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4 avril 2019
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HALIFAX, THURSDAY, APRIL 4, 2019

COMMITTEE OF THE WHOLE ON SUPPLY

4:32 P.M.

CHAIR

Suzanne Lohnes-Croft

 

THE CHAIR: Order. The honourable Government House Leader.

 

HON. GEOFF MACLELLAN: Madam Chair, would you please call the continuation of Estimates for the Minister of Health and Wellness.

 

THE CHAIR: The honourable member for Cape Breton Centre.

 

TAMMY MARTIN: Madam Chair, I would like to talk to the minister now about mental health. Not everyone is afforded the same opportunity to get help with mental health; we have limits on how much public help people are eligible to receive. There are serious inequities in access to mental health care in our province. We essentially have a two-tiered system where people who have decent supplementary health insurance can get access, and some who do not have that privilege struggle with long wait times, if they can manage to get through the door. Not everyone is afforded the same opportunities to get help, period. We have limits for both - people who have access, people who have good benefits, and people who don’t.

 

Madam Chair, I would like to ask the minister: Could the minister point out what money is in the budget to walk us back from this mental health crisis that we’re in, and possibly two-tiered system?

 

HON. RANDY DELOREY: As I have previously indicated, and I will again, I sincerely thank the member for bringing this theme, this topic, of mental health to the floor of the Legislature. As we all know, it’s an area of the health care system that I believe all Parties and all members of this Legislature, regardless of their political affiliation, take to heart. We all recognize the stigma that continues to persist and exist around mental health and addictions. I believe we all sincerely work to address and reduce that stigma and increase acceptance and support of those who are suffering from mental illness and addictions.

 

The member asked specifically about investments in mental health and addictions. We are spending just under $300 million just within the health care system on mental health services. We are making investments specifically in some initiatives that we think are very important to help, as the member noted, address perhaps some of the root causes to help, as the member said, walk back from the challenges in the mental health and addiction space. Some of those investments include our investment in the Kids Help Phone, expanding access to the online chat services.

 

Madam Chair, two important things about that - we’ve had the Kids Help Phone, in terms of a service that’s well recognized across the province and beyond, but when I met with them they provided me with information based upon the services and the information they’ve been tracking about the services they provide to Nova Scotians. One of the things that was flagged, or identified for me, was that Nova Scotia youth actually utilized the technological interfaces, the chat interfaces, more than they do the traditional phones, in a way that is actually on a per capita basis or is higher on a per capita basis than many other jurisdictions, so ensuring that we have investments because that’s a way that youth do reach out to begin the care for lower acuity but also to help them identify, and identify if they need more supports and direct them in the appropriate way.

 

I think in the mental health and addictions sphere it is well known, clinically anyway, whether it is as well known in broader society I don’t know, but the earlier that one identifies the condition, has it diagnosed and receives the treatment, the better the outcomes. That’s why we target programs and initiatives, and particularly towards youth, so that we can identify as early as possible and provide those supports before the condition becomes too acute. We can introduce coping mechanisms and techniques and the tools needed to help those youth support themselves, to make sure they have those supports around them so their conditions may not become more acute.

 

I want to be clear; we do recognize that mental illness is a chronic illness. Often when people suffer from mental illness it is lifelong, like addictions - mental health and addictions, I should say both - that you live with. You may be well for an extended or shorter period of time, but the risk of having a recurrence of your illness still exists. Those coping mechanisms and those skills, not just for coping when you’re not well but also to be able to identify when your mental health is beginning to deteriorate to know, as part of those coping skills and mechanisms, to reach out and where to reach out and so on. That’s why we’re targeted towards youth, because we do that and, as a society, we become more capable as individuals to support and have the tools and so on, see less acute conditions coming into our system.

 

Even though the investments are a large part, continuing to spend in our main mental health and addictions services, many of the new initiatives are targeted towards youth because we believe that’s preventive and supportive and will pay dividends not just for those youth but so that those youth don’t have a lower likelihood of having a more acute condition, it reduces the pressure on the higher acute mental health services which will support people within the entire mental health and addiction services.

 

Some of those other initiatives we’re investing in, about a little over $1 million expanding and supporting our youth health centres in schools. A big part of this is a recommendation that came to us from a panel on mental health. Right now, I believe it’s four or five schools across the province that we’ve been working very closely with some experts to assess and give feedback on a standardization approach. We’ll be evaluating how this rollout works in those schools to then determine how we can best roll that out to other existing youth health centres across the province.

 

I’ve mentioned in this House before - the CaperBase, or the adolescent outreach model that we announced an expansion of, and they now have more access in about 41 or 42 additional schools across this province because of a $1.25 million investment. The member for Cape Breton Centre would be well aware, I suspect, of the CaperBase program and how Dr. Stan Kutcher came back from a visit in Cape Breton, where he was evaluating mental health and addiction services and that was a big recommendation because he said everywhere he went, from the clinicians in the hospital system to parents, to youth, CaperBase was flagged as a model that was well respected and had positive outcomes, and he looked into it further and recommended that this type of adolescent outreach model should be expanded in the province, and we did that this year.

 

There are other investments to our First Nations communities. We’re spending just under $900,000 - $896,000 to be more precise - to fund eight mental health clinicians in First Nations communities in the province. We do this targeted investment in communities that we know have broader mental health and addictions challenges than the general population on the whole. We do this because it’s the right thing to do.

 

We continue to invest to establish the Central Intake program, just under $1 million. That Central Intake program is designed to ensure that the process is standardized and best practices for when people reach out, that they get the same assessment and treatment regardless of where they are in the province. It also allows for the central point of contact; no door being the wrong door. We want to know that, because we’ve recognized that one of the most difficult things when presented with mental health or addiction is actually for the individual to recognize that they need help and to reach out.

 

In far too many cases in our current system people reach out and then they get redirected somewhere else, and that’s the motivation behind a central intake so that the system, when they reach out, they’re able to fall in behind and ensure they help navigate the individual to the appropriate resources. Rather than simply redirecting, they actually support them in making sure they get to the supports that they need.

 

Mental health crisis expansion, $1.6 million, and SchoolsPlus, we’re spending $6 million on clinicians in the SchoolsPlus program. These are just some examples of investments and monies that we’re spending as part of that almost $300 million going towards mental health and addiction services to really help make sure that we provide the care that Nova Scotians need and deserve.

 

TAMMY MARTIN: Madam Chair, I’d like to ask the minister about the crisis line that he spoke of. How many people called the crisis line last year and what is the average number of calls per day?

 

RANDY DELOREY: Perhaps for the sake of ensuring we get to the most questions possible, I don’t have the data right here with me, but we’ll certainly reach out. If I get it, I’ll perhaps interject at a later point during our discussion today and perhaps the member could move on and we’ll delve into the next question.

 

TAMMY MARTIN: Thank you to the minister for that response. What are the health outcomes for people who use the crisis line and where do they go when they’re being referred? What happens next - who do they contact after the crisis line?

 

RANDY DELOREY: The answer is it kind of depends, much like showing up at emergency departments, what path you take really depends on the condition for which you show up. Similarly, with the crisis line, what really happens is when you call, you should be assessed. There are trained people on the other end of the line to complete an assessment based upon the description, whether it is the individual themselves, or a loved one, a family member, a friend who is observing and calling to report an individual in crisis. They should be assessing the information they’re provided by the person, the individual, who has initiated the call. From there, they determine what steps may follow next.

 

[4:45 p.m.]

 

In the event that there are crises, they may engage and have a crisis team dispatched to the location where the crisis is being had. That’s really mostly in the central region where they have the crisis response team that can actually be dispatched to a location to help. This is an important aspect. They’ve done work on that. Again, we’re talking true crisis here, situations where when they’ve done the assessment, they believe in that immediate kind of intervention and they have teams to do that.

 

In addition, they may just make the recommendation and connect with crisis teams to go in and support emergency departments in a regional facility if necessary, so they can respond if someone shows at an emergency department. They can have a crisis team go and support and step in at that location.

 

Then there is work in the mental health crisis response expansion. There are efforts being made to have a rapid follow-up by mental health clinicians when someone is discharged from an emergency department. If someone does show up at an emergency department, obviously they’re being assessed there for their condition and a decision is made as to whether the nature of the condition requires admittance or a discharge with a referral. Some of that is to have a follow-up. Again, some of these investments are going to ensure that they get a rapid assessment follow-up.

 

We know sometimes the volume of calls are high, so there have been more investments in the crisis line as well to ensure that there is no more than a 30-minute delay in following up. If there’s a high volume, they never want those calls to be any longer. Obviously you want the length of time if the lines are busy and all of the clinicians or people receiving the calls are busy, they want to get back to people as soon as possible, because the absolute thing that we want to avoid is someone reaching out for help and feeling like there is no help for them. We do have investments and they’ve added staff to try to shorten that delay time.

 

The other thing I would advise, or perhaps let the member know, is the crisis team - I know some representatives for the crisis line - actually came into our caucus, so perhaps the members of the other caucuses could talk to their Leaders and caucus chairs to see if perhaps they would like to reach out, if they could get more information as well directly from them on exactly the different scenarios, because I think they’re certainly more well-versed than I am on the specific details of when someone calls, how exactly that flow- through works and in what situations. They could ask them perhaps more specific localized questions there as well.

 

To the member’s earlier question, I do have some updates. It may not be all the information that they’re looking for. The number of interventions, we have more on a monthly basis, so I don’t have them totalled up, but just for example - in August 2018, there were 1,898 interventions with the crisis line, but in the most recent month I have, which is January 2019, it was down by about 100 - 1,799 - so it’s still high. Of those interventions though, unique callers, in August, was at about 720.

 

Although there were almost 2,000 calls, they were return calls by some callers, so unique Nova Scotians who have used the crisis line in August 2018 was about 720 and that was down to 685 in January of this year. I think for mobile responses to calls, there were about 82 in 2018 and 101 in January. First-time callers to the crisis line are relatively consistent, about 30 per cent of the unique callers, so just over 200, about 220 callers in both August - and that’s relatively constant throughout the months there. First-time callers who had not used the service within 60 days, so either first time or have not used it within 60 days, was about 70 per cent of the unique callers, which is about 500 of the callers, and that’s 506 in August and 497, so roughly that 500 range.

 

Interventions from the HRM environment, so those total calls that I’d mentioned earlier were about 1,900 in August 2018. Just over 1,200 of those 1,900 calls came from HRM, and of the 1,800 in January, just over 1,300 of them came from HRM. The vast majority of people using the crisis line are coming from the HRM or Central Zone and the interventions are also disproportionately connected there. By the other zones, I guess these are just the interventions, not the calls. Outside of the Central Zone - sorry, I guess these are the calls, so you can do the math from the difference there but it’s about 200 of the calls are from outside of Central Zone kind of consistently across the months, and then there’s data in average answer time when someone calls - the average answer time is about a minute that someone gets connected.

 

I talked earlier about the investment saying we didn’t want people waiting. There may be times where there is a higher call volume. The effort is to ensure it isn’t 30 but the average answer time in this data says it’s about one minute to answer. The vast majority of the calls are, but there are sometimes outliers based on certain circumstances. Every effort is made to be as responsive as possible because as I said a few moments ago, the absolute most important thing is when someone reaches out for help, whether for mental health or an addiction, someone needs to be there to answer that call and help navigate and let them know that someone is there, someone is listening, that they are cared about, that they are important. I think that’s an important part of ending the stigma and ensuring the first step of getting them connected to the care that they need.

 

Before the member asks her next question, although I’ve highlighted some information and this is specific on the crisis, we do know that more work needs to be done. We do in the acute and I do know in the member’s own community, in the Sydney area, of the vacancies of the psychiatrists for those acute services. I’ve met with the psychiatrist from Cape Breton from early on. I had multiple meetings, read through, discussed in person various proposals and I’m very proud and appreciative of those psychiatrists who continue to work in the Cape Breton Regional Hospital knowing that there are a number of vacancies that have been vacant for a period of time.

 

They continue to go above and beyond to serve those people in their community, but I hope they equally appreciate the efforts that we’ve undertaken to implement many of the recommendations that they’ve made, not steps that I’ve taken and gone with a flashy news release or anything, I’m just doing these initiatives on the ground. I’ve mentioned them only in responses to people’s questions predominantly because we’re just trying to get stuff done. We’re trying to respond to those concerns on the front line and some of those recommendations came from Cape Breton. They were good ideas that support Cape Breton, but they are also applicable in other parts of the province - things like clinical assistants for those psychiatrists in areas that have higher vacancies, like the Cape Breton region and the Northern Zone, so the first two clinical assistants.

 

That took some time to get in place though because we have to get the college to recognize this model of care to license and oversee them. We’ve got that in partnership with Dalhousie and the NSHA, but it’s in place, they’re being trained now and so they’ll be in the ground, we hope, in the next month or two to help those psychiatrists while we continue to recruit to fill them.

 

The fact that the vacancies haven’t been filled does not mean we’ve forgotten about Cape Breton; in fact, we’ve been taking other steps like those clinical assistants, like some additional investments. We’ve changed our locum programs and incentives to encourage other psychiatrists from other parts of the province or elsewhere to go and support the Cape Breton psychiatrists. We’ve seen uptake. There are psychiatrists who are going now, since we’ve made those changes, that were not going previously, so there has been some support filled in because of some of those changes.

 

Then, of course, leveraging technology for those psychiatrists in other parts of the province who may not be able to travel to Cape Breton, but they may have the time to do some consults through video or teleconferencing. That’s being done and leveraged, both for adolescent youth with the IWK and at the Nova Scotia Health Authority.

 

We are taking these things very, very seriously and operationally trying to get as many supports - multi-pronged, different ways, and taking suggestions we’ve heard right from the ground and getting them implemented. It’s going to take some time, but we are making those efforts.

 

TAMMY MARTIN: I appreciate the response from the minister. I would ask though if the minister could talk a bit more about rapid assessment and how quickly somebody would actually get into counselling or therapy.

 

RANDY DELOREY: For the rapid assessment program and the team there, I don’t have off the top of my head the exact work that they have been working towards, but broadly, earlier this year - I believe in January - the Nova Scotia Health Authority updated the mental health wait times website. So the wait times that are posted online now include - and I believe we’re the only jurisdiction in the country, only province, territory, in the country the last time I checked - that does post our wait times across the province for the entire jurisdiction. There are some specific facilities in other jurisdictions that post wait times, but not an entire jurisdiction.

 

The standards or goals that they work towards, which are also outlined - this data is part of the wait time, so that when you’re looking at the wait time, this is what those wait times are being assessed against. In an emergency situation, the objective is to have no wait time - that when you show up and you’re in the hospital that you get the emergency care and service that you need. Of course, an emergency situation for mental health conditions, just like physical health conditions, we want to be assessed and treated as such.

 

In an urgent context - not an emergency, but urgent - it’s within the week. For a regular or non-urgent, it’s within 28 days or three weeks for non-urgent mental health and addiction wait times. So again, the emergency, no wait - same day; urgent is a week; and regular, non-urgent conditions would be about 28 days. Again, there are wait times, they’re not hitting those targets in all of the situations, but the percentages and the data that shows how well they are doing to hit each of these are posted to the website, and I believe that data is updated quarterly.

[5:00 p.m.]

 

TAMMY MARTIN: I’d like to ask the minister now, if the minister could tell us: How much federal money is in the budget this year for mental health and what programs does that support?

 

RANDY DELOREY: From the bilateral agreement with the federal government in Health and Wellness, it’s about $11.6 million that’s going towards various programs. Where we’re directing some of those funds includes programs with expanding our youth health centre programs and the CaperBase, many of the problems that I’ve talked about, those ones that we’re able to target and invest in. We are leveraging federal funds to ensure that we’re able to get those programs, especially the newer ones like the expansion of the adolescent outreach model off the ground the way they’re supposed to. We’re able to move faster and expand faster than we would have otherwise without the federal investments to support us.

 

TAMMY MARTIN: Where can we see this in the budget - is it within the NSHA and the IWK specifically?

 

RANDY DELOREY: I don’t know that the specific programs are broken down in the budget document at that level of detail. The funding, because the programs are run by different entities, so some of these services are run through the Nova Scotia Health Authority. Although from a federal perspective the funding flows from the federal government to the provincial government, we identified the programs that we think we can invest in or expand and then we move them to the party that delivers it.

 

Some funds go through us to the Nova Scotia Health Authority, some to IWK. Some of these funds show up in many different specific budget line items. I’m not aware that the budget document’s details actually go down this level to the very specific program level though, to follow the bilateral, but again, certainly we and the federal government, a big part of the bilateral agreement was for the federal government working with us to assess our outcomes and so on. That’s part of what they want us doing, monitoring, so we have to know what we’re doing and why we’re doing it. Again, these are programs targeted towards youth. I think the federal government shares our belief that investing early, investing in preventive, investing to have those supports and tools early will have the best bang for our buck, so to speak, for long-term investment in our mental health and addictions system.

 

TAMMY MARTIN: I wonder if the minister could table a document that lists specifically what the federal funding pays for or what program.

 

RANDY DELOREY: Madam Chair, I think some of the information is already posted publicly when we did the announcement and the bilateral, but I’ll endeavour to pull together a document that we can table with that information as well to provide either through Estimates or provide to the member when we get it pulled together for her.

 

TAMMY MARTIN: Sadly, it’s very disheartening to hear the minister’s numbers, to think how many calls are coming in from people who need help. I find that staggering and to be called - and I know I’ve said this in the House before - by a mum on Friday afternoon at four o’clock telling me that her daughter is going to commit suicide and what can I do to help her, it’s a terrible place the world that we live in right now to think that our numbers are increasing instead of decreasing and I would suggest that the most money that could be spent to help kids early on like I would suggest . . .

 

THE CHAIR: Order. Time has lapsed for the NDP. We’ll move to the PC caucus.

 

The honourable member for Inverness.

 

ALLAN MACMASTER: Thank you, Madam Chair. Thank you, minister and staff for having the opportunity to ask some questions. I could ask a thousand, but I only have one tonight.

 

Madam Chair, through you, the question is about Foyer Pere Fiset in Chéticamp, a nursing home, and they have made requests recently for some capital work - namely, bedpan sanitizer, some replacement beds, roof repairs, plumbing repairs, and air-quality improvements.

 

Last summer, it was quite hot. We know we hear about the winds in Chéticamp, Les Suêtes, but it was a pretty hot summer last year and I know the air quality was not great and so one of their requests was to make improvements so that in future situations they could keep the residents comfortable.

 

Plumbing repairs - I know the facility is moving towards being 50 years old and, in terms of the plumbing repairs, there have been leaks which have caused areas to be closed in the nursing home and for people to be compacted into other areas because of that; bedpan sanitizers - to me it seems like something very basic for the health of everybody so that there is a bedpan sanitizer to help those working in the facility to make sure there’s not the spread of things like C. difficile; roof repairs - I think the roof is in pretty good shape but there are valleys in the roof where they have been experiencing some leaks; and the replacement beds as well, but all this to say they seem to me to be very basic capital needs for the smooth operation of that nursing home.

 

Can the minister confirm if, within this budget, funds are going to be made available to Foyer Pere Fiset to make these improvements that have been requested?

 

RANDY DELOREY: Merci, Madame la Présidente, et merci à mon collègue pour la question. C’est vraiment important à tout le monde that long-term-care facilities are maintained to provide the environment that the residents and staff can support. As I understand, the request from the facility in question has been recently received and it is being reviewed by staff, but a final review and recommendation on the request has not been made so there isn’t an allocation specifically because the review hasn’t been completed. I want to assure the member that a review that hasn’t been complete is not the same as a decision not to invest.

 

We do have funding set aside for long-term care facilities, the Continuing Care program, to ensure that we also respond to capital. Some is planned capital; some is emergency capital requests that are needed in facilities. While there may not be a specific program or investments targeted specifically to the request, that does not rule out the possibility for the opportunity for funding to be advanced through this fiscal year if deemed appropriate, but the review just hasn’t been completed yet.

 

ALLAN MACMASTER: Mr. Minister, I’d like to turn the remainder of our time over to my colleague, the member for Northside-Westmount, who is in the Pictou West seat here for those who are controlling the microphones.

 

THE CHAIR: The honourable member for Northside-Westmount.

 

EDDIE ORRELL: Thank you, Madam Chair, and thank you to the minister and his staff for allowing me to ask a few questions today. I will try to be brief. If the answerer will try to be brief, I will try to be brief. If not, we can have an exchange. I’m okay with that. I’ll make that agreement with you, Mr. Minister, if that’s the case.

 

The first question I have to ask is - I was in town last week for the announcement of the new emergency centre, cancer centre, and critical care centre, which is a great announcement, I think it’s fabulous. We’ve been talking about expansions to the emergency rooms in Glace Bay and Sydney and the talk was a 50 per cent expansion. But in that expansion, there are only 12 new beds being built at the regional hospital to replace both New Waterford and North Sydney and a bigger space and a wider space, I get that.

 

How are we going to be able to accommodate the increase in the amount of emergency room care with just 12 new beds to be added to that space, and where are we going to get the doctors for them?

 

RANDY DELOREY: Madam Chair, I thank the member for the question. I know how important this redevelopment is for the people of Cape Breton, the entire region.

 

The process that was undertaken as we announced in June 2017 was to establish a functional planning process, and that is to get a team together to look at the needs. They’ve reviewed the volumes for the region and like we’ve been doing, and we’re several years ahead so we’re able to actually move faster on the Cape Breton redevelopment based upon lessons learned as we’ve been progressing through the QEII redevelopment here in Halifax.

 

The teams are more familiar with the types of questions and how to engage and so on. It’s one of the advantages we’ve actually been able to advance work quicker because they know the right questions and work to be done and what they’ve really done and these were really engaging with the front line and assessing based upon what is the data and the population telling them the historical trends and that’s what has been used to influence, and then the team that’s charged with it made the recommendation in terms of the size of the facility’s work to government and I believe they had, from a functional perspective, the recommendations essentially the same but a few different configurations or options because the initial plan in June was we were going to expand inside of the facility - like just tack on and do renovations in the existing facility.

 

But through that functional planning process is what actually led to - well, we could do that as intended. This is what it would look like and they did say, but actually that work in the back end, there’s space in that parking lot to actually build the building a little bit more efficient to do that, but as far as the configuration and the size, the number of beds, that came from the team on the ground doing that assessment. That fed that into it and that’s what took place to identify, so we’re just taking the word of the people who are really the experts in the space to have the conversations, assess the information, and make a recommendation.

 

EDDIE ORRELL: Madam Chair, as you know, Northside General Hospital and New Waterford Consolidated are losing their emergency room space. They’ve been closed more than they’ve been open, as has the Glace Bay Hospital more because of staffing issues than anything I believe, or if it’s the intent to close them.

 

[5:15 p.m.]

 

I guess my ask is: With the regional hospital - until that new space is built - the regional hospital can’t handle that space, can’t handle the vast number of patients, the 10,000 patients a year on a limited opening of the Northside General, and I think it’s around 7,000 or 8,000 visits a year at the New Waterford Consolidated Hospital with limited time open. Glace Bay is now closed more than it’s open. The month of March, I think, it was closed 65 to70 per cent of the time due to lack of physician coverage - are we working on that physician coverage now?

 

Even the doctors working at the Regional say there are not enough right now to cover the shifts at the only regional hospital we have east of Antigonish - not enough to cover. That’s not including anybody who comes from the Strait-Richmond area that may need speciality services at the hospital but would come through the emergency department. Can we even look at, or get a commitment to at least try to keep two to three of the emergency rooms open at any given time? We just can’t handle the volume and having sick people who are scared to go to the emergency room because they’re sick, and there are sick people and they can’t afford to get sicker. Having them wait 10, 12 hours is not right, it’s almost inhumane.

 

RANDY DELOREY: I apologize. The member did ask essentially that part of the question in the first one as well. I would say yes, efforts are made to fill the shifts for the emergency departments. Obviously, the criticality of ensuring that the regional shifts are filled first is of utmost importance because of the nature of the services provided throughout that hospital environment at the Regional - as it would be across the province that our regional facilities need to be staffed and that’s number one.

 

Our community emergency departments following that, trying to make sure - whether that’s the complement of the physicians or the nurses which at times in different facilities, it’s different health care providers availability. That is ongoing, the Health Authority engaging with the staff and physicians to follow up when they try to schedule in advance to fill the shifts a month or two in advance as people are identifying that they’re going to have vacations or there are vacancies, to try to fill them.

 

That’s within the existing complement of health care providers in an area recognizing that obviously the pressures when you’re looking to recruit more to an area to help spread the workload around. Those ongoing recruitment efforts are happening, but knowing that until you get your permanent complements, a new physician will move into the community, it doesn’t really reduce the pressure on the existing complement of physicians.

 

That’s one of the reasons why we changed the emergency shift premium for hospitals as well as the locum incentive programs. We made changes to those over the summer, I think it was somewhere over 200, 220 shifts that were filled between August and January across the province because of changes that we’ve made like that. It’s not perfect, but that’s the kind of effort to try to get people, physicians, to come in and cover those shifts when there are vacancies, to help reduce the pressure while the ongoing recruitment for permanent placements is happening.

 

Every effort is being made to fill them, but until they’re landed, signed on the dotted line, it doesn’t get the bodies, the boots on the ground.

 

EDDIE ORRELL: Thank you for that answer, but with all due respect, I’ve had emergency room physicians in my office who came from other countries - one example, practised in Ireland for 25 years, trained somewhere else in the world but came to Cape Breton, worked here for two years under supervision with one of the doctors. The supervision left, took a new supervision on, he had no support in writing his exams, he had no time off to study for his exams, he had no resources given to him to help with his exams, he had to have supervision when he worked at the Cape Breton Regional Hospital but when he went to Glace Bay, New Waterford, or the Northside, he didn’t need that supervision.

 

He was quite capable of doing the job, but was told when shifts were open in these facilities that they didn’t need him over there because they were closing them anyway. They were being closed. With due respect to the recruitment part of it, the people we represent on the Island who have a doctor willing to work and is told by the Health Authority that he’s not going to work in these facilities because they’re planning on closing, or they’re closed anyway - a chance to open it for a day or two and they’re closed for a four- or five-day stretch.

 

Subsequently that doctor - anyway we won’t get into that - he didn’t write the exam because he did not have the support, and other issues came up. He’s now not able to practise anywhere in the country, or anywhere in the world, because he doesn’t have a member in good standing. I think that’s absurd that we bring people in from other countries and don’t give them the support they need because of where they practise in Nova Scotia. If they came to Halifax, they’d have the medical school, they’d have the library, they could get some time off to do that. If we could change that, and that alone would make a big difference in what we do and how we do it. That’s the stuff - please look into that.

 

RANDY DELOREY: In all sincerity, a situation like that has not been brought to my attention before. To the member’s last statement, the request if I could look into it, most definitely because that is concerning to me. If there’s an opportunity to maintain and keep it open with the staff and health care professionals to do that, who are willing to work the shifts, then I can assure all members of this Legislature, my expectation is that those shifts would be covered and open.

 

As we’ve said, the facilities are still operational in North Sydney and New Waterford until we complete the redevelopment project, which there’s still much work to be done. There should still be work being done and if shifts are able to be covered, they should be done that way.

 

In terms of the, I guess the context outside the closure piece, but about the support for, and what the member was referring to is the international medical graduates, just a little context for the physicians who are fully certified in jurisdictions that do not have, or are not recognized by the College of Physicians and Surgeons, the regulatory body, that would provide the licence in the province, that’s where the starting point of those frustrations comes from.

 

What happened was, in 2017, I believe, is when a policy change within the licensing stream of the regulatory body, the College of Physicians and Surgeons of Nova Scotia, went into effect. Historically, for I don’t know how many years or decades, the province and other provinces would be able to have internationally trained physicians come and they would get a defined licence, as I think the member is aware. When that policy change came, that’s when those other circumstances that the member flagged, became challenging. It introduced a requirement then, within a certain time period, for those physicians to write the national Royal College certification exam. That is where the member has raised the question of the supports to write that exam.

 

I just want to highlight that the changes in the requirement was not a government policy change, but rather a regulatory body change - one that certainly took me by surprise to be able to respond to that situation when people need to write. I guess if government policy had been anticipating, or if it had been government policy, we might have been able to have programs and things in place. I’ve heard it even locally in my own constituency, some physicians out of our regional hospital, some great people have been providing a lot of great support, that we’ve lost for similar circumstances as the member highlighted.

 

Unfortunately, we didn’t have the programs and supports there, but efforts have been made to improve that process. Just a couple of weeks ago, I met with the Doctors Nova Scotia president and executive director and this is one of the items we talked about because there’s a collaborative program initiative being done. I think they’ve identified a number of physicians who are in need of writing that Royal College, and they’ve been working with the Health Authority and the medical school to try to address just that gap of the supports that they need to complete their college licence.

 

Over on the government side, one of the things we’ve done and changed here in response to the college was the Practice Ready Assessment. It’s a new program that ensures that we have people set up for success rather than being set up for failure. The unfortunate reality is there are people, too many, who have been caught in that transitional period. That’s a problem the member highlighted, and we’ve been working on that but also working on the Practice Ready Assessment, so we have a program that ensures that when these internationally trained physicians come to the province they are set up for success, not for failure.

 

It is open, the website is available now and that was done in collaboration with the college, the medical school and the Health Authorities, and the department.

 

EDDIE ORRELL: I’m going to switch gears a little bit to the redevelopment program in Cape Breton that is going to build a new - I’ll say collaborative facility, for lack of a better term. I’m told that everything in the existing hospital now, except for acute beds and an emergency room, will exist in that afterwards. I’m hoping that’s the case.

 

I do want to ask, and it’s just a request and I’ve mentioned it to some of the people on the redevelopment team, we have no real, what we call “acute care” or “acute clinic,” a “minor injury clinic,” call it what you may. If we’re going to build this facility, can we have at least something in there that would be like an acute care centre, four or five beds? If we have a bunch of doctors who are going to come in and work in this collaborative centre - I’m hearing the number nine, if right or wrong, but at any given time there should be five or six within the building - if we could have an acute care collaborative type centre where a mother, a baby cuts her lip open, can go into this centre and get stitches instead of having to wait at the Regional, it could be manned by the doctors who are working the clinic because they could take an hour at a time, they would have a great flow of patients.

 

It would relieve the pressures on the emergency rooms that we have for people who don’t have a family doctor to go and get a prescription. It would be like a walk-in clinic, but it would be something that would be done in a new build. If there’s some way that we could put maybe a bed or two in there in case someone has to be in a hospital bed just for a couple of days to recuperate instead of taking up a bed at the Regional. If we’re going to do well with our surgeries and so on and so forth, recovery can be done in something like that for a day or two instead of having to stay - it would be great for our older senior citizens, they wouldn’t have to travel back and forth.

 

RANDY DELOREY: I guess first I want to thank the member for not just raising the request here on the floor but that he indicated he already provided to the team on the ground that has, or is in the process of collecting that information and preparing the recommendations back to government on the development for the community health centres in New Waterford and North Sydney. I believe the member is predominantly talking about the North Sydney site, I’m assuming that, based on his constituency, so I do appreciate it.

 

The work there, in terms of these larger primary care facilities, it’s true, we made the recommendation, you’d still be able to do things in there, like some X-rays and things or you can do urgent response, so I believe there are aspects of that. I don’t have a recommendation yet, but that’s certainly where the early stages thoughts were, so we’ll see the details on the specific clinical pieces that are going to come forward, but that was the broad model.

 

I think we’ve already shown our willingness to listen to the feedback both in the QEII and the Cape Breton redevelopment where preliminary assessment on the Cape Breton Regional, as we’ve said before, was to do an expansion within kind of the existing footprint and maybe add on a little bit in those different wings. But as they assessed, and they looked at the details and they determined what was going to be required, it actually made more sense.

 

[5:30 p.m.]

 

We have confidence in the team on the ground to assess the information to truly assess the feedback coming in and make the right clinical recommendations and recommendations to clinical and technical recommendations to us.

 

I think we have shown, as a government, our willingness to assess and make good decisions based upon those recommendations.

 

Again, I’m not going to stand here on the floor and pre-assume what the final recommendation is going to be, but certainly any input that’s been provided - that’s the goal. We asked for it in all sincerity and we will make decisions based on the information that comes forward.

 

EDDIE ORRELL: Thank you for that answer. I guess when you’re looking for written suggestions, I will make sure that that gets in that way.

 

I know Dr. Orrell is getting on that team, so he can have a voice in the medical side of it because they were complaining they didn’t have a voice as doctors in Cape Breton in what was going on. That’s great. I will have a chat with him, as well.

 

The new emergency room is great. Everything is good. We’re going to lose - we’re getting some nursing home beds. At first it was only 50 and I’m glad to see that in the budget it has gone up to 120, but that is still not going to handle the ones in hospital waiting. Anyway, we’ll get into that at another time.

 

We are going to lose the acute care beds at the Northside General, I understand they are probably going to go to Cape Breton Regional. Are we going to add any more acute care beds at the Cape Breton Regional Hospital in the space maybe where the emergency department was, or the acute care area was, or X-ray was? Are we going to add some acute care beds there because the beds we’re going to lose between the Northside and New Waterford we are going to need somewhere? We don’t have the beds to handle now, and if we don’t have them it is going to have an impact on surgeries, the lengths of stay, and they will be filled again with people waiting for nursing homes once people realize that.

 

Are we going to add any more beds to that facility?

 

RANDY DELOREY: At this point, the full functional plan on those bed counts through the two sites, New Waterford and North Sydney, haven’t been completed so the needs of how that fully rolls out hasn’t been finalized.

 

Those final aspects are not in place yet, but as the member would know, with the decision we made to build a new emergency department and the cancer centre, it does actually provide more space in the Cape Breton Regional, which gives us more flexibility for other parts of redevelopment, either directly, as part of this immediate redevelopment and/or future redevelopment initiatives, to make sure the facility does have the capacity to provide the services that are required by the community and the health care providers there.

 

Within the overall flow though, and that is important, is that with the emergency department at the Regional and all that growth for the services and critical units, it ensures that people with the higher acuity and acute needs are there.

 

Again, with the additional long-term care beds in those facilities and some of the opportunity for some innovation in those long-term care facilities with those long-term care beds, we are really looking at leveraging that part of the build in New Waterford/North Sydney to really set the stage for our continuing care/long-term care facility structure and we are really excited to see some potential for innovation there, as well. That, as part of the integration within the overall health care system, can actually provide improved outcomes and better patient flow for the residents too.

 

EDDIE ORRELL: Thank you, Madam Chair. I’ll have one last question and then I can turn it over to my colleague, but I may be back.

 

I do have to ask the question about the residency system. It’s personal to me now. It wasn’t when I started in this job, but now I have a connection.

 

I also have to say, in the budget I noticed they’re going to phase out grants to students where a program is offered in the province and they leave the province or leave the country to get some education, which is going to do us a disservice for kids that are studying abroad in health care that could get in here if they waited, but that’s not going to solve our problem with shortages. The amount we’re putting out, the amount that are staying, the amount that are leaving, not going to cover it just from Dal. If we can have some influence on some of the grants that would go out to some of these kids that are studying abroad, that’s something else.

 

My question to the minister is: Will he look into how we may be able to, I won’t say change the system, but maybe massage the system a little bit so that we can get some of our people who are from here that are studying abroad, that would like to be here? I’m not saying relax the rules, because I don’t want to see anyone without the qualifications come back. But if they’re qualified, they’re looking to come here and they’re willing to stay here, their education costs are costing government no money. They’re paying for it out of pocket. Is there some way we can look into it with the federal Health Minister, some of the other provinces, how we may be able to look at getting some of our own kids back? Maybe if not for a residency, helping them with their education a little more because they don’t qualify for anything, so that we’ll have more people want to come back to the province?

 

RANDY DELOREY: For the sake of time, I am quite certain, the member as he noted is familiar, so I won’t go through the process of the residency, because I believe he understands that. I will highlight just a couple things about what we have in the province.

 

First, I’ll clarify for the members here, when the member was talking about grants and education grants, I believe those are Labour and Advanced Education grants, not the programs and the supports we provide to medical students and tuition-relief programs and debt-relief programs we have in the province. Those are not changing. I just wanted to be clear for the members on that point.

 

The other thing though, one thing when I’ve responded to some of the questions in Question Period that I’ve discovered subsequently I wasn’t aware of before, because I know we’ve had this conversation a couple of times, we actually do have some residency seats that are reserved for international medical graduates. I think it’s three or four of the seats, I hadn’t realized that they were reserved. What that means is in the first round of the match, they are reserved, and I guess, the cost, so to speak, to the international medical graduate who gets one of those coveted seats, is they have a return of service, so that’s kind of the trade off there. The second round though, an international medical grad is the equivalent, there’s no disadvantage to an international medical grad in the second round.

 

It’s a really difficult policy place to be in because on the one hand, we have our medical schools, and it’s the medical schools that are quite involved and engaged with the CaRMS matching program and they’re working together to match the opportunity for the specific training. It becomes particularly important with the specialties and the sub specialties, because you can’t necessarily have them trained for these very specialized items everywhere. You sometimes have to have them only done in Toronto or in those larger centres. We rely on that and that’s why being part of that national residency matching program is important and provides a value, so it’s trying to strike that balance.

 

I can assure the member I’ve heard him, I’ve heard from other people, I’ve heard from some students who have gone through the programs. It is something that’s on my radar, to try to say what, if anything. Each time I ask the question and I delve in it’s like, have we thought of this? Have we looked at it from this way or that way? I am challenging. I think I mentioned it earlier in Estimates debate about my critical approach, I do challenge people within the department and other partners that come to the table. I don’t generally just take a no, I try to drive in and understand it. This is one that I’m trying to work through and see if there are some options, but it is a very tricky balance and I want to make sure we get it right.

 

I certainly hear and appreciate, particularly for those Nova Scotia international medical graduates - it’s unfortunate there aren’t enough seats for everyone. Nova Scotia, though - I’ll reiterate this point and then move on - of the jurisdictions across the country, the highest proportion of residency seats, and we are doing our part in making that available. It is more complicated.

 

We are nearing capacity for the number of residency seats that we can have because we need those preceptors, we need the supervisors to go with the residency seats. Between the expansion and our residency seats and the practice-ready assessment, which also requires supervisors, we are adding those pressures, those supports. We still rely on our front-line health care professionals, our trained physicians, to do those supervisory roles, so we do have a finite capacity to add more spaces. It’s not like we can just say, let’s put more in.

 

Looking, considering, trying to find that path within the resources and the capacity we have, so duly noted - if I can find a path, I’ll certainly work to get it implemented.

 

EDDIE ORRELL: Thank you. I’m going to offer that I am willing to be part of the solution, I’m not trying to be part of the problem. If there’s anything I can help with, I’m offering that to you here in the public and I’m not trying to be part of the problem. If it seems like it sometimes it’s because I’m passionate about what I do, I’m passionate about where I live and what I can do to help ease the problems of the people who are in my office who are crying because they don’t have family physicians. I’ll turn the rest of the time over to the member for Queens-Shelburne.

 

THE CHAIR: The honourable member for Queens-Shelburne.

 

KIM MASLAND: Thank you, Madam Chair, and thank you to the minister and staff for being here tonight. It is certainly a great opportunity to be able to ask some questions from my constituents in Queens-Shelburne.

 

The first question I’m going to ask is about Roseway Hospital. I know it’s shocking. As I’ve said to the minister before in Question Period and Estimates, I have two ERs in my constituency: one that has never closed its doors since it opened in the 1940s, and one that sadly seems to be experiencing weekly temporary closures. Actually, I think it’s closing at six o’clock tonight until tomorrow.

 

Roseway Hospital in Shelburne has been closed 730 hours just since the beginning of this year and nearly 1,000 hours in 2018. Shelburne, while it is not geographically isolated, it is in a unique situation that the access to health care services given are over 100 kilometres on each side.

 

My question to the minister is: Can the minister please advise what is in this budget that will give residents of Shelburne County reassurance their local ER doors will be opened instead of the continuous closures they have been experiencing?

 

RANDY DELOREY: I guess a couple of things, one through the investments that we’ve made perhaps in the past but it’s the operations side, with the primary care centre that just opened up this year provides the opportunity and part of the hope to reduce some of the lower acuity emergency care needs, that they can be seen and treated there and not have to go to an emergency department. That’s one piece of the path forward. I am pleased to have been able to make those investments and get that centre up and running to support those health care workers, those physicians in the community.

 

Other work that is ongoing and it’s really similar to not just Roseway but other parts of the province, finding temporary relief, so that’s kind of that short-term piece, were changes to our local incentives and emergency shift programs, so they are targeted to try to fill those hard-to-fill shifts when the local physician population isn’t able to cover those shifts.

 

We know in the province we’ve seen since we made those changes I think in about August or so, late summer, early Fall of 2018 - by about January, I think over 220 shifts were covered in different parts of the province, not just at Roseway. These are some of the things that we are initiating. I hope that shows to the member, and she can share with her constituents, that we’re listening and we’re implementing things. Rather than waiting until today to announce changes to the locum incentive program and the emergency shift premium, we made that change partway through the year last year. Those investments are continuing into this year’s budget. There isn’t necessarily a specific line item that says, this is Roseway, and this is the investment. We have been listening to our physicians and health care providers to try to better understand and make those adjustments.

 

[5:45 p.m.]

 

In addition to that, again broadly, we are at the negotiating table with Doctors Nova Scotia on behalf of physicians to negotiate the next master agreement around compensation for services delivered. That would be part of it. The details obviously don’t show up directly in a line item in the budget because the negotiations haven’t concluded yet, but they are ongoing. I look forward to coming to a conclusion with those negotiations and having an agreement that meets both the needs of physicians from a compensation perspective and for the people of Nova Scotia to ensure those physicians are available to provide the need in the primary care, emergency, and acute settings.

 

KIM MASLAND: I certainly agree with the member. The collaborative care centre that is there is a beautiful building and very much welcomed in the community. It’s very important that investment is made into locum programs. I know we have a wonderful husband and wife who fill locums at Shelburne. They need vacation too. They’re doing a great job. It’s very important to continue those investments. I’m sure the minister will agree primary care is primary care at the collaborative care, but emergency care is emergency care. Residents of Shelburne County really need reassurance that their doors are going to be open.

 

My next question is keeping on with Roseway. I have recently been notified that another lab technician has left Roseway, and there’s no advertisement for a replacement. I’m wondering if the minister could advise if the position will be advertised and filled; and to take it a step further, what is the long-term plan for lab services at Roseway Hospital?

 

RANDY DELOREY: I don’t have details on specific lab services at that specific facility. The operational side of the health care system in our hospital environments is managed and administered by the Nova Scotia Health Authority. That would really be an operational piece. I wasn’t aware of the lab tech departure because that would be administered and managed by the Health Authority. Every staffing change or departure in the health care system doesn’t get brought up to my desk.

 

My role and my level of engagement is really in the department looking at the data, the trends, and the policy side of saying, these are the types of things when we look at it. For example, on the primary care side, it’s the policy of government that collaborative care is what we see as the future development of primary care services because we see that as what new physicians and other health care practitioners, when they’re graduating, are looking to do if they’re looking to work in a primary care environment. It’s looking to the future, saying, if we stay with only a traditional model of primary care delivery, then we will have a harder time recruiting and retaining physicians going forward. It may not be that all physicians in the current system believe it’s the right model, but it is the policy position we have taken based upon the evidence we have looked at and the feedback we have received, in particular that it is the direction that new graduates have trained and studied in, so they expect to be graduating and working in that kind of environment.

 

That’s a policy that we make, and then it’s over to the Health Authority when they’re doing their hiring practices to implement that and ensure they provide those opportunities. Because it’s a new policy, it’s a shift in the way our system operates, we have also been providing the financial resources to establish these teams. In this year’s budget, we added $10 million to support the policy shift that we started with. The actual hiring of the physicians and the nurses and the other health care providers that support those collaborative teams are all decisions being made in the Nova Scotia Health Authority because they are operating the facility. That’s why sometimes I don’t have the specific answers on specific front-line hiring and site-specific details because that’s just broadly how the system works.

 

KIM MASLAND: I’ll move on to long-term care. It’s refreshing to see some of the nursing home replacements in this year’s budget, but of course, being the representative for Queens-Shelburne, I didn’t see anything about Roseway. I would have been over the moon to see that show up there.

 

In 2013, Roseway Manor was actually approved for replacement. Although that was well before my time, I have not seen a hint from government where this might go ahead. I actually toured this manor and I must say I left with a very heavy heart. There are buckets in the hallways collecting water, uneven floors that make it a hazard for seniors with restricted ability to even try to walk down the hallways, residents sharing bathrooms.

 

Although these amazing people who are working there put smiles on those residents’ faces every day, I was absolutely shocked to see the conditions they are required to work in, and of course, our most beloved seniors to live in.

 

My question to the minister is: Considering we didn’t make the budget line this year and the promise is still there from 2013, what are the plans for the replacement of Roseway Manor?

 

RANDY DELOREY: I thank the member for the question. No, I wasn’t surprised at all that the member would be delving into that particular area of interest. What I can say is kind of picking up on the last response, and I won’t restate it, but that policy kind of piece of it. One of the things when we came in in 2013, one of our policies in the continuing care space was to invest in the home care side of the continuing care equation, in part because we saw data that showed residents of long-term care facilities in Nova Scotia were staying much longer in the facilities than in other parts of the country.

 

When you say why is that and is that a good thing or a bad thing? As we looked at it what we were determining was it seems that we had fewer supports and so on to keep people in the home. What was happening was that in Nova Scotia over time our continuing care system did not have sufficient supports for home care to allow Nova Scotians to stay where many of them wanted to stay, if given the opportunity. In the absence of those supports they then had no choice but to go to a long-term care facility, which only increased the pressure and demand on our long-term care facilities.

 

We came in and said okay, we have this opportunity to have a more efficient system to make use of our long-term care beds while at the same time supporting people to stay where they want to be, safely in their home, by providing those investments in their home care system as that part of it. When you do that, you really don’t know at the front end, as you make those investments to address the wait-list for home care and provide those additional supports and investments - we made tens of millions of dollars of investments in our first term. Those investments were not one-time; those are the ongoing, increased capacity in our home care side of the continuing care.

 

We needed to make those investments and see how that then impacts and changes the system dynamics and the flow. We’ve seen some positive results. We’ve seen reduction in how long people are waiting on the wait-list, both in home and in hospital, so they are getting into those beds in long-term care facilities more quickly, I think 30 per cent to 40 per cent more quickly, than they were when we first came into government.

 

We obviously still have more work to do. We want to be able to improve and address that wait-list, so we’ll continue that work.

 

We did those investments, we’ve kind of seen the stabilization in that space and we’re seeing how that has played out in our long-term care facilities across the province. Now we’re at that point we’re saying now we have kind of the new flow within our system, now we can understand what those demands are on our long-term care facilities and we’re starting to see our commitment there to the Cape Breton redevelopment and looking at that facility or that region now, in part because we were looking at that region for the overall health system, and it just made sense to include those long-term care facilities and beds as part of that overall health system plan for that region. That’s how the decisions around Cape Breton’s expansion took place; and then the Mahone Bay and the Villa Acadienne were on the placement. We’re at the point now that we’re working on this to move forward, so we look forward to seeing the continued analysis and recommendations of facilities.

 

In the meantime, we do still continue to respond. The member for Inverness asked earlier this evening about a particular facility in his community, to review and assess specific capital maintenance requests and provide those funds on an ongoing basis, to make sure we respond. I also would be remiss if I didn’t touch on, not just the bricks and mortar in our long-term care facilities, but our commitment through the long-term care panel to the quality of care - great care that’s being provided by front-line health care workers. But we wanted to know what else we can do as government to influence and improve their work environment and the care provided to a long-term care resident.

 

That work is ongoing, and investments are being made there; the equipment being made for wound pressure - we use the mattresses and the cushions and other equipment - as well as the broader investment in other initiatives that will support the staffing and other pieces of the recommendations in the short term. The investments in this year’s budget to support the long-term care panel expert review is only for those short-term early stages.

 

There will be continued investments as we continue to address the medium- and long-term recommendations out of that panel’s report.

 

KIM MASLAND: I thank the minister for that response. As he well knows, I was a senior safety coordinator prior to becoming the member for Queens-Shelburne. I was in seniors’ homes in Queens County on a daily basis. It’s great that so many seniors have the opportunity to stay at home and age in place, it’s wonderful if they can do that. But I do believe that when it’s time for seniors to go to a long-term care facility, we need to make sure that it is a comfortable place for them to age in their last years. I look forward to seeing Shelburne, maybe in the same type of concept you’re talking about, for next year.

 

Moving on to Queens County, I mentioned earlier about two ERs, one that’s open all the time. Queens General Hospital has never closed its doors since it opened, I think, in 1947. Queens General Hospital is really feeling the pressure in its ER right now with the continuous closures in Shelburne. What used to be wait times of three to four hours are now nine to 12 hours. Our doctors and nurses are run off their feet and really feeling excessive fatigue.

 

I know the doctors and nurses at Queens General Hospital work amongst themselves to make sure they’re keeping those doors open. What’s happening to them is not fair. Right now, one doctor on a shift is seeing up to 60 patients a night at Queens General. Those people are coming from Shelburne, Lockeport, and even Lunenburg County actually.

 

My question to the minister is: What is the number of doctorless patients being seen at the ER in Queens General; where in the budget can we find some help for these doctors and nurses at Queens General, so we are not put in the position of temporary closures happening at Queens General Hospital?

 

RANDY DELOREY: I don’t have that right at my fingertips, data on the number of ED visits by patients that are unattached to a primary care practice. I believe there was recently a FOIPOP on that and there’s been some public information; I’m not sure if the Queens site was reflected in that FOIPOP data or not. We’ll take a look if the data is readily available and try to get that to the member.

 

[6:00 p.m.]

 

Regardless of that particular data point, the question, I think, underlining the member’s question is exactly that. I’ll phrase my interpretation this way: What is being done to improve the situation or reduce the pressures at emergency departments? I know the member is asking specifically about Queens, but really, we’re looking at this because it’s occurring in community hospitals and regional hospitals in other parts of the province as well, so we’re looking at this as a system approach and not just in individual hospitals.

 

Again, as I had mentioned I think in the first response, one of those things - because one of the early comments we had as well - volume of emergency responses is going up. One of the first things I was advised when I came in as I started saying well, okay, let’s look at this emergency challenge that we have in these communities, but a lot of the emergency visits are lower acuity and they have a clinical assessment called CTAS score, and so they’re the lower acuity ones on that score. When you get triaged, you get assessed in terms of how high. Those lower acuity ones, those less-urgent assessments, would be the things physicians would say that you don’t necessarily need to be seen in an emergency department if you have that primary care access. You reduce the pressure on your emergency department as you strengthen your primary care access.

 

That’s why for the last number of years, we’ve been focused on improving our primary care access through in part, the investments in our collaborative practices and the recruitments and initiatives. For example, when I went to Roseway in 2017 as part of my first trip around the province, I spoke to one of the physicians and he stressed or pointed out, I suppose, that at that time they had, I think, with the four physicians, that was the highest number of family physicians they had in the community for many years. That work to improve that primary care coverage has had some positive effects. Unfortunately, the comment was, but that’s not translating to maintaining. Although they may have had fewer primary care providers that change in the work environment, that move to collaborative teams, you’re not always getting the physicians working in the emergency department, they’re working differently.

 

It just introduces that challenge to have those same physicians who in the past in some of our rural communities, would work the shift at the office, a shift with the emergency department, do their rounds on a regular day and then they would do their shifts in the emergency departments as well. That’s not the way that you’re seeing new graduates and newer physicians working in our health care system.

 

We’re continuing to work to identify the approach to ensure we respond to that change in the industry. It’s a pressure point that’s changed and is not unique to Nova Scotia. It’s happening right across the country.

 

We really believe in these investments and supports to stabilize on the primary care side. We’ve seen some improvements with the investments. We’ve seen that plateau in the people signing up for the Need a Family Practice list, so we’re seeing that that’s starting to happen now. We look forward to continuing that. We think with the negotiations, some of the things being discussed at the table again - we’re working with Doctors Nova Scotia to hopefully ensure the compensation program is the appropriate one to help with retention and recruitment of physicians. But as I said to one of the other questions, we didn’t wait until the contract was done, the master agreement. Last year we made some investments and changes to the way we compensate to help address those things and get more people attached. Changes to the rate, we increased the office rate for fee for service and alternative payment plans quite significantly, for those providing comprehensive primary care.

 

I think the fee for service went for something like $32, $33, or $36 - a fairly significant investment for every office visit, when you attach, and you have a long-term relationship with your provider. We also provided an incentive so if you have an existing practice, for this one-time incentive you take someone off the 811 list or take some of the patients from a retiring physician, you’ll get some additional compensation there, as well.

 

We’ve done some of those things last year and those investments continue into this year’s budget. These are some of the things, but we continue to look at those opportunities to improve the efficiency.

 

You would have seen recently where the Health Committee talked about the off-load time at emergencies. Part of the work that is ongoing with the Health Authorities is actually not just about the off-load, that is kind of that first step to be specific, but it is looking at how we then improve the whole flow of patient care and get those efficiencies in our system.

 

One of the things we’ve done at the policy level for government, was a policy decision to implement a new program. It started in Cape Breton, and is called the Community Paramedicine Program. The intent behind that is to see improvements, to see people discharged from the hospital more quickly. If you can get someone discharged from the hospital, that’s an opportunity for someone else to come in. The Community Paramedicine Program can allow people to be discharged a little bit earlier - discharged safely, this is critical - and have the paramedic go to the home and help them with those post-discharge, until home care is set up and provides that, or VON, or whatever care they might need. They get discharged in the Community Paramedicine Program. That’s a fairly new program, but these are some policy changes we are making to help alleviate that side that should allow them, but the NSHA is still looking at other opportunities to invest in.

 

To the specific question, I just got the number of unattached ED in-patients for the Western Zone. In 2013, it was 8,432; in 2017, it was 5,906.

 

THE CHAIR: Order. Time has lapsed for the PC caucus.

 

We will turn it over to the NDP caucus for one hour.

 

The honourable member for Cape Breton Centre.

 

TAMMY MARTIN: I’d like to continue with mental health.

 

The World Health Organization suggests a target of 10 per cent; a 10 per cent increase to the mental health budget. Six years have passed since the Mental Health Strategy for Canada recommended that mental health spending increase to 9 per cent of overall health spending.

 

The Canadian Mental Health Association says Canada’s health care system is unbalanced, with lower treatment rates for mental health conditions; premature mortality of people with mental health problems; and underfunding of mental health care relative to the scale and impact of mental health problems.

 

If the Nova Scotia Government just wanted to achieve the average national level of funding for mental health, it would have to add almost $40 million in new mental health spending. If it were more ambitious and decided to chase the recommended 9 per cent target in the national mental health strategy, Nova Scotia would need to find another $115 million to add to the already $287 million it will spend on mental health and addictions this year.

 

I have two questions for the minister: Has the minister read these recommendations and, if so, does the minister agree that we need to be making more investments in mental health?

 

RANDY DELOREY: While the breakdown of mental health and addictions investments specifically in the Department of Health and Wellness is a percentage of the budget of the Department of Health and Wellness, it may not reach that threshold.

 

What is missing out of the calculation is the investments in other parts of government, and in our society, through initiatives like in the education system, Community Services Department, and other departments that also support mental health services and supports for Nova Scotians. Not all investments to support the mental wellness of Nova Scotians take place through our health care system.

 

Notwithstanding that, to the specific question that the member asked about increasing investments in mental health, what we’ve been doing is continuing to increase our investments in mental health services and programs in Nova Scotia because we believe this is a priority area for government.

 

We know we have more work to do. We knew we had more work to do last year, so we’ve made more investments this year and we are going to continue to work to tackle and make improvements as a province in responding to the mental health care needs for all Nova Scotians. That’s an important priority for this government and for me personally.

 

TAMMY MARTIN: Recently, the NSHA wrote, “Collaboration is underway across Central, Northern and Eastern zones to establish a model of psychiatric service delivery, using technology, to address the current psychiatry vacancies in the Northern and Eastern zones,” and, as mentioned earlier, significant shortages in the Cape Breton area with, I believe, 16 psychiatrists - 11 vacancies. That’s better than what I thought.

 

Can the minister provide some detail about how much money is being spent on this new service delivery model with psychiatrists, and whether or not that work is being contracted out to a private firm?

 

RANDY DELOREY: There are a number of different things taking place and some of it is working with third parties. When the member says is it outsourced, things like I’d mentioned, Kids Help Phone has a technology component of support, that would be outsourced. It’s a third party providing that care. We do some mental health services, outsourced through an organization called Strongest Families Institute. Again, outsourced, but there is a technological component to it.

 

I think that portion that the member was delving into is more on the acute side of it and attaching or providing opportunities to use that technology to connect with specialists, psychiatrists in other zones.

 

I don’t have a direct dollar figure to that, but it’s really targeted towards taking those specialists at the IWK Health Centre, for youth and adolescents, and having them connected through video conferencing, for example, with other parts of the province. So two advantages: the specialists are in their offices providing the care without losing clinical time to travel; while, at the same time, the family members don’t have to travel to receive the care - as they do their assessments, many of them can be done virtually, and determine if an actual in-person visit would be necessary, or a referral or not. That is also being looked at, I believe, in helping expand the availability of assessments virtually through the NSHA and adult mental health care. But I don’t have the specific dollar amount broken down to that particular initiative at this point.

 

TAMMY MARTIN: Maybe I’m just, I won’t say old because I’m not, but I wonder if I’m just not technologically savvy when I wonder, if my loved one or anybody really, could get the correct or the best care or assessment, virtually, maybe my head’s just not there yet, but I just wonder how that would go.

 

Is this program being used by youth in Cape Breton or is it just for adults? I guess the evidence is out there, but for me personally, I guess I’m just more of a hands-on kind of person, but has that been substantiated?

 

RANDY DELOREY: Actually, there’s been quite a bit of work and research around the use of digital services to support mental wellness. Generally, the evidence that I’ve been shown has shown very positive outcomes for engagement and, in fact, there are a number of areas assessing, as I’ve mentioned, the Kids Help Phone, and I guess, let me put it this way, I’ll say to the member for Cape Breton Centre - and I’m being very careful, Madam Chair - she may not have made use of these services herself growing up.

 

However, as I believe I mentioned earlier this evening, the data from a long- established organization providing virtual telephone care - for example, when I was growing up, the Kids Help Phone - you see the public service announcements and TV ads and different flyers and ads. As a child, although I’ve been privileged enough not to have ever called in, I’ve never used the service myself, I was certainly aware of it. I knew the service was there if I needed it and I believe I understood why it was there. I would hope that had I needed it, I would have been aware enough and recalled enough to make that outreach.

 

[6:15 p.m.]

 

What I’ve seen though, and I only became aware of this since becoming the Minister of Health and Wellness, that in Nova Scotia the Kids Help Phone service offerings have expanded and they have an online chat option now, so advancing with the ages and technology. Again, they are actually seeing the growth and in Nova Scotia, fortunately our youth are engaging, and they are choosing, when given the option, traditional telephone has been around and getting care, to chat and interface. They are choosing the technological and texting, typing interface with those clinicians to get help.

 

I guess just to help as I understand some of the technology, number one, I think the member has demonstrated her awareness of health care from her own past experiences, work in the field, that she knows that in mental health and addictions that step and probably the most critical step, is for the individual to reach out for help. That is a critical step on the path of wellness, whether it is for mental health or addictions.

 

If our youth or our citizens are responding to the technology as the first entry point to engage in our health system, it’s important to have those options there because they are responding, even if it’s not the model for all the care, it is a model to get them into the system to show that there is a system and they can address it.

 

Now where the research is very strong is for certain conditions, so is it right for all conditions and for all people? Not necessarily, but the research is growing and evolving and shows very promising and positive results for particular conditions, like anxiety and conditions like that, very positive results coming from the engagements. You are seeing it being adopted here.

 

We know that Labour and Advanced Education is working with our universities and has rolled out and is rolling out a program there for wellness and those technologies to do that, again do have outcomes and are being received. I guess just to put it in context, in a way I guess to look at it from another perspective, when one asks whether technology can have a positive impact on one’s mental wellness. Sometimes what I ask people is, cyberbullying that takes place using technology, I believe most of us here have had conversations about this and we’ve seen tragic results that have negatively impacted one’s mental wellness through the use of technology.

 

If technology can have a negative impact on one’s mental wellness, it would seem reasonable the evidence that shows that technology can also have a positive impact on one’s mental wellness is equally possible. I use that as an illustration for the member to say yes, the research is showing positive results through the technology. Again, particularly types of mental health conditions, so it’s important to continue to pursue these advances in technology and clinical treatment options.

 

TAMMY MARTIN: I’m curious, if this new technology that’s being used by youth in Cape Breton and are being sent to Halifax, will adults use that as well? Is it for one or the other or for everybody?

 

RANDY DELOREY: Programs like Strongest Families, the Kids Help Phone, and so on would obviously be targeted towards youth, the Strongest Families towards families, so parents and caregivers can get involved in that area.

 

We announced in our budget some investments to expand some services to work on a pilot with Strongest Families, a pilot to target it towards caregivers so that it provides a program for caregivers. As we know, the stress of caring for a loved one in their home can be stressful at times, especially for those Nova Scotians - as they call it, the sandwich generation, when you still have a young family but you’re caring for an aging parent as well. Your time is being pulled in both directions: getting your children to their sports or recreational activities and school and homework; while at the same time, helping your parents stay in their home and care for them.

 

We do know there’s lots of data on the pressures and the stresses for caregivers. Strongest Families is there for people, but it’s not just for Cape Breton. This is a program we’re piloting for caregivers in Nova Scotia through Strongest Families.

 

The video conferencing piece though, that is more in the hospital environment, so this is one really in the clinical hospital side. I believe the IWK and NSHA both have some video conferencing capacity to make some connections. I don’t have data though on exactly how much of that is taking place specifically in Cape Breton or across the province, but it is a move and an effort is being made to develop the relationships and clinicians have to connect and work together to have those sessions take place between the jurisdictions through the video conferencing technology. It’s the move towards finding those opportunities to connect more people and leverage the special expertise we have in the city to parts of the province outside the city.

 

TAMMY MARTIN: People believe or suspect this is a move to get away from recruiting psychiatrists, that everything can be done virtually or on the phone or texting, those other means. Is there truth to that or are we still recruiting while we’re using these other methods?

 

RANDY DELOREY: We continue to recruit, I believe the vacancy of psychiatrists in Cape Breton stands at 11. Although the technological programs like the Kids Help Phone, Strongest Families, and things like that, those investments are taking place regardless. We want to provide as many options where youth are comfortable so that they reach out. These would be often the lower acuity and maybe a youth in crisis would reach out but at least the professionals on the other end of like the Kids Help Phone would know then how to connect and direct that youth to the appropriate resources they might not otherwise be aware of. They’re very important to be there and they work as part of the continuum or the suite of programs and have been around for a long time.

 

I think where the member would be flagging the concern is in terms of that consult and video conferencing, a psychiatrist through video conferencing in Halifax, if it’s being done to replace and it’s not. It’s actually being done to support those psychiatrists who are working short in Cape Breton right now. For the Eastern Zone, I believe the vacancy rate is 11; I think it’s eight in the Northern Zone. I read the numbers off earlier on a previous day in Estimates.

 

Recruitment is still ongoing for those sites and, in fact, part of our commitment to 15 specialty residency seats, at least three of them are dedicated to psychiatrists. There’s a youth, an adult, and a geriatric psychiatrist, so three different psychiatry positions to serve each of the age groups. I know there are at least three. What I’m not remembering in those recruitments is if it included multiple in any of those categories because we do know there’s a need. Part of that need is driven by the workforce availability across the country. The need exists across the country. I do believe personally that part of that is driven by the success we have had as a society in reducing the stigma around mental health and it’s a positive and negative thing, simultaneously.

 

We needed to, and we need to do more, and we need to continue to address the stigma, so the people are comfortable coming forward and asking for help, not being judged for asking for help; not being told, if someone has depression, telling them, don’t be so lazy; just get up and get going. Unless you’ve suffered from depression, not truly being able to appreciate or understand, they want to get up; they want to engage with their families; they want to go to work. They can’t, and they don’t know why they can’t.

 

Unless you have suffered through it yourself or you’ve seen a loved one do it - suffer through it - I don’t think you can truly appreciate what it means. That traditional “pull yourself up by your bootstraps” kind of post-war mindset is not in the best interests of achieving a mentally healthy population.

 

As we’ve seen improvements, again it’s not fully resolved, in reducing the stigma, we are seeing more people reaching out. But the system wasn’t prepared for that, is what I think is a contributing factor. So, we need to ramp up those training opportunities and that’s why Nova Scotia has responded by adding additional residency training seats; to positively contribute to the supply of psychiatrists for our population. It does take time, though.

 

We are responding to the needs and we are taking multiple approaches to doing that.

 

TAMMY MARTIN: Sadly, well, not sadly that I would agree with the minister, but sadly I do understand, and it is true. It’s nice to see that people are more willing to admit that. I always say it’s like being a diabetic. If you are a diabetic, you need insulin; if you have a mental health issue, it’s the same thing. It’s just now being accepted, though, in order to be able to say that out loud without being ridiculed. You know, like you said, suck it up and get on your way.

 

Following along that line, I wonder if the minister could tell me, how much is being spent on e-mental health programs this year?

 

RANDY DELOREY: We don’t have a line item for that specifically because the nature of the programs and investments are kind of scattered in different pockets throughout the program.

 

Just some examples, there is an investment of about $1.5 million to provide for the use of some technology in IWK youth mental health treatment network supports; some clinician supports to provide mental health and addictions capacity; that Strongest Families Institute pilot that I mentioned, there is a $300,000 investment there.

 

Again, I don’t have a specific line item that says, explicitly for e-mental health services, because we have them in different programs and different buckets allocated throughout the budget. But those are just a couple of examples and really these become kind of part of operational costs. Like video conferencing isn’t its own program, it’s just some technology that exists, and our hospitals already had video conferencing technology. It’s really about the scheduling and getting people connected and comfortable in using and leveraging that technology to make those consults together. So it’s not really a need for new investment. It’s a need for a new way of working together across the province.

 

[6:30 p.m.]

 

One of those advantages of having a single Health Authority - really, whether you’re working out of Cape Breton or you’re working out of Yarmouth or Halifax, you’re all part of the same health system serving the people of Nova Scotia. We want to have our skilled health care workers working to their scope of practice providing care to Nova Scotians who need it, wherever the Nova Scotian or clinician is located. If there’s an opportunity to do that remotely and fill a need and help support those who are on the ground, we want to take advantage of it.

 

Again, I just don’t have a specific line item, but it is a shifting model and we are leveraging and looking for those opportunities to expand when it makes sense to do so.

 

TAMMY MARTIN: Knowing that university is a difficult time for so many, especially if they’re moving away - even if they are going to St. Francis Xavier University and only a few hours away - is the e-counselling program that’s available for university students under this same umbrella?

 

RANDY DELOREY: No, the university-based program to support university campuses is actually part of the work and the support with the Department of Labour and Advanced Education, because it is the universities. It’s similar to how much of the investment in our school systems is done in partnership with Education and Early Childhood Development. Sometimes those budget items are - although policy-wise, it’s executed through the department, because it makes more sense to do that.

 

With the Department of Labour and Advanced Education, their relationship with the universities - the Department of Health and Wellness really doesn’t have that main mandate connection with them. So rather than having universities start to build a second doorway into government, we believe it would be more efficient to do it at the Department of Labour and Advanced Education perspective. I think the investment in that program for the universities on the mental health initiative is about $500,000.

 

TAMMY MARTIN: There is mounting evidence that it’s crucial to have a wide age range when designing mental health programs for youth. Young people are falling through the cracks when they leave school and they’re no longer eligible for youth mental health services through programs like we talked about with SchoolsPlus.

 

One of the major objectives of the ACCESS Open Minds service transformation currently happening at sites across Canada is to eliminate transitions based on age - that is, to make sure that rapid-access mental health services are available to young people until they’re 25.

 

I know that $1 million is included in this budget to continue funding for 11 mental health and addictions staff to support an adolescent outreach program in 41 schools in western and northern Nova Scotia. If I could just clarify, are the services provided through those school-based programs available to people over the age of 18?

 

RANDY DELOREY: That adolescent outreach model that the member just referred to - that program and that investment - is the expansion of what already exists, and was modelled off something in her community in Cape Breton, in the Sydney area: the CaperBase model. These investments are rolling out in the adolescents targeted. That’s new for us in Nova Scotia. We’re rolling it out in the school system.

 

We recognize that transition point even within the school year itself. The concern raised by the member about a transition period from youth to adulthood - we also recognize that the value of using our school system is that we have access to youth where they are for much of the year, but there are also two months of the year where youth are not in school. These investments are actually to keep running and maintain connections with community groups, and they will continue to support our youth even over the summer.

 

But it is targeted to the school-aged programs at this point, recognizing that this is the expansion of new programs. We’re filling a gap at the present time at this stage, and we’re working toward improving the overall system. If we’re getting more people diagnosed and identified and supported younger, then as they move to adolescence or move out of that adolescent phase, the goal is that they already have the tools and the capacity to transition and have less demand on the acute system as they transition out of our school system, because they’ve been well supported throughout our school system and have been identified and interventions taken to support them. That’s the goal at this point, based upon this investment. We want to make sure that we get it right, that we get it working properly.

 

I will say that when I visited CaperBase myself, as we were learning more about that particular model, one of the things they highlighted was that when they started, they just started delivering the programs in the school system. This program is designed for those clinicians to be working and connecting with youth in the school system, but also to connect with other mental health community supports out there. They’re actually attaching and connecting youth to other supports in their specific community, so that’s part of that bridging as well. Those community supports may be broader community supports not necessarily targeted at youth.

 

While the adolescent outreach model is delivered and tied to our school system, which would be tied to the school age of youth, again, if a youth has been going through the program and has been connected with other community mental health supports, the care may continue through those means even though the adolescent outreach model isn’t necessarily the program for them.

 

There are aspects, and people are thinking about these things, but specifically the program and those counsellor supports are really for those who are school aged, but they do work. The goal is to support them and connect people and connect with community supports as well over the year, and continue that over the summer, because of those challenges where people feel lost without the supports that they’re used to during the school year during those summer months. The goal of that program is in part to make sure that they have the supports over the summer months as well.

 

TAMMY MARTIN: On that line of thinking, currently in Cape Breton - and I’m really not sure if it’s anywhere else in the province - there are two youth centres called Undercurrent. I don’t know if the minister is familiar with them, but I was just really lucky to meet with the gentleman who runs the one in Glace Bay, and it’s a remarkable facility. It’s remarkable what it’s doing for kids.

 

I don’t have the stats because I didn’t know I was going to have the time to ask this question, but the percentage of kids who are getting off the street and off drugs and have supports like the minister mentioned, like if you need some help with homework or if you need some counselling - plus they have activities, floor hockey and basketball and all of these things, and they get to eat there.

 

This program has just decided to waive the $3 per event fee because some kids can’t afford it. It means them staying off the street and staying off drugs or paying the three bucks. So they’ve just come out with a plan to ask people who can to sponsor a child. They’re looking at expanding to New Waterford, which would be remarkable.

 

I don’t know the answer to this, but why doesn’t the government help this? To me, this would be a way to help to ensure that kids have healthy lives. Is there something that we can do to support them, even getting them off the ground?

 

RANDY DELOREY: The name of that specific program isn’t ringing a bell. I think what that goes to show - as I think we do already know, as members - is that there are many amazing people stepping up to the plate to serve in many different capacities in their communities, developing innovative programs to support each other within their community. I think that is a hallmark of Nova Scotia and our communities, and I think this is an example, just like CaperBase was a program I hadn’t heard about before.

 

The description of some of the services that the member for Cape Breton Centre just described about this Undercurrent program offering in Glace Bay is actually quite similar to CaperBase. CaperBase started with a school-based connection and programs. They did expand in the Sydney area to have a physical location outside of a school for our drop-in centre, so able to run some other programs. I believe they had some clothing there, help with resumé writing. They have a wellness room with some yoga and meditation opportunities with youth - different things like that.

 

When I talked to the group from CaperBase, one of the things they explained is that one of the reasons they moved to that model, or expanded to include that model, was the gap, per the member’s last question. If a youth dropped out of school, they wouldn’t be accessing the CaperBase programs that are only offered in the school, so they built this as a spot to catch those youth who would be at potentially even higher risk within their community. They have some snacks and food in the kitchen and stuff that you can do on a drop-in basis. It’s really a drop-in type of centre to support the youth and build community for some youth who may not have other options.

 

I’m not specifically familiar with this one, but I’m sure my colleague, the member for Glace Bay, will fill me in and see what the details are. Nothing specific here, but again, recognizing that that type of adolescent outreach program, in principle, is what we’re investing in. We do see value in it. That’s what those expansions in the school systems are, but this is the start, not the end, of what we’re doing to improve supports and availability of program delivery to support the mental wellness of our youth and adolescents in the province.

 

It’s great to know, and I’m sure the next time I get an opportunity to get up to Glace Bay, my colleague, the member for Glace Bay, would be happy to make sure that we get connected and get over to visit the Undercurrent group.

 

TAMMY MARTIN: It’s a huge investment in our future, and being proactive as opposed to being reactive in trying to deal with the problems that so many youths in this province experience. When I was there two weeks ago, they were having pizza in the kitchen and they were teaching little kids how to skateboard, and those who were there as clients or as participants as youth are now back volunteering as support or supervising or whatever.

 

There was even an early 30-year-old person who had had some difficulty and just wanted to give back, so they find that - not just those who need it but those who just want to help out. The gentleman I met with was phenomenal, and he said they’ve been successful getting government grants for lighting or furniture or those types of things, but it’s the start-up - it’s the building that’s significant. I think they should be right across the province, quite frankly, but any support that we could find to put these in communities would be phenomenal, especially with what’s going on with youth today.

 

When we talked about Neils Harbour - I just want to confirm, and I know the member next door talked about the lab tech position - I believe the minister said that that position was being posted and recruited for now? I just want to confirm that.

 

RANDY DELOREY: That is correct. The position in Neils Harbour - I’m not sure, as I haven’t looked to verify that it is actually on the website, but that is my understanding. If it’s not there, it should be going up shortly to recruit and fill that position. That’s part of the delivery of care in the community. I believe they may still be rolling out point-of-care testing to support the lab tech, as well, so it’s really providing both services to the facility.

 

I don’t recall seeing anything directly to myself, but there has been some concern that I’ve heard percolating out there in the community, about whether or not this hire is just temporary until point of care is implemented. That’s not the goal. The goal would be they are there, and point of care may still be implemented at the site, but then you have that to support the benefits of both systems being there - the lab services that are done onsite at the lab, but also those advantages that were talked about earlier with the point-of-care testing technology and the speed and the ability to have that right onsite.

 

[6:45 p.m.]

 

TAMMY MARTIN: I thank the minister for that answer. One of these days in Estimates or Question Period, we talked about the new interpretation of old contract language and how nurses are paid their overtime premium. I’ve recently had discussions with some stakeholders who tell me that that is currently being reviewed.

 

I know the minister has told me that the department is not the employer, but the department is the funder. Can the minister provide any clarification on whether this is being revisited?

 

RANDY DELOREY: The member is correct. We set policy and provide funding to the employer, and I believe pretty much from day one, when a question has been asked on this topic - I don’t recall if it came up specifically in Question Period, but I think with media - I’ve been advised, when I was having the conversation with union representatives and I believe with media, when I reached out to inquire with the employer, the Health Authority, they had indicated that they were having conversations, and my conversations with the union representatives, they’d indicate that there were conversations.

 

The request of me was to intervene and make sure that the conversation went exactly the way the union wanted, but really, I think it’s important to recognize that the parties are at the table having some conversations to understand the impact of the decision made by the employer, to see if there’s common ground in terms of the needs and the objectives of the employer and those of the employees, as represented by the union. I believe that’s the way labour relations are designed to work and interface. I think as long as the parties are together having those conversations, listening and learning, the worst thing would be for me to intervene in that regard.

 

I know that’s not what the member asked, but I just wanted to confirm her question: yes, the last I heard, conversations are still ongoing between the two parties involved.

 

TAMMY MARTIN: I’m really pleased to hear that conversations are still ongoing, because it is causing a severe impact on staff at the hospitals across the province. I know one young woman had seven calls in one day for a shift, but wouldn’t go because she wasn’t going to be paid overtime. She probably would have gone on the first call had she been paid the appropriate amount of overtime.

 

Moving on, I would like to ask the minister: What plans are out there, if any, for the expected vacant New Waterford and Northside hospitals? What is going to happen to them?

 

RANDY DELOREY: Those decisions haven’t been made yet. At the front end, nothing is going to happen to the facilities until new facilities are in place. We’ve been clear on that from day one, when we made the announcement. I want to be clear again that those facilities will continue to operate. We’ll be making the investments and having new facilities up and running before and then services transitioning or transferring to the new spaces. I think that’s an important thing, hopefully to alleviate some of the concerns - not all, but some of the concerns that I think were out there early on, when we made the announcement.

 

I think it’s possible that some people in the community may have thought the announcement meant immediate closures, which was never the intention, but rather afterwards. So the investments and our focus have been predominantly on doing the functional plan, planning around what the facility needs are so that we know what we’re going to be going out to market with. Then once we know what happens there, we’ll know and be able to assess and determine what happens with those facilities when the work is done.

 

TAMMY MARTIN: At the recent announcement in Membertou, there was talk about 2020, I believe, to break ground for the new cancer centre and the new emergency room in Sydney. Correct me if I’m wrong, but if that’s the case, there has never been a date, or a time given to break ground for New Waterford or North Sydney.

 

RANDY DELOREY: That’s a good question. For the Cape Breton redevelopment, I’ll say partially yes.

 

People may see work before then. What was actually said at the announcement, maybe not at the table but with media interviews as people were delving into this point - what’s happening with the Cape Breton redevelopment is the RFP is going out to complete the detailed design, and then, when that’s complete, to have the construction done in earnest, which we would expect to start next year. But we know there are certain preparatory things that need to be done onsite.

 

For example, given that the new building will be embarking on an existing parking space, and we know those parking spaces are needed by the facility, a temporary parking lot needs to be built before the structure goes up and takes over. We have every intention of starting the work on the temporary parking area. I think they have already identified the area that they’re going to. I think it’s on the side of the building, which allows them to do that work in advance. People in Cape Breton should see work before next year.

 

It’s working in parallel with the design, the building up of the new facility on the back of the Cape Breton Regional. I believe we’re anticipating the design to be done and the construction RFP being completed and seeing that work started in about 2020.

 

The second part of the question being what about New Waterford and North Sydney, it’s true that no dates have been identified, but they’re at a different point in the planning process. The Cape Breton Regional decision was further along in the planning process, because we knew what we were going to do when we were going through that design phase. We’ll have more details once we complete that functional plan piece and know the kind of structure that we’re going to be building. When we bring that to the communities, we’ll have a better idea then of the detail design, just like in Cape Breton, and an idea of when we might see the construction start.

 

In Cape Breton, as I said, we expect sometime very soon in the Spring to be able to go to the communities and deliver that information, provide the most up-to-date information and details that we have at that point. Cape Breton Regional had dates because we were at that point where we were going out to get the design and the construction done. We’re not quite there, but we have made a lot of progress with the North Sydney and New Waterford facilities. We aren’t at the same spot yet, but we are getting close.

 

TAMMY MARTIN: That begs the question, then, why announce New Waterford and North Sydney first?

 

RANDY DELOREY: I’m not sure - if I’m interpreting the question correctly, I think the specific question was why Northside and New Waterford first, when we made the announcement?

 

In June, we made the announcement about the overall region and some of the big components that we were anticipating and the rationale for that, which included the replacement of the New Waterford and North Sydney with new community health centres. The reason is, they were actually announced together, not first. It was all part of the overarching announcement.

 

The other critical piece that was part of that announcement was the recognition that, now that we have a very high-level overview of what we believe the future of health care infrastructure would look like to serve the community, the consultation and functional planning work could begin. That work is ongoing. That work is taking place. I believe the teams have said they have had literally hundreds of meetings throughout the process.

 

What has really happened is that the Cape Breton Regional planning process made it to that critical juncture point where we were able to make some decisions and make that announcement. When we get there on Glace Bay, New Waterford, and North Sydney, we’ll be doing the same thing and bringing the information when we get to that point.

 

Progress has been going along all the way. We certainly didn’t just focus on Cape Breton Regional and then say, okay, we’re going to go now and just focus on another site.

 

The fact of the matter is, as I believe we were very clear from the beginning, this is about re-evaluating and assessing. You couldn’t really make your decisions about one site without considering all the sites, but then to make the specific details of what this looks like for each of these sites, there are some specific details that need to be done. That’s the stage we’re at. That’s why I’m confident in saying we’re getting close, but it is working out those final details that are site specific before it comes up to me with those final details for recommendation to government and approvals or decisions to be made.

 

I’m being assured that a lot of good information has been solicited. A lot of those meetings - we saw the result of that at Cape Breton Regional, and we’ll be seeing it at the other three sites. When we have it, we’ll make the decisions. We’ll be moving that information forward. So it wasn’t why - before, after, it all had to be looked at at the same time, so it’s all part of the same announcement.

 

This is the same way we did it in Halifax as well, with the QEII redevelopment, so we’re not treating a - we learned a lot from the QEII redevelopment. There are a lot of announcements and work that were begun over at the Dartmouth General Hospital to support the QEII redevelopment because we knew we were going to have to do some of those things, even before the final redevelopment piece of the QEII to replace the VG in its entirety. It’s kind of the same thing. We don’t want to hold everything up if there’s an opportunity to move part of the project forward, because we know it’s long overdue to have these investments and new infrastructure for our health care systems, both in Cape Breton and in Halifax.

 

TAMMY MARTIN: I’ll reiterate my concern and my worry about the acute care beds. As hard as I try, I can’t wrap my head around where the acute care beds from New Waterford and North Sydney are going to go. The minister has talked about increasing emergency room size and the cancer centre, which is remarkable. There’s nobody who is going to disagree with that. But the roughly 23 and 26 in-patient beds in New Waterford and North Sydney will be lost.

 

If John Doe has pneumonia, he can’t really go home. He doesn’t need to be at the Regional but can’t go home, so where are those patients to go? At the end of the day, in my calculations, we will still be down 50-ish acute care beds in Cape Breton.

 

RANDY DELOREY: I thank the member for the question. The member noted the announcement at the Cape Breton Regional, which was saying that the new emergency department, which will be doubling in size, the new cancer centre effectively doubling its size, I believe - but what wasn’t mentioned was the new critical care unit, which covers cardio, intensive care, and intermediate care units. That is effectively tripling the size of those existing units in that critical care space. So there is significant expansion in that side of the Cape Breton Regional Hospital as well.

 

There is a fair amount of investment going on there in terms of the overall bed flow. As we see the final functional plan details and recommendations coming out from the New Waterford and North Sydney facilities, I think that will make more clear what and how that flows, because we’ll know what those facilities look like. We’ll know with the Cape Breton Regional.

 

The other thing that’s important to note with the Cape Breton Regional is that as we’re building that new complex - new cancer centre, new emergency department, new critical care - all of that current space for the cancer centre, the emergency department, and the current critical care units, or the units that make up the critical care space, will be vacated. It will be moved into the new space in the hospital, the new wing of the hospital, so that gives more flexibility within the existing Cape Breton Regional centre for other enhancements.

 

[7:00 p.m.]

 

TAMMY MARTIN: From what I understand, it’s 12 new ICU beds, if I’m not mistaken. I take that perhaps the minister is suggesting that there could be some new in-patient beds in these vacant spaces. We can definitely use them - more so than offices, I’m sure - but if we’re going to have vacant space, then perhaps I could assume that that could be looked at in the future.

 

RANDY DELOREY: As I’d indicated before, when we made the announcement in June, the work to put the meat on the bones of the changes to health care infrastructure and to support the delivery of modern health care in the Cape Breton region was going to be fed through the functional planning process and the consultations and the work that would be done. That work has been ongoing in the community, led by people in the community on the front lines to communicate and engage. The recommendations in terms of the bed counts and the bed flows, including the recommendation that’s already been announced around the number of beds for long-term care facilities, has come through that process.

 

While we made the announcement in June, we anticipated that we would have a need to roughly double the long-term care bed capacity in New Waterford and North Sydney. Through the functional planning process, we’ve gotten to the point where it’s actually even more than that now. Instead of 48 beds or so off the original June in both communities, it’s up to 60 beds now in those communities to support the needs based upon that functional plan.

 

When the member asks about the number of beds that have been announced for Cape Breton Regional Hospital, it’s the bed count and the location in the various units based upon the work of Dr. Orrell and others on the front line meeting and consulting and assessing what data they have on the care needs of people in the community. The whole point has been to assess what the needs are within the community and what anticipated infrastructure needs would be required to fulfill those health care deliveries.

 

In terms of any future expectations or outcomes, those will come as further steps in the functional planning, and decisions are made. I haven’t received final recommendations on the New Waterford or North Sydney sites to make a final decision on those points. We did have some updated information. I think people were feeling quite confident that the number of 60 for the two sites for the total number of long-term care beds was the right number, and that’s kind of been tightened up. I did disclose that information - I guess my colleague, the Minister of Finance and Treasury Board did in the budget - recognizing that there was a level of confidence in that piece of information, and recognizing after the announcement at the Cape Breton Regional Hospital that people in the community were starting to wonder if we were doing work on their health facilities as well.

 

That was just a way to illustrate that work has been ongoing and we’re getting close, because we’re able to confidently say that 60 was the number for those long-term care beds. We know we have the physicians and other clinicians on the front line providing input to guide the recommendation, and then ultimately, as government, we have to make a decision based upon those recommendations. When we get to that decision point, we can then go out and communicate it to the public. That, I think, will address many of the questions that the member has been asking.

 

TAMMY MARTIN: As I said, over the past week, almost every day there were in excess of 18, 20, 23 in-patients admitted to the regional hospital in Sydney, which left them with no beds. So while we will agree to disagree - it’s not 60 new beds in each community; it’s a total of 60 - we know that we have long-term care beds or ALC beds in Glace Bay that I don’t know if they’re part of this calculation. Are those patients who are in ALC or long- term care on 4 North in Glace Bay coming to one of these new long-term care facilities?

 

RANDY DELOREY: I think this is the first time I get to stand when the member for Cape Breton Centre gets to the point of agreeing to disagree where I will disagree with her agreement to disagree, because I, in fact, agree with the statement the member made. Yes, there are 60 total beds. It is an increase of - I don’t know what that works out to - it is 74 in total, I think, between the two communities; about 36 or 37 new beds in each community, more than doubling the number of beds.

 

But we do agree, and I didn’t mean to suggest that there were 60 new beds in each community, there were 60 in total. We do agree that it is 60 in total, and not 60 new, for a total of about 74 new beds between the two communities.

 

We didn’t talk much about Glace Bay as part of this, but it is part of the redevelopment process functional planning work, as with Cape Breton, the Sydney area, New Waterford, and North Sydney.

 

Unfortunately, the member for Glace Bay doesn’t have the opportunity to stand in this Legislature to go on the record and ask many questions about the work being done at Glace Bay, the functional planning work, but I assure the member opposite and all Cape Bretoners, particularly those in Glace Bay, the member for Glace Bay is active in asking these very types of questions to stay on top of how the development progress is going.

 

With that progress, as with the rest of it, it’s the functional planning - those beds - the decisions around Glace Bay also haven’t been made yet, but work is progressing well. The detailed changes for Glace Bay, when it gets to that point, as with New Waterford and North Sydney, as happened in Cape Breton and Sydney, when we get to that point where the recommendations come forward, and government has had a chance to review those recommendations and make a decision, we will make sure that the community knows what those decisions are.

 

THE CHAIR: Order, please. The time for the NDP caucus has expired.

 

The honourable member for Queens-Shelburne.

 

KIM MASLAND: My first question is back at Queens General Hospital again. I understand payment for emergency services and in-patient coverage hours have changed in some hospitals. For example, in Digby, emergency room physicians working in the ER will be compensated to cover calls for in-patient units.

 

At my local hospital at Queens General, primary care providers have provided 24-hour, 365-day coverage for the emergency room, office, in-patient, nursing home, and palliative care since it opened. As I mentioned previously when we were chatting, the volume and seriousness of the types of conditions have increased significantly and our doctors are exhausted with the influx of people coming from neighbouring communities.

 

Although I understand and appreciate the incentive to encourage people to work in underserved areas, it is also important to not forget what we have; these doctors at Queens General continue to offer top-notch health care to the community and to the residents of Queens County. These doctors are providing this full service, the full meal deal, so to speak, and they are not being compensated the same as those who provide itinerant care. My question is: Can the minister explain why this is happening to the doctors at Queens General, and can they expect to be treated equally?

 

RANDY DELOREY: I guess the best response is, number one, I agree with the member in terms of the work being conducted by the physicians and other health care professionals in Queens. I believe that just within the last week or two I did have representatives from the Department of Health and Wellness down to meet with physicians in Queens, and a number of other hospitals in the region, to talk about this very issue.

 

This is also an issue at the negotiating table. Recognizing the compensation structure at our community hospitals throughout the province is an important piece of the negotiations for an updated master agreement.

 

There has actually been, without going into details, some very positive progress, I believe, from what I’m hearing from the table in terms of some new and innovative ways to address some of the concerns. What is challenging, and to the member’s comment on why things are different, unfortunately, things are different in large part because we previously had nine different health authorities, and programs and models were developed at hospitals very differently.

 

As we’ve brought in the Health Authorities to help move away from these differences to standardize so we establish a baseline standard of compensation and care expectations throughout the health care system, unfortunately, as you start moving the levers to bring in standardization where systems change in communities, people will feel a change and they will interpret it as someone getting more, someone getting less. I think it’s important to look at overall changes in the structures and the compensation models, because it is attempting to modernize.

 

Some of it is attempting to modernize and respond to the nature of collaborative care practices and the changes in the culture and the approach of the delivery of primary health care services. Aspects of that are being evaluated and looked at - for in-patient care, as well - in our hospital systems. How does that work, how do we manage it? Again, how care is being delivered is different. How can we be continuously respectful to those who have worked under a particular model for many, many years, a model that has worked in particular communities? Unfortunately, many communities in the province are falling apart because the models in those communities aren’t working. As a province and as a system, we’re trying to establish a model that standardizes and works to the best we can.

 

Does that mean everybody will be happy with where it lands? Like all negotiations, generally, everybody is not happy with every aspect of the outcome. But when you look at the totality of those negotiations and the outcome, the goal is that we’ve reached a positive spot for the majority of people in that program. In these negotiations we’re particularly looking to the future and future proof in establishing and addressing the current concerns and issues in a way that looks to the future, to ensure that we start building and strengthening the environment for health care workers, in this case, physicians for today, but into the future as well. It is a transition point, and like I said, just within the last week or two, there were staff and representatives that were down. I had a brief conversation on their experience going around to the communities, and I recall that they talked specifically about the feedback they heard from the physicians at Queens General Hospital.

 

KIM MASLAND: I thank the minister for that response, and I am very encouraged to hear that members were down to meet with our very valued doctors at Queens General Hospital. The men and women who practise in Queens County, those doctors are just absolutely incredible. I just feel so privileged that I live in a community where they are. Still on the same subject of Queens General Hospital, I want to talk about dialysis. It was welcome news last week: the new dialysis unit at South Shore Regional Hospital. But this House created a little bit of uncertainty with some of those in Queens-Shelburne who access the Liverpool site.

 

Can the minister confirm that the new site in Bridgewater will be an addition to the unit and will be an addition, and the unit at Queens General Hospital will remain in place?

 

[7:15 p.m.]

 

RANDY DELOREY: As the member noted, there will be the establishment of a dialysis unit at the South Shore Regional Hospital in Bridgewater, but there will be no change in the plans to Liverpool.

 

KIM MASLAND: I’d like to touch on lab services at Queens General Hospital. I’m told that samples are collected at this lab and sent to the South Shore Regional Hospital by courier. To take that a step further, the South Shore Regional has lost cytology, histology, microbiology, and half of hematology in their lab. Along with Queens General Hospital samples, Fishermen’s Memorial Hospital samples are also being collected at the regional hospital and then sent to Kentville by courier up to four times a day. I’ve been told, and I can understand, that there is a concern for compromise of these samples.

 

I’ve also been told that breast cancer samples are being sent to Kentville, when the pathologist used to be able to pull that sample right after identifying breast cancer from the screening and notify the patient immediately. At our Regional hospital, we have a lot of exploratory surgeries that are being done and now those samples are being sent to Kentville.

 

My question to the minister is: Could the minister explain the plan for the regional hospital lab going forward; is there a plan for this just to be a stat lab with all routine testing being sent out?

 

RANDY DELOREY: I don’t have details on that specific site. As was noted before, the Health Authorities work with the operations and the clinical side of the facilities.

 

What I can advise is, as an MLA in my communities, I’ve seen some changes to the lab structure over the last couple of years. In my research as MLA, even before being Minister of Health and Wellness, the information I was provided around this space - and I certainly dug in quite detailed and pushed to get to a certain comfort level - with the notion of having samples transported to different locations, you start to raise questions.

 

Some things that I’ve been assured of is, number one, the services used to transport lab tests are certified; they are national, and they have to meet national standards for transportation of these samples. It’s not some random Uber to provide the transportation. They have to be certified in the transportation of these samples. It ensures the continuity and the integrity of the lab samples. I think that’s a very important thing to keep in mind.

 

The other piece is that one of the driving or contributing factors had to do with advances in the lab technology and the increased specialization of equipment and its ability to actually increase its capacity. As you have more advanced and capable equipment, the costs rise with that as well; the capacity is greater and would end up being underutilized if you put it in every facility that may currently have older technology. At the time, older technology would have perhaps been necessary to provide all of the services, but with the advanced technology, they have the capacity to work and support other facilities.

 

We all want to ensure that our system provides safe, quality, and efficient care, and results, but we also want to make sure that we make the best use of the investments we’ve made. I think that’s what has been happening in certain parts of the province. If a facility has the capacity to provide the results and it’s done in a clinically appropriate manner, they’re looking to leverage those opportunities for those efficiencies. In some cases, that means locations get increased support services and others still maintain the clinical response times that are expected for the particular blood tests and deliveries.

 

There’s still work being done locally, but for other specific blood samples, they may require transportation. On any given site, I’m not sure what the specific changes are, but a lot of it is supported by technological advances within the lab DI space that allows it to be done safely and still meet the clinical requirements.

 

KIM MASLAND: Madam Chair, I have a question about parking fees. I hear from constituents who have loved ones in hospital, waiting for placement in long-term care, about the costs they’re incurring to visit their loved ones on a daily basis.

 

We also know that families are encouraged to come and support their loved ones and be an extension of their care team while in the hospital. It may not seem like a lot of money, but for families visiting morning and night, and sometimes several times a day, it can be very expensive for them for parking costs just to spend time with their loved ones.

 

My question to the minister is: Considering we have more people staying longer in hospital waiting for long-term care, are there any plans to provide some assistance to these visiting families to help with the parking fees? And to take another question: Where do those collected fees go? Are they returned back to the individual hospital or do they go into general revenue?

 

RANDY DELOREY: To the second question first, I’m not sure, broadly. I know in my own community the parking fees are directed towards the hospital foundation. I believe the parking pay system was implemented by the foundation and is used as a contributing support for the foundation as a revenue generator there. I believe that is the case at some other hospitals, but I don’t believe it is all hospitals, so some of it would be revenue for the hospital Health Authority. At the end of the day, supporting the foundations is supporting the hospital as well. I don’t think it is consistent.

 

Going back to the fact that we had nine health authorities, different policies were established over time, so differences are to be expected, or it’s understandable that there are differences in those policies throughout the province today. Over time, perhaps there will be efforts to standardize throughout the province, but it’s one of the many types of examples of, if you are a patient or a loved one of a patient in one part of the province, it’s different in different parts.

 

Again, that’s one of the reasons we felt it was important in 2013 to say we should establish a single Health Authority, so that we can start working toward establishing - particularly driven on the clinical side - standardization and ensuring that we get consistent care and processes across the province. This would be another piece that people don’t often think about as part of the care program.

 

To the first part of the question, about supports or assistance, policies might be a little bit different. I’m not sure about the specific example the member is referring to - presumably either Roseway or Queens - but I know that there are many hospitals around the province where if somebody is having an extended stay, you can get a weekly or a monthly parking pass that does provide a reduced rate. Relative to many spots, you can get relatively cheaper parking, to be able to get a pass that goes in and out.

 

Again, I’ll just use my own hometown. I believe in the main gated parking lot it’s $2, but not timed, so you go in, you pay the $2, and leave, but you can get a parking pass for the month or the week. I can’t remember what it was, because it’s been almost five years since my last child was born and I had any extended period of time in the hospital, but I know we had the pass. Then you could go in and out multiple times a day, so you aren’t getting dinged, and it gives that flexibility to your visit. Again, policy would be a little bit different at different locations.

 

The other thing, just for quick clarification, I believe in the support of the preamble, if I heard correctly, I believe the member made a reference to: given more people waiting longer in long-term care. I’d just like to correct that. The data since we’ve come in shows that fewer people are waiting in the hospital for long-term care and they’re waiting less time than when we came into government, so we are making improvements there as well.

 

KIM MASLAND: The minister has great listening skills there. He picked up on that one pretty quickly.

 

This is my last question, and then I’m going to turn it over to my colleague. We’ve been advised there have been cancelled scans at the VG for certain cancers because of equipment breakdowns and an interruption in the supply of the isotopes. Is the minister aware of this situation and can he advise what is happening to make sure this doesn’t happen in the future?

 

RANDY DELOREY: The member was correct. It is isotopes. That’s not a situation that’s been brought to my attention, but I’ll certainly look into it. Perhaps not at Estimates. That’s an operational thing, but certainly one worth delving into to better understand. I thank the member for bringing it to the floor, so I can take a look into it.

 

THE CHAIR: The honourable member for Sydney River-Mira-Louisbourg.

 

HON. ALFIE MACLEOD: What a way to end the evening. First, I want to thank you for the opportunity to have a few questions during this time and I thank your staff for being here.

 

My first question for you has to do with something we’ve talked about before. Right now, we have a large number of people who travel from different parts of the province to come here to Halifax to the rehab centre. People who have prosthetic limbs sometimes drive for four hours for a 10-minute meeting to get some adjustments made.

 

In days gone by, at Northside General Hospital where the current rehab centre is, there was a facility where people could come to get adjustments made and that could cut down on the travelling because a trip for somebody to come to Halifax, as you know from your own travels, is quite expensive.

 

We’ve talked several times in the past, and even with your predecessor, about the possibility of having someone come even one week a month to the Northside General Hospital, or any of the facilities, just to have the ability to get their adjustments and whatnot done. We know that you have to come here to get the actual prosthetic made but it is the fine tuning of it that creates a lot of travel sometimes.

 

I know we talked about this several times before and I wonder if you could give an update: Has anybody actually looked at that idea or is there any hope in something like that happening? I used the Northside, but I’m sure people in Yarmouth and Amherst and other areas are in the same boat.

 

RANDY DELOREY: I thank the member. I appreciate that this is a very specific request that can have an impact - perhaps not the largest portion of our population, but the nature of the impact is quite significant for those for whom this request would serve.

 

I did inquire, after we last spoke, and the initial information that I have at this point from the NSHA was talking about some of the services being offered at Harbourview within the space. That’s really where they were leaning on and responding back to me in terms of the nature of the care and the supports that they have for the space. I gather from the member’s question though, that those supports did not or are not fully addressing the request and the concerns that are being brought to the floor; that is, the services being offered at the Harbourview location are not the same, or the full suite of adjustment services, that the member is inquiring about.

 

[7:30 p.m.]

 

That is a different type of service and I think, perhaps, I may not have communicated the inquiry clearly enough when I asked people to look at it, because the information that came back was referring back to the services and the supports at the Harbourview site. I kind of left it with that, thinking that there were those services and supports.

 

Clearly, it seems that I didn’t communicate it properly and misunderstood the specifics of what the member asked, or again, thought that the Health Authority, when they responded, were responding to the specific inquiry about those adjustments. I think I’ll have to go back at this one again to see if I can get - unless the member indicates that Harbourview is meeting the needs, but the fact that he brought the question to the floor suggests that it’s not.

 

ALFIE MACLEOD: To the best of my knowledge, my understanding is that Harbourview is not meeting it. I have had on different occasions taken people with me in my travels to Halifax, who have had to come here for adjustments. In particular, there’s one gentleman in his early 90s who has had to come here on a fairly regular basis and again, it is a challenge.

 

I know we can’t give a full range of services but by the same token, as you know, I’m fortunate, I’m here on a regular basis so I can come here, and I can get the adjustments for my own prosthetic, but other people aren’t that lucky. Again, it could be like an $800 trip for people.

 

If we had a technician, and I don’t know what the status is now but at one point when we started this conversation, there was a technician who was willing to travel to Cape Breton for a week, a month, or whatever it would be, and people could be scheduled there. It would be a help for the individuals. I think in the long run it would save a lot of dollars for people. I know from discussions that we’ve had that the well-being of the client is something we all want to see put forward. If you could re-address that, that would be great.

 

RANDY DELOREY: Indeed, I will. In the information that I had been given about Harbourview, there was a reference to someone from Halifax who went down - and when the member raised this question, I do remember that we talked about it. I don’t remember if it was in Question Period or in Estimates last year, but I do remember us having this conversation and I did take it back to look into it. That information, as I recall, did indicate, I believe a reference to someone from Halifax going down to Harbourview. But again, perhaps I misinterpreted, or I assumed that was someone going down, dealing with the types of adjustments the member raised.

 

I will take another look at it. Perhaps offside, if the member, just in that last mention, indicated that he thought there was a technician who might have been willing to travel for that, if he has a name or anything, if he passes that on the side it might help me more clearly move forward and have someone who can talk about possibilities.

 

Certainly, I’m willing to take another stab at this particular request, recognizing I have the privilege of living perhaps almost exactly halfway between Halifax and Cape Breton, and I seem to be travelling in both directions from time to time of late. I know I’ve commuted with my colleague from Glace Bay on a couple of days and when we’re late getting back and he’s dropping me off in Antigonish, I know he still has that much further to go to get to Glace Bay. I certainly appreciate how long that travel is taking; an entire day of travel.

 

ALFIE MACLEOD: I thank you for that, and I look forward to you having the opportunity to look into that. I believe that Mother Webb’s Restaurant is actually halfway between - the odd time I may have stopped there to check things out.

 

Another topic that is on the minds of many people, and again, as a disclaimer I guess, but to make it clear, my wife has MS and it is not unknown to the members of this House. We’ve talked in the past about how sometimes people with MS have to do a fair bit of travelling.

 

We do have a program in the province that helps people who have cancer and who are travelling outside the province and have to make special trips. We talked on one or two occasions about the ability or the possibility of trying to help people with MS. It can be a very debilitating disease and a lot of times people, when they get MS, they can’t afford to work and so their income is limited.

 

I’m just wondering if the minister has had any opportunity, with everything else that I know is on his plate, to search that out more, or if you haven’t, would you at least put it back on your radar screen?

 

RANDY DELOREY: I thank the member for bringing this question forward. Although making a personal disclosure, I think one of the things about MLAs in the Legislature that allows us to effectively represent the interests of our constituents, is that at the end of the day, believe it or not, we all have families and family members who have the same challenges as every other Nova Scotian. We are Nova Scotians. We are the community members of the communities we represent, and the member has, again, disclosed in this particular case.

 

What I assure other members in our conversations is he is not bringing this up for personal means, but rather he uses that personal experience to illustrate to Nova Scotians that he understands and appreciates the struggles and the challenges of others with the same debilitating condition, and I understand and appreciate that.

 

In fact, in response to the question, but not specifically to MS, what I can assure the member is, in part because of the inquiries he has made, that it is something I’ve been processing and thinking about and looking for opportunities.

 

The member mentioned we have an out-of-province travel policy but not an in- province travel policy. Earlier in Estimates, his colleague, the member for Argyle- Barrington, raised a question asking for a status update on the Yarmouth cancer review. I may be confusing members here by talking now about a cancer review when the question was about travel for MS, but there is a connection because that review of the cancer services in Yarmouth actually came out with a number of recommendations.

 

One of the recommendations was identifying the challenge of travel. If you look at cancer services that are being offered with the centres in Halifax and Sydney, and you draw a two-hour circle around that, you’ve got some pieces of Guysborough on the Eastern Shore and then around the Yarmouth and South Shore areas that do not fall within that two-hour distance and they are saying that these people have more challenges than those within the two-hour circumference.

 

One of the recommendations was specific about how we can reduce the travel burden for their treatments to level the playing field a little bit more in terms of their care because others live closer and don’t. That work is ongoing.

 

One of the things from my perspective - I’ve had some thoughts and I’ve been looking at ways to adjust and work within some of the programs and funding - is that we have to see where we can look to make some changes that could support something like this.

 

Now that we have these very direct recommendations, I’m looking at them and saying, if we are looking at this, I anticipate there are others because I knew this particular request was outstanding, and so, as I’m evaluating, I am evaluating and saying, if we are going to do something, that is really about an in-province travel component to address some of the Yarmouth cancer and Eastern Shore-Guysborough challenges. If we’re going to get something or if we can design something, how do I design it to be of maximum benefit?

 

Much like our out-of-province travel program, which we’re taking a look at now based upon some recent information about how lung transplant, timely for today - the fact is, as a percentage, the program seems to work for the majority of people who travel - but the nature of the travel for lung transplant patients is significantly different than many other people who need to travel out-of-province. We are looking at that program as well.

 

I guess to answer the member’s question, I know that this is one that he has asked before, I haven’t forgotten about it. It has actually been on my mind and I’ve been looking for those opportunities. I don’t have a solution yet, and I probably won’t have a solution where it would be specifically for MS; but rather, as I look at the notion of what kind of program or policy out of the Yarmouth travel program on that cancer side, I want to maximize the value of that program that we’re developing. I’m not sure what that’s going to look like yet, but I certainly will ensure that the member’s inquiry helps me look at that as I’m trying to make some decisions.

 

ALFIE MACLEOD: I want to thank the minister for that answer, because I think we’re all aware that people that have acute health care problems, if they can stay in areas that are familiar to them and they’re easier for them to travel, that has an impact on their ability to get better.

 

Certainly, the Cape Breton Cancer Centre in Sydney is one of the finest operations that are around and there are a lot of people who travel there that are certainly outside that two-hour travel limit. Anything we can do to make people more comfortable and make sure that they get the treatments that they need is a good thing. I do thank you for that.

 

I’ve had a few of my constituents and people from other areas talk to me about their concerns about long-term care. I know in the past there have been programs where smaller long-term care facilities have been built by private operators and whatnot.

 

One of the questions was: Is there a program today that may allow someone to build a 20- or 30-bed unit? If there is, what kinds of guidelines would be there? There are people who would like to do that, some of it because their own family members are heading in that direction and they want to be able to keep them in their own communities, or whatever.

 

I’m just wondering if the department has any thoughts on that or any programs, or if they would give consideration if there isn’t a program currently. As I say, I do know in the past that there have been some small operators that have done that, and it seems very successful. The people who live in those homes consider it to be home. They are very happy in those facilities.

 

RANDY DELOREY: I’m not aware of any programs that are in play today; I’ll take the member at his word that one existed previously. It’s not something that has come up, that I recall, in any of my discussions or engagement with care providers across the province to date. This is a question that has never been posed to me, that I can recall.

 

Certainly, in terms of long-term care and having access on two fronts; one is, as the member knows, we are at that stage as we’ve seen our home care investments kind of stabilizing within our continuing care environment. We’ve seen some improvements from that. It allows us now to start making some decisions about infrastructure and long-term care facilities like the decisions in North Sydney and New Waterford, as well as Meteghan and Mahone Bay, work that’s ongoing. We’re making progress and we’re at a different stage than we were even last year. So that’s us on a provincial scale looking at building facilities in that traditional model.

 

[7:45 p.m.]

 

I guess as far as the private operators or private developers building, certainly as a province, the opportunity exists for private developers to build and operate long-term care facilities on a private basis, which the province would still license and provide the licence and the overview from a regulatory perspective. But there are no programs to support the capital or operational expenses of those private facilities.

 

ALFIE MACLEOD: I do want to say thank you to the minister, but I also would like to say that it may be an avenue that we as a province should be looking at, especially in smaller or more rural communities, as an opportunity for people to stay in their communities, and at the same time, get the private sector engaged in some of the things that need to be done.

 

Numbers say that it is cheaper to have someone in a long-term care facility rather than in an acute care bed. This may be an opportunity to look at that and develop a program that would not only help the individuals but the government as well.

 

RANDY DELOREY: It’s interesting that the member raised the notion of the small versus large facility. As many people are familiar with social media and the advances of social media and the ability to curate social feeds, they’re obviously news aggregators that develop and learn from the nature of the work. Coincidentally - I don’t remember if it was last night or this morning - one of the articles that showed up in my newsfeed was titled, the pros and cons of large versus small long-term care facilities.

 

It’s an interesting question and obviously it’s one that’s being raised outside of this Chamber as well. That’s not a provincial article that I read. It’s a broader industry-based inquiry and question. So, interesting question that the member has brought to the floor, and one that by coincidence, I’d just read about earlier in some third party’s assessment on that same point.

 

ALFIE MACLEOD: I want to thank the minister, and I can tell you, there’s a reason why my children call me the “dinosaur” when it comes to accessing different stories and whatnot on the Internet and the cellphone and all those other things.

 

The reality is that as a province, and as a government, regardless of who happens to sit in those seats, we have to start figuring out ways outside of the box to try to accommodate our aging population. We as baby boomers are heading in that direction, and - okay, me as a baby boomer, I’m heading in that direction, quicker than I’d like to admit some days - but when things started out, when the baby boomers started, what did we do? Well, we built more schools because we needed more schools, because there were more children. Then we built more hospitals because they were getting older and they needed more care. Now we’re at the stage where people are starting to need more long-term care, and we have to start looking at how we’re going to tackle that problem. Again, not any specific government. All of us who are in this room have to be keeping that in mind.

 

I appreciate what you said. When I go home on the weekend, I will ask my daughter to find that story for me.

 

One of the challenges that we have, and we’ve been seeing it a lot lately, is with the operation of our ambulance services and some of the things that have happened. In Sydney, we have an EH base that’s quite a nice facility, with the ability to service a number of vehicles and whatnot, yet the operator keeps cutting back. There are stories - and at this point I can’t guarantee that they’re 100 per cent accurate but I can get witnesses if we need them - of how ambulances are being taken out of service in Sydney, shunted to Halifax for things as simple as an oil change. That cannot be a good way of using our resources.

 

I understand that it’s an outside contractor that has it but at the same time, when we’re going through a period of time when we have ambulances that are in need and they are out of service because they are doing something as silly as that, there is something wrong with that.

 

The facility they have in Sydney is state-of-the-art, it’s not that old, and yet my understanding is they’ve laid off the mechanics they hired there.

 

Now, like the fellow says, I guess, if it’s a lie from me it’s a lie to me. The trouble is the story and the concerns have come from too many people for it not to have a basis of some accuracy. I think we just renewed a contract with EHS or Blue Cross, which some of the things that they do for us, I really would hope that with the challenges we’re seeing with ambulances not being available that somebody would look into this situation and see if there’s any truth to it, but more importantly, if it is broken, let’s try to find a way to fix it before it causes somebody’s life to be lost.

 

RANDY DELOREY: I’ll make no judgment as to the validity or not of the information that has come here. As the member knows, on the floor of this Legislature we are all honourable individuals and we often bring the concerns brought to our attention by our constituents to this floor and indeed, even outside of this Chamber, MLAs bring their concerns that they hear from constituents to ministers to investigate.

 

This is one I can honestly say I had not heard of before. As the member requested, I’ll certainly have some people dig into this and determine if this is the situation or not and investigate and respond accordingly. Notwithstanding the maintenance and the servicing side of it, certainly the operational side and the concerns of our paramedics. The member made reference in this context of an ambulance going to Halifax for maintenance purposes, which I’m not aware of, but will investigate. Certainly, we hear similar stories where they are moving for clinical purposes to Halifax, but unfortunately, being in an emergency or at the hospital for an extended period of time to unload and for some of our paramedics they are actually there for an entire shift.

 

That’s not the environment that paramedics want to be in, in staying with and monitoring their patient but rather, doing the travel back to the community to provide the emergency case that they are trained for. That’s why we’ve made some changes and we’ve asked the NSHA to work with MCI, the service operator of our EHS ambulance system to make the changes so those ambulances and those paramedics can transfer the care of the patients to the hospital staff and get back out on the road, so we do get those ambulances used.

 

As I provided that broader clinical that we are hearing from paramedics and trying to make improvements, I’ve managed to track down an answer for the member. I’m being advised that the EHS oil changes and maintenance are being provided by a Ford dealership in the Sydney area.

 

ALFIE MACLEOD: The following statement is really going to worry the minister because I actually agree with most of what he said. The reality is that some of the oil changes are being made in Sydney, and that’s right. But again, the more important thing is the ability to make sure that we’re getting the best service out of our ambulance service that we can, because we have the best paramedics in the world operating them.

 

What we need to do and what government and we in this House need to do is make sure that they have the tools that they need to do the job that they’ve been trained to do, and that is the reason that some of these things are brought up. I can say honestly, I hope I’m wrong, but if I’m not, then I think we have to address that as best we can, and not just as a government but as the community that’s in this room. We’re here. I believe the majority of us are here for the right reasons, and we’ve had that discussion before.

 

Another situation that’s been brought to my attention that, again, is worrisome and it has to do with a lady who had a mastectomy 25 years ago, was going for regular exams, and she just recently went for an exam and they went through the mammogram and she was told that she didn’t have to come back anymore. We’ve changed our policy how we’re monitoring this, and we’re not going to be doing you on a regular basis; we’re not going to be following up with you. And I’ve heard other ladies talk about their concerns when it comes to the whole breast screening program that’s being offered. I think that Nova Scotians who are very resistant to change and get a piece of paper handed to them - and I have a copy of that paper at my desk - it’s really hard for them to comprehend that and it creates another type of stress on them.

 

I’m not sure if you’re aware of it; I’m not sure if you know that those kinds of changes have taken place. I would be the first one to tell you that I don’t know the reasoning or the rhyme behind it. There may be some, but it is something that has stressed out a few individuals who have come to my office.

 

RANDY DELOREY: I thank the member for bringing the question to the floor. I’m not familiar with a change in policy within the Nova Scotia Health Authority or the IWK for their mammogram services, but I can advise the member that, notwithstanding the fact that I’m not aware of changes in the process, I have previously read material completely outside of the context of the Nova Scotia Health Authority but more in a scientific, clinical context about changing clinical contexts and not just for mammogram screening services but other types of clinical services. There is evolving research that seems to be indicating in many cases the outcomes for more frequent tests is not any better than a less frequent testing cycle. That’s not something the NSHA or any other clinicians have brought to me and it’s certainly not something I’ve brought to them.

 

I leave the clinical work to them, but in this specific context that the member brings this up, I can say I’ve read material independent of anything really in the office. I like to read the things that pop up in my newsfeeds and, for some reason, my newsfeeds seem to think I like medically related information and so I have read about these evolving changes in clinical testing requirements. I guess as the member brings it up, on the one hand clinically speaking it seems to be supported by literature that I’ve read, but I wasn’t aware that the NSHA had adopted or modified their approach and policies for that. I guess to that end, if I check I would suspect they would probably refer me to some of that literature that I’ve previously read if they’ve actually updated their policy and testing programs like that.

 

ALFIE MACLEOD: I want to thank the minister because there is no way that he can be up to date with everything that’s going on, and I appreciate that.

 

[8:00 p.m.]

 

When we bring items forward in this setting it is an opportunity for you to research and maybe find out some of that and see if it is right or wrong, again, always keeping in mind the impact it’s having on our patients and on our population because, at the end of the day, and I can’t say it enough, I know we all want to make sure we do what’s best for everybody.

 

Having had to use the services of the health care system on more than one occasion, I’m not happy about that, but I’m very glad it was there. The staff and everybody associated with it do a fantastic job and we are quite lucky as a province to have the people we have.

 

One of the things that happened today - we heard that the number of doctors, the number of individuals without doctors is on the rise again after, I think, about four months of seeing it drop. The whole issue of doctor recruitment and how we retain doctors is one that we’ve had discussions about, lively at times, but I just wonder if, when previous people were in places with the Health Authority, they had said they were going to implement exit interviews for doctors and try to get a handle on what it is and why it is that people are leaving us. I know last week the NSHA had about 133 requests for doctors.

 

I would like to ask the minister: Is there a defined program for interviewing doctors who are leaving, and if there is a way that any of that information, if it is taking place, can be shared so people will get a better understanding of why it is that doctors may not be here?

 

RANDY DELOREY: With respect to exit interviews, the Health Authority would, when they are made aware that a physician is completing or indicating that they are completing their services or winding up their services in the province, offer to complete an exit interview.

 

Certainly, if anybody is aware of a departing physician who hasn’t been offered, please feel free to let me or my office know, and I will follow up with the Health Authority on that, but they should be making that offer explicitly to the physicians.

 

Participation in an exit interview, obviously, is really at the discretion of the individual physician. Number one - my understanding is that the offers are or definitely should be made by the Health Authority administrators to have those interviews conducted.

 

If people know that they are not being offered or if they know someone in their community who would like to provide the feedback and haven’t been given the opportunity, certainly feel free to let my office know and I will definitely follow up because I agree, and I’ve said it before, that the opportunity to hear from our health care providers when they make decisions can help inform ways that we could improve the system going forward.

 

I know that I’ve met with some physicians who have left. In fact, in my own community a gentleman, a physician who had made the decision to - a young physician who is actually younger than I am - had made the decision to leave. Actually, given the timing, I don’t know if he made the decision to leave because I was appointed or if he had made that decision before I was appointed, but it was within weeks of my appointment that the individual was leaving. Actually, I’m quite certain there were a number of variables at play there, but it did provide a lot of great information to me about their experiences.

 

There were a number of variables at play, not any one specific thing, but that very early opportunity to have a sit-down and conversation actually has informed my thinking, approach, and awareness of the broader health system, particularly in our hospital setting, because of this physician. My ability to assess feedback that I receive from other physicians against what this physician’s experience was, is also a helpful thing. So, I do believe that they’re the appropriate thing.

 

In terms of publicizing the results, specifically the results or the summary data of exit interviews, one of the things is certainly around privacy of information. I know often in doing interviews with people if they think that information will be made or disclosed, even if it is anonymized, people do sometimes take a different approach. They might be a little more reserved in the disclosure of the information for privacy reasons; that often is the case in clinical reviews and so on. I’m not explicitly an expert in the HR side of the field for exit interviews, but what I can assure the members, as the reviews are completed, the information that is provided through the exit interviews certainly - and really, how could it not help inform the policy positions and the decisions being made by the Health Authority in its recruitment and retention efforts?

 

That’s an important source of information, direct first-hand information. It’s certainly the best way to understand why people are making those decisions to leave and, hopefully, inform new policies or program offerings that could help retain and possibly recruit other physicians to the province and serve our communities.

 

THE CHAIR: Order. The time has elapsed for the PC caucus. We will hand it over to the NDP for the remaining time this evening.

 

The honourable member for Cape Breton Centre.

 

TAMMY MARTIN: I’d like to talk briefly about autism in children. Families know that there are huge service gaps when it comes to getting help when you have autism. According to families that we’ve spoken with, mental health services that are available to some children, like recreation therapy, often exclude kids with autism. Children who are experiencing a crisis are showing up in emergency rooms and being sent home.

 

While we’re happy with the investment in new support teams, it doesn’t seem to address the emergency situations which we’re hearing more and more about. I’d like to ask the minister: Is there any money in this budget to address the fact that families are being sent away from emergency rooms, in some cases being told the next step is to have their child taken out of their care? As well - a two-parter: What in-patient care is available for children with autism, and how long does the in-patient care last?

 

RANDY DELOREY: I thank the member for raising the question; I know many members of the Legislature have raised this question. Knowing that we’re in Autism Awareness Month, I think it’s worth noting that the services and supports are an important component. There are a number of programs made available through our department, the Department of Health and Wellness, as well as the education system.

 

I believe the member’s specific questions though are predominately focused on a more acute side of the care. She had mentioned the emergency department visits, so there are two pieces to this that I’d like to advise the member of and share. One is a program announcement that was made just a couple of weeks ago. The program is, I believe, the BIOS program.

 

This program that was just announced, the Brief Intensive Outreach Service that we rolled out is to give us that opportunity to build the support teams that can go out to the community, whether it’s in the school environment or in the home environment when an individual, a child, youth, or adolescent with autism spectrum disorder is reaching a point with their caregivers and an intervention is required to stabilize. What we’ve established is that by having this program - we share the concern that the member has brought up that showing up at the emergency department is when the family or caregivers have reached a point where they truly feel they’ve run out of options and don’t know where to turn.

 

This intervention program that we just announced the pilot for, to establish these teams are to be connected with to then go out to work with the family or caregivers. It could be in the home setting or in a school setting, but to help stabilize behaviours in that, I’ll say, natural or regular environment rather than being taken to an emergency room, possibly admitted to a hospital setting to try to stabilize in an institutional environment. The goal here is to allow the intervention before it reaches crisis, allow that intervention to take place in the home or community environment, get the stabilization, help with new tools and approaches that can support both the caregivers or family members and the individual, and that’s the goal of this program and with that initiative the goal is that individuals and caregivers don’t expand to the point of crisis where they feel they have no options and have to go to the emergency department.

 

That’s one thing, to actually reduce the pressure point that they have a need to go to the emergency department in the first place. That’s an important investment that we’ve made this year and there was a recent announcement and I’m quite optimistic about the benefits of that program.

 

The other thing that I would like to advise the member of, and this one isn’t a program per se, so there was no press release or fancy announcement about it. Perhaps I’ll provide the context for the member. About a year and a half ago, the members challenged me on more than one occasion in the Legislature in the Fall session of 2017 about a couple of situations that were in the media that I believe the member is referring to where families reached a breaking point and showed up at the emergency department. In those circumstances, we came together to investigate - myself and my colleagues, the Minister of Education and Early Childhood Development and the Minister of Community Services - to try to figure out what could be done to respond to these specific acute situations that were occurring and challenging these families and youth, and we responded to them.

 

In responding, what I discovered was perhaps one of the root causes for why these families felt they had to go to the media on those specific situations was it seemed like - and I’m oversimplifying - they would go to one department and say this is what’s happening, and the department would say I don’t have something specifically for you, try this department, and then the family would have to go to the other department and say no and it didn’t really matter which department they started with, whether it was education or health, and it was getting passed around because no one department had a program or service to support the specific situation that that family was experiencing at that moment in time.

 

[8:15 p.m.]

 

Again this BIOS program, we think, is something that can be directed to and help them in these situations. We hope to learn a lot about that in the first year, so we can see if we need to tweak or modify the program a little bit.

 

The other thing though, even before we got this program and this investment, with my colleagues we basically came to the conclusion and said if the three of us can sit down and hammer some stuff out and say I may not have a specific program and you may not have a specific program but together, when we piece our programs together, we actually do have something and a means to respond. So, the direction we gave to our departments was, do you know what? The next time someone knocks on your door or calls you up, don’t say this is what we don’t have, say we don’t have something specific, but we know that as government we need to come together.

 

What we’ve done, again it’s not a specific program, it’s not something that’s budgeted, it’s simply changing our mindset and approach to responding to Nova Scotians. Subsequent to those situations that made the media, there were a few other times where I was advised that there were situations emerging and the departments came together, and those situations never made it to the media.

 

I didn’t follow up to get additional information because the system seemed to have been working. Again, it wasn’t a change, we didn’t need a new program or a new investment, it was really just about changing the way we work. I just wanted to highlight that to the member.

 

Again, it may not be perfect, there may still be instances that don’t go the way that we all believe they should, and I would like to acknowledge the work of my colleagues but also the staff in the Department of Health and Wellness, the Department of Community Services, and the Department of Education and Early Childhood Development for their willingness to embrace and come together and change the way they work together. I think at the end of the day that is having a positive impact.

 

I also hope with this BIOS program that those situations won’t even emerge in the department anymore, because we have this team to go out and help support in the community or at home, to have that intensive intervention and training that can take place to stabilize and reset the situation so that people can continue to get the care, parents can keep their loved one at home and stabilized and loved the way they do.

 

That’s our goal and it’s what we’re working on and we’re investing in. I hope we hit the mark, but if we don’t, we are going to tweak and take another stab at it.

 

TAMMY MARTIN: I really appreciate the answer from the minister.

 

I’d like to talk about Pharmacare now and ask the minister: How much does the province budget for all of the Pharmacare Programs each year, and can you provide a breakdown of each program, or by program?

 

RANDY DELOREY: The budget that we have is for pharmaceutical services and some other items, like extended benefits that fall in, which aren’t really pharmaceutical. The total amount is going to be about $20 million higher than what the - when she adds up the numbers I’m going to give here on strictly pharmaceutical, it’s about $22 million higher than those numbers. The total amount for the pharmaceutical and extended services is just under $319 million.

 

Nova Scotia Family Pharmacare is $40.9 million; Seniors’ Pharmacare is $184.8 million; and the special drug program is just about $71 million - it’s $70.9 million. I guess, if you total that up, it’s $296.6 million just for pharmaceuticals. That category in the budget would be $318.8 million, but the other $22 million is for non-pharmaceutical supports that fall within that insured extended program.

 

Pharmaceuticals - $296.6 million, broken up between Family Pharmacare, Seniors’ Pharmacare, and special drug program - big asterisk on that and it does not include the DCS Pharmacare Program because that is budgeted out of the DCS program. There are additional Pharmacare services provided by the Department of Community Services and that shows up in their budget. I don’t have that information with me.

 

TAMMY MARTIN: I’m wondering, could the minister tell us how much the province receives in premiums?

 

RANDY DELOREY: We have the revenues categorized a little different than where we have the expenses, so I have the revenue expense for the largest Pharmacare Program which is the Seniors’ Pharmacare. As I said, the expense is $184.8 million and the revenue for that program was $56.5 million.

 

We are just looking but we didn’t find it for the Family Pharmacare. Again, special drug would be different, but I don’t think we have the Family. If I get it, I will bring it back later rather than taking more time.

 

TAMMY MARTIN: I appreciate the answer. I know I’ve said this before in the House, but it’s worth repeating, I believe. When I was canvassing prior to the election, I learned so many horror stories about seniors and their medications - seniors selling drugs because they couldn’t afford to eat, and they were making money off their drugs; I talked to a senior who would cut their pills in half because they couldn’t afford the full dose; and I talked to a lot of seniors who went without their medication because they just couldn’t afford the premiums.

 

I wonder, has there been an analysis or an investigation into the benefits of a national pharmacare program shared, of course, with the federal government? It’s like what I believe in long-term care - it would be a huge investment up front to build however many beds we need, just like with national pharmacare, but being proactive instead of being reactive, I think the benefits would be amazing - has there been any thought or cost analysis done on that?

 

RANDY DELOREY: I thank the member for the question. In fact, I think most Nova Scotians and, indeed, most Canadians are likely aware that the topic of the national pharmacare, although it had been around, was really launched in Canada about a year ago with the federal government budget last year, so work was done in the last year. The federal government established a committee to go around the country to evaluate provincial programs.

 

We participated, as did our sister provinces, and provided information to the committee. A little asterisk or aside: Nova Scotia was very well represented because a former colleague of ours in this Legislature, a former minister and Deputy Premier, Diana Whalen, was actually part of that national committee and so we had a Nova Scotia lens, someone very familiar with the Nova Scotia situation. The province answered and provided the information requested by that committee. I don’t believe the report has been fully finalized. I think they were hoping to have it done by the end of fiscal and I believe they’re now looking at perhaps in June or sometime early summer to have it complete.

 

There’s a lot of information, a lot of perspectives on a national pharmacare, what it might look like, the pros and cons. Our starting points are very different, and in fact, that’s part of the reason the federal government initiated this conversation and invested in a committee to go around and answer these questions.

 

In this year’s budget, the federal government has continued to signal their intention to continue to pursue a national pharmacare program. The details are still preliminary and they’re still waiting on the final report from the committee they established to review and provide some recommendations. But any time the federal government attempts to establish a national program, that requires the engagement and participation of the provincial and territorial governments as well, particularly when it is a program in an area that fundamentally is constitutionally a provincial responsibility, such as health care. I think the response from our province has been very positive. In terms of participating and providing the information to the federal government to assess, we haven’t received so I’d don’t know the results of that committee’s report, but progress is being made and work is ongoing.

 

Answers aren’t complete, but we are participating with the federal government and our sister jurisdictions to evaluate and review, and that committee’s work is ongoing. On the other hand, and recognizing that the federal government is doing some work, but also in an Atlantic context, really the truth of the matter is our Premier has been a leader in the Atlantic and national contexts for more interjurisdictional co-operation, and Atlantic Premiers came together to recommend that we work together. So, regardless of what happens on the national stage, we believe that working together with our sister Atlantic Provinces we, too, can still get some value and possibly move even faster than nationally in some regards. Those efforts, too, are ongoing.

 

Those are two pieces of relatively new work, and I mean “new” in the context of government. With government, a year is a blink of an eye in the system. That review federally has been going on for a year and it’s still not complete, but that’s because of the volume of information that has to be assessed and input into this, but there has also been other work: some of those features, like cost-saving opportunities within drug programs to save and ensure that we have the most efficient procurement of drugs to provide to citizens across the country. Provinces recognized that a number of years ago.

 

In fact - and I’m just checking my dates here. I’m not certain about the dates but I believe somewhere in 2009-10, which would fall under the previous NDP Government, there was work at the national table with provinces and territories to establish an entity to review and negotiate nationally for drugs. That work has been established to drive down prices.

 

[8:30 p.m.]

 

There was work done with the jurisdictions to establish a body to negotiate and get a national price, a price for all jurisdictions. That work is done to establish negotiations when a new pharmaceutical product, a new drug, goes through the approval process. It gets clinically assessed so it gets approved by Health Canada then it goes through a clinical assessment to make sure the benefits are clinically adequate or sufficient. Then this other body, pCPA, goes through negotiations with the manufacturer to come to terms on the actual price for the product. Then that price gets to be a price we can use provincially with each province when we add the drug to our . . .

 

THE CHAIR: Order. The time allotted for consideration of Supply today has elapsed.

 

The honourable Deputy Government House Leader.

 

KEITH IRVING: I move that the committee do now rise and that you 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 8:32 p.m.]