Emergency department closures are up for the year again in Nova Scotia, this time driven by sharp increases in Cumberland County.

The Health Department released its annual report on closures Thursday for the 2017-18 fiscal year.

It shows a total of 30,500 closure hours — 18,000 of which were scheduled. That's up from the total of about 25,000 closure hours in 2016-17.

The biggest jump was in Zone 2, encompassing Cumberland County, which had a total of 6,400 closure hours, none of which were scheduled.

The total the year before was just shy of 2,000 hours.

Big numbers

All Saints Springhill Hospital (1,530 hours), North Cumberland Memorial in Pugwash (2,212) and the South Cumberland Community Care Centre in Parrsboro (1,784) all experienced significant closure increases from the previous fiscal year.

Other notable jumps included:

Roseway Hospital (789 hours in 2017-18 from 421 hours in 2016-17).

Annapolis Community Health Centre (385 hours from 136.5).

Strait Richmond Hospital (828 hours from 0).

Glace Bay Health Care Facility (1,835 hours from 888.5).

Victoria County Memorial Hospital (194 hours from 0).

Northside General Hospital (6,606 hours from 6,378).

Eastern Shore Memorial Hospital (227 hours from 0).

Tanya Penney, senior director of the emergency program of care with the provincial health authority, said the driving factor behind closures is physician recruitment. Efforts continue to get more doctors in the province and get them working in underserved areas, she said.

"We just don't have the physician numbers working in those areas."

Health Minister Randy Delorey says he's hoping new programs for doctor recruitment and retention will help improve services. (Robert Short/CBC News)

Health Minister Randy Delorey said the province is beginning to see some success by offering premiums to cover hard-to-fill shifts, as well as changing the locum incentive program to keep emergency departments open, something he hopes is reflected in future reports.

More medical residency seats and the return of a practice-ready assessment process for internationally-trained doctors should also help with recruitment and retention, said Delorey.

"We're trying to get the programs and supports in place to support these communities."

Changes in approach

Summaries from community meetings in the last year note nursing availability was a factor in some of the closures.

Penney said officials have spent much of 2018 looking at the nursing strategy. One successful effort has been orienting nurses to be able to work at sites close to where they live, making them more mobile and helping address staffing needs.

Meanwhile, health authority officials continue to look at service planning and the need to ask tough questions about what makes sense in terms of resources when several sites are in close proximity to each other.

Much the way people have come to understand family doctors don't all practise the same way they once did, Penney said people at community meetings in the past year seem to understand that emergency care today can't look like it did in the past.

Penney pointed to Lillian Fraser Memorial Hospital in Tatamagouche, where the emergency department structure was altered after doctors, health officials and the community met to discuss what would be the best way to use the area's doctors.

Critics point to crisis

Tory health critic Karla MacFarlane said the government can't fix the problem until Delorey and Premier Stephen McNeil acknowledge the system is in crisis.

"I don't think they can consider anything or do anything until they acknowledge and admit that there's a crisis."

MacFarlane said she didn't have enough details to know if some problem sites should remain open or be considered for closure. But, in the meantime, people who live in communities with facilities expect to receive service at those sites, she said.

She said the matter must be a non-partisan issue, with all parties working together to solve it.

911 always an option

NDP health critic Tammy Martin said the closure numbers compromise people's ability to get care in some communities. In a news release, she accused the government of abandoning rural emergency rooms.

"People see it in their communities and these numbers confirm it."

Mike Nickerson, president of a union local representing paramedics, said in the same news release the closures create backlogs at other hospitals and increase ambulance offload delays.

Despite closure problems in some communities, Penney and Delorey both said people always have access to emergency care when they need it via the province's 911 system.