HALIFAX, MONDAY, FEBRUARY 24, 2025

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

4:51 P.M.

 

CHAIR

John White

 

 

THE CHAIR: Order. The Committee of the Whole on Supply will come to order. It is now 4:51:30 p.m. The committee must rise to report to the House before the hour of adjournment, which today is 10:00 p.m.

 

The honourable Deputy Government House Leader.

 

MELISSA SHEEHY-RICHARD: Chair, would you please call the Estimates for the Department of Health and Wellness, Resolutions E13 and E31.

 

THE CHAIR: With about 40 minutes left in the Liberals' time which was conceded to the independent member, the honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: Conceded, I love that. We all work together, work together over here.

 

Happy Monday. Chair, I have a few more questions for the Minister of Health and Wellness on behalf of my constituents and all Nova Scotians. One of the questions that I had asked the Minister of Health and Wellness last week I wanted to follow up on it and ask the minister if she might be able to give me a little bit more direction with that. It was regarding registered nurses, the nurses who are non-unionized, who didn't get the retro pay like the unionized nurses. I know the minister had said that that would be for a different minister. I wasn't sure which minister I should be directing that to.

 

Again, it's that there was significant retro pay given to NSNU nurses. I guess the argument that all nurses should be treated equally is under the legislation - equal pay for equal work. There are nurses here in Nova Scotia who are doing the exact same work but not in the union. I want to make sure that they are treated equitably and fairly. I'm looking for the minister's advice on where to take that.

 

THE CHAIR: The Minister of Health and Wellness.

 

HON. MICHELLE THOMPSON: I believe Hansard will show that last week I directed the member opposite to speak with the Minister of Labour Relations.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister for that; I'll follow up with that.

 

A couple more questions to the minister regarding nursing and then I'll move to another topic. Last week we talked quite a bit at length about the bridging program that has been paused to accept any new international nurses who have their nursing licence here, from the college in Nova Scotia.

 

I'm wondering if the minister can speak - has the department, has the Nova Scotia Health Authority, whoever is responsible for the bridging program, had any conversations with NSCC to see if there may be opportunities there to work with them, to look at using their skills lab if the Nova Scotia Health Authority doesn't have the capacity in-house to provide staff mentoring and support for new employees?

 

MICHELLE THOMPSON: The Nova Scotia Health Authority and the Department of Health and Wellness are looking at a variety of different models but there's really nothing to say about that right now.

 

ELIZABETH SMITH-MCCROSSIN: Okay, that's interesting. Certainly the reason I brought this up in Estimates is the vacancy rates of nursing are quite high, specifically in our area when they were 30 per cent last year for registered nurses and 22 per cent right now. I'm hearing from nurses on a regular basis who do not feel safe to practise in the current conditions, due to understaffing and due to overcapacity, combined with putting patients in non-traditional bed areas.

 

Maybe we can ask a couple more questions around what are the vacancy rates for both registered nurses, as well as licensed practical nurses here in the Province of Nova Scotia?

 

[5:00 p.m.]

 

MICHELLE THOMPSON: I don't have rates per se. I have vacancy numbers, but I can say that Nova Scotia's RN workforce grew by over 1,300 registered nurses from 2023-24 to 2024-25, which has been the largest single-year increase in history. We are really pleased with that. We see that opportunities for nurses continue to expand. Not only are we able to fill some vacancies, but also increase the number of programs and opportunities for where the nurses work.

 

In terms of vacancies, between the Nova Scotia Health Authority, IWK Health Centre, and Continuing Care, LPNs are at 630 vacancies; nurse practitioners around 100; and registered nurses are 1,273. I will note though that in Cumberland the vacancy rate has dropped for nurses from around 35 per cent to 26 per cent.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister for that answer. I believe what I heard was 630 LPN vacancies and 1,073 registered nurse vacancies; I believe that's what the minister said. I'm wondering if the minister can provide a little more detail with those vacancies. As far as a percentage in the four different zones, are they 70 per cent of the vacancies at the QEII, or are they at Cape Breton Regional Hospital? Where are we seeing those numbers reflected around the province?

 

MICHELLE THOMPSON: I don't have that breakdown, no, not with me.

 

ELIZABETH SMITH-MCCROSSIN: Would that be something the department could provide, whether it's per facility, the vacancy rates for LPNs and RNs at each of the facilities here in the province, or by zone?

 

MICHELLE THOMPSON: We'll have a look and see if we can do it by zone. We won't do it by facility.

 

ELIZABETH SMITH-MCCROSSIN: I guess I asked per facility because that's what I was provided for Cumberland Regional Health Care Centre. I just made an assumption that if those vacancy rates were available for Cumberland Regional, they'd be available for each regional hospital, at least, in the province. I know that information is something that nurses have been asking for, so they know the real numbers.

 

My next question is around education. Can the minister share with us where the degree programs are currently available here in the province? How many registered nurses graduate yearly in Nova Scotia, and in relation to that, what is the average wait time to get into a nursing degree program here in Nova Scotia? Then looking for the same information for the LPN program. How many LPNs graduate annually here in Nova Scotia and what is the average wait time to get into the LPN program? There may be quite a discrepancy around the province. I know in Cumberland - at the Cumberland Campus, which we're so grateful to have - there is about a three-year wait to get into the LPN program. It may be shorter at other campuses. I'm looking to see if we have that information.

 

MICHELLE THOMPSON: I can give you a bit of information, but I would say that it is not something that we would have. We would have to reach out to the Department of Advanced Education. The member will have to speak to the Minister of Advanced Education around wait times. Those are not things that we would typically track. What I can tell you is that there are now 143 new permanent Bachelor of Science nursing seats: 63 new at Acadia University; 28 at Cape Breton University; 26 at Dalhousie University; 26 at St. Francis Xavier University, and 300 new permanent LPN seats at NSCC.

 

The way, of course - the intake at universities is obviously generally in September, with some exceptions for the expedited program. I know that with the LPN seats, sometimes there's a staggered enrolment. Sometimes they come in in September, and sometimes they come in in January. Those questions are best directed to the Minister of Advanced Education.

 

ELIZABETH SMITH-MCCROSSIN: Does the department have a nursing recruitment strategy and retention strategy? I thought that the department did, and that's why I asked these questions. I would have thought these would be the types of numbers that the nursing recruitment and retention strategy would have, to look at the vacancies that exist, how many nurses are being trained, what the wait-list is, how many of those nurses who are actually graduating we're retaining, and the length of time that we're retaining those nurses.

 

For example, if we have 150 registered nurses graduating in any given year, are they staying for 10 years in the Nova Scotian workforce on average, or are they staying for three years? I know there was a report released through a Montreal company last year, I believe. I don't have that on me to table, so I won't reference it too much. There were some concerns there around retention of nurses here in Nova Scotia. Can the minister answer: Is there a nursing recruitment and retention strategy through the department?

 

MICHELLE THOMPSON: Certainly nursing recruitment and retention has definitely been top of mind. Of course, we started government by having the Office of Healthcare Professionals Recruitment. That really has a primary focus on building our workforce. I'll just go through a few things here in regard to that.

 

The plan really is around creating a strong nursing workforce through financial incentives, job offers to Nova Scotia graduates, a comprehensive nursing strategy, expanding access to education, and career development opportunities. The workforce of nurses in the province has had unprecedented growth, reaching its highest levels to date. Based on annual registration, there are 23,500 licensed to practise in Nova Scotia. Nova Scotia's strategic international recruitment carries on and certainly working with the college around where it's easiest for us to register folks.

 

Since 2021, government has provided $4.7 million in funding for employers to support their recruitment efforts: educational and professional development, orientation and mentorship initiatives that foster recruitment and long-term retention. The funding includes the RN education incentive and the Nurse Practitioner Education Incentive which provide financial support for nurses who are pursuing their education. We talked about that the other day, I think, about folks who want to ladder. If you're in one designation of nursing and you want to continue your studies and move to a different designation, you're certainly able to do that and be supported.

 

The financial incentives - certainly the contracts that have been settled, we were very pleased to be able to do that. There was a 12 per cent to 17 per cent increase in compensation rates for LPNs, a 15 per cent to 21 per cent increase for registered nurses, and 21 per cent for nurse practitioners. Also, we have made changes to existing incentives for shift premiums and, of course, to the member's point earlier, making sure that there are incentives for experienced nurses for preceptorship and also for reassignment.

 

In 2024, the province also opened More Opportunities for Skilled Trades and Occupations, which returns the provincial portion of the first $50,000 of an individual's income tax. Nurses were included in the MOST program. In 2023 and 2024, there were targeted initiatives around a thank-you bonus: $257 million was put towards bonuses for 11,000 nurses in 2022-23 and then 9,800 got the sign-on bonus the next year, which resulted in $91 million.

 

We talked a bit as well earlier about the L'nu Nursing Strategy, working in Indigenous communities to support Mi'kmaw nurses and increasing representation throughout the province. We're really proud of that program.

 

Nursing student job offers: the Premier has guaranteed all nursing graduates in the province positions through to 2026.

 

Nursing education and career development: currently Nova Scotia offers two-year, three-year, and four-year B.Sc. nursing programs with extensive hands-on at four universities across five campuses. A portion of the nursing strategy funding is designated to support orientation of new graduate nurses transitioning to practise with employers.

 

There has been a great deal of work that has been happening. Of course, we do have the Provincial Nursing Network, which takes employers, educators, Department of Health and Wellness and puts those folks together to look at ways in which we can continue to entice people into the profession, make sure that we have adequate graduating classes, and to make sure that they have a good working environment, not only to recruit people into positions but also to retain them.

 

[5:15 p.m.]

 

ELIZABETH SMITH-MCCROSSIN: I was aware of much of what the minister has shared again on that. I guess what I was looking more for is actual recruitment and retention strategy that includes data, to look at actual numbers of nurses being trained, look at the numbers of retention here in the province - is it different in different zones - in conjunction with how many nurses are being educated.

 

I don't know, from the minister's response, if anyone is doing that. I would assume there is someone. I guess I'll move on to a different question.

 

I do want to emphasize the reason that I've spent so much time asking about some of these questions is because - I guess I'm not a Health Critic anymore. I guess I'm a Health Critic as an Independent. I get messages every day from people around the province who have had challenging experiences as a patient or family members of patients. I hear their complaints, and I always do my best to listen.

 

Almost always when there are concerns around quality of care, the nurses get blamed. I feel it's really unfair to our nurses because the patients and family members don't know that this nurse or group of nurses - they don't know the conditions they're working in. They often don't know that they've worked short-staffed or that they're working in a situation where there's a 36 per cent, or whatever, vacancy rate. They don't know that they're responsible to take care of patients in areas where they don't have access to the equipment they need. That's why I keep asking these questions.

 

I think it's important that we dig a little deeper and not just talk about surface-y answers. I think it's really good to look at the data and to look at what's being done. I think our nurses need to know that we are doing the work that's needed to make improvements. We're not seeing that, Chair; we're seeing conditions worsen.

 

Last week in my questioning I asked about the budget. How much money is being saved with these nursing vacancy rates? The minister did assure me that there's no money being saved, because of the travel agency nurses hired and other.

 

I will say that we were told in the Fall that we had 50 per cent staffing in our ICU and some days less than that in our emergency department. We were told it was because the budget was all used at the regional hospital, so it was a budget decision at that time.

 

Just for an example, Chair, there are normally eight nurses who staff the emergency department - six RNs and two LPNs. One day there was one nurse. Someone somewhere made a decision that no new travel agency nurses were going to be hired and there weren't enough staffing nurses. That was back in November.

 

We're continuing to see the problems with our nurses, not just at Cumberland Regional, but at Cape Breton Regional, in the Valley, in Bridgewater, in Yarmouth. I have families and nurses reaching out to me. That's why I've asked so many questions, to try to better understand what money is being spent in our budget to try to make improvements. The patients and the family members need it but also our frontline staff need it. They are strong and they're good but they're only human.

 

I'd like to ask the minister a question regarding staffing of our emergency departments. I won't ask too many. I know my colleague from the NDP caucus has asked a lot. I want to ask a very specific question, and it is to do with the staffing at North Cumberland Health Care Centre, physician staffing, and this is the question that came from a patient.

 

Some days, the physician that's hired to be there from, I believe it's 8:00 a.m. to 6:00 p.m. - some days the physician is there from 8:00 a.m. to 6:00 p.m., and other days people will show up at 5:00 p.m., and they'll be told that the physician left at 3:00 p.m. I'm wondering if the minister can let us know, are the doctors at the Collaborative Emergency Centre paid a sessional fee, or are they paid by the hours they actually work?

 

MICHELLE THOMPSON: It's going to take some time to get that, so if the member wants to wait, that's fine. But otherwise, she can go on to another question. It's her preference.

 

ELIZABETH SMITH-MCCROSSIN: I will go on to ask another question, and if the department wants to get me that information, that would be great.

 

In my last couple of minutes, I would like to pivot and ask a couple of questions about emergency ambulance response. I'm wondering if the minister can let us know here today about the paramedic situation. I believe the free tuition for paramedics was a step in the right direction. We all know the difficult job that our paramedics do here in the province, and retention is definitely an issue.

 

I'm wondering if the minister can let us know, specifically, if the relationship with Medavie Blue Cross has changed at all. When is the contract up between the department, between the government, and Medavie Blue Cross? And is the department looking at renewing that contract with the private company, or are they considering creating a public ambulance service, which is what the paramedics have asked for? They've asked to become employees of the government, similar to nurses and other health care professionals. We all - I believe many Nova Scotians - have not been happy with the private ambulance service for years, due to the long delay in the wait times and the long waits that people have had after calling 911.

 

I know this government has made a lot of positive changes there - not to take away from that, but I'm still - just last week I got a message from someone who waited in a medical crisis for over an hour and a half, and they were very upset. I know I echo the thoughts of quite a few people around the province. They think that if there is not going to be any accountability with the private company and there are not going to be any fines or penalties when the private company doesn't meet the benchmarks or KPIs, then we should be looking at a different model to try to improve emergency ambulance response times here in the province.

 

Again, I am wondering if the department - when is the contract up? Is the department considering another model that would look at running a publicly funded and publicly owned emergency ambulance system here in the province of Nova Scotia?

 

MICHELLE THOMPSON: As the member mentioned, EMCI - Emergency Medical Care Inc. - has been contracted to operate ambulances since 1997. The current contract commenced on April 1, 2021, and its term is ending March 31, 2026. We have moved from a contract manager over the last number of years to a true regulator, and that is a result of the folks who are working in the EHS portion of the Department of Health and Wellness. They've done incredible work, and EMCI has been responsive to the concerns that we've had.

 

To the member's point, we've invested heavily in EHS in the workforce, and we continue to work with this partner, but I have nothing to say about the contract at this time.

 

ELIZABETH SMITH-MCCROSSIN: Maybe the minister can speak to - have there been any fines paid by the company? I remember the last time I heard this question posed to the minister was a while ago, and I remember being surprised when I heard the answer “no” based on the data in the province and the challenges. Maybe the minister could let us know if there have been any fines levied towards the Medavie-owned company, Blue Cross, in EMCI for not meeting the contract targets.

 

Also in relation to that, one of the complaints that I've heard pretty consistently is that sometimes the numbers that are shared publicly - paramedics often believe it is not a true reflection of what is happening in the field. For example: What they have shared with me is that the response times are often given from when an ambulance is dispatched to the scene of an accident or where the person has called 911 versus when the call to 911 was made. There can be quite a large discrepancy in that.

 

If I called 911 at 2:00 p.m. and the ambulance arrived at 5:00 but it was dispatched at 4:30, then the response time is given as 30 minutes as opposed to three hours. A lot of people feel it's a little deceitful; it's not really accurate reporting. I'm wondering if the minister could speak to that. My question is: Could they start reporting on the response time from when the call is made to when an ambulance arrives on site?

 

[5:30 p.m.]

 

MICHELLE THOMPSON: As I said, there has been a great deal of data collected, more data in the system than there has been before. I think it's very unfair to insinuate that the Department of Health and Wellness would be deceitful or that the folks who are managing the contract or regulators are being deceitful in terms of hiding things.

 

I will say that there has been an 8.4 per cent increase in EHS calls over the past three years and certainly heavily invested in the ability for paramedics to respond in the field, making sure that there are supports, making sure that there's access to a physician 24/7, a registered nurse 24/7, to support paramedics in the field. If there is someone who is concerned about response times in their local community, it really is important that those paramedics on the frontline work through the supervisor and talk to the managers. There has been a tour that has been under way over the last number of years. I know that Matthew Crossman who is the CEO, and Jeff Fraser who works in the Department of Health and Wellness have done a number of visits throughout this province, from one end to the other, to hear directly from paramedics about their concerns. I would really encourage paramedics to reach out directly to their supervisors and through their own management structure around those response times.

 

We have seen, actually, improvements over the last number of years in the response times. It has also improved some off-load times. We have seen a great deal of movement in the paramedic workforce: 267 paramedics have been hired since 2021. Our in-House paramedic is happy to hear that. There are 48 paramedic vacancies as of December 2024 compared to 135 vacancies the previous year - so really making some great gains.

 

Introduction of EMRs as well to support folks in the field supporting patients: There's really a lot of work that has happened, additional medical communications officers, who of course are essential in order to make sure that the calls are responded to appropriately. Just giving people opportunities and a place to work, the acute care . . .

 

THE CHAIR: Order. That completes the time for that round. It is now the NDP's turn.

 

The honourable member for Sackville-Cobequid.

 

PAUL WOZNEY: Good afternoon, Minister. Premier Houston announced a major overhaul of emergency and in-patient care in December 2022. Most of the work connected to that announcement has been housed in the capital plans for 2023-24 and 2024-25 under the umbrella of the Halifax Infirmary expansion project. That's my sense of what that umbrella term means. Am I accurate on that?

 

HON. MICHELLE THOMPSON: We just may need a little bit of clarity. There is some money available to us in the Department of Health and Wellness associated with new builds, the redevelopment project in Cape Breton, HIEP, those types of things, but there is also some redevelopment that's happening under the Department of Public Works. I just want to make sure we understand the question from the member.

 

PAUL WOZNEY: Hopefully to put a more specific point on it for the benefit of the minister, in the capital plan for 2023 - I'm curious. That announcement in December of 2022 on improving both emergency and in-patient care - there was a major announcement - and the place in the capital plan. I understand not everything is broken out in itemized ways, but I understood that work was dispersed across HRM. It didn't only apply to expanding capacity at the Halifax Infirmary site. It also included funding for some stuff at Dartmouth General Hospital. There were also some references for stuff at the Cobequid Community Health Centre. In the capital plan, it seems to me - and I may be in error - in the document for 2023 - where did it go? - in the document for 2023-2024, on Page 7, there's an item that says “Halifax Infirmary Expansion Project,” and then in the document for 2024-2025, also on Page 7, that label appears again: “Halifax Infirmary Expansion Project”. My question is: Does that label apply to all of the expansion initiatives captured in that 2022 announcement of expansion of emergency and in-patient care in metro?

 

THE CHAIR: As per the Rules of the House, I would ask the member to table the document you're reading from at some point today.

 

PAUL WOZNEY: Sure.

 

MICHELLE THOMPSON: Anything that's labelled “Halifax Infirmary Expansion Project” is the actual campus on site at Halifax Infirmary.

 

PAUL WOZNEY: That 2022 announcement by the last Houston government made clear . . .

 

THE CHAIR: Order.

 

PAUL WOZNEY: Sorry. The previous government.

 

THE CHAIR: You did get me the first time, and I had to be reminded that we were not allowed to refer to them by name, so the Premier or the title.

 

PAUL WOZNEY: Thank you, and I apologize. I'm not sure where I find funding that might be attached to the various aspects of that announcement. In the capital plan, I mistakenly guessed that that's where it was. I raise this question of where it is in the capital plan in relation to my home constituency of Sackville-Cobequid. I'm proud to represent a constituency where we have a really important health centre, the Cobequid Community Health Centre, which delivers emergency care and a number of different types of care above and beyond that, largely on an outpatient basis. That announcement indicated that the government was making a commitment to expand the number of hours that emergency care would be available. At present, the hours are limited. It's not a 24/7 emergency room like the Halifax Infirmary or the Dartmouth General Hospital. And there was an announcement that included the development or the building of an additional building adjacent to the current facility that would provide 36 in-patient beds that didn't currently exist.

 

I'm asking about this announcement in particular. It's been two years since the announcement was made. I understand that planning capital projects between the time you announce and the time that something actually gets built and is operationalized, that doesn't happen overnight, so there's nothing untoward there.

 

The expansion of emergency room care, I know that in the recent election campaign the government-side candidates campaigned very strongly on: Hey, this stuff is just around the corner, you can count on this. I'm not quite sure where to find in the capital plan the funding to make those promises happen. Where in the budget am I going to find the funding that expands the hours of emergency care access at the Cobequid Community Health Centre?

 

I have a separate question about the 36 in-patient beds so maybe I'll let that one sit and I'll come back to the other question later. Is that all right with you, Chair?

 

THE CHAIR: Excellent. The honourable Minister of Health and Wellness.

 

MICHELLE THOMPSON: In 2022 we did have a big announcement. We looked at the Halifax Infirmary. To the member's point, there were other things happening. We talked about a transition-to-care facility which, of course, changed course. We initially thought we would have two sites and now we are fortunate enough that we will be able to have both those facilities in one site.

 

The QEII Halifax Infirmary Expansion Project is the physical thing that we can see. There is Central Zone master planning happening right now. That is being based on in-migration, immigration, and also the health and wellness of the population, understanding who is living locally, those types of things.

 

Work has carried on with those projects. There are a whole number of teams. Just for the Halifax Infirmary alone there were 40 clinical teams that have participated in trying to understand what really is the scope of that project, making sure that it's future-proofed. Similarly, Dr. Christine Short had the opportunity at the news conference the other day to talk about the master planning that's happening in Central Zone.

 

The work hasn't stopped but right now it's still really in that planning stage, looking if there's a requirement to get assets in order for expansions, et cetera. I just want to assure the member that that work is under way and there is money allocated to that Central Zone planning. We do look forward to being able to talk a little bit more about that.

 

In concept, all of those things stay. There's no change conceptually but the details will continue to evolve. That's certainly under the work of Dr. Christine Short at the Nova Scotia Health Authority, who is heavily involved in that master planning.

 

It does take some time. We needed to get this first, big chunk done. We recognize there are opportunities off the peninsula to provide a variety of different care. That work is well under way. More to say, just not right now.

 

PAUL WOZNEY: My question was: Where in the budget do we find the funding to expand access to emergency health at the Cobequid Community Health Centre? I got an answer about central planning. It's unclear to me that money is devoted. This was a promise made before the election campaign. It was a promise that was trumpeted during the campaign that expanded emergency room access. It was just around the corner.

 

Where is the money in the budget to deliver on this campaign promise that the residents of Sackville and communities that rely on emergency at the Cobequid Community Health Centre in Sackville - we draw in from Uniacke and from lots of places that are outside of the HRM - where is the money in this budget to deliver on emergency care at that facility? Where do I find it in the budget?

 

[5:45 p.m.]

 

MICHELLE THOMPSON: We don't have specific facilities operational. We give grants to the operators, who then would have a budget themselves in terms of how money is allocated. In terms of site-specific information, we wouldn't have anything that's site-specific.

 

What we would have would be - this year in the budget, as an example, there's $19 million in addition to regular funding to support emergency room expansion, different care providers, et cetera, across the province. Really, the site-specific allocations are under the Nova Scotia Health Authority's budget.

 

PAUL WOZNEY: I appreciate the answer, but there's a degree of impatience in my community. The burden on the existing facility - there's been assurance on the part of this government, for a matter of years now, that they have our backs, and that emergency care is going to be expanded and made more accessible, and there are going to be more hours that you can go and get care.

 

Wait times are through the roof. Staff talk about very challenging conditions that continue to go unaddressed. To hear that we're not quite sure where the money is, or how much money is there, is of concern to me and the people of Sackville, especially after this drum was beaten so loudly during the election, that you can count on us to do more, faster. It seems like all we've heard about is money for planning, not actually delivering more emergency care in Sackville.

 

My other question is on the development of 36 in-patient beds. I understand that we don't build new facilities in the blink of an eye. Health care facilities require a complexity of planning that maybe is not applicable to buildings in other government portfolios. That's fair. I understand the reasons for that. How close are we to the plans for those 36 in-patient beds at Cobequid being fully planned, and moving to the tendering and the building of those beds?

 

MICHELLE THOMPSON: As I said before, there is master planning that's going on in the Central Zone looking at all of the infrastructure assets, looking at population, et cetera. There's really nothing that I can say about that right now. I believe in the teams that are doing that, the clinical teams who are future-proofing our health care system. They have done a very good job. I know the operator is looking at that. I know those clinical teams are talking about what's happening informed by data.

 

There's nothing really changed in the plan, but it does take time. This is a once-in-a-generation build, and I appreciate that people are anxious.

 

Cobequid continues to be open from 7:00 a.m. till 12:00 a.m., and that will continue for the foreseeable future. We have to consider staffing. We have to consider a whole myriad of things. I want to assure the folks in Sackville-Cobequid that that work is under way, and as soon as we have something to announce, we'll be happy to do that.

 

PAUL WOZNEY: As the Official Opposition, we certainly support decision‑making founded on good data. Sackville, according to Statistics Canada, is the fastest-growing community in Nova Scotia and has been for a number of years and is projected to maintain that level of growth. The pressure on this facility is not waning. It's waxing. It continues to grow as our community builds up.

 

I guess the other question I have is - I understand that sometimes when you have to develop builds from the ground up, there's no planning done, and you have to start from scratch. That can really drag a process down in terms of how quickly it can move forward. It's a matter of record that when this facility was built under the government headed by then-Premier Hamm, the designs for this building included the capacity to expand it up vertically, scale it up beyond the structure that was built at the time.

 

This build in particular is not a build where the department is having to start from scratch in terms of looking at where we are going to put things or how we could expand capacity. Previous governments have already devoted significant resources in terms of planning to be able to scale this facility up in response to needs that they saw in the near future would arise, pressures that would soon come.

 

My question to the minister is: How has the solid, collaborative, careful work done by a previous government, by - it wouldn't be Capital Health but under a different health board, the kind of work that I hear the minister talking about in terms of talking to clinicians in a number of different practices - how is the government making use of resources already spent to be able to move forward in a timely way on a facility where there's already good planning done?

 

MICHELLE THOMPSON: What I would say is we're not building bungalows here. These are very purpose-built facilities. There have been plans for a very long time for the Halifax Infirmary that were not doable. It was absolutely not achievable. There can be plans, but whether or not they can be executed is something entirely different. That plan, prior to us forming government, was never going to work. There was no opportunity - the workforce could not build and actualize that plan, so it had to be taken back. We had to start from scratch.

 

Actually, we had to look at different places across HRM to see what the potential was. It is a different plan, in fact. We have focused on the Halifax Infirmary expansion project. We were able to do early work. We're really pleased with the way that facility is coming along. We were able to reach financial close just recently. We added beds to that facility, 36 more based on the new plan. We added four more operating rooms, and doubled the size of the emergency room because all of the previous models were built on a declining population, which is not actually the case. We do have to go back to square one and understand the needs. Where can we best serve? I don't know that the growth was predicted outside of HRM or around in - further outside of HRM. I don't believe that that was the case. Our models were on a smaller population not a bigger one, and the technology is incredible. We have to future-proof our buildings so we're not in the same boat in 35 years.

 

There's been incredible work that's been done. I want to thank the teams for the incredible work they've done. They are the experts in this area, and we rely on them heavily in order to help us build the health care system. We know there's some work to be done at Dartmouth General Hospital. We know there's some work to be done at Cobequid. We know the Halifax Infirmary is a generational project.

 

We did have to start pretty much from scratch in order to realize a very different model where we decentralized some of the services, making sure stuff is closer to people throughout HRM. The transition-to-care facility is the addition of 178 new beds into our system; that wasn't contemplated in any other plan.

 

I want to assure the member that folks who are leading this work are very good at their jobs. They're in tune with the community changes - also new technology and cutting-edge therapies - and I can assure them that this is top of mind, and we'll continue to work with those experts. As soon as I have more to say, I will be able to share that.

 

PAUL WOZNEY: I appreciate that the minister's response is the minister's response, but I'm here today because I was asked point-blank on hundreds of doorsteps in Lower Sackville about whether I, as an NDP candidate running for election in a constituency held by a PC member of this legislature who was not re-offering, was going to be an obstacle to achieving the commitments of the previous government.

 

I looked every single one of them in the eye, and I told them that I would in no way be an obstacle. I would be a champion to see that work move forward in the most timely way possible because I heard over and over again that people in my community don't have access. They go to emergency care, and they go home again. Then they go back the next day, and they go home again. Yes, it's open from 7:00 to 12:00, but that's not - and yet, it's not enough.

 

I don't hear any money devoted to expanding the care that was promised by this government in 2022. I don't hear that there's money in the budget to deliver more emergency care at that site in this year to come. That's what people were promised in Lower Sackville. That's not making it happen, that's: Well, we'll hope it will happen at some future point.

 

In terms of the 36 beds, there's been two years to start the work of planning the development of that facility. The terms of the release talk about a facility adjacent to the existing footprint. That wouldn't mean you would have to compromise the existing building or pause programs. It would be an additional building to what's there. It doesn't sound like the plans for that building are anywhere close to being able to put a spade in the ground and start building those 36 in-patient beds.

 

People from Sackville continue to make long commutes into Halifax for beds that simply aren't available. It doesn't sound like there's a plan to get the beds that were promised for Sackville built in Sackville so people don't have to put additional burden on this generational investment in the Halifax Infirmary.

 

I'm not sure what needs to happen in the budget, but the people of Lower Sackville are looking for the government to make it happen. It doesn't sound like the money is there to do that in this coming budget year.

 

MICHELLE THOMPSON: I appreciate the member's impatience. It's hard when you're new here and trying to figure out how it all works. As I've said before, that work is under way. Just because we don't have anything right now to share doesn't mean those teams are not working diligently to support Nova Scotians and to make sure that plan is future ready.

 

There are a number of things that are happening in this budget. I appreciate it's fire in the belly, but that work is well under way. This is not a bungalow. This is a purpose-built facility with experts who have to - it needs to be a different grade. We need to make sure we have a workforce. We need to make sure there are a number of things.

 

I appreciate the member's impatience, but I want to assure the folks from Sackville-Cobequid that the former member who represented them represented them well. We know there is urgency around this, and that work is under way. I'll be happy to stand in community and to give them some information as soon as I'm able.

 

THE CHAIR: The honourable member for Halifax Armdale.

 

[6:00 p.m.]

 

ROD WILSON: Interesting note: I used to work at Cobequid and went from the old one to the new one. One of the reasons I quit working there was the frustration that we were supposed to close at 12:00 a.m. and transfer all patients. I think originally it was 10:00 p.m. and then it went to 12:00 a.m. but we had so many in-patients and we couldn't get any ambulances so we would be lucky if we could get the patients out of Cobequid before we opened at 7:00 a.m. There was a real situation there.

 

A question I do want to ask, optimistically, hopefully - I'm happy to see the new Halifax Infirmary expand. If anybody has been there - I can say this and I'm sure you'd agree with me - when will the horrendous VG be decommissioned?

 

HON. MICHELLE THOMPSON: That is part of the work that's happening. That's why the Halifax Infirmary - Dr. Short did a wonderful job explaining that the priority is to take in-patients and operation rooms over to the new Halifax Infirmary. Maybe not all of that building needs to be torn down. That's some of the work that's happening with Central Zone master planning, looking at what the assets are there. There may be portions of it that need to come down. Nothing is going to happen imminently - really looking at the assets and understanding what the potential is for that site.

 

The priority is certainly surgical suites, OR theatres, and in-patient units once that facility is built. Then, as the building is built, those clinical teams and those master planners will be looking at how to best use that VG site.

 

ROD WILSON: All I can ask is that if there are any parts that are saved, they actually have safe water and heat, so staff don't have to wear their coats, and, hopefully, fewer rodents. When that does happen, one of the floors that will probably be closed is the seventh, the palliative care floor.

 

With that in mind, we know there's lots of evidence across the country that most people spend - in Nova Scotia, the higher rates of hospitalization are at end of life. The Department of Health and Wellness guidelines suggest that there should be seven palliative care beds per 100,000. That would save roughly 76 on current population.

 

To the best of my understanding, there are 10 in Halifax, 10 in the Valley, leaving a huge deficit. Our population is aging. I didn't see anything in the Speech from the Throne or in this budget for increased expansion of hospice across Nova Scotia, particularly in Cape Breton and other areas. Can the minister speak to that?

 

MICHELLE THOMPSON: I'll just give an overview of current hospice capacity. There are three 10-bed residences - Valley Hospice, Hospice Halifax, and Hospice Cape Breton. There is a total number of 30 beds for hospice, and there are 41 dedicated palliative care units in the province that provide specialist in-patient care with the primary aim of crisis intervention and medical stabilization.

 

In the Northern Zone, Aberdeen Hospital has six, and Colchester East Hants Health Centre has ten; Cape Breton Regional Hospital has nine; St. Martha's Regional Hospital has six; and the QEII has ten. Approximately 24 designated palliative care comfort beds exist across the province, additionally, to support people with specialist palliative care needs where palliative care units are limited or don't exist.

 

We do appreciate - we're working with several organizations across the province. We understand that there is a need across the province for a variety of different models, not just in hospital or hospice but supporting families who want to keep their loved ones at home. I can assure the member opposite that there is work happening under way on this file. We will continue to work in community and see where we can support communities based on the model they choose. Some do want hospice, others need increased access perhaps to home-based step palliative care, but we'll continue to work in community to understand communities needs and continue to support and expand the program.

 

ROD WILSON: First, I thank the minister for the correction numbers. I was looking to see how much was in this budget - in these Estimates - for hospice and where it may be. On an anecdotal note, I was on the Hospice Halifax Board for the last year before recusing myself, and it was disheartening every month to see more people pass away waiting to get into hospice than we could serve.

 

I am curious - I don't know - within these estimates, how much is dedicated to hospice and palliative care for the coming year?

 

MICHELLE THOMPSON: For hospice care in this budget, there is $6.7 million allocated for hospice, and there are different funding models for hospice across the province. There is $18 million for palliative care units across the province. Now, that's not to say palliative care doesn't happen in our regular parts of the hospital, as well, but that would be the two budget line items for direct and targeted funding.

 

ROD WILSON: Back to my favourite topic: emergency services in rural Nova Scotia. I'm wondering: In the previous year, we saw some emergency departments change to urgent care sites and a change in counts. Are there any plans in the coming year for any of the emergency departments to be changed to the service level of an urgent care site?

 

MICHELLE THOMPSON: No, there are no current plans to change.

 

ROD WILSON: Before we get into the Estimates specific to emergency (inaudible), I'm wondering - we have a number of emergency departments that were intended to be open 24/7. For a number of reasons - I'm sure the minister knows better than I do - their hours were much less than communities would want and no doubt what the minister wants.

 

When we look at the funding for the coming year for emergency departments, is the funding based on an expectation of 24/7 availability of emergency services, or have there been any adjustments to the funding - certainly the smaller sites - in anticipation of a reduction of hours?

 

MICHELLE THOMPSON: There isn't any reduction. If we can staff those facilities, then we do staff them. It's utilization, really. There's no change in funding levels. It's around whether we have the staff to staff them.

 

ROD WILSON: Bouncing around here a bit. Since the announcement in the Lieutenant Governor's speech and in the press release, I have had a number of calls in my constituency saying, Tell me more about the menopause clinic. Questions are: Will it be located at the IWK Health Centre? What will be its deliverables, hours of service, and wait times?

 

With wait times, you don't know until you do, but people are curious as to what this goal is, what the deliverables will be, where it will be located, and what to expect in terms of service. Could the minister speak to that item, please?

 

MICHELLE THOMPSON: The new menopause centre of excellence is currently under planning now. In some way, shape, or form, IWK will be involved, as well as the Nova Scotia Health Authority and the Menopause Society of Nova Scotia, which is new. Also, ideally, we'll be looking at Nova Scotia Health Innovation Hub and looking at not only innovation in research and evaluation but where the other opportunities are for us to become a full centre of excellence and do research as well as treatment.

 

There are some things happening now. The IWK Health Centre is establishing two centralized health hubs, in Dartmouth and in Halifax, to support a variety of women's health. There'll be more. We recently had a meeting about the menopause centre of excellence and the model. That information will emerge, but we are quite focused on it, making sure that we're including all those voices and that we have an opportunity. We recognize - I suspect it's definitely going to be located in HRM, but our ability to provide services to rural Nova Scotian women is important, as well.

 

That will come along. There's lots of excitement about that. I get lots of calls and emails about that, as well. We're heavily under the planning stages right now, grateful for the expertise around the table, and looking to understand what the best model is to help the 350,000 women who are either perimenopausal, menopausal, or post-menopausal. We're excited about that, and that work is well under way.

 

[6:15 p.m.]

 

ROD WILSON: When should we expect that to be open and the first patient to be seen?

 

MICHELLE THOMPSON: I do not have my crystal ball, but I can say that folks are working very hard. The Premier wants that clinic up and running as soon as possible, but, again, we have to plan appropriately. We need to make sure that we have the right clinicians, that we have the right model, that everybody - not only that people are there to give service but evaluation as well, and so we'll be - it will be sooner than later, but I really can't say with any certainty right now what the date will be, but we're anxious to get it open.

 

ROD WILSON: Will it be open within this coming fiscal year?

 

MICHELLE THOMPSON: More to say at another day.

 

ROD WILSON: In previous discussions this evening, I mentioned the gaps in terms of CCAs and RNs, and we also talked last time about physicians. The numbers are staggering. I wanted to know how much is being dedicated to funding for recruitment for the entire health care workforce - it's a big question - because we understand there's also a shortage of occupational therapists and respiratory therapists. Is that recruitment being led in-house, internally, or is it being contracted out, that recruitment? How much is the budget? I don't expect per provider, but global budget, and how is that being delivered?

 

MICHELLE THOMPSON: I think I'll start with the Office of Healthcare Professionals Recruitment that has an $8.6 million budget designated specifically for supporting recruitment of health care professionals through the office. There's also a $2 million fund in addition where we work with community grants that are applied for by community organizations to support recruitment. The operators of the Nova Scotia Health Authority and IWK Health Centre would have their own recruitment efforts in-house. We would also have sign-on bonuses for physicians through physician services. There's a variety of different avenues but, designated specifically, we would be looking at the office. It has a budget of $8.6 million per year.

 

ROD WILSON: Thank you, that's helpful. One of the concerns that has come to my attention both when I was in practice and recently with the increasing wait times and lack of access to primary care, we've seen private care grow, particularly in metro Halifax. I don't mean publicly funded private delivery.

 

We know there are two clinics offering primary care, pay-as-you-go. One of the websites calls it “a la carte concierge”, which I find quite offensive, so you actually pay. You get after-hours service, you pay for the fees. I understand they don't bill MSI.

 

The question I have and certainly clients have who can't afford those services, are these clinics that have been operating for a couple of years - one has physicians, one is operated with mostly nurse practitioners - and also now with Maple providing private services: Does the minister feel these are operating within the Canada Health Act?

 

MICHELLE THOMPSON: Of course in our province we don't regulate private clinics. Our role is to look at publicly funded services. We've said to patients it's really important, kind of a buyer beware, making sure that people are credentialled, making sure that these individuals have access into the health care system, which they often don't.

 

We have had conversations with the federal government. We feel it's important that the Canada Health Act be updated and if there is a recognition or a want for us to be more closely integrated or understand what's happening in the private space, that Canada Health Act needs to be updated. We really don't have a line of sight on any of those clinics.

 

ROD WILSON: I'm surprised by that because in my time in the Department of Health and Wellness, 2017 to 2019, there was a requirement with the transfer of funds that the deputy minister and also the minister had to report back for transfer funds, whether there were any services provided that people paid for outside of MSI and the province had to make remittances back to the federal government.

 

Has this Department of Health and Wellness had to make any remittances back to the transfer of funds because of private delivery?

 

MICHELLE THOMPSON: As far as we're aware, there's only been intervention from the federal government since 2022. Health Canada reduces Canada Health Transfer amounts when it considers patients are being directly billed. Nova Scotia has received two deductions - one in 2022 and one in 2023. These clinics are private, and we have no legal authority, so the federal government looks at a variety of different things, including Statistics Canada, which is why we would really like to have an open conversation about opening the Canada Health Act and really modernizing it to reflect current models of care.

 

We really can't regulate a private business to understand what services they're providing. Similarly, it would be the same with other private providers, like private physiotherapists, private registered massage - there's a variety of different clinicians that we don't regulate, and we can't compel information from a private business. We only have history back to 2022 and 2023.

 

ROD WILSON: The minister mentioned deductions in 2022 and 2023. I don't understand what that is and what that means. Could I get some clarity, please?

 

MICHELLE THOMPSON: As I said, Health Canada reduces Canada Health Transfer amounts when it considers patients are being directly billed, so there are these clawbacks reflecting Health Canada's estimate of the activities of a private medical imaging clinic located in Halifax. In 2022, there was a clawback, an amount of almost $1.27 million, and in 2023, $1.794 million. Again, we have to talk to the federal government about where they're getting their numbers. We cannot compel information from these private clinics, which is why it's so important for that legislation to be updated. The medical imaging clinic that provides private services has just recently entered into an agreement with the Nova Scotia Health Authority to provide publicly funded services at its facility.

 

THE CHAIR: With four minutes left, the honourable member for Halifax Armdale.

 

ROD WILSON: I think that's a big difference between deductions and clawbacks. We have private plastic surgery clinics; we have private Botox clinics. They're regulated - those physicians and that. Other provinces have a private health facilities Act, and we don't have that in Nova Scotia. There's a health facilities Act as it applies to nursing homes, but we don't have a private health facilities Act as it applies to these clinics, which means do we have any understanding of infection control and other issues in those clinics, whether it's the plastic surgery clinics, whether it's the primary care clinics? They're private businesses. Their services are clawed back. Has the minister ever considered that in the name of public safety perhaps we need a private health facilities Act? Other provinces have them, and they are inspected and regulated to make sure that infection control is there because in other provinces, we've seen outbreaks because of poor infection control in private clinics.

 

[6:30 p.m.]

 

MICHELLE THOMPSON: That's exactly why we have a real buyer beware. We don't regulate. We don't have legislation to regulate, which is why we need a comprehensive review of the Canada Health Act. Wherever we enter into public-private partnership for services that are insured - some of the services are not insured that people are going for privately, we don't have purview over those - but when we do have a public-private partnership agreement, as an example I'll use Halifax Vision Surgical Centre. We actually designate them as a “hospital” in order for us to hold them to the same standard that we would any other hospital, so accreditation, infection control, and quality, and they are required to report their data to the Department of Health and Wellness similar to other parts of the health care system. So, again, it really is a buyer-beware environment, and we - again - call regularly for that Canada Health Act to have a consistent and comprehensive review and application throughout the provinces.

 

THE CHAIR: With one minute, the honourable member for Halifax Armdale.

 

ROD WILSON: I guess I expect more in public safety than buyer beware, so the question is: Don't do it, but why not do it when other provinces do it?

 

THE CHAIR: Order. The time allotted for the NDP this hour has come to an end.

 

We will recess for a 10-minute break.

 

[6:33 p.m. The committee recessed.]

 

[6:43 p.m. The committee reconvened.]

 

THE CHAIR: Order. The committee is back is session.

 

The honourable member for Sydney-Membertou.

 

HON. DEREK MOMBOURQUETTE: For our time for Estimates, I'm conceding my time to the member for Cumberland North.

 

THE CHAIR: The honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: That's good. Thank you. When I was finishing off the last session with the Minister of Health and Wellness, I was asking about the paramedics and emergency ambulance response times, and I was specifically sharing some concerns that had been shared with me about what's being measured. Would the minister be able to share with us what is shared as far as the response time? Can the minister share? Is that from the time that 911 is called and the ambulance arrives on scene, and if not, what is the measurement of time that is being shared with the public based on?

 

[6:45 p.m.]

 

HON. MICHELLE THOMPSON: So, 911 is the sorting. It's not from the time of the call. Once the address is validated by 911 and EHS is made aware, that's when the time starts counting. It stops when the crew arrives on scene.

 

ELIZABETH SMITH-MCCROSSIN: It certainly is a very challenging time when you're the person waiting for the ambulance. I've had quite a few people ask me: “Why can't the 911 dispatcher let somebody know what the approximate wait time will be?” - just for peace of mind or so they can make an educated decision, if maybe they wanted to transport themselves.

 

I know that's always discouraged from a clinical, legal liability standpoint. The reality is that there are times when people will make that decision, rather than if they knew the wait time for the ambulance was going to be two hours or three hours, they sometimes will make that decision.

 

One of the bills I had tabled in a previous sitting was to put GPS trackers on our ambulances, similar to what we have on our snowplows, so you can go online anywhere in the province and see where our snowplows are. Could we not do the same for our ambulances? Then people, if they are having a medical emergency, they could go online and see: Okay, the closest one to Amherst is Pictou, so I'm going to make a decision to transport a different way.

 

I wonder if the minister could respond to that. Has there been any consideration given to putting GPS trackers in our ambulances and to meeting the requests of so many people who want to have an estimated wait time of how long it would be before the ambulance would arrive?

 

MICHELLE THOMPSON: Lots of changes in the Chair.

 

No, I don't think it would be a prudent thing at all. Snowplows are pretty different from ambulances, and we have a policy around how roads are cleared and when and why. Our ambulances are based on our status plan. It depends on why you called. You may see ambulances nearby and there may be times when there is a delayed response, but you are able to speak to the physician. It is always prioritized to the highest acuity of a call. I would hate to think that people would make assumptions about the acuity of other calls, about the acuity of their own call, and actually try to transport themselves.

 

Always there are medical first responder units that can come. Emergency care starts the moment you are on dispatch. We are looking at a video link that we are using in some situations where physicians can immediately go in and help the paramedics on the scene and kind of assess the situation. We have physicians 24/7 and we have nurses 24/7, so I don't think it's a fair analysis or comparison to say that the ambulances are like snowplows and they're just spread out wherever.

 

Patients need to call. They get care immediately from great dispatchers - people who can help support the call that they're on, giving them more information. It really would not be a fair assessment. If I call with a low-acuity call and you call with a high-acuity call, the ambulance will be prioritized to you for very good reasons. The system status plan decides where things go, and I would hate for individuals to make assumptions about where an ambulance is or why it's there. Very different, as I said, from snowplows, which have a policy about the Trans-Canada Highway, trunks and routes, et cetera, et cetera. It's a very predictable plan with timelines. Certainly an emergency health system is not in a position to be able to do that, and I think it would actually put people in jeopardy if we were to use a model such as that.

 

ELIZABETH SMITH-MCCROSSIN: The core of my question is that people have waited and are waiting often an exorbitant amount of time for an ambulance during an emergency situation and they just want to have the information to know whether I'm going to be waiting 15 minutes or am I going to be waiting two hours? I can tell you, in Cumberland there are many times - Cumberland is the largest county in the province - and there are many times there are zero ambulances physically in Cumberland.

 

There are times when people have had heart attacks, and the closest ambulance was in Pictou, an hour and a half or two hours away. In those situations, people have said to me - and I think they're right - that they deserve to know if they are going to wait. In some communities there are medical first responders and the medical first responders have said to me: It's not right. They have been told - fire departments have been told they're not allowed to transport for legal reasons, and they're forced to sit and wait, sometimes for an exorbitant amount of time.

 

I'm just passing that on and asking the minister, because that has been asked of me many times. Why will dispatch not give an answer? Law enforcement has asked me that question, because often our police are the ones who are waiting by the roadside or waiting with a patient who is unconscious or unresponsive and it's a very, very stressful time for them.

 

I had one more question to follow up with that and I just lost it. It'll come back to me. In relation to paramedics, I'm wondering if the minister can - oh, I know what it was - first responders. The minister may not be aware, but in the town of Amherst the fire department members are not actually trained as medical first responders. The town of Amherst is quite a large town, over 10,000 people, and what I've been told - and this has not been verified, I will say - but I've been told that they were told they would have to pay quite a fee for each of the fire department members to be trained and that it was an expense that wasn't affordable. Right now, the firefighters, volunteer and non-volunteer, are not medical first responders in the town of Amherst. Not every town in Nova Scotia has that luxury of having first responders to respond to medical emergencies.

 

My question to the minister is: Are there any plans to expand the use of department paramedics and their scope of practice here in the province of Nova Scotia?

 

MICHELLE THOMPSON: In regard to the medical first responders, there are 237 medical first responder agencies across the province. In 2024-2025 there was a $1.5 million investment to support agencies in receiving new and ongoing training to better serve Nova Scotians, new clinical treatment protocols as well to support, and also looking at expanding the GoodSAM Responder app video link to medical first responders.

 

There was also a significant investment in the first annual EHS Medical First Responder Expo that was held in Truro in the past year to really hear directly from our firefighters across the province and it had overwhelmingly positive feedback as a result.

 

There's lots happening with medical first responders. They are very valued. We appreciate that there are different abilities of departments in order to fund but we certainly have leaned into that space to support medical first responders.

 

In regard to department paramedics, I don't understand what that means. Maybe the member could clarify that.

 

ELIZABETH SMITH-MCCROSSIN: My question regarding the scope of practice for paramedics is: We are starting to see some paramedics work in emergency departments, for example. Is that going to be continued and used across the province? Many paramedics would say that they still are not being used to their full scope. Is that something the department is willing to look at and work with paramedics on?

 

MICHELLE THOMPSON: We continue to look with the Nova Scotia Regulator of Paramedicine around scope of practice. Sometimes there are paramedics in emergency rooms, sometimes there are physician assistants, sometimes there are nurse practitioners, sometimes there's a physio. We really do look locally at the resources and what that team feels would be in their best interest, as an example.

 

What I will say is scope of employment can often be different than scope of practice so they're not always exactly the same. In emergency rooms there would be a scope of employment for paramedics but certainly in the field and in the emergency health system we are constantly striving to ensure that paramedics not only have the scope but also the competencies in order to use the skills they have.

 

Sometimes that would involve simulation, looking at ways we can support their practice and ways in which they can ladder their career, if they are interested in doing that.

 

There's a lot of work that happens around scope of practice but we also have to remember that in different settings there's also scope of employment.

 

ELIZABETH SMITH-MCCROSSIN: One of the other questions I wanted to ask specifically for paramedics was around workers' compensation. Of course paramedics have a very difficult job, much more difficult than many people realize. They have high stress, a high burnout rate as well. Many are off on sick leave and through workers' compensation, due to job injury.

 

I'm wondering if the minister can speak to that, that they are often given less benefits than other first responders; RCMP, for example, get much greater benefits when it comes to sick time and time off with pay due to workplace injury.

 

I'm wondering if the minister is looking at that and looking to make improvements for paramedics here in Nova Scotia?

 

[7:00 p.m.]

 

MICHELLE THOMPSON: Sick time, of course, is negotiated through a collective agreement. I have no idea about RCMP benefits, and WCB, to my knowledge, is not discretionary. There are WCB papers that need to be filled out, and there is a trajectory that is supported both through employer and WCB.

 

In 2022, they formed an employee advisory council to support the introduction of power loaders and stretchers, lighter medical kits, things that can help paramedics move patients more easily, and ergonomic adjustments to support their physical health. They introduced connect and recover, which is a modified return-to-work plan that helps paramedics who are off work due to illness or injury to safely transition back. In 2023, the Department of Health and Wellness began paying all short-term disability premiums for paramedics and medical communications officers.

 

EMC health and wellness team contracted a psychological health and safety adviser to provide mental health expertise, support, and education to the organization. EMC has implemented standard operating procedures to improve paramedic and patient safety through reducing driving time and distances, for folks to have a better work-life balance. Collaborating with the Workers' Compensation Board of Nova Scotia, an injury-prevention task force, which meets regularly, has been struck.

 

EHS LifeFlight has introduced occupational health and safety measures for paramedics, including specialized personal protective equipment to protect EHS LifeFlight critical care teams in high-risk transports.

 

There have been a number of things that have been invested in in the last number of years to support paramedics. We very much value the work that they do. Again, we're in constant communication to make sure that we have the things that paramedics need in the field.

 

The other thing I will say is that the ambulances themselves are built in Yarmouth - very proud of that - and certainly done with paramedic feedback. Any time they're looking at what they can do differently, the frontline voice is very important to make sure that it's an environment that paramedics feel meets their needs and also patients' and that they have an ergonomically appropriate environment, as much as you can in the back of a truck. There have been a number of investments made to support paramedics' physical and mental well-being over the last number of years.

 

ELIZABETH SMITH-MCCROSSIN: I agree. Paramedics do amazing work here in this province.

 

Back to something I had asked - I just remembered part of that question. With regard to emergency medical first responders in the Amherst area - and there may be other areas of the province that are the same - my understanding is that they didn't qualify in the town of Amherst for the provincial funding, because we had a higher ratio, or the ratio of ambulances that were in our town, it was deemed that the town or the fire department would have to pay for the training.

 

One of the reasons that this was brought to me was because, of course, one of the complaints that we have is that most of the time, our ambulances are not anywhere close to Amherst or anywhere in Cumberland County. They're pulled centrally into HRM. It seems, I would say, unfair that this money isn't being provided or allowed for the training of first responders, given the lack of ambulances that, in reality, are available to the people.

 

I look at the budget here and I notice that under Provincial Programs, the funding is actually down from $30 million to $28 million - I guess it's $29 million, so it's not down a lot, but I'm wondering if the minister can share what provincial programs are being cut there, to show the decrease in that budget. That's on page 15.9 in the Health and Wellness budget.

 

MICHELLE THOMPSON: That budget has been transferred over to Operations. It originally started in Health Transformation, but it's part of the training piece, and it's been transferred over to Operations.

 

ELIZABETH SMITH-MCCROSSIN: Is the minister able to share what that was for, specifically?

 

MICHELLE THOMPSON: There is no change, but the money that was moved over is for tuition for paramedics. It's just in a different - it's just been moved. There's no reduction or change in programs at all.

 

ELIZABETH SMITH-MCCROSSIN: I have a few different questions in a few different areas. Just bear with me. The first question I have is around Seniors' Pharmacare. Looking at the budget, also on the same page, under Seniors' Pharmacare it has $207 million estimated for last year and $204 million for this year. We're seeing a decrease of around $3 million or so.

 

The reason I'm highlighting that, and would like the minister to speak to this budget line, is that I'm hearing from seniors and their family members, on a fairly regular basis, that people are upset that they have to pay a late fee.

 

More and more seniors are working past the age of 65 and don't want to pay for Seniors' Pharmacare. Oftentimes they'll delay joining Seniors' Pharmacare until they absolutely are in a position where they need it, and then they are sent a bill for a late fee. That upsets a lot of people. They feel their government is punishing them for working past the age of 65, but we really need them in the labour force.

 

I'm wondering if there's been any consideration given to removing the late fees for Seniors' Pharmacare. In relation to that question, can the Minister give us a number of how much money does the government collect each year in the form of late fees for Seniors' Pharmacare?

 

MICHELLE THOMPSON: For late fees, co-pays, and premiums, the total revenue is $66 million. The total expenditure of the Seniors' Pharmacare program is $204 million.

 

ELIZABETH SMITH-MCCROSSIN: Can the minister break those numbers down a bit? The number the minister gave included the co-pay fees as well as the late fees. I'm looking specifically for the late fees.

 

Does she have the information of how much the government has collected for late fees specifically, and specifically for the Seniors' Pharmacare? Also, in relation to the question, I'm wondering if the minister can speak to why the decrease from $207 million down to $204 million in the budget.

 

MICHELLE THOMPSON: We don't have that breakdown available this evening. The change the member is discussing is around utilization. It doesn't matter what the number is. As people apply, if they're eligible then they're enrolled in the program. It's based on our best guess, but it can be above that or below that, depending on utilization. There's nobody who is never included in it. We don't exclude anybody from the program when they apply. It is our projected utilization.

 

ELIZABETH SMITH-MCCROSSIN: I think what the minister is telling me is that they're projecting that fewer people will utilize the program. I think that's what she shared. There are people that who are denied the program if they don't pay the late fee. If they're sent a bill for the late fee, they are not allowed to join until that fee is paid. Those are the people who - the minister probably has some of her own constituents who have called about that. I think all MLAs hear from some people at some point.

 

I'm wondering if the minister and the department would be able to provide the information about how much money the government collects in late fees for the Seniors' Pharmacare program. Is that something that they would be able to provide for me at a future date?

 

[7:15 p.m.]

 

MICHELLE THOMPSON: That can be tabled at a future date, yes.

 

ELIZABETH SMITH-MCCROSSIN: I'm going to move in a different direction. This is a topic that probably doesn't come up very often, at least here in the Legislature. It's kind of a sad time when people need medical examiners. I've had some concerns brought to me by families that have requested an autopsy and were denied. I'm wondering if the minister can speak to - if the minister is aware. This is quite particular information, so they may have to make some calls or find out later.

 

I'm wondering if there is a shortage of medical examiners here in the province who would normally be working for the Nova Scotia Health Authority. I'm asking that question because I'm wondering if that is the underlying reason. I've read the legislation around when an autopsy is supposed to be completed. If there's a death within 24 hours of coming to the hospital, for example, that's automatically supposed to trigger an autopsy. There are other rules and policies as well. For a couple of years now, those have not always been done consistently. I'm wondering if the reason is because of a lack of medical examiners. Can the minister respond to that?

 

MICHELLE THOMPSON: The Nova Scotia Medical Examiner Service actually sits under the Minister of Justice. That would be a question that would be best answered by the Minister of Justice.

 

ELIZABETH SMITH-MCCROSSIN: I will ask the Minister of Justice that question. It does affect our health care system, especially if there are policies that aren't able to be followed due to a potential shortage. I'll look into that with the Minister of Justice.

 

A couple of questions around emergency departments - again, my colleagues have already asked a lot, so I'll just ask a couple of specific questions. One is particular to Cumberland Regional Health Care Centre. My understanding is that Cumberland Regional is the only regional hospital in the province that has only one ER physician staffed 24/7. I realize that there is a second position that is staffed sometimes, when staff is available, for eight hours a day. I'm wondering if the minister or the department has given any consideration to staffing Cumberland Regional with two full-time physicians, 24/7. I'm asking that question because of the long wait times that people are waiting, up to 14 hours. Pretty consistently long, long wait times. I know it's hard on staff. It's hard on patients. It's hard on families. It's hard on everyone.

 

I know that there is a shortage of space, and we're all very thankful that the minister and the Premier came through with Premier McNeil's announcement of the ER expansion. He made that announcement in December 2020. Just a couple of months ago, the Premier and MLA for Pictou East and the minister made the announcement that construction was starting in the Spring, to double the size of the emergency department. That's very much needed. However, we need to have staffing, as well, to help reduce the wait times. I'm wondering if the minister can speak to that and tie it into that question. I think our regional hospital is also one of the only regional hospitals that doesn't have a rapid assessment zone. I'm wondering if that also is something that the Nova Scotia Health Authority and the department would consider implementing at Cumberland Regional, again with the goal of trying to reduce the ER wait times.

 

Some can say there is no space, but one of the things we did when there was a flood in our emergency department and our emergency department was closed and moved - there was a temporary emergency department - is the ambulatory care unit was used temporarily during this time. The ambulatory care unit is used during the daytime hours only. It is closed usually by 4:00 p.m. or 5:00 p.m. every day. Ambulatory care, which is adjacent to our emergency department and has numerous exam rooms all set up, could be used and utilized for this rapid assessment zone and/or overload and carryover for the emergency department.

 

Some have asked, “Why don't we have an after-hours clinic or a walk-in clinic in the ambulatory care clinic every evening, taking care of those patients who are triaged 4 or 5?” Your lower-acuity patients, who would be appropriate for a walk-in clinic, could be taken away to reduce the congestion in the emergency department and reduce the stress there as well.

 

There are a few options and ideas that people have shared around - the rapid assessment zones, a walk-in clinic or an after-hours clinic in the evening - to utilize that space that right now is not being used at all. I'll circle back to the beginning of the question and that is staffing. Again, I think our emergency department is one of the only regional hospitals that does not have two full-time ER physicians. Given the demand and the numbers that are being seen in our emergency department, I'm wondering if the minister could speak to that.

 

MICHELLE THOMPSON: There are a number of hospitals across the province that don't have two physicians on 24/7. Antigonish, as an example, does not, but I do see here that Cumberland Regional is fortunate. They have waiting room care providers, also LPNs, physician assistants, and nurse practitioners who work in the emergency room. Those hours are allocated and there is also opportunity. The Murray hybrid model is used around staffing emergency rooms, and we recognize that not only acuity, but complexity is different in our populations across Nova Scotia.

 

There is work under way to review that, and there are actually - based on that formula - additional physician hours allocated by site. There is a possibility that there are additional hours. The staffing really is the issue. Certainly, whenever people are able to staff, that happens. I know that there is a very committed group of locums working in the member's area.

 

The team are the best deciders of how to utilize those resources. In community, physicians are independent practitioners. We can't mandate the hours that they work. They are independent, so we cannot mandate our physicians to work after hours or weekends in an after-hours clinic, but we can incentivize them. With the Longitudinal Family Medicine payment model, we have seen increased access on evenings and weekends for physicians who participate because we've incentivized them.

 

I would say that if there is a willingness amongst the staff to consider a rapid assessment zone, certainly they should speak to their management and see what the capacity is at the site, not for staffing and space. If that team of individuals wants to come forward and talk to management and its own leadership about what the possibilities are, I think that would be entertained.

 

ELIZABETH SMITH-MCCROSSIN: I asked about the rapid assessment zone area not because people from Cumberland Regional had asked me to ask that question, I'm just aware that they exist in other hospitals.

 

My question was more like, is it something that the Nova Scotia Health Authority management would take a look at if it's helping reduce wait times. I think the whole purpose of them is to reduce wait times and to do rapid assessments. Then, if it's helping in other hospitals, is it something that could also be happening in our hospital? If physical space is an issue because we need the ER expansion, could they be looking at using ambulatory care, which is adjacent to our ER? That's sort of the reasoning behind that, just knowing that it's at other hospitals.

 

I do want to ask a couple of questions that are around governance. I know my colleague in the NDP has already asked some really great questions around the Canada Health Act. I love those questions because living in a border community, of course, we share health care services, clinical health care services with not only New Brunswick but also P.E.I. I am aware that in some of the other provinces not everyone is following the Canada Health Act. Not that long ago I had a patient contact my office. They were quite angry because they were sent a bill for seeing their doctor who was in Cumberland County and they were sent a bill from the P.E.I. government. I said, I think you need to call your P.E.I. government; they live in P.E.I. now.

 

What happened is that P.E.I. now have a policy that if you have a physician outside of P.E.I., you have to pay for it. That actually violates the Canada Health Act. It violates the portability principle.

 

Our provinces really need to work together. We live in such close proximity and because there's such a shortage of family physicians, when people move even two or three hours away, I know people in Amherst who have moved to Cape Breton, they kept their family doctor in Amherst because they don't want to give up their family doctor. They are willing to travel four or five hours. The same thing happens if they go to New Brunswick or P.E.I. and vice versa.

 

The Canada Health Act does matter in those principles and making sure that people can go anywhere in the country and receive medical care they need.

 

I won't repeat his questions, but I will ask specifically if the minister can speak to what work is being done on an ongoing regular basis to collaborate with specifically New Brunswick. I say that because, of course, it is an area that we share a lot of clinical health services with and, of course, a lot of New Brunswickers come to Cumberland and Truro, as well as the IWK Health Centre. We have a lot of cross-border shared clinical health services.

 

I'm wondering if the minister can speak to what is being done on a regular basis to ensure there is a smooth transmission and shared services between our provinces so that patients are getting the best care they can get that is closest to home, regardless of what province they live in.

 

[7:30 p.m.]

 

MICHELLE THOMPSON: We do have an agreement with Nova Scotia, New Brunswick, and P.E.I. A lot of the work happens at the operational level amongst the CEOs, but there are very regular meetings with the Department of Health and Wellness and their counterparts. Of course, we do share services - look at the IWK Health Centre, as an example.

 

There is a current focus on surgical services and cancer care, and those, as I said, meet very regularly. There is also some sharing of EHS LifeFlight resources.

 

The Atlantic Premiers have challenged and directed us to really look at health human resources and how we support one another. As the member said, there can be a lot of cross-border travel. A great example of that would be the Atlantic licensure for physicians and the ability for physicians to move amongst the Atlantic provinces and provide care.

 

I can assure the member that there's lots of work that's happening, and in the event that someone requires care outside of the province, there is a reciprocal billing process that's been in place for a long time.

 

ELIZABETH SMITH-MCCROSSIN: I'm wondering if the minister could speak about the OR operating capacity. I'm wondering if the government is still giving consideration to looking at using our ORs in the province for much longer hours. I know during not this past election but the previous one, that was part of the platform. It's something I've long advocated for. ORs cost a lot of money. The fact is that in this province a lot of operating rooms are only used from Monday to Friday, eight hours a day. I know the government had looked at, and was looking at, trying to decrease the wait times in the province by getting our operating rooms running for more like 12 or 16 or more hours a day.

 

I'm wondering if the minister can speak on how that plan is coming forward, if that is still being worked on.

 

MICHELLE THOMPSON: There have been a number of things that have happened to support improving surgical access. First of all, there has been a partnership with private surgical clinics. The Nova Scotia Health Authority has completed 1,638 cases at Atlantic Canada ambulatory services up to December 31^st; 826 cases from the IWK Health Centre wait-list were done at Scotia Surgery or the Atlantic Canada ambulatory services. Halifax Vision Surgical Centre also has really supported more cataracts being done. There's also been an expansion to other things like endoscopy procedures and making sure that people have better access across the province.

 

Surgical capacity expanded through the hiring of staff - surgeons, anaesthesia, nursing, and perioperative staff. There are expanded agreements with assets in the community that at some times are private but can be used in the public system. Endoscopy capacity has increased significantly, especially at Dartmouth General Hospital.

 

A more modern and electronic referral and booking process has really allowed us to modernize the ways in which we move patients through the system. It actually gives better line of sight about capacity in other hospitals. It has been very, very helpful, that electronic referral process.

 

There's a new surgical payment initiative for physicians, supporting more evening and weekend surgeries, and surgeries on statutory and recognized holidays. That has resulted in approximately 140 additional surgeries. The surgical robotics program has expanded as well. There's a new In-province Travel Assistance Pilot Program for folks. We've expanded the number of operating rooms and the number of procedures that can be done in procedural rooms, freeing up OR space.

 

Looking at the zone level, we're seeing where the assets are in a community, what the current practices are. As an example, advances in cataract surgery, not using conscious sedation routinely, but actually looking at ways people can be treated in procedural rooms or lower-acuity environments, versus using those more high-acuity OR theatres for simple procedures. There's been a lot of work that's been done across the province to improve surgical access over the last number of years.

 

ELIZABETH SMITH-MCCROSSIN: I could really go down that rabbit hole and ask more, but I will not. Minister, there's a question here around virtual care. I had quite a few people ask me why the government limits people who have a primary care provider to only two virtual visits a year that are covered.

 

The reason they're asking me this is because oftentimes their own primary care provider is not available. You could make an assumption that if people were using virtual care more, even if they had a primary care provider, then that primary care provider could be freed up to see other sick patients that are calling them. I'm wondering if the minister could speak to that. Has there been any consideration by the department to increase the number of visits from two, for people who have a family physician in the province.

 

MICHELLE THOMPSON: Currently, VirtualCareNS is available unlimited to people who are not attached to a primary care provider. Again, it allows people to then get in-person care, should the virtual care provider deem that that's necessary. Because there is no attachment, that is something we're happy to be able to provide.

 

People who are attached also have a variety of different options - primary pharmacy clinics, mobile units, and urgent treatment centres. I do think that if you're attached, particularly if your physician is on a longitudinal family medicine contract, they actually are paid to care for you. It really is a matter of understanding how that practice functions.

 

It is important that patients talk to their physicians about their access when they're attached. There's a practice optimization team that can go out and have a look at these practices across the province. I use this story all the time about Dalhousie Family Medicine clinics. They felt they were going to have to decant patients. They really were feeling overwhelmed. This optimization team went in and were able to work them with very closely and recognize where things were clogged. With some small tweaks to the practice - additional resources - everyone assumes they need more physicians or more nurse practitioners or a variety of allied health care professionals, but it was actually the addition of administrative staff that made a significant difference in that space.

 

I would encourage any physician who's having difficulty seeing their patients in a timely fashion to phone that helpline that's available for primary care providers. That helpline is an opportunity for people to reach out and explain that there are issues within the practice - through no fault of anyone's. Practices evolve.

 

When you're a new physician, and potentially your practice was younger 30 years ago or 20 years ago or 10 years ago, your ability to see patients may have been different, but we know the complexity of patients is changing. We know that the complexity of therapy is changing. So, we are trying to move as quickly as possible to team-based care to support not just physicians but nurse practitioners to provide a variety of different care modalities.

 

I think we do have finite resources. We've spent a lot of money on health care, and in some ways, we have potentially overbuilt the system in spots. So, we do really expect that if a patient is attached to a primary care provider, they should get in to see them.

 

I would say that if that's an ongoing issue, they should be able to speak to the physician about that. Two virtual care appointments are something per person - it's not per family. But there's also expanded scope for other of our allied health care professionals, like the pharmacists, who are working not just in a primary care clinic but in pharmacy overall, able to do more things. Urgent treatment centres are available, and certainly in the Cumberland area, they have some incredible success stories. It was one of the first things that we were able to implement and review.

 

Overall, there are 840,000 new access points in the system annually, which is about 70,000 per month. And so, if those two virtual care appointments are exhausted, then I think there are other opportunities, but I do really think that people should expect that their physicians and their nurse practitioners have the capacity within the office.

 

Again, if there are clinicians listening and feeling that their practice is overwhelmed, I would really encourage them to reach out, and also folks who are considering transitioning out of practice. Sometimes people are near the end of their career, and they're considering transitioning out of practice, and if we know in advance, we're able to provide opportunities. So, perhaps they can work in a part-time model, or they could work in some of those other access points that I spoke about in order to support patient care. I know it can be frustrating. It can be difficult at times. We've seen success with practices who have gone to same-day, next-day access. I think I spoke about that last week briefly, that particularly if you're fee-for-service, it can feel a bit scary, I'm sure, when you look and you see that your calendar is empty, when in fact we know that there's demand for services, and we'll certainly be able to make sure that those appointments are filled.

 

I appreciate the request, but right now, we really are in a position where those two are all we're going to be able to offer, but I would encourage people to look at the other access points across the system.

 

THE CHAIR: Order. The allotted time has elapsed. It will now be the turn of the NDP for a full hour. Before we begin, minister, do you need a recess? Good to go? Good to continue. Okay.

 

The honourable member for Halifax Armdale.

 

ROD WILSON: A couple of quick ones, and then I really want to spend the last hour getting to Estimates. I think we've been arguing that - and the minister is probably aware - rural emergencies are struggling, and even if there is funding for two people, often there are not physicians available. With the new physician assistant coming on, and there's an ER stream, I know some of the students I teach with are quite keen. I guess my question is: Is there an opportunity or will physician assistants be dedicated to rural emergency departments? Places that come to mind that could really benefit from a physician assistant, I think, are Guysborough, Canso, Annapolis, Shelburne, and Digby. Would those areas be a priority for physician assistants in the ER scope of practice?

 

[7:45 p.m.]

 

HON. MICHELLE THOMPSON: Emergency rooms are part of the plan and hope for physician assistants but also primary care, as well, as I said last week. We know physician assistants do need to work under the direction of a physician.

 

What's important is that there's a most responsible physician in a community that can support a physician assistant in their work. I know it's top of mind; the Nova Scotia Health Authority is very interested. We're going to graduate the first 24, and they will have no trouble finding opportunities throughout the province.

 

We're going to have to continue to build the workforce. As time goes on, as things evolve, we'll be able to look at what roles they play, which emergency rooms are best suited for them - primary care environments, et cetera.

 

I can't presuppose and say one is going to go here, there, or wherever, but I can say that there will be lots of opportunities for those individuals. That position will continue to evolve in Nova Scotia as we continue to bring more people into the workforce.

 

ROD WILSON: As people probably know, the Halifax Professional Fire Fighters Association approached HRM Council about securing funding for cancer screening. There's pretty good evidence now that screening people with long-term exposure, after five to ten years, can get early detection. Firefighters, as we know, are at higher risk of colon cancer, lung cancer, certain types of leukemias, and skin cancer.

 

When I reviewed what the cancer screening was, the reason they're asking for coverage is that when they go to their family doctor, the family doctor cues in that they're not eligible for the screening test they want because it's a screening test. If they went in with a cough, as I did this week in emergency, everything would be done.

 

There's nothing spectacular or fancy outside of the screening test when I reviewed them; it's blood work and chest X-ray. The difference is that if you present with a symptom, it's covered, but if the family doctor puts in a billing code as “screening,” it's not covered.

 

It could be done in any centre in Nova Scotia. There's nothing fancy or exciting about the screening test.

 

My question to the minister is - I'm not sure what HRM is going to do, but I think they've tabled it, and they're going to bring it back. It does raise the question: Shouldn't screening be available to firefighters in Cape Breton and those in rural Nova Scotia who are volunteers, who may be five to ten years on the job and, while lower volume, probably have some degree of exposure over time? It's the nuance between if they're presenting with a cough or presenting for screening because some lab tests will be accepted if they're presenting for a cough, but if they say it's screening, it's all rejected.

 

My question to the minister and the Department of Health and Wellness: Would the Department of Health and Wellness seriously look at providing coverage for cancer screening across Nova Scotia for firefighters at risk?

 

MICHELLE THOMPSON: We continue to have ongoing discussions. We had the opportunity - the former Minister of Labour, Skills and Immigration and I were able to attend an event in 2022 where we announced that we would be increasing coverage - the presumed-to-be occupational diseases for firefighters from 6 to 19.

 

There is a national framework on cancers linked to firefighting, and it was released in October 2024. There is some ongoing work that's happening with that. Right now, I don't have anything to announce about that.

 

We have a good relationship with the firefighters, and we have heard from them. That document is being reviewed in the department.

 

ROD WILSON: I looked at the bill that expanded WCB compensation for injuries after they have occurred related to occupational illness. It was pretty unanimous, and I think it could easily be unanimous support for the cancer screening. I offer that out there. Again, they're not complicated tests. Get a coffee and get it done.

 

One quick question and then I'll switch the rest of the time to look at the document, the Estimates. First question I have before we get into that is, how many collective agreements does the Department of Health and Wellness have outside of the doctors' master agreement, which doesn't expire until 2027? Are there any that either have expired or will expire in the coming fiscal year?

 

MICHELLE THOMPSON: That's something that we'll table in future. I don't have it at my fingertips. The collective agreements that we have negotiated over the last number of years have a variety of different lengths. Some are two, some are three, et cetera, some are four. It's not something that's just at the tip of my fingers. It can be tabled at a later date.

 

ROD WILSON: Having done some program planning, one of the challenges - and I'm curious what your response was or how the minister or the Department of Health and Wellness approached it - we saw the population grow between 2001 and 2023 by about 72,000 to over a million. As you look at these Estimates for the coming year, what have you factored in in terms of population growth, if any impact that might have on the Estimates?

 

MICHELLE THOMPSON: Yes, there would be some recognition around population growth, not only within the province but Canada Health Transfer payments as well. We would look at that, but, again, we also have to look at program-specific investments - the number of people in Seniors' Pharmacare, the number of people getting the continuous glucose monitor in the Insulin Pump Program. All these different things have different demographics. Yes, we do look at population growth, but we also know that each individual is unique and the burden of illness and complexity can vary. There are some variances that are not captured fully by a population. We look at our utilization numbers that are predictive in nature in terms of what we think of - there's a population, but then the utilization as well.

 

ROD WILSON: The rest of my questions will speak to line items in the Estimates and supplementary details, so I'm just checking to make sure, Minister and deputies, that we're on the same document.

 

THE CHAIR: Thumbs up? All good?

 

The honourable member for Halifax Armdale.

 

ROD WILSON: Perfect. Obviously, Section 15 is Health and Wellness. I'm looking at Page 15.2 under Strategic Direction and Accountability. Down that first - Strategy, Performance and Partnerships: there's a significant difference between the estimate for 2025, the 2024 forecast, and the 2025-2026 estimate. What is that, and why the difference?

 

[8:00 p.m.]

 

MICHELLE THOMPSON: Under the Strategy, Performance and Partnership, that includes a staff complement that had been moved around a bit. It also includes the Patient Access to Care Act. There is some money designated there as well for the Physician Assessment Centre of Excellence, our contributions to the pCPA program, some salary increases, those types of things. That kind of waxes and wanes based on what we have in front of us in terms of departmental projects.

 

ROD WILSON: That describes what it is, but it is an increase. What's the goal with that increase?

 

MICHELLE THOMPSON: The increase is around $5 million, and so the Patient Access to Care Act and the Physician Assessment Centre of Excellence is roughly $4 million of that, and the remainder are other salary increases, as I said, pCPA program, those types of things - really around the utilization of that standing up our PACE clinic.

 

ROD WILSON: Again on Page 15.2 under Service Delivery and Supports - I am quite excited about this one, so I am curious more than anything - Emergency Health Services is going up in this Estimate. I am just curious as to what that is.

 

MICHELLE THOMPSON: This is EHS. The majority of that number actually is collective agreement requirements. Operational things like lease removals, fleet preventive maintenance, those types of things. This is really operational funding and the majority of that would be around negotiated items in the collective agreement.

 

ROD WILSON: Excellent. That sounds like good news. I now turn to Page 15.3 under Funded Staff, Total - Funded Staff, top line. Forecast for 2024-2025 was 240 and the estimate for 2025-2026 is 289. Again, why the difference in - what's the deliverable?

 

MICHELLE THOMPSON: You'll notice the 2024-25 estimate and then the forecast is actually really essentially what it was because there were some vacancies in the department. The 2025-26 is our estimate.

 

ROD WILSON: I now turn to Page 15.4 Programs and Services, Office of the Minister, looking at FTEs, I see 11.6 and 17. Why the difference?

 

MICHELLE THOMPSON: It's actually our communications staff who work with the Department of Health and Wellness. They have been brought into the department.

 

ROD WILSON: I now turn to Page 15.6 under Programs and Services, on Page 15.6, Corporate Strategic Administration, the forecast was $766,000, the 2025-26 estimate is $1.810 million. What is that, and why the change?

 

MICHELLE THOMPSON: It really is just a movement of staff. You'll notice under - there's new - it's just a movement of staff to new items, new budget lines. If you look at the bottom, the estimate last year, 2024-25 was 116. It's really only 3 additional FTEs. It's just moving when we realign the department.

 

ROD WILSON: Further down, again, just curious, Policy and Corporate Operations is increasing between the estimate, forecast, and the estimate this year. Why the change there? What's that?

 

MICHELLE THOMPSON: A couple questions ago, you asked about Strategy, Performance and Partnerships. That was on page 15.2. This is just a breakout of that. It's the same breakdown.

 

ROD WILSON: Moving to 15.8, both look like good news stories. Longitudinal Family Medicine, I was - helped - involved in that. I know it as the Blended Capitation Model. I see it's increased, which looks like good news, although the forecast was 182 of 118.

 

I guess the question I have - again, highly supportive of the Blended Cap Model. The minister may have told this earlier today or last week. How many - I'm assuming most of these Longitudinal Family Medicine may be either in private practice or joining a collaborative care group. How many - and pardon me if I have already asked the question. How many community collaborative practices does the Department of Health and Wellness - the minister - hope to have up and fully at capacity by the end of the fiscal year?

 

MICHELLE THOMPSON: In Spring 2024, there were 103 collaborative family practice teams or health homes that operated under the Nova Scotia Health Authority. In 2025, there are 115 teams. We're increasing by 12 teams, and there may be - hopefully - more expansion over the year, but the expectation is there'll be 115 teams.

 

ROD WILSON: Okay. Sorry.

 

MICHELLE THOMPSON: The hope is that we will be at 134 by the end of 2025 fiscal - 134 teams.

 

ROD WILSON: Just so I understand - it's all good news - 134 total, not another 134, so about another 20. Okay.

 

Roughly - again, all good news, highly supportive. Is there a standard template to each one, and what might be the standard cost to provide that service? Is there a standard template for a community collaborative practice and the cost from start up to a year of function - a year of practice?

 

[8:15 p.m.]

 

MICHELLE THOMPSON: There would not be a standard cost per se. It would depend on whether we're growing a team or starting a team, what the space is like, whether it's equipped, not equipped, et cetera. In the settings, we look predominantly at doctors, nurses, nurse practitioners, and other health professionals like social workers, dieticians, pharmacists, and OTs so that they can work in the same clinic. I think that's probably the beauty of the model, that we don't say, Thou shalt have this, this, and this. It actually allows us to be a bit more community-specific and practice-specific. There are a number being built across the province. They're all unique, is what I would say.

 

ROD WILSON: Turning to Page 15.9: Pharmacare, one big question that's looming is, with the Pharmacare agreement potentially under way in negotiations - and I know there are eight different types of Pharmacare: there's Seniors', special drugs, there's HIV, there's MS, there are about six specialty drugs in there, PrEP. What might the Department of Health and Wellness be anticipating how this whole budget's line and services might change? How might it change, should we reach a Pharmacare agreement?

 

MICHELLE THOMPSON: That's quite difficult to answer, because we don't have those negotiated settlements in place yet. There's just a variety of different things. If we looked at, as an example, the diabetes care program, we already have a stand-alone CGM program, which isn't necessarily captured fully.

 

It's not really that easy for us to know exactly until that amount is negotiated, for us to understand really what the final impact will be.

 

ROD WILSON: As far as I know, PrEP, which was introduced - antiretroviral prevention for HIV - the Pharmacare coverage was introduced in 2018, maybe early 2019. The recommendation of the day was universal coverage. Based on evidence in B.C., the government of the day decided to do Pharmacare qualifications and Pharmacare eligibility versus universality.

 

If you look at the HIV rates of new infections in Nova Scotia, they haven't really dropped in the last eight years. There was a small spike, but the number hasn't really dropped. I also know that my colleague, the member for Halifax Citadel-Sable Island, brought on at least once, if not twice, a vote for universal coverage based on the fact that the evidence shows that universal coverage has a much better outcome. The cost would be about $300,000. I'm curious that, given the cost - we also know the evidence says preventing one case would save about $250,000. That's really well documented.

 

I'm curious why PrEP - why the vote against it, based on the evidence that so clearly - and based on seeing that the PrEP that's being offered hasn't reduced the HIV infection rates in Nova Scotia over the last four years?

 

MICHELLE THOMPSON: PrEP continues to be available through our Pharmacare program with the usual deductibles and copayments. It's one of the prongs of supporting community. We look at a variety of different things. There's just been a pilot with pharmacists prescribing PrEP. The College of Pharmacists is including that in the scope - looking at how we can improve access, and also trying to expand testing kits, et cetera.

 

I think what I would say is there are so many demands on the system. There are lots of requests. Every year, incrementally, we try to do a few new things. This year we're in a position where we could add RSV and we could add a shingles vaccine. We do what we can. We always wish we could do more, but incrementally we try to increase access and improve benefits across the board.

 

There's nothing in this year's budget for this. We're going to continue to do things the way we have, but we're interested in the information that's garnered from that feasibility study of the pharmacists prescribing PrEP. It is on the radar in the Department of Health and Wellness, but there is no change in the program this year.

 

ROD WILSON: I guess I'm still a bit perplexed. The evidence for the last 10 years has been overwhelming, and the cost - when I was involved in that program costing it out - the difference between Pharmacare and universal was less than $500,000, but the evidence was so overwhelming that if you provided universal coverage, we could reduce the HIV infection rate by 50 per cent in Nova Scotia.

 

Incremental is great, but it almost feels like the evidence is being ignored, so I have to press on this. It's low-hanging fruit to me, in terms of good medicine and prevention. Again, I'm just surprised - incremental for something that's so well-documented and implemented in other provinces is surprising. Help me understand why not.

 

MICHELLE THOMPSON: I just explained why not. We've been trying over the last number of years to incrementally increase a number of things. This year, folks would say arguably Shingrix should have been covered long ago. There are other things we were able to do this year. We looked at high-dose flu last year. We're looking at a variety of different things. We've looked at CGM and expanded those programs. We've introduced Meningococcal B for certain populations.

 

I appreciate the member's point, but we have a finite number of resources. We're trying very carefully to increase services to the best of our ability on an annual basis.

 

It's on our radar. We're aware, but there's nothing in this year's budget for that. We're going to continue to offer it through Pharmacare. We're going to continue to understand how we can increase access through pharmacists. Maybe in future there will be more to say, but this is what we're able to do this year in the budget. I do appreciate the member's question.

 

ROD WILSON: Turning to Page 15.10 - again, whenever I see funding going up, I think it's a good idea. I just don't know what it is.

 

I'm looking under Other Programs, Page 15.10. The description of the program is a bit vague, but I'm optimistic. Increase in acute and primary health care, I'm not questioning the number, just questioning: What is it, and what's the desired impact?

 

MICHELLE THOMPSON: It's actually wage increases for Nova Scotia hearing and speech centres - an increase in operational costs and wages, and also increased wages for St. Anne Community and Nursing Care Centre.

 

ROD WILSON: Thank you. That's a good-news story.

 

Another potentially good-news one, but I'm just curious as to where the resources are going: Communicable Disease and Prevention is substantially increased in the estimate this year. I have to applaud the direction. I just don't know what direction it is.

 

MICHELLE THOMPSON: The federal funding for COVID vaccinations has stopped, so that would include our RSV vaccine, our shingles vaccine, and our COVID vaccines.

 

ROD WILSON: On that matter, a question I have - that's excellent news - is related to COVID swabs and testing. I know the strategy was changed in about October, that there is an inventory here now. What's the plan for the COVID swab inventory over the coming fiscal year?

 

[8:30 p.m.]

 

MICHELLE THOMPSON: Really, we're at a place now where we're living with COVID. It's certainly going to stay with us for a long time. Of course, obviously, we want people to be vaccinated, particularly high-risk groups, but we will stay with the current way in which we're managing tests now.

 

There are limited supplies in community. If you're high-risk, you can go on and do the assessment and follow the testing page to see if you're eligible. You can pick up tests, or you can potentially have the PCR. We don't perceive any change whatsoever in our current strategy with COVID.

 

ROD WILSON: Almost there. 15.11: Programs and Services. I'm curious about Other Acute Care Expenditures. The forecast is much higher than the 2025 estimate, yet the 2025-26 estimate is lower than the 2024-25 estimate. Could you explain to me what that is and why?

 

MICHELLE THOMPSON: That's mostly the health transformation budget. We can expect that, over time, that will continue to come down a bit. In the beginning - this is our fourth year of being in transformation - developing the plan, the implementation stage in those early days was more intensive, and now we're more in that stabilization phase of it all. An example would be patient access and flow. You can imagine during procurement and those types of things, there would be an up-front cost, but we're now getting into regular utilization. It's health transformation.

 

ROD WILSON: Another one that just seems a bit vague is Page 15.12, under Programs and Services, Other Acute Care Expenditures. Again, discrepancy between the estimate for 2025, the forecast, and then the estimate this year. What is that and why the discrepancy?

 

MICHELLE THOMPSON: Similarly, it would be the same - just around stabilizing that transformation envelope. It's a nominal amount, really, in the overall budget - $200,000.

 

ROD WILSON: Not to test, but just out of curiosity, can you explain that a bit more?

 

MICHELLE THOMPSON: Similar to the previous question, when we start transformation, there's always that initial cost: you're planning, developing, implementing. This is simply coming back into normal operations. We use the example of access and flow. These different ways in which we're doing things differently have to become part of normal operations. Often costs are higher up-front but will actually drop a bit and then plateau over time.

 

ROD WILSON: The minister will be happy to know that, given the hour, while I have more questions, I'm going to defer to my colleague.

 

THE CHAIR: The honourable member for Cape Breton Centre-Whitney Pier.

 

KENDRA COOMBES: I have a couple of questions for the minister. The minister and I have had this conversation before, so I want to follow up. Individuals experiencing miscarriages that are under 20 weeks are often not sent, for example, to the Cape Breton Regional Hospital but are sent to another local hospital emergency room.

 

I'm just wondering if this practice has ended or if it still continues.

 

HON. MICHELLE THOMPSON: There's a variation here around zones, but I will speak about Eastern Zone. The Highland Community Midwives offer miscarriage support through clinic and home visits. Miscarriages occurring after 20 weeks are offered a perinatal clinic follow-up, and those before 20 weeks are managed by family physicians or OB/GYNs. Miscarriages past 20 weeks are supported by a family/newborn unit.

 

I will say that recently - probably in the Fall - I was at the quality day for the Nova Scotia Health Authority, and there actually is a pilot project out of Northern Zone where they're looking at miscarriage support and doing some evaluative data on that.

 

KENDRA COOMBES: I just want to follow up further. I'm talking more about where (inaudible) refer to. For instance, I will get personal. In my case, I was taken by ambulance, experiencing a miscarriage. I was sent to Glace Bay Hospital because they would not take me at the Regional, because I was under 20 weeks. However, they did send me to the Regional because I needed gynecological care. My question is: Why are individuals experiencing miscarriages being sent to, say, a local emergency room rather than the regional emergency rooms, where there is gynecological care?

 

MICHELLE THOMPSON: I think that really depends on the situation for individuals. There are some miscarriages under 20 weeks that are absolutely devastating, but they can be cared for locally. When there is a more complex situation, then they should go on to obstetrical care and gynecological care. There are also individuals who get to stay in their home community, and they get to have care from a practitioner they know. I don't think there's one cookie cutter, but I will say that they're looking at a pilot on pathways to inform by first voice to improve the experience for individuals.

 

KENDRA COOMBES: I cede my time to the member for Halifax Armdale.

 

THE CHAIR: The honourable member for Halifax Armdale.

 

ROD WILSON: Not one to throw in the towel, I wanted to ask a question I asked yesterday and never heard the answer. It's a good-news question: Given how demoralized people are feeling in emerg, I asked yesterday: Would the Minister of Health and Wellness be prepared to visit our rural emergencies - Guysborough, Canso - and just say, “I'm here, how are you doing?”

 

HON. MICHELLE THOMPSON: I visit hospitals all the time, on a very regular basis. So I'm happy to do that. Sometimes I'm probably in some of those places too often.

 

ROD WILSON: I just want to say thank you for doing that - it makes a big difference - and thank you for your patience and questions over the last two to four days. I've lost track. Thank you so much.

 

THE CHAIR: The honourable member for Sydney-Membertou.

 

HON. DEREK MOMBOURQUETTE: I was going to cede my time to the member. I'll take a few minutes. My colleague from Cumberland North may have a question left before we finish. We also want to make sure you have enough time to - through you, Chair, to the minister: How much time do you need? (Interruption) Good to know. A couple of years of practice.

 

I'll take a few minutes just to talk about the ER at the Regional. There have been some pretty heavy concerns coming from the Regional Hospital, just in messaging that we're hearing from the community around wait times. I mentioned this to the minister, so this isn't meant to be a question to put the minister on the spot. It's a concern with most of the ERs in the region. We're hearing - again, I don't have the details in front of me, but we've heard we've lost a number of doctors who were involved with the ER at the Regional. There are some safety concerns as well, when it came to some aggressiveness over the last couple of days with patients.

 

My question to the minister is: Are they looking at any new steps at the Regional Hospital in Sydney to address what we're hearing on the ground when it comes to wait times and some of the other concerns? I believe - and correct me if I'm wrong - the wait times at the Regional in Sydney are the highest in the province.

 

[8:45 p.m.]

 

HON. MICHELLE THOMPSON: I know that there certainly have been some staffing challenges there, but there have been some attempts to improve. The Rapid Assessment Zone model is available there, which I think has been very helpful. A split flow, renovations, waiting room attendants, and waiting room care providers have helped and a focus on off-loads. I know that staffing has certainly been a challenge, not only nursing but physicians.

 

Again, we continue to work in the zone. It's great that there is a nursing school right there and certainly there has been some luck with recruiting some internationally educated nurses there, and what have you. It's a work in progress, there's no question about it, but we will keep slugging.

 

DEREK MOMBOURQUETTE: My next question is: Can the minister provide a breakdown of how many new doctors have come to Cape Breton and how many have left in the last year?

 

MICHELLE THOMPSON: I should have known. I should have had a tab for Cape Breton. It's okay. I will get that for the member. It's a great question. I know anecdotally it seems that there are a number of people coming in through the Nova Scotia Facebook page and those types of things, and certainly my conversations with the MLAs from down there, but we'll be happy to get that.

 

DEREK MOMBOURQUETTE: Thank you, and I could have been more specific about that, Chair, through you to the minister. A breakdown of - I don't just want family doctors. I was looking for doctors and specialists in all areas. I know Cape Breton - if you could provide - CBRM is so much bigger in the sense of it being a municipality, but if you could provide a breakdown of CBRM and then the Island, that would be great.

 

My next question is kind of the same question around nursing. I know the minister will probably not have this and she can respond if she does, so it'd be great. Could the minister provide a breakdown of the number of nurses who have started in the CBRM, a breakdown of the number of nurses who have started across Cape Breton, and how many nurses have left the profession?

 

MICHELLE THOMPSON: We'll get that information but it will be Eastern Zone. We'll do it by the zone, not just Cape Breton. We have to tuck the rest in, just a little, if you don't mind.

 

DEREK MOMBOURQUETTE: Is that for the doctors as well? All right, we'll have to figure out the information from the Island.

 

There's only 11 minutes left. I appreciate the minister's opportunity to answer some of my questions. I'm going to cede the last 11 minutes to my colleague, the member for Cumberland North.

 

THE CHAIR: The honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: My last few questions that I'd like to ask the minister today are around governance. I'm wondering if the minister can let us know, is there any plan to reinstate or to put in place a new Health Authority board.

 

The reason I ask that question is because if you read the Health Authorities Act, that is how the governance structure is laid out in the Health Authorities Act, that there is supposed to be a board of directors governing the Nova Scotia Health Authority. I'm wondering if the minister can provide an update for us today.

 

One of the reasons I think this is important to have an answer for is that there are certain committee structures that came off that provincial board, specifically for things like safety, quality, quality management. Without having the board and those board committees in place for the Nova Scotia Health Authority, there's been some concern that there have been some deficiencies without that governance structure in place.

 

At a grass roots level what we're hearing, myself and other MLAs in the province, is when patients come to us, or family members, with concerns and complaints and they issue that complaint through the Nova Scotia Health Authority, not everyone is getting a response.

 

Going back to quality control and knowing that that is actually a committee that comes from the governance structure of the board and without the board being in place for over three years now, I'm wondering what is the department's plan for that?

 

HON. MICHELLE THOMPSON: We recently appointed a new administrator to the Nova Scotia Health Authority. Under the Act, the Act allows for an administrator, other than a board. For the foreseeable future we'll continue to use that model.

 

I will say as well that the current administrator has a long history in health care, the individual has a nursing background and actually was the CEO of the Canadian Patient Safety Institute for a number of years so we're in good hands. That administrator functions as a board would function and certainly has a background that allows them to look at the quality and safety information that comes, amongst other metrics as well.

 

Certainly the patient feedback line is part of that information that we get, and folks are able to phone that line, but they are also able to email as well. For the foreseeable future we'll remain in that model.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister for letting us know and giving us that answer. I'm wondering if the minister can let us know the plan - now that we know the administrator is going to be kept in place - what is the plan to ensure the governance structure of the committee work that was part of the Health Authority's board of directors, for things like quality assurance here in health care, quality improvement committees as well?

 

In line with this question, I'm wondering if the minister can speak to her government's plan around local decision-making in health care. We didn't hear much about this in the last election but in the previous election that was one of the platform pieces, to bring back local decision-making in health care. It was also brought up for schools as well and we didn't see that.

 

This is an important issue. It matters in small communities, Chair, that people know there's someone they can go to when there's a problem. Years ago, under the direction of Premier Hamm, there were nine health authorities in the province. Some would say that was the best model of health care that we've seen. Certainly, most people don't want to go back to what we used to call in health care “the Savage days”. Those were really rough years here in the province. Under the direction of Premier Hamm, there were nine health authorities. Each health authority had their own CEO and their own local board. The local board was made up of local community members. If there was a concern around staffing, of nursing or doctors, or problems consistently with the hospital, community members knew they could go to those community health board members and share their concerns. Now there's not that same governance structure. People can call their MLA offices, but that's not the same. It's not the same as when you have local community members.

 

Under Premier McNeil, when he brought it in in 2013, when he took that away and brought in the Health Authorities Act a year later and centralized health care, he removed those nine health boards and brought in one health board. Now, there are no health boards - there's no local or central. There are no health boards here in the province at all providing any community representation in our health care system.

 

I just want to add a little note, just to give you an idea. For any of the MLAs here who are from small communities like I am, you might be able to understand or relate to how your people in your area would feel if this happened. Our regional hospital - a long hallway when you came in - had the pictures of all the former chiefs of staff, all the physicians, for years. It was something that people were proud of. It might have been from back in 1990 or 1980, and you would reminisce about that medical chief of staff. A few months ago, all those pictures were removed from our hospital. It really upset the local staff and the local foundation - even a picture of former Premier Roger Bacon, who happened to be the chair of the hospital when our hospital was built. He chaired the foundation to raise the funds for Cumberland Regional to be built. Even his picture was taken down. When someone asked why, they said, Oh, it's fire code. No, it was to do with COVID. They said that it was infection control. I don't know, Chair.

 

The reason I make that point is having local community engagement and local decision-making does matter. I'm asking these questions because they matter to the people in my area, and I believe they matter to the people around Nova Scotia. They also matter from a governance structure. I'll bring it back to the very first part of my question and leave two minutes to close.

 

What about the quality control committees and those governance structures that were in place as part of the health board that were removed three or four years ago and now we're hearing are not going to be reinstated?

 

MICHELLE THOMPSON: I want to assure the member that there are local folks in most of the hospitals who are the site managers and who are working really hard, as well as community organizations. We do want local voices and certainly we work at a zone to make sure that the needs of communities are addressed, and the community health boards as well.

 

THE CHAIR: Shall Resolution E13 stand?

 

The resolution stands.

 

Shall Resolution E31 carry?

 

The resolution carries.

 

[9:00 p.m.]

 

THE CHAIR: Order. Seeing that there a minute and a half left, I ask, is there unanimous consent to deem the four hours concluded? It is agreed.

 

The time allotted for consideration of Supply has elapsed.

 

The honourable Deputy Government House Leader.

 

MELISSA SHEEHY-RICHARD: Chair, I move that the committee do now rise, report progress, and beg leave to sit again.

 

THE CHAIR: The motion is carried.

 

The committee will now rise and report its business to the House.

 

[The committee adjourned at 9:01 p.m.]