HANSARD
NOVA SCOTIA HOUSE OF ASSEMBLY
STANDING COMMITTEE
ON
HEALTH
Tuesday, July 11, 2023
COMMITTEE ROOM
EHS Off-load Times
Printed and Published by Nova Scotia Hansard Reporting Services
HEALTH COMMITTEE
Trevor Boudreau (Chair)
Kent Smith (Vice Chair)
Chris Palmer
John White
Danielle Barkhouse
Hon. Brendan Maguire
Rafah DiCostanzo
Gary Burrill
Susan Leblanc
[Rafah DiCostanzo was replaced by Hon. Zach Churchill.]
[Gary Burrill was replaced by Lisa Lachance.]
In Attendance:
Judy Kavanagh
Legislative Committee Clerk
Philip Grassie
Legislative Counsel
WITNESSES
Department of Health and Wellness
Jeannine Lagassé
Deputy Minister
Jeff Fraser
Executive Director, Emergency Health Services
Emergency Medical Care Inc.
Charbel Daniel
Executive Director, Provincial Operations
Nova Scotia Health Authority
Dr. Tanya Munroe
Co-Lead, Access and Flow Network
International Union of Operating Engineers (IUOE), Local 727
Kevin MacMullin
Business Manager
HALIFAX, TUESDAY, JULY 11, 2023
STANDING COMMITTEE ON HEALTH
1:00 P.M.
CHAIR
Trevor Boudreau
VICE CHAIR
Kent Smith
THE CHAIR: Order. We’ll call this meeting to order. This is the Standing Committee on Health, and I’m Trevor Boudreau, MLA for Richmond and Chair of the committee. Today we will hear from the Department of Health and Wellness, Emergency Medical Care Inc., the Nova Scotia Health Authority, and IUOE Local 727, regarding Emergency Health Services Off-load Times.
I’d ask everybody present if you could put your phones on silent. We’ll start with committee members introducing yourselves, stating your names and constituencies, starting with MLA Smith on my left.
[The committee members introduced themselves.]
THE CHAIR: For the purposes of Hansard, I’ll also recognize the presence of Legislative Counsel Philip Grassie and Legislative Committee Clerk Judy Kavanagh.
As I mentioned before, the topic is EHS off-load times, and we have a number of witnesses with us here today. I’ll get everybody to introduce themselves first, and then after the introductions, we’ll go into remarks. I’ll start on my left, your right, with Mr. Fraser.
[The witnesses introduced themselves.]
THE CHAIR: I think there are four of you who have opening remarks. We’ll start with Deputy Minister Lagassé. You can begin your remarks.
JEANNINE LAGASSÉ: Thank you for the invitation to appear this afternoon. Mr. Fraser, Executive Director of Emergency Health Services with the department, and I are pleased to join our colleagues from Emergency Medical Care Inc., the Nova Scotia Health Authority, and IUOE Local 727, the Nova Scotia Paramedics Union to discuss EHS off-loads.
To begin, I would like to thank the paramedics who work so hard in communities across our province. Paramedicine is a demanding and difficult career, but I imagine it is also one of the most rewarding. I want our paramedics to know that we are all committed to making changes to better support them and the important work that they do.
Our health care system remains under pressure, including within the emergency care system. This is not unique to Nova Scotia. We are working hard to alleviate this pressure to ensure that those with the most urgent needs get care sooner, improve ambulance response times, and offer more options for care.
We are also focused on initiatives that improve how people move through the hospital and our health care system, known as access and flow. All of these things are connected, and we are making progress working on them as a system. We need paramedics to do the work only they can do. That’s why we expanded the medical transport service and the patient transfer units to move low-risk patients who do not need medical oversight during transport. Paramedics now handle fewer than 20 per cent of these transfers, down from 86 per cent, freeing up ambulances and paramedics to respond to emergencies.
Nurses and physicians in the EHS Medical Communications Centre give advice over the phone. This initiative and other new primary care options help divert patients who don’t need emergency care to more appropriate places for the support that they need.
The Single Paramedic Emergency Advanced Life Support and Basic Life Support program, or SPEAR, has paramedics respond to lower-acuity calls without tying up an ambulance. We’ve had great success with this program and will add six new units over the next year, doubling from six to twelve.
We will soon have a second air ambulance to move patients from Sydney and Yarmouth to Halifax for routine tests and treatment. This will free up ground ambulance resources that would otherwise be driving up to 10 hours round trip, and will also allow for several patients to be transferred at the same time.
I mentioned access and flow improvements earlier, and I’m sure Dr. Munroe will have more to say on that piece, but I want to quickly mention a key part of that work. The new care coordination centre gives health care teams real-time information on bed availability, diagnostic tests, procedure status, wait lists, ambulance off-loads, and patient transfers. This and other initiatives that improve the flow of patients through the system, including emergency departments, help patients return home sooner and open capacity in our hospitals for those who need to be there.
Government’s Action for Health plan is built on the voices of health care workers.
We are making progress in its implementation. More EHS transport operators have been hired, a new fleet of ambulances is on the road, more campuses offer paramedic training, and there is a tuition rebate for that training. More staff like patient advocates, physician assistants, and off-load teams now support patients in emergency departments, helping ambulances get back on the road faster. There are more primary care options, like mobile clinics, new and growing collaborative care clinics, new pharmacy clinics, and expanded virtual care. Last year, the number of family doctors who started working in Nova Scotia reached a three-year high and more nurses are staying in our system.
While more can and will be done, ambulance off-load times have been trending down over the last six months. We will continue to act to ensure that Nova Scotians can get the care they need when and where they need it.
THE CHAIR: Mr. Daniel, I believe you have some opening remarks.
CHARBEL DANIEL: Hello, everyone. I would like to extend my sincerest gratitude to the committee members for inviting Emergency Medical Care Inc. to participate in today’s discussion on the challenges, progress, and continued opportunities within our current health care system, specifically regarding the issue of off-load.
We recognize that off-load delays can cause implications for ambulance availability and response times. We know this is a concern for Nova Scotians, including our frontline team. The shared understanding of the value that a reliable and accessible emergency health system holds within our province’s integrated health care framework further amplifies this concern.
I want to assure the committee and Nova Scotians that nothing is more important to our team than delivering safe, high-quality patient care to the residents and communities we serve across Nova Scotia. We are committed to doing everything we can with our partners at this table to ensure that we are giving the right resource to the right patient at the right time.
Our highly skilled and dedicated paramedics - whether on board an ambulance, aircraft, or single response unit, or engaged in a community paramedic program - promptly respond to your calls, ensuring exceptional patient care. Our dedicated team at the EHS Medical Communications Centre is part of our patient care team and is comprised of skilled communications officers who are there to provide precise instructions when you dial 911. Our clinical team is equipped with on-site physicians, nurses, and paramedics who diligently assist in identifying the most appropriate care options for your unique circumstances.
Additionally, our supervisors and leaders remain vigilant in continuously monitoring the EHS system and the broader health care landscape to optimize community coverage. We collaborate closely with the Nova Scotia Health Authority and their emergency department leaders to ensure that your care remains a priority until you can be safely attended to in the waiting room or received by an emergency department clinician.
To our partners, including those present today, we express our profound gratitude for joining us at this table to address the complex challenges confronting our health care system. As a solutions-focused organization, we recognize that strong collaboration is the cornerstone of progress, and together we are making progress and moving in the right direction.
From shaping collaborative policies and practices to formulating solutions tailored to the needs of specific patients through the care coordination centre and other initiatives, our collaborative efforts span the entire emergency health system. We work in close coordination with medical first responders, police, fire, and emergency measures organizations not only on a regular basis but also during major events such as the recent forest fires.
Working collaboratively to find solutions also includes unions who represent our team, including IUOE Local 727. I want to assure the committee and our partners that we are committed to continuing to work with each and every one of you to help transform our emergency health system.
Finally, it fills me with immense pride to stand before you today as a representative of the entire EHS/EMCI team. Our EHS clinicians, support staff, and leadership teams are focused and dedicated to delivering high-quality and safe emergency, critical, and supportive care to the people of Nova Scotia. I extend my deepest appreciation for your unwavering commitment and selfless service in your daily efforts to serve the people of Nova Scotia. We hold our experienced team members in high esteem while continually seeking to welcome new students and recruits into our ranks.
On behalf of our entire team, I want Nova Scotians to know that despite the formidable pressures and demands on the EHS and health care systems, we will always be steadfast in our commitment to respond promptly and effectively as we continuously work to meet the ever-changing needs of our communities.
THE CHAIR: Dr. Munroe, I believe you have some remarks as well.
DR. TANYA MUNROE: Thank you for allowing me to appear as a witness for the Nova Scotia Health Authority to discuss the topic of EHS off-load times. I am the senior medical director for the integrated Access and Flow Network in the care coordination centre. Additionally, I am an emergency physician and a former EHS medical online physician, so I am familiar with those strategic and operational aspects of access and flow.
Throughout my medical career, I have witnessed first hand how ambulance off-load times impact patient care and how patient flow impacts ambulance off-load times. These systems do not work in isolation but must collaborate effectively to ensure efficient access to care in a hospital setting.
I’d like to highlight several access and flow initiatives currently under way to alleviate the pressures on emergency departments, and consequently improve ambulance off-load times. These initiatives are the C3: Care Coordination Centre, SAFER-f, and Home First.
C3 is the first province-wide flow command centre in Canada. The analytics involved through our C3 tiles support decision-making in various ways to improve patient monitoring and bed use; have more efficient discharge planning; enhance staff scheduling capabilities; and increase collaboration between units and across facilities. C3 is enabling staff and physicians to spend more time providing care as opposed to coordinating it. By directly addressing the need for faster access to care, we are positively impacting patient flow within the hospital system, which in turn impacts the availability of ED stretchers and ambulance off-load times.
Another priority initiative is the SAFER-f patient flow bundle. SAFER-f is a comprehensive set of best practices for hospital patient flow designed to reduce unnecessary waiting. When consistently implemented, this bundle leads to better multi-disciplinary team collaboration and care coordination; supports well-planned and timely discharges; reduces patient deconditioning and deterioration through earlier discharge; enables patients to feel a sense of partnership with clinical staff, as they know what is happening with their day-to-day care; and reduces health care provider and patient exposure to risks, errors, and omissions through a more coordinated care approach.
Since it was rolled out in June 2022, eight pilot units - two in each zone - have adopted the SAFER-f bundle. In September, a new cohort of units will be engaged, and this will continue until all the acute care units across the province have SAFER-f implemented. This will result in increased bed availability on in-patient units, resulting in decreased in-patient onboarding in emergency departments.
The last initiative I wish to highlight is Home First. This Home First philosophy is being implemented province-wide. The goal is a health system that enables patients to safely age in place with supports and programs. The goal is to also establish discharge plans that promote healthy, independent, and safe living at home for as long as possible or is reasonable. Home First focuses on minimizing patient risks through a discharge back to a patient’s home with appropriate organization and community supports.
With these initiatives, I am encouraged by the progress we are making in improving patient flow. I see that the health care system is functioning as a cohesive one rather than in isolated silos. I have witnessed positive outcomes and localized improvements in providing alternate access to care outside of emergency departments, as well as improved, timely access to in-patient care, which reduces waiting in emergency department beds.
However, it is essential that we continue to forge ahead and sustain the momentum in enhancing the patient experience by delivering the right care in the right place at the right time, reducing unnecessary waits, and ultimately preventing bottlenecks in the system.
THE CHAIR: Finally, Mr. MacMullin.
KEVIN MACMULLIN: Hospital emergency departments: More hospital emergency departments are closed across Nova Scotia than ever before. This results in more demand for emergency departments, usually the regional facilities, to support these closures. Illnesses, accidents, and medical emergencies do not decline because emergency departments are closed, placing more demand on our EHS system.
Supply vs. demand: As everyone is aware, a period of declines in births, increased retirements, and generally people living longer has evolved over the years. Families in the past were larger. Sometimes six or seven children were the norm. However, that has reduced dramatically, resulting in a smaller workforce. As our population ages, the demand for health care services increases yearly. Keeping pace with this demand with a reduced supply has placed extra challenges on an already-stretched health care system.
[1:15 p.m.]
A growing province: In our province of Nova Scotia, we have seen robust growth in population due to people from other countries and regions seeing potential in an increased job market and better lifestyle here on the East Coast. Many Nova Scotians who relocated for work are now retiring, selling their home away, and moving back to Nova Scotia. They bring increased purchasing power, resources, and demand on our health care system.
The fallout from reduced emergency departments: When you look at reducing emergency departments, it results in an increased demand for paramedic services, EHS, and extended transport times to open facilities. Upon arrival at these ERs, paramedics face reduced nurse staffing - nurses who face similar challenges in their workforce. With fewer nurses to look after patients in ER beds, paramedics are forced to wait, keeping their patients on stretchers to provide care for those stable enough to receive it. This triage delay becomes increasingly frustrating for paramedics, nurses, and patients.
EHS challenges: Our paramedic resources are shrinking for various reasons, including a global shortage of qualified, skilled, and experienced paramedics. Increased retirements in the past few years of an aging workforce have negatively affected us as we lose quality and experience. Approximately 70 of our 884 active paramedics are presently over the age of 55. Our paramedics are being recruited from field operations into Nova Scotia Health Authority positions due to their scope of practice and ability to work independently.
Nova Scotia paramedics are known to be a valued resource and are being recruited by other provinces due to their highly regarded training, extreme competency, and knowledgeable experience. Those outside offers of better working conditions, increased benefits, and a better remuneration package have resulted in a dire loss of workforce who are a valued investment that this province must retain. To keep training the top Canadian paramedics and have them leave the region is assuredly adding to the current state of health care.
These issues are reducing staffing levels and, combined with off-load delays, often make working conditions unbearable for the paramedics who have chosen to stay. Close to 200 medics in our workforce are off for various medical reasons, and we are seeing an increase in operational stress injuries.
Solving the off-load delay: Fewer staffed units, longer transport times, and even longer off-load delays prove that paramedics are not being used efficiently or effectively. Paramedics want to avoid standing in hallways providing care for stable patients knowing that they could be used in a more urgent and critical setting at that exact moment. We need to fix this off-load delay issue now, not down the road sometime. It has been discussed long enough, and our Premier and Minister of Health and Wellness have tasked this challenge to all stakeholders.
As stakeholders in this matter - whether you’re NSHA, DHW, EMCI, EHS, or IUOE - we all must sit together at one table and discuss a solution. Working as a team and supporting one another, we can accomplish the goal of an improved health care system for Nova Scotia. This is a necessity, not a desire, if we wish to successfully solve this crisis and provide the care and emergency support that Nova Scotians deserve daily or in a life-or-death situation.
THE CHAIR: That concludes our opening remarks. We’ll now move on to the Q&A portion of the committee. I’ll just remind everybody to wait to be recognized. The light will come on and you’ll be able to speak into Hansard. Each caucus gets 20 minutes of questioning, followed by up to 10 minutes, as time allows. We go until about 2:45 p.m. If your 20 minutes are up, I will stop your answer or your question at that 20-minute point. After the wrap-up at 2:45 p.m., if there are any closing remarks, I’ll offer that up to the witnesses.
With that being said, the Liberal caucus will start. I see MLA Churchill has his hand up. MLA Churchill, the floor is yours.
HON. ZACH CHURCHILL: I’d like to thank all of the presenters for coming in and being here to talk about this important topic. We all know how important off-load wait times are when it comes to how our emergency departments are functioning, when it comes to the stress levels on our paramedics, impacts to patients and patient outcomes. It’s all very important when it comes to saving people or losing people. I do appreciate a number of the initiatives that were mentioned by staff today as well. I remember when some of those began just over, I think, two and a half years ago.
We are seeing a pretty dramatic trend upwards, when you look at the numbers from August 2020 to our current day, when it comes to off-load wait times. We received this information through Freedom of Information, so I have the off-load wait times for every single hospital in Nova Scotia. If you look at these numbers I have - they date from April 19th to March of 2023 - you can see that from 2019 to 2020 there was a trend of decreasing off-load wait times. We were seeing improvements in that period. Since August 2020, we’ve actually seen an incredibly drastic increase in off-load wait times at almost every single hospital, every single emergency department. Every hospital has an emergency department in the province, and I’ll just give some examples.
We’ve had, of course, the off-load wait times increase from the two large ones in Halifax. We’ll go with the QEII Health Sciences Centre, from 104 minutes - which is well above what the ministerial directive was at the time of August 2020 - to now being over 124 minutes. We’ve seen the off-load wait time at Yarmouth Regional Hospital increase from August 2020 from 21 minutes - which was below the ministerial order of the day - to close to 60 minutes. So we’ve seen a tripling at Yarmouth Regional Hospital in the last two years.
We’ve seen an incredible increase at Cape Breton Regional Hospital, which in August 2020 would have been 35 minutes off-load wait time to currently 135 minutes. We realize that the government and the government’s representatives have spoken numerous times about all of the initiatives that are intended to impact off-load wait times, but we’re actually seeing the opposite happen in very dramatic and consequential ways.
My first question to EHS is: Obviously, even when we’re seeing these numbers just at an urban hospital - off-load wait times were at one point only really a major issue at the QEII and the Dartmouth General Hospital in metro. We are now seeing off-load wait times become a problem in every single emergency department across rural Nova Scotia as well. Can Mr. Daniel please talk about the impacts to ambulatory care in rural Nova Scotia when they see these off-load wait times increase in hospitals? It is important for people at home to understand what happens when at Cape Breton Regional Hospital there’s an ambulance waiting there an average of 135 minutes. What does that mean for patients who are out there potentially dealing with a very traumatic, life-threatening illness and the care that they’re going to get?
THE CHAIR: Just before I recognize Mr. Daniel, at the end of the meeting or whatever, can you table the documents that you used?
CHARBEL DANIEL: Great question, for sure, and definitely a point of concern for all of us. That’s what we’re here to discuss today. You mentioned a lot of points, and I just want to take a moment to unpack some of these, and maybe talk a little bit first about our actual system status plan - how it works and what these impacts would mean to it.
As many of you are probably aware, our provincial coverage - our system status plan - operates almost like a net across Nova Scotia. At our peak deployment, we have X number of units that are deployed across the province, and when a unit is responding to a call, it’s pulled out of that net and the net essentially stretches. As it returns, the net returns to its appropriate level of coverage. There’s no doubt that any spike in call volume, increase to off-load times have an adverse effect on that net. The longer it’s stretched, the more strain it’s under and required to have the resources come back in.
When talking about the dates and times of these changes, the first thing I’d just like to acknowledge - which is probably the most obvious one - is that within that time period, we experienced probably the equivalent of two tectonic plates colliding with each other, which is COVID-19. As a result, we’ve got a ripple effect that’s going to happen afterwards. We’ve seen that ripple effect take place and it probably peaked about six months ago.
As you look at the data and all the changes that we’ve put in place, you’ll see the enhancements that, as of six months ago to today, are trending in the right direction. What those enhancements include is - when we talk about that net and what resources are getting pulled into, we’ve been focused on ensuring that the resources are not being pulled for things that they shouldn’t be doing.
One of the first things we did over the last couple of years is the expansion of the transfer service. Prior to that expansion, we had about 55,000 transfers that were done annually by the EHS system, and over 40,000 of those were completed by ambulances. With the expansion that’s taken place over the last couple of years, that’s reduced down to below 10,000, which means there are 30,000 fewer transfers that these ambulances are attending and are remaining within the system and that net to provide coverage.
The same thing we’ve seen with our single-response units that are working in tandem with the virtual care team and the EHS Medical Communications Centre that are responding to these low-acuity calls, not sending an ambulance, where they can treat the patient, provide an alternate disposition safely, and keep the resources within the system.
I think all of these impacts that have happened and that we’re putting in place are starting to trend in the right direction and provide relief into the system. It’s important to note that these are not one-off solutions. They’re the start of a process that will continue to enhance and continue to adapt to properly provide coverage for the province.
ZACH CHURCHILL: Despite all the initiatives and all the money that’s being spent, we’re still seeing a really dramatic escalation of our wait times. This used to only be an issue for our two biggest emergency departments here in Halifax. Now we are seeing this massive escalation - two times or three times more added to the wait times in nearly every single emergency department in the province.
Just some more examples - Valley Regional Hospital went from 29 minutes in August 2020 for an off-load wait time to 78 minutes. We’ve got South Shore Regional Hospital - from 37 minutes in August 2020 to current day 90 minutes.
My question to Dr. Munroe: Where off-load wait times previously, up to August 2020, were solely an urban issue impacting the two largest emergency departments, would you now say that off-load wait time is a major issue in rural Nova Scotia emergency departments as well?
TANYA MUNROE: I certainly acknowledge that ambulance off-load is an issue for emergency departments across the province. It is a challenge to varying degrees from different sites.
When I think about the difference between August 2020 and present day, I am mindful that the emergency department demand looked different in August 2020, courtesy of the pandemic. We did have - at least in the zone in which I worked, there was a decrease in visit volumes year over year. What we now see is increasing demand, perhaps even more than would have been there if we hadn’t just spent two years on COVID-19, because it was delayed access to care. People chose not to present for care. Some chronic diseases became that much more complex.
We have increasing demand. We have patients who require hospitalization, perhaps at a bit higher rate. We’re working to try and increase the speed with which we can get admitted patients out of the emergency department and into the in-patient units to free up those emergency department spaces for EHS.
We have seen across the province that, yes, wait times have been increasing, but they’re starting to trend back down. The initiatives that we have ongoing within the Nova Scotia Health Authority - they recognize that solving the ambulance off-load problem is not going to occur solely within the bricks and mortar of emergency departments. We have to look at the system end to end, from increasing capacity to provide care in the community before and after hospitalization to improving our throughput within the hospitals, to looking creatively at many of the projects that Mr. Daniel just outlined, EHS stating your care with a care team in the communications centre. I am encouraged that I’m seeing some local trending down. I absolutely acknowledge we have more work to do, and that work is ongoing.
[1:30 p.m.]
ZACH CHURCHILL: When you’re looking at the numbers, hospital to hospital, it may be that some regional numbers are trending down, but if you look at the hospital-to-hospital numbers, which we acquired through a Freedom of Information request, you’re not seeing much downturn in off-load wait times. Many of our hospitals are still experiencing major upticks.
I’d like to thank Mr. MacMullin for your comments earlier. You talked about the impact of emergency room closures on off-load wait times. You spoke about the impact of losing emergency rooms in rural Nova Scotia, how that can impact wait times in other emergency rooms. When you’re looking at Valley Regional Hospital - which again in the last two years has gone from under a 30-minute off-load wait time - 29 minutes - to, in March of this year, 78 minutes - again, that’s the average - two major things have happened in that time. We’ve had one emergency department closure in Middleton, and we’ve had Annapolis drastically lose hours in emergency. Has that impacted the off-load wait times and emergency care in the Valley, those closures, would you say, and increase the pressure on your members and the work that they have to do?
KEVIN MACMULLIN: Without a doubt, closure of hospitals in settings like Middleton, and Annapolis being reduced, that creates an issue for us, because now the transport time is longer. We’ve got to look at the longer distance to take that patient, and as a result it means that all the areas are now transporting to, say, Valley Regional Hospital. That creates a burden on the Valley Regional Hospital because, like every hospital today, they’re understaffed, we’re losing nurses in these ER departments, the increased demand from the public because they no longer can go to their ER departments in the Middleton area. It means that they’re going to travel to Valley Regional Hospital.
They’re going to be impacting wait times because they’ve got to be seen also. As a result, our paramedics are stressed out, they’re leaving their area to transport to another area which is farther away, and now they are sitting there, looking at their screens, and saying: There’s nobody even in my area. How am I going to be able to respond appropriately to a call that may be one of my neighbours whom I know - family, whatever? It is a stressful situation.
Sure, we are looking, and EHS is implementing better systems, but we have to get ambulances out of ERs. We can’t have them sitting there any longer with paramedics tied up. It’s a waste of resources. We’ve got to do something that’s going to make a change. We’ve got to be able to off-load these patients. If they’re stable enough, they should be off-loaded and looked after, and our paramedics have to be back in their regions.
Just the other day, I heard of paramedics who travelled 1,700 kilometres in their shift. That’s 1,700 kilometres providing coverage usually. That’s not going and sitting in an ER, that’s just travelling around. I hear from some of my paramedics out in the field, they’re putting sometimes 700 kilometres on a night shift travelling all around. They may start in Springhill, and the next thing you know you’re in Truro. You might be down to New Glasgow, then you’re down to Sheet Harbour, you’re up to Halifax, wherever. It’s a lot, and it’s wear and tear on these people when they’re out on the street, driving these excessive hours late at night. It’s bad. We have to turn around and come up with a solution to fixing the off-load delay.
ZACH CHURCHILL: We are seeing that the government closing the emergency departments has increased off-load wait times, particularly in rural Nova Scotia. I wonder if that’s also the case in Cape Breton, where now the only place, I believe, to off-load emergency patients is at Cape Breton Regional Hospital. Ambulances, paramedics used to be able to off-load in Baddeck. That emergency department, of course, has been shut down. We had tragic deaths that we’ve heard about in Cape Breton, also in Cumberland. In Cumberland, we’ve seen at Cumberland Regional Health Care Centre the off-load wait time go from 24 minutes on average in 2020 to 79 minutes.
Of course in Middleton, we just heard about the tragic deaths there. There have been two tragic deaths, where actually the volunteer fire department had to be called in to treat somebody in hospital. So we are seeing the impact of government policy where emergency departments are closed, in part contributing to off-load wait time increases at hospitals that never had off-load wait time problems previously. We are hearing about anecdotally some very tragic deaths in these areas.
We are seeing a correlation, I think, between decision-making, closures of emergency departments, drastic increases in off-load wait times in every single hospital, every single emergency department in the province, which again previously didn’t have these issues, and we’re hearing more about these tragic deaths occurring. Certainly, the stakes are very high when it comes to off-load wait times and outcomes for patients.
When we heard about the deaths in the emergency departments in Cape Breton and Amherst, the government responded with an action plan. However, there was a public letter to the Premier signed by, I believe, close to 40 emergency room doctors, suggesting that this plan wasn’t actually going to address the major issues that were affecting these issues in the emergency departments. They talked about how long waits and fewer ambulances in communities lead ultimately to tragic outcomes. I can table this letter as well.
Would we say that one of the root causes of these challenges that we’re seeing is off-loads? Would we say it’s having an extreme impact - we’re seeing how it’s impacting patients, but would you say it’s having an impact on morale of paramedics as well and their ability to do their job, and even keep their job, stay there? Are we seeing more paramedics leave as a result of these additional system pressures?
KEVIN MACMULLIN: For sure, it’s an issue. We are looking at a lot of stressors there on our paramedics. Some of them are just at a breaking point. They’re being recruited by the Nova Scotia Health Authority, and they’re being recruited by other provinces. We have to use our paramedics efficiently. As I’ve said to my colleagues numerous times, you have to manage the resources we have before you don’t have the resources to manage. If we see a dramatic outpouring of our paramedics, and we see decreased numbers, that’s not going to help us.
We’re losing a lot of very valued, experienced paramedics right now. It’s continuing. We are replacing them, but we’re replacing them with graduates and brand-new paramedics who need mentoring in the first year or so of their career. Otherwise, we’re going to lose them too. It is impacting us, and the off-load delay issue. We have to fix that problem.
ZACH CHURCHILL: Do we know how many paramedics we’re net negative this year?
KEVIN MACMULLIN: Yes, we do. Presently we’ve hired 53 paramedics. We’ve lost 49 paramedics. Sixteen of those were advanced care paramedics. So yes - it’s not good when we’re losing people, and out of those 53 paramedics, you’re looking at 30 of those paramedics are graduate paramedics - 30 or more.
ZACH CHURCHILL: I’ll just conclude this by saying off-load wait times are impacting morale for our paramedics. It’s impacting the number of paramedics we’re able to keep, let alone recruit. It’s impacting access to emergency care in rural Nova Scotia. It’s impacting ambulatory response times to people who need it in their most desperate hour, and we’re actually seeing evidence, anecdotally at least, that it could be potentially increasing death in Nova Scotia as well.
THE CHAIR: Order. Good timing. That concludes the Liberal caucus’s 20 minutes. We’ll move on to the NDP. I see MLA Leblanc. You may begin.
SUSAN LEBLANC: Thanks very much, Mr. Chair, and thank you to everyone for being here.
I didn’t realize this when this question was planned, but I’m going to speak of someone who’s at this table. The Province’s contract with Emergency Medical Care Inc. was signed by the Leader of the Liberal Party, who was then the Minister of Health and Wellness in 2021. It’s worth about $165 million a year and was for a five-year term.
There are many performance targets in the contract that cover things like response times and staffing coverage. The actual targets are redacted, but it seems pretty clear that we’re not meeting many of the targets. We know that only 56 per cent of ambulance response times are on target and only 26 per cent of off-load times are under the targeted 30 minutes. We’ve just heard in the last 20 minutes that these trends are worsening. Freedom of Information records show that staffing was below 90 per cent planned for every month between April of last year and January of this year.
My first question is for the department. The contract with EMCI contemplates penalties for missed targets, but our office has received records through FOI that suggest that the penalty has never been levied in the history of the contract. I just want to clarify if that is true, and if so, why not?
THE CHAIR: Mr. Fraser.
JEFF FRASER: Thank you for the question. You asked two questions there. One is around the key performance indicators or the response time requirements. There are such that are in place. The issue we’re here about today is to talk about the off-load. EMCI would not necessarily be in a place where they could change that outcome, other than some of the other programming we’ll talk about later that they’ve helped us put in place.
The reality is that the reason we can’t hit those targets is because we’re not able to get out of the hospitals. It’s very difficult to impose a penalty or a fine on an organization for something that’s out of their control.
We do monitor. We do hold to account. We do meet on a regular basis to review operational performance. It’s very important not only to Nova Scotians but to the service. But beyond that, we are also working on a much more comprehensive reconciliation piece around performance focused on outcomes. We’ll be one of the few services in North America that take this on. It’s less about how many times we arrive at somebody’s side within a defined time period. It’s more about did we select the right route? Did we select the right practitioner? Did they travel the safest way to the call? Once they got there, how was their medicine performed, and what was the outcome of the patient?
We’re quickly moving into that realm, because that’s going to give us the information on how to make our service much stronger.
SUSAN LEBLANC: Thanks for that. I see your point, that it’s hard to levy fines against something that’s not the fault of the company. But then why is it in the contract? Where do we find who’s responsible for that, and how do we get to the bottom of it?
JEANNINE LAGASSÉ: Thank you for the question. I think the point of not imposing the penalty is when it’s something that’s outside of their control. We certainly are monitoring things, and if there is a performance indicator that is not achieved and it is something within the company’s control, then we will move toward enforcement of it, for sure. But I think that we’re trying to - in the circumstances that we’ve been in, when it’s a system issue - I think a lot of the things that we’ve talked about already today talk about the action that we’re trying to take across the system.
Off-loads are a large and complex issue that isn’t just about EHS. It’s not just about the emergency department. It’s about primary care. All of these things lead into it. That’s why, when we were looking at it from a system perspective and have not felt to date that it’s been appropriate to impose a penalty if it’s something that’s outside of the company’s control.
SUSAN LEBLANC: Can anyone speak to what the management fees in the contract are?
JEFF FRASER: No, it’s redacted.
SUSAN LEBLANC: Yes, that’s why I asked the question. We got the FOI, and it’s redacted.
I just think that it would be good for Nova Scotians to know how these contracts are worked out. What money is going to paramedics? What money is going to the service itself, to the trucks themselves, and what money is going to manage the contract?
[1:45 p.m.]
I’ll move on and say, and this is for Mr. MacMullin and the department: Thinking of the stories of people who have waited too long for ambulances with tragic outcomes - we don’t need to repeat them here, we all know of some of the terrible stories we’ve heard in the last couple of years - people are very concerned about their ability to get an ambulance. Of course, we want to reiterate, always call 911, but people are genuinely concerned, for good reason. Paramedics are doing their best under very difficult circumstances. My question is: Does the department and does the union think that we’re getting good service for the $165-million contract?
JEFF FRASER: Yes, I do believe that we are. I think the Deputy Minister mentioned in her opening remarks that we are starting to see a bit of a change within that off-load piece. It’s early, but Mr. Daniel walked you through some of the programs and the innovation that’s been driven through the system over the last year and a half - the split production model of actually separating out the transfers, recognizing that there are more appropriate people who can move patients around through our system.
Basically all the strategies that we’ve put in place, the best thing we can do as a system to prevent off-loads is not to get into it to begin with. We have to look at the patient, put them in the centre, and begin to treat the patient for what they need versus what we’ve always done. EMCI has been instrumental in helping us deliver on that over the last couple of years. A lot of changes, and we’re just starting to see the benefit of that now.
KEVIN MACMULLIN: Of course, it’s improving. We’re seeing more investment in our paramedic services, in the lines of equipment, better training for our paramedics, which leads to the fact that we have some of the best paramedics in Canada right here in Nova Scotia, highly trained, very efficient, willing to do a great job. The problem we’re faced with is that the working conditions are not great when you’re tied up in the ER system and you can’t respond appropriately to that call that you know is quite a distance away because you had to travel for an extended period of time to a regional facility.
SUSAN LEBLANC: I just want to pick up on that. I don’t know if it was Health Committee or Public Accounts Committee, but a couple of years ago now, it feels like - it was definitely in the Main Chamber - we had a discussion about an innovation that was happening at the Dartmouth General Hospital. Of course, I knew about it as a Dartmouth MLA, but there was some innovative work in the ED around off-loads where folks were able to go to a second triage room and be monitored by health professionals who weren’t paramedics. Paramedics were able to go off.
At the time it was a pilot, or it was being looked at as a pilot. Can someone update on what’s going on there? Has that system been adopted by the regional hospitals, at least, throughout the province?
TANYA MUNROE: I don’t have great working knowledge of the Dartmouth model, but I think you’re referencing a rapid assessment zone. Patients would be cleared from paramedic stretchers, the care signed over to an emergency department care team, thus freeing up an ambulance to return to community call. Those do work until we’ve maxed out that capacity. I think the solutions across the regionals and Dartmouth General Hospital vary based on the particular problems that hospital might be facing. Is it a hospital that’s fully staffed but has a poor physical plan and needs an emergency department redesign? Has it got a Cadillac department but not enough people there that day? Is the issue that the medicine service is overwhelmed, and the medicine patients are occupying 30 per cent of the emergency department footprint?
The strategy you roll out does vary based on the individual circumstances. The rapid assessment zones, yes, they do tend to work - particularly if you’re able to cohort patients who are able to be cared for upright in chairs with monitoring, as opposed to lie-down spaces. That’s been adopted to varying degrees across the regional sites. It may look slightly different site to site, but the underlying principle, yes, has been adopted.
JEANNINE LAGASSÉ: The other thing that I would add to that is in the announcement that we made in January about emergency room improvements, we had also introduced the Flow Lead and Off-load Assessment Teams program, which is a physician who leads a team within the emergency who attempts to do an expedited triage of the patient to be able to get them out of off-load quicker. I can advise that that’s currently implemented in five of the regional sites: Cape Breton Regional Hospital, Aberdeen Hospital, Colchester East Hants Health Centre, Valley Regional Hospital, and the QEII. The remaining sites will be implemented in the next quarter. It’s a variation on the theme of the rapid assessment zone.
SUSAN LEBLANC: Is that on top of the rapid assessments, or going to replace the rapid assessments?
JEANNINE LAGASSÉ: In addition to where, as Dr. Munroe has said, it’s appropriate for that to be provided.
SUSAN LEBLANC: So we’ve heard already that we are entering another Summer where ERs are being closed often, especially in rural areas. The Canadian Association of Emergency Physicians has been sounding the alarm about ER closures. I will quote from a statement that they released. “The Canadian Association of Emergency Physicians (CAEP) is once again deeply concerned about the increasing trend of emergency room closures during the summer months across Canada. These closures not only pose significant risks to patients but also place additional strain on an already overwhelmed healthcare system. CAEP rang the alarm bell last summer with this release and unfortunately governments and policymakers have failed to enact positive changes to prevent future closures.” I will ask someone to get me a copy of that to table.
I’m wondering if you can talk, Mr. MacMullin, about the impact of those closures. You talked a little bit about it, where people are on the road for 1,700 miles or kilometres or whatever. I know paramedics who travel from the Valley to - I don’t know, New Glasgow and back again a couple of times a day because of this.
Anyway, can you talk just really quickly about the impact on the patients, but also on the workers?
KEVIN MACMULLIN: Yes, Susan, it has an impact. You’re stretching your resources. With ER closures, we also are coupled with units being down due to vacations, due to sickness - sometimes people are sick and that. With fewer units on the road and farther response times and farther transport times, it does have an impact on our paramedics and their mental health. They’re quite concerned about leaving their communities wide open with nobody back there who is able to respond immediately.
We have a robust system, as Mr. Daniel has explained, in that we have the EHS Medical First Response program, but it still preys on the minds of our paramedics. We have to have them back in their areas quicker. That means we have to have a system in place where we can off-load. If you look at the Aberdeen Hospital, it’s one of the better hospital ER systems that we have in the province of Nova Scotia. I’m very impressed with that - but let’s have that right across the province. Let’s implement whatever they’re doing right. We’ve got to adapt to that so we can get our paramedics back on the street where they should be.
THE CHAIR: MLA Leblanc. We will ask you to table that quote.
SUSAN LEBLANC: Yes. Thanks. Just quickly, about flow again, and off-loads and waiting and the patients - the other end of the flow, which is the folks who are in acute care beds who are waiting for long-term care, and therefore people in emergency waiting for beds.
Can anyone provide an update on the Hogan Court hospital or hotel - I forget what it’s actually called - and also any new long-term care imminently opening to relieve some of these pressures?
JEANNINE LAGASSÉ: Hogan Court - a transition care facility is what it’s termed, and it is moving forward. The project is being run out of the Nova Scotia Health Authority, so I don’t have an exact timeline on that. But it is absolutely moving forward, as we had expected.
Again, I don’t have any information on Seniors and Long-term Care. I apologize.
SUSAN LEBLANC: I’ll pass it to MLA Lachance.
THE CHAIR: MLA Lachance, you have six minutes or so.
LISA LACHANCE: Thanks so much for being here, everyone. We’ve talked a bit about the challenges facing human resources - the challenges facing the people doing the work, and the draw on our paramedics, recruitment out and that sort of thing. There have been a number of initiatives trying to start to dig away at some of the health human resource pressures, but it seems to me that paramedics haven’t received equal coverage by those. Paramedics received half of the retention and sign-on bonuses that nurses were offered. As far as I understand, paramedics are not eligible under the More Opportunity for Skilled Trades initiative, and they just haven’t seen the amount of raises, like when CCAs got raises.
We have these vacancies and people are leaving all the time. Maybe I’ll start with you, Mr. MacMullin. What has been the impact of these exclusions or lack of access to some of the incentives that other health community human resource professionals have had on paramedics and on retention issues?
KEVIN MACMULLIN: Certainly, we were not consulted with in regard to the government announcement to some of these initiatives to retain staffing. We’re disappointed that we weren’t consulted and had an ability to turn around and present other solutions to this issue. We’re currently working with the government, and they have provided some initiatives to retain and also some new initiatives into recruitment of new paramedics into the program by offering schools in different locations. We have a new one coming up in Stellarton, one in Yarmouth, which will enable people in those regions the ability to go to school in their region so they don’t have to face the high cost of trying to come to Halifax, for example, and live in Halifax, where it’s very expensive.
As an added bonus, the government has allowed $11,500 in funding towards the education tuition for these programs. These are good initiatives, but we also need more initiatives down the road, and we’ll work on that. The big thing is the paramedics we have out there, to bring their morale up, is get them back out into the streets. We need to get out of the off-load flow delay system. There are a couple of things we can work on toward that initiative. We should be able to work as a team in every way, shape, and form with the union, the government, the employer, and the health care system. That’s the key thing - we have to improve this for the public.
JEFF FRASER: Mr. MacMullin covered a lot of the points. We are making incremental adjustments. We’re very concerned about the workplace itself, and as Mr. MacMullin I’m sure will tell you, he sits every month in our paramedics report meeting looking for some solutions that we can implement to really drive improvements for patients, the public, and our providers. A lot of our focus has been on not taking patients to emergency departments. That is a wonderful opportunity for us - recognizing that not all of our patients are critically or acutely ill.
Those changes will allow us to create capacity across our communities and be a lot more patient-centric as we move forward. In turn, it gives the paramedic staff more options when they’re dealing with folks on the street, versus always having to do the same thing. In our system, we believe that transportation is ancillary, not mandatory. We don’t have to take every patient to the hospital that we see. I think although it’s early days, we’re starting to demonstrate that some of these changes that we’re putting in place are much more patient-centric. We’re leaving patients with plans and/or taking them to hospitals at a time that a hospital can accept them and actually expedite their care through the emergency department.
LISA LACHANCE: I’m just wondering - the stats around 53 higher this year, 30 recent grads - it would seem that things like the More Opportunity for Skilled Trades program might be a real opportunity there to help recruit new grads, and to show our support for them for welcoming them into working in our province. I think I hear the workflow, and I know it’s a real focus, but at the same time, I know we’re losing paramedics and we need to think of all the various ways in which we can make this an attractive place to work.
[2:00 p.m.]
THE CHAIR: Perfect timing. That concludes the NDP portion for the first 20 minutes. We’ll now move on to the PC caucus. You have 20 minutes. I see MLA Smith has his hand up. MLA Smith.
KENT SMITH: I’ll echo the sentiments of my colleagues opposite to say thank you to the witnesses for being here today. I have a few questions, and then I’ll pass it off to my team. I’m going to start with a follow-up for Mr. Daniel. One of my colleagues opposite talked about the challenges and wait times over the last two - three years since 2020 or so, but we’ve really seen a drastic improvement in the last six months. I’m curious to know from Mr. Daniel, from your position, could you attribute that to one initiative that we’ve put in place or that you’ve put in place, or is it a combination of factors? I’m just wondering if you can expand on the last six months of improvement that we’ve seen.
CHARBEL DANIEL: It’s definitely a combination of several initiatives that have been put in place, and moreover, it’s been the collaboration and the close ties when working with our partners both at the NSHA and Department of Health and Wellness in prioritizing how we’re modernizing the system and what we’re doing. When we talked about some of these enhancements - again, these changes started about two years ago. When they went into place, like any change, you wouldn’t expect the result to happen overnight, but it takes time to feel the impact, see the results, and enhance them and make them better.
With the transfer service expansion, when we started this a couple of years ago, it started with the medical transport service, which was a bus-like transportation for six patients. Then we took our patient transfer units that had paramedics on them, and we doubled those, then we introduced our low-acuity transfer units across the province. In turn, we really increased the capacity of that transfer service by about 400 per cent over the last couple of years using resources other than paramedics to do calls and transport patients who don’t require clinicians.
Again, that’s just the beginning. Currently, we’re reviewing and preparing to deploy another six additional transfer units across the province to continue that positive work, but moreover, by the end of this month, we’ll have our non-critical care air transport unit deployed. That will see transportation of patients between HRM and Yarmouth and HRM and Cape Breton. What that means to the system and what it means to ambulances is that normally that patient, the one patient who has to come in from Cape Breton to the Halifax Infirmary would take that entire ambulance out of service for the whole shift. They’ve got five hours in, they’re going to wait, and then five hours back. They’re not doing any other calls. That’s for one patient.
This fixed-wing aircraft has the ability to transport up to six patients - two stretcher, four ambulatory - and in turn, we’re leaving these resources in rural Nova Scotia, where we’re hearing about these impacts, to stay there and do the work that they need to do.
My colleague, Mr. Fraser, talked about these single response units that we also started and worked around over the last couple of years. Those have absolutely been instrumental in providing the right resources for the right patient at the right time; 70 per cent of the calls that we receive are low-acuity calls, calls that don’t necessarily need an ambulance. What we have been doing, and I use this example mirroring what our police agencies do, they’ve got their SWAT teams and they’ve got their police cruisers. What we’ve done for years is sent our SWAT team to every call. It’s not the best use of resources, because it’s not required. They don’t need that.
Now, as we’ve implemented this virtual clinical team in a communications centre that can review the calls and identify appropriate resources, it allows us to deploy more resources and treat patients in their homes or provide an alternate disposition.
The SPEAR units that we talked about earlier, just as an example, their non-transport rate for the specific SPEAR calls is upward of 50 per cent, and that’s drastic. That’s a huge burden lifted off the system where patients are still receiving safe care and what they require.
All of the work that we’re doing, we have been working with Fitch & Associates, and they have validated the efforts that we’re putting in place to the point where they’re using us on a national platform to promote the work that’s happening in Nova Scotia, understanding that it takes time to come out of the situation that we’re in now and understanding that the system is under strain and we are moving in the right direction.
With our NSHA colleagues, we’ve never been so intertwined as we are right now with our communication pathways, the collaboration, immediate escalation of things that need to happen in real time, both with off-load and even hospital closures. These are things that, if we have a heads-up and we’re talking about it, we plan accordingly to ensure that resources are deployed as they should be in those local areas.
The best part of all of this is that about a year and a half ago, we built this employee advisory council made up of our frontline team members who have all of these great ideas, all of which we’re talking about today and really where the inception of these ideas came from. They’re on the front line. They’re seeing the impacts on the system. They’re understanding the issues. They’ve got fantastic ideas. All we have to do is listen to them and find ways to map them out and implement them.
That’s just scratching the surface of a lot of the things that have been happening. It’s a combination of all these things working together to enhance the system and trend it right back in the right direction.
The one last point I want to add is that what we are on is not a destination. It is a journey. What we need to build and what we are building are processes to continuously review the system and enhance it so that we don’t wind up back here. It’s not that this transfer expansion and separation is a one-time solution and we never have to touch it again. It’s the enhancements that are happening now, the attention that’s continuously being there that continue to help it evolve and provide what’s needed.
If we go back four years ago and look at our communities across Nova Scotia, what they needed was very different than what they need today, and it’s going to be very different from what they need four years from now. We’ve done a lot of work with our integrated health programming across the province, which has been around for some time, and continue to evolve and grow that as well by providing these unique resources in areas for patients and essentially, at the end of the day, providing a unique patient experience and helping them receive the care they need.
KENT SMITH: Thank you very much for that, Mr. Daniel. It’s encouraging to hear your optimism. It’s encouraging to hear someone who lives and breathes this every day say the things that you’re saying from your first-hand experience and not speculating. You live and breathe - this is what you do every day. I think you do a fantastic job for us. Thank you.
I have one more question. It’s going to the department. Deputy Minister, to you first - and you may want to pass it off - there are several initiatives under way across the system to address the access and flow challenges that we have. Can you talk about some of those options for access and flow improvements - how they’re administered and rolled out in each different facility? How do you choose which facility to roll them out in?
JEANNINE LAGASSÉ: I’m going to ask Dr. Munroe to start on the access and flow things directly - that she is familiar with from the network, and then I’ll pick up after that.
TANYA MUNROE: Very good question. The initiatives I spoke of in my opening remarks are in varying degrees of implementation across the Nova Scotia Health Authority. We have just started the SAFER-f rollout. As I said, the solution to ambulance off-load is not going to be found in the emergency department alone. It really does require a whole-system end-to-end community in-patient community approach.
The SAFER-f flow bundle implementation - we basically look for units that are ready, interested, and willing to start. They join in a quality collaborative type way. The entire focus is continually being the best at getting better. What processes do we need to improve to reduce unnecessary waiting? What other processes can we find along the way that we need to continue to work on?
This has been successful in the first eight sites. I can speak a little bit about the impact to ambulance off-load at the SAFER-f bundle at the Colchester site. That is the site I’m most familiar with. It had two of its three medicine units involved in the SAFER-f flow bundle. It has had a month-over-month, for the last three months, sustained reduction in EHS off-load time. It’s had an improvement in flow-through facility. We definitely are getting the patients the care they deserve in the appropriate environments faster. As we spread SAFER-f across the organization, it is anticipated that we will see these improvements also continue in other sites.
The care coordination centre is another big-ticket item that has started to function at the QEII. It will function across the province by the end of 2024. It will enable us to see in real-time where the patients are, where they need to be, and how we get them where they need to go, and get them home if that’s their ultimate destination, with supports if needed. EHS will be embedded in C3. It’s already embedded in our daily access and flow communications. We are collaborating and coordinating like we never have before during my 25-year career in the Nova Scotia health system.
The third piece we can’t forget about is caring for patients at home. Can we support them at home and avoid a trip to the emergency room, either through the initiatives that Mr. Daniel spoke of or through a ome First approach - partnering with continuing care, and when they are ready to go home from an acute care visit, can we get them home a little faster, a little safer? Can we put some additional enhancements to keep them safe at home? This is also in varying degrees of implementation across the province. Everything that needs to bring the EHS wait time down and improve emergency department flows, it’s going to be a series of additive results from the entire basket of initiatives.
As we get going, I think we will see increasing positive improvements, and the critical enabler is the staffing. Much like the paramedic staffing - staffing across all aspects of health care - it’s challenged, and it’s not a Nova Scotia-specific problem. It’s a global problem. When we have adequate emergency physicians, we will not see emergency department closures. When we have adequate emergency nursing support, we’ll be able to keep the sites open as well. Once that piece gets sorted and we’ve got all these other initiatives that we’ve been working on, I think we’re going to take our health care system to where we all want it to be, where it deserves to be for Nova Scotia.
JEANNINE LAGASSÉ: I’ll just pick up quickly because we’ve mentioned this a few times, but I think it’s important at this point in this question that access and flow is really - and the issues that we’re talking about are whole of system. What Dr. Munroe’s been able to take you through is the middle piece of it, because you have input into the system, throughput, and then an output. Really, she’s spoken to you about the throughput piece in the hospital, but we’ve also taken a lot of steps with EHS and other primary care initiatives so that we can avoid people having to go to the emergency department in the first place.
Our primary care community pharmacy clinics, our primary care clinics for unattached patients, VirtualCareNS - all of those in addition to the EHS diversion initiatives are all things that helped to prevent getting people there in the first place. Then on the output side are things like the transition care facility that MLA Leblanc had asked about, more seniors in long-term care homes, and all of those things - but it’s the whole of system. As Dr. Munroe said, we’re layering all of these pieces and hopefully as our health human resources circumstance improves, we’ll start - we’re already seeing traction. We’re already seeing some of our times improve, but we will really see things take off once we’re able to layer all of these things and move them forward.
KENT SMITH: Thank you for those great answers. I’m going to pass it over to MLA Palmer to not take all of our time.
THE CHAIR: MLA Palmer.
CHRIS PALMER: I really appreciate this conversation this afternoon. I think there’s a take-away that those Nova Scotians who are watching this, and as they hear about our meeting today, I think they’ll get a take-away that it is an overall system approach. I appreciate those comments that are being made today and the collaboration of everyone working together is - we’ll see the progress. I believe that will happen.
I have a couple of questions regarding a bit around that system approach and that overall - not in silos specifically - but I understand that physician assistants and nurse practitioners, they’re obviously playing a key role in delivery of services in ERs and out of ERs. Mobile primary care clinics are something that are used quite a lot in areas that I represent. Can you talk about how some of those ways are working to increase the availability of all those providers together and how they’re working to help the off-load times?
JEANNINE LAGASSÉ: I think that, certainly for the mobile care clinics in particular, as you raised that one - I didn’t raise that in my last answer, but we’re looking to get care to people as close to home as possible. What we do with the mobile units is look where we see areas where there are higher numbers of unattached patients, places where there might not be as many services available, and then making sure that the mobile units are going there to help. Again, it’s all in an effort so that people can get the service that they need without necessarily having to go to the emergency department; but if they present at the mobile and are in need of a higher level of care, then absolutely, the pathway is found for them to get there.
[2:15 p.m.]
I think the physician assistants and nurse practitioners piece that you raised is another part of the announcement that we made in January. I just wanted to look to make sure that I had my number correct, but I think that there are 24 nurse practitioners now trained to both admit and discharge from facilities, so that helps with our access and flow. The physician assistant pilot is under way. There are currently three at South Shore Regional Hospital, and one is posted there. There are two working at Dartmouth General Hospital, and two further positions posted there. There’s a total of four and a half FTEs for Cumberland Regional Health Care Centre that are currently posted. There are two to be starting at Cape Breton Regional Hospital in September, and two more to be posted there. So all additional resources in the emergency department to be able to help with access and flow.
CHRIS PALMER: Thank you for that. I want to address my question to Mr. Fraser, if I could. I live with a frontline health care provider. My wife is an X-ray radiological technician, I guess is the word. I love speaking with people on the front line, and paramedics and nurses in the hospital. I understand you used to be in the field yourself at one point. Thank you for all you’ve done through your advocacy through health care.
Your work with EMCI, and now your role here with the Department of Health and Wellness - this question is two parts. Can you talk a little bit about some of those changes that you’ve seen since your time in the field and some of the improvements that have been made? You also used the term patient-centric. I’m really curious to hear more about that and how that’s maybe the future of where we’re going. Expand on that, if you could, please.
JEFF FRASER: I’ve been fortunate to have over three decades in the emergency health services system. I am serving in a different capacity now representing the department and the office of the regulator, which is certainly a different lens. I will say, I am flattered with the work that has happened across the system in the last couple of years. You talk about being patient-centric, or I raised being patient-centric earlier. We recognize years’ worth of data, and I think Mr. Daniel highlighted as well, the staff are bringing these ideas forward.
Everybody’s got a part and a role to play here. EHS system’s role to play in the off-load piece is being patient-centric. How do we not take patients to emergency departments who don’t need to be there? We’ve instituted a number of programs to actually support that.
You’ve heard about this clinical pod that Mr. Daniel talked about. Essentially, that is a clinically-astute training paramedic specialist who works in that centre, and they’re paired with a physician who has boots on in that centre. The physician’s job is to advise on things that happen after an ambulance call is processed. Really, it’s about the potential to mitigate transportation to hospital safely. We almost put the patients in a virtual waiting room. The 20 physicians who work in that program are all active emergency room physicians with a great deal of experience and very familiar with the EHS system.
The end of November this year we added in a nurse program, and that’s a response mitigation strategy. It takes about two minutes to process a 911 call when it comes into the EHS system through the PSAP, or the public safety address point. In those two minutes, what the staff are going to do is ask a bunch of key questions, and they’re going to wait for the response from the patient. A lot of our calls in the system come in second- and third-party. We don’t always have the luxury to speak to a patient. But when we do, it allows us to put that patient into that nurse and recognize that what was explained earlier with those questions that were asked and the answers that came in, there is an opportunity here not to do things like Mr. Daniel said with the SWAT team. That’s the change that we’ve been waiting for within our system for a very long time.
It’s patient-centric because a lot of those patients whom we go to who may not need to go to the emergency department, if they don’t get what they need, they tend to cycle in the system. What we want to do is holistically address that. How do we give a patient a plan? They don’t always know what they need. They count on us to do that. It’s our responsibility. On the 911 end in Nova Scotia, we’re trying some different things that other jurisdictions have taken out for a walk and have been quite successful.
This is going to drive the change. This is where we’re looking at the patient, putting the patient in the centre, and then helping them navigate their needs, versus just taking them to an emergency department, leaving, and/or spending hours with them. Most of those ideas, MLA Palmer, come from our front lines, and they see these things, much like - you’ve identified your spouse works in the system. That’s exactly what we’ve been focusing on.
THE CHAIR: MLA Palmer, you have 20 seconds.
CHRIS PALMER: I just want to thank you all for coming today. I don’t know if my colleague could get anything in in 20 seconds or not. (Laughter)
I just want to thank you all, and I think working together is the way to do it. The whole overall system approach is great.
THE CHAIR: That concludes the 20 minutes for the PC caucus. We’ll now move back to the Liberal caucus. You have approximately eight minutes for the second round of questioning, and I see MLA Churchill has his hand up, so you can begin.
ZACH CHURCHILL: We’ve gone the last two years from having an off-load wait time problem at our two big emergency departments in Halifax to an off-load problem across the province. This has now become an issue in rural Nova Scotia. I’m looking at the numbers here, and while we have seen some marginal pullbacks in off-load wait times over the last six months, when you compare it to two years ago, we certainly have seen an explosion in wait times. We’ve seen it become a problem not just in Halifax, but, again, in every single emergency department in the province.
If you look at the areas that have been impacted by ER closures, those numbers still aren’t improving as of yet. If you look back to August 2022, Cape Breton Regional Hospital - the average wait time for that month was - off-load wait time was 129 minutes. That has increased to this date. If you look at Valley Regional Hospital where in August of last year, we had a 60-minute off-load wait time. That number has increased close to 80. Again, we’ve seen these off-load wait times double or triple overall, even with any of the small gains that we’ve made in the last six months across the board in every single hospital.
We did talk about some of the reasons for that. ER closures, we’re seeing a direct correlation between that and the regional hospitals that have to take over. We’ve talked about paramedic and staffing fatigue and retention issues, and Deputy Minister Lagassé also brought up the impact of primary care. The other thing that’s happened over the last two years is we’ve seen the number of people who need a family doctor shoot up in Nova Scotia. We started out, I think, at 69,000; we’re now, I believe, close to 150,000 people without a family doctor. We can see how these things have impacted the wait time, certainly from a system perspective.
My question to EHS would be: Where we’re seeing this now become a problem basically everywhere in rural Nova Scotia, can you run us through what some of the challenges are going to be for patient response times and patient care in rural Nova Scotia as a result of these increased off-load wait times?
CHARBEL DANIEL: You know, a great question, for sure - this is a concern that’s top of mind for all of us. We talked earlier about how our system status planning works and the impact that any type of long response time or extended off-load time has on that overall net and coverage, but what we didn’t get too deep into is the updates that we’ve done to our system status planning over the last several months and as recently as a couple of weeks ago to ensure that resources are present and available in their local communities. As recently as a couple of weeks ago, we’ve implemented a new process for the deployment of our system status plan across the province that holds resources in their local communities a lot further than we had previously. This is to help ensure that local resources in rural areas are present and are not drained by high call volumes or impacts of any other local areas as we would have seen previously.
Above and beyond that, we’ve also implemented a new role in our medical communications centre approximately six or seven months ago, and this is our joint operations supervisor. The significance of this role is that their main mandate is to keep an eye on provincial off-load for all hospitals and direct our leadership on different areas to focus on and help release resources where they can at different hospitals. This might mean that certain crews will double up or triple up. This might mean that patients go directly to the waiting room.
We’ve seen some great results, as well, from the policy that we put in place about a year ago June 1st, which is our direct to triage policy. This has allowed ambulances to transport patients directly to the waiting room, bypassing the triage nurse, bypassing the entire process. In the last six months of 2022, we saw almost 2,000 patients go through the direct to triage process, which means that 2,000 ambulances did not wait in off-load, and were able to clear and come back into the system pretty quickly.
Right now, we’re in the midst of reviewing that process on how we expand it, how we grow that demographic and allow greater populations to safely be able to move into the waiting room and allow ambulances back in.
As my colleague Mr. Fraser mentioned, currently the goal of off-load is to not get into off-load. That’s a lot of the challenges and things that we’re putting in place right now.
ZACH CHURCHILL: Obviously, retention has been an issue. We’ve lost a lot of paramedics. We’ve had Mr. MacMullin with the union tell us that the union was not consulted with the bonus that was given to paramedics.
Mr. Daniel, can you tell us if EHS was consulted on that decision, quickly?
CHARBEL DANIEL: No, we were informed when the decision was rolled out.
ZACH CHURCHILL: That’s so concerning. We’re seeing these numbers drop everywhere - nurses, paramedics - and we do not have representatives of the company or the paramedics who were consulted. I talked to paramedics. They were upset about that. No matter where you go, paramedics are furious about that. Overall, that would be close to a $350 million to $400 million spend from this government on a two-year retention bonus that, based on what I can tell, upset just as many people in the system as it would have made happy. Clearly, the way we’re spending money is not making sense here.
We also had a government that cut the family doctor incentive in Halifax. Deputy Minister Lagassé talked about the impact of primary care access on our emergency rooms and off-load wait times. We had a government that cut a family incentive that was working in Halifax where there wasn’t a patient-attachment issue. The number of people needing a family doctor, I think, has gone up three to six times in Halifax, depending on what community you’re in. We’ve had the Premier recently, in the last session of the House, say that the days of having a family doctor from when you’re born to when your kids are born are over. So I do think we’re seeing the impact of government policy impacting off-load wait times in a negative way, disregarding the need for family practice and cutting an incentive that was there.
Closing emergency rooms - recently, the emergency department at Eastern Shore Memorial Hospital is closed now, I’m seeing. We don’t even have an updated number for how many people they’ve seen in March. I’m assuming that’s because it’s not open.
We’ve seen the impact on walk-in clinics, and we’re seeing the outcome with patient care and an increase in hospital death in the province. Yet when it comes to major government investments - up to $350 million - we don’t even have representatives from the system who were consulted with by the government on making that decision.
Mr. Chair, on off-loads, we’ve gone from having an isolated problem in two hospitals here in Halifax to having a global problem at every single hospital in Nova Scotia. Whatever the marginal gains have been in the last six months, they do not make up for the doubling or tripling of off-load wait times that we’ve seen in nearly every single hospital in the province. I think we’ve seen, based on the evidence provided today from presenters, that some of this is directly related to government decision making and government policy.
Hopefully we’ll start seeing an adjustment to this.
THE CHAIR: Order. The eight-minute time for the Liberal caucus has expired. We’ll move on to the NDP caucus.
I see MLA Leblanc had her hand up. You may begin.
SUSAN LEBLANC: I just wanted to pick up on the discussion of the system. Of course, I totally understand that it is a system issue. I want to ask two questions about that. Even as we speak about the system, when we’re talking about ambulances and paramedics, at the heart of the system is the paramedic, right? They are the ones at the heart. It’s patient centred, but it’s also paramedic centred, or it should be. They’re the ones at the centre of all these issues.
We know that paramedics in Nova Scotia are the lowest paid in Canada. The starting wage is $26 an hour. The starting wage in most other provinces is $38 an hour. The highest end of the wage scale in Nova Scotia is $36 an hour, whereas in British Columbia or Ontario, the highest-paid paramedics make close to $50 an hour. I know that there are different levels of paramedics and there are the advanced-care paramedics, but generally across the board, our paramedics are paid less.
[2:30 p.m.]
Are we going to start paying paramedics more? What is happening with that? We know we’ve talked about this before at meetings. We’ve heard from paramedics that every paramedic has an exit strategy. I know that part of it is the issue of wanting to be able to go out and do your job well and not have the stress of leaving your community alone or sitting in the ER while there are no trucks on the road. There is also the matter of compensation. Can anyone answer me? When are paramedics going to get the pay raise that they need?
CHARBEL DANIEL: Again, great question. First, I just want to highlight that the retention of every single paramedic within this province is our top priority and always will be - always has been. We know that that retention is focused on several different avenues, one of them being salary and wages. What I can say to that is that we are in the negotiation process right now with the union. We are currently going through that. I can’t share any details, that would be disrespectful to the bargaining process, but we had also agreed to meet and have this discussion several months earlier than when the actual due date has been.
The focus on retaining paramedics is not only on the salary piece - it’s about the work environment. We’ve heard concerns about that, and it’s something that we are diligently working on always, because the strain of the system will always impact frontline people more than anyone else.
Some of these enhancements that we’ve done over the years have been implementation of shift-end policies to ensure our paramedics can go home on time. We’ve worked very closely with Mr. MacMullin and the union on increasing vacation approvals, so much so that we’ve almost increased those approvals by 300 per cent over the last two years, ensuring that our paramedics have the time off that they need to recoup, because their mental health is of the utmost priority. We are focused on the work environment, we’re focused on making sure they have the right wages, and we’re at the table right now going through that negotiation process.
SUSAN LEBLANC: Let us hope the negotiations go well. The other part of the system I want to talk about is the primary care part. For sure I know that in my community, which is not a rural community, there are people taking ambulances to the Dartmouth General Hospital because they can’t afford a taxi or they’re sick enough that they cannot get on a bus and that kind of thing. I know that is happening. It’s not their fault, it’s because of the lack of primary care, it’s because of lack of income. Mr. Daniel, you were talking about how you’re sending your SWAT teams out for regular - whatever the analogy was.
What can we do to make sure that people have primary care in their communities? What is happening? We know that there’s investment in primary care. Is there a strategy across the province? Can there be a strategy to make sure that every community has at least - not necessarily a primary care physician, but primary care in their community so that they can go there instead of taking an ambulance to the hospital?
JEANNINE LAGASSÉ: Considerable investment is going into both strengthening and expanding collaborative care centres across the province. I think for today, too, it’s important to note - and I think both Mr. Daniel and Mr. Fraser spoke about it, that - two things. First of all, expanding the collaborative care centres and strengthening them across the province, and then also introducing a number of other options for people to get to if they are either an unattached patient or they just need primary care - the pharmacy clinics, all of those different options that I discussed before.
I think the other key things where our partners at EHS have been involved is now that we’ve got the nurse and the physician right in the communications centre, as Mr. Daniel said, sometimes when those calls come in, the nurse would be able to speak with that person, and hopefully they would avoid having to take the ambulance to Dartmouth General, because they would be able to give them a pathway to one of the other primary care options.
Absolutely, large priority to be able to expand primary care within communities across the province.
THE CHAIR: MLA Leblanc, you’ve got two minutes.
SUSAN LEBLANC: Two minutes. I’ll have to look at my list here. I guess I’ll end with this. Mr. MacMullin, I think it was the last time that we had you at committee, you had mentioned that you were having trouble getting a meeting with the minister and the Premier. Just wondering if you’ve got an update on that.
KEVIN MACMULLIN: Yes, we have met due to our tour across the province, which I’ve been invited to with Deputy Minister Lagassé. We’ve had some conversations, that’s for sure.
SUSAN LEBLANC: I don’t know how to end this. I could end with a question, or I could end with just talking. This always happens in the Health Committee, where it sounds like everything is going really well, and yet on the ground we know that, in fact, it’s not. Things are improving, but not improving fast enough. We’ve heard from paramedics saying the system is in failure. Is the system still in failure? Is the system getting out of failure? Is the system recovered? Where are we? I put that question to anyone, because what we hear here is hopeful, and then what we hear on the ground is something different.
CHARBEL DANIEL: One of the things as we modernize the system, a liberty that we don’t have is - similar to other organizations such as retail and things like that when they need to make huge changes - we don’t get to shut down. We don’t get to stop business for 60 days and renovate and do things, and the challenge . . .
THE CHAIR: Order. The time for the NDP questioning has expired. We’ll leave it as a rhetorical. Now the PC caucus has eight minutes. MLA White, I believe you’re up.
JOHN WHITE: I believe anyone watching today will realize very quickly just how complicated the system is. We can’t talk about off-load times without considering access to care. It’s streamlined through the system.
My question is kind of a broad one, and any of you or all of you can answer, if you’d like. When I think about patients looking for long-term care, the CCA wage increase and 2,000 CCAs we put through has a big impact because it then opened up beds, which freed up the hospital, so people who are chronically ill can now get into a bed instead of clogging up ERs. You can’t just take a small view of this.
When I think about the primary care clinics, the urgent care clinics, the pharmacy care clinics, people have access. It’s going to take time for us to realize that. I was talking to someone just today about this who went to an emergency room, forgetting they could go to the pharmacy. So it’s going to take us time to do this.
I actually agree with the former Minister of Health and Wellness with the importance of the rural emergency rooms. Although he was unable to open a Glace Bay emergency room in his term, it is open now. The last time it was open I think was June 2019, and that was for four days. Now it’s open two days a week at least, and it’s regular. It’s open Monday and Tuesday. People know, and they go to it. After talking to doctors over there several times, I understand that it benefits the regional hospital by hours in shortening up wait times.
When we talk about all this stuff, I also want to bring up this one. When you look at what’s plugging up the emergency room - which is then causing backlog because you folks have nowhere to put your patients - the regional hospital doctors tell us that the problem is the cardiac catheterization lab. That was the answer. We made that announcement last year. These patients are waiting five to 10 days to get a catheter put in, which is typically 24 to 48 hours for the national average. That’s what we’re trying to move to. It saves lives. It has people surrounded by family members when they go for these surgeries, and it prevents loved ones from losing work. (Interruption)
I just want to give you an opportunity to . . .
THE CHAIR: Order. MLA White has the floor.
JOHN WHITE: I guess the former Minister of Health and Wellness didn’t like the fact that he couldn’t open an ER. I don’t know. Regardless, my question to any of you is: When we look at off-load times, how are systems that I just talked about, all those different policies, how are they making a difference in off-load times?
CHARBEL DANIEL: I can start. At the end of the day, one of the comments that was made earlier by Mr. Fraser is about providing the right care pathway for patients and not taking every patient to the ED because they don’t all need to go there. Ensuring that they have the right pathway - and a good example, when we talk about the VirtualCareNS team that’s in the communications centre, just as an example and anecdotally, they’re able to divert calls even away from ambulances. They’re able to divert calls that we don’t need to respond to. They can be things that come in, that people were looking to go to the emergency department to get their prescription refilled or another prescription done, and they can direct them to their appropriate area: pharmacy or sometimes even help them fill it out over the phone.
Ultimately, all of these tertiary pieces that are happening in and around the EDs are helping alleviate pressure on off-loads. The goal is to find - enhance the patient experience, find alternate, better care pathways for patients to receive the care they need, but not always going to the ED because it’s not, ideally, the location they all need to go all the time.
JEANNINE LAGASSÉ: The issue, too, of the hours that it is open now in Glace Bay, that I know we’ve heard from a lot of communities that they want that stability. I think the thought’s that it’s when things - they don’t know whether it’s going to be open or closed, that there’s a lot of frustration that comes into the community. We’ve heard that a lot of the communities would prefer to know that it’s Tuesdays and Thursdays, or Monday, Wednesday, Friday. You’ll see that at a lot of the places where the ED is not able to operate 24/7, that they’ve instituted - that NSHA has instituted standard times so that people know when they can go there. I would say that helps to divert, again, from the regional, and then would have an impact on off-load times.
TANYA MUNROE: I’d just like to pick up on Mr. White’s point about the opening of the cardiac catheterization lab in Cape Breton. When we talk about layered initiatives eventually having additive benefits on access and flow, even though at first blush a cardiac cath lab in Sydney doesn’t seem to help Truro, it actually does. The average wait-time in a regional facility to be transferred to cardiology in Halifax is about five to seven days, sometimes 10 in Eastern Zone if transport’s an issue. If we have two cardiac cath labs in this province, Eastern Zone, Antigonish and up, they’re going to be well served by the one that’s in Cape Breton, reducing the demand on the one in Halifax, alleviating some flow challenges in Western Zone and Northern Zone. This is the way we have to think about the initiatives. How do they have ripple effects that impact the system more than just giving care closest to home, which is also a goal?
JEFF FRASER: I just wanted to add along the cath lines, until that cath lab is up and running, our non-critical care air program is going to make a big difference. To go back to a question that MLA Palmer asked me earlier, it’s a long ambulance ride on a stretcher from Sydney to Halifax. Much more patient-centric for the patients who will qualify to be able to be flown in an hour. It’ll be way more comfortable, and it’ll drive a lot of efficiency through our systems, so we’re quite excited. The initiative’s going to roll out here in about three weeks.
THE CHAIR: MLA White, you have about a minute and 30 seconds.
JOHN WHITE: I want to pass it to MLA Barkhouse.
THE CHAIR: MLA Barkhouse.
DANIELLE BARKHOUSE: The youngest child - I get the worn-out jeans. (Laughs) I have a laundry list of questions, but I’m almost out of time. Currently, paramedic training is only in Sydney and Halifax, but recently government announced that it was going to be in other places, offered in other places throughout the province. I’m just wondering if I could have a quick update on that. I despise saying quick, but time.
JEANNINE LAGASSÉ: The two new locations that were announced in January are Yarmouth and Pictou. Yarmouth is already under way - classes started in May, and there were nine of 20 seats filled there. Please correct me if I’m wrong on the numbers, Mr. Daniel. Pictou started just yesterday with 15 of 20 seats filled.
DANIELLE BARKHOUSE: I’d just like to thank you all for being here. It was very informative and truly appreciated by, I’m sure, all three caucuses.
THE CHAIR: That will conclude our question-and-answer period. I will open it up to any witness who would like to have any closing remarks.
[2:45 p.m.]
CHARBEL DANIEL: First off, I just want to thank everybody for giving us the opportunity to be here to talk about something that’s clearly near and dear to all of our hearts.
Throughout the session, I kept my phone here in front of me because I’ve got a picture of my family on it as a reminder of why we do what we do, and that when we’re providing care for Nova Scotians and your families, we’re providing care for our own families as well. It’s that important to us. It’s something we take very seriously, and we’re working diligently with our teams to ensure that the proper care is delivered across the province.
We know the system is strained. We know that our teams have been instrumental in providing some great initiatives and ideas that have been implemented, and we continue to implement and listen to them.
We just want to reassure everybody in Nova Scotia that if you’re experiencing an emergency, please, this is what we’re here for. Don’t hesitate to call 911. Your care is initiated the second the phone line is picked up. We talked about our VirtualCareNS team that is present there, and we will be there.
JEANNINE LAGASSÉ: Just quickly, we really appreciate the opportunity to be here today. We know that we were here to speak about a particular issue, but we do need to talk about the system. I hope that’s what really came across today, that we’re looking at all of these issues as a system. We have a plan. We’re taking action. We’re doing everything that we can to improve, in particular, off-load wait times, but the system as a whole.
KEVIN MACMULLIN: Thank you, everybody, for attending today. I know it’s a busy time in everybody’s lives, especially in the Summertime, and to my colleagues who showed up today, and rightfully so - there are improvements in the system. It’s working - very much so. But as paramedics, we like to see things working really fast, because that’s our issue. We’re the ones who get the 911 call. We want you there right away. Everybody’s waiting. We want to see the system work better. That’s our big goal here - to make sure that we concentrate on the off-load delays so that we can get our teams out there.
We have highly qualified paramedics in this province. They will show up and give you the best care you could ever receive.
THE CHAIR: With that, on behalf of the committee, I will thank the witnesses for coming. We will take a two-minute short recess and then we’ll be back for committee business.
[2:47 p.m. The committee recessed.]
[2:50 p.m. The committee reconvened.]
THE CHAIR: Order. We’ll return to committee business. There is one item that should be quick here, and then we’ll get to - I know there’s another item that MLA Leblanc wants to get to. Basically we have one item of committee business: the date of the rescheduled meeting for mental health supports for First Nations communities. Witness Lindsay Peach of Tajikeimɨk has asked whether Thursday, October 19th is possible. Normally it’s the first Tuesday of the month, but if the House is sitting on October 19th, we would have to meet 9:00 a.m. to 11:00 a.m. rather than in the afternoon. Is everybody okay with that? That’s what works best for them in that month. No objections to that? October 19th for committee. It’s a Thursday.
Thursdays typically work better for them. (Interruptions) General consensus here seems to be okay. I think we’ll go with that, if everybody is all right with that. That was the only item we had for business up front. I know MLA Leblanc had requested a motion.
SUSAN LEBLANC: Before I table my motion, Mr. Chair, I just do want to point out, in case we do want to discuss this, that our next meeting is scheduled for election day in Preston. Don’t know if that matters to anyone, but we might want to look at changing the date of the meeting if that’s possible. Just putting that out there.
This is my motion. The health care context has changed significantly since the last audit of a previous Emergency Health Services contract, and the Province’s relationship with EMCI needs to be reevaluated in this new context. Nova Scotia’s paramedics are an incredibly skilled but overstretched workforce. We’ve heard a lot about that today. They and the people they serve deserve to know whether the government’s contract with EMCI is providing adequate checks and balances on the service it is intended to provide.
The Province engages Emergency Medical Care Inc. to carry out this service through a contract worth over $165 million a year. The company continues to struggle to meet objectives. A copy of the contract has been released through Freedom of Information, but it is heavily redacted, making it very difficult to determine whether the terms are sufficient to deliver the emergency response service that our province needs. Response time standards are redacted, as are the response time penalties and management fees. We have a duty to examine the contract with EMCI to ensure its terms are sufficient.
I move that the Health Committee write a letter to the Office of the Auditor General in support of an audit of our province’s Emergency Health Services contract with Emergency Medical Care Inc.
That’s the motion. All we’re doing is writing a letter to the Auditor General. I think that, given what we’ve heard today, we’ve heard a lot of improvements to the system - or planned improvements - but we also know that the system is under incredible stress, and we also know that we couldn’t get any questions answered about the contract with EMCI, which is worth examining. I urge my colleagues - you all - to support this.
Again, all that this motion says is that we write a letter to the Office of the Auditor General asking her to take a look at it. It doesn’t mean she’s compelled to take a look at it.
THE CHAIR: Any discussion?
CHRIS PALMER: Thank you for putting that forward on the table. I think this side of the table would agree that it’s in the best interest of all Nova Scotians to ensure that Emergency Health Services are meeting the needs of all of us in Nova Scotia. In preparation for this, after we received the motion, I just wanted to go and check to see what the Auditor General says on their website. On September 26th, lo and behold, it looks like the Auditor General will already be releasing an audit on ground ambulance services delivery, which should provide the exact insight for what we’re talking about.
I would just like to read from that, just so everyone is aware of this. From the Auditor General’s website: “September 26: Ground Ambulance Services. This audit will determine if ground ambulance services are meeting the needs of Nova Scotians in a cost-effective manner.”
I don’t know, maybe we could just wait. I think that could maybe provide the insight that we’re looking for, that the member is bringing up, maybe. I just wanted to bring that up. I can table that.
SUSAN LEBLANC: I think that will be a very great companion piece to this meeting, but it’s not about the contract specifically. Maybe it is. Maybe there will be stuff about the contract, so I take your point. If there is information about the contract, that’s helpful, but if there’s not, I think we should revisit this. What we’re saying is we think that the contract itself with EMCI and that relationship needs to be investigated.
THE CHAIR: Maybe what I’m hearing is let’s see that report, and if it doesn’t have that, then this could be something that we bring forward? Okay. We do have a motion on the floor. With unanimous consent, we can rescind that motion until - we can wait until after that report. Is that okay?
If everybody is in favour of that, we will rescind that motion and wait until that is released. I see nodding heads, and MLA Maguire has his hand up.
HON. BRENDAN MAGUIRE: I just want to put a motion on the floor. I move on behalf of the Health Committee that we write to the Office of Healthcare Professionals Recruitment and NSHA on how many family doctors have retired in the last 12 months, and how many family doctors - not total physicians - have been hired in the last 12 months. The government promised 100 new family doctors a year and that’s what they said the system needed. We heard today from the deputy minister that this was directly impacting EHS, so I think it’s good for us to actually dig down into it and figure out how many family physicians were hired, and how many we lost for a net gain or net negative. I’m asking that we write a letter to the Office of Healthcare Professionals Recruitment and NSHA.
THE CHAIR: Any discussion on that item? MLA Leblanc, I see your hand.
SUSAN LEBLANC: Just to say that we would support this motion. I think it’s a good idea.
THE CHAIR: Any further discussion? MLA Churchill.
ZACH CHURCHILL: I just think it’s imperative that we do this. We’ve heard from the deputy minister today the impact a lack of access to family doctors is having on the system. We’ve seen the number of people who need a family doctor skyrocket in Nova Scotia in the last two years, and we’ve also had people taken off that list who - not because they didn’t have a family doctor, because there was an error with their MSI card. I think this information is imperative to the committee and the public.
THE CHAIR: Any further discussion?
CHRIS PALMER: If I could just ask MLA Maguire to please - just give us the motion again so we kind of understand?
BRENDAN MAGUIRE: I move on behalf of the Health Care Committee that we write a letter to the Office of Healthcare Professionals Recruitment and NSHA on how many family doctors have retired in the last 12 months, and how many family doctors, not total physicians, have been hired in the last 12 months so we know the net positive and negative.
I call the question.
THE CHAIR: There’s been a call for a recorded vote.
[The Clerk calls the roll.]
[2:58 p.m.]
| YEAS | NAYS |
|---|---|
| Susan Leblanc | Kent Smith |
| Lisa Lachance | Chris Palmer |
| Hon. Zach Churchill | John White |
| Hon. Brendan Maguire | Danielle Barkhouse |
| Trevor Boudreau |
THE CHAIR: For, 4. Against, 5.
The motion is defeated.
We have seven seconds left in the meeting, so . . .
SUSAN LEBLANC: We’ll call it a day.
THE CHAIR: Just before we do . . . (Interruptions) I have to announce the meeting.
The next meeting is scheduled for August 8th from 1:00 p.m. to 3:00 p.m. - the Pharmacy Association of Nova Scotia and the Nova Scotia College of Pharmacists Re Expanded Scope of Pharmacists.
The meeting is adjourned.
[The committee adjourned at 3:00 p.m.]
