Must-read: “Dying to be Seen”

A former nurse and union activist has drawn on her decades of experience in the sector and written a book the chronicles the systematic dismantling of the public health care system, and what we must do to restore it.

Catherine MacNeil began her career as a Registered Nurse in 1976, and was a member of the NSGEU, serving as both a Shop Steward and Vice President of her local over the years. She went on to work in health administration, helping to manage a busy emergency department, then co-managing a long-term care facility before she retired in 2016. She currently teaches Continuing Care Assistants at a career college and supervises their clinical placements within long-term care. On top of that work, MacNeil has spent the last seven years researching and writing about the ongoing attack on our public health care system.

The final product of those efforts is “Dying to be Seen: The Race to Save Canadian Medicare,” a 372-page read that outlines how we got to this point, and what evidence-based action is needed to save our public health care system. It was published in January, around the same time as Allison Holthoff and Charlene Snow’s deaths were reported in the media.

As someone who held a variety of different positions within the healthcare system – bedside nurse, manager, administrator, and now, a teaching role – MacNeil was able to draw on those first-hand experiences when writing.

While MacNeil says there have always been “peaks and valleys” in our health care system, things have consistently declined since the cuts in the 90s. She recalls realizing what budgetary cutbacks really meant for care when she was working as a nurse in day surgery, and patients were suddenly required to come in as out-patients for testing prior to their procedure, and then come in the day-of their surgery:

“Somebody who’s 23 and having an ACL repair, does that person need to come in the day before and take up a bed? Probably not. But before I left the bedside, I had a couple who were 85 – he was having a hip or something done, he was first case (of the day), and they … had to get up at like 3 a.m. in the dead of winter and drive to the Halifax Infirmary. They weren’t familiar with driving, they got kind of confused about parking, this little old couple, and I thought, ‘this is the story of slashing services. It never just ends at the 23-year-old. It just goes on, and on, and on.’”
From there, things have gotten progressively worse. MacNeil was a manager in the emergency department when Dr. John Ross called a Code Orange – a call that’s normally reserved for an external disaster. While that move briefly got the attention of politicians and media, it eventually quieted down, although its clearly raised its head once again.

Health care is a complex issue, involving many stakeholders and a wide range of priorities and measurements of success. And politics plays a big role.

MacNeil recalls in 2014 when NSGEU’s home care workers were making $16.67 an hour, and they were asking then-Premier Stephen McNeil for $18.83 an hour – a $2.16 an hour raise that would bring them on par with their counterparts in the acute care sector.

“They do crucial work to get people out of beds in hospitals and get them home. I knew some of those home support women – a lot of them single mothers, a lot of them from other countries, a lot of them grandmothers – and at $16.67 an hour, some of them didn’t even have vehicles to get around – they were taking Metro Transit to get to their clients,” she recalled, “… (Premier McNeil) offered them I think $1.28 per hour, and they said, no, we want the full $2.16. To show you how much of a bully he was, he immediately enacted Bill 30, which was essential services legislation, and sent them back to work. They were separated by 88 cents an hour and he would not give in. Fast forward to 2015 and he gave RBC $22 million in payroll rebates for 150 jobs because they took over the Blackberry place that had been empty, and his argument was, ‘this is how you build the economy, you give people money, they pay taxes.’ Well, you could have upped the salary of the home care workers … All of those arguments he gave for RBC could have been transferred to supporting home care workers, but he chose not to do it.”

MacNeil also has concerns about Tim Houston’s approach to fixing health care, which seems to rely heavily on the private sector to deliver public health care.

“Whenever you set up private entities within a private system, it creates competition for human resources and now the nurses … have not had a lot of support, they’ve had these horrific shifts, they’ve worked short, they’ve been denied vacation, so if a clinic opens up down the street that offers them as much money or more, and these clinics cherry-pick the healthiest patients, so acuity is lower, the clinic is open 9 to 5, Monday to Friday, no weekends, no holidays, that’s a big draw to exhausted and exasperated nurses who feel they have not been listened to in years.”

She hopes that government officials will read her book, but really, she wrote it for all Canadians who fund the system, particularly those who work within it. And despite it all, she remains optimistic about the future of our health care system.

“I think it is possible to turn it around, but I think if there was one thing (government) could do, it would be to commit to public health care, and fund it robustly and somehow demonstrate accountability for how they’re doing that.”

*This article appeared in the spring edition of The Union Stand.