NOVA SCOTIA HOUSE OF ASSEMBLY
Tuesday, December 13, 2022
Surgical Backlogs and the Extension of Operating Room Hours
Printed and Published by Nova Scotia Hansard Reporting Services
Trevor Boudreau (Chair)
Kent Smith (Vice Chair)
Hon. Brendan Maguire
[Trevor Boudreau was replaced by Melissa Sheehy-Richard.]
[Chris Palmer was replaced by Dave Ritcey.]
[John White was replaced by Nolan Young.]
Legislative Committee Clerk
Nova Scotia Health Authority
President and CEO
Cindy Connolly, Director, Clinical Networks
Perioperative/Surgical Services (Co-Lead for Surgical Access Initiative)
Dr. Doug Sinclair
VP Medicine, Quality and Safety
Department of Health and Wellness
Chief, System Integration
Nova Scotia Nurses’ Union
Doctors Nova Scotia
Dr. Leisha Hawker
Dr. Andre Bernard
Anesthesiologist and Chair, Board of Directors
Scotia Surgery Inc.
Dr. Philip Cyr
President and Chief Executive Officer
Surgical Services Manager
HALIFAX, TUESDAY, DECEMBER 13, 2022
STANDING COMMITTEE ON HEALTH
THE CHAIR: I call this meeting to order. This is the Standing Committee on Health. My name is Kent Smith, the MLA for Eastern Shore, and I’m chairing today in the absence of MLA Boudreau, who was stuck by the weather in Richmond County.
We will be hearing from witnesses today regarding surgical backlogs and the extension of operating room hours. I’ll ask everyone first to please set your phones to silent if you have not already done so.
We’ll begin by asking the members of the committee to introduce themselves, starting on the government side to my left.
[The committee members introduced themselves.]
THE CHAIR: For the purposes of Hansard, I’d also like to acknowledge Legislative Committee Clerk Judy Kavanagh; and Gordon Hebb, who is Chief Legislative Counsel for all things provincial.
I will now ask the witnesses to introduce themselves. Just introduce yourselves to start, and I’ll come back to you with any of you who have opening remarks.
[The witnesses introduced themselves.]
THE CHAIR: I should just acknowledge as well that each of the witnesses has a team with them. If any of those team members do approach the mic to help answer any questions, I’ll get you to introduce yourselves at that time, please and thank you.
Now we’ve come to the point where any opening remarks . . . (Interruption) My apologies, we have a virtual witness. Dr. Sinclair.
[Dr. Sinclair introduced himself.]
THE CHAIR: Thank you, doctor - my apologies for not getting to you the first time around.
We can now have opening remarks from those folks who have them. Deputy Minister Lagassé.
JEANNINE LAGASSÉ: Thank you all for inviting us today to speak about government’s plan to address surgical wait times in the province. Colin Stevenson and I are pleased to be here on behalf of the Department of Health and Wellness to answer your questions and provide information on the plan to reduce surgical wait times.
I would like to start by acknowledging the many dedicated health care workers who continue to provide excellent care to Nova Scotians every day. They are working with us, doing everything they can despite many challenges, to make our health system better. I also want to acknowledge those Nova Scotians who have been waiting far too long for surgery. It’s not acceptable. We know that you deserve better. We are making changes, and we do have a plan to make sure the health system is ready when you need it, responsive to your needs, and able to provide reliable care you can count on.
The challenges we are seeing in our health system are not new or unique, and the impact of COVID-19 is still being felt today - not just in Nova Scotia, but across the country. These are not excuses; they are facts. We have a lot of work to do, but we have a plan to get it done.
You will hear from my colleague, CEO Oldfield, about the many initiatives we have under way to help clear the backlog of surgeries by the end of 2025 and establish a manageable wait-list that allows patients to get their surgeries within wait time targets.
Our plan, rooted in Action for Health, is based on three components: increasing capacity, improving efficiencies, and improving quality while reducing and diverting demand. Of course, this is not as easy as it sounds. Having enough surgeons and surgical staff to perform surgeries is only one factor. Lowering our surgical wait times means fixing issues in many areas of the health system. It means looking at everything connected to surgery, including more beds for post-surgical care, more operating room availability, eliminating the one million paper-based referrals processed annually, centralizing multiple surgical wait-lists that exist, and ensuring people can get diagnostic tests, MRIs, and CT scans sooner.
Reducing our surgical wait-list will take integrated systemwide solutions. Every change we make needs to be a change we can maintain. We know our health care staff are exhausted, so whatever we do needs to improve, not increase, their workload.
Before I conclude, I would like to speak briefly to accountability and availability of information for the public. Nova Scotians can visit waittimes.novascotia.ca to get information on surgical wait times, find the shortest wait time, and identify potential options for reducing their wait time. On the Action for Health website, we post quarterly progress updates on all solutions, including our promise to implement innovative solutions to reduce surgical wait times, provide safe, quality care, and achieve benchmarks. The daily dashboard contains information on the number of surgeries performed at every Nova Scotia health site and the IWK each day. This information is available 24/7 for Nova Scotians to see.
In closing, I’ll say again that the wait times for surgeries in Nova Scotia are not acceptable. Nova Scotians who are waiting for surgery expect us to do better, and we are working hard to do that. I look forward to your questions.
THE CHAIR: Thank you, deputy minister. Ms. Oldfield.
KAREN OLDFIELD: Good afternoon and thank you for inviting me to give Nova Scotians an update on surgical services. I’m proud of the ground we are covering, and know we are on the right path to creating the ready, responsive, and reliable surgical system that Nova Scotians expect and deserve.
Like the deputy minister, I want to acknowledge the dedication of all those working in operating rooms and supportive services to provide care to people in our province over the very difficult circumstances of recent years. Thank you.
This meeting comes near the tail end of a series of conversations in communities across the province. Patients and their families shared their real concerns about the health care system, but also shared their ideas about what we can do together to make things better. This includes changes to surgical services. In the year - actually, 16 months - since I’ve been interim President and CEO of the Nova Scotia Health Authority, I’ve had a laser focus on change. Guided by the Action for Health strategy, our clinicians and staff are helping us push forward to create a ready, responsible, and reliable health care system. Right now, we’re in the thick of a multi-year plan to improve access to surgery, and we are achieving early results. These will set a strong foundation for future growth and improvements.
Job one is to restore our services to pre-pandemic levels. Despite unprecedented bed pressures, staffing challenges, and even unexpected issues like Hurricane Fiona, we’ve been forging ahead. From April to now, we have moved the needle, increasing from 90 to 99 per cent of our overall 2019 volume and hours, and more improvements, investments and changes are coming. We’re on track to implement a new single-entry intake model by the end of March that will be supported by an eReferral tool available to all referring providers.
I’ve been impressed with the robust information on surgical access that is used daily to support operations and planning, but because surgeons currently receive referrals directly and manage their own lists, we - as in the administration at the Nova Scotia Health Authority and the department - lack a line of sight into how many Nova Scotians are awaiting a consult.
Our new model will fix this. It will support more timely and equitable access to consults, improve communication with patients and providers, and give us the information we need to more effectively plan and allocate surgical resources - all this while continuing to support patient and provider choice.
Our health zones are also expanding centralized booking approaches to be able to coordinate and prioritize surgical scheduling across the province. Models like these were recommended by the Auditor General almost a decade ago, and we’re finally, as a system, getting this done for Nova Scotians.
Our plan also includes targeted strategies to increase surgical capacity, improve quality, increase efficiency, and reduce or better distribute demands. This includes targeting 2,500 additional surgeries by March 31, 2023 compared to a baseline year pre-COVID of 2019, and further increase is planned. That’s an ambitious target.
Similar targets are in place for endoscopy services. We are on pace to complete more than 2,400 more endoscopies this year, and addressing backlogs to achieve more manageable wait-lists, with a commitment to more than 250 full-time positions over three years, including new physician extender roles. Our plan will help stabilize our surgical workforce to ensure that resources are in place over the longer term.
Further investments are committed for new medical beds, increased operating room efficiency, capacity, new processes, and more. We are innovating and changing how we do things when it makes sense. A great example of this is our increased focus on outpatient joint replacements, which can allow some patients to have surgery and return home the same day. These can contribute to timely care, allowing surgeries to go ahead even when beds are limited. We have already completed more than 780 this year compared to just 49 in 2019-20.
Our teams are facing unprecedented pressures, including the combined ongoing impact of COVID-19 and a significant respiratory illness. They have been through so much, but with the full support of the government behind them, they are seizing this opportunity to make long-overdue changes and investments on behalf of Nova Scotians and our patients.
I look forward to the discussion today.
THE CHAIR: Thank you, Ms. Oldfield. Ms. Hazelton.
JANET HAZELTON: Good afternoon. Thank you for the invitation to appear before the Health Committee. We are always eager and appreciative of the opportunity to
bring the nursing perspective to forums that shed light on the health care system and the work lives of nurses.
As most of you are aware, I am Janet Hazelton. I am the president of the Nova Scotia Nurses’ Union. I’ve been the president since 2002, so I’ve seen a great number of changes. I am, or was, a surgical nurse. I worked in the operating room at Colchester Hospital for several years.
I would like to start, like my colleagues, by recognizing the incredible dedication and resilience of our nursing profession. These are really trying times for our health care system as our workforce copes with a multitude of difficulties. We have an unprecedented respiratory season, workplace violence, severe health human resources challenges, overcapacity, and the ongoing fallout from the pandemic.
Surgical and procedural backlogs were already commonplace well before COVID-19 hit our shores. It certainly has exacerbated the backlogs within our system, with capacity often focused on the pandemic response. This has led to significant delays, with many Nova Scotians languishing on years-long wait-lists for necessary care. Addressing this backlog is vital to ensuring the quality of care for Nova Scotians.
I know we are here to primarily discuss surgical backlogs and the extension of operating room hours. However, more OR time is not the only solution to resolve the backlog. System capacity in general - we need more surgical capacity in our public system, a system where nearly 2,000 vacancies in acute care alone.
Turning to private or nursing agencies is not the answer. The high price our government is willing to pay to agencies for nursing services demonstrates the high market value of the expertise of nurses - and nurses themselves should be properly compensated for their value.
I will reiterate: Now is not the time to use provincial dollars to subsidize the profits of private companies. High utilization of travel nurses in this province jeopardizes the continuity of care and is often demoralizing to our regular nursing staff.
The many reasons that nurses turn to travel agencies for employment should be examined, and those very reasons should be used to recruit them back into the public system. Better pay, guaranteed time off, and an overall work-life balance are just a few reasons nurses are attracted to travel agencies.
Many are travelling within their own province, so it’s clear they want to remain in
Nova Scotia and practice their profession. We just need to ensure they are attracted to the working conditions in our public system instead. That way, all Nova Scotians will benefit equitably.
If we are to truly solve the surgical backlog issue, we need to focus attention on retaining our health care professionals. If we want to keep our ORs open longer, we need to make those variable hours and typically less-favoured shifts more attractive. We have to make training more affordable for nurses and give them access to time off to pursue educational opportunities that will allow them to work in specialized areas like our operating rooms. Overall, we need to create working conditions that make the Nova Scotia health care system one that we will continue to be proud to work in.
This government has made some significant efforts to keep our nurses working in our province. It’s a team approach. It needs to be the unions, it needs to be the IWK, it needs to be the Nova Scotia Health Authority, and all the other health care agencies. We need to work together to solve this problem.
It’s not Nova Scotia Health Authority’s problem, it’s Nova Scotia’s problem. Unless we solve it, it will just perpetuate. I think there are solutions, and I’m happy to discuss some of my thoughts on the solutions that I think we can work together on.
THE CHAIR: Dr. Hawker.
DR. LEISHA HAWKER: I’m Dr. Leisha Hawker, President of Doctors Nova Scotia. In my early career, I was a physician working in the Northwest Territories doing primary care and emergency services. For the past nine years, I’ve been a primary care provider at the North End Community Health Centre just up the street on Gottingen Street. I also work at Regency Park Family Practice, and I’m one of the founding physicians of the Halifax Newcomer Health Clinic, which serves refugees in Halifax.
With me today is Dr. André Bernard, the board Chair of Doctors Nova Scotia. He’s an anesthesiologist with Nova Scotia Health Authority, an associate professor with Dalhousie’s Department of Anesthesia, Pain Management and Perioperative Medicine, and he’s also associate head of his department.
Today’s panel is large, so I’ll keep my remarks focused on our priorities. We’re glad to be here today to discuss surgical backlogs and the extension of operating room hours, which is core to the issues of both patient access and physician resources. Doctors Nova Scotia works to ensure physicians in our province are members of an adaptive, resilient profession that can thrive in a rapidly changing health care environment.
The COVID-19 pandemic has had major impacts on our health care system. With more than 25,000 Nova Scotians currently waiting for a procedure, doctors and our colleagues are frustrated by the wait times. The challenges we’re facing today are not new. CIHI data shows our province has had high surgical wait times for over a decade. The reasons vary from a growing demand for more services to a shortage of human resources. The situation is made worse because of the pandemic. While there are no [Inaudible] patients deserve much better.
Our province doesn’t have enough providers to address the current backlog without finding innovative solutions. We need to use the resources we have more effectively, recruit and retain more physicians along with other providers, and ensure we’re keeping our workforce well. We believe the solutions are in the health partners working together to improve access to care. Physician recruitment and retention, patient attachment to family doctors, and a better work environment for all and for physician wellness.
Doctors Nova Scotia is committed to working with our partners to address health care system challenges so that Nova Scotians have access to the care they need.
Thank you again for having us today. We welcome your questions.
THE CHAIR: Thank you, Dr. Hawker. Dr. Cyr.
DR. PHILIP CYR: Thank you. I would like to begin with a brief history of the conception of Scotia Surgery Inc. Before 1991, all oral surgeons provided oral surgical services at in-hospital clinics located in various hospitals within the province. At that time, most of the services that oral surgeons provided were charged to the Province under the defined dental surgical benefit program administered by MSI.
After 1991, the insurance of most ambulatory oral surgery procedures and subsequent closure of hospital oral surgical clinics was witnessed, leading to the need for private ambulatory surgical facilities to provide safe care for these oral surgery patients.
In 2003, a plan was developed to create such a facility, which would also service other non-MSI-insured procedures. The target population was for ambulatory oral surgery, cosmetic surgery, general dentistry, workers’ compensation, and military and RCMP patients. Construction began in 2004 and was completed in December of 2005. Design and construction followed the non-hospital surgical facility standards and guidelines issued by the College of Physicians & Surgeons of Alberta in 2005.
One year after opening, we met the requirement to apply for accreditation with the Canadian Association of Accreditation of Ambulatory Surgical Facilities, which was passed easily. The accreditation has been maintained to the present day.
Our mission was to provide private-pay surgical services which did not include patients who were funded by the principles of the Canada Health Care Act. Providing this service would also direct private patients away from the more expensive hospital care and hopefully free up access for those who qualified for care under the Act.
Our first OR list schedule for orthopaedic workers’ compensation patients under an unwritten agreement was cancelled by the board two days before the scheduled surgical date. In 2008, money was allocated by the Department of Health to the Province aimed at decreasing orthopaedic wait-lists.
A three-year contract with Capital District Health Authority was created to provide public-funded ambulatory orthopaedic surgeries. This contract was monitored closely by CDHA to assess patient outcomes and satisfaction. Renewal of the successive contracts over the past 15 years is testament to the quality, care, efficiency, and cost-effectiveness of the patient care initiative.
In 2017, NSHA requested a short contract to provide a variety of surgical services at Scotia Surgery during the renovation at Hants Community Hospital. This contract was completed within five months, while orthopaedic services continued as scheduled at Scotia Surgery. We demonstrated during that time that we had both the capacity and the flexibility to respond to this short-term need.
In February 2022, the IWK contracted Scotia Surgery to provide a variety of pediatric surgical services for their facility. This was to be a trial contract for 17 months, after which continuation of the ongoing contract would be considered. It appears that the IWK and their patients and families have been pleased with this arrangement.
Our current list of public surgical services includes both adult and pediatric orthopaedics, pediatric dentistry, pediatric oral surgery, pediatric cosmetic surgery, and pediatric urology. Our private surgical services include oral surgery, orthopaedics through a variety of private insurance companies, and centralized surgical services program patients under WCB, as well as occasional RCMP cases, and cosmetic surgery.
Under the government contracts, the patients are subject to the single-pair formula under MSI. Patients are not permitted to jump the queue. All surgical lists are managed by the individual surgeon’s office. Surgeons and anaesthetists are provided by the central district hospitals. Management, nursing staff, and support staff are provided by Scotia Surgery.
In conclusion, Scotia Surgery has proven to be an efficient, cost-effective model of treatment for a broad spectrum of surgical services and an excellent tool to reduce surgical wait times in this province, and our contracts are not in conflict with the principles of the Canada Health Act. The patients, of course, must meet the criteria for safe treatment in a privately owned ambulatory facility, and are screened prior to being booked at Scotia Surgery.
Backlogs of surgical cases appear to be a universal problem throughout Canada. Many provincial health care departments are looking at existing private surgical facilities to assist in the management of this ever-increasing backlog. Scotia Surgery looks forward to ongoing participation in the management of increasing surgical wait-lists and can increase the current capacity with the addition of a third surgical suite if or when it is required in future.
Thank you for the opportunity to speak to this committee, and we’ll take questions.
THE CHAIR: Dr. Sinclair, if you have any opening remarks, I’d ask you politely to keep it under three minutes, please and thank you. We’re getting tight on time. MLA DiCostanzo, this is a Liberal topic with many witnesses who were chosen by the Liberal Party. Dr. Sinclair.
DR. DOUG SINCLAIR: My name is Doug Sinclair and my background is in emergency medicine, although I’ve been a hospital administrative leader at the IWK and Central district for many years and at the university. We are key partners with the Nova Scotia Health Authority. Obviously, we do pediatric surgery for the entire province when necessary, and gynecology and breast cancer surgery for Central Zone. We’re key partners with the Nova Scotia Health Authority, and as Dr. Cyr said, we’re involved in the current pilot project with Scotia Surgery.
We’re key partners and we’re happy to answer any questions from the committee.
THE CHAIR: Thank you, doctor - appreciate your efficiency. I would like to remind everyone - and for those of you who may not have been here before - the format for this committee is 20 minutes per caucus of questioning. Please consider me like the traffic cop of the day. Try not to speak unless you’re addressed, called upon, and your microphone light comes on. We will begin with 20 minutes for the Liberal caucus. Please go ahead, MLA Maguire.
HON. BRENDAN MAGUIRE: I ask respectfully that we keep the answers short. We’re a half-hour in and we have yet to been able to ask a question. Respectfully, I just ask that we keep these answers short, because there’s a lot to be answered.
My first question is to Ms. Oldfield. At the Public Accounts Committee, on October 5th, I asked you about a contingency plan for the Halifax Infirmary. You said the second part, in terms of contingency, well, we’re not there yet. We’re going through a process, and we’ll let the process continue. Then we will see where we are to determine whether a contingency plan is something that needs to be discussed or something needed.
Other officials stated that they were fully focused to make the procurement process work. This was exactly eight days before senior health officials directed the redevelopment team to start negotiating a multi-million-dollar withdrawal of the proponent. I’ll ask you again, with the new revelations about the once-in-a-generation redevelopment project not going through as previously determined, what is the government’s plan to replace the Victoria General? Why eight days before the removal of that proposal did you sit here in the Public Accounts Committee and say there was no contingency plan, which has an impact on surgical?
THE CHAIR: Ms. Oldfield.
KAREN OLDFIELD: If the member would like to elaborate on the latter part of the question, I’ll try to answer it, but we’re here to talk about the surgical wait-list. We’ve got a huge team here with a lot of expertise to talk about it, so I will try to respond to the question if it can be a little bit more specific.
BRENDAN MAGUIRE: I think I’m really clear on the question. A new QEII redevelopment, which actually has surgical rooms and state-of-the-art surgical operation rooms, which was planned, has an impact on surgery times, has an impact on recruiting health care officials.
We are no longer going through with the plan for the QEII redevelopment, which includes surgical beds. You said eight days before the withdrawal of the proponent that there was no contingency plan for this. What is the contingency plan for the QEII redevelopment, including surgical beds, at the QEII?
KAREN OLDFIELD: Mr. Chair, I’m not a hostile witness. I come in peace. I come to address the surgical wait-list topic. I’m happy to come to the QEII as it relates to the list, but Mr. Chair, I’m here to talk about Nova Scotians who are waiting too long, as my colleagues have indicated. I’d like to discuss how we are going to deal with that.
The QEII is an element of it. I’m not here to argue. I’m not here to fight. I’m here to, as my colleagues have suggested, work together with them, and frankly, with you, to solve the surgical wait-list issues faced by Nova Scotians in our province.
THE CHAIR: MLA Maguire, I would encourage you to keep your tone amicable, and the topic today is surgical backlog . . .
BRENDAN MAGUIRE: I would argue that, again, surgical times and wait times - the available beds and spaces and technology available will attract surgeons to this province, will keep surgeons in this province, and will have an impact on timely surgical procedures. That was all part of it. To be clear, I actually have the original documentation on the redevelopment of the QEII, and it specifically mentions surgical beds, surgical wait times, and how this project will have an impact on it. You yourself just said that it is a component of it.
We can’t pick and choose, Mr. Chair, what components we want to talk about. I’m not being hostile. What I’m saying is we were told that there was no contingency plan for the redevelopment of the QEII in October at the Public Accounts Committee. Eight days later - and those were the words of the president of the Nova Scotia Health Authority, not my words. I’m asking: What is the contingency plan, which includes multiple surgery beds, multiple surgical state-of-the-art facilities, that were planned for the QEII redevelopment? Now that that’s not going through, what is the contingency plan to replace those surgical resources?
KAREN OLDFIELD: May I say that when the government is prepared to announce and make that plan public, it will be made public. It is not my ability to answer all of the questions that the member has put to me. As he knows, we are in the middle of a procurement process - a procurement process that his government did design. He knows that it is confidential until completed.
BRENDAN MAGUIRE: Talk about confrontation. Let’s be clear here. We are no longer in a procurement position, because on the original redevelopment plan the individual companies have withdrawn, and one of them is, in fact, being paid millions of dollars to withdraw. That part of the procurement is over, and I’m asking about what the plan is.
Maybe we’ll bring the tone down a little bit, but it’s very important not just to the health care workers to know that the resources are going to be there. It’s also very important for Nova Scotians to know that when they go to the hospital there will be beds, when they go to the hospitals there will be state-of-the-art technology.
We’ve heard from doctors. I’ve heard from doctors personally - young doctors in particular - that they’re going to leave the province because of the state of the infrastructure.
Again, it’s not my place, and it’s certainly not the place of individuals, I think, to comment on Liberal, Progressive Conservative, NDP, when you’re at the helm of the Nova Scotia Health Authority. I don’t think this is a partisan conversation.
What I’m trying to ask is quite simply: What is the plan to ensure that we have these beds in a timely manner now that the proponents have withdrawn and we’re no longer in a procurement process with those proponents?
KAREN OLDFIELD: To the member, thank you for bringing the temperature down. I’m just going back to Global, November 28th, where you were stated to say, “Instead of saying, ‘you broke it and we’re going to fix it,’ it should be, ‘we’re going to build on things, we’re going to work together to do what’s right for Nova Scotians,’ Maguire said.” Mr. Maguire, that is the spirit in which I’ve come to the committee, and I truly appreciate the temperature coming down. I’m very happy to discuss how we solve the problem together.
I will add that part of the plan always was beds at the Dartmouth General, ORs at the Dartmouth General, the hybrid OR - tick, tick, tick - and there are other components to the plan, which, when the procurement process has been completed, the government will speak to and I will be able to speak to.
BRENDAN MAGUIRE: I appreciate that, and I’m well aware of what has happened over the last several years with the Dartmouth General. I think a lot of us were there when those announcements were made, and I think those are great, but again, the question is not being answered. It’s fine to do your research on what I said as an MLA and spend your time going through Global to find out what I said, and I stand by my words.
Your words exactly were: “The second part, in terms of contingency, well, we’re not there yet. We’re going through a process, and we’ll let the process continue. Then we will see where we are to determine whether contingency is something that’s to be discussed or not.” Those are your words. I stand by my words, that we need to put partisanship aside for health care workers and for people in Nova Scotia. I don’t know the political affiliation of anyone at this table, but I’ll bet you it’s all different, and I don’t really care, as long as things are getting done.
I stand by my words. I would like to know, eight days before the withdrawal of the proponents, there was no contingency plan. Just yes or no. Those were your words. Is there a contingency plan now that the full redevelopment of the QEII - the $2-billion redevelopment - is no longer moving forward as originally planned?
KAREN OLDFIELD: The Province of Nova Scotia is currently in a procurement process. The procurement process has not been concluded. Unfortunately, I cannot speak to anything beyond that procurement because those are the rules. I’m sworn to secrecy. Happy to discuss as soon as I’m able to - believe me.
BRENDAN MAGUIRE: I’d be interested to know who we’re in procurement with when the original proponents have withdrawn. That’s what’s interesting to me. All I’m trying to get at here is that this is the largest redevelopment of the health care infrastructure in Nova Scotian history. We want to make sure that these things are on time and they’re efficient. We saw the Bayers Lake facility was on time, the parking lot on time, and I think two different governments of political stripes had their hands in that. Kudos to everyone involved. So did our health care unions, so did our health care workers, to make sure these things happen.
The last thing we need is to be unable to get answers on these things. We know, quite frankly, that the $2 billion price tag has ballooned. We don’t know what that is. We don’t know if that’s the reason why the original companies pulled out of procurement. We can’t get those answers, even though . . .
THE CHAIR: Order. MLA Maguire, I’ve been as lenient as I possibly can in referencing the topic of today’s committee meeting. (Interruption) Order. We have a lot of witnesses who have come in here today to talk about surgical backlogs, and I’d encourage you to bring your questions back to surgical wait times. I’ll give you an extra 30 seconds based on calling order. MLA Maguire.
BRENDAN MAGUIRE: We now have this large infrastructure project that is being postponed as originally designed, and that will have an impact on our surgical wait times. That will have an impact on our resources. When can Nova Scotia expect a plan on the full redevelopment of the QEII? I’m not asking for names. The original proponents - are we no longer negotiating with them or are we still in negotiation with those proponents on the development of the QEII? Two questions there. I apologize.
KAREN OLDFIELD: The procurement is ongoing. It has not concluded. There are proponents in that process, and until it’s concluded, that is where we are. I can’t go beyond that. I’m sorry. If I could, I would. I cannot.
BRENDAN MAGUIRE: I don’t think we’re going to get any answers on that. What is the time frame? Originally, the redevelopment of the QEII had some time frames. It was online. After the October Public Accounts Committee, that website was taken down. It actually redirects you now to Build Nova Scotia, I think.
My question to you is: Do you have new timelines on the redevelopment of the surgery beds and the entire redevelopment? Has it been pushed out past 2025, or whenever? Are you expecting it to be delayed?
KAREN OLDFIELD: A bigger and then a smaller answer to the question. First of all, I think it is important to note - while I’m not directly asked, it is important to note that a number of surgical beds have opened in the province over the past while: beds at Valley, beds at Dartmouth, beds at Aberdeen. A real push on making sure that surgeries are going as quickly and as efficiently as they can with the beds available and with the staff available. As I indicated in my opening remarks, we have seen some good strong glimmers of hope. That’s on the bigger picture.
On the smaller picture, again, just specifically on the redevelopment, all will be known. I cannot say it. This is a government announcement. This is a government decision. It is not mine to make. I assure you, and through you, Mr. Chair, to the member and all Nova Scotians, we are on the bed when it comes to delivering surgical procedures to Nova Scotians in as timely a fashion as humanly possible.
I again want to recognize the effort that has been put forward by our surgeons and our surgical teams to deliver that care to Nova Scotians. It’s very important for people to understand that we do see some real strong glimmers of hope that our strategy is working. It’s remarkable that from April 1st of this year to the end of November, there has been a 9 per cent increase - that’s massive - in surgery utilization in the province. That’s great news.
We’re just getting going here in terms of having a plan, putting the resources in place, putting the staffing in place, getting all of the different components that are required - and it’s not one thing. It is ORs. It is staffing. It is beds. There’s not one thing. There are many things. Our strategy is pushing on all of those components to make sure that Nova Scotians can get timely access to care.
THE CHAIR: MLA Maguire, with four minutes and 20 seconds remaining.
BRENDAN MAGUIRE: I’m glad that you brought up results. If you look at the mandate letters in the government when they first got in, they said within 18 months surgery wait times would be at a national level. The Fraser Institute just released that we are now the second worst in the country.
How do you measure what you just said - that everything’s moving in the right direction and we’re seeing massive improvements - but we’re seeing the Fraser Institute, which is a non-partisan institute saying that we are now the second worst in the country?
KAREN OLDFIELD: I did see the Fraser Institute survey information. I don’t think that’s actually been a change from the last time that was put out. But that doesn’t matter. Any time that Nova Scotians have to wait is too long. If you are on a surgical wait-list, it doesn’t matter if it’s one hour, one day, one week, one month, one year. It’s too long. It’s scary. People want to know what’s going to happen to them.
The first goal, as stated earlier, is to get our surgeries back to pre-pandemic level, which we’re very close to. That’s a testament to the resilience of our staff.
The second goal will be to get into the national benchmarks, which we have set in our plan. It will take until mid-2025 to do that, and that will happen at a rate of 2,500 additional surgeries a year. Currently, right now in the province of Nova Scotia, there are 50,000 scheduled surgeries. Taking on that workload plus additional to eat into the wait-list is no easy task. It’s all hands on deck. It’s staffing, it’s resources, it’s dollars, it’s OR, it’s technology, it’s process, it’s teamwork - and that’s the plan. We are making progress.
BRENDAN MAGUIRE: Listen, I’m not going to sit here and pretend like it’s an easy position to be in for any of you, to be quite frank with you. Health care is extremely complicated with many moving parts. My final question to you would be: Are you comfortable with where we are on the QEII redevelopment? Are you personally comfortable with that? Do you think that we’re going to be able to provide the services in the near future for graduating doctors and nurses to want to stay here in Nova Scotia based on the technology, the buildings and the age of the buildings we have? Are you comfortable where we’re at in the process of the redevelopment?
KAREN OLDFIELD: Where is a Bible? Where is a Bible? We don’t have a Bible? Then I cross my heart. I cross my heart. We will move these surgical wait-lists. We will provide the right care in the right place to Nova Scotians as quickly as we possibly can. That is a promise.
BRENDAN MAGUIRE: The question was: Are you comfortable with the redevelopment of the QEII, where it’s at now and where it’s supposed to be?
KAREN OLDFIELD: I can’t really do much better than cross my heart. Working with my colleagues at Health and everybody across the line here - I would say please allow the process to conclude, to allow the government to grapple with its decision, make the decision. We will implement as quickly as humanly possible. We are moving fast.
THE CHAIR: MLA Maguire, the bell is going to go.
BRENDAN MAGUIRE: That’s fine.
THE CHAIR: We’re going to Ms. Chender with the New Democratic Party caucus.
CLAUDIA CHENDER: Good afternoon. Thank you for being here. I’m pleased to have the opportunity to ask a few questions. I’ll begin with Ms. Oldfield. You said that you have a plan. I think that’s what we’re here to ask about. Those were your opening statements. Is it fair to say that the Nova Scotia Health Authority and you are running point on this plan, notwithstanding that there’s teamwork involved?
KAREN OLDIFLED: I would say that it’s really a plan that emanates from the Health leadership team. As has been stated previously to this committee, the Health leadership team is comprised of myself as the interim CEO, the deputy from the Department of Health and Wellness, Dr. Kevin Orrell, and as well, Ms. Janet Davidson. A good part of the plan comes from that. I hope people understand how closely the deputy minister and I are working together so that we’re bringing a systems approach to the challenges, and certainly as relates to this surgical wait-list plan, yes.
CLAUDIA CHENDER: You have mentioned several times this morning that you are in an interim position. You mentioned that you’ve been in it for 16 months. Will you be the person who sees this plan through? Will you remain in an interim position? Is there a plan for a permanent president and CEO of the Nova Scotia Health Authority?
KAREN OLDFIELD: I do serve at the pleasure of the minister and the Premier of the Province, so I would defer to them in terms of my ultimate - you know, what will happen. But certainly, my intent at this moment is to do everything I can to move the various aspects of the health care challenges in front of me. I have no plans on going anywhere, and I have no plans to do anything other than spend my 24/7 doing the things that we’ve been talking about. It’s not all in my hands, as you know.
CLAUDIA CHENDER: Thank you, I appreciate that. I think, as you mentioned, you’re answering this from your perspective as the interim President and CEO, but of course, you were also on the Premier’s transition team. We know that you were involved with the thinking around how this government was going to move forward in a systemic way, and also in a political way. We know that one of the first moves was to fire the Board of Directors of the Nova Scotia Health Authority. We’ve heard nods in passing that accountability and transparency might need to be reinstated at some point. Do you have an idea of when that might be?
THE CHAIR: Ms. Oldfield, but I’ll remind MLA Chender to kind of bring it to the topic at hand, please and thank you.
KAREN OLDFIELD: I guess I could perhaps answer that in a couple of different ways. As the deputy minister noted, we are trying very hard to be transparent. The deputy minister referred to the wait-list being available to Nova Scotians, Action for Health, the benchmarks there being available to Nova Scotians, and other aspects of the system which we’re trying to make available to Nova Scotians so that they fully understand what’s going on and where they may be in the bigger picture.
In terms of ongoing, with respect to the Nova Scotia Health Authority and the current governance model, I would expect that at some point there will be decisions made. But at this moment in time, I can’t give you a time frame, no.
CLAUDIA CHENDER: I think, especially given the lack of representation of health care experience and leadership on that team - there is some, but certainly there is also a lot of administrative and innovative experience. I think people are eager to see that kind of board reinstated and that kind of input welcomed again into these important decisions.
I want to move on. The promise to fix health care - I understand there’s a plan. I understand things are changing, but if you ask someone on the street, how it’s going, they would say very, very poorly. If you ask people about what the state of surgeries is in Nova Scotia, they would say really crummy. Then they would immediately follow up with a story about their mother, or their sister, or their brother, or their friend that was terrible. As MLAs, we hear these stories all the time.
To your point about there being information public, when we checked out some of that public information that was available on the wait times website, it showed that knee replacement wait times we see in Queue 1, 2022, 636 days. In Queue 2, 2022, it’s 728. The long-term trends may be good, but it doesn’t seem as though the short-term trends are. Similarly, hip replacement seems to have increased from 581 days in Queue 1 of this year to 653 days in Queue 2. Can you comment on that?
KAREN OLDFIELD: Yes. As to the latter points, I’m going to ask my colleague, Cindy Connolly, to provide a little bit more detail, but as to the first part of the question or the comment, I’m well aware of Nova Scotians’ views. As I mentioned in my opening remarks, the deputy minister, the Minister of Health and Wellness, Minister Michelle Thompson, and I have completed 15 of 18 stops around the province of Nova Scotia. We’ve taken the last seven to eight weeks and gone into many of the communities. We’ve spoken to many Nova Scotians, to health care workers, to physicians, to many. Some of the stories are very moving and very difficult to hear. That’s why we’re doing it - so that we can understand where the issues are and address our attention to the highest-priority matters to be attended to.
I just want to share that with the committee, because I think it’s important for leaders to get out of their offices and to speak to people and to understand exactly what’s going on, much as you do yourself. That we have done, and we’ve spent hours. Of course, travelling with the minister and the deputy minister also gives us an opportunity to identify in quick order the actions that we can take.
As to the latter part of your question, with respect to the knee replacements and the hip replacements, I’m just going to ask my colleague Ms. Cindy Connolly to come here to the microphone and specifically address that.
THE CHAIR: Thank you, Ms. Connolly. Can you please introduce yourself before carrying on with the answer?
CINDY CONNOLLY: My name is Cindy Connolly and I am the clinical director for the periop network and the co-lead for the perioperative strategy initiative to look at the surgical backlog and the surgical wait times - surgical access.
Thank you for your invitation here today. I’m happy to answer your question. If I could just recap, your question was around the orthopaedics wait times - hip and knee replacements, and your comment earlier about patients calling your offices every day. Absolutely. We get the same kinds of comments every day, and it’s extremely sad and disconcerting to hear patient stories. I certainly empathize with them.
Orthopaedic surgery, for better or worse, is what we would normally call a scheduled surgery or an elective surgery, which means that in times when there are patients with more urgent needs, those surgeries get delayed. That is exactly what happened during the COVID period. Prior to COVID, you’ll all remember the orthopaedic strategy where there was huge investment. We were getting really close to achieving our benchmarks, and then COVID came and kind of threw us a curveball. A lot of the orthopaedic surgeries were delayed, were cancelled. You can speak to any orthopaedic surgeon, and they will tell you it’s still not getting a whole lot better.
However, what we have done that goes along with our periop strategy, with quality improvement and looking at evidence-based practice, we are now working to do as many surgeries as possible in an outpatient or day type of procedure, where patients come in - and I think it’s remarkable. You get your knee . . .
THE CHAIR: MLA Chender.
CLAUDIA CHENDER: I just wanted an answer to a simple question. I’m fairly familiar with the orthopaedic situation generally. We are asking about the increase in wait times from Q1 and Q2 to this year for hip and knee. Can you speak to that?
CINDY CONNOLLY: Apologies. In general terms, Q1 to Q2 - that would be April, May, June, July, August, and September - bed pressures. The ED overflows, and bed pressures. Again, many of those patients require an in-patient stay, so they get postponed.
CLAUDIA CHENDER: Thank you very much. Maybe you could answer this question for me as well. Presumably, bed pressures are not decreasing. In May, we understood that there were 26,000 people waiting for a surgery. Do we have that number now? Do we know how many people are currently waiting for a surgery?
CINDY CONNOLLY: Yes, we do: 22,600.
CLAUDIA CHENDER: I guess the one other question - I don’t know if this is for you. I’m not sure who this is for, but one of you three can probably answer it. Ms. Oldfield said in her opening comments that we don’t have a window on how many people are waiting for a consult because of, I guess, the paper record system. So this number is just the people who - I don’t quite understand how we don’t have a window on that, but we have a number of people waiting for surgery.
CINDY CONNOLLY: It is a little bit confusing. There are two parts to the surgical process. That first part is the time it takes from when the primary care provider sends a referral to a surgeon’s office. That is the piece that we don’t know. We don’t know because they’re kept in surgeons’ offices. They’re not part of the Nova Scotia Health data piece. The 22,000 people on the wait-list, that happens after the consult when that decision to treat is made. The surgeon and the patient have that conversation, make an informed decision, and the patient now comes onto a surgical wait-list. That’s what you’re looking at there.
CLAUDIA CHENDER: I wanted to ask you a couple of questions, Ms. Hazelton, based on your remarks. I think you did mention some general numbers, and certainly, we know about the HR crisis in nursing in our province and across the country. I think you also spoke to the strain that the public system is under, and the need for us to actually shore up that system as opposed to looking to other alternatives.
I know this is a little awkward with Scotia Surgery in the room, but I will say that many have pointed out that moving to contract and private provision of health care in fact exacerbates the problem. I would say that we’ve seen this with travel nursing in particular. I’ve heard from a number of nurses who have said, the woman sitting next to me is making twice what I’m making, and she has a housing allowance and more flexibility - why would I do this? (Interruption) She’s in a condo on the waterfront. That’s right.
I was really pleased to hear your comments on, I guess, a silver lining, if you will, that that actually shows the value of nursing. Have you made specific suggestions on how we could reverse that trend - how we could make nursing a more attractive profession? You started to point to some of those. It seems to me that remuneration and flexibility is part of it, but do you have a more detailed picture that you could paint, and maybe that you have or would share with them?
JANET HAZELTON: Actually, recently CFNU met with all the Minister of Health from across the country, and all the Premiers from across the country, and gave them a lot of ideas on how they can attract nurses. Loan forgiveness - it’s high. It costs a lot of money to go to four years of university. Return for service: We have lots of places in rural Nova Scotia that we should be looking to those high school students because we know if you grow up in Ingonish, you’re more likely to go back to work there.
We have the Nurse Practitioner Education Incentive, where nurse practitioners are paid their full-time salary to go to school and come back to that community to work as a nurse practitioner. There are a lot of - but they all take time, and they all take commitment. When I refer to the private - the travel nurses - it is really discouraging to work beside someone making more money than you, especially when they’re from the same province as you.
We identified that as a national problem because it’s a problem everywhere. What happens when travel nurses come into our units? They don’t do the same work we do because they can’t. They’re not oriented. We do a lot of the work teaching them what to do, and then they’re gone. I think everyone’s identified that.
When we talk about private health care, oftentimes those are - I’ll give you an analogy. When we introduce CTAs to help CCAs - what the CTAs did was all the better part of their job: walking our seniors, doing their hair. Then the CCAs were left with the heavier, more complicated care. The same goes for surgery. When I worked in the OR, you’d do a big heavy case like a bowel resection, and then you’d have a couple of lighter cases where you could catch your breath and maybe have a coffee, but those disappear when those cases go to a private clinic. Those lulls in your day - and you’re still working, but it’s just less intense. You’re not scrubbed for four and a half hours.
When those cases disappear from our workload, from our workday, it makes our workday really tough. It’s hard. They’re all big cases. So then where am I going? I’m not doing this every single day, five days a week. I’m going to go somewhere where I can have the lighter days, not the weekends, not the evenings, not the nights, not the call. Part of being an OR nurse is you have to take call. That’s part of the job. Well, if I can go somewhere and do what I love but not have to take call and get paid, why wouldn’t I do that?
That’s why we’re losing nurses to travel nurses. If we think it won’t happen if we open private surgicals, if we think nurses are going to stay in the public system, that’s not going to happen, just like they’re going to travel nursing. They have control, they have better hours, they have more time off, and they get more money.
We should learn from that mistake that is happening across this country. Travel nurses are a thing. It’s huge. We’re losing our younger nurses because it’s attractive.
THE CHAIR: MLA Chender with two minutes, 50 seconds.
CLAUDIA CHENDER: I have a bunch more questions, but I want to follow up and say, I know that some of those return to service - those are longer-term solutions. Have you identified any quicker solutions that would allow us to bring some of those travel nurses - particularly those who are resident in Nova Scotia - back into the public sector?
JANET HAZELTON: Newfoundland and Labrador just introduced travel nurses. They’re travelling around Newfoundland and Labrador, getting paid more. But they’re Newfoundland and Labrador nurses being paid by the health authority there. I just got a copy of that, and I’ll be asking Ms. Oldfield to consider it.
CLAUDIA CHENDER: Great. That sounds very interesting. A last short snapper if I have time is that patients don’t seem to have any individual communication regarding their wait times. This is particularly a problem for patients without access to primary care, older patients who can’t advocate for themselves, or my own family members who are shy to call. Will that change? When will people be able to keep track of that?
KAREN OLDFIELD: This is where a really good thing is going to happen, and it will be good for all Nova Scotians. I can give you the top line, but let’s let Ms. Connolly give you the specifics. This will be happening in March. I will allow her to come to the microphone please.
THE CHAIR: Ms. Connolly, you’ll have 55 seconds to summarize.
CINDY CONNOLLY: I’ll keep it short. What Ms. Oldfield was referring to is our single entry for referral project that will go live at the end of March. This is an eReferral tool that primary care providers will use to send referrals to surgeons, and if the patient gives consent, there will be an email notification to the patients that will say, your referral has been received by this doctor on this date. Patients will now know that their referral is not lost in space.
CLAUDIA CHENDER: Will they then be updated as to their place, or can they inquire somewhere?
CINDY CONNOLLY: We will be setting up a central intake office that will have the ability to answer questions, and certain updates will be forwarded to the patients, again if they’ve given permission to use email.
THE CHAIR: We will now turn our attention to the PC caucus, beginning with MLA Ritcey.
DAVE RITCEY: I’m going to welcome back Ms. Connolly here shortly. Sorry, Ms. Oldfield. It’s an expansion to the last question. Can you tell us a little bit more about the single entry referral system and the central wait-list, and how they are expected to help address the surgical backlogs? Maybe expand on it a little bit more. That would be great.
CINDY CONNOLLY: This is an innovative solution. It’s not new, but it certainly is new for Nova Scotia. It has been used across the country. A single entry model for referral has been shown to reduce wait times for patients. The benefits are when we proposed this solution to our colleagues and to our health leadership team, we had data to demonstrate that there is huge variation in the wait times between surgeons, between where you live, for patients. Some areas might have these really long wait-lists, and others might have shorter.
There was no way for us to provide that information in an easy manner to the primary health care providers. With this system, primary health care providers, when they look up, my patient needs to go see an orthopaedic surgeon, it will give a list of all the surgeons and a list of their wait times. So they will know that Surgeon X has a wait time of this for consult, and Surgeon Y will have a wait time of ABC.
That, again, will facilitate that discussion between patient and provider, and they can make a decision on where they would like to go for that surgery. It gives patients more choice. It gives primary care providers more information. It also provides primary care providers a bit of one-stop shopping. In the past, primary care providers would not necessarily know what information was required for that referral. They wouldn’t know where to send it, so sometimes there was a shotgun effect, and the referral would get sent to three or four surgeons.
What we realized as part of our wait-list validation is that many patients are on a wait-list three and four times. That just - our data was not clean. The teams have done a tremendous amount of work to clean up their wait-lists. Now primary care providers know who does what, and they will also know what information they need to send. In the past, referrals could ping pong back and forth. You send it today - oh, no, you need to send in an X-ray. Okay, so now we need bloodwork.
All of that will be in this eReferral form. The requirements will be there so that primary care providers will know from the get-go. It’s going to save primary care time and be better for the patients, and the system will actually have some of that information now to help us with our planning.
DAVE RITCEY: I have a second question - maybe totally different, I guess. Talking about impact and different factors that can impact wait periods, can you share with us how appropriate wait times are determined?
CINDY CONNOLLY: There are a few procedures that have a national benchmark for wait times. Hip and knee surgeries have a national benchmark of 182 days; cataract surgery, 112 days. But that is it, from a national perspective. Other agencies have tried to determine appropriate wait times and it hasn’t necessarily worked out for the best.
Within Nova Scotia Health Authority, we have surgeon-defined priority levels. We have six priority levels, and surgeons would select those. When we talk about patients meeting the wait time targets, it will either be the surgeon-selected wait time and/or the national benchmark.
DAVE RITCEY: Now we’re going to play musical chairs. Mr. Stevenson, I’d ask you to come to the seat.
THE CHAIR: Mr. Stevenson, if you don’t mind introducing yourself for the record, please and thank you, before you begin with your response.
COLIN STEVENSON: I’m Colin Stevenson. I’m the chief of System Integration with the Department of Health and Wellness.
THE CHAIR: MLA Ritcey.
DAVE RITCEY: Wonderful. Thank you, Mr. Stevenson. Could you tell us a bit about your role in quality and patient safety, as well as your thoughts on how quality initiatives are going to support and improve access and care?
COLIN STEVENSON: I think as both the deputy minister and Ms. Oldfield have indicated, the surgical strategy within Nova Scotia really is comprised of a couple of different components or elements. Part of that is really trying to address the access component, which a number of questions have been about. Ms. Connolly has talked about some of the efficiency opportunities as it relates to eReferral and central booking.
There are other pieces of work that both Nova Scotia Health Authority and the IWK have been tackling, which I would say are more focused around quality and quality improvement within the direct delivery of the service. I’m sure either Dr. Sinclair or Cindy could give more detail, should you wish.
A few of the areas of focus would be that the Province of Nova Scotia, specifically through Nova Scotia Health Authority, is a member of the National Surgical Quality Improvement Program. What that means is that there is a team of abstractors and clinicians within Nova Scotia Health Authority who actually do a retrospective review of patient charts to understand the actual process of the individual who received the surgery and what their outcome was.
They also, through a defined number of individuals, do a focused interview with the patients themselves to understand how they’re doing post-surgery. What that allows for is a more robust availability of data, which the surgical team can use to compare their performance across surgeons and across sites, nationally and internationally - because we participate through this with the U.S. as well.
The opportunities that that generates actually help to drive specific improvements within the quality of a surgery and the outcome of the patient, which actually has a system impact. One example could be that identified opportunities to improve urinary tract infections, which can be common or could be a complication associated with surgery. They’ve been able to identify opportunities to improve that within Nova Scotia. The impact for the patient is obvious: better health, better outcome, shorter length of stay. From a system perspective - back to earlier conversations and questions - it actually helps to generate better availability of beds, which allows us to do more surgeries.
There are pieces of that that are within the surgery strategy as well, which we’re seeing great improvement on, regardless of the progress that we’re making in the surgery wait-list, which we’ve heard progress on. We’re also seeing good outcomes as it relates to individual improvement processes.
DAVE RITCEY: Thank you so much for your time. I’ll pass it over to my colleague, Ms. Sheehy-Richard.
THE CHAIR: MLA Sheehy-Richard.
MELISSA SHEEHY-RICHARD: I just want to touch base with regard to the deputy minister and Ms. Oldfield travelling around for these community health conversations, which is the second time that you guys have travelled around the province. I know that they began in my community of Hants West. Unfortunately, we were in the Legislature, and I wasn’t able to be there, but I did take the time to listen and watch the video, and recognized the voices in the crowd. You had a bit of a tough sell there with the community, but I just need to take a moment to say that I received emails after that, and it really meant a lot.
It makes me a bit emotional because I know these people first-hand and I know the hard work that they’re doing. You’re taking the time to listen and really find out how a community hospital can benefit and do things for a community - and not just have regional hospitals - that these little community hospitals have a key part to play in working together. From those discussions - this session and the first session - can you provide me with any new insights or solutions that came about from these conversations that might address the surgical backlogs and the wait times?
THE CHAIR: Deputy Minister Lagassé.
JEANNINE LAGASSÉ: What we have found very interesting is - as I think Ms. Oldfield said - we’ve done 15 of the 18 sessions that are planned now, and each community, as you would know, is a bit different. Their local issues are a bit different, the people who come to the meetings are a bit different, but I would say that we generally have a number of health care workers who are there. When Ms. Hazelton was at this in Truro, there were a number of retired nurses there in particular. We see a number of health care workers, we see a number of just really engaged community members, and some people who have, as Ms. Oldfield said, some heartbreaking stories that we need to hear and that we can learn from.
From a global perspective, what I would say is that what we’ve learned from people mostly is that they understand the need for change. The message that we are bringing - and as we talk about Action for Health and the changes that we’re bringing - is that people understand that the system as it is cannot stay as it is, and that we need to make some really big changes to it in order for there to be improvement.
Do they want to see it faster than we are being able to do it? Yes, absolutely, but they completely understand that this isn’t a tinkering around the edges anymore, that this is big change. They recognize that will take some time. I would say I think that’s one of the things that’s really been reinforced for me, and I think it shows that people are seeing that we’re on the right track. That’s the global comment, and now I’ll let Ms. Oldfield speak to the more specific things that we have actually acted on since we started.
KAREN OLDFIELD: I’ve just been writing busily as I’ve been thinking about the 15 places where we spent time. For example, last week in Digby, the point was made that more information should be available if somebody calls 811 - for example, hours of operation of every facility in Nova Scotia Health Authority. I would have thought that was done, but we have made the point that it needs to be done.
Another example, from Port Hawkesbury last week: In Halifax, chiropractors are able to order X-rays, but outside of Metro, they’re not necessarily able to order X-rays. Is that something that we can do quickly? The notion of plain language - using plain language, talking in plain language, having websites in plain language, and so forth - has been made a number of times around the province. What we are able to do there is certainly, in our outward communications, but also in websites and the like, to just take the jargon down and use words that everybody can understand. That’s a very important learning.
Everybody wants virtual care. Virtual care is available currently to those on the Need a Family Practice list. There’s been some discussion in the media over the last week or so. It is popular, but it’s also really needed. Staffing it by Nova Scotian providers currently and meeting the needs is the first challenge, and then secondly is to determine ways to scale that so it can be available to all Nova Scotians whether they are on the Need a Family Practice list or not. It is quite clear that people do want access to a virtual solution that is not a paid-for solution, but it is available free of charge, such as Virtual Care Nova Scotia.
That also leads to other challenges, of course, because once you’re outside of the Metro area - and many of the MLAs will appreciate this - internet is not always the same around our province. It shows the absolute need to have availability of internet services, and as well, availability for computer services. Not everybody is computer-savvy or tech-savvy, so at our sessions around Nova Scotia, we did have booths at each session where information was provided on virtual care and the ability to sign people up on the spot, continuing care, mental health services, primary health care access, and so forth. While having the town halls, we were able to also have information available to Nova Scotians.
We were also able to encourage communities to engage in projects such as the Aberdeen Health Foundation, which partnered with its local library to host a Virtual Care Nova Scotia kiosk, and to help seniors or others to have a place where they could sign up and actually undertake their appointment. We also have a similar one in Bear River and a similar one either up or coming soon in Yarmouth, but those are community partnerships.
I think the final point I would make just by way of example is apps. For a lot of people, their life is on their phone. In many jurisdictions around the world, the same is with health care. People can access their records, their blood results, any lab results, diagnostics, appointments, and so on and so forth. That was also something that came up around the province quite clearly - the fact that our system is just dying for technology in the sense that with paper and with faxing - we’re really behind the times on the technology. I say that because it doesn’t really matter what demographic, but our technology in the health care system is really not where it needs to be, so there’s a huge impetus to raise the bar there.
MELISSA SHEEHY-RICHARD: From those conversations, were there any great ideas that could work at solving some of the surgery backlogs? Maybe doing a couple more surgeries out of my second OR at Hants? Just curious. In seriousness though, were there also innovative ideas that could maybe be applied?
KAREN OLDFIELD: I think the single biggest idea coming out of the town halls would have been how can communities partner with either the health authority or others to help to retain and recruit health care workers to their community - honestly. Yes, that would go to the surgical wait-list in a way. But mostly, it’s getting primary care providers and other important health care professionals in the community to stay in the community, family in the community, and truly part of the community.
In many cases, the question is: How can we participate? What are other communities doing - other communities which have been successful in this regard? How can we learn from that? I would say that was probably the biggest thing. I don’t know, deputy minister, if you have something to add to that, but that would be my thought.
MELISSA SHEEHY-RICHARD: I remember reading and watching the videos and commentary on the robotics. It was quite exciting, and I think we talked about it at the Public Accounts Committee, but I just want to know: Is robotics already playing any role in addressing the surgical backlogs for the province?
KAREN OLDFIELD: I think robotics - it’s very exciting. It’s really important, and it is the wave of the future. In terms of right now, today, yes, we do have surgical robotics in Dartmouth General and also at the HI. Are they impacting our wait-lists? That’s yet to come, but what they are doing is the surgeries which are being performed with the robotics, they’re very precise, which can mean fewer revisions and/or corrections. It provides a level of surgery where people can go home sooner, so they would be in hospital for a lesser amount of time, which frees up beds and so forth. It’s not all the time. We don’t have robotics where we’re just going like crazy. We’re still in a fledgling state in Nova Scotia.
However, I think it’s really important to say those surgeons who are trained on and who are training on the robotics - we’re either number one or number two in the country in this area, depending on what robot you’re talking about. That’s really important, and that’s good news for Nova Scotians, and it’s good news for our recruiting.
The other important part that comes from robotics is the data. Because it is robotics, there are a lot of analytics that are associated with it. We can then use the data to predict and get into what we would call predictive analytics to either better position for future surgeries or use them in any number of ways. There are good things that come from robotics. The QEII Health Sciences Centre Foundation and the Dartmouth General Hospital Foundation and others have been key partners in securing robotics for our surgeons.
THE CHAIR: MLA Sheehy-Richard, 29 seconds.
MELISSA SHEEHY-RICHARD: I will be so kind as to pass that over, because my next one is too long.
THE CHAIR: That concludes the first round of questioning. Just for the benefit of the witnesses, we typically have up to 10 minutes to work with, based on the time we have left in committee. We have to be done around 2:40 p.m. to 2:45 p.m. in order to complete some committee business. With that in mind, I’m giving each caucus three minutes for round two. We will begin with the Liberal caucus, and that will be MLA DiCostanzo.
RAFAH DICOSTANZO: I have at least two or three questions. I want to start with my first question to Doctors Nova Scotia, to Dr. Hawker. I was speaking to a couple of OR doctors I know and have spoken to many times. He literally said to me, we are running OR on the edge every day. He said to me, first we have to check whether we have rooms, whether we have enough nurses, whether we have equipment - every morning. He said that ICU investigations are being done six months in advance. By the time the patient makes it to the OR, their condition has changed and they may not be able to do the operation.
The other one was discharges. We are discharging them and they have no family doctors. A simple infection ends them back into emerg. They’re constantly seeing this. My question is: How can we solve those before we can extend the operating rooms? This was a government promise. Many promises have been broken. I can tell you, many people would have voted for the Conservatives because they’re going to get their operation faster. They’re going to do it 24 hours, evenings, and weekends. How do you see that ever being possible?
THE CHAIR: I would remind MLA DiCostanzo that it’s the Progressive Conservative Party. Dr. Hawker.
LEISHA HAWKER: Thank you very much. As you know, and we’ve spoken about it previously, primary health care is the foundation of the health care system. As you mentioned, the surgical backlog is multi-factorial: bed shortages, human resources - physicians, nurses and other health care providers.
But we also know that primary care is focused on prevention. If we focused our efforts on that, so that every Nova Scotian had access to a family doctor in a timely matter, we could focus on prevention of obesity and keeping our seniors well and active - and upstream, reduce the demands on orthopaedic surgery.
Those are long-term solutions. In the short term, we need to recruit and retain more physicians and nurses as well, and other physician extenders, and look at innovative ways to manage the backlog. For example, the single-entry pilot that’s starting in the Spring - I’m really hopeful that will have some significant efficiencies with that. I look forward, especially as a family doctor, to having that streamlined access for surgical services for my patients.
THE CHAIR: MLA DiCostanzo, 22 seconds.
RAFAH DICOSTANZO: Maybe Ms. Hazelton can answer this one quickly. The government had promised that they’re going to have 24 hours. Did they sit with you to say how they are going to pay? Right now, nurses are working 9 to 5 or 7 to 4 for operations in the OR. How are they going to . . .
THE CHAIR: Order. The time for the Liberal caucus’s round two has expired. I will turn my attention to MLA Burrill of the NDP.
GARY BURRILL: Thanks. I’m just thinking about this problem of clearing the backlog of surgeries and what’s to be done about this. The Canadian Cancer Society has this recommendation that government should bring forward and make public a plan - “plan” meaning to set some benchmarks and timelines - and that should be available with a reporting mechanism.
This accords with common sense. I’m interested, Dr. Hawker, Ms. Hazelton and Ms. Lagassé or Ms. Oldfield, if you would comment on this and perhaps, in your own case, does the government have this on the screen?
THE CHAIR: Dr. Hawker.
LEISHA HAWKER: Cancer is another great example, similar to orthopaedic surgery. Nova Scotians - we have an older population and a higher rate of obesity, alcohol use, and smoking, so we have higher rates of cancer in our province. It goes back to primary care once again, where we could prevent many cancers in our province and reduce the downstream demands on cancer care services.
THE CHAIR: Ms. Hazelton.
JANET HAZELTON: I think we could do our surgical services better. We can’t be all things to all people. We need to develop some of our operating rooms in the province and redesign them to do only certain surgeries. We’ll have to figure out a way to get people there to have their surgeries, but we’ll be better able to keep the people there trained, educated and specialized in certain surgeries.
We’re doing some of that - Dartmouth General’s orthopaedics, Aberdeen’s orthopaedics, Colchester’s urology - but we need to do more of it. I think people being able to see where they are and decide for themselves - because they don’t have that decision-making power now. I go where my primary care refers me. But if I’m given a choice - you can go here and get your surgery in three weeks, or stay and wait for him or her and it’s six months - I can make that decision myself. And maybe I have the ability to get there because I have family members who can take me to Dartmouth to have my surgery. I think all of those together are going to help.
The more information patients get, the better.
THE CHAIR: Ms. Oldfield.
KAREN OLDFIELD: Thank you. I think the short answer is yes. Our whole intent is to be as open and transparent with respect to the data as possible. That’s just the overall mantra. It’s trying to find the ways to put it in place and measure it appropriately with the right data.
I just wanted to make one other point. We recently in the province procured a new technology with respect to cancer surgeries. It’s called Ethos. It enables - it’s really state-of-the-art, and it’s really amazing.
THE CHAIR: Order. Apologies. Don’t mean to be rude. PC caucus, MLA Young.
NOLAN YOUNG: My question would be for Deputy Minister Lagassé. Can you tell us a bit about last week’s announcement of shorter wait times for eye surgeries by the expansion of the partnership between the Nova Scotia Health Authority and the Halifax Vision Surgical Centre? I’m hoping you can explain how these partnerships with private clinics can help us to address surgical wait times.
JEANNINE LAGASSÉ: There has been a partnership with the Halifax Vision Surgical Centre since 2020. It originally started to help alleviate some of the wait times that had accumulated for cataract surgeries during COVID-19. It was an effort to be able to get people seen quicker at that particular centre. That contract has since been extended, and now it’s been just announced that next year it will be up to 6,000 more surgeries that will be able to be done through the centre.
I think that I heard comments from Ms. Hazelton earlier about how there’s a balance to be made here. We’re looking at everything that we can do to help reduce wait times, but we also have to consider all of the other impacts on the system. In this particular case, it will allow us to have considerably more cataract surgeries done and allow more Nova Scotians to get their services done quicker.
NOLAN YOUNG: I’ll pass it back to my colleague, MLA Sheehy-Richard.
MELISSA SHEEHY-RICHARD: Let’s just talk about other models needed to improve wait-list oversight and coordination from the 2014 AG Report. That was a while ago, and I’m just curious about if you can speak to how the government’s actions and surgical strategies will improve the wait times from that.
JEANNINE LAGASSÉ: I can go quickly because I know that we don’t have much time, but I think that one of the big things that came out of that particular report - one of the things that we talked about earlier that we’re implementing - is the eReferral and the single entry wait-list because we’ll have much better information. We’ll have much better communication with patients. It’s those types of models. It’s about being able to do more surgeries to get things done quicker, but it’s also modernization of the system. There are a number of things that we know we need to do modernizing, so all of these digitization things are helping us to modernize.
THE CHAIR: MLA Sheehy-Richard, 27 seconds.
MELISSA SHEEHY-RICHARD: Investments for new medical beds increase operating room capacities, and new processes will all be wonderful things too. I hope that you’re going to say yes to all of those as well. Thank you.
THE CHAIR: Thank you very much to the witnesses for being here today. That’s reached the end of our question-and-answer period. If everyone agrees to be very efficient with their closing remarks, I can offer up until about 2:45 p.m. We have a couple of pieces of committee business that we must get through today. Ms. Hazelton.
JANET HAZELTON: In conclusion, I talked about how we have to look after our health care workers. We have to make sure that they get a work-life balance. We’re not going to be able to keep people if they’re not treated properly in the system, but I think talking to the staff has helped. Dartmouth General’s operating room, for example. When they do a hip, they used to have to move from operating room to operating room, so they made some common-sense decisions, and they’re able to move a lot quicker. Those ideas came from staff, so I think those are the kinds of things. They’re going to find the solutions, and they want to find the solutions.
We want to provide good health care to Nova Scotians, and we’re committed to doing so. We - the health care unions - will do whatever it takes to make sure that we co-operate when it comes to improving health care for Nova Scotians.
LEISHA HAWKER: I want to thank you again for inviting us to participate in the discussion and to reiterate the importance of partners working together to improve access to care, and to improve the working environment and physician wellness. To address hospital overcapacity, staffing shortages, and long wait-lists, all partners must work the together to find the creative solutions to address the many challenges. I think we’re on the right track, but there’s still always more that we can do to make sure that Nova Scotians have access to comprehensive and timely care. Thank you once again for inviting us to participate in this conversation.
THE CHAIR: Dr. Cyr.
PHILIP CYR: Thank you for having me. It’s been an interesting session from my perspective, simply because I haven’t been asked any questions, which is probably a good thing, because I have a long list of things to say. However, all I would say is that all of the conversations that we’ve had in the past with members of the Legislative Assembly, members of NSHA, members from IWK, is they’re looking for capacity, and we have capacity. We’re under contract presently and have been for the last 15 years, providing capacity for the health care system to through-put surgical cases, and we will continue to do so if allowed to. That’s basically it.
THE CHAIR: There’s a parting gift for you from the Commissionaires for not having a question today. (Laughter) Dr. Sinclair.
DOUG SINCLAIR: Just to share some information with the committee: You’ve read about other pediatric hospitals across Canada cancelling surgery due to the viral surge. I just want to let everyone know that is not the case at the IWK. We moved some surgery to day surgery. We have not had large-scale cancellations, so we’re working hard to make sure that we provide that service to our pediatric population and our women and gender-diverse population. That could all change in a week, but that’s what we’re doing right now.
THE CHAIR: At this time, the witnesses are free to go with the thanks of the committee. We look forward to seeing you again.
As the witnesses gather their things, we have a few things to complete. Order, please. The most important topic on our agenda is the January meeting. I know so because Ms. Kavanagh told me. Two of the witnesses have conflicts with their regular meeting date of January 10th. Dr. Fierlbeck teaches all day Tuesdays that term, and Dr. Kirk will be unavailable during the week of January 9th to the 13th. Does the committee agree to meet Thursday, January 19th from 10:00 a.m. to noon? It’s a Thursday, in the morning.
BRENDAN MAGUIRE: Maybe we’ll just send that to our own caucuses and get an answer by the end of the week.
THE CHAIR: I’ll ask the clerk to respond to that. Do we have any leeway on the timing before we can confirm it?
JUDY KAVANAGH: The sooner the better, but yes. I’m just checking with our Legislative Counsel. That means it would have to be decided by an email poll.
GORDON HEBB: Unless the committee delegates the authority to make the decision to the Chair or you and the Chair. That’s possible. Then you wouldn’t need that unanimity.
JUDY KAVANAGH: Based on one answer from each caucus?
BRENDAN MAGUIRE: I’m not asking for the email to vote. I just think we need time to review the date. I think if you give us 24 hours or something, we come back to make sure that we’re all free on those dates and we have the proper resources. I don’t care about unanimous votes. If the Chair wants to make the decision, that’s fine.
THE CHAIR: I think it’s fair to give 24 hours to check the schedule, but to keep in mind this meeting has been rescheduled twice already. We have a date that we know the witnesses can be here, so if we can accommodate them, that would be lovely.
JUDY KAVANAGH: For the record, this can be decided by majority, if the committee agrees to that.
BRENDAN MAGUIRE: Yes. Instead of unanimous, let’s do majority, but in case there are issues . . .
THE CHAIR: If I’m understanding, the will of the committee is that the general consensus is we’d this to happen on January 19th. We’re going to check our schedules, and within 24 hours, we’re going to let the clerk know.
I have confirmation from the NDP - MLA Burrill - that they’re good for the 19th. I have confirmation from the PCs that they are good. So 24 hours for the Liberals to hopefully agree with that and fit it into the schedule.
The next item on the agenda is the March meeting date. We are scheduled to meet on what would fall on March Break. March 14th is what we’re assuming it is. Possible dates are: Tuesday, March 7th, Tuesday, March 21st, or any Thursday, March 2nd, 9th, 23rd, or 30th. We can either decide and debate on the date, or we can allow the clerk to choose a date and let us know depending on the availability of witnesses.
Any comments or discussion on that, or should we leave it to the clerk to try to schedule a date that’s not March 14th, and then discuss it after that? With nods and smiles, we’ll say: Madam Clerk, could you please schedule a date for us, and then we’ll figure out a way to accommodate it?
The last two pieces on the agenda are correspondence. An October 26th letter from Tanya Penney at the Department of Health and Wellness in response to additional information from the October 11th meeting. Any discussion on that letter? Seeing shakes instead of nods - we’ll log it.
The September 18th letter from Brenda Sterling-Goodwin regarding vector transmitted infections was sent to members on October 5th and again yesterday. Any discussion? Seeing none.
Is there any other business to attend to? Seeing none. Thank you for this meeting.
The meeting is adjourned.
[The committee adjourned at 2:46 p.m.]