HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

STANDING COMMITTEE

ON

HEALTH

 

 

Tuesday, July 8, 2025

 

 

LEGISLATIVE CHAMBER

 

 

Expansion of Multidisciplinary Care Teams

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

 

John A. MacDonald (Chair)

Adegoke Fadare (Vice Chair)

Hon. Susan Corkum-Greek

Ryan Robicheau

Nick Hilton

Lisa Lachance

Rod Wilson

Hon. Iain Rankin

Hon. Derek Mombourquette

 

[Ryan Robicheau was replaced by Melissa Sheehy-Richard.]

[Lisa Lachance was replaced by Susan Leblanc.]

[Rod Wilson was replaced by Paul Wozney.]

 

 

 

In Attendance:

 

Robin Dann

Legislative Committee Clerk

 

Gordon Hebb

Chief Legislative Counsel

 

 

WITNESSES

 

Department of Health and Wellness

Colin Stevenson, Chief, System Performance and Integration

 

Joy Knight, Executive Director, System Integration

 

Nova Scotia Health Authority

Dr. Annette Elliott Rose, Chief Nurse Executive and Vice President, Clinical Performance and Professional Practice

 

Dr. Aaron Smith, Medical Executive Director, Provincial Operational Co-Lead, Primary Care Clinic and Health Home Model

 

 

 

 

HALIFAX, TUESDAY, JULY 8, 2025

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

John A. MacDonald

 

VICE CHAIR

Adegoke Fadare

 

 

THE CHAIR: Order. I call the meeting to order. For the purpose of today's meeting, jackets will be optional, and then you should do what I thought I did, which is silence your phones.

 

This is the Standing Committee on Health. I'm John A. MacDonald, the MLA for Hants East and the Chair. Today we will hear from the Nova Scotia Health Authority and the Department of Health and Wellness regarding the expansion of multi-disciplinary care teams.

 

Another reminder: Please put your phone on silent. Just a reminder: Don't touch your mics because they'll pick it up.

 

Now I'll ask committee members to introduce themselves for the record by stating their names and their constituencies.

 

MLA Mombourquette.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, to my left is . . .

 

GORDON HEBB: Gordon Hebb, Legislative Counsel to the Committee.

 

THE CHAIR: To my right . . .

 

ROBIN DANN: Robin Dann, Committee Clerk.

 

THE CHAIR: Thank you. Now what we'll do is have the witnesses introduce themselves - just name and position - and then we'll get back to doing the opening statements. We will start with Mr. Stevenson.

 

[The witnesses introduced themselves.]

 

THE CHAIR: I see I have three with opening statements so I will go backwards starting with Dr. Smith. Do you have opening - I believe you do - then I'll work this way.

 

Dr. Smith.

 

DR. AARON SMITH: Thank you all for the opportunity to join you. I am very excited to be here to talk about the work that we're undertaking.

 

Just a bit of a backstory for me. When I began my career as a family physician back in 2008, I couldn't have imagined how dramatically or how quickly the landscape of primary care, community care, and hospitalist-based care would change, and what this shift would mean for our patients, our health system, communities, and providers like me.

 

At the time, I was like many other family physicians working in a solo practice with all the pressures you might expect, with those responsibilities squarely on my shoulders. The things in addition to direct patient care that I was responsible for were to stand up and operate the practice with staffing, leasing, procuring supplies, health records management, financial, and the pressure to be available for my patients - everything they needed me to be. Despite these pressures, I took pride in delivering comprehensive care for my patients, responding to acute illnesses, managing chronic disease, facilitating and following up on specialist referrals and testing, staying on top of routine screening and, of course, supporting wellness and prevention services.

 

When I started out, the concept of team-based care where it wasn't just me to fulfill all my patients' needs was just gaining some traction with new roles like nurse practitioners and family practice nursing introduced. As with most change, there was initially skepticism: We've never done things that way. Others didn't have our training or our background. But conversation by conversation, pilot project by pilot project, and role by role, we began to understand how multidisciplinary care would improve patient outcomes and physician satisfaction. Specifically, we began to understand that other health care professionals had in-depth knowledge, that they too had completed comprehensive education and training programs, they too had achieved the requirements set out by their licensing bodies, and they were qualified and equipped to join us in delivering care in our clinic rooms, at patients' bedsides, in emergency departments, operating rooms, and more.

 

Reflecting on my own clinical experience as one of the first family physicians to partner with the Nova Scotia Health Authority to support a nurse practitioner in the primary care environment, I am still struck by how significantly it impacted quality patient care, patient experience, and my own joy in my work.

 

Similarly, while providing care for hospital-admitted patients, I am privileged to experience first-hand the impacts of working within a multidisciplinary care team alongside roles such as mobility support workers, continuing care support workers, and nurse practitioners, to name a few. Impacts include improved patient outcomes, holistic care of the person and not the disease, and improved patient flow through the hospital environment and into community.

 

In my previous roles as the medical executive director for the Nova Scotia Health Authority's Northern Zone, and more recently as the provincial medical executive director and operational lead for health home transformation, I've also had significant responsibility and involvement in physician recruitment and retention efforts here in the province, across Canada, and internationally.

 

I can confirm that word is out about the benefits of collaborative practices and health homes in Nova Scotia, with candidates consistently expressing their desire to work within multidisciplinary team models that allow them to focus more on their patients, and to be part of a team that supports timely, appropriate, and comprehensive care, positive patient experiences, improved access, improved outcomes, and more. As a striking example of this, all 89 primary care providers who set up shop in Nova Scotia over the last year were recruited into collaborative teams.

 

Looking back over the past several years, we have so much to be proud of, and the momentum is still building. We have more work to do to ensure that Nova Scotians get the team-based care that they deserve, and we're working hard on it.

 

Nova Scotia now offers several avenues to access primary care, most of which are supported and made possible through multidisciplinary teams. For example: health homes, VirtualCareNS, primary care clinics for folks who don't have a primary care provider, mobile primary care clinics, after-hours clinics, community pharmacy primary care clinics, and various specialized programs.

 

The landscape has shifted and will continue to shift into something even more remarkable in this province and something even more impactful, thanks to brave conversations, bolder actions, and our shared commitment to innovate, adapt, and build the new system that Nova Scotians need, a system where we commit to fully leveraging the knowledge, skills, and experiences we can all bring to bear for our patients and clients together.

 

THE CHAIR: Next will be Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: Good afternoon. Thanks for having us here this afternoon.

 

Across Nova Scotia, we have many multidisciplinary and interdisciplinary teams, as Dr. Smith shared, and there is exciting transformation that is happening in all areas of care. Their composition and areas of focus vary, but each team is ultimately focused on supporting Nova Scotians, their health, and their health needs. It's about the right care in the right place at the right time by the right provider.

 

Whether it is the collaborative primary care teams and access that Dr. Smith referenced, the teams enabling more patient-centred care in our emergency departments; those working together to make sure patients move from the hospital into the place they call home; or very specific teams like our orthopaedic and spine assessment clinics working to make sure patients get the assessments they need and to determine whether or not they need surgery, it's all about supporting care and meeting the needs of Nova Scotians.

 

It's a privilege to speak with you today and share some of the specific examples happening across the province. In health care, as it is often said, our people are our greatest strength, our most important asset. I can say that without hesitation.

 

While we have many investments in very important things like technology, equipment, and infrastructure, what is important every day is the people taking care of the people in Nova Scotia. They're providing care that is timely, compassionate, competent, and considerate of the unique needs of Nova Scotians and the circumstances of each Nova Scotian and their family.

 

More and more, we see that our strength comes not solely from the contributions of individual clinicians, but from the combined power we harness when we wrap collaborative, interdisciplinary, and multidisciplinary teams around patients in a good, comprehensive, appropriate, and efficient care.

 

Our experiences here in Nova Scotia, across Canada, and internationally demonstrate that supporting the health and well-being of patients takes a village. There are established and growing bodies of evidence and data - data here in Nova Scotia, evidence here in Nova Scotia, and data and evidence nationally and internationally - that support team-based approaches. Connected care translates to the best care for patients' positive experiences and health outcomes.

 

Research highlights benefits such as improved medication management, reduced adverse events, and better chronic disease management. Effective collaboration reduces duplication of services or redundancy of services, and as Dr. Smith referenced, it's actually the way people want to work. Clinicians are looking for opportunities to come to Nova Scotia, to stay in Nova Scotia, and to share their clinical talent.

 

It's also an opportunity for us to think about how we advance collaborative teams, clarify roles and responsibilities, and obviously communicate clearly with Nova Scotians about who is providing their care. It's about creating trust and respect among teams and trust and respect with Nova Scotians.

 

At a time when we are fiercely competing with other markets for highly skilled health professionals, this is all so important. As we seek to enhance care for patients and lead important changes that are contributing to Nova Scotia's growing reputation for innovation, we are pleased to see examples of our collaborative teams. We get calls quite often - all of us here - from colleagues across the country and internationally, wondering “What's happening in Nova Scotia and what are you doing? We want to learn more.” We learn from them as well.

 

Nova Scotia's introduction and expansion of registered nurse authorized prescribers and the introduction of a new program in the introduction of physician assistants; the growth of collaborative primary care teams, including pharmacy clinics; the early assessment teams that I referenced before around surgical care; regulatory changes that have happened over the last number of years; and the efforts for us to build up some of our internal teams differently are all changing the way that we provide care. We're excited to share more details about that with you today.

 

Multidisciplinary care teams are helping us create space for individuals - for professionals to work to full scope, to feel valued and respected, to do the work that they are educated to do; to respond to the complex care needs of Nova Scotians and their families; and to break down silos. Part of the multidisciplinary care team are not just clinicians. There are many people working in health care, and at the centre of it all is the Nova Scotian.

 

As we work with the Department of Health and Wellness and other partners and health care teams, we want to advance connected, responsive, and reliable care for Nova Scotians. We will keep reimagining. We'll keep test-and-try pilots - all the things we need to do to get better over time.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: Good afternoon. Thank you for the opportunity to be here with colleagues from the Nova Scotia Health Authority and the Department of Health and Wellness to talk to you today about multidisciplinary care teams.

 

It's our vision that everyone should have access to comprehensive and connected care. Backed by investments in infrastructure, technology, and people, it's an ongoing and evolving process, but one that has yielded positive results: fewer people on the Need a Family Practice Registry; people choosing a more appropriate care option instead of presenting to emergency departments; and helping patients in hospital return to where they call home sooner.

 

At the core of these and many other examples are multidisciplinary and interdisciplinary care teams who work independently and collaboratively to share information and coordinate care for patients. These teams exist throughout our health care system. They work in acute care, ambulatory care, and primary care settings. They work in community and in hospital.

 

The work of the department and the Health Authority is to support the continued growth and expansion of these teams. We do this by ensuring that we have the right composition of providers to provide the best care, by supporting providers to work to their full scope of practice, and by matching the skills of providers and care teams to the needs of communities and patients through focused recruitment and retention efforts.

 

We have improved access to primary care because we have brought together a breadth of services like mobile clinics, virtual care, community pharmacy primary care clinics, and health homes into a system of care. We're wrapping health care programs, services, and teams, both in-person and virtually, around patients where they live. We're creating connection between people and health care professionals and providing options for care while we do that.

 

In acute care, we've implemented technology like the Care Coordination Centre and expanded the hours of multidisciplinary and interprofessional teams. These improvements help people return to where they call home sooner with the right resources to ensure success and safe recovery.

 

[1:15 p.m.]

 

We have made improvements in emergency care with patient advocates, waiting room providers, physician assistants, and introducing virtual care - all measures to help reduce overcrowding and wait times.

 

The ability to work as part of a multidisciplinary or interdisciplinary team is an attractive option for many health care providers because of the opportunity for collaboration and added care they can provide to patients. We've made regulatory changes like the Patient Access to Care Act that improves recruitment and licensing processes and provides us with greater flexibility and ease to expand scopes of practice to meet the needs of the system and patients.

 

We know health care providers want to work to their full scope of practice, and we want that for them too. We've expanded the scope of practice for imaging and radiation therapy professionals, lab assistants, chiropractors, physiotherapy, paramedicine, nursing, and pharmacy. In fact, pharmacists in Nova Scotia have one the broadest scopes of practice nationally and internationally. We could not achieve any of this without people. We continue to recruit internationally and have established supports like the Physician Assessment Centre of Excellence to help internationally trained physicians work in Nova Scotia sooner. We have created more opportunities to train physicians in Nova Scotia; the new Cape Breton medical campus is on track to open this fall with the first cohort of students starting in September.

 

Change doesn't happen overnight; it takes time. We've laid the groundwork, we've made notable improvements, we've seen results. Now we seize that momentum and continue to fulfill our shared vision of a health care system that provides comprehensive and connected care to every Nova Scotian.

 

Thank you, and we look forward to answering your questions.

 

THE CHAIR: As is the common practice of the committee, it's 20 minutes per caucus. At the end of 20 minutes, I'll have to say, “Sorry,” and interrupt you. We'll start with the NDP, and I guess it will be MLA Leblanc.

 

SUSAN LEBLANC: Thanks for being here today. I do want to say that we were really anticipating the presence of Karen Oldfield, the interim president and CEO of the Nova Scotia Health Authority, to be part of the witnesses today, and we only found out last night that she wouldn't be in attendance. I just wanted to say that we are disappointed that she won't be here to answer questions. I'm very happy to see both of you to answer questions on behalf of the Nova Scotia Health Authority, and I have a lot of them. We have another topic in August coming up where the Nova Scotia Health Authority is invited as well, and I'm hoping that Ms. Oldfield will be there for that meeting.

 

I appreciate all of the opening comments. It occurs to me that when I was thinking about this topic, I was thinking about primary care in particular - the multidisciplinary teams and collaborative care teams in primary care - and I'll talk more about that in a little while, but as you have all pointed out, there are a number of ways to think about collaborative and multidisciplinary teams.

 

I do want to focus mostly on primary care and the idea of a patient or a person being connected to a team because there have been a number of references to the community pharmacy primary care clinic program and mobile health clinics, all of which I have used, even though I have a primary care provider. The fact is that if you don't have one, those are all great to get the care you need when you need it, but there's no continuity, there's no continuation. There's nowhere that those reports are going. Sometimes mobile health clinics can't do certain things because there's nowhere to send the reports, certain tasks - that kind of thing.

 

I want to be really clear that I think, at least in our position as constituency MLAs, we still need to work toward attaching every person in Nova Scotia to a team, preferably in their community.

 

That being said, in 2021, when the Liberal government left office, there were around 75,000 Nova Scotians without a family doctor. Last summer, that number surpassed 160,000. How did the primary care crisis get so bad between those years? Anyone?

 

THE CHAIR: You're not specifically? Does anybody? Mr. Stevenson, you moved first.

 

COLIN STEVENSON: I'll try not to flinch next time. I don't know that I'd have an expert or a definitive answer to what caused the full increase, but there would be a few factors that I could offer up and ask my colleagues to jump in as well.

 

A few things happened over those particular periods of time. One was - I think 2021 was the reference date that you started from - that we were still in, but coming out of, the tail end of a pandemic globally, as we all know. That created a lot of pressure on the health care system, practitioners, administration, and staff throughout the system. We did see some people make decisions to leave the workforce who may have otherwise stayed in the workforce. So some reduction in workforce associated with that particular timing and what was happening within the system.

 

Following that, in Nova Scotia as well as other parts of Canada, we were aggressively recruiting and increasing our population. We had growth within the population, within the province over that same period of time, which creates the need for people to seek access or attachment to primary care. Those would be two factors that were occurring between that 2020 period of time up to 2024, where the system, through implementation of different strategies to address both care to population more broadly - as well as to address the shifting and the change in the workforce. We've been able to start to see that turn. I think the most recent numbers are now down to approximately 91,000 people who are unattached.

 

MLA Leblanc, you referenced the other ways that people are accessing care. We really haven't just waited for recruitment to take hold and for teams to build up. We've had a really strong focus in the system around creating the access points that you've referred to. Creating access through virtual care, pharmacy clinics, and some of those other points have also helped to augment how people are connected to the system. It's an access point, but it is allowing them to be connected to the system, understand what their care needs are, and make sure that they are referred to the appropriate care location if they need additional supports.

 

SUSAN LEBLANC: As you note, there are 91,000 people, or thereabouts, still on the Need a Family Practice Registry. Mr. Stevenson, I'm wondering: Would you agree with me that we are still in a primary care health care crisis?

 

COLIN STEVENSON: We're still in a situation within primary care where we know we have steps to be taken. I think what we've see within primary health care over the last three to four years has been a significant increase in the means in which people can access primary care. Within the collaborative practice or our primary care practice environment itself, there were over two million appointments from April to November of last year, which is about 2 per cent more visits than occurred in the previous time frame.

 

Over the last couple of years, we've seen an increase in other access points - over 800,000 additional primary care appointments that didn't exist in the system prior to that. While we still have individuals who are unattached and there are aggressive moves to continue to attach those individuals, I would say that the primary care system is in a significantly better place than it has been historically, because of the growth in the opportunities for people to see a primary care provider, either through their own attached provider or through other means, which is really creating a stable system. It's creating an opportunity for people to get care sooner than they would have otherwise and be able to ensure that they have good continuity of care and follow-up.

 

SUSAN LEBLANC: I take your point, but I also want to reiterate my point, which is that when folks don't have a family attachment to a health home or a family care provider in some way, things can fall through the cracks. I definitely think that the pharmacy clinics and those types of access points are very important, and they are definitely relieving pressure at emergency rooms for people who aren't attached.

 

In terms of the word “crisis” - someone like Cathy Croskery, who was in the news - there was a CBC article about her recently - she spent months trying to get a cancer screening that she needed. She almost wasn't notified of her diagnosis because she didn't have a family doctor. Nova Scotians deserve better than that. Maybe we'll say, well, someone like Ms. Croskery fell through the cracks, but with a breast cancer diagnosis, it could be a matter of life and death if you're falling through the cracks.

 

You say that you are aggressively working to attach people and get them off the wait-list. Do you have a timeline? Can you tell us when you expect everyone in Nova Scotia to be attached to primary care?

 

COLIN STEVENSON: I might lean on my colleagues here in a minute. I won't give a specific timeline associated with it. I think the evidence would show that there has been a significant reduction in the number of individuals who are unattached. More and more people each month are becoming connected. If we look back to February 2023, just two years ago, that number was 133,000; now we're at 91,000.

 

I can't tell you today. I'll ask Dr. Smith or Dr. Elliott Rose if they have additional information with respect to the timeline, but the plan continues to be to recruit into teams to build, expand, and strengthen more teams, to manage down that existing number of individuals who are on the unattached list.

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: MLA Leblanc, I appreciate your comments, and I agree with you that Nova Scotians deserve the best primary care system in Canada, if not the world. We're working hard toward that. I also agree that all residents of Nova Scotia should have connection and attachment to primary care in line with what's been described with Jane Philpott's excellent book, Health for All, which I'm sure you've read.

 

Following up on the connection comment because I think that's something critical - that folks are connected across our primary care system. For folks who don't have current attachment to a health home, we do have a network of primary care clinics across the province. There are 19 of them, and they are specifically designed to provide care for folks who don't currently have attachment. They provide care in a multidisciplinary way. There are teams that are comprised of physicians, nurse practitioners, physiotherapists, and occupational therapists. They are there to provide both episodic care - things that don't require planned or structured follow-up - and they're also there to provide continuous care for folks who have complex care needs or chronic disease management.

 

In terms of connection to these clinics, we have inflow pathways that are structured. We call them request-for-care pathways. That will be from, for example, VirtualCareNS. If they assess somebody and they feel it needs follow-up, either episodically or continuously, they will make the referral to the primary care clinic that's nearby, and it will be followed up as needed. Similarly, for outflow from emergency departments, for example, you can activate a request for a care pathway, and they'll be seen quite promptly within their local PCC. We're working very hard to make sure that connection exists because, as I said, I agree that's critical to quality patient care.

 

In terms of the Need a Family Practice Registry, it's very hard to say when we'll get to zero. We're going to work hard to make sure everybody is connected, but one of the things we have in this province is that we're very blessed that people want to come from all over the world and live here, and we're seeing unprecedented population growth. We're trying to build a system that can connect that, can catch that when people arrive, and they can be connected to primary care in a meaningful way.

 

SUSAN LEBLANC: I'm going to pass it on to my colleague.

 

THE CHAIR: MLA Wozney.

 

PAUL WOZNEY: In May 2023, the government released a plan to create eight new collaborative family practice clinics. Recently announced clinics in Halifax, however, were not on that list. Why isn't the plan to expand collaborative care teams publicly available to Nova Scotians?

 

THE CHAIR: Anybody specific? Dr. Smith.

 

AARON SMITH: I can answer very generally, and then I can hand it to my colleagues. What we're making sure of when we're building health homes is that we're being very responsive to community need. We're looking at rates of chronic disease in community, rates of social supports versus not, unattached rates, and also the need to stabilize when physicians decide to end their practices and move on to other scopes of practice or to retire. We certainly have plans in terms of how we support populations, but oftentimes, we're also reacting to and planning for community need.

 

[1:30 p.m.]

 

PAUL WOZNEY: I thank Dr. Smith for those comments. I guess I would say the fact that there's a plan that people can't see offers small comfort to people who don't understand when they're going to get connected. People need to know what they can expect for their family's health care.

 

What possible reason can the Nova Scotia Health Authority or the government offer to justify keeping Nova Scotians in the dark about when collaborative care is going to be available to them in their community?

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: As referenced, in May 2023 there was a plan that was released and made available that highlighted the intent to move forward with - I think it was approximately 60 new and expanded primary care clinics within the province. I would say at this point, we've probably as a province collectively - between the Nova Scotia Health Authority sort of leading that primary care piece of work and investments through the department - been able to achieve or exceed what that number is.

 

To Dr. Smith's point, some of that has been in response to requests for support within a particular community and/or provider group in order to stabilize a practice and a system. We've tried to be flexible and respond to the needs. There are, on a regular basis, community conversations that happen to help support an understanding of what's happening with primary care within the respective communities, to talk about how services are available within those particular communities and what the intentions are to try to strengthen or deliver a new sort of practice type within those particular communities. Those conversations happen on a regular basis across the province, which would be one means for the community to hear more about what's happening within their particular area.

 

PAUL WOZNEY: Yesterday three new health homes were announced, but the health homes Citadel and Needham aren't expected to open until this October, barring construction or staffing delays. Are these the next most likely homes to open? A follow-up to that is: Why isn't the government clearly laying out a timeline for each region of the province and the opening of collaborative care that has been previously announced?

 

COLIN STEVENSON: Maybe I'm going to lean on Dr. Smith and Dr. Rose, just in the sense of the likelihood of other clinics opening sooner or what the status of the planning is from an operational perspective.

 

AARON SMITH: Yes, we were excited to announce the new health homes. As in the announcement, this will eventually provide attachments for folks and their families for approximately 20,000 people.

 

As you are aware, there's a lot that goes into opening these health homes, including infrastructure, the set-up, and also making sure that we're building and supporting the multidisciplinary teams that practice within - again, the folks like family physicians, NPs, family practice nurses, occupational therapists, social workers, what have you.

 

The other thing to keep in mind with these health homes is that folks can't start from scratch with their full panels. It would be irresponsible. We have to make sure we're metering the inflow of patients and families, balancing people's needs for attachment but also making sure we're providing the care in the safest and highest-quality way.

 

To my knowledge, the East and Central Zones are the highest priority and will be next up coming up, but we have health homes across the province in various stages of maturity. One of the other things we're doing to support health homes across the province is we have what's called a practice-support program. Within the Nova Scotia Health Authority, we have expertise in terms of not only patient care and interdisciplinary care but also in terms of the mechanics of running a practice: helping with patient flow, helping with panel management, and validating and helping with processes. We've been supplying that support to health homes right across the province. We'll continue to improve them on an ongoing basis.

 

PAUL WOZNEY: The NDP learned that between March and April of this year, over 4,200 Nova Scotians added their name to the family practice wait-list. Meanwhile, the government has only reported on the number of people coming off the list. Why is the government more interested in convincing the public they're making progress than accurately portraying the whole story to Nova Scotians?

 

COLIN STEVENSON: The numbers continue to move down. I'll start with that. What we do from the Department of Health and Wellness and working with the Nova Scotia Health Authority is make sure that we're accurately collecting and reporting on the numbers related to the Need a Family Practice Registry. The number that's reported is a net number. It takes into consideration the increase in people on the registry, which could be because they're new and moved in or they've lost their health care provider, and the number of people who've been attached. It's an accurate number that actually reflects what the shift and the change is.

 

Some months there's a bigger shift than others in one direction or another. I would say we've been fortunate in the sense of all the work that's been done over the last number of years around recruitment and planning and building towards health homes and collaborative practices. That's been able to create a more stable trajectory of those numbers going down, which is what's reported. There's no misinformation or misreporting associated with what those numbers are; it's intended and always has been an accurate number that is reflected.

 

There continues to be work - which my colleagues from the Nova Scotia Health Authority may want to speak to - there continues to be work as it relates to validation of people on that list to make sure that people who have found attachment or who have left the province are removed from the list. There continues to be work to ensure that there's accurate information associated with the health status of the individual so that if there are opportunities to more appropriately match them to other care options, that that's occurring throughout the process.

 

All of that is shifting what the registry is, how it has historically been used . . .

 

THE CHAIR: Order. Time for the NDP caucus has elapsed. Next will be the Liberals. MLA Mombourquette.

 

HON. DEREK MOMBOURQUETTE: I appreciate the opportunity to ask some questions today. Thank you all for being here. It's a balance for you, because you're the ones doing the work. I was involved a lot with collaborative care when we were in government. There are some great examples in Cape Breton around nurse practitioners coming into the practice. You're doing the work, and then there's the marketing machine that is the government. I want to focus on the list for a second because we've referenced the list. We heard in a press release yesterday that 20,000 people are potentially going to come off the list, but now the list isn't public. I question the list completely, because the current government used that list as the benchmark for them to come to government. Last year, before the last election, they removed that data for the public to see.

 

My first question is around the public. I can ask this to the presenters: Do they believe that that information should be accessible to the public?

 

THE CHAIR: Who specifically are you asking it for?

 

DEREK MOMBOURQUETTE: I'll ask Mr. Stevenson.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: I feel like I can pick up a little bit from where I was for the answer, but yes, it is the intention of the health system to continue to make the number of people on the registry public so that we can continue to build an understanding from the public around the impact that the changes are having on people's ability to be connected to the primary care system. It's important for people to know that. That is a commitment that will continue to happen.

 

As I was saying, we continue to see a shift and improvement within that number. That is as a result of the contribution of the work that's happening around recruitment and building of health homes, and as we're here talking about today, the importance of multidisciplinary teams in how that stabilizes care, stabilizes the workplace, and has more people more interested to come and work in Nova Scotia. All those things contribute towards that ability to continue to move people off the list, which is what our commitment is.

 

As I was saying, there's a lot of effort that's been going on to validate the information that has been historically collected. It's been the intention of the health system to mature what that registry has, which has largely been a database or a list where people could add themselves, but didn't have any ability to remove themselves. There is always going to be, and there continues to be work within the health system to validate, to check with people, find out if they've actually received care through some other means, ensure that their health information is accurate, that they're still seeking care and be able to match them to the most appropriate care provider. That work will continue. We'll continue to report and disclose what the number is as it shifts from month to month.

 

It's also important for the public and members to understand that the information associated with that does help from a system planning perspective. There is an understanding that it's not the only information that actually is used within the system, but understanding the number of people on the registry, even in a broad geographical area, helps us to understand what needs to happen from a workforce planning perspective, from an infrastructure perspective, how we actually link different access points to care, where we may have gaps within care. All that information is important, and the registry is a very active tool for us today.

 

DEREK MOMBOURQUETTE: Thank you for that. I still think it should be public. This government removed that information for people to see, and the government used that information on a daily basis when they ran to become government. I would reiterate that this current government removed that information by zone, and because of that, it makes the presenters' jobs more difficult because Nova Scotians have questions.

 

To your point, there are gaps in the system. There are some pretty significant stories, and people are working very hard, but I use the Cape Breton Regional Hospital as an example. The ER wait times are the highest by far; ambulance off-load times are up 300 per cent in Cape Breton. There are some significant challenges. I come to this from experience as someone who is a former Cabinet minister. People every day were following that information. Health care providers were following that information and it was public for everyone to see.

 

I really wanted to get that point ahead. That information should be public. You're referencing an announcement yesterday that you're going to take 20,000 people off the list - the government's going to take 20,000 people off the list. Show the public those numbers. It's one thing to break it down by zone. Celebrate that instead of taking that information away from people.

 

My question is on the registry. I'll ask Mr. Stevenson: How is it ultimately defined that someone comes off the list? Is it because they have access to a doctor, or is it because they went - for example, they got care through a pharmacy, they got care through someone else. How would someone ultimately be taken off that list?

 

COLIN STEVENSON: I'm probably going to pass this down to my colleagues from the Nova Scotia Health Authority. The Nova Scotia Health Authority actually manages the registry and the placement of people from the registry to practices.

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: Thanks for this, it's an important clarification. When we talk about attachment, we're talking about longitudinal attachment to a team, whether that team be a physician and other interprofessional, multidisciplinary folks, or whether that be another provider such as a nurse practitioner. If somebody accesses care episodically, it wouldn't be attached. It's the longitudinal care - to a team or an individual.

 

DEREK MOMBOURQUETTE: Just to clarify so I'm getting it right: When you say a team, it would be a collaborative care team that would include access to a family doctor within that team, so they would have a doctor.

 

AARON SMITH: Yes, and just to clarify a bit, as we were talking about today, multidisciplinary teams. That's how I framed my answer. It also may be attachment to a family physician primary care provider who isn't part of a team within the province. Once we have that longitudinal attachment to either an individual physician or a provider within a care team, we would count that as attached, yes.

 

DEREK MOMBOURQUETTE: My next question is around the announcement from yesterday. Again, you're doing the good work of the people - as people who are trying to navigate a massive marketing machine which is this government that came out yesterday and essentially said that they're going to remove 20,000 people by October from the Need a Family Practice Registry. Through you to the presenters - and I pass it over to, maybe, the Department of Health and Wellness - just to confirm: Do you feel that 20,000 people are coming off the list in October?

 

THE CHAIR: Dr. Smith, are you taking that?

 

[1:45 p.m.]

 

AARON SMITH: I can take that, yes. Within these clinics - how they're structured, what the planned staffing model is - I feel very confident that we'll be able to take these folks off the list. Again though, I'll clarify that this isn't going to be on day one. To take care of these folks in a responsible way, we have to make sure we're onboarding them and that we understand their health needs as they're coming into the practices so that we understand how the teams can be best positioned to support them.

 

I feel confident that the teams will work very hard and that they'll attach all the folks they can. It won't be on day one. But I can confirm that our providers, whether they be physicians, NPs, or other multidisciplinary care providers - they care very deeply. As I said, they're Nova Scotians. These are folks' neighbours. They're their teachers. They're their classmates. Folks within our teams care very deeply about providing the best access they possibly can.

 

I had the privilege recently of travelling around the province and meeting with primary care teams in health homes from one end of the province to the other. What was striking to me is how invested people were in terms of providing this type of care and how much they valued and appreciated the increased attachment numbers we're getting within primary.

 

DEREK MOMBOURQUETTE: The reason why I ask these questions is because you're absolutely right. I had the privilege of working with some great folks on the health care redevelopment in Cape Breton. Tough decisions - we worked with some great doctors around collaborative care centres on the Island as well.

 

When I see the government come out with - and the government generally does this the day before committee, whether it's this committee or any other. There will be a press release that will come out about something that the government is committing to. When I saw that yesterday, I said to myself, they're putting the pressure on these people - who are out there doing their thing and caring about people - they're telling Nova Scotians that 20,000 people are going to come off the list, and there's a ton of work that has to go into that. They're also referencing a list that they no longer want to show the public.

 

Obviously, we're going to ask questions about that. When you see an announcement come out where construction is not complete on the buildings - I know your people are working hard to staff them. They're not fully staffed yet. When you're coming out and telling Nova Scotians: Oh, that list you can no longer view? We're going to take 20,000 people off it by October.

 

To me, I just don't understand why they do that. These collaborative care centres have been supported by all political stripes over the years. These started long ago - the concept around them - and they continue to build and they continue to evolve. The nurse practitioner piece was a big part when we were there - bringing that piece into the team.

 

I wish you well in that. We all celebrate the capacity of people coming getting access to care. I question the list, myself. That's something that they never should have taken away from the public.

 

You've indicated that - do you feel confident that you'll have the staffing complement for those three projects that were announced yesterday by October?

 

AARON SMITH: From a physician perspective, and if the Chair will allow, I'll ask my colleague . . .

 

THE CHAIR: You can ask somebody else to answer. You just moved forward quicker.

 

AARON SMITH: Maybe briefly, what I'll say is that from a physician perspective, we are enjoying and appreciating unprecedented levels of interest in practice in Nova Scotia. We're welcoming people from all over the world. Physicians are joining our team - not just in primary care, in speciality services - in numbers that are unprecedented and generational. Our recruitment team is working very hard right across the board and Nova Scotians are benefiting from that.

 

I think it's not just the number of physicians we're getting in. It's also how we're supporting them, in terms of our onboarding supports, our practice supports, and again, ensuring that the teams are in place to practise in the way they would like to practise, which typically is in collaboration with a multidisciplinary team.

 

Perhaps I'll ask Dr. Elliott Rose to elaborate.

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: Building on Dr. Smith's comments, we did see 253 physicians recruited last year; 89 were family physicians. It's a great success there. For all clinicians, they are looking to work in teams, more so than ever before. That's a significant recruitment effort.

 

For the other professions, we did see that - this is Nova Scotia Health Authority-specific - there were 998 nurses who were recruited to the Nova Scotia Health Authority last year - a significant gain there. Many of those will be working in primary health care as family practice nurses, as registered nurses who are authorized prescribers, and as nurse practitioners.

 

We did also see a growth in all of our priority professions in allied health. Some of the numbers are small for some of them, but significant growth for net new for most of them. Again, some targeted recruitment efforts, and also some broader recruitment efforts. We have an active campaign in the United States, so we are seeing lots of interest from the United States, and of course some collaborative connections with other countries as well, so lots of good success.

 

DEREK MOMBOURQUETTE: Again, I appreciate the comments, but I do want to go back to - I'll finish by saying this: I appreciate the work that people are doing, but yesterday, the government announced three projects and 20,000 people are coming off the list in October. That's not the folks who are here, but that's the announcement and that's the marketing machine that we're seeing from government.

 

We know that staffing is a process. We know that to staff a collaborative care centre, you want to be unique to a community, but when I see announcements like that, Nova Scotians would expect that 20,000 people are coming off the list in October. I'll ask this question again, and anybody can answer this. Again, it goes back to the attachment list. The government is announcing that 20,000 people are coming off the list in October. Is that going to happen?

COLIN STEVENSON: Maybe a little bit of echoing Dr. Smith's comments and Dr. Elliott Rose. Confidence in recruitment has been good success over the last couple of years, and the efforts with respect to scope of practice, gateways to recruitment, and gateways to training are all in place. As I said in my opening remarks, it's really just our opportunity now to continue to mobilize that work. Really, we should be able to continue to see unprecedented growth in care providers within the province, which means higher quality care for Nova Scotians, both from an access perspective and the type and quality of care that they receive.

 

The numbers of people on the registry that get attached to those particular clinics, or the providers and practices within those clinics, will be exactly as Dr. Smith has indicated. When they are attached to a provider within a practice or to an individual provider separately, that is when those individuals will come off the list. The number of 20,000 is a real number based on the composition of the teams and the intention around recruiting and what that collective group of providers should be able to provide as a service to the population or to their specific geography.

 

We have confidence in the ability. The timing associated with it will be as providers are onboarded and as they gradually increase their practice size.

 

DEREK MOMBOURQUETTE: I'll go back to a comment used earlier, which is around emergency care and how emergency care is improving. A lot of good people are working day and night - doctors and medical professionals in communities across Nova Scotia. There are some cases, and we're hearing from families - I referenced the Cape Breton Regional Hospital and the extensive wait time there. I've referenced that ambulance off-load times are up 300 per cent at that hospital. My question to Mr. Stevenson is: Based on your comments about the improvement in emergency care, what do I tell the folks in Cape Breton about what steps are being taken to help improve that? It has gotten drastically worse over the years.

 

COLIN STEVENSON: Exceptionally important topic and part of the system. I would say that what we want to be able to do for Nova Scotians is build confidence that the system is there to support them. At all times, the investment that we've been making from a system perspective - we've been talking a lot about primary care, but there have also been investments within emergency care and within the emergency response system to try to ensure that we're creating the right opportunity to support people in the care where they need it, and as we've said, as close to home as possible.

 

The increased investments in pharmacy clinics, virtual care, and collaborative practices are having an impact on the emergency departments. For like populations, as we see an increase in the utilization of pharmacy clinics, we are seeing a reduction in lower triage levels or lower acuity of care patients who are having to go to the emergency department. The evaluations associated with VirtualCareNS where people are accessing care - either the full service or through the virtual care light or basic service - a high percentage of the individuals who are responding or saying if they didn't have access to that service, they would have gone to an emergency department. The initiatives that are being implemented to support people and get them connected to the right type of care are making a difference.

 

The investments that we're seeing within the emergency departments themselves for advocates, different types of care teams, rapid assessment zones, and a split flow model where people are triaged and provided care or given access to virtual care in an emergency department are starting to have a change within what people's experiences are. I appreciate that the individuals within your constituency may not be feeling it, but I want to build confidence that we are seeing the results take hold. It's an opportunity to continue to spread those.

 

We know that ambulance off-load times have had about a 150-minute reduction across the province on average. We're seeing a change there. The time to transfer a patient from the emergency department into an in-patient bed has reduced, so that's having a positive impact on emergency care and people waiting for services, which has that cascading effect. We've had more time through some of those measures and the access through primary care being able to give back to ambulances to get back on the road. There's been an increase in the hours of actual ambulances being able to respond to people, which has a positive impact as well, associated with the care that individuals within all of Nova Scotia - your constituency included - would have a benefit of.

 

I think the message really is that we've laid foundation, we're making changes, we're seeing improvement, and the work is not done. We just need to continue on the path that we are. We need to continue investments around training people and onboarding people. We need to continue investments around primary care with a real, strong focus on getting people attached to teams that we've been talking about, and to continue to make sure that we have . . .

 

THE CHAIR: Order. Sorry. That's the 20 minutes for the Liberal Party. MLA Fadare.

 

ADEGOKE FADARE: Good afternoon, everyone. Once again, I want to say what incredible work the Nova Scotia Health Authority is doing and the Department of Health and Wellness. I think what we're doing is something that we can truly be proud of.

 

Chair, I wanted to alight on an earlier statement that was made by the NDP caucus regarding the interim CEO for the Nova Scotia Health Authority. This is a government topic, and I remember clearly that her name was not included when we were doing agenda-setting, so it's not an issue about her having to apologize or her having to miss this obviously important session. I just wanted that to also be on the record, that she was not part of the agenda-setting. I just wanted to state that because I did realize that was echoed at some point in time.

 

Also, I just wanted to ask a question, but I'll give a bit of a preamble. Yesterday, I had the opportunity, on behalf of the Minister of Health and Wellness, to make those announcements. I was very careful in the words that were used. I know that one of the things we said was that the two other HRM homes would be operational by October. We said that when it's fully operational, we're going to be having 20,000 because I know there's been a lot of conversation today around October being when 20,000 people - that's not what I said. I could refer back or I could share my notes at any point in time regarding what I said. I said it was going to be operational, but the renovation work is going to start on the two other HRM areas that we're looking at and when they're fully operational, we're going to be able to have over 20,000 be absorbed from the Need a Family Practice Registry. That's what I said yesterday. I just wanted to state that.

 

[2:00 p.m.]

 

One of the things that I wanted to quickly ask is for anyone in the Nova Scotia Health Authority. From yesterday's announcement, we're considering adding more and more collaborative care centres all across Nova Scotia from Dartmouth to Antigonish, to Sydney to Pictou, to Shelburne, to Eastern Passage to Masstown, Amherst, and the like. We can literally say that this is going across all of Nova Scotia. The question I want to ask is: Could you outline how these collaborative care clinics work for both the patient and the provider for perspective? We talk a lot from - and that's Opposition so unless, whatever - but I want us to talk more from the perspective of the patient, more from the perspective of the provider, and how does this (inaudible) maximize the number of patients who are attached and seen? Anyone from the Nova Scotia Health Authority can . . .

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: We're very excited about the announcement yesterday around the health homes. We know that it will take some time, of course, to get things established. When we look at collaborative care generally, there are a number of advantages around multidisciplinary teams and collaborative care. I mentioned in my opening comments around the right provider at the right time for the right purpose for the right health need for Nova Scotians. Really, when someone is attached to a health home and attached to a primary care provider and connected to a team in the health home, and they have a particular need, and they come in for an appointment, that need is matched to the best provider or providers.

 

I'll give some really concrete examples. If you have some needs related to housing or food security, really, the best person for you to see is a social worker who navigates the system, knows all the community connections, and can help you connect to the best resources in the community in that local area. If you have the need for your medication to be reviewed - really looking at interactions between your medications - a pharmacist is the best person to look at your medication review and make some recommendations around interactions between medications.

 

If you have a chronic disease challenge, maybe you need a few different providers involved in your care, and your point person can be your primary care provider, physician or nurse practitioner who can coordinate your care. You may need a referral to a specialist; that referral will go on. For the Nova Scotian, you would connect in with that team, and they would match you in a coordinated way with the best person to provide your care in that moment.

 

You'd also have members of that team wrapped around you who are looking at all the pieces of what being you is all about. Health is bigger than illness. Health is about the social determinants of health. It's about wellness. It's about self-management. All of those resources will be our part of the health home team. Really, it's about a patient-centred journey in the health home and connection to health need. Dr. Smith, did you want to add to that?

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: Just to build on Dr. Elliott Rose's comments and the collaborative shared care model: Another important thing to note is that the information is also shared. For example, if a physician sees a patient, and then subsequently a continuing care support worker sees the patient, they can see on a shared record what's been done and the conversations that have been had, which will really positively contribute to the coordination of care and ultimately better patient outcomes and patient satisfaction.

 

ADEGOKE FADARE: One of the (inaudible) a lot of innovation goes into this. I see that the conversation has been broadened by the Nova Scotia Health Authority from just being tunnel vision but making us see that it's actually a much bigger picture. That's what I seem to hear today. One of the things I would say before I ask my next question is: I had an opportunity to tour one of the site facilities yesterday, and I was really impressed. Seeing 27 operational rooms, seeing accessibility: all of that was in place. You could see that it was all designed with the patient in mind, and I think that's remarkable.

 

I know that the doctors have already been hired; they're just in the process of onboarding. I know we're going to have a total of seven physicians in that place also with the physiotherapy. I think that's really commendable work. It's no longer an assumption - it's real. You can work it, you can feel it, you can breathe it, and you can also have the experience in there - just really incredible stuff. They're there, and the clerical support that's going to be offered to those physicians and nurse practitioners - I think that's really remarkable.

 

I just want to ask my final question. We talked about this multidisciplinary care. I would also like to talk about who the various professionals are who are going to be involved in that care, so that people can have an understanding. I was able to meet some of them in the course of my experience yesterday, but I'm just curious. Would you be willing to be able to expatiate or elaborate on those various professionals' disciplines who will be part of that? Also, what are the benefits of such a team, and how this is a shift from how our health system was previously designed. We know it's really innovative; this is very different. Anyone from the Nova Scotia Health Authority.

 

ANNETTE ELLIOTT ROSE: I can reference some specifics around the number and types of providers and clinicians who are part of those teams. Thank you also for referencing clerical staff. Sometimes we forget that there are many people providing services to Nova Scotians, which are absolutely important for that direct care. We forget that there are many people behind the scenes making care happen. There are people who are booking patients for care and following up, and some people who may not even have direct patient connections and public connections, but they're still part of the team.

 

We have - this is a head count as of March 31, 2025 - interprofessional team members working in Nova Scotia Health Authority homes that include: 536 family physicians; 125 - almost 126 - nurse practitioners - that's at FTE; 133 family practice nurses and registered nurses - some of those are also authorized RN prescribers. That means their scope of practice is such that they can prescribe for some minor illnesses, which improves access, of course, for Nova Scotians. We have 44 licensed practical nurses; almost 39 social workers - again, this is shifting to FTE; 17 full-time equivalent registered dieticians; almost 8 FTE pharmacists; occupational therapists, 5 of those; 13 other team members - clerical will be some of those other team members; and then more than 125 who are working to make sure care happens in a good way.

 

From a patient perspective, collaborative care is really about improving patient experience and outcomes. When patients have their health needs matched to the right provider, that's going to be an improved service for them. We know when teams work well together, and it's not just about shared space. It's about shared time and space, role clarity, understanding the scope of practice of each other, communication as Dr. Smith had mentioned. That's a better care plan for patients. Patients have the best care possible because they have the diverse expertise of that full team behind them.

 

We've talked about access to care. If we think about the health home model and someone's coming in with a particular need - maybe they have a respiratory infection - on that day when they come in, they may not actually need to see a physician because their care need isn't as complex as someone else who may need to see the physician. You're actually freeing someone up to see the most complex patients. Maybe on that day, that person sees a nurse practitioner or sees someone else on the team, but they're still followed by the team, and they have that wraparound service.

 

Of course, efficiencies - I think we mentioned earlier that this also eliminates redundancy in the system and efficiencies and is most cost effective. We have examples, of course, where strengthening primary health care as the foundation for health care in our system is also keeping people out of emergency departments. That's so important.

 

Someone earlier mentioned innovation. When you have teams coming together like this in collaborative groups, that's actually the spark for innovation and creativity. All of us say across the health system, but particularly at the Nova Scotia Health Authority - we have almost 40,000 people working with us when you think about employees, learners, physicians, and volunteers. It's the folks doing the work who are actually the most creative. The people who do the work have the wonderful ideas. They bring those ideas, and we do the pilots, and we do the test and tries, and we give it a go. That's what transforms and improves care. Coming together in collaborative teams helps people spark those ideas. It's so important.

 

AARON SMITH: Again, I really appreciate your reference to administrative supports in the clinics. Maybe if I could just give an example of that - of the non-patient-facing or non-clinical roles that have positively impacted our health homes. As I've travelled around the province and talked to teams, teams increasingly have a position called a care team assistant, which is net new into our system. The care team assistant helps reduce the burden on other team members by taking on tasks such as equipment ordering, managing inventory, and room preparation. It frees up administrative staff to focus more on their own core functions and also smooths the way for providers and clinicians interacting with the patients.

 

When I talk to physicians around the province in teams, I was marked by how impactful the addition of this one role is to patient access, to work pathways within the clinics, and also in terms of patient experience.

 

THE CHAIR: MLA Corkum-Greek.

 

HON. SUSAN CORKUM-GREEK: I just want to take a moment. When we have these opportunities, we of course want to make the most of our collective time, of your time, for being here with us. I think it's quite easy to fall into moving to the next question, but I want to rewind just a bit. The statement was made: unprecedented levels of interest in practising in Nova Scotia by Dr. Smith a short time ago. I realize we are all constituency MLAs. We know that every day that a Nova Scotian who is not yet attached, every day longer that they wait is a day too long.

 

We know that there's work to do, but there is also great focus and determination to do that. Also, part of the success that's driving that recruitment - what I'm hearing from the assembled witnesses today - is this collaborative care, multidisciplinary approach. That is actually the topic of today's session, and for my own headspace if not for someone else, others here, I think that's really hopeful and really something worth pointing out and celebrating.

 

This collaborative approach - I had a conversation with a local pharmacist working in hospital, and interestingly, he was at my office on another matter yesterday. We were talking about this, particularly his observation that new doctors - people who are newer into practice - this is what they crave. This is how they wish to work. This is how they hope to have a life balance that sees them stay with their spouse over time and really not sacrifice other areas of their lives.

 

I was very excited when the position of physician assistant was brought in. Our regional hospital, the South Shore Regional Hospital, I understand has a physician assistant, as well as a nurse practitioner and an advanced care paramedic. I would really love a little bit of a dive into - we've looked at collaborative care as a primary practice and how that structure assists in better care on that particular platform, at that particular location. If someone could speak to the use of interdisciplinary care in the ER. Dr. Smith, I think I see you nodding.

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: Perhaps I can start, and then again pass it to my colleague. Just to go back a bit around unprecedented interest in Nova Scotia, if I could: Between April 1, 2024, and March 31, 2025, we welcomed 253 new doctors to the province, which is a net gain of 187 physicians. Roughly 90 of those are family physicians, and the rest are all specialist physicians, which would include services such as hospitals, emergency medicine, surgery, and internal medicine.

 

The attraction to Nova Scotia goes well beyond the primary care context. The emergency department is another area where multidisciplinary care really shines. We have physicians working, we have RNs, LPNs, but we are also starting with the new roles. For example, we have nurse practitioners working within our emergency departments. I'll defer to Dr. Elliott Rose for the comments there. We have physician assistants, as you said.

 

[2:15 p.m.]

 

For folks' awareness, physician assistants are folks who are trained within a medical model of care. They have the ability to diagnose, manage, and make suggestions on the care for folks with both acute illnesses and chronic disease. They are experts in coordinating care. They can build and propose treatment plans for acute and episodic and chronic care needs. Their role for physicians in specialty services like emergency departments, as well as in primary care, has proven to be incredibly impactful and well-received.

 

In terms of the NP role within the emergency department, I'll defer to Dr. Elliott Rose.

 

THE CHAIR: Dr. Elliott Rose with a minute and a half.

 

ANNETTE ELLIOTT ROSE: Okay. Adding to the PA - the physician assistant - scope of practice, NPs can do all of that and they are independent clinicians, self-regulated and licensed. They have their three- to four-year RN - undergraduate nursing - degree and then an additional two or three years on top of that as nurse practitioners. They can work in primary health care, but they also work in a number of specialty areas, including the emergency department.

 

Mr. Stevenson mentioned a split-flow model in the emergency department. If you think of that, there would be Nova Scotians coming in for emergency care and there would be triage, and of course we would take the patients who are most ill coming in for our service. Then in the split-flow model, some people who may not have as urgent care would go into that lane of care, and the nurse practitioner could see them very quickly and provide services. They may not need to see a physician at all. They would get services. They would get a prescription if they needed it. They would be diagnosed.

 

The wonderful thing about our legislation here in the province is that it supports full-scope practice for many clinicians, including NPs. Nurse practitioners can both admit and discharge, so if they needed to be admitted to the hospital because their needs were more complex, then they would be admitted to the hospital as well.

 

NPs - we have waiting care assistants who are re-triaging and connecting people as . . .

 

THE CHAIR: Order. Sorry. Based on the calculation, it's going to 11 minutes each. The NDP - MLA Leblanc.

 

SUSAN LEBLANC: I've heard so much that I want to comment on. Obviously 11 minutes is not going to do it.

 

I want to talk about the Dartmouth North clinic - the Dr. Maria Angwin Memorial - Wyse Road Health Clinic, yay. In case people don't know about the clinic that has just opened, it literally was the advocacy of - like 11 years of community advocacy. Grassroots, moms in Dartmouth North saying, “There are not enough services here. We need stuff happening in our community, for our community, by our community” - which is not quite achieved yet, but in some ways it is.

 

I'm so pleased that it's actually open. The Dartmouth North community health planning team, which I've been a part of for seven - eight years now - we got a tour the other day. We had supper with the doctors who were in place, and the nurse practitioner and the nurses. It's kind of the model to look to. It's not quite the model of Jane Philpott's imagination. I also have read the book, and I think this is the model we need to have in Nova Scotia. I'll tell you why, and I want to know what the plan is.

 

So there's the nurse practitioner. There's also the IWK Health Centre, which is amazing. There may be a social worker. There's an application in for a social worker, is my understanding. But in terms of the picture that you're painting, Dr. Elliott Rose - which I love - I don't see the plans for that. Is the idea that we're panelling up, getting people attached, and getting people to their primary care provider, and once that is kind of done, is there a plan for those allied health professionals? If Dartmouth North is to have a social worker, that's a great idea. In fact, years ago when we planned with the Nova Scotia Health Authority about what we would want to see in such a health home, we talked about chronic disease management and we talked about social work, and there was one other thing - like geriatrics, basically. Maybe that's a continuing care adviser or something like that. What is the plan for that in the whole plan? If you could answer that really quickly. Are you paying attention to it?

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: I will say that I have great affection for Dartmouth North, because as a registered nurse, I did some work there early on in my career. I was part of the family resource centre and a few other things. Wonderful people, you're right, with a lot of passion and commitment for advancing care.

 

I'm going to reference what Dr. Smith and perhaps Mr. Stevenson said earlier, and that's really looking at the community needs. There could be a core team for health homes. You may look at a primary care provider or two. It could be a couple of different folks. Some nurses, we mentioned clerical staff, others would be part of that. As you look at the community needs, who do they need to meet their health needs? This also aligns with our workforce planning. We use an integrated needs-based workforce plan. That really looks at the local needs of the community, of Nova Scotians. How do you match the human resources and the services to meet those needs? How does that improve outcomes and experiences?

 

My short answer is, yes, we are paying attention to that. I don't know if, Dr. Smith, you have additional details.

 

SUSAN LEBLANC: I just have a number of questions. We know that the best practice for a properly resourced health home or collaborative practice is that each clinic could take 10,000 patients. In Nova Scotia right now, how many of our health homes or collaborative clinics have 10,000 patients attached?

 

THE CHAIR: Who's going to guess that one? Dr. Elliott Rose or Mr. Stevenson? Mr. Stevenson.

 

COLIN STEVENSON: I'm looking down at my colleagues, and I don't know if any of us would actually be able to give you an answer on that today.

 

THE CHAIR: The clerk can actually send a note back to get that answer later. That way, I don't eat up all of MLA Leblanc's time. MLA Leblanc.

 

SUSAN LEBLANC: In Dartmouth again, I understand the health home will have the capacity to take 6,400 patients off the wait-list when it's fully operational - it sounds like the Death Star when we talk about that, by the way - when it's at full capacity. I hope it's not the Death Star. We know that even in the area right around the centre, there's a huge housing boom. Sixty-four hundred is better than nothing - obviously, it's amazing - but what is the pathway for expanding once things are in place? Is there a way to expand in terms of geographic expansion? How are we working to get 10,000 attached to each health home, in particular in Dartmouth North, where we're hearing right now the number is 6,400? Dr. Smith?

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: To go back to the 10,000, I think it's important to clarify that our teams are varying sizes. We have some health homes that have one provider; we have some health homes that have many more than that - similarly with our multidisciplinary teams associated. The number of patients or families that a health home will attach is really predicated on the number of providers within that health home.

 

Larger health homes with more providers could be expected to handle many more patients compared to smaller ones. The 10,000 is very hard to say. We can certainly get you that information about how many would have that, but again, it's predicated on how many providers and the team size that's there.

 

In terms of expanding those teams geographically or with regard to the team's composition, as I think I understood, one thing that's important to know is that we're also engaging with these teams not just with our community statistics and data, but we're engaging with the actual team members to ensure that they know and fully understand the scope of all these other multidisciplinary providers. We're working with them to make informed decisions about what they feel their team needs to best fit with the needs of the families and Nova Scotians who are in front of them.

 

In terms of geographic expansion, I'm not sure I can answer that, or I quite understand the question. Maybe I'll defer to my colleagues.

 

THE CHAIR: I think Mr. Stevenson might be able to answer it for you if you want that right quick. (Interruption)

 

COLIN STEVENSON: Okay, real quick. Part of the process from a health home and a geography perspective is that a health home doesn't need to be constrained to one physical location. Broader geography - you could look at health home in combination with other groups of providers within the same geography in order to support the entire population. We talk about things from a health home having a particular catchment, then we talk about a health neighbourhood, which is bringing together multiple health homes and other access points and services to serve the broader geography. That would be part of the strategy from the Province.

 

SUSAN LEBLANC: That brings me to a big question around this: When the department or the Nova Scotia Health Authority announces health homes - like what happened yesterday - are they always net new services, or is it the case that the Nova Scotia Health Authority will come in and take over a practice that's already existing, and because the Nova Scotia Health Authority is now the administrator of it, it's now a health home? Can you break down the numbers of what we currently have in Nova Scotia? From, say 2021, what is a new health home, and what is an existing practice that was taken over?

 

COLIN STEVENSON: I'm going to start talking while they look for numbers and maybe they'll find something that can give you a little bit more on the specifics. I think all of what you said is a yes. They're not all net new. We've talked about - from a planning perspective, there's new and strengthening. New is: it wasn't there before; it's bringing together or could be recruiting new providers into a particular health home. It could include taking in a provider who has a solo practice and no longer wants to work in a solo practice and combining, which is sometimes why you see that the number of new people coming off the list looks lower. It's because they're bringing their practice in with them.

 

Some are new. Some exist and are strengthened by adding actual team members; it could be a couple of physicians who are working in practice, but we're adding nurse practitioners, family practice nurses, or other providers. There are multiple starting points that are allowing us to move toward that health home model.

 

SUSAN LEBLANC: I look forward to the breakdown. If you have to get that after, that's fine. For instance, in the announcement that was made yesterday, you're talking about 20,000 people coming off the list when it's fully operational. That suggests net new. Can someone clarify that?

 

ANNETTE ELLIOTT ROSE: We don't have the breakdown. As of March 31^st - of course, this wouldn't include new health homes since then - we have 118 health homes that are operated under the Nova Scotia Health Authority. What we'll do is follow up and give you a breakdown of net new versus taking over a practice. I will say that taking over a practice also has nuances. Not only what Mr. Stevenson mentioned around bringing people in in time to add folks to their practice but also making it a truly multidisciplinary collaborative practice as well.

 

SUSAN LEBLANC: What about yesterday?

 

THE CHAIR: Her other one was about the new ones - they were all net new. That was MLA Leblanc's question on the three that were just announced.

 

ANNETTE ELLIOTT ROSE: The three?

 

THE CHAIR: Dr. Smith with 10 seconds.

 

AARON SMITH: I can follow up on that. My understanding is it's either a combination of net new or physicians or medical practitioners who are expanding their practices, but we'll follow up with you on that.

 

THE CHAIR: Order. I gave you an extra second since I had to talk. The time for the NDP is done. MLA Mombourquette.

 

HON. DEREK MOMBOURQUETTE: The Liberals, you mean. The Liberals. (Laughs)

 

THE CHAIR: What?

 

DEREK MOMBOURQUETTE: You said the NDP. The Liberals. Anyway, it doesn't matter.

 

THE CHAIR: No.

 

DEREK MOMBOURQUETTE: Close enough. My first question is around the announcement yesterday. You're looking at 16 doctors, probably. Correct me - that was part of the announcement yesterday that you'll need 16 doctors. Are they currently in the province? Are you actively recruiting or are contracts signed with them?

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: I'll have to follow up on the exact numbers with you. I think it's important to make the clarification, though, that we're talking the equivalent of 16 physicians if they were doing full-time practice. We know a lot of our family physicians do a lot of office-based care, but they also contribute to care in many other important areas such as supporting our rural emergency departments, working at our primary care clinics for those who are unattached, supporting VirtualCareNS, and also supporting hospitalist medicine within our acute care facilities. In terms of the 16 physicians, it could be the equivalent of 16 full-time office space physicians, but the actual number may vary. We'll make sure we get that information for you.

 

[2:30 p.m.]

 

DEREK MOMBOURQUETTE: With the addition of potential nurse practitioners into these centres, will you see an increase in patients who will come through because of the nurse practitioners coming into the collaborative care?

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: The short answer is yes. Nurse practitioners are considered primary care providers, so they would also have patients assigned to them. As we add more NPs with the family physicians, then that would increase the practice or be part of the estimate of the practice.

 

DEREK MOMBOURQUETTE: I'll move to Mr. Stevenson. In your comments, you mentioned that ambulance off-load times have decreased significantly. I'm just looking for the statistic that you used. I believe it was 150 per cent. Again, I reiterate that the ambulance off-load times have increased 300 per cent in Cape Breton. My question to Mr. Stevenson is: Can we explain what's happening in Cape Breton when it comes to this difficult issue around ambulance off-load times?

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: I can't, based on the information that you're providing. I think it could be based on - I'd have to know the time frames that you're looking at from a before-and-after perspective. The last available information I had - I think you're referring to Cape Breton Regional Hospital from 2023 to 2025 - actually had a reduction of about 150 minutes between those two time frames. If you've got a different starting and ending point than what I'm referencing, we can come up with a different number, and that may be part of the explanation.

 

DEREK MOMBOURQUETTE: I'm happy to talk to you afterwards as well, if we want to talk about the numbers. We've seen a large increase in Cape Breton at the Cape Breton Regional. As I've said, we've talked about this over the years when it comes to the ER in Cape Breton, as well as having the highest wait times in the province. We hear from families in Cape Breton who have had to use the emergency services.

 

My next question is to Dr. Smith and Dr. Elliott Rose. As you're planning your work on where to expand and invest in collaborative practice teams, do you look at where in the province has the lowest attachment to expand services there as critical areas?

 

ANNETTE ELLIOTT ROSE: Referencing some of the conversation earlier, yes. We would be looking at the health needs of Nova Scotians and looking at the resources that are available in that local geographic area, looking at the need, of course, to be attached in that area, looking at some of the other primary care access opportunities that Dr. Smith and others have referenced. That will help us determine priority across the province.

 

DEREK MOMBOURQUETTE: Clare is probably one of the best examples in the province. That was a community that really came together over the years to provide some of the best attachment in Nova Scotia when it comes to attaching folks to primary care. Again, I go back to the fact that the Province no longer publishes this information. These were statistics that were openly available to people on a monthly basis being reported. Again, I go back to the fact and ask the question to the committee of why this information isn't public anymore.

 

COLIN STEVENSON: As mentioned previously, there is still a lot of effort going on with respect to the validation. We do anticipate that will continue to be an ongoing process. There's a strong desire, I think, for all of us to be confident with the numbers that are published at a very detailed level - and recognizing that that validation process continues to require a reach-out to individuals who are on the registry to make sure they are still seeking care. The numbers - we have confidence with from a broad perspective and a broad geography to be able to use from a planning perspective. We want to make sure that we're comfortable and confident with the registry, how we're redesigning that, and what its potential future use could be before we release any detail or data at a level different from what we are today.

 

DEREK MOMBOURQUETTE: Just for clarification on the list: Folks who access virtual care, are they removed from the list? Or do they have to be attached to a team?

 

COLIN STEVENSON: If they are attached to a primary care provider, as described by Dr. Smith earlier, they can continue to use virtual care as a basic service, which is where all Nova Scotians have access to two free appointments.

 

If they are unattached, they have the opportunity for the unlimited full-scope VirtualCareNS virtual care service. Once you are attached to a provider, you don't have access to that same virtual care. If you are using the virtual care as an unattached, that does not mean you're attached. You're still on the registry if you're logged onto the registry and you're still seeking attachment to a team.

 

DEREK MOMBOURQUETTE: Again, it's just one of those things for me. I know there's validation when it comes to the list and everything else, but I do reiterate the fact that the government used this list for years to track and to advocate for health care. I just don't understand why we wouldn't make that information as public as possible to people.

 

I do want to talk a bit about as well - just making sure I've got all my questions in. I'll go back. As of the last update in Nova Scotia, more than 90,000 - as we've learned today - are still on the list without a family doctor. My question through you is: As you're attracting doctors to communities across Nova Scotia, what other incentives are you providing to doctors? There have been incentives over the years around tuition relief to go to rural communities. We know there's some infrastructure happening at CBU and some other aspects.

 

What are the key pieces for you to attract doctors into rural Nova Scotia?

 

AARON SMITH: We do have a comprehensive incentive program for physicians. We can certainly give you the details on that. I will say that there are very competitive incentives for rural care especially, both to help people offset moving costs but also to recognize the contribution they're making and their commitment to those communities.

 

We'll make sure we get you full detail of our recruitment plan and incentives.

 

DEREK MOMBOURQUETTE: A quick question: What's the average roster for a family doc outside of a collaborative care clinic?

 

AARON SMITH: That's very hard to answer. Physicians where they're not employees of the Nova Scotia Health Authority have the autonomy to carry what panel size they would want to carry. It is up to them, and it is up to us to support them in that way.

 

Physicians both outside of multidisciplinary collaborative practices and within - either in those practices or folks who are operating independently from the community, they are autonomous in terms of how many patients they would like to carry. It's hard to say, on average, what those numbers would be. They're highly variable across the province.

 

DEREK MOMBOURQUETTE: I appreciate the information. You hear that the rosters can vary right across the province.

 

My next question is in regard to Cape Breton. We've seen some new infrastructure happening. There's a centre in Sydney River and there are some other things, but I think it's just a transfer from one building to the next. My question is: What's the next plan for Cape Breton? We have some gaps in communities across the Island in rural communities. If you can give me an update on what's next for Cape Breton, that would be great.

 

AARON SMITH: I can answer on a high level, and then we can get you more specific plans from there. As I said, I had the opportunity to travel across Eastern Zone - Cape Breton and many of the rural areas, as well as Sydney itself. I was struck by the compassion and dedication of the teams. It's important that we understand how we can support them, both from supporting physician and NP practice in terms of panel management, onboarding supports, et cetera, but also understand exactly what supports they feel they need.

 

We're really making sure we're engaging with those teams to understand how we can support them going forward.

 

DEREK MOMBOURQUETTE: With 15 seconds, I'll finish by thanking the committee for being here. One of the aspects I hope you're looking at as you expand - I was involved with some of it - is the mental health side, to help support people who need the support.

 

THE CHAIR: MLA Hilton.

 

NICK HILTON: Thank you all for being here today. Prior to this, I was a nurse with the Nova Scotia Health Authority for 21 years. I've mentioned this before, and I'll continue to mention that it's over the last three years that we've seen a significant change in health care morale improvement - feeling like recruitment and specifically retention mattered. I thank all of you for that. It's partly what drove me to run for this government.

 

When I hear things like “unprecedented interest in Nova Scotia” and being part of or attached to the health department, and talking about the 250 net doctors that we've recruited to Nova Scotia, those are things that we haven't talked about in the past.

 

We have things like the first class graduating from the PACE clinic, CBU accepting its first class later this fall, partnerships with Lebanon and South Africa to bring doctors here from across the world, 1,000 new nurses, unprecedented numbers of health care professionals. My Opposition colleague talked about using virtual care, YourHealthNS app, pharmacy clinics - those are all things that have come into the discussion in the past three years. New investments in infrastructure: I know my community's excited about the new ER that's being built in Yarmouth that recently broke ground. Those are all exciting things, and they're all things that have happened recently.

 

Prior to 2021, I heard the unattached list being attached as a spreadsheet that was on the side of someone's desk, that wasn't updated and wasn't an appropriate way to follow patients. I have to ask because this hour's kind of gotten away from us, from collaborative care and more focused on the unattached list: Dr. Smith, do you feel positive about the care that Nova Scotians are getting right now?

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: Nova Scotians are receiving world-class care in primary care and across the acute care realms. We are second to none in terms of the quality of care we're providing, both in terms of how our physicians are providing care across family medicine and specialty services. As Dr. Elliott Rose has said, our NPs, all the other multidisciplinary care providers - I'm very confident that Nova Scotians are receiving world-class care.

 

NICK HILTON: I totally agree. I think it's important that we instill that, and that be the message that leaves here today for all Nova Scotians - that things are improving. Do you believe that without these initiatives - prior to 2021, if things continued - would we be talking about a number that's decreasing or increasing?

 

AARON SMITH: What I can say is that I have the opportunity to be involved in recruitment activities for folks both within Canada and across the world. Some of the developments that have happened in terms of our primary care and acute care systems and how we've approached collaboration, as well as very competitive payment options for family physicians, I am consistently struck by the national and international interest in coming to Nova Scotia to practise, specifically. We are in a very good place in terms of recruitment and interest in coming to join our team.

 

NICK HILTON: Thank you very much for those answers. It's much appreciated, and I hope that's the message that leaves here today.

 

Just back to the topic: Multidisciplinary care is so important in the caring for patients in hospital. Could you talk about the impact in interprofessional teams at the regional hospitals, along with the launching of the Early Mobility Program for older adults, is having on patient outcomes and early discharges?

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: If we think about the patient journey and someone comes into hospital, we want them to stay in hospital only for the length of time they need to be there to get their medical care needs met, and then, of course, to have the supports to go back to the place they call home. The mobility team and the mobility initiative is really part of the team working on the acute care in-patient units who enable that to happen. Making sure people are up and moving around appropriately, and feeling their best, and getting ready to go home is part of making sure that they leave hospital when they should. That's not only good for the individual to go home and heal and be well with their family and in their community, it's also important from a service and a system perspective, because then that frees up a spot for the next Nova Scotian who needs surgery or needs care in the hospital.

 

[2:45 p.m.]

 

We know mobility is one of the key things that we need to do as humans. We need to get up and appropriately move around in the best way that we can to feel well. It also helps in rehabilitating and going home sooner. The mobility team has done an amazing amount of work. It's a key strategic initiative at the Nova Scotia Health Authority.

 

NICK HILTON: The new physician agreement had several elements to encourage moving to more multidisciplinary care. One of them was the allied health practitioner pilot. Could someone please talk about what that program is and how it's going?

 

AARON SMITH: The pilot is a great development. It supports folks who are not within the Nova Scotia Health Authority turnkey environments to have multidisciplinary folks on their care teams. It will provide practitioners - I believe it's up to $110,000 per provider from an approved list to offset the cost of having these folks within their care environments. There's been great uptake on that thus far. As I said previously, physicians are very interested and want to work in these care environments. The pilot has allowed folks who are not within the turnkey environment to really benefit from that multidisciplinary team.

 

THE CHAIR: MLA Sheehy-Richard.

 

MELISSA SHEEHY-RICHARD: I just want to go back a little bit - I think that Dr. Elliott Rose had mentioned about the transition of older individuals back to the place they call home. Transitional care is really another great example of multidisciplinary care and how it's making a huge difference. I know my husband's aunt recently had a terrible fall and broke her kneecap so badly she required immediate emergency surgery, taking up the acute care bed. As she transitioned, she got ready and was moved to Hogan Court, which, in my mind looks - how great that is, because not only is she now in a place that she can get the actual care that she needs at this point in her healing process, but it freed up an acute care bed so that somebody else who maybe needed a surgery has the opportunity to use the bed.

 

I feel that not only have things improved that way, but things have improved really with this government in non-traditional or innovative ways, if you will. I was wondering, in the brief time that's left, if you could speak a little bit more about Hogan Court specifically and the model of care that's offered there, but also The Bridge and the type of model of care that's there. I know recently that was expanded for another term of operation.

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: It's very exciting. I will say that there are transitional care spaces and opportunities across the province. I just wanted to say that. There are spaces at St. Martha's Regional Hospital and the Victoria General, at the Yarmouth Regional Hospital, and West Bedford Transitional Health is certainly a prime example of a wonderful system partnership and multidisciplinary teams in action. Right now, since the opening, they've successfully discharged 217 patients. Just to pause for a moment, that saves 13,831 total patient days in acute care. Think of how many more Nova Scotians we can serve because we can move folks to a more appropriate space where they can actually be rehabilitated.

 

I've toured the space a couple of times, and it is phenomenal. It has wonderful services for the teams working there. I think the other thing that really struck me is that patients can have their family members be actively part of their care, which is so important as you think about transitioning back to wherever you call home, into your home communities.

 

There are NPs, RNs, licensed practical nurses, care team assistants, occupational therapists, physiotherapists, dieticians, and social workers all part of that team, and physicians as well, all working together to make sure people get home as soon as possible, get the rehabilitation that they need in West Bedford, and then move home as soon as possible. I have details too around the care model there, if folks are interested.

 

The Bridge was established in 2023. It's Atlantic Canada's first integrated shelter-health care initiative. I will say that I've had many calls from team members over the years. I used to work at the IWK Health Centre and I'd be on call, and I'd get calls from team members who would say, “We have someone here who doesn't need medical care - someone in the emergency department - but they don't have anywhere to go. What are we going to do about that?” The Bridge is about serving those needs and people who need to transition into a space to feel safe. It shelters 190 residents over seven floors. We're very excited that that service has been extended.

 

MELISSA SHEEHY-RICHARD: Thank you for sharing that. I actually wasn't aware of the other transitional facilities, so that's good to hear, that they are spread more broadly . . .

 

THE CHAIR: Order. That concludes questions. This part will be closing remarks. What we'll do is we'll start with Mr. Stevenson and work that way.

 

Mr. Stevenson, any closing remarks?

 

COLIN STEVENSON: Just briefly and quickly, I do appreciate the opportunity for us to be here collectively to talk about the importance of teams when it comes to care. Lots of great questions and conversation - it's really important that we had an opportunity to recognize all the different team members who contribute toward care for Nova Scotians. It's not just a physician. It's a nurse practitioner. It's all the way through the team composition and the staff who support that directly within a care environment or in a supporting environment.

 

It's an incredibly important topic. It's getting national and international attention. Within Nova Scotia, we take it very seriously. We're investing in it. We are keen to continue to expand that, not just from a primary care perspective but in all care environments because of the results that it's showing for the province. We're seeing reductions in - as has been alluded to - our acute care capacity, which is giving us other opportunities. We're seeing reduction in those who are actually showing up in the emergency department. We're seeing improvements in those who are being attached to primary care. It's an important topic and we appreciate the opportunity to be here.

 

THE CHAIR: Speaking of team, Ms. Knight, do you anything to close? They didn't ask you much. Just giving you a closing if you'd like.

 

JOY KNIGHT: Thank you for the opportunity. As somebody who sits in a policy-making seat, it's always really valuable to hear a little bit more first-hand around the experiences of Nova Scotians. In everything we do, we want to keep Nova Scotians at the centre. Thanks for the real-time examples and sharing from your constituencies. We'll take that away. It's very valuable.

 

THE CHAIR: Dr. Elliott Rose.

 

ANNETTE ELLIOTT ROSE: I echo the thanks for the opportunity. I would say this conversation is an intersect of the three loves in my career. One is clinical care, of course, as a clinician. The second is needs-based planning. We're thinking about how we plan services based on the needs of Nova Scotians, which is so important. And the third is workforce planning. That is actually an area of great interest. We are doing a lot of work, as all have shared here, around recruiting the best talent to Nova Scotia and retaining wonderful talent in Nova Scotia. We often say we want people to grow their health careers and live in the beautiful communities of Nova Scotia.

 

Thank you for this opportunity.

 

THE CHAIR: Dr. Smith.

 

AARON SMITH: Also thanks for the opportunity. We spent some time talking about specific care teams and contexts, but I just want to highlight that the Nova Scotia Health Authority is a multidisciplinary team of 40,000 people who care very deeply about providing the best possible care for Nova Scotians. Thank you for the opportunity to share the work we're doing.

 

THE CHAIR: Thank you. You're all excused.

 

We only have some quick things, so instead of doing a recess, I figure we'll go through them, if that's agreed.

 

Integrated Youth Services: alternative witness. Maureen Brennan, clinical director of Mental Health and Addictions with the IWK Health Centre, has informed us that the approved witness, Daphne Hutt-Macleod, director of Integrated Youth Services, is not available to appear as a witness at the September 9^th meeting. Ms. Brennan has assured us that they will get the right representative in her place.

 

Is that agreed upon? Any objection? Okay.

 

A reminder that August 1^st we have a caucus agenda so we can do an agenda-setting thing.

 

Any other items?

 

The next meeting is August 12^th from 1:00 p.m. to 3:00 p.m. on Primary Heath Care Attachment. Witnesses are the Department of Health and Wellness, the Nova Scotia Health Authority, the Nova Scotia College of Family Physicians, and Doctors Nova Scotia.

 

We are adjourned. Thank you.

 

[The committee adjourned at 2:55 p.m.]