HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

STANDING COMMITTEE

ON

HEALTH

 

 

Tuesday, May 14, 2024

 

 

COMMITTEE ROOM

 

 

Public-Private Partnerships in Health Care

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

 

John A. MacDonald (Chair)

Danielle Barkhouse (Vice Chair)

Chris Palmer

John White

Nolan Young

Hon. Kelly Regan

Rafah DiCostanzo

Gary Burrill

Susan Leblanc

 

[Hon. Kelly Regan was replaced by Braedon Clark.]

 

 

In Attendance:

 

Judy Kavanagh

Legislative Committee Clerk

 

Gordon Hebb

Chief Legislative Counsel

 

 

WITNESSES

 

Nova Scotia Health Authority

Derek Spinney, Vice-President of Corporate Services, Infrastructure, Chief Financial Officer

 

Department of Health and Wellness

Kim Barro, Associate Deputy Minister

Colin Stevenson, Chief, System Integration

 

Nova Scotia Health Coalition

Alexandra Rose, Provincial Coordinator

 

Nova Scotia Government and General Employees Union

Sandra Mullen, President

 

Doctors Nova Scotia

Dr. Colin Audain, President

 

Pharmacy Association of Nova Scotia

Allison Bodnar, Chief Executive Officer

 

 

HALIFAX, TUESDAY, MAY 14, 2024

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

John A. MacDonald

 

VICE CHAIR

Danielle Barkhouse

 

 

THE CHAIR: Order. I call the meeting to order. This is the Standing Committee on Health. I'm John A. MacDonald, the Chair and the MLA for Hants East.

 

Today we'll hear from witnesses regarding Public-Private Partnerships in Health Care.

 

Just a reminder to put your phones on silent. I'll now ask all the committee members to introduce themselves for the record by stating their name and their constituency, starting with MLA Clark.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I'll also recognize the presence of Chief Legislative Counsel Gordon Hebb and Legislative Committee Clerk Judy Kavanagh.

 

I'd like to welcome the witnesses. I'll start by going from left to right, if you could just introduce yourself. Then we'll get into opening remarks.

 

[The witnesses introduced themselves.]

 

THE CHAIR: I'm going to allow opening remarks. Everybody, due to the number of witnesses, realize to keep your remarks preferably two minutes or under.

 

I guess we'll start with Mr. Spinney. Do you have opening remarks?

 

DEREK SPINNEY: Good afternoon. Thank you to the committee and everyone for having us here today. It's an important time as we all take care of health care here in Nova Scotia.

 

Our focus at the Nova Scotia Health Authority is always on providing top-quality, safe patient care. To do that, there are almost 30,000 employees here at the Nova Scotia Health Authority, and last year our budget would have been over $3 billion. We take that amount of stewardship extremely seriously and work every day with our employees, who are very proud to do what they do, to provide service to Nova Scotians. Their commitment to patient care, innovation, and quality improvement means that we are always refining models of care, trying to find new ways of doing things, being creative, and trying to find the best solution for each and every person we see every day.

 

Neither our government nor our public would be satisfied if we set our sights only on what we can achieve internally. This is one of the reasons we have created the Nova Scotia Health Innovation Hub, as just one example. It brings together partners from many areas to create solutions for Nova Scotians. That's why, where appropriate, we will partner with the private sector to expand and enhance the care that Nova Scotians need and deserve. Any such standards must meet our quality and care standards, and that's very important for us. That's a non-starter, if you will. That's non-negotiable: the care and experience being at least equivalent to what would be provided in a Nova Scotia Health Authority setting and at no cost to our patients.

 

Private delivery is simply a means to improve the economy, efficiency, or effectiveness of the services that we provide. The best-known example of this would be the operating room capacity that we purchased and use at the space next to Dartmouth General Hospital, best known as Scotia Surgery Inc. The civic address there would be 18 Acadia Street.

 

Through many years and three different governments, both patients and surgeons have been very pleased with the quality and timeliness of care that we have been able to provide through that venue. Most recently, the Nova Scotia government has purchased and invested in the facility, enabling us to make more use of those ORs for a wider range of procedures.

 

Our newest such partnership is with HealthView Medical Imaging here in Halifax. Faced with long wait times for MRs, scans, and ultrasounds, we are pulling every lever we can to expand access. We are adding new machines, replacing older ones, and investing in technology that will, for the first time, allow us to move MRI technology to areas of need. It only makes sense that we would simultaneously take advantage of technology that already exists and is staffed to provide more of the same service. Where we see additional opportunities to augment the skills and resources of the Nova Scotia Health Authority to provide better, more timely care to Nova Scotians, we will pursue them. I look forward to your questions today.

 

THE CHAIR: Ms. Barro.

 

KIM BARRO: Thank you, Chair, and fellow committee members, for the opportunity to discuss public-private partnerships in health care.

 

I want to begin by stating that in Nova Scotia, we believe in our publicly funded health care system. We also believe Nova Scotians deserve the best health care in the best facilities, improved access to care, and the tools that will enable and support them to access care closer to home.

 

Our commitment to the public health care system is evident in the investments we've made: investments in new and strengthened collaborative family practice teams, primary care clinics, urgent treatment centres, virtual care, mobile clinics, and community pharmacy primary care clinics, just to name a few. We've invested in physical infrastructure like new clinics, emergency departments, long-term care facilities, a new medical school in Cape Breton, and critical health infrastructure.

 

We are investing in innovating and modernizing health care with digital solutions like One Person One Record, YourHealthNS and eReferrals. We're also investing in people. We are doing new and different things to remain competitive in the current market to recruit, retain, and incentivize health care professionals to work and live in Nova Scotia. As an example, we recently announced 30 paramedics from Australia who are coming here to work.

 

We are following our strategic plan, Action for Health, to transform health care in our province, and it's not a journey we're on alone. Managing our health care system is a constant balancing act. We must ensure the system is flexible to meet the needs of our province as other factors around it change - factors like an aging population and a growing population. We've topped one million people and we're still counting in this province. Factors like high demand for skilled health care professionals - we address these and other challenges in investing and working with community groups, health care partners, and with the private sector.

 

As a province, we've maintained public-private partnerships in health care for decades now. Publicly paid surgeons have used privately owned operating rooms for low-risk day surgeries. More recently, more than 1.5 million COVID-19 vaccine doses were delivered through privately-owned pharmacies in Nova Scotia. VirtualCareNS is supported by Maple, a private virtual care provider. Nova Scotia Health Authority has an agreement with them to deliver the service to Nova Scotians for free.

 

These and other arrangements have allowed us to provide patients health care faster, fairly, and equitably. We don't enter into these partnerships lightly. Any public-private partnership must add value to our health care system and come at no extra cost to patients or the Province. There is no queue-jumping or preferential treatment in our partnerships. Contracts are negotiated to ensure we receive the best value for Nova Scotians, which comes down to more than just a dollar figure.

 

We have pressures across the health care system that need to be relieved sooner rather than later. Public-private partnerships add value, allowing us to deliver more care, faster. As the health care landscape changes, we will need to be even more adaptable to face the challenges and the pressures. We will do that by continuing to invest in our publicly funded health care system and seek opportunities to strengthen it with partnerships that help deliver the care that Nova Scotians deserve. I look forward to taking your questions.

 

THE CHAIR: Ms. Rose.

 

ALEXANDRA ROSE: I'm here and I'm happy to represent the Nova Scotia Health Coalition. We're an organization dedicated to protecting and strengthening our public health care system to ensure that all Nova Scotians have equitable access to the health care that they deserve.

 

Although we recognize the need for innovation in this health care space in Nova Scotia, as we continue to face unprecedented times of backlogs and wait-lists within our health care system, the Nova Scotia Health Coalition is happy to be a part of this discussion. It is imperative to recognize potential pitfalls and challenges inherent in blending public and private interests within the health care landscape.

 

Justifications for choosing P3 delivery often include: giving the greatest certainty for work to be done on budget and on time; P3 delivery offers more government flexibility for continuing with the rest of its capital plan for other projects such as schools and roads; risks associated with large infrastructure, such as health care redevelopment and maintenance, are transferred to private corporations; and P3 delivery offers the best value for money. All sorts of past P3 projects abroad, in the rest of Canada, and here in Nova Scotia have proven that these justifications are often untrue and inflated in favour of P3 delivery. The critical analysis of these justifications has led to P3 delivery being proven to be more expensive, less accountable, and a riskier option than more traditional models.

 

Thank you for inviting me here today and I look forward to participating in this conversation.

 

THE CHAIR: Ms. Mullen.

 

SANDRA MULLEN: As president of the Nova Scotia Government and General Employees Union, our union represents over 37,000 individuals who help deliver many of the programs and services people depend on. In the last 10 years, the livelihoods of many of our members have come under attack with the use of public-private partnerships. In many cases, these partnerships mean the loss of public sector jobs. Generally, these contracts are positioned as being done as a cost-saving and efficiency solution. While it makes for an interesting story, the facts don't often check out. In fact, these partnerships are usually done outside the scope of an open and transparent process using what's called an alternative procurement process.

 

This was the case for nearly 100 unionized workers when the Province wanted to contract out the work of converting personal health records from paper to electronic. The government claimed it would save money and be more efficient to contract the work out. The union took a deep dive into the business case prepared by the Nova Scotia Health Authority and found that many of their claims were not accurate. The union prepared its own response to the report, titled A Matter of Trust - A Review of NSHA's Quiet Plan to Hand Control of Nova Scotians' Health Information to an American Company.

 

The union discovered a discrepancy in the claim of cost savings and found that in the early years of the contract, there would be no cost savings but a cost increase due to payments required to be made to impacted staff that was not accounted for. In addition, the decision to contract out the complete management and control of every private hospital record for every Nova Scotian to a U.S. company was a matter of critical public interest and was not part of the public disclosure. With the recent privacy breaches throughout health care and the civil service, it makes sense to make sure that these security concerns are fully explored. In the end, NSHA pushed the pause button on the private contract and those 91 people kept their jobs.

 

The main point here is that public-private partnerships have an illusion of cost-saving and efficiency but because they are often done away from public scrutiny, they can be damaging, cost more and may not be in the best interests of the public. No one should ever have to FOIPOP a public-private contract. This is one example of the many that demonstrate how short-sighted these kinds of contracts can be. If used, they must undergo fair and open scrutiny.

 

I look forward to your questions.

 

THE CHAIR: Dr. Audain.

 

DR. COLIN AUDAIN: Good afternoon. It's my pleasure to join you today. I am Dr. Colin Audain, the current president of Doctors Nova Scotia and a staff anaesthesiologist based in Halifax. It will come as no surprise that Nova Scotia's health care system is under significant strain, with aging human health resources and patient populations. Nova Scotia also struggles with long wait-lists for services in many areas. Family medicine shortages and lack of access are straining the system. Until we stabilize the health care system, we should carefully consider how we use these limited resources.

 

Doctors Nova Scotia firmly believes that access to health care in Nova Scotia should be based solely on need and not on an individual's ability to pay. We believe in a publicly funded health care system that best reflects the values and needs of Nova Scotians. Doctors Nova Scotia is not opposed to private sector involvement in delivery of services as long as those services remain publicly funded and accessible to all. Nova Scotians should not have to pay for health care services from their own pocket. We need to stabilize primary care in the publicly funded system so that all Nova Scotians have good access to the care they need, and this will relieve the pressure across the system.

 

THE CHAIR: Ms. Bodnar.

 

[1:15 p.m.]

 

ALLISON BODNAR: Good afternoon. Thank you for the invitation to speak today. There's a lot of attention lately on the privatization of health care, yet I'm not sure that everyone agrees on what public versus private health care is or necessarily the underlying concerns around it. In Canada, we've never really had a fully public health care system. It has always been a mix of publicly and privately funded care. While care provided within a hospital setting is generally provided at no charge to patients and considered public, many other critical elements of our health care system are not.

 

Psychological care, dental care, prescription medications, ambulances, physiotherapy, optometry are paid by the patients, or if they're lucky, their private insurance. Other parts of our system are publicly funded but privately delivered: physician clinics, pharmacy walk-in clinics, some surgeries, virtual care, the Family Pharmacare Program. Even though these providers are small and sometimes large, their funding comes directly from the government. Patients do not pay for those services and regulators in government have oversight.

 

What is it that we are worrying about? Leaving aside arguments about the Canada Health Act, I would suggest what we should be concerned about: access. Our system needs to ensure that all residents have access to health care based on need - equity. As a Canadian, we take pride in our health care system and hope that it provides equitable access to care. We must not enable a system that allows patients to bypass publicly funded care by paying for privately available care. We need to create a system that is available to all, regardless of an ability to pay.

 

Cost: We should not be paying more for care by one location or by one provider than another. This means ensuring that services and service providers are appropriately compensated, and work environments are appropriate to retain staff. The concept of travel nurses and private relief agencies is a race to the bottom for our public health care system, and standards of care. We need to ensure that providers are providing the same standard of care regardless of how they're funded. They must enjoy the same standards of practice, and we need our government and our regulators to enforce those standards.

 

Regardless of how a provider is structured or how their salaries are paid, we need to ensure that there are standards and oversight in place to ensure that there is access, transparency, equity, equality, and cost-effectiveness in every service provided.

 

THE CHAIR: In this thing, we have 20 minutes, 20 minutes, 20 minutes for each caucus, and then we'll divvy up the rest of the time in the lightning round. We'll start with the Liberal caucus. MLA Clark.

 

BRAEDON CLARK: Thank you, everybody, for being here this morning. I just have a few questions, and I believe - if I'm wrong, certainly whoever is best suited to answer - but I believe this might be a question for Mr. Spinney, related to the development of the YourHealthNS app. I'm just wondering: Do we know to date how much the Province has spent on the development of that app?

 

DEREK SPINNEY: I believe that the information provided before was that it was $12 million.

 

BRAEDON CLARK: Is that essentially a set figure at this point, Mr. Spinney, or are there ongoing costs related to that as well?

 

DEREK SPINNEY: There would be ongoing costs, for sure. It's not a static environment. We continue to both plan and develop new applications of how best to use that for Nova Scotians. One of the examples of that is the trial that's under way right now, for instance, where Nova Scotians can see, through the app, their primary health care record and what we have in electronic format from their hospital stay - blood tests, for instance. There's a trial under way right now with a limited number of primary care facilities that are participating. That information has been brought together and made available through the app, so that's one example of what we're doing with it.

 

BRAEDON CLARK: From a procurement perspective, Mr. Spinney, would these additions or new projects - pilots, whatever they might be - are those all contained within an original agreement and then added onto, or are there separate processes depending on the project? How is that playing out from a procurement standpoint?

 

DEREK SPINNEY: The primary care records being joined with the acute care records through the trial is through the arrangement of the vendors that were involved at the beginning. There's no new procurement for a new thing through that app right now.

 

BRAEDON CLARK: One of the things that I've heard the Premier and others talk about a lot is how many downloads there have been of the app. That's one piece of the puzzle, but another thing that I think would be more valuable - we all have dozens of apps on our phone, and we don't use many of them. They just sit there on Page 4 of your app screen, and you forget about them.

 

Does the department track not just downloads, of course, but use? Do we know, you know, 20 per cent of users are using it X number of minutes per day? Do we have that kind of data? And if we do, what does that look like, generally speaking?

 

DEREK SPINNEY: Two answers. Yes, is the first one. Perhaps we'll take that away to give you a fuller answer as well to share more with it. But just as examples of some things that we're seeing through there, as you said, number of downloads of those health records, for instance, is one. We're well over 20,000 now through that, and this is only in the trial period. We're quite pleased with that uptake - over 200,000 downloads of the app so far.

 

Both of those numbers, I think, aren't new to the panel here today. In addition to that, at one point - I'm probably a few weeks out of date now - there were about 100 interactions a day with the chatbot, trying to determine where best to find care - many of those being diversions from the ED, of course. In addition to that, we see between 400 and 500 virtual-care visits being provisioned through that app, through the service, every day.

 

BRAEDON CLARK: I appreciate that, Mr. Spinney. Perhaps we can do this during committee business, but it might be helpful for the committee to write and ask the department. It would be helpful to see that breakdown. I do think there's - as I say, downloads are one piece of it, but use is really important. Thank you for that.

 

Just to switch gears here a little bit: Dr. Audain, if I could just ask you about - obviously the meeting is about public-private partnerships, and as Ms. Bodnar said, it's true that health care in Canada has always been a bit of a mixed bag, in some cases, between public and private services. In Nova Scotia today, there's a lot of use of Maple as an option for people. I've heard from constituents and others who have used it, and many of them see value in, and I see why they do.

 

From your perspective as a doctor and representing Doctors Nova Scotia, what are the challenges, I guess, of accessing care through a service like Maple? Obviously, we understand the benefits in terms of immediacy and so on, but what are the challenges, especially when you're not just dealing with a simple prescription renewal or a one-off case? What do you see from a clinician's perspective that could be a challenge in the use of that kind of service?

 

COLIN AUDAIN: To answer your question, virtual care as a concept has been very helpful. It's something that we've leveraged more since COVID-19. It allows patients who might not otherwise easily be able to get to a hospital or maybe a specialist because they live in rural places in the province have access to care that they might not otherwise easily have.

 

To your specific question about a service like Maple, in my mind it serves as an opportunity for people to have access. It's a bit of a band-aid solution, in a way. Ideally, what we'd like to see is attachment to primary care providers, and that's not what Maple provides. When you look at the number of Nova Scotians who don't have access to primary care at all, I think it's a very important service to get access for more patients.

 

BRAEDON CLARK: Dr. Audain, I'm not sure if this is a fair question or not, but it's something that we've heard - that people using Maple might often say: Well, I had an appointment, but I was just kind of referred on to a specialist, and it was not a waste of time, but I didn't get exactly what I wanted.

 

Is there a sense that, when you're using a service like Maple, you might be getting referred on to someone else more often than you would if you had attachment to a primary care physician with whom, in many cases, you have a long-standing relationship? Do you have a sense of that at all?

 

COLIN AUDAIN: I don't know if I can say that you're referred on more often with Maple. I don't have any data to support that one way or the other. Certainly, there are going to be lots of instances where even if you have an in-person appointment with a family doctor, for example, it will end up with a referral. It's possible that there may be more referrals in the virtual environment because you're not able to do the same type of assessment that you might need in some instances. It's possible that the referral rate is higher, but I can't say one way or another if that's actually true.

 

BRAEDON CLARK: Just a question for ADM Barro, if I could: You mentioned in your opening comments OPOR, One Person One Record, which is a really important initiative that has been in the works for many years. It's very difficult, expensive, and costly. I'm just wondering: Does the department have a timeline or a goal for when we will be able to say with confidence that we've achieved it and we do have One Person One Record in Nova Scotia?

 

KIM BARRO: We do have a timeline for OPOR. There are several milestones that need to be met along the journey. The biggest significant one is January 2025 - I would defer to my colleague Derek - with a launch in Dartmouth General Hospital, and then it goes from there in terms of all the other facilities, et cetera, to come online. At the moment, we're on target to meet those deadlines. Once that gets in the queue, we will be able to see the benefits of OPOR.

 

THE CHAIR: MLA Clark, did you want to check with Mr. Spinney on the date? She referred that he would have . . . (interruption).

 

BRAEDON CLARK: Yes, sure.

 

DEREK SPINNEY: The date is sometime next Spring. I'm not going to say January. One of the things that we've learned from others who have done this and the partners that we're with is they make sure that we're doing it appropriately as we go through. To that end, they bookend months in which you try to implement something. They don't try to get that specific because it really depends on where you are in the journey making sure that all your work flows and the drug formularies and all of these things are actually in place.

 

At the same time, it becomes very specific to the site. When you enter a site - the Dartmouth General Hospital, as ADM Barro just mentioned will be the first site - we need to make sure that the site is ready for us at the same time. It really comes down to even the day of the week. When we do that - typically it would be a Friday or early Saturday morning - and making sure that the number of surgeries and everything else that's going on in the hospital and all those schedules have been adjusted appropriately too.

 

That's a long way of saying that there's a lot of planning that goes into it, but it is next Spring for sure. To expand a little bit further on when we will be available to say we have One Person One Record, it is a rollout across the province. This has never been done before, as far as we can tell, working even with Oracle, our provider. This has never been done, that a whole province - one large system, where we have 39-plus sites - will be going live. We're actually doing it over two to three years, where sites will come on, I'll say, one at a time or shortly thereafter. The IWK Health Centre is in the top three. I can't remember right now if it's the second or third. It will take us some time to get across the entire province because of the sheer magnitude of what we're doing in Nova Scotia.

 

BRAEDON CLARK: I'll pass the microphone over to my colleague from Clayton Park West.

 

RAFAH DICOSTANZO: If I can start with a question to Ms. Mullen regarding the travel nurses and the capping of hours that was announced: I just want to know how that has worked so far, if you have any information. We know that other provinces have tried it, and it hasn't been very successful. Do we know how many hours or what has happened since the capping? If you can highlight that, please.

 

[1:30 p.m.]

 

SANDRA MULLEN: That's a good question. We speak of this between our colleagues at NSNU. While we both lobbied strongly for reducing the use of travel nurses, we also have yet to see the full impact. We know they are still being used across the province. That is because of an extreme vacancy rate still existing in many aspects of health care, long-term care throughout the province.

 

I believe at a previous meeting, my counterpart from NSNU spoke on why not allow the nurses in this province to be able to travel within the province to provide coverage where coverage is needed. To be clear, it is a private for-profit situation we're talking about and public health care, and the private for-profit nurse agency has shown the exorbitant amount of money paid on behalf of that situation. Perhaps we could have used monies to fund the programs for nurses here in this province and allowed the students in this province to take those programs at a far reduced tuition, if not even free, to make a commitment to work here in this province.

 

We applaud the fact that they're reducing the hours, but we're not yet ready to be able to fill those positions. It's clear these private nursing agencies are a private for-profit organization, and this is why we want to see more transparency on these agreements - because we've had to really explore and dig deep into that.

 

RAFAH DICOSTANZO: Thank you for that answer. We know that in December, there were 350 travel nurses working throughout the province. I don't know if Ms. Mullen has the information or if the associate deputy minister would have the information. Do we know how many travel nurses are currently working in Nova Scotia, and has that number reduced since the cap? What was the reduction?

 

KIM BARRO: I'm going to defer to my colleague, Colin Stevenson.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: I don't have a number that's different from the 350. I think our estimate is still that it's approximately 350 or in that range of people who would be agency nurses still working at any given time within the health system. I won't disagree with Ms. Mullen's comments about the desire to actually create the investment within the health system itself through people working full-time within the Nova Scotia Health Authority, IWK, or within long-term care facilities. It's certainly the emphasis and the importance that we're placing around a lot of the workforce strategy within the health system. Investments within seats, training and support development, mentorship, trying to recruit and support people to come from out of province or out of country is certainly where most of the investment and the priority will be.

 

We are seeing some impact on that, and Mr. Spinney may have numbers similar to what I understand. I know within the past year, I think the Nova Scotia Health Authority and the IWK have actually seen a reduction in the vacancies within the health system by just over 400, which is substantial, and great to see that some of those strategies are already starting to pay off. We're optimistic that path will continue, and the number of agency nurses will continue to decrease.

 

RAFAH DICOSTANZO: Do we have any figures of what have been used up to the announcements of the cap? Since then, what is the reduction in the dollar value that we have seen?

 

DEREK SPINNEY: We can certainly get that. We meet literally every Friday on this. I just don't have it in front of me, so we'll blame the lack of a number on my memory as opposed to really having one. That's a great question, and we can bring that back to the table.

 

RAFAH DICOSTANZO: Appreciate to have those numbers. Thank you.

 

My next question will be for PANS, if I may. We know that we have a shortage - we're going to have even more shortage of pharmacists. We know we have some already, and we definitely have shortages in pharmacy assistants and pharmacy technicians. What have you seen from government to help reduce, prevent - or increase the number of enrolments in those fields? We met in the last committee meeting, and you've announced those. Have you seen any change in enrolment or number of seats, or some incentives? Just like for the CCAs, to have higher salary for them so it will encourage more enrolment for pharmacy assistants and pharmacy technicians, and pharmacists as well.

 

ALLISON BODNAR: We'll start at the pharmacist level. As you know, we haven't filled those classes since the Pharm D program came into effect. Part of that relates directly to the tuition. It is now the same cost as medical school, so the return on investment on the other side is substantially different.

 

We're still looking at things that can be done from a policy perspective. I can say that there is a standing committee that meets regularly on pharmacy human resources specifically, and looking at what policy levers can be implemented from student loan programs, loan forgiveness, and tuition support in return for contracts of service and things like that. There is some work under way. I wouldn't say - there's not been a policy change at the pharmacist level, but there is a lot of work being done for multiple groups. Dalhousie University, I think I can say, is optimistic about filling a class this coming Fall, so that's good news.

 

At the technician level - we still see very few enrolments at the technician level, unfortunately. One thing that has happened that is going to help us in that area, however, is the implementation of a bridging program to enable experienced assistants to bridge to become a technician. That took a couple of years, but the approvals and all of that happened, and the first class was launched in March. We have three full cohorts that started in March, and another three full cohorts already enrolled for June. Probably a fourth will fill. That will bring us in the neighbourhood of over 300 technicians on stream within the next 12 to 16 months, which then begs the question of assistants.

 

There is no formal training, per se, for assistants. You can come in after high school. Lots of kids work in high school and then carry on. Still looking at what opportunities we have as a system to encourage that. What I can say is that the bridging program is one way to do that - people who come in as assistants, who know they have a career path beyond that.

 

Again, there's a lot of work - policy work, there's workplace work, there's remuneration work. All of that has to happen to solidify that workforce for the long term.

 

RAFAH DICOSTANZO: If you can give us, in a very short - what are the numbers that you're hoping to get, whether it's technicians or - do you have a plan of numbers that you hope to . . .

 

ALLISON BODNAR: We've estimated that we have a deficit of about 500 pharmacists and pharmacy technicians over the next couple of years.

 

THE CHAIR: Order. Sorry about that. At the end of the 20 minutes, I have to do that.

 

Next is the NDP. MLA Leblanc.

 

SUSAN LEBLANC: Very interesting discussion so far. I have lots of thoughts and lots of questions, so I'm going to try to stay on track.

 

My first one is for the NSGEU and Doctors Nova Scotia. We know that there aren't enough health care professionals. We just heard an example from pharmacy, but we know it's across the health care continuum that we're low on professionals.

 

With the increasing prevalence of private health care clinics or agencies, as we've just talked about with agency nurses, have you seen - and I know you have, Ms. Mullen, because you've just talked about it - the movement of skilled professionals from the public sector to the private sector?

 

SANDRA MULLEN: Exactly that. There are identified over 1,000 vacancies in health care in this province. We represent almost 15,000 who work in health care. In immediate health care, that's 160 different jobs within the system. None of the procedures can take place without the support of our health care folks.

 

They are leaving for private organizations. When you talk about Scotia Surgery Inc., they are working in hospitals on the public side, and they are seeing that the folks who have been referred to these outside agencies are usually the easy ones. But any complex recovery from any of these private situations are referred back to the health care system - the public health care system - so they're seeing what they have to deal with - exactly.

 

The private system is again making offers to these folks, taking them out of the public system, which makes our public system very difficult to work in - staff shortages, cause of a number of issues within the workplace. Just like the travel nurses, the morale that has been put in that workplace because your travel nurse is paid far more on an hourly basis than the nurse who is working full-time as a resident here in Nova Scotia living and paying taxes here in this province. It's very challenging for those folks, and absolutely why they are against that. While we welcome the reduced hours to that, we need to collectively - and we are doing our part across the country to push that. If we can all eliminate the agency part of it and the discrepancy in wages and all of those things - but it's definitely a pull.

 

SUSAN LEBLANC: Dr. Audain, do you have any . . .?

 

THE CHAIR: I apologize.

 

SUSAN LEBLANC: It's fine if you don't, because I have lots of questions.

 

COLIN AUDAIN: What I would say to that is anecdotally, as an anaesthesiologist, I have seen nurses whom I work with leave to go to other places, but from a physician point of view, I would say there are fewer options to work privately just because of the way things are generally funded. Because not everything is funded by the public system, you will see movement of people, but more what we see, I think, is, if you use family physicians as an example, if you're trying to prioritize primary care, family physicians have a lot of different places they can work in the system. Although it's all publicly funded, if the priority is primary care, those are the things you need to try to work towards and incentivize. Otherwise, people make decisions to go to other areas of health care.

 

SUSAN LEBLANC: Right, and I would imagine virtual care is possibly an example of that. The virtual care situation - in her opening remarks, Ms. Bodnar said - and I think Mr. Spinney also said that we need to make sure that with public-private partnerships there are no costs to patients, and that people aren't paying for health care that is otherwise available publicly. I would say that in the case of Maple, for instance, I think that's going against what you're saying in that case.

 

For instance, I have a family physician, but I get my two free Maple appointments, and so I used one of them. If use a second one, then I understand - this has not happened to me - I will be offered an opportunity to pay for a subscription to Maple, and I could do that instead of going to my publicly funded family physician, which is exactly contravening what you're saying should be happening.

 

My question for the Department of Health and Wellness is about Maple. The contract with Maple to deliver virtual care was initially put in place to serve those on the Need a Family Practice Registry. We know this. We've heard from Dr. Audain that it is a band-aid solution. Is government funding for this type of private health care a short-term measure that we can expect to be phased out after we get our ducks in a row in terms of providing attachment to primary care? Is there a timeline for how long we can expect to be paying for Maple while we are providing attachment to every person in the province?

 

KIM BARRO: What we would say is that virtual care is absolutely here to stay, that it's very important that people have all different kinds of access to primary care practitioners. There are lots of people who would rather utilize primary care through a virtual care approach than having to - maybe they don't have a car. Maybe they don't have something that would enable them to get to a face-to-face. What I can say is that if you utilize VirtualCareNS, which we have a contract with Maple to do, then if you need to see a face-to-face person, there's a pathway to being able to do that.

 

[1:45 p.m.]

 

We're not looking at a timeline to wind back virtual care. We actually feel that it's benefiting patients in terms of access to primary care practitioners, and we're building the appropriate pathways so that if you meet a primary care practitioner through Maple and you need some other type of service, like a face-to-face or specialist, that those pathways are built. It's not expected to be out of the envelope of services that Nova Scotians can expect to receive.

 

SUSAN LEBLANC: I just want to follow up on that. I hear you, and I know that I have benefited from having phone call appointments with my family doctor during COVID-19, for instance. It was awesome, and we know that for so many people, it's the way to go. What we're saying is that a publicly provided system of accessing your doctor or primary care provider whom you are already attached to is very different than the system we have right now with Maple, which is: I don't have any attachment, I'm in a real bad state here, I need some help, and so I'm going to use this system.

 

For me, when I used my system, I had a lung thing. I was really sick, and I needed some puffers, but I wasn't going to get to my doctor for three months, so it was perfect for that moment. But if that happens to me again and again, I have to look at other ways of accessing primary care.

 

I would like to know if you see that there is a difference between those types of situations. Yes, it's here to stay. It's an important form of accessing your primary care provider, but it's different from filling in the gaps while we wait for everyone to be attached. I could word that question another way. My question also could be: Do you see, and does the department see or prioritize attachment for every Nova Scotian - permanent attachment, as in to a clinic or a person - maybe not a person, but a clinic - in Nova Scotia? Is that still a priority of this government?

 

KIM BARRO: Yes, it's absolutely a priority of this department to ensure that all Nova Scotians have access to primary care practitioners.

 

SUSAN LEBLANC: I said attachment, not access.

 

KIM BARRO: Sorry, my apologies. Yes, I understand it's different. They're actually attached and have the ability to continue to access through that attachment. I'm going to pass it over to my colleague Colin Stevenson, as he might be able to talk a little bit more about how virtual care works in that space.

 

COLIN STEVENSON: To expand a little bit on ADM Barro's comments, from a design of the primary care system and where we're certainly trying to go within the province, I think your comment is completely accurate. We're really focused and continue to be focused on ensuring that people are attached to the system. That is the priority for us within the province and the work that we do with the Nova Scotia Health Authority, with primary care leadership, with Doctors Nova Scotia, and others as to how we actually ensure that that's going to occur. That can look different for different people.

 

Ultimately, you still want people to be able to get access to the right provider in the way that makes the most sense for them and that is based on that provider relationship. We do support virtual care and many different means, as ADM Barro has talked about - VirtualCareNS - to provide access to people who don't have as easy access to a regular primary care provider. We also have a virtual emergency care and virtual urgent care, all of which are actually helping to support the delivery of care in their respective environments.

 

Ultimately, we want to make sure that we're finding that balance between how people are accessing through virtual and in-person care. The policy in place within the province actually does require any virtual care provision of service to have a direct pathway to in-person care when it's required. It's intended to govern and align with what the standards of care are for the health profession, through the College, so it aligns with that, but there is an expectation that anybody providing virtual care understands and has a pathway to refer somebody to in-person care when they require it.

 

SUSAN LEBLANC: A question for Nova Scotia Health Authority: Around the Winter holidays between December 24^th and January 1^st, the available hours for VirtualCareNS were limited for those without a primary care provider but unlimited for those with a primary care provider. Can you explain why there were different degrees of availability between the two groups?

 

DEREK SPINNEY: I'm going to return the favour to my colleague Mr. Stevenson. (Laughter)

 

COLIN STEVENSON: Just to make sure I understand the question, I believe it was: Why would there be a difference between access for people unattached and attached?

 

SUSAN LEBLANC: Yes.

 

COLIN STEVENSON: Okay, thanks. There is a difference between the two services. The VirtualCareNS program for unattached is using the Maple platform but it's delivered by Nova Scotia providers, so they're in the province. They actually require coverage by those providers in order to deliver to that population. The virtual care for individuals who are attached, your two free if you want to take advantage of that as a service, is actually based on a partnership agreement between Maple as an organization and their broad national bench of providers and the Nova Scotia Health Authority.

 

If the VirtualCareNS schedule - if they didn't have a full slate of providers at that time and able to provide that slate of service, then they could have had a break in service - which could be unfortunate and doesn't often occur - but that doesn't restrict anybody from being able to access the full bench through Maple for that limited service across the country.

 

SUSAN LEBLANC: Thank you for providing that explanation, but that does beg the question: What is the rationale between providing or offering people these two free? I've already explained that I've used it, and it was convenient because it takes a long time to see my primary care provider, but I could have just as easily, I guess, or almost as easily gone to a walk-in or a mobile clinic. It feels like it's an advertising scheme. It's a way to get you hooked on this very convenient thing because you're right - the provider I had was from Calgary and I never realized that there was a difference between them. What is the rationale?

 

COLIN STEVENSON: I think your example is a very good one. It is intended to actually help provide people with access to care who might not have an option with their own primary care provider. What they would see as what's available to them is maybe going to an emergency department, as one example. Many of the services or the intention is low-acuity, low-risk care that could be satisfied through that type of service - that is the best place for it. It helps to ensure that we're not overburdening other parts of the system. That really is the intention around it.

 

We do know that people who use virtual care services and people who are using the pharmacy walk-in clinics - we know that there actually is a reduction in their visits to the emergency department. They are actually closer to emergency department visits as to anybody who's attached to a provider. We are seeing a value and a benefit associated with these virtual options and the community pharmacy clinics where it's actually helping to unburden other parts of the system where we need them to be there to support higher critical care requirements.

 

SUSAN LEBLANC: Can you table that information, the data that you're referencing? Is there something that you can table? That is interesting to me. Do we know for sure that because somebody went to a pharmacy clinic, they didn't go to the emergency? Do we have numbers on drops? I wasn't aware that our number of visits to emergency rooms had dropped substantially since these programs have opened, so I'd love to see that data. That's just Part A.

 

Part B is: On the Nova Scotia Health Innovation Hub website, it's noted that many of the virtual care appointments delivered through Maple subsequently did result in in-person visits. Can you clarify what that means? My colleague asked a question, and I think he was suggesting that they resulted in referrals to specialists, but I'm wondering if you can speak to the number of people who use Maple and then are referred to an in-person primary care visit?

 

DEREK SPINNEY: Yes, and we'll get more specific numbers to you. I'm going to give you a range, though, just to paint the picture. Between 10 and 20 per cent of the time, when the 400-plus people a day I mentioned are using virtual care every day on the unattached list, between 10 and 20 per cent of those were not being able to resolve their question in that session.

 

What we then do is we provide them the pathway - someone mentioned earlier - into one of the primary care collaboration centres. You'll start to hear us use words like “health home,” for instance. This is to your earlier question about connections and attachments, I think is the word you used. Trying to help people understand how they're being attached to the system and to a place where they can call back. They may not get the same physician, but I'm going to say people know them there because it is their health home. Their record is there. We understand that.

 

Between 10 and 20 per cent of the time, they're referred to an in-person visit. We place them, take care of that for them, make the appointment at the primary care place, and then they can go in and see somebody in person. From there, they may end up being referred to a specialist as well. That's the pathway as it is right now, yes.

 

SUSAN LEBLANC: Thank you, that's helpful. Back to the data question. I'm wondering if the department or the Nova Scotia Health Authority has developed any metrics to ensure effectiveness. What are all the things you're looking at to know that this is working, basically?

 

THE CHAIR: Mr. Spinney or Mr. Stevenson. Which one?

 

DEREK SPINNEY: I'm going to start and then quickly hand it off. We absolutely do. One of the things is we're very data driven. Our chief data officer is actually sitting behind me, so I'll put in a commercial for Mr. Murphy as well. Yes, we do, and the Innovation Hub has evaluation teams that go in and look at this. Unfortunately, I don't have those six or ten metrics to actually share with you today with the values, but I think that's something great that we should submit back to the table because there are absolutely key performance indicators that we're tracking to make sure we're actually hitting the mark.

 

THE CHAIR: MLA Leblanc, do you want Mr. Stevenson?

 

SUSAN LEBLANC: No, that's okay. Sorry. No offence. (Laughter) Guess I'll just quickly ask with the time I have left in this round - again, many of you talked about the importance of quality of care in your opening comments. For things like pharmacy appointments, or perhaps virtual care, or even travel nurses, how do we make sure that the quality of care is there? Are there audits done? Are there checks and balances in place? What is happening to make sure that people are getting the care they deserve and need?

 

KIM BARRO: First of all, all of those practitioners that you mentioned would be regulated health professions. They actually have, through their licensure, the expectation of quality of care within the standards and ethics, and all of the pieces that would back them as regulated health professions. I can't speak to the contracts specifically around those, but I would say that in terms of public protection for practice of care, that would be the relationship of that person if they had a complaint back to their college, and that should be followed up. So that's one - we would hire licensed professionals in all of those instances to ensure quality of care.

 

THE CHAIR: MLA Leblanc with five seconds.

 

SUSAN LEBLANC: Thank you so much for answering my questions.

 

THE CHAIR: MLA White.

 

JOHN WHITE: My questions are to the department and to the Nova Scotia Health Authority. We realize that the province is facing an aging population, population growth, and of course, the shortage of health care professionals. I just wonder if you can take a few minutes to explain how the province is adapting to these challenges, and more specifically, how the public-private partnerships are a solution to any of this.

 

KIM BARRO: I'll take a kick at it, and I might invite my colleagues after. Just a step back - we've always had public-private partnerships. In terms of our relationship with doctors, it's always been through a public-private partnership. Many doctors are incorporated, so this is not new.

 

To address the issues of a growing population, the aging population, and the fact that we have a shortage of health care professionals, we need to utilize the assets and the infrastructure that public-private partnerships enable us to do. It's a wave of the future - that we really have to capitalize on all of the assets that we have in Nova Scotia. As an example, the relationship with HealthView Medical Imaging, where we're buying more MRIs and other diagnostic imaging, enables us to address the huge wait-lists that we have. I'm sure you know that we're also receiving clawbacks from the federal government because we're allowing HealthView Medical Imaging to operate. This way we're actually buying more seats, addressing the wait-lists and probably satisfying the federal government's requirements for ensuring that we have publicly funded - we can't stop a company like HealthView from operating, but what we can do is enter into a partnership that allows us to buy the assets that we need to address the concerns at no cost to the Nova Scotian. We are by no means entering into any public-private partnerships that require the public to pay out of pocket for any of these services. We're utilizing that asset as opposed to building and costing us more to build that type of infrastructure. HealthView has it already and we're buying assets from them, as an example.

 

[2:00 p.m.]

 

JOHN WHITE: When some people hear public-private partnership, they assume it means privatization of services and unequal access. I'm wondering if you can help clarify how it actually works.

 

KIM BARRO: A private service would be one that is not paid for by government or under our provincial health services plan, which is MSI. There are lots of examples that were already mentioned of those services - dentists, optometrists. There are many services that lie outside our medical insurance plan, but the government also provides some of those services in other publicly funded settings like hospitals, et cetera. It's a really complicated landscape in Canada. I think we've already mentioned that. It sometimes leads - because some folks like better accessing private care from a dentist or what have you - if they're lucky enough to have health insurance, then they get that. If they're not, they may not. That really leads to inequitable care.

 

Our investments here in Nova Scotia are to really ensure that we have a robust enough publicly funded system that's addressing the needs of Nova Scotians. That would be in the bucket of what you typically would not have to pay for - things that you would experience in a hospital setting or a physician's office, et cetera. Privatization would mean that people would be paying out of pocket for services, and they would potentially be queue-jumping. That's not what we're doing with public-private partnerships.

 

When we enter into public-private partnerships, we're ensuring that there's equitable access to all using public funding, as I said, to augment the assets and the resources that private companies have and making sure that it's equitable and fair so that we're levelling the playing field by increasing more access points, more services to Nova Scotians that we need to do more quickly. Public-private partnerships enable us to do it faster but we're still maintaining the principles of the Canada Health Act, which means that our citizens are not paying out of pocket for those services.

 

JOHN WHITE: Would it be fair to say that the Province is using public funds to provide equitable access to services for all?

 

KIM BARRO: Yes, we would always be using public funds to ensure that - what we're using public funds for is ensuring more equitable access to services.

 

JOHN WHITE: I'm going to pass it over to my colleague MLA Young.

 

NOLAN YOUNG: ADM Barro, in your opening remarks, I think that you had mentioned about public-private partnerships - you mentioned pharmacies. I think of the pharmacy that's across the street, the pharmacy clinic in Shelburne that seems to be taking a tremendous number of people through. I'm wondering if you could tell us more or if you could even elaborate more on this partnership.

 

KIM BARRO: I think it's a really important partnership for access to care in Nova Scotia. Pharmacists are one of the most accessible health care professionals that we have, and so by entering into a partnership with the pharmacies and increasing what they can provide to Nova Scotians, it's actually increasing the services that Nova Scotians get. It stems back to even - the PACA legislation that we passed last Spring enables increased scope of all the professionals. The professionals are now able to and we're working towards making sure that all health care professionals are working to maximum scope - all the things that they're able to do - and that legislation also enables us to bring in others from different parts of the world or Canada with no barriers. We're using that as a way to get more practitioners in.

 

The pharmacy example is that we have ensured that pharmacists are working to maximum scope, and that we are publicly - we enter into a relationship where we can provide public funding to enhance that. It's all about making sure that we're using that private asset in a pharmacy situation to ensure we have more services that pharmacists can do so that Nova Scotians get more care faster.

 

NOLAN YOUNG: I'll ask this question to Mr. Spinney, and perhaps the Department of Health and Wellness may want to comment. You mentioned health homes. It rolled right off your tongue. If you could break it down - just explain what a health home is. How does it work? What does it mean for patients? in simple terms.

 

DEREK SPINNEY: The way that we access care is changing, as we've all talked about. There are different ways, whether they be virtual care, whether they be expanded scope, whether they be the more traditional way of a primary care setting where you go in and see the same family physician time and time again. However, as all of that evolves, what we're learning together is that it isn't so much that you need to see the exact same person all the time. What you need access to is somebody who understands your situation, understands the system, and can help you navigate through it so you can get the best care possible. That's actually the goal.

 

We're trying to sit back and look more at what the intent is. The intent isn't to see the same person. So what we're trying to work our way through right now is better articulating that to the populace, and also set up the organization accordingly, so that when people come in - whether it be through virtual care or potentially otherwise - if you're not attached to the same family physician all of the time, that you are attached to a health home that understands your situation. They understand the help that you need, and they understand the system, and how to help you navigate through that.

 

Throughout the province - I don't have the numbers here, but happy to provide them - we have an extraordinary number of primary care collaboration centres already in place that are busy seeing patients every day. As I mentioned, 10 to 20 per cent of the time that the folks who don't have a family physician - the same family physician - when they call in through virtual care, they're sent to these health homes. That's in effect what it is. We're trying to do a better job of explaining that in new ways to folks so that they can understand they are cared for. That is what we're trying to accomplish - they just may not see the exact same person all the time. We're trying to make that distinction between the real goal of the situation, which isn't to see the same person but it's to make sure I get the care I need, when I need it, and I have somebody who advocates for me, and can take me to the place I need to go next.

 

NOLAN YOUNG: One more quick one, if I could. Okay, here. We'll throw it to - come back to Mr. Spinney, I guess, or the NSHA. The Nova Scotia Health Authority has several private partners to deliver health care agreements - they have several agreements with, sorry. If you could just tell us more about the agreements that you have in place, and the impact they are having on reducing wait-lists and improving access to care.

 

DEREK SPINNEY: As you mentioned, there are numerous - somebody said it well at the beginning that private partnerships are not new. They've been around for a very long time. It's really making sure that we use them in the best way for Nova Scotians - not do they exist or not. To that end, just one of the examples, I guess, that we've been doing over the last little bit is our agreement with Varian.

 

Varian is a global leader. They have the market share - the 70-plus per cent market share - in the world with cancer care radiation equipment. We've been using that equipment here for some time. Dr. James Robar is a world-leading expert with it, doing amazing things with that. Well, we entered into a 10-year agreement with them to do a few things - one of which is to provide Nova Scotians the latest, greatest equipment. So on January 4^th of this year, the first person in Canada to receive treatment with the new Ethos units with HyperSight Imaging was done here in Nova Scotia, which is pretty cool - and beyond cool, I guess, to explain the magnitude of that. What would typically have taken 20 sessions of radiation can now be done in five. It's amazing what it can actually do.

 

Something else that they're in the process of doing with this right now is opening a global software development office here in Nova Scotia with a minimum of 60 people who will be in that office to work through some imaging software together. We're actually going to be able to participate in that. The cancer team will do a better job of explaining how all of those things are impacting the wait-list and the care that people are getting, but I think that paints the picture a little bit.

 

In the case of 18 Acadia Street, otherwise known as Scotia Surgery Inc. - but we really shouldn't be using that name; that's a company name that is not the facility that the government now owns - we've seen the number of surgeries for the Nova Scotia Health Authority in the past year increase by a couple of hundred. We're over 500 a year now where we were just over 300 a year ago. So it's a significant increase there, and some really great patient experience comments are coming out of that facility, as there always have been. This has been 15-plus years. This isn't a new thing, except the government now owns the facility to really gain access to that.

 

People often ask: Why can they do it? Why is that different? Why can't we do it? Well, we can do it. We are doing it with them. One of the things, for instance, that's taking place there is it really becomes a centre of excellence for particular types of surgeries. Somebody mentioned earlier that sometimes it's the easier ones, and the harder ones go elsewhere. Well, the easier ones should be cohorted into one place so that you can become really efficient and that you can get more people through it. Those are two of the examples that we've been up to, with more if we had more time, perhaps.

 

NOLAN YOUNG: I'll kick it over to MLA Palmer.

 

THE CHAIR: MLA Palmer.

 

CHRIS PALMER: This is a great conversation so far. I'm madly taking notes here, and I have so many different thoughts that I'm formulating as I've been listening to our witnesses today. The only thought that's really come to my mind a lot is that if we really want to build a system that's truly patient centred and patient focused, I believe it's our responsibility to leave no stone unturned to provide the most equitable, best access we can for patients. I think that's what we all agree that we need to do, right?

 

One of the best examples of public-private partnerships that we've seen, and that's been touched on here so far, is the community pharmacy primary care clinics. I have a couple of questions for Ms. Bodnar, and maybe the associate deputy minister would like to give her thoughts as well. Just a bit more specifically, I had the privilege of having the Premier in my area last week, and we visited a community pharmacy primary care clinic in Greenwood. We had a good chance to hear what's happening there and the access that's creating. Ms. Bodnar, could you talk about how especially in rural areas those community pharmacists and the government are working together to fill those health care gaps, and talk about the future potential expansion of that - how we can continue to work with community pharmacy primary care clinics going forward?

 

ALLISON BODNAR: Sure. I think people would be surprised. Those clinics have now delivered in just about 15 months over 160,000 services to Nova Scotians, and that's across the entire province. We have clinics in Yarmouth, Shelburne, Greenwood. We have clinics in Sydney and Chester, and otherwise.

 

These clinics are creating access that didn't exist. When we look at new points of access in the system - whether that's mobile care, virtual care, even urgent care - these clinics do more than all of those. These are a really important element of the system. They're important for patients, for the system, and for the providers. If we want to keep providers - and I mean all providers, whether that be pharmacists or nurses or physicians - they have to want to go to work every day. They have to want to get up and provide that care.

 

These clinics utilizing pharmacists to their full scope of practice are making our members proud again to do what they do. I think that's going to not only keep our pharmacists here but it's attracting pharmacists. We were just in London over the last few days, and we had 142 people express interest in coming and wanting further information. We've had 14 people through our expedited process licensed here in Nova Scotia since January and another 29 files opened. What we're doing here in Nova Scotia is world-leading, and it's making a difference to patients, the system, and providers.

 

[2:15 p.m.]

 

CHRIS PALMER: I have spoken to many pharmacists who have said the same thing. They've been wanting to do more in their scope for so long. They are just as much - they are not allied health care professionals. They are just as much professionals as anybody. I have had those conversations with those pharmacists who are really happy that they have the ability to use their full scope now, for sure.

 

This idea that we have these public-private partnerships that we've talked about - it's not like privatization, where we're getting people to pay with a credit card or anything like that. I take that pharmacy care clinic in Greenwood. The people down there aren't walking in the door after they get an appointment and saying: Someone is going to profit off me today. They're saying: My child has an appointment for their strep throat. I'm glad I have access to that service and primary care.

 

To your point, it is a success story, I know, in my area. I have two community pharmacy primary care clinics, and they are really well received.

 

I do have a question that I think I'd like to ask the Department of Health and Wellness. The government's added a lot of new health care professional seats in different professions and is building up the infrastructure. Could you speak to the partnership with our post-secondary institutions, and talk about how those seats will help create more sustainable health care professionals going forward? Could you speak about that?

 

KIM BARRO: Yes, it's really important to build as many seats as part of our recruitment strategy, making sure that we're accessing all Nova Scotians who are eligible and want to go into those health professions by increasing the seats.

 

The other important thing we're doing with those seats is ensuring that we have seats that are guaranteed for our First Nations and our African Nova Scotian Black populations, so that those populations will see more practitioners who look like them. That creates a better safe environment.

 

We're really pleased that we're able to increase the number of seats, and that we paid attention to those elements of equity that are really important as we build our health care professional infrastructure in Nova Scotia. I think we're doing a good job there.

 

CHRIS PALMER: How much time, Chair?

 

THE CHAIR: Fifty seconds, assuming you don't do much of a preamble.

 

CHRIS PALMER: Am I known for that or something?

 

Again, I just want to reiterate - and maybe Ms. Bodnar could touch on this, and maybe I'll just ask in the next round when it comes around. For those rural areas, just to maybe expand and talk about the significant role and how we were able to see how we were going to use pharmacies in the experience of COVID-19 and during the pandemic time, and how we used the pharmacies to help us in vaccinations and different things like that, and how that maybe created the template for how we could work with them going forward - if that makes any sense.

 

THE CHAIR: Ms. Bodnar with 12 seconds due to preamble.

 

ALLISON BODNAR: I think we'll maybe address this after, but obviously 1.5 million vaccinations in one of the only health care centres open during COVID . . .

 

THE CHAIR: Order. The next round will be seven minutes.

 

It will be the Liberals.

 

RAFAH DICOSTANZO: If I may go back to OPOR, I have a burning question, honestly. All we heard today is about all the access points, whether it's pharmacy, whether it's virtual care - and all of this is wonderful, but when we decided on OPOR, we did not include them. The people who are using these access points because they don't have a family doctor are the ones who need it the most. It's been three years now for some of them without a family doctor, and they've had no record. They show up at emergency, they show up at a pharmacy, and to me, it is a liability to the doctor in emergency, to the pharmacist, not knowing their record. But this government spent $360 million and did not include them. How did that decision come about, and why?

 

DEREK SPINNEY: I'll start. I'm certainly not the decision maker, so I'll defer to others on that part, but what I can say, I think definitively, is that nobody was excluded. We simply said that we needed to start, and we needed to start with the acute system.

 

I suspect - again, I defer to other decision makers - but that is the natural extension of where we go with this. We just simply needed to start with the acute system. Then rolling it out to those other things I think makes 100 per cent sense. In fact, I think that's how we deliver a health home that I talked about earlier. We need to be able to have access for others through that system, and I don't think anybody's going to disagree with that. I think it's really about trying to get there as fast as we can. That is the change that will take place through data that the minister spoke about the other day at the Halifax Chamber of Commerce luncheon as well. In order to deliver on that, we need to do exactly what you just said. We need those other avenues included in One Person One Record.

 

RAFAH DICOSTANZO: I believe the announcement said that OPOR is over 10 years, that $360 million. If you can just tell some timelines so that first you're starting with this, and that's going to take 10 years. When will we have the pharmacists, the virtual care, and everybody else? Will that be 20 years? What are we looking at here before we have access to our records?

 

DEREK SPINNEY: I obviously don't have a specific time with that, but just to comment on the 10 years, the rollout across the province throughout the 39-plus facilities we have takes three years. The 10 years includes the continued support and evolution of that and the partnership with Oracle. It isn't a 10-year implementation. The implementation period is actually much smaller than that. I think you're asking exactly the right questions, and I think that those are the things that need to be determined over the next while here as we implement because I think those are the right next steps. It's just a matter of the sequencing of those things, yes.

 

RAFAH DICOSTANZO: I think we need to be honest with our population as to when they expect to have that with their record. Another thing that surprised me was when the $360 million was announced with OPOR with Oracle. Not even a week later, there was another announcement of $120 million for the cancer as a different software with Varian. To me, I said: Okay, if OPOR is not good enough for cancer - the whole point of OPOR is to unite 80 systems together. That is just within the hospital system. We have 80 systems; we are trying to do one. Then a week later, we spent $120 million on a different system with a different company. How can you explain that to me?

 

DEREK SPINNEY: One of the things that One Person One Record is aiming to achieve is bringing all those different systems together, like you just said, and it's an extraordinary number which makes it so complex. By virtue of having that number, it shows that we're not dependent on only one system. There are other systems involved.

 

In the case of Varian, as part of the announcement that you're talking about there, we determined that we would be able to start providing cancer patients their electronic cancer record - I'll say now - immediately. We don't have to wait for a three-year implementation. The Province made the decision to engage with them to get that rolling now, fully understanding and appreciating that it could integrate with the OPOR system, and that's what we're seeing right now.

 

In many of the hospitals in the province, you'll start to see - if you haven't already - some posters on the walls talking about ARIA oncology information system and some software that you can use that allows you as a cancer patient to log in, see your cancer treatment plan. You can do your scheduling and interact with your care provider. That didn't exist, and we didn't want to wait three years for that. We've done that now, and that's being implemented and rolling out through the province. That's why. It wasn't in contradiction to something; it was simply much faster to be able to start a piece of this journey, and not at the expense of that larger system because it would be able to be integrated.

 

RAFAH DICOSTANZO: I'm still a little puzzled that the Varian system is faster and delivered much faster, but we didn't choose it for the rest of the system. It doesn't make sense to me that there is a system that is faster and has achieved more than OPOR, and we went with it after we announced OPOR. I don't know how you can square that one.

 

THE CHAIR: Mr. Spinney, 12 seconds.

 

DEREK SPINNEY: A much smaller group - here are 50,000 people in Nova Scotia with cancer, and it's not the one million populace that we needed to deal with the 80+ system. That's the 12-second answer.

 

THE CHAIR: And it was 11 seconds. You did very well. MLA Burrill.

 

GARY BURRILL: Ms. Rose, it's been said here a number of times this afternoon that P3 arrangements have always been with us - nothing new - so it's only a question, not whether or not we're going to have them but how we're going to use them. I want to say that I don't think that's the question at all. I think the question is: With the very serious problems we have in our health care system - wait-times to access all different forms of care - is the best path the path of contracting private-service-providing entities to provide the services we need? It seems to me that is the question that's in front of us. I wonder if you would speak to the coalition's position on that question?

 

ALEXANDRA ROSE: The coalition's position is we do believe in strengthening our public health care system, not in the form of contracting it out to private providers. Sorry, could you repeat the second part of that question?

 

GARY BURRILL: Yes. Is the best path the path of turning to private service providing entities, agencies, companies to deal with the big problems that we have? Is that the path that we ought to be on?

 

ALEXANDRA ROSE: We think no, it's not. Ultimately, these processes - I mean, it does range whether we're talking about private hospitals, or different centres, or travel nurses, or Maple and the virtual care. All of those vary greatly. Some things, of course, have always been private, but we do believe that the better option for Nova Scotians to get the care that they deserve is to keep it in the public system and strengthen the public system instead of opting for more expensive options that don't always provide the solutions that they do. I mean, it would be great if they did, and if they did, maybe I would be out of a job for everything to work super smoothly the way it does. I think, realistically, we should be looking at reinvesting in our public health care system.

 

GARY BURRILL: I'm thinking back a couple of years to the position that the coalition took about the partnership with Maple when it was first entered into. The coalition was a very clear voice - this is the wrong direction we should go. Is this still the coalition's position, and given the couple of years' experience that we've had, have you been led to change that, or is it something that's modified, or do you still think that this is the wrong path?

 

ALEXANDRA ROSE: We still stand by that; things should be kept within the public system. In saying that, obviously it's no one Nova Scotian's - we don't blame them for obviously accessing the Maple app. I use it myself; I don't have a family doctor. I've only lived here for a couple of years. Largely, we do believe in keeping it within the public system as just an overall statement.

 

GARY BURRILL: Then related to that, I wanted to ask you: What is the coalition's thinking, then, on the Nova Scotia Health Authority's partnership with Think Research Corporation in the development of the YourHealthNS app?

 

ALEXANDRA ROSE: It remains kind of the same as the - it would depend on a whole lot - we would love to see the Nova Scotia Health Authority develop it on its own, but I think that's a little bit unrealistic when we talk about developing an entire app. That obviously takes a lot of time and a lot of money, so of course we understand that different routes have to be taken.

 

[2:30 p.m.]

 

GARY BURRILL: I want to purse the same question in a different form, Ms. Mullen, to you. I guess it's important to be clear on the fundamentals of this. The union, not very long ago when the QEII redevelopment began, said that the P3 arrangement was like taking money for our health care and turning it into another yacht for a CEO. Can you expand on why the union thought that, and is that still the union's position on using P3 as the backbone for the expansion of the health care system?

 

SANDRA MULLEN: Definitely the union still believes in publicly funded, publicly delivered health care. We've seen a number of issues go by the wayside that were in a private, for-profit partnership. We've seen projects fail. We've seen projects not completed, not even started, under that route. We have our members who work directly within those systems seeing what happens when there is a private for-profit system come in to try to deliver services. Whether that's just the day-to-day service within the organization, whether it's laundry, they're bringing it back in house because they know - I do believe the employer knows that our members do a better job of delivering services.

 

It's definitely our position to continue along. We lobby with both the Nova Scotia Health Coalition and the Canadian Health Coalition, which is offering and working towards the federal pharmacare program - that will help keep folks out of the ERs, which again is a prevention model. The dental care being offered to seniors and to youth - those are all preventive measures that are publicly delivered.

 

I have seen the opposite of the Maple where Maple is coming in and being offered to employees of post-secondary as a benefit package that they have to pay for. It is similar to an advertising scheme that yes, you get two free, but your next trial is like Columbia House Records and you're going to be paying forever.

 

GARY BURRILL: Then I want to ask you, Ms. Mullen and Ms. Rose, do you have concern with the expansion of the role of private entities in dealing with our problems, that this is leading us on a path towards a two-tier system?

 

SANDRA MULLEN: I do believe that's exactly where we're heading. The very reason we want to see some transparency on these contracts - to be able to show Nova Scotians that it is a benefit should not be difficult. If it is for the public benefit, it should not be hidden.

 

CHAIR: Order.

 

CHRIS PALMER: I just want to go on the record and say I actually bought 20 Columbia House CDs for 99 cents once, so thank you for bringing that up. (Laughter) Ms. Bodnar, could you finish your answer about the experience of the pharmacies during the pandemic and how that provided an example for future partnerships? You were answering that question.

 

ALLISON BODNAR: Absolutely. I think we started with the fact that when many organizations were closed and access to care was limited during the pandemic, all of the pharmacies remained open and the pharmacy staff there. I think the public's relationship with pharmacies started to change a little bit when they recognized the skill set and the services available, and that has just translated into a bigger demand and bigger interest in building on that relationship.

 

These are community health practitioners whom even patients who are unattached to other health care providers are often attached to. They have a wealth of information and history on which to build and provide care and provide that navigation to other parts of the system. Since that time, we've been able to open these clinics. We're focusing those clinics in areas of highest need. I think the previous committee testified as to how those selections were done based on the registry and ensuring that they were spread throughout the province. I think it's just something to continue to build on.

 

Again, I'll reiterate most of primary care is delivered through private entities - publicly funded through private entities - whether that's physicians or dentists or optometrists or pharmacists, it's the only care in acute facilities. I think we need to ensure all of the things we talked about before: access, equity, transparency, cost, standards of care. If we can do that, how the money flows, I think, is a little less relevant than ensuring we have those standards, cost-effectiveness, and access.

 

CHRIS PALMER: I'll pass it on to my colleague.

 

THE CHAIR: MLA Barkhouse.

 

DANIELLE BARKHOUSE: Dr. Audain, you've been so quiet over there I think I'll ask you.

 

What do you think of partnerships like Halifax Vision Surgical Centre where surgeons can use their facilities to cut down on surgical wait times? How do you see it helping doctors provide better and faster service?

 

COLIN AUDAIN: Sorry, I'm not sure if I completely understand your question.

 

DANIELLE BARKHOUSE: Halifax Vision Surgical Centre is allowing surgeries to take place in their facilities. I'm wondering how you - well, it cuts down on the surgical wait times for anyone needing that service. I wonder how you see it helping doctors provide better and faster service for patients.

 

COLIN AUDAIN: My understanding of Halifax Vision is that it would fall into a similar category as Scotia Surgery Inc. As far as I know, those services are still publicly funded. It would allow more patients to receive eye care that they otherwise wouldn't be able to receive if they were just waiting on their ophthalmologist to be able to treat them in the hospital system.

 

Does that answer your question?

 

DANIELLE BARKHOUSE: I guess, sort of. I'll just move on because we're down to 10 minutes. I'll move on to the next one.

 

THE CHAIR: Three minutes.

 

DANIELLE BARKHOUSE: Of course. Three minutes.

 

How do you anticipate partnerships like this to further improve efficiency and effectiveness of health care delivery in Nova Scotia?

 

COLIN AUDAIN: I think that for me, most of these partnerships that we're talking about are still, I would consider, publicly funded in that the patients aren't having to pay out of pocket for these services. I would also caution that they're there to allow patients to have access to services that they're otherwise struggling to have access to.

 

To my earlier point, in instances where patients have no access to a physician at all, it's better to have access rather than no access. But the ultimate goal should be attachment. The idea of a health care home is what, ultimately, we should be striving for, in that it's a collaborative model where the patient's information is in one place, and it's not scattered in different silos around the province. We should still be striving to utilize health care workers, whether it's pharmacists or nurses or nurse practitioners, to their full scope of practice, but not in this way where it's in silos and not integrated, in a way.

 

It's important that we have these measures right now, so that people have access that they otherwise wouldn't have, but we shouldn't lose sight of the long-term goal to provide attachment to everybody in a way that should be a standard of care.

 

DANIELLE BARKHOUSE: I think we've heard this from the department in regard to doing home care and trying to - One Person One Record, things like this - I think, from listening to you, kind of nails that all down to what you would like to see happen.

 

I would like to know if you could explain to anybody - these millions of listeners out there today - how NSHA and the Department of Health and Wellness work together to come up with decisions regarding how they spend their money on what kind of public health funding. So that would be to the ADM.

 

KIM BARRO: We work very closely together to ensure that we're on side, so that NSHA, who would be the operational arm of the health system, would understand what they need in that space. What we work through is business cases where they would express what they would need and for what benefit, et cetera. Then the department would work with that submission. Actually, it's the ultimate decision of Treasury Board and Cabinet sometimes to ensure that that's what government wants to invest in.

 

We have a system where we work very closely. The health authority comes up with the type of initiatives . . .

 

THE CHAIR: Order. That ends all the questioning. We'll go for closing statements. I will start with Ms. Bodnar. Do you have any closing statements?

 

ALISON BODNAR: Just quickly, again, I think we really need to understand the concept of private versus public health care, and really focus in on those elements that I mentioned earlier. I think if we could ensure access, equity, transparency, cost effectiveness, and standards of care, then we will have achieved the health care system that we want.

 

COLIN AUDAIN: Thank you again for the opportunity to participate today. It's an important topic, and what we want is to ensure that Nova Scotians have good access to care. When it comes to public-private investment, we must step carefully. Private sector involvement should complement the goals of the public system for primary care and other specialty services, including universal access, connection to a health home, continuity of care, and so on. It should not come at the expense of equitable access for Nova Scotians or create health human resource challenges for the public system. Ideally, we need to stabilize primary care in the publicly funded system, so all Nova Scotians have good access to the care they need. This will help relieve pressure on the system.

 

SANDRA MULLEN: To elaborate on that again, we want to stop the exodus of staff to these private organizations. Whether it's an agency or whatever, private practices are taking our members away. The other side of it is - we reiterate the fact that it is private for-profit, and therefore while they may not be paying for those services out of pocket, they are paying it with income tax. Here in Nova Scotia, it is their cost, so we also need to make sure that those agreements are transparent and accessible to show the members of this province.

 

ALEXANDRA ROSE: Thank you for having us here today as well. Ultimately, while the Nova Scotia Health Coalition stands by keeping our public system fully public or as public as it can be and introducing the parts that are private back into the public system or into it for the first time, public-private partnerships are clearly here and perhaps here to stay. For that, we would love to focus on transparency with the public, and also putting resources into keeping services and employees back into our public system to benefit all Nova Scotians.

 

KIM BARRO: I would like to thank everyone for the very important topic today. I would just like to reiterate that we believe and continue to strengthen our publicly funded health care system. We believe that robust and transparent, equitable partnerships with private industry is one way that we can ensure services that Nova Scotians need and deserve faster.

 

DEREK SPINNEY: Thank you for the opportunity today. I really appreciate these sessions. The transparency - what we're all striving for - couldn't agree more. I'd like to publicly thank - for the millions that are tuning in, I heard earlier - all 30,000-plus people working at the Nova Scoita Health Authority every day. We are very proud of the work that we do. We're proud of our teams, and we're grateful for the opportunity to be helpful.

 

THE CHAIR: Thank you. This concludes this portion of asking questions. What I will do is recess until 2:48 p.m., and then we'll be back to deal with our business. We're in recess.

 

[2:44 p.m. The committee recessed.]

 

[2:49 p.m. The committee reconvened.]

 

THE CHAIR: Order. We have some committee business. On April 26, 2024, we had a letter from the Department of Health and Wellness written in response to a request for information made to the Office of Healthcare Professionals Recruitment during the March 19^th meeting. It was forwarded to everybody. Does anybody have any comments?

 

RAFAH DICOSTANZO: Just to thank Judy. She did a lovely job with our letter.

 

THE CHAIR: She always does a great job.

 

RAFAH DICOSTANZO: Yes.

 

THE CHAIR: Next item: This is a reminder. At the last meeting, I reminded everybody that we will be having an agenda-setting meeting on June 11^th. Each caucus is asked to ensure they send the list of proposed topics to the clerk by Wednesday, May 29^th.

 

July 9^th: There is a proposed alternative witness to represent Nova Scotia Health Authority's Cancer Care Program if the topic is the Cancer Screening Programs. I just want to remind people we're coming up to Summer and we're having some issues with getting witnesses. (Interruption) The approved witnesses are Cancer Care Program senior medical director Dr. Helmut Hollenhorst and senior director Jill Flinn. They may not be available in July or August and have asked whether other senior staff and medical leads could appear in their place. What's the committee's view on that? If we decide not to do that, then we'll have to try to figure out what the July topic is.

 

RAFAH DICOSTANZO: I'm just trying to remember what other doctors were - what I was interested in is Dr. Siân Iles. Is she coming in or is she one of the ones who is not coming?

 

THE CHAIR: No, the two are Dr. Hollenhurst - whose name I probably said wrong - and senior director Jill Flinn. Those are the two who are unable to come in July and August . . . (interruption).

 

JUDY KAVANAGH: These two can come.

 

THE CHAIR: It's the two doctors from the Nova Scotia Health Authority who are unable to come in July and possibly August. Anne Yuill from the IWK Health Centre is able to and Dr. Siân Iles is able to. The question is: Are we fine with those two?

 

SUSAN LEBLANC: I think if they're senior staff and working in the Cancer Care Program, I think that would be fine. It might be nice to see if we can get one who is administrative and one who is a clinician, if possible, but I think senior staff is great.

 

THE CHAIR: Agreed? It's agreed. The next meeting is June 11, 2024, 1:00 p.m. to 2:00 p.m., agenda-setting. Is there any other business? Meeting adjourned.

 

[The committee adjourned at 2:52 p.m.]