The political risks of going like hell on health care

By his own admission, Nova Scotia Premier Tim Houston is not a patient person.

Since forming government in 2021, Houston has used slogans such as "go like hell" and "more, faster" to emphasize the urgency he feels to make good on his central election promise to fix the province's ailing health-care system.

There have been times where this approach has shown positive results.

Putting primary care clinics in pharmacies, expanding health-care professionals' scopes of practice, using more mobile clinics and increasing the availability of virtual care have all created new pathways to access services for people who might otherwise be forced to wait hours in overcrowded emergency departments for basic care.

The Nova Scotia government purchased this unfinished hotel for $34 million to convert it into a transitional care unit. Renovations have cost $17 million so far. An opening date has yet to be announced. (Paul Poirier/CBC)

But a report from the province's auditor general on Tuesday highlighted just how badly things can go when the emphasis swings too far toward going like hell at the expense of ensuring I's are dotted and T's are crossed.

Kim Adair's report on the process the government used to purchase an unfinished hotel for the purpose of converting it to a patient care facility is as damning a report as that office has produced in years.

The government positioned the creation of a transitional care unit as a way to get people out of precious hospital beds when they no longer need them but are awaiting a long-term care placement or are not well enough yet to return home.

Freeing up some of those hospital beds would mean overwhelmed emergency department staff would have a place to send some of their patients, who can wait hours or longer in hallways until a bed becomes free and they can be admitted.

Nova Scotia Auditor General Kim Adair speaks to reporters in Halifax on Tuesday. (Paul Porier/CBC)

On paper, it's a logical move and the kind of thinking the health-care system could use. Reading Adair's report, however, it seems the government had its mind made up about what it wanted to do before any due diligence took place, regardless of the consequences.

The government entered into negotiations to purchase 21 Hogan Court, just off Highway 102 near Bedford, not with the property owner, but with developer Cresco Holdings, a company that once owned the property and was looking to buy it back.

Province incurs unnecessary fees

Cresco bought 21 Hogan Court and then sold it to the province for $34.5 million, keeping some land that it could later develop. The result was the province being saddled with $500,000 in deed transfer fees it would not have needed to pay if it had negotiated directly with the property owner.

Cabinet ministers on Tuesday brushed aside concerns about the process.

The report from the auditor general found the government seemed settled on Hogan Court even before conducting a scan of available properties that could suit the project requirements.

An appraisal of the property's value was based on the idea that construction was complete and that the building would be an income property, despite the fact the project was clearly for patients — not hotel guests or office tenants — and was nowhere near finished.

The government signed the agreement to purchase the property without an accurate assessment of how much work would be required to renovate the site (it has cost about $17 million so far, on top of the purchase price).

When it did receive a consultant's report on the topic — a report that cautioned that even with costly renovations it wouldn't be able to accommodate some patients and advised against choosing that location — the deal to buy the property was already done.

To date, Hogan Court and another transitional care unit planned for Bayers Lake have cost the province $81 million in sole-sourced and untendered contracts.

What it could mean for Halifax Infirmary project

Using a so-called alternative procurement process is not uncommon and there are cases where it's appropriate. Adair's report, however, found that government procurement protocols were often not followed in this case.

Speaking after the release of Adair's report, Health Minister Michelle Thompson and Internal Services Minister Colton LeBlanc defended the government's work on the project.

It will add 68 new beds for the system two years sooner than if the building were constructed from scratch, they said, and at a comparable price to a new long-term care home. The system desperately needs new beds and they were elected to fix health care, the ministers reminded reporters.

All of that is true, but the government struggled to explain why it required abandoning what would seem like minimal due diligence and resulted in what Adair described as "a highly unusual transaction" that left the government at risk of being overcharged.

There's also the political risk it creates for Premier Tim Houston's government.

Hogan Court is small potatoes compared to the multi-billion-dollar redevelopment of the Halifax Infirmary that the government is negotiating. Like Hogan Court, that project is months behind schedule and LeBlanc has not provided a detailed explanation for the delays.

"Go like hell" could be a good idea in theory, but it might not have the same appeal with the public on a project they'll be paying for for generations if it results in the same red flags Adair found with Hogan Court.

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