, like Chile, Peru and Ecuador, and see more “reefers”?arrive in Halifax — those being temperature-controlled containers that keep perishables cool, and frozen seafood frozen.??

And in Newfoundland, the Port of Argentia is taking advantage of the push to wind power, striking a deal with a Danish manufacturer to store 220 massive turbine blades before they are shipped off to U.S. projects. Canadian ports are well positioned to benefit from an arcane piece of U.S. legislation called the Jones Act, which demands goods shipped between domestic ports be carried on vessels that are U.S.-built, owned and crewed.?Because there are so few American?ships designed to carry wind turbine monopiles and blades, international suppliers are looking to store them at Canadian ports upon first landfall in North America.

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