HALIFAX, THURSDAY, MARCH 7, 2024

 

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

 

3:45 P.M.

 

CHAIR

Danielle Barkhouse

 

 

THE CHAIR: Order. The committee will come to order.

 

The honourable Government House Leader.

 

HON. KIM MASLAND: Chair, would you please call the Estimates for the Minister of Health and Wellness, Resolutions E12 and E29.

 

THE CHAIR: Resolutions E12 and E29 will continue with questioning by the Liberal caucus, with 25 minutes remaining in their hour.

 

The honourable member for Bedford Basin.

 

HON. KELLY REGAN: To the Minister of Health and Wellness, can you please confirm the cost of the YourHealthNS app? Is the $10 million figure reported in the media correct?

 

THE CHAIR: The honourable Minister of Health and Wellness.

 

HON. MICHELLE THOMPSON: Yes, that's correct.

 

KELLY REGAN: Did I not hear that there was an additional $2 million for something else to do with that app as well?

 

MICHELLE THOMPSON: I don't know what the member heard, but it is just over $10 million in 2023-24 - if that's the question, is that what we spent?

 

KELLY REGAN: On February 10, 2023, the Government of Nova Scotia awarded a sole-sourced contract to Think Research Corporation. What was that contract for?

 

MICHELLE THOMPSON: In the 2024-25 budget, there's $4.5 million allocated to the portion of the app that Think Research is responsible for.

 

KELLY REGAN: Thank you very much for that information, but I was asking about February 10, 2023. The Government of Nova Scotia awarded a sole-sourced contract to Think Research Corporation. What was that contract for?

 

MICHELLE THOMPSON: I'll get back to the member about that. That's last year. I'm here with information for the upcoming year, the budget and forecast. I'll get that for the member after.

 

KELLY REGAN: I do have a number of questions about this. In addition to the upcoming budget, we often ask questions about the year prior. I have a few questions about that particular contract, so perhaps I'll just run through those, because I think we're going to be here for a few days, so the member can respond to those later.

 

My questions are: What was the contract for? Again, it was February 10, 2023, and the value of the contract was $49.6 million. I'm wondering what Nova Scotians are getting for that particular one. Once I get those answers back, perhaps I'll have some more questions around that particular contract.

 

THE CHAIR: Unless I'm mistaken, I don't hear a question for now, so I recognize the honourable member for Bedford Basin.

 

KELLY REGAN: Okay, I think we'll move on to something else: doctor numbers. In May of last year, the Province announced that in fiscal year 2022-23 there was a net gain of 86 doctors in Nova Scotia; 168 doctors started practising, and 82 left practice. Do we have preliminary numbers for this year?

 

MICHELLE THOMPSON: Just in terms of overall, since September 2021 we have a net gain of 195 physicians - 405 starts and 210 departures is what I have.

 

KELLY REGAN: So that's from September 2021. Do we have those broken out by year? Could I get those?

 

MICHELLE THOMPSON: Since September 2023, Nova Scotia has had 72 physicians start - 21 family physicians and 51 specialists - compared to 20 departures, for a net gain of 52 physicians. Then there's that number I just told you. Since September 2021, Nova Scotia has had a net gain of 195 physicians - 405 starts and 210 departures.

 

KELLY REGAN: I'm having a bit of trouble writing those down. If the minister could go a little slower so I can get those written down, or if there's a chart, I'd be happy to just take a snapshot of that so I can get those numbers. Sorry about that.

 

MICHELLE THOMPSON: Since September 2023, Nova Scotia has had 72 new physicians start - 21 family physicians and 51 specialists - compared to 20 departures, for a net gain of 52 physicians. In total since September 2021, Nova Scotia has had a net gain of 195 physicians - 405 starts and 210 departures.

 

KELLY REGAN: Do we know how many of those starts are doctors who are practising full-time? Do we know how many physicians have reduced their hours during those periods? I guess we break them out into September 2021 and since September 2023.

 

MICHELLE THOMPSON: I have to check with the department to see just exactly how to do that or to what degree we can. There are people who are purely primary care providers; there are people who work as hospitalists; there are people in oncology, ED - it's quite an in-depth question and analysis. I actually don't know that I could - they're just going to be able to roll with that off the top of their heads.

 

The other thing, too, is we just started the new contract so we actually are seeing a scaling up of some people's hours, so I think it will take us a little bit of time to get that full report. Until I speak to the department, I don't want to commit that I can actually figure that out entirely.

 

KELLY REGAN: I have been able to get the numbers for my area, so I think they do have the numbers. It's probably a bit of work to get, but I have been able to get that kind of information for my area, so I think they do have the information. It just probably takes a little bit to get sorted through what is going on in each area.

 

In 2023, the minister estimated that we needed 153 new doctors every year to keep up with the Need a Family Practice Registry need. Is that number still accurate? Is that what we're looking for every year?

 

MICHELLE THOMPSON: I would say that is the same. Because we see a number of physicians who are ready for retirement, we have 120 vacancies for family physicians across the province, and also to manage that ongoing reduction in practice in retirements, as well as population growth, that number would be roughly the same.

 

KELLY REGAN: In February of this year, and I know the minister is aware, the number of Nova Scotians on the Need a Family Practice wait-list reached 153,373 Nova Scotians and that's a new record for our province. Could the minister comment on why the number of Nova Scotians without a family doctor or a nurse practitioner keeps growing?

 

THE CHAIR: I'm sorry, could you please repeat the last part?

 

The honourable member for Bedford Basin.

 

[4:00 p.m.]

 

KELLY REGAN: Can the minister comment on why the number of Nova Scotians without a family doctor keeps growing?

 

MICHELLE THOMPSON: What we're seeing with the Need a Family Practice Registry - 35 per cent of the people who are on that list are people who have moved to the area - who identify, when they go on the list, that they are new to the area - which is a sign of our population growth. We see another roughly 24 or 25 per cent of individuals whose physician has left or has retired, and it would depend on where they're at. We also anecdotally understand that there are some individuals who have a family physician in a different area of the province - not just in-migration but have moved from one area of the province to the other. They may be technically attached to their physician in their previous community, but they have trouble accessing them because of distance, so they have put themselves on the registry to signal that they would like something closer.

 

KELLY REGAN: I'm assuming that those people are considered new to the area even though they may not be new to the province, but they're new to the area.

 

When I add up the Nova Scotians whose doctor or nurse practitioner has shut down their practice or whose primary care provider has retired or is retiring, that's 55 per cent. It varies a little bit across the province, but it's not a huge change. I just fundamentally believe that people don't care why their doctor has left. They just know they're without a doctor. Their doctor has left - whether they retired, are retiring, or closed their practice - 55 per cent of the people who are on the list are on there because they had a doctor, and their doctor has closed their practice.

 

I was wondering if the minister could speak to that - to the number of people who are on the list who do not have a family doctor because their doctor has closed or is closing their practice.

 

MICHELLE THOMPSON: I think there are a few things there. When we look at - first, we have had population that has increased, and the practices have felt more pressure. The other piece is that, respectfully - very respectfully - there was an overwhelming lack of planning regarding seeing our baby boomers, who are inevitably going to retire. It takes 8, 10, or 12 years to train a physician.

 

Part of the things that happened in the 1990s is that the governments of the day felt there were too many nurses and physicians and changed the requirements for education, so we have seen a steady decline in the numbers. Also, there was a policy prior to our coming in under which one doctor had to leave before another physician could come in and take their practice. As a result of that policy, we were unable to recruit physicians who were ready to transition into practice and transition out.

 

Part of it is an aging population of physicians, and we want our physicians to retire. We want them to retire with their heads up. We hear regularly, particularly in rural communities, that physicians feel incredibly guilty about leaving their practice, and they're leaving their practice in their 70s - sometimes late 70s - because of the shortage of physicians that we're experiencing.

 

I do think the major reason is because of lack of planning and lack of investment in medical residency seats when looking at how we support people from Nova Scotia coming in. Those are some of the things that we have looked at. We have increased the number of medical residency seats. We have opened it. We're working with CBU to open a new medical school, looking at workforce in a very intentional way, and arguably with nurses as well.

 

When there were diploma-trained nurses, you graduated at 20. By the time you were 55 years old, you had a full career, your age and years of service matched, and you were able to go; but we didn't plan for that in an adequate way in order to backfill this incredibly experienced workforce that is ready to go and should be able to go and enjoy their retirement after a number of years of service to their communities.

 

THE CHAIR: The honourable member for Bedford Basin with a note that the time will soon expire.

 

KELLY REGAN: I would gather from the minister's comment that that must have been fairly common across the country, because we do often hear that there is a doctor shortage across the whole country, so the lack of planning must have been across the entire country. Would she say that is the case?

 

MICHELLE THOMPSON: I would say it is the case. I would say that we are not unlike any other province. The Canadian Association of Emergency Physicians put something out last January and it said exactly that. Again, respectfully, governments of all stripes since the 1990s have not invested adequately in heath care and it has chipped away.

 

There have been policies though, more recently in this province, like the one-in-one-out policy that existed under the former government where physicians weren't able to pass their practices over until they wanted to leave them completely. We have changed that policy now. We have transfer in, transfer out. We are taking physicians. We are looking for ways to accommodate wherever we can. The more specialized you are as a physician, the more difficult it is sometimes to place you, particularly if you have a partner who has a different specialty or is a family physician. We are just looking at different ways to work with physicians. Also, the virtual option has been very helpful, as well. We're trying to create practice environments where physicians can come in, have some choice to the best of our ability, in order to make sure that our communities are served.

 

KELLY REGAN: I want to thank the minister for that answer. Can the minister give us an update on how many doctors currently practising in Nova Scotia are over the age of 65? It might be difficult, and I am assuming we must have a number that we know are retiring within the next, I don't know, year?

 

MICHELLE THOMPSON: Four hundred and eighty-seven physicians are between the ages of 61 and 70, and 146 are over 71. As always, we never really know when someone is going to retire. There is certainly no mandatory reporting required. I think we can guess when we think people are going to retire. I will say that there has been some work done in the past year that has allowed - I have heard anecdotally, and I actually got an email today - that have allowed physicians to consider staying longer, so more options being able to reduce from a full-time complement.

 

We received an email just in the last couple of days: As a family doctor, I have been planning to retire from medicine to switch to a different career and so, in light of the new contract, I feel family medicine is getting the support that it has been lacking for most of my 23-year career and I no longer have plans to leave the profession.

 

I say that because it is so heartening to hear because we have been working with family physicians to understand how best to support them. Strengthening clinics, we have a physician hotline, the new contract is very good, and so we are hopeful. We are not going to alleviate all retirements, of course, but we do feel that the current practice environment is positive for particularly our family physicians.

 

KELLY REGAN: I recently received a letter that was forwarded to me from a gentleman in Dartmouth who received this particular letter from his physician who said: “I am writing to inform you that after one year, I am closing my family practice of medicine as of . . .” and then it was February 2024. I just want to make sure - I don't think it's the case - are we bringing people in for one-year contracts or anything like that? It didn't make sense to me.

 

THE CHAIR: Order. The time has expired for the Liberal caucus. It is now time for the NDP caucus.

 

The honourable member for Dartmouth North.

 

SUSAN LEBLANC: Thank you to the minister for her opening remarks, and to the staff who are here. I fear that my questions will be kind of all over the place today.

 

I first wanted to start with some questions that I sort of jotted down as the minister was making her opening remarks. Just a few short snappers, as it were, from some of the stuff that was in the opening - just questions about that.

 

The first one is, there are a lot of numbers and a lot of amounts invested in the sort of care coordination centre, SAFER-f, all of those, I'm pretty sure that's all sort of hospital flow stuff.

 

The budget highlights document stated that there will be $19.8 million for initiatives to move patients through the health care system more quickly. My question written down is: Can you elaborate on this? I think that some of that was in your opening, but I'd just like to know what is for what exactly again. Also, is the idea in general to have patients in beds for fewer days? Or is it to have faster access to health care procedures?

 

MICHELLE THOMPSON: This is probably not a short snapper, but I will do my best. What I will say is that there are multiple initiatives that are under way to improve patient access and flow. You've heard us talk about SAFER-f. SAFER-f is a set of best practices for adult in-patient units that is being rolled out province-wide to improve patient flow and to prevent unnecessary waiting for patients.

 

To the point, there are coordinators associated with it to improve the efficiency, making sure that diagnostic tests are done on the day before discharge, or early in the morning as a result, so that when the physician or nurse practitioner comes around, the patient can be discharged or transferred from hospital.

 

This SAFER-f flow bundle is having a pretty significant impact. I think I mentioned it yesterday, but we move away from “How long are they in hospital?” to “How long are they away from home?” With that whole thought, how do we get patients home in a timelier fashion? Also looking at the number of patients who are in hospital 28 days or more - really looking at that data, and understanding and mining it to understand how that happens and why, if people are not receiving active care. Interprofessional teams are also included in that, so that's physios, dietitians, pharmacists, OTs, and discharge planners, to increase evening and weekend access and make sure that people can get home over the weekends.

 

There will be work happening as well in the Department of Seniors and Long-term Care, when you have a shot to talk to her, so that they're actually accepting admissions. Historically, perhaps, we really didn't admit to long-term care on weekends, as an example, or later in the day, so looking at some of that flow issue.

 

Early mobilization teams - health care professionals really intentionally move and get people on their feet at least twice a day, which maintains their function, because we know that deconditioning can occur, one, because of the illness, and then, two, prolonged time in hospital.

 

Transitional care, those types of things, and then the care coordination. There are a number of things that are happening in order to support access and flow. Just to try and make that stay more efficient and doing - like discharge planning should start the day the patient is admitted, really. If they're admitted to a critical care unit, then perhaps it doesn't start until the day they go to a stepdown unit, but it really does have to start now with all the different agencies and some of the barriers to being transferred home.

 

[4:15 p.m.]

 

SUSAN LEBLANC: That's very helpful. Just a couple of clarifying questions. In that system, that care coordination, all of the people you've mentioned - the physiotherapists, the lab technicians, all of those - is the bulk of the money for more people to be hired? Or is it for a computer program that sort of you punch everything in and it spits it all out? Is it actual full-time equivalent positions? I guess my B part to that would be: With this SAFER-f program, are there benchmarks and timelines attached to that program that are the best practices that are trying to be met?

 

MICHELLE THOMPSON: The majority of it would be people is what I would say. Generally, we see that. Everybody's probably cringing, but I'll just say, operationally, generally 70 per cent is often the people, and then 30 per cent would be the other things that we need to do it.

 

The interprofessional teams are an example of hiring more people. Clinical assistants and those types of folks, the SAFER-f bundle, resource 11 inpatient units across the four zones. It is the people in order to do the work. It's not necessarily a thing. It really just requires more individuals and a more coordinated approach.

 

SUSAN LEBLANC: I guess the question is: Do we have the people? Are these new postings? Have we started posting? Have we seen some activity around applying for the jobs? Is it moving people around, or is it new hires? I guess if it's more money, then it's new hires. I think that it's great, but do we have the people to actually do the jobs?

 

MICHELLE THOMPSON: It's a little bit of both. If we could boil the health care system down to two things, the biggest parts would be beds and people, 100 per cent. We're underbedded - pretty much across the system, in acute care and in long-term care - and we're underpeopled.

 

Sometimes there would be senior folks, based on where they are on the seniority list, et cetera, who would move into some of these positions. In a way, that's really helpful, because it allows for entry-level positions for folks in different areas.

 

We're seeing an increase, of course, in the training that we're doing. The internationally educated nurses is an example. The pathway to licensures that we're working really hard with the colleges - so pharmacy, nurses, physicians, et cetera. The Patient Access to Care Act, which allows us to accept credentials from anywhere. We do see some repatriation of people coming home and being able to come and live home again, after being away for a period of time.

 

There is also an investment in the physician assistant program, and we've increased the nursing seats. It is happening incrementally. A lot of the initiatives that we are talking about start in a test-and-try environment, rather than trying to scale across the province really quickly. We start in a test-and-try environment, we staff up a particular spot, and then we're able to kind of move. It's not a big draw all of a sudden across the entire province. It is a real intentional roll-up. Where we're able, we move.

 

It's a little bit of all of those things. We're going to be in a shortage of health care providers for a pretty long time while we train. We're trying to extend our more senior health care professionals by trying to give them opportunities to stay a little bit longer.

 

We're doing a lot of work, because we have so many new clinicians, particularly nurses, coming into the system. We're looking at mentorship programs, as an example, and hoping that some of our more seasoned and experienced nurses will stay a bit longer in order to support our entry-level and more intermediate nurses, in terms of not just skill development, but in terms of the management of the complexity of the health care system and the patients now.

 

We're trying to hang on to people. Recruiting new people and trying to retain the folks in the middle is really a part of this, but there are more positions available in the health care system as a result of the changes in these programs.

 

SUSAN LEBLANC: Another question on this whole thing. You mentioned in your comments last night, and then you mentioned it again today, that there's $7.8 million to hire health care workers for evening and weekend access to care. I wasn't sure if that was in this scenario that we're talking about, or is that urgent care centres? Or is it both? I guess what I'm saying is: Is it hospital care or is it primary care?

 

MICHELLE THOMPSON: Access and flow generally is hospital-based care. It is patients and families having access to team members seven days a week. Typically, we would have, perhaps, some allied health care professionals who wouldn't typically work evenings and weekends, and we're addressing that. Fewer discharge delays related to having access to these folks.

 

The impact of that interprofessional team, that allied health care professional team in hospital - in different emergency departments, as an example - some folks, if they are seen and assessed, perhaps by a physiotherapist, can be returned home with exercises as opposed to being admitted. So it is in the acute care system.

 

SUSAN LEBLANC: Just to clarify: In the old way, those folks would have to wait until Monday to get discharged, but now if they get seen on a Friday afternoon, they might go home Friday evening if there are those people who can do that work. Okay. Great.

 

Another thing from the minister's opening comments: The minister mentioned - I'm going to have lots of questions on the transitional care facilities, but the minister mentions opening this Summer. Love to know a date, but who will actually - who are the people who will actually move into, say, Hogan Court?

 

We've understood from a variety of sources that there will be fewer beds than originally hoped for, but also that there will be people of a certain acuity who won't actually be able to go there now. Can you paint me a picture of Mrs. Smith who leaves Halifax Infirmary and goes to Hogan Court?

 

MICHELLE THOMPSON: Currently, we have a number of individuals who are in hospital who would be considered medically discharged. There are a lot of reasons why people are there. Sometimes health care providers feel fairly confident when somebody comes in whether or not they're going to be able to transition home at all following their illness process. We really are looking, predominantly, at frail, elderly people.

 

I don't know if you're familiar with Dr. Rockwood's frailty index, but he has, really, a world-leading frailty index. We have him and his team and Dr. Christine Short as an incredible resource in our province, looking after frail, elderly individuals. So, there are individuals who we would expect will be reconditioned. It's different from rehab. Usually there's an injury associated, whether it's a brain injury or perhaps stroke, et cetera, a significant traumatic event.

 

There are people who, in hospital over longer periods of time, decondition and there is always hope that they can recondition. In fact, sometimes that happens when they go to long-term care. They do recondition as a result of the recreation that's there, lack of isolation, mobilizing. There are a lot of motivating factors when there are a lot of activities around and when there's more of a social environment. Even simple things such as seating.

 

I don't want to be disrespectful in any way to acute care. The acute care staff in health are amazing. They have a very particular job and skill set. Then we have community-based care providers, like those folks in long-term care, like our rehab professionals, our allied health care professionals, and recreation therapists who are incredible in terms of reconditioning people, motivating folks, making sure that they feel connected.

There will be some people with mobility issues, but those will not necessarily be all of the individuals. There is a subset of people who, with reconditioning, with the right supports at home, with reversing isolation as a result of a prolonged hospital stay, or perhaps being home for a long time on their own as well, that we would be able to support in that environment. I can table this document if I can find it. I have, like, a million of them here.

 

I think, too, one of the big things is, when you really look at the care people need, the right care in the right place with the right provider can make a significant difference. In the AG report, it did talk about the cost: $975 per day for individuals, just in direct care costs. In fact, in a transition to care facility like Hogan Court, that's roughly $544 a day. That's operating and direct care costs. They're apples to oranges in many ways, but over a year, 68 beds can save $10 million, and it's the most appropriate care, because it's not - it's skilled nursing care to some degree, but it's also the allied health care professionals who keep people motivated, make sure that they have the things that they need at home, transition them to home. If we can delay admission to long-term care facilities, as an example for six months, a year, two years, whatever it is, it also has a big impact on individuals who don't have that option to transition to community.

 

I am really excited about this model. I think it's new, and I think the folks who are involved in it are excited about it. I think it's a really great addition to our health care system to transition people.

 

SUSAN LEBLANC: Another thing that the minister said in her opening comments was that there's some money in the budget for incentives for people to study primary care. What are those incentives?

 

MICHELLE THOMPSON: I don't remember saying that. There are incentives to attach patients. There are some tuition rebates for paramedics - $11,500 for those folks who are studying paramedicine. I just don't have the exact - I can look in my speech, but I don't think I said that.

 

SUSAN LEBLANC: I guess that means there are no incentives for people to study primary care? Just to clarify.

 

MICHELLE THOMPSON: There are lots of incentives to work in primary care, and those types of things. I think there's some work happening, too, in the Department of Seniors and Long-term Care around supporting individuals who are moving from CCA to LPN, as an example. There are retention bonuses, and there are sign-on bonuses, and it's all of those things. Currently, we're supporting the CCAs, of course, throughout the province, and Minister Adams can speak about that. We're supporting paramedicine as well, and offsetting tuition costs for them with a return of service, and certainly subsidizing some of the EMR - the first EMR course that started on Monday.

 

SUSAN LEBLANC: In the minister's opening speech, there was a long list - or litany, as it were - of appointments. This many people were seen at urgent care centres, and this many people were seen at mobile primary care units. It went on and on. It did strike me as the kind of thing where we hear, like, 50,000 people went to the food bank this year. It's a weird thing to boast about. Primary care is not a weird thing to boast about, but the alternatives to being attached to a practice with a nurse practitioner or a doctor - I just want to ask the minister: Is this government prioritizing access to primary care, or attachment to primary care?

 

[4:30 p.m.]

 

MICHELLE THOMPSON: It's both is what I would say. I'm attached, and I actually have good access to my family physician, but if I have a sore throat, I'm going to go to the pharmacy, because that is now a skill set, and it's a very efficient way for me to have that seen. Similarly with my children, they're very fortunate to have a family physician whom they like. They've had him for a long time. They actually would rather do quick things. It isn't one or the other.

 

We want to give people a variety of access points. When you have everybody trying to go through two doors, which is your primary care provider or emerg, there's no way we're all going to fit. But now, we've created 60,000 more appointments every month for people to be able to go. Some of those folks are not attached, so we have to look at them together. There are people who are attached who can't get an appointment for six or eight weeks, so we need to look at those practices and say, okay, what is the issue here? What is the panel size? What are the practices? If you've had an office for 30 years and you're running it exactly the same way that you did when you finished medicine, there's probably more efficient ways, more ability.

 

The mobile clinics are amazing, and we're able to put those in communities where we feel there is a need, and actually anticipate. Perhaps Acadia is an example: In health care, there are waves of things that happen. I can almost promise you that every university in this province just right around - and the Pages will probably tell you - right around their first mid-terms, everybody gets sick. They've just sat there, and they've all been together long enough, and they're exhausted, and they all get sick.

 

So now, here we have mobile units, we have pharmacy clinics, we have pharmacy-plus clinics, we have after-hours clinics, we have virtual care if folks aren't attached. There are just so many ways for people to get care.

 

Our emergency rooms should 100 per cent be used for emergency care. When we can take individuals and give them another option, it frees up space in that waiting room and alleviates some of those long waits.

 

We're very focused on attachment. Just to let you know, from July to October 31^st we put a challenge out, an incentive out to physicians, to talk about who could accept 50 patients who had higher needs on the Need a Family Practice Registry, because we asked people to tell us a little bit more about their health status. So 65 physicians participated in that, and through that incentive over 15,000 patients were attached.

 

I think, when we think about it, we're going to have health homes, which I know you're interested in probably talking about at some point. We're going to have health homes - so it's not just a family provider, it's not just a nurse practitioner or a physician - so that if we have a physician who moves on, or a nurse practitioner who retires, we're immune to being unattached, because now we have this health home.

 

Outside of the health home, we have a health neighbourhood where different places across our communities help us look after the care that we need. The app is going to be very important. First of all, it's a navigation tool. So, if I'm travelling, I'm going somewhere into a community, and then somebody in the car gets sick and I know I need help, this app is going to help me see what the assets are in the community that I may be unfamiliar with.

 

It's also going to allow me to have my health record with me, eventually, so that if I do need to go see someone, I am able to talk about the last time I was at the physician or the emergency room or whatever it is. I will have recent diagnostics on my phone. There will be a limited amount of information that I can share in order for me to have agency, and I really think that people, all of us, need to know that we are the most important person on our health care team, right? We saw a very similar app when we were in Denmark, and we saw it again somewhere else, where at 16 years of age every single individual has their health record on their phone.

 

It just changes the way in which we are able to navigate the health care system, and then what's the possibility for folks when they retire, when physicians are set to retire? We can actually give people access to their record, and they're not trying to find it, whether it be digitally stored or stored in a box, et cetera. It really is around the transformation of it.

 

I will never say that we will have one doctor for every Nova Scotian, but the goal is to have a health home for every Nova Scotian, and access. I have a 21-year-old son. He has, fortunately, no health care needs. He's into episodic care right now. He is fortunate to be attached. But right now, that's what he wants - episodic care. In the event that he were to have a diagnosis, we would absolutely need that regular, consistent care for him.

 

It really is around a system that can be fluid and respond to people as they need that. It's building, and it's going to be incremental, but that's the dream. Health homes, health neighbourhoods, and lots of points of episodic care and chronic disease care, right?, so that people who live with chronic diseases actually have expertise in specialty care that allows them to integrate with their health home.

 

SUSAN LEBLANC: Yes. I mean, listen, I am a big fan of health homes. I've been advocating for one in my own community for six years, and we finally - I mean, the minister still has not said that we're getting it, but you know, I'm pretty sure there's some lease being signed in the next month. It's kind of amazing that the minister will not say yes or no. I'm . . . (interruption). What? Exactly.

 

Anyhow, no, I am a big fan of health homes, but I do - it's interesting that the minister uses the example of her son. He's 21, he's into episodic care, he likes to be able to go to the pharmacy and get this test and that test or whatever, and I like that too, because I'm a busy person and I've done that. But, you know, if the minister's son didn't have a primary care attachment and did get a diagnosis, then there'd be some issue, right? Like, yes, but I think that the priority needs to be - this, everyone's attached to a health home, I get that, but I hope that that is the - show me in the budget the money this year to attach more people to health homes.

 

MICHELLE THOMPSON: We are continuing to - we planned 60 new - there are 23 and 37 strengthened clinics, and this has allowed us to stabilize attachment for 15,000 patients and attaching 52,000 more. It really is around incremental building. There are some that we started last year. We're continuing to invest in those practices - fill the positions, as an example - and we continue to expand.

 

It is workforce. Some of that sits in workforce, some of that sits in the model. We just simply have to look to the model that we've recently implemented in Clare. Working across with the municipalities, working with the practice, working with the members, we'll be able to take almost everybody off the Need a Family Practice Registry in Clare, Weymouth, and Digby. These are the models, so it happens incrementally.

 

One of the other things - when we look at an example of Dalhousie Family Medicine Clinics, or we look at the clinic in Clare, we look at some of the places in the Northern Zone, in terms of the medical residency program. As an example, we bring medical residents in, we get them accustomed to a practice - a way of practising, et cetera - and then we're able to either adopt them into that practice or move them into another one. It is going to be cyclical for a fairly significant period of time.

 

That's where the money will come. Some of it comes through the initiatives to increase seats - the incentives, the on-boarding, the different allied health care professionals, all of these different things, RFPs that go out for space so that we can identify places where people go. It's across all of the different components in order for us to realize that expansion.

 

SUSAN LEBLANC: Speaking of attachment, or access, I should say I did have a situation where I felt like maybe I had pneumonia, and I was in a caucus retreat - of all places - in a hotel. I decided to use one of my free Maple visits. It was kind of amazing. I was texting with a doctor in Calgary who basically said she didn't think that I had pneumonia but didn't check my temperature. She had to rely on my saying I didn't have a fever but prescribed me some puffers. And it was about 15 minutes.

 

But the whole thing - I always thought virtual care was a video call. It's not; it's a texting conversation. My thought was: How would a lot of people manage this? First of all, you have to have a device. Lots of people in my community don't have devices. Second of all, you have to know how to navigate the device. And even if you do have a device - I love my mother very much, but she has a lot of problems using her computer.

 

How are we accounting for the many people who have to rely on Maple to actually know how to navigate it and use it? And who can help them with that? I can.

 

MICHELLE THOMPSON: What I would say is we've had experiences with virtual care in our family as well. It can sometimes be a phone call. We do have times where there is a virtual - it depends on the provider; it depends on the presenting complaint. The other thing is if the provider in virtual care feels that you need to be seen, there are a number of primary care clinics across the province where you can very quickly - well, first of all, they want to know if it's an emergency.

 

The other thing I would say is, in regard to the app, you can also call 811 and 811 will walk you through that app, that decision tree that you go through as you access virtual care. There are a number of different modalities that you can use. If I go on the app, and I say, “Get care,” it takes you through all of those things; 811 actually can help you do that, as well. So there's a person on the phone helping you navigate.

 

It is a variety of different things. Virtual care is an incredible enabler in order for us to be able to see people urgently in the emergency room. We've been able to implement that in several emergency rooms. It shortens people's visits. It gets them what they need. It's low acuity and move on. Virtual care isn't for everything, there's no question about it.

 

We're also starting to put some virtual care options in the EHS system so that the doc in the box can send a link to the SPEAR or to the scene, maybe to the medical first responder, and actually be able to see. What I say is “short of breath” and what you say is “short of breath” may not be the same. But when a physician sees that, they can better ascertain what's going on. There is a variety of ways to access it.

 

Since 2022 there have been 70,409 appointments in VirtualCareNS. May 2021 to December 2023, virtual care prevented about 24 per cent of users from going to an emergency department, and 36 per cent of users from going to a walk-in clinic. So it is allowing people to off-load. It may not be for everybody, but the people whom it works for, it works well. And it takes them out of an in-person situation so that those who need in-person can be seen more quickly.

 

SUSAN LEBLANC: Big announcement about diabetes care in Nova Scotia. Happy to see it. We've been calling for some of that - both CGMs and expansion of the insulin pump program - for a long time, so I'm happy to see those investments.

 

Also, there was a big announcement in Ottawa about the beginnings of a universal pharmacare program, including diabetes medication.

 

[4:45 p.m.]

 

I just want to hear that the minister and the department will be signing that agreement and signing onto the federal pharmacare program.

 

MICHELLE THOMPSON: The department officials are talking. I don't think we have all the details just yet. We are anxiously awaiting - there's the announcement, and then there are the details.

 

The departments are working together. If it's the right thing to do, then we will do that. We need to see what it is. We also need to understand how long the agreement is in place. There are a whole bunch of things.

 

We're pleased to hear that announcement. We don't fully have all the details. You can appreciate that until we see the details - we expect to be able to sign on to it, but I don't want to commit to that until I fully understand what the deal is.

 

I certainly think the intention is to make diabetes care more accessible. Our hope is that it's going to complement our diabetes care program and it will be a win-win for everybody.

 

SUSAN LEBLANC: Yes, of course we need to see the details. I'd love to know what the timeline is on that. Also, if the department discovered that it wasn't a deal that the Province was going to sign on to, would the department be looking at subsidizing diabetes medication - and also birth control - in a fuller way?

 

It is not a secret that our party has been calling for a universal birth control program in this province. It happens in other provinces. For us, this federal announcement, if it works, will be the answer to that call. If the Province isn't signing on to the federal announcement - or the federal deal - then how are people going to access birth control and insulin in Nova Scotia?

 

MICHELLE THOMPSON: We do have the Seniors' Pharmacare Program and the Family Pharmacare Program. There are several demands on those. We're constantly looking.

 

Through the budgetary process, we continue to look at what we're able to offer. Those are the means in which - if people don't have private insurance or after they reach the age of 65, Seniors' Pharmacare and Pharmacare are the ways in which we can currently support Nova Scotians. There is birth control available through Pharmacare, and certainly there is support for seniors through the Seniors' Pharmacare Program.

 

We continue to look at ways that we can help. We're proud of this investment. It's significant. It will make a huge difference for people living with diabetes, particularly those who require insulin. Multi-daily injection users now have access to a pump and access to continuous glucose monitoring. We're proud of that.

 

It will have a significant impact on people in terms of the bottom line. We know that that program alone - one individual indicated it would save them up to $600 per month. It's a pretty significant investment. We'll just see where we are after that.

 

Again, we must wait and see in terms of a timeline. It really is a federal timeline. It's not something we're able to speed up. We must wait and hear what the federal government is going to tell us regarding how they're going to roll that program out.

 

SUSAN LEBLANC: I'm going to focus a little bit of time on recruitment. With incentives from the private sector becoming more prominent, what is being done to retain paramedics, nurses, home care workers, and family practitioners who already devote their time to the Nova Scotia health system? This is retention, not new hires. How are we going to keep the very valued and valuable workers that we have? How are we going to keep them in Nova Scotia?

 

MICHELLE THOMPSON: There are a couple things that must happen. Certainly, as government, there are things we can do as enablers for retention - I'll talk about those in a moment - but also, when we look at the care providers - our operators throughout the province - it really is important that they're working directly with staff.

 

As an example, the Nova Scotia Health Authority has undertaken what's called stay interviews. We often do exit interviews once people have signalled that they want to leave, but for the people who stay, we need to understand what it is that keeps them there and how we can make the work environment better. There is a significant onus on the employer to look at the conditions in which individuals work to understand what that would be. Maybe that's self-scheduling. Maybe that's whatever - obviously, within the confines or the parameters of our collective agreements.

 

From a government perspective, I'm proud of the work that's happened with the employers, the unions, and the department around negotiating fair and competitive contracts. I think that's significant. The physicians, as an example - that was incredible. The email that I read earlier - I don't know if you heard it, but that longitudinal family medicine contract that we've implemented for family physicians is significant. It's retaining physicians in their practice longer. It incents attachment. It incents access. We say it's good for physicians and it's great for patients, because we're looking at what the mutually agreeable things are. Similarly, with the nurses - a five-year nursing agreement, which is effective until October 31, 2025. We went through interest-based negotiations with the physicians and the nurses, which was really good, and it's very competitive.

 

Also at that table, in addition to compensation, the teams were able to talk about things like - the nurses in particular - nurse safety, as an example, and the initiatives we can do to protect nurses from violence. I can tell you, specifically, that there are certain areas in health care where there is more likelihood of violence. Looking at how we tackle that has been something that the employer and the unions have been discussing for a long time.

 

Looking at the paramedics, we were able to settle a competitive contract with them as well. Also, allowing people to use the fullness of their scope - as an example, nurse practitioners, in addition to being the highest paid in the country, also have the broadest scope of practice. They can admit and discharge. They are the most autonomous nurse practitioners in the country. It also helps us recruit and bring people here. It is around scope of practice. It is around being creative and making sure people feel valued. It is around competitive contracts.

 

Again, we must recruit to the vacant positions, so that when you're at a full complement, your work-life balance is very different. There are some health initiatives as well, mentorship for junior health care workers - there are a few things that are happening - and investing in equipment. Also, tackling difficult issues - if you are an OR nurse or an OR surgeon and you know that wait-list is long, it is tough. You know that - you're working hard, but there are people waiting. When we invest in things that make that quicker, you feel like you're getting somewhere.

 

There are a whole bunch of things we must do to support health care workers and show that we're investing time and energy in them and these big problems that have persisted over time.

 

SUSAN LEBLANC: We know the population is growing, so we know that we could be in sort of a one step forward, two steps back situation for a while, in terms of recruiting and then more people moving. Is there an analysis of the projection of population growth that the Office of Healthcare Professionals Recruitment is using, and do they have a strategy to make sure there will be enough health care professionals as the province grows? I guess a B part to that is: Is there discussion of housing for all the health care professionals that we need?

 

MICHELLE THOMPSON: There are a number of things. We have the Office of Healthcare Professionals Recruitment. What is important is that it is a system-wide approach, so the employers, of course, know - it goes beyond vacancy rates, I guess, is what I would say. The employers are able to help us with vacancy rates. Colleges are able to tell us, as an example, years of practice and age of the participants. When I register, I indicate how - so we can guess in terms of when people are going to retire. We have to look at a variety of different things.

 

Not everybody knows when they are going to retire; there are leaves, et cetera. There is a lot of work around system planning not only for acute care, but also, we have to look at our community-based care and a variety of different health care professionals. We work with the Department of Advanced Education; we work with the system partners in terms of those who deliver care. For housing, we do work - there is some housing.

 

We all work increasingly with municipalities. Municipalities have recruitment committees in many cases. We fund them through the Canada Community-Building Fund and support the initiatives that they have at a community level to attract and retain folks. We work with the Department of Labour, Skills and Immigration. When we have internationally educated nurses or physicians or health care workers coming, how do we settle them intentionally because we want people to feel welcome? We have to work with the health care worker, but we also have to work with community.

 

This is really a trans-departmental approach. We also have the NICHE program where it's very intentional settlement. I'll give you an example: With the Ukrainian nationals who were displaced unexpectedly, who came to Nova Scotia, through that NICHE program we looked for health care workers. We were able to hire people who spoke Ukrainian to help settle in communities and support people. So the NICHE program looks at folks coming in.

 

We do have housing, people moving home, so it is cross-government in order for us to be able to support in the community. We also have to look at daycare. We're looking at different daycare options. There aren't really many departments that aren't touched by the work that is happening in health care to build our workforce but also to raise the population.

 

SUSAN LEBLANC: You may have just said this, and I apologize, but does the Province track how many physicians retirements are likely to occur? I know I've asked a similar question to this before, and I have been told that we can't really track anyone who is not a Nova Scotia Health Authority employee. Surely, at this point in the crisis that we are in, we could somehow make it so that we are able to keep track of that. I'll leave it there.

 

MICHELLE THOMPSON: The colleges would do a bit of that work because regulated health care providers have to register on an annual basis. One of the questions that I answer every year is: Am I planning to retire in the next five years? There is some modelling that can happen as a result of that.

 

We also look at the age. I said earlier there are 487 physicians who are between 61 and 70 years of age, and then there are about 140-145 who are over 71. So we see that, but it's not really for us to say when people will retire, and there's no mandatory age.

 

We can see, perhaps, who is in the last 10 years, give or take, and so we need to obviously overlay that not only in recruitment but where does the supply of individuals come from in terms of growing our own workforce as well as recruitment. The Office of Healthcare Professionals Recruitment oversees that workforce and is building the models because the data were really poor - over the last couple of years, has been working hard to increase our data points so that we are able to better identify and model what our needs will be in the future.

 

[5:00 p.m.]

 

SUSAN LEBLANC: Yes, well, it sure was. I remember when I first got elected and they - we were hearing that several Dartmouth physicians were getting ready to retire, and I think largely a bunch of them did. There are a couple who are still doing some primary care work - I'm talking about primary care physicians - but at the time, when the Liberal government was overseeing all this, there was no tracking of it. We were saying, Listen, I've heard that Dr. So-and-so is going to retire. What are we going to do with the 2,500 people whom that doctor treats? There was no kind of consideration of that. I am glad to see that there is some modelling being done, because it is going to continue for a while, as we know, as the baby boomers retire.

 

The budget highlights document notes that the government will spend $360.7 million more for the Nova Scotia Health Authority and IWK Health Centre to deliver their programs and services to a growing population. My questions to the minister are: Can the minister expand on how this funding will be used to serve a growing population? Does the minister anticipate the need to respond to the health needs of the growing population that will primarily exist in the HRM? Can you expand on the funding - on how it will be used to serve our growing population - and do you anticipate the need to respond to the health needs of a growing population that will primarily be in HRM?

 

MICHELLE THOMPSON: Yes. Part of this will - one is the expansion of the programs, so the implementation of different - the mobility teams like the SAFER-f and those types of things. Increasing the workforce is one - so wages but also utilization. As our population ages, we are going to see increased utilization in our health care system. We know that for many frail, elderly people, the greatest use of the health care system is in the last year of their life, so it tends to be very acute and highly resourced. We know that there is going to be increased utilization.

 

A project that we are just starting to undertake is our partnership with Novo Nordisk Canada. Through the work that happened there, 67.2 per cent of Nova Scotians - 12 years of age and older - identify that they have one chronic disease or more. We can anticipate that utilization is going to increase over time because we need to do chronic disease care. We need to do acute care, and we have an aging population who inevitably are going to need more care towards the end of their lives. That is utilization: wages, cost of admissions, and those types of things. That's where that money will go - and to expansion of programs to better serve communities.

 

One of the important things about the data that we're collecting is that it allows us to get community profiles in a different way, so we can see community needs and we can kind of overlay, but we can also see community clusters and help us better plan. For instance, what are the types of things that some communities need that maybe are unique from others? Those are some of the ways in which that money will be spent, but utilization is certainly up.

 

SUSAN LEBLANC: The minister made a reference to a “Nova Nordis.” Was that a study? Can you expand on what that was? Is that a consulting firm? What is that?

 

MICHELLE THOMPSON: I'm going to read it off my phone because I don't have it here. Novo Nordisk is unique. It is a foundation based out of Denmark. We met them through the MOU process and through some of the work that's happening between ourselves and Denmark. Novo Nordisk is a foundation that has a subsidiary drug company. We're used to the opposite - a drug company with a foundation. It was developed - I don't know all the history, but the primary goal of this foundation is to eradicate diabetes. They have a subsidiary drug company as a result.

 

They are working with us to look at ways in which we can address childhood obesity. They have donated $1.5 million and we have matched it. We have $3 million to look at how we can tackle childhood obesity in Nova Scotia - 73 per cent of children and youth are overweight or obese in our province. Obviously, in addition to that, there is also potential for chronic disease development as a result. We will be going out to other government departments and to industry to see the ways in which we can affect, positively impact childhood obesity but also attaching it to an economic driver - health and wealth - so that we can look at ways in which we can not only address wellness but also the economic development that could accompany it.

 

It's called the Nova Scotia Lighthouse project. It is the first Lighthouse initiative outside of Denmark, and we're really proud. We're in the early stages of it. We signalled, and now we're going to reach out to stakeholders to see what the art of the possible is and get some proposals to see how we can address this. We need a multi-sectored approach. This doesn't just sit in health. It sits in wellness. We want others throughout our community - not just government institutions but our businesses, municipalities, et cetera - to really look at how we can create environments where we can be healthier, and we're going to start with our children.

 

SUSAN LEBLANC: In the Minister's mandate letter, there was a part that referenced working to bring family physicians' salaries more in line with specialists'. I'm wondering if there has been any increase in the budget to payments for family physicians to bring them in line with specialists as per that mandate.

 

MICHELLE THOMPSON: We did go through interest-based negotiations with Doctors Nova Scotia on behalf of physicians. The four-year physician agreement was reached. The longitudinal family medicine payment model was born out of those negotiations. It's a new payment model, prioritizing access and attachment and improving accountability and compensation for office-based family physicians who are part of the model.

 

As of January 2024, 346 physicians have moved to longitudinal family medicine. We actually see some fee-for-service physicians choosing to come into longitudinal family medicine as a result of the contract. Certainly, the compensation package has been very well received by physicians. We have other work to do with other specialty services, but we're really proud of that contract. It has gone very well, and physicians are pleased.

 

SUSAN LEBLANC: I only have a minute left, so I guess I'll ask my question and then I'll come back in the next hour. A recent report from the Auditor General brought to light that last year's $10,000 nursing incentive program fell short of this government's predicted outcome. While it was estimated that the return-to-work incentive would bring back 1,500 to 2,000 nurses, only 148 - less than 10 per cent of the estimate - actually were. I'm wondering if the program has been assessed. What went wrong with the program, and will it be offered again?

 

THE CHAIR: Order. The time for the NDP caucus has elapsed. It is now time for the Liberal caucus.

 

HON. KELLY REGAN: Does the minister need to use the facilities or anything? You're okay. Okay.

 

I was talking about a letter that this gentleman from Dartmouth had received saying, After one year, I am closing my family practice of medicine. It closed February 18^th. I think the doctor was from England.

 

We're not bringing people in on short-term contracts or anything. When we bring people in, it is with the intention that they settle here. I just want to confirm that.

 

MICHELLE THOMPSON: We absolutely want to bring folks in and settle them. Often, if there is any type of additional training that's required due to coming in, we try to have return-of-service agreements. Practice-ready assessments are often attached to a return-of-service agreement so we can get folks here to be settled.

 

There is some turnover, of course, with physicians who prefer to be locums, but we wouldn't necessarily settle them in a practice, as an example. We would have them maybe cover a practice for short periods of time, or they would work in other capacities in the system. The intention is for them to stay forever when they come.

 

KELLY REGAN: I just thought that the language - I've been here for one year, and now I'm leaving - I thought it was a little odd. Just as the minister has trained as a nurse, I'm trained in language. When something is phrased oddly, I think it's weird. I wanted to confirm that with you.

 

This government's spoken at length about the many efforts they're making to increase the number of surgeries and reduce backlogs. Can the minister give an overview of what the department is doing to increase the number of surgeries?

 

MICHELLE THOMPSON: Let me see here. We used 2019-2020 as a baseline year to consider the pre-COVID-19 year. The Nova Scotia Health Authority surgical wait-list has been reduced by over 5,346 patients, so it's been reduced 27 per cent from April 1, 2022, as of February.

 

In terms of what we've done, surgical capacity has been expanded through more nursing and perioperative staff - very specialized nursing - to expand operating room and bed capacity.

 

There are new and expanded agreements with public-private partnerships with Halifax Vision Surgical Centre and Scotia Surgery Inc. and recently indicated - if we needed more capacity, we've signalled that there could be a contract with LASIK MD, as well. It allows us to take low-acuity procedures out of hospital. Cataract surgery, of course, has changed so much over the years.

 

Endoscopy capacity has been increased significantly over the past two years in all zones. There has been an additional endoscopy suite for scopes added to the Dartmouth General Hospital. The more modern and electronic eReferrals and booking process has been very effective. Physicians are liking that it allows us to get away from the old fax machine and hoping that somebody's got paper, ink, and all the other bits of it on the other side.

 

A new surgical payment incentive for physicians is facilitating more evening and weekend surgeries as well. That was negotiated through the most recent contract with physicians.

 

There's the new In-province Travel Assistance Pilot Program to Support Surgical Access to individuals - low-income individuals - to ensure they have access. The surgical robotics program is amazing, and it continues to expand. We're really looking at our capacity to expand the number of operating rooms and where possible, designating spaces for procedures that are lower acuity. So our big ORs are for our big surgeries, and looking if there are opportunities for other spaces to be utilized in other parts of a zone, as an example, in order to do some low-acuity and day-surgery procedures.

 

[5:15 p.m.]

 

KELLY REGAN: If we look to the Action for Health - Public Reporting portal, I guess we call it - dashboard, that's what we want. In the first eight weeks of 2024, there were 13,951 surgeries done in Nova Scotia. Is the minister pleased with that number?

 

MICHELLE THOMPSON: I would have to have a quick look at the dashboard to understand what the trend is. I don't know those numbers off the top of my head because it's more of an operational. What I do know is that the surgical teams - what we are seeing increasingly is that, as an example, when we had our seasonal upper respiratory illness that we so often see - we had that over the months of November, December, and early January - there was minimal disruption in surgery as a result of that.

 

Of course, sometimes the staff get sick, but we are really making sure that through bed allocation, through the work that is happening, those surgical times are protected and increasingly seeing that we are meeting and exceeding year-over-year surgeries. I'm not sure if there was a blip in that month. I'd have to look at the trend.

 

KELLY REGAN: In the same period in 2019, there were 13,879 surgeries done. This is for a two-month period: January and February of this year. But in 2019, in January and February, there were 13,879. So we had 13,951 done this year, in the first two months of this year, compared to 13,879. That's only an increase of 72 surgeries.

 

With the amount of money that's going into health at this time, I would have - and when you consider how much our population has grown since 2019, that would be a reduction, really, in the rate of surgery, when you're seeing the number only go up by 72 in five years. Obviously COVID-19 came in between, so that's why we're going back to 2019. But we're looking at that, and it's only 72 surgeries.

 

MICHELLE THOMPSON: When we look at the fiscal year to date, there can be disruptions month over month. We see that there are ups and downs, but in the fiscal year to date, we are 2,626 surgeries above where we were last year. It really is not about the actual month but about the trend, and so we will see that there will be a reduction. Sometimes it could be due to illness, vacations, et cetera, but what we do know is that, year to date, we are 2,626 surgeries above where we were last year. We are performing more surgeries.

 

THE CHAIR: Order. Before the next question, I have been informed by the Clerk that one of the Rules of the House is that ministers are only allowed to have up to two staff people with them, and right now we have three. We have to ask . . . (interruption).

 

The honourable Minister for Health and Wellness.

 

MICHELLE THOMPSON: I want to signal that if there are infrastructure questions, maybe we put them all together so we can switch out as opposed to - it's a new file for me, and I am going to need a different team. Just to let you know we might have to do some jigging.

 

KELLY REGAN: We've seen that the number of surgeries, in those two months, has only increased marginally over what it was in 2019. It may be an increase over last year, but it is not an increase over what it was in 2019, and we have seen an increase in our population. One would expect to see an increase in the number of surgeries, given the population growth from that time, but also the amount of money that has gone into the health care system over the last couple of years. We keep hearing about surgeries, but when we look at the numbers, we are not seeing the numbers there. I am just wondering: Is there anything in this budget that should go toward increasing the number of surgeries? Just to clarify for the minister, I am asking: Are there new programs to increase the number of surgeries?

 

MICHELLE THOMPSON: There are certain surgeries where there's been the greatest wait-list reduction since 1920. Ophthalmology, as an example, has had a 40 per cent change in terms of the number of surgeries that are completed. Orthopaedic surgery, general surgery, and oral maxillofacial surgeries - all of those have had a significant reduction.

 

In terms of the surgical bundle that we see, the investments - there is an additional $11 million, so we are looking at cataract surgery, robotic urological oncology, investing in very specific equipment to support the robots program. At the IWK Health Centre there's a gynecological and urogynecological service, improving access and reducing wait times. A variety of different things. Improved access to spine surgical consultation, as well.

 

Some of this is through hiring. Some of it is through specialty services when we are able to hire new specialists. You can imagine the specialty of a urogynecological service. They are pretty specialized folks.

 

Again, looking at ways in which we can create contracts so that we can take some of those low-acuity surgeries outside of the hospital. And I'm also looking at diagnostic imaging and the eReferral for MRI, as some of the diagnostics - shortening the wait time, not only to surgery but to the diagnoses that may require surgery. There are a number of different things.

 

Of course, some of the investment will also be around incentivizing physicians to do evening and weekend surgeries and the teams. There are a variety of different things; it doesn't just sit in one. Some of the workforce - work that's happening will also contribute to the reduction of the surgical wait-list.

 

KELLY REGAN: In the Central Zone, if you look at the number of surgeries that were performed in January and February of 2019, that was 5,439 surgeries for those two months, the first eight weeks of 2019. And then we go to the first eight weeks of this year, and that has dropped to 5,022. That's a decrease of about 7.5 per cent. So, what's going on in Central Zone? Why are we seeing the number of surgeries actually go down from 2019?

 

[5:30 p.m.]

 

MICHELLE THOMPSON: For January and February, based on the information from the department, all surgeries are 550 more compared to the same time in 2019. So the data at the Department of Health and Wellness say that in January and February there were an additional 550 surgeries completed. The wait-list has been reduced by 5,346 patients, and overall, we have done 550 more surgeries this year than in the period being referenced in 2019. That's what we have from the department.

 

KELLY REGAN: That appears to contradict the information that's available publicly online. What we're seeing in the Central Zone is the number of surgeries is down 417 from 2019. That's what available publicly to us. That is a contradiction there.

 

Is there something going on in Central Zone? Do we have a lot of vacancies there? Do we just need more surgeons there?

 

MICHELLE THOMPSON: Some of the things, I think, that would contribute in Central Zone: We have 50 per cent of the population in a confined area in Central Zone. We also need to consider the fact that in Central Zone, the reason we want to talk about infrastructure is that we need to expand based on the population and the needs of the population to expand our surgical capacity.

 

We do look at adding additional OR sites, streamlining the processes, adding additional endoscopy suites, and taking those surgeries outside of the hospital wherever possible. One of the things - we look at Central Zone - not only is it the local hospital, but it's also the quaternary and tertiary hospital. In addition to serving this population, the folks in Halifax also serve the entire province. The most critically ill or injured folks often come here for specialized care. That, of course, would impact some of the surgeries.

 

There has been a great deal of work done around streamlining processes and looking at ways to expand surgeries, and we are seeing some early results in that approach.

 

KELLY REGAN: In the month of February, according to the NSHA website, there were well over 800 vacancies just in the Nova Scotia Health Authority. Can the minister comment on why that is?

 

MICHELLE THOMPSON: I would ask the member to repeat that question, because we've talked about - was it 800 in total? Is that what you asked?

 

KELLY REGAN: Yes.

 

MICHELLE THOMPSON: Obviously the vacancy rate in the Nova Scotia Health Authority is tracked on a regular basis, and we do get updates, so there would be - there are always ongoing vacancies. Not only do we need to attract from outside, to bring more people into the system; we also have a lot of internal churn in an organization that is this big. There may be a posting; I may already be a full-time employee and may move into that posting. It leaves my vacancy. It is a bit of a moving target, so there is a vacancy rate. Those postings would be the most current, trying to bring people in from the outside, across all disciplines - I'm assuming, yes.

 

KELLY REGAN: When we talk about doctor recruitment incentives - I was pleased to see the announcement yesterday about the plan to return the doctor recruitment incentive to the Central Zone. Can the minister speak about why that incentive was taken away? I've made no bones that I thought it was a mistake, but as the minister likes to point out, I am not a physician, a nurse, or any of those things.

 

I thought it was a mistake because 50 per cent of the population does, in fact, live here. We've had two years when we did not have that incentive, and we saw that wait-list skyrocket, particularly in the Central Zone. I wonder if the minister could speak to why it was taken away, why it was returned, and why now.

 

MICHELLE THOMPSON: As we've said before, the prior incentive programs meant that 60 per cent of physicians prior to the change in 2021 settled in this area. I mean the Central Zone when I say “this area.”

 

We know, through discussions with a variety of different people that we also have to ensure that our wait-list and our rural folks are - also ensuring that we can settle physicians there. There are different amenities. We hear from physicians that there are different amenities. There are people who prefer an urban practice. It can be more specialized, I guess, in terms of office space care versus perhaps in a rural community, where there would be other expectations around coverage of long-term care facilities, hospital emergency departments, hospice care, et cetera.

 

I can tell you that since 2022 there were 43 physicians who settled. There was a loss of 42, so we didn't see an exodus of physicians or any difficulty. The recruitment remains static in the Central Zone as a result. We do continue to work with recruiters, and we work with our operators, et cetera.

 

Now that we have had some success recruiting outside of Central Zone, we feel confident that we are increasing the number of physicians. As we said, there are net new physicians. We felt that this was the time to implement a Central incentive.

 

I think it's an extension of the program we already have. We're going to continue to look at it through the Office of Healthcare Professionals Recruitment and through our recruiters at the Nova Scotia Health Authority and we'll continue to adjust to the market.

 

We're also really pleased with the - again, I go back to that contract, and that in itself is such a significant recruitment tool. We're really pleased to have that settled.

 

KELLY REGAN: We have heard consistently, and not just from this health minister but from previous health ministers, that new doctors who are beginning to practise don't take on the number of patients that doctors did in the past, so unfortunately one old-time doctor - I don't know what to call them - senior, grizzled veteran does not equal one new doctor, unfortunately.

 

When you have a growing population, as we do here in metro, it doesn't equal. It's not like, oh, they're balanced out. They're not even remotely balanced out, so we saw massive growth in the number of people without doctors in this area over the last two years.

 

I feel like, and what I hear from constituents is they feel like we were sacrificed during those two years. We have people who do not have doctors. The guy who gave me the letter about the doctor leaving after one year went on the wait-list for the third time in two years. Doctors kept leaving. Every time he got a new doctor, they left. I know him, I don't think it was him.

 

The HRM, Central Zone in particular, was adversely affected by the decision to remove that incentive. At a time when you have a population that is growing - I mean, we hear about it all the time, right? Everything is growing, it's better. I'm on my third constituency, that's how much population growth is happening here in metro. I'm on my third constituency because it just keeps getting smaller and smaller because we have so many people coming in. Yet we have the same number of doctors as we did the year before, and it doesn't work.

 

Why now and not two years ago?, I guess, is my question. Was it the wrong decision to take that physician incentive away? is what I want to know.

 

MICHELLE THOMPSON: There have been a number of things that have been happening. Different things have been happening in different areas of the province, based on the need. One of the things I will mention is that we've really been working on strengthening collaborative care teams.

 

Again, moving away from that promise of one doctor for every Nova Scotian to a health home, there have been 29 collaborative family practice teams that have been strengthened in the Central Zone as a result of the investments that we've made that have allowed people to use the fullness of their scope.

 

The incentives - again, I feel very confident in the approach that we've taken. Some of the work that's also happened in the Central Zone is around the incubator clinics. Really supporting folks who wanted to be in an urban practice, bringing them into Dalhousie Family Medicine Clinics, using a practice optimization team, panelling people up and moving them along so that we can actually seed and create more collaborative family practice teams. I'm okay with the approach. We're competing nationally; we're competing internationally for physicians, and I expect that over time, our incentives, our approaches, the ways in which we attract people, will change. What works in one area of the province doesn't work everywhere. Daycare is very, very important, as an example.

 

There are things that we need to do outside of incentives to support our health care providers, not only physicians but others as well, and so we continue to do that through the work that is happening in community with the Office of Healthcare Professionals Recruitment and with the employers.

 

KELLY REGAN: Well, I hope none of those physicians has new babies, because it's really tough to find a daycare for infants right now. I think we've all heard from constituents, and they are not finding that, and that's here in metro where there's supposed to be more of that kind of thing here.

 

What I'm hearing from the minister is that the fact that they cancelled the physician recruitment wasn't a mistake. It was a good thing. When we look at the doctor numbers, when we start going around metro, we can see huge increases. And in fact, when I look at what was the number of people on the doctor wait-list in September 2021 - September of 2021 - for the entire Central Zone, that's pretty much the number of people who are on it just for the Bedford-Sackville area now. I'm having trouble remembering the different names, but the Beford-Sackville area - that's basically the number on the list, the doctor recruitment list, waiting for a doctor. That number there is what were on the list for the entire Central Zone back in September 2021.

 

I really want to drive home to the minister that there are a lot of people who do not have access to doctors now as a result of a policy decision that was taken that basically meant that we were not recruiting doctors in this area. If we only replace the ones that were going out, that wasn't enough. Population was growing, and the people coming in - the doctors coming in - were, in fact, taking fewer patients. Saying that we had basically the same number of doctors, that doesn't work in this equation, because the doctors are taking fewer patients and there are more people who are on the wait-list.

 

As the minister herself spoke, I think about 35 per cent of the people who were on the wait-list are on there because they're new to the area - however you determine the area, and it could be the province and it could be just - you know, they could have moved within the province.

 

The other part of it is that you have 55 per cent of the people who were on that wait-list and are on there because their doctor left, and they don't care whether they retired . . . (interruption).

 

[5:45 p.m.]

 

THE CHAIR: Order. I'd like to remind the member for Cape Breton Centre-Whitney Pier of Rule 13(6) about bowing coming in and out of the room. Normally I would not bring that attention, but you have been in and out a lot lately. Excuse me.

 

The honourable member for Bedford Basin.

 

KELLY REGAN: Perhaps we'll move on. Absolutely, I'm happy to hear what the minister has to say.

 

MICHELLE THOMPSON: I do want to respond, just in terms of access. I do want to remind us, if you are on the Need a Family Practice Registry, you do have access to primary care through VirtualCareNS, and it is free. There are a number of primary care clinics that will see you in person in the event that you need to be seen. So there is access for individuals.

 

We are, right now, testing and trying an app that will allow individuals to have access to some of their records, which we would say, arguably - in terms of how do I get these different - my diagnoses, et cetera. But part of the issue and how we work with physicians now is that we need to be open to different ways.

 

Part of the issue is that there was always a “one out, one in.” So, in order for a new physician to take over a practice in the earlier years, there had to be a physician who left. And so we were not able to overstaff areas where we anticipated some of this growth. We do know that this could have been corrected to some degree, not all, by bringing in physicians and allowing them to work, reducing their hours.

 

This transitioning in and transitioning out is a really important policy change that has occurred that allows our senior physicians to work in a lesser capacity if they choose to and mentor new physicians as they come and enter and take over practices.

 

KELLY REGAN: I do want to say I was really pleased to see this government continue the work that we started with having pharmacists expand their scope of practice - for example, having virtual visits, that kind of thing. To me, that was important. But it does not replace having a family physician - let's be clear.

 

And that app, that was the $2 million. That's what that $2 million was. I was trying to remember it earlier. The $2 million was for that, for some patients to be able to get their records. I was at that announcement. They talked about it, $2 million. And the problem with that is, of course, it's not in metro, and it's for people who already have a doctor. So, it didn't help the people who I'm talking about at all, that trial. So, that's where that $2 million was.

 

The other day in the House, the minister spoke about - I think concerns were raised, it might have been by me, I can't even remember - people who don't have doctors and who need to be followed by a family physician or a nurse practitioner. They need someone with eyes on what's going on with them. And the minister spoke about some patients who really need to have someone following them. Let's say they're undergoing treatment for cancer or something like that.

 

Could she explain how you move from being on the family practice wait-list. Who decides that you need to be followed by someone? How does that happen? Because I don't think that's well understood. And if - what are the criteria? How do you suddenly go from being on the Need a Family Practice Registry to - someone somewhere decides that you need to be seen by a doctor on a regular basis? I'd love to find out some more about that.

 

MICHELLE THOMPSON: There have been a couple of things that have been under way. When we formed government, the Need a Family Practice Registry was a list, and it was simply that. It didn't really give us any line of sight on the individuals on the list. And appreciating that everyone needed a family practice, there were individuals who had more acute chronic health care needs.

 

In Spring, we asked people to update their information through 811 or through an email process, and we verified the list. We asked people to tell us about their health status. We needed to know a little bit more about them because it simply was a list of names, and it really was not - so it allowed us to appreciate individuals who needed to be seen more urgently.

 

We did create an incentive, first of all, that was eligible to physicians from July 1^st to October 31^st, as long as patients were onboarded by end of calendar year. If physicians took 50 patients with higher needs from the Need a Family Practice Registry, they would receive $10,000. Sixty-five physicians participated in that. Through that incentive and other access and stabilization investments, there were about 15,316 patients that were attached as of December 2023.

 

The recent contract, of course, with physicians also incents people to attach and provide access to patients, and also the primary care innovation hotline resulted in about 13 requests that allowed almost immediate support to strengthen and stabilize practices, which also prevented 16,000 patients from going on the list. Those were some of the early initiatives.

 

We do have primary care clinics across the province where people can be seen. What we've seen across the province is that when people are referred through virtual care, virtual care providers will assess whether or not the chief complaint that you call in with needs to be seen in person. Individuals who need to be seen in person can be seen, and those clinics, in most acute cases, can follow patients in order to provide them with care. The other thing is it does help when they transition to their provider, to their practice, to their health home, because they have regular care. Their medications are up to date and things like that. The primary care clinics are an important adjunct in order for people - and that happens when you're on the Need a Family Practice Registry, that you update your health status. After a virtual care visit, if the primary care provider feels you need to be seen in person, you'll be referred to the primary care clinic.

 

KELLY REGAN: I did want to say, I do think the primary care clinic - the mobile one that comes to Sackville on the weekends - I think is really valuable. I've referred tons of people to it. It's really important when you have close to 20,000 people without family doctors. The knowledge that people can go in there on the weekend and get that care is really helpful to them, and I really appreciate that new service. I think it's very valuable. I'd love to see it seven days a week. I would put a plug in for that, that really when we have areas that have 20,000 people who do not have family doctors, I think we probably need it more than just two days a week, but I'm really happy that we have it.

 

I will say that when I went in there one Sunday, though, when I asked one of the people working there, they said, It's on for now. I said, What does that mean? They said they didn't know. I do know there have been times when it's not on the schedule and then suddenly it's on the schedule again. I'm looking for an indication from the minister that this is going to continue for the foreseeable future until the doctor wait-list comes down in that particular area.

 

The other ones around the province that are being held in places where there are not enough family doctors, I want to make sure that those continue to serve those areas, not just until an election or a by-election. I want to make sure that they actually continue on so that people can get the care they need. Right now, I can tell you, if you're trying to go to a walk-in clinic in the Bedford area - and I'm assuming Hammonds Plains too - good luck.

 

MICHELLE THOMPSON: There is no plan to reduce those mobile clinics. They've been incredibly effective. They were stood up within 24 hours of Hurricane Fiona and back to support folks in Cape Breton. It was amazing to see actually how quickly that came together. I'm really grateful for the folks who work there.

 

I will also just mention in terms of folks needing ongoing care, there are a number of things that are happening as well. I just want to speak a little bit about the chronic disease care that's happening. There are investments happening around chronic disease in the province. The other thing I would say as well is, by using the full scope of practice and that enablement that happened when we announced those clinics, people are saying they've been trained for 20 years and never had the opportunity to practise in the province until those clinics opened.

 

There is a lot of chronic disease management that's happening with the pharmacists across this province, particularly in cardiovascular disease and diabetes management, and it's been very effective and people quite like it. It does allow kind of outside of regular office hours, as well, for folks.

 

We're looking at the INSPIRED COPD Outreach Program to support people living with chronic obstructive pulmonary disease. We're also looking at home-based chemo and oncology care. The Oncology Transformation Project also provides really great support and we're looking at cardiac rehab programs because we know that cardiovascular disease is so prevalent in Nova Scotia.

 

KELLY REGAN: One of my colleagues met with a young woman recently who is in her thirties. She has cancer and she has no family here. Her oncologist had to put her on palliative care so that she could get a blood test. I think there are still people who are falling through the cracks. To me, somebody like that, who's on the doctor wait-list, who has cancer, should not have to go on palliative care so that she can get a blood test.

 

If the minister could speak to that, and also give us a number of who to call so we can make sure that this young woman has somebody following her. We can't have people with cancer going into palliative care so that they can get a blood test.

 

MICHELLE THOMPSON: I think what I would say is that oncologists are able to order blood tests, so I think I would really need to understand that individual case. It's not something I can comment on.

 

The Oncology Transformation Project, as an example, is a project that connects patients directly to their health care providers. Again, I think that's a very individualized case. I'd have to know a little bit more about it.

 

There's significant work happening that's going to give access to cancer patients in the province to clinicians, 24 hours a day, seven days a week. There is AI built into this. It's a project we're working on with Varian Medical Systems. There is also a web of providers across the province. Sometimes patients are referred to palliative care for symptom management because they are experts in symptom management. I've seen that over the course of my career.

 

I think it's a very individualized case and I'm happy to talk to the member about it afterward, but I would not think that would be the norm. I need to learn a little more.

 

KELLY REGAN: I have let the member know that she should reach out to you and then you can have that conversation. Thank you very much on that particular one.

 

If we look at the budget here, could the minister point out to me which lines are related to doctor recruitment incentives? Are there any other new incentives for doctors in the budget other than the one that was announced yesterday? It wasn't mentioned in the Budget Speech, which I find odd because that's a big deal for metro, to actually be getting that doctor recruitment benefit back. I am surprised it wasn't mentioned in the Budget Speech, but if you could just point out where those are, on what page, et cetera.

 

MICHELLE THOMPSON: It would fall on Page 14.8 in the budget - Physician Services - Other Programs. It would be included in that number.

 

[6:00 p.m.]

 

What I will say is that there is no cap. We're estimating for sure because there is no cap on the amount of incentive. We will give incentives to the numbers that we can recruit to.

 

KELLY REGAN: Is there another program to help bring doctors in other than the one that was announced yesterday? Is there anything new that this government is doing to incent doctors to come here, other than what was announced yesterday?

 

MICHELLE THOMPSON: There are several things that are happening around the recruitment of all health care professionals, but regarding physicians specifically - certainly working with the College of Physicians and Surgeons of Nova Scotia and looking at the licensing requirements.

 

Looking at mid-career exams - as a result, certain areas - UK physicians, as an example, no longer need to take mid-career exams. I can tell you that's very enticing. Some of those policy changes, looking at credentials - the US physicians, as an example, being able now to come and work. The incentive programs are one thing.

 

Also, a lot of recruitment missions have been happening with the Office of Healthcare Professionals Recruitment and the Department of Labour, Skills and Immigration, as well as colleges and employers going and talking about Nova Scotia - sending physicians wherever possible, sending Dr. Grant. Making sure we can offer on the spot: These are your credentials, this is this, let's go. Working with the folks in Immigration to understand how to bring folks here.

 

Arguably, the reputation Nova Scotia is gaining - we're adding physician assistants, scopes of practice, health homes, and the infrastructure. There have been a few things, like the robotic program; Varian is first in the world. In addition to family physicians, I will put in a plug for that Ethos system, that radiology and oncology. Dr. Robar, and the program he and Dr. Caissie have developed, are really going to be world-renowned, and success breeds success. There are a number of things.

 

Also, the Patient Access to Care Act. We also have - I can't remember off the top of my head, I'll look for the number - the Atlantic Register, which allows physicians to move through the Atlantic provinces and work. There are roughly 150 physicians who have taken advantage of that program, which gives them some economic mobility, and there are physicians who like to go away and work on their vacations. Not all of us prefer that, but some of the physicians do, or they'll come home for the Summer and be able to work.

 

There are several things that are helping us support the system and support physicians.

 

KELLY REGAN: I was thinking I would ask a few questions about hospice care. My understanding is that Hospice Halifax comes under your purview, and I know we're expanding some programs for grief and things like that. I wasn't sure whether the grief programs came under your - the Office of Addictions and Mental Health? Okay.

 

Hospice Halifax - we don't have enough beds for our population here in Metro. Was there any request from Hospice Halifax to expand their services? Are you planning to expand their services? Any of that.

 

MICHELLE THOMPSON: What I would say is that under this budget process, there were no requests. Sometimes we get off-cycle requests from individuals or organizations, and so if there is something that came from Hospice Halifax, it would be done kind of outside of the budgetary process in terms of the contract with the Nova Scotia Health Authority.

 

There is hospice care, but I also would just like to say as well that there are palliative care nurses and physicians and staff throughout our health care system, and there's actually an excellent program that many health care workers are trained in called LEAP, which is a palliative care program. In addition to hospice, palliative care is delivered in our acute care system as well as in our long-term care facilities.

 

KELLY REGAN: I want to make sure I'm sort of getting the language right here. When you say outs, it was nothing in this budget process. Are they invited to let you know what their needs are? If they put in a request, do you view it as outside the budgetary process if you didn't invite them? I'm just trying to figure out how that works for this particular stakeholder.

 

MICHELLE THOMPSON: It is a contract with the Nova Scotia Health Authority, so if there was a request for an expansion of contract, there is a business case process that often comes through. There has been an increase in utilization pressures for hospice of $411,000, so I don't know - I just don't know if there's a business case that is in front of us that I'm not aware of, but it did not come through the normal budgetary process. But partners know how the budget works, and certainly business cases come to us on a regular basis. There would be ongoing dialogues with service providers throughout the province. It's not like we don't pick up the phone the rest of the year. When we know that there are service providers with pressures, there is a contact at the Nova Scotia Health Authority whom they can contact and let us know.

 

There is an increase of $411,000 for utilization pressures. Outside of that, I don't know if there's anything else that's been submitted.

 

THE CHAIR: The honourable member for Bedford Basin, with a note that she has four minutes and thirty seconds remaining in her time.

 

KELLY REGAN: Certainly, I think the norm is seven or eight beds per 100,000 people, and I don't think Hospice Halifax has anywhere near that. I would not be surprised if they were looking to expand, or something like that. I just think health care can include end-of-life care, as the minister well knows, given her background and given where she used to work.

 

I do want to put it out there that I know we have a number of hospices throughout the province, and I think it's important work. I have a friend who passed away in that particular hospice, and it was - actually, she didn't pass away there. She came home, but she was in that hospice for a long time. I just think it was really a lovely place for her to be for a good portion of the last part of her illness. I guess I will leave that there.

 

I did want to mention that some time ago when we were in government, we did up the budget for research on ovarian cancer here. That's an illness that, you know, affects women, but also it's often tough to diagnose, et cetera. I was just wondering: Is there any money in the budget to increase the money that goes to ovarian cancer? I don't have to tell the minister, because I know she knows - we've talked about this before - but often women's health gets short shrift, whether it's a gynecological issue, heart issues, or anything like that. I would love if she could speak in the final two minutes here about what they're doing to improve women's health here in Nova Scotia. I apologize if I haven't given you a lot of time to do that.

 

THE CHAIR: Order. I would like to have that on record.

 

The honourable member for Bedford Basin.

 

KELLY REGAN: I apologize for not giving you a lot of time to answer that question, but we can always continue it later and I can ask it in my next visit back here.

 

THE CHAIR: I would also like to state that there's a lot of chatter in the room, and I've tried politely to get eye contact, but please keep it down. Some of the honourable members' voices aren't as loud, so we want to make sure that the minister hears them and I hear them as well.

 

The honourable Minister of Health and Wellness.

 

MICHELLE THOMPSON: In terms of women's health - the primary care clinics for women and people with uteruses - we are looking at well woman clinics across the province to make sure that people have the care that they require.

 

I would also like to say that we've been very fortunate. We've been able to work with the Health Association of African Canadians and have been able to expand the Nova Scotia Sisterhood initiative, which is really important. The Nova Scotia Brotherhood Initiative pre-dated our government, and when we were here, we were able to work with how to expand that.

 

The Sisterhood team provides medical care, managing ongoing health conditions, clinical therapy, obviously health care system navigation, so we're really pleased about that. Ten prenatal clinics offered by physicians across the province, obviously, and there is an unattached newborn program in Central Zone which connects newborns to a clinic . . .

 

THE CHAIR: Order. The time has elapsed.

 

The honourable member for Dartmouth North, with an hour of questioning.

 

SUSAN LEBLANC: I'm happy if the minister wants to finish her answer to the member for Bedford Basin. Go ahead. At some point, probably.

 

MICHELLE THOMPSON: I said she'd probably ask the same question eventually anyway, so we'll kill two birds with one stone here. Again, around the perinatal and the newborn services - also the ROSE Clinic, which was formerly the Termination of Pregnancy Unit and is now called the Reproductive Options and Services Clinic, is still available, of course, and there is absolutely no change to the care that's provided in this very important service in the Nova Scotia Health Authority.

 

The pelvic health centre at the IWK Health Centre, which is a women's ambulatory program - two sub-specialty clinics, the Endometriosis and Chronic Pelvic Pain Clinic and the Maritime Centre for Pelvic Floor Health, have been developed, and we're happy to support them through the IWK. In 2022-2023 there were 65 new and 132 recheck appointments. This is a program that runs over a number of weeks, in order to support people.

 

The cervical screening program continues, the Nova Scotia Breast Screening Program - and in regard to the specific question about ovarian cancer, I did miss a tour with them recently. I believe it was because of weather. I can't remember if it was during the “Snowmageddon” we recently had, but I was able to meet virtually with the individuals involved in the research, and I have agreed to go at a later date after the House to see a tour, but there hasn't yet been an official request. I suspect there will be, but at this current time there has not been one.

 

SUSAN LEBLANC: Right before I finished my previous hour, I asked about the nursing incentive - the $10,000 incentive program, and the report from the Auditor General. My question around that was: Has the department assessed what went wrong with the program, and will it be offered again?

 

[6:15 p.m.]

 

MICHELLE THOMPSON: The 2,000 was the allocated amount. We didn't really know how many we would invite back. There were 148 people who came back over a 10-day period. What's really important about that is - I don't have the number off the top of my head, but I'll find it - that a number of those folks who came back out of that 148 came in very-hard-to-recruit areas - critical care units, smaller hospitals, and those types of things. The 148 did have a significant impact in terms of staffing very-hard-to-staff areas, very specialized nurses who came back into the system. We were pleased with that.

 

The 2,000 was the cap because we really couldn't ascertain, because of individual circumstances, how many we would attract back. We were very, very pleased in 10 days to have 148 people come back and take permanent positions in the health authority, particularly in those hard-to-staff areas.

 

SUSAN LEBLANC: The minister mentioned a 10-day period. Was it only open for 10 days? Or is it rolling? Have there been more people who have taken advantage of the program outside of those 10 days? Can the minister explain that? Also, will the program be offered again this year in this budget?

 

MICHELLE THOMPSON: This year, there is a retention incentive for nurses - frontline registered nurses, licensed practical nurses, and nurse practitioners - who remain working for a publicly funded employer in 2023-24 and sign a two-year return of service by March 31, 2024. We don't have the numbers because they're just starting to sign up for those two years. They would have got their retention bonus last year; this is the second part of it. This is the retention incentive. By March 31^st, the end of this year, registered nurses, licensed practical nurses, and nurse practitioners can sign on for a two-year return of service, and they will receive an additional $10,000 by March 31^st. We don't have the numbers yet.

 

SUSAN LEBLANC: We keep hearing this 148 people, but really, it could be more than that.

 

MICHELLE THOMPSON: Last year, there were three streams. There was a thank you bonus for nurses who were working in the publicly funded system, and it was prorated to their FTE. Nurses got that.

 

The incentive that you were talking about was a return to nursing incentive. We allocated enough for up to 2,000. We really weren't sure about the uptake, because those folks had left the system for a variety of different reasons. It was paid to nurses who left the public system and who agreed to return with a two-year return of service at that time. It was signed before March 31, 2023, and that's where the 148 nurses came from. All nurses who are in the publicly funded system got $10,000.

 

The return to nursing incentive was for people who left the system and who would get $10,000 if they would come back to the publicly funded system and sign on for two years at that time. It would take us to - from 2023, they had to sign by March 2023, and it would bring them - they had to remain employed until 2025 in that position. There were 148 of those individuals who came back into the system, particularly in hard-to-care-for and hard-to-staff areas.

 

SUSAN LEBLANC: Okay. Then, by this March 31^st - you don't have the numbers because you're - there's another pot of money for this current fiscal year that we're about to end. There may be more people who sign that agreement. The 148 signed it by March 31, 2023. There'll be another group of people who may have signed it - or may sign it - by March 31, 2024. Is that correct?

 

MICHELLE THOMPSON: There are two separate streams. If you were in the publicly funded system last year and got $10,000 - or your FTE equivalent of that - you are now, if you remained in the system, eligible for the $10,000 this year.

 

The others were people who left the system and came in. It's not complicated, but I don't want to say it wrong. You got me?

 

SUSAN LEBLANC: I got all that part.

 

MICHELLE THOMPSON: Okay. The signing isn't until the end of this month. If you're in the publicly funded system as a registered nurse, licensed practical nurse, or nurse practitioner, and you are going to remain in the system, you can sign by the end of this month. We budgeted an allocation for it based on utilization last year, but until we see who's going to sign those, we can't really tell you what the number is.

 

SUSAN LEBLANC: I get all of that, but what I'm asking is: Are there more people - is there more money or more allocation in the past fiscal year for the return to nursing program? There were 148 who returned to nursing by March 31, 2023. That's almost a year ago. Has there been an opportunity for people to return to nursing between April 1, 2023, and March 31, 2024? Are we waiting to find out how many people did that, or is that program over, and it's the people that are now in the system?

 

MICHELLE THOMPSON: That incentive is over. However, there would be places where there would be sign-on bonuses for nurses returning - you know what I mean. There are a number of different things.

 

SUSAN LEBLANC: I'm so glad I got to the bottom of that.

 

An email shared with our caucus in October of 2023 describes a nurse practitioner's position untimely dissolution from Nova Scotia Health Authority and being deemed redundant. We're told that staff cited not having a need for another prescriber, despite any nurse practitioner's wide array of skills. This nurse practitioner sent letters expressing their concerns to the government and did not receive a response.

 

Why is the Nova Scotia Health Authority dissolving positions where health care professionals are willing and able to help?

 

MICHELLE THOMPSON: I' m not really in a position to speak about an individual situation. My understanding is that the Nova Scotia Health Authority is recruiting. I really can't comment on that.

 

SUSAN LEBLANC: Without talking about the individual situation, is it a practice of the Nova Scotia Health Authority to deem nurse practitioner positions redundant? I guess that's a more generalized question on that.

 

MICHELLE THOMPSON: That's really an operational issue. So, whatever happened in terms of a position would happen between the employer, the employee and the union. The recruitment continues in a variety of different areas, but that's an operational question I really can't comment on.

 

SUSAN LEBLANC: Since the Come Home to Nova Scotia program was launched, 11 physicians have started practising here. In November and December 2023 no new physicians started practising under the program.

 

I'd like to know how much was spent on the Come Home to Nova Scotia program. How was the program's effectiveness measured? And again, is it carrying on into this current year's budget?

 

MICHELLE THOMPSON: I would have to check specifically on that. The Office of Healthcare Professionals Recruitment through their operational funding would have a variety of different ways they would reach out to people. I recently saw a video that, hopefully, will be launched as well. There's just a variety of things. In terms of that particular video, I would have to check. There is an operational budget that allows the Office of Healthcare Professionals Recruitment - and then NSHA would also have how they market us as a great place, a great destination, to come home and live and work. I know that they're often working on promotional tools, not only within the department but with some stakeholders as well. I would have to check on that particular video. I don't have it off the top of my head.

 

SUSAN LEBLANC: It was the video - I'm asking how much the program cost, so that would be the cost of making the video?

 

[6:30 p.m.]

 

MICHELLE THOMPSON: I would say it's embedded in the operational work of the Office of Healthcare Professionals Recruitment, because that's part of the work that they're doing, creating promotional marketing things for when they do international - that would target a particular individual that we want to come home. There would be other campaigns, as well, where they would take the promotional materials on their recruitment missions, as an example. It would just sit in the operations of the department, in terms of the marketing approach. They would use the marketing budget.

 

SUSAN LEBLANC: If you could get us the budget line for the marketing for the office, that would be great.

 

We received a letter from the nursing team and other health care team at the North End Community Health Centre describing how they were deemed ineligible for the provincial retention bonus. Since the North End Community Health Centre is funded in large part by the Nova Scotia Health Authority, what was the department's rationale for deciding which nursing staff in the public system would be eligible for the bonus?

 

MICHELLE THOMPSON: The incentive was for publicly funded employees. There are individuals who work for community-based organizations or other organizations that maybe receive grant funding, but they actually are employees of a different organization. This was open to individuals in the publicly funded system. There were some folks who were excluded as a result of that. Perhaps that is one of the organizations that was excluded. They work for that community-based organization rather than for the system, in the publicly funded system itself.

 

SUSAN LEBLANC: With all incentive programs, I guess there has to be some kind of cut-off, but I wonder if there's value in expanding that program. If you're seeing good results with the retention bonus, then has it been considered to extend it to other organizations? Maybe not private companies, per se, that don't get any, but organizations like the North End Community Health Centre have a ton of funding from the Nova Scotia Health Authority and the department. They are at their own - I understand they are the employer, but is there a suggestion or a thought to maybe expanding that program? If we can't keep nurses in those organizations and they go, then nurses from another place that's publicly funded could migrate there. A nurse is a highly valued nurse. Wouldn't you agree?

 

MICHELLE THOMPSON: Of course, there are several nurses who work in the system who are not part of that publicly funded system. It doesn't mean they are not valuable. We did have to have parameters around the incentive program that we offered - the thank you bonus that we offered - and for the most part, the parameters will remain the same. The point is taken.

 

I heard from several people - nurses who provide footcare. There were several people who worked in the different organizations. It is difficult, but as you said, there must be parameters. I appreciate the comments, but I don't expect there will be any change in the next tranche of incentives.

 

SUSAN LEBLANC: I appreciate the minister's candour and honesty in her answers. It is refreshing.

 

Applications for the Office of Healthcare Professionals Recruitment Community Fund were accepted until November 2023. Were any of the funded projects successful in their recruitment efforts? How many projects received funding, and how many health care professionals were recruited?

 

MICHELLE THOMPSON: In 2022-2023, there were 28 applicants who received funding. We used the money that was allocated. These are grassroots organizations that would do things like hosting events, but promotional materials were also created because of that. There was a podcast, and I think there were a magazine, videos, et cetera, for promotion. Overall, it adds to the recruitment.

 

Certainly, in some of the conversations that I've had, not always - I'll just give you an example. We bring together the individuals in those community organizations on an annual basis. Last year was the first one, and we will do another one this year. It is interesting for them to learn from one another.

 

One of the other things that stuck with me from that conference - and some of the comments were that all of those organizations are beginning to see that, while they represent and advocate for their own community - Healthy Pictou County talked about: If we can't recruit to this community, but we maintain and recruit somebody in Nova Scotia, we feel that that's a win. It does add to the recruitment efforts across the province.

 

I don't know that we say, We spent this - this is the grant, and this is how many health professionals we got as a result of that, but these are the folks who are really - in some ways, the goal of the operator, Nova Scotia Health Authority, as an example, or IWK Health Centre, is to recruit the physician in this case. But this team of individuals actually talked about recruiting the family, making sure that they take them out and around and to see all the different amenities.

 

I don't know if I can draw a straight line to it. It certainly adds to the recruitment efforts and the welcoming, and it adds to the retention of health care workers when they have a good start in their community. I don't think I could draw a line to that.

 

We do have a number of projects that are just about to be announced that were applied for. I can't give you all of that information tonight, but it was well received. It's important to support and engage and encourage and financially support municipalities and community-based organizations that are volunteering to help bring health care professionals into the province, so we will continue that program.

 

SUSAN LEBLANC: As of May 2023, physicians were able to opt into the Atlantic Registry, allowing them to practise throughout the region. How many physicians have opted into the registry? That's my first question.

 

MICHELLE THOMPSON: Since its launch on May 1, 2023, over 270 physicians have joined the Atlantic Registry.

 

SUSAN LEBLANC: Two hundred and seventy. How is the impact of the registry being measured? With the registry being in place for almost a year now, is there any indication that the registry is helping increase physician access across Nova Scotia? Is there evidence that the registry is reducing competition between areas that have equal need for physicians?

 

MICHELLE THOMPSON: This is an initiative of the Council of Atlantic Premiers, so the evaluation is happening under them. It's being watched very closely by the Canadian Medical Association, which talks about a pan-Canadian licence, so this is really country-leading, in terms of our ability to do this. The feds are watching as well - very interested in the results, so that evaluation is under way.

 

We don't have any early indications that there has been any net loss as a result of this, which I think was the fear, that people would move. There will be more to say, but I just don't have that information. It is under CAP, and that evaluation is taking place now.

 

SUSAN LEBLANC: I'm going to move on from recruitment and retention to primary care. What are the department's goals and budgetary commitments for the Nova Scotia Health Authority providing service through VirtualCareNS or Telehealth from professionals other than family physicians?

 

MICHELLE THOMPSON: This year, there will be an additional $16.6 million to expand virtual care - more after-hours and weekends on top of it. We're also looking at asynchronous virtual care, so, our ability to email our own primary care providers. There are just different types of virtual care. There's synchronous, where we're together and we're back and forth, but there's asynchronous as well.

 

Perhaps there are things that can happen between us and primary care providers in an asynchronous way. There's a pilot for $518,000. It does get a bit convoluted, so we give it to Virtual Care Nova Scotia, which then has contracts, so the panel - the companies that we contract decide who's on the panel. We need to have primary care providers, so it's physicians and nurse practitioners, but the panel is - we don't hire the people. It's the contracted companies that we use. But there is another investment - the total budget for virtual care is $29 million.

 

[6:45 p.m.]

 

SUSAN LEBLANC: I guess my question was actually for services other than primary care. Is there an expansion or contemplation of virtual care with physios or with, I don't know, health care professionals other than primary care providers?

 

MICHELLE THOMPSON: It's a good question. I would say not yet, but we've seen it in other places. We've seen virtual physio, as an example, when we were in Denmark.

 

We are doing some chronic disease management - I would point to the Oncology Transformation Project - using that app to provide some virtual support to individuals undergoing cancer treatment. I think there are opportunities as we move forward. There are some in-patient things. We're also - just to give you a little hint about some things that we're doing under test and try - cardiac rehab is an example. What are the options with wearables? So looking at using technology to help monitor our own health, but also to feed that information up to our health care providers. We do have a cardiac rehab program, but through the Innovation Hub, just trying to wonder what could happen with wearables in that case. What does a heart rate go up to when there's exertion and all of these different things to support people. I would also say with the INSPIRED COPD Outreach Program we are doing some in-home and in-pharmacy, but what is the opportunity for us to expand to more of a virtual chronic disease management model?

 

I think there are lots of people who would benefit from that, so I think you'll see it expand but not at this time. We've got our hands full with what we've got, but I think that is the vision moving forward and certainly we've seen it in other places.

 

SUSAN LEBLANC: I hate to ask but I've got to ask: Why was there no tender issued for the YourHealthNS app?

 

MICHELLE THOMPSON: There was an existing contract with Ernst & Young and it was an extension of the contract with that organization.

 

SUSAN LEBLANC: Ernst & Young developed the YourHealthNS app? How was the host platform chosen and why did that not go to tender?

 

MICHELLE THOMPSON: I think in the interest of time, I'll get back to you on that question, if you want to ask the next one.

 

SUSAN LEBLANC: I have a couple of other questions, too, for that. I'll give you them all and then I would love to get the answers maybe tomorrow. The question was: Why was there no tender issued for the YourHealthNS app? How was the host platform chosen, and why did that not go to tender?

 

It's been reported that both EY Canada and Think Research Corporation have been contracted to work on the project. What role is each company playing in the app's development? Are there any other third parties contracted to work on the app? How long does the Province's contract last? Good? Okay.

 

My next question: Emergency Medical Care Inc. employs the contract workers who staff the 811 lines for initial patient contact. Many of these workers are on contracts with pay as low as $16 an hour. Does the department consider this amount of money for this work acceptable?

 

MICHELLE THOMPSON: The wages related to that contract - we have the contract, but EMCI as the operator is responsible for the wages associated with that contract.

 

SUSAN LEBLANC: I understand that EMCI is a private medical service provider. Yet we still live in a country and province where, technically, our health care system is supposedly universal.

 

I understand the minister's answer, that it's a contract situation between the employer and the employee. But the government - our public dollars are going to fund EMCI to pay for those workers, and so we do have a say in how much they get paid, and that can be contracted when we contract EMCI. The question is, does the minister think that $16 an hour for that work is acceptable?

 

MICHELLE THOMPSON: Again, the individuals who work in 811 are unionized. We respect the bargaining process. Certainly, we have shown that we bargain in good faith. We've had other opportunities to settle through employers with a number of health care workers. We know that there are reviews under way now, so I think that will unfold as the process unfolds. We respect the ability of the employer and the unions to negotiate fair wages, and we will continue to do that.

 

SUSAN LEBLANC: Following the meeting of the Standing Committee on Health about Indigenous communities' access to health care services, has a plan been drafted or implemented to uphold the Truth and Reconciliation Commission of Canada's Calls to Action in the provision of health services to Indigenous communities?

 

MICHELLE THOMPSON: As the member knows, in April 2023 the Province, the federal government, and the Mi'kmaw chiefs signed a trilateral agreement. The MOU is in the first phase of kind of a multi-year health transformation. That work is happening with the department.

 

[7:00 p.m.]

 

The chiefs - while they oversee the work that's happening, we do work with Tajikeimɨk and the health directors in community. There is work under way. All parties have been engaged with the initial draft and anticipate an agreement in principle. In collaboration with Tajikeimɨk, we've committed to funding the Mi'kmaw and Indigenous Patient Navigator program. There have been some strategic health partnership initiatives that have happened. It was just signed less than a year ago, but that work is under way. It's very important to us and the department.

 

We very much value our relationship with Tajikeimɨk, not only in terms of the work that we can help to support in community but also in terms of how we create a more equitable and safe health care system for all equity-seeking communities. We are working closely with Tajikeimɨk on initiatives as well.

 

SUSAN LEBLANC: Great. I know you signed in April, so almost about a year ago. What money was in the 2023-24 budget for Tajikeimɨk for initiatives? How much is allocated this year for initiatives going forward in this fiscal?

 

MICHELLE THOMPSON: I would say, again, not a super-straightforward answer for you, so I'll just talk a little bit about progress. I will say that since 2022 there has been a significant federal investment of $15.75 million and $2 million has come from the department to support mental health and addictions strategy work in community.

 

There are designated positions and work that's happening, which is roughly about $1 million, so making sure there are navigators at both the IWK Health Centre and throughout the Nova Scotia Health Authority. There is also work that happens beyond the department between the service providers and the communities. As an example - I think it was probably about six months ago, perhaps the Fall - I was able to visit Eskasoni, sit with Chief Denny, understand the community and some of the concerns they have in community there, and visited their health centre. We were able to connect the community with Dr. Karen Cross - as an example - who is doing some research on wounds. There is other work that is happening around service provision. There was a request at the time to increase the number of services available in the Eskasoni Health Centre - and so working with the Nova Scotia Health Authority and doing some work at Cape Breton Regional Hospital with the Nova Scotia Health Authority.

 

It really is a partnership, where the Department of Health and Wellness officials, the Nova Scotia Health Authority, and Tajikeimɨk health directors meet on a regular basis to talk about the priorities that each of the communities have and how best we can support them. Some is federal funding or funding that comes to the band that is funded in community, and the rest is the work where we provide primary care and emergency care, et cetera.

 

It is a complicated relationship, financially, but we do work hard to support our - the health directors and our Tajikeimɨk colleagues.

 

SUSAN LEBLANC: The minister just mentioned some work - $2 million on some work or $1 million to do - no, anyway, $2 million and then $1 million. She mentioned mental health services. At that meeting of the Health Committee, I remember the conversation about the idea of moving mental health services away from emergency rooms and emergency departments and more into the communities. My question to the minister is: What work has been done in that area thus far? I see the Minister responsible for the Office of Addictions and Mental Health sitting behind, so maybe he can help.

 

MICHELLE THOMPSON: There is a crisis line for addictions and mental health based out of Eskasoni. It is available to all First Nation communities, and it is available in Mi'kmaq and English, is my understanding. What is important to understand is that First Nation communities collect their own data and know the needs in the communities, and not all the communities are the same. We work with them as partners.

 

Communities identify things they are concerned with and areas of importance to them, and we lean in and work with them as a partner, but they have the sovereignty through the band to identify some of the needs that are important in the community. I will also note we are looking at what is the art of the possible with medical first responders in First Nation communities, as an example, with the EHS system.

 

I know the Minister of Seniors and Long-term Care can speak about the development that started under the former government for Kiknu, which is also in Eskasoni. Working and understanding. There is, of course, a federal responsibility in terms of funding and a provincial responsibility, so we also try to work within the parameters of that funding.

 

THE CHAIR: The honourable member for Dartmouth North, with a note that the time will soon expire.

 

SUSAN LEBLANC: I just wanted to ask about care for people with dense breasts. We saw a huge press conference happen yesterday in the Legislature. I've met with Dense Breasts Canada. The government made it possible for women with breasts of C and D density to know that they have dense breasts, yet we hear lots of stories of women not being able to get follow-up screenings after a regular mammogram and lots of cancers being missed.

 

I also understand that some of the response to that is that the science doesn't show with this secondary screening that lives are saved. I want to challenge that a little bit and say that we may not be just talking about lives being saved, but talking about quality of life and what kinds of treatments women have to go through, people with breasts have to go through, when cancer is detected later than earlier.

 

I just want to ask the minister: Has the department allocated any additional funding for dense breast screening to be provided at no cost, as is the case with the current standard breast screening program for women with dense breasts?

 

MICHELLE THOMPSON: We discussed this a little bit yesterday in the Legislature. Currently, there is no funding allocated for that. We've done a jurisdictional scan, and there are no provinces offering supplemental screening by MRI or ultrasound as part of their routine breast screening processes, although there are some provinces where it can be accessed by primary care provider referral to select locations. That may be private clinics. We're learning a little bit more about that.

 

There are currently no clinical trials in Atlantic Canada for dense breast screening. We wanted to look jurisdictionally to see if that was happening. What I said yesterday, and I'll repeat in the House, is that I can't change clinical pathways on the floor of the Legislature. It's not my place. We need to work with experts and understand the pathways.

 

I have committed, after the House rises, to speak to folks involved in the breast screening program to understand the gap between the folks who are advocating, and the clinical research, and what the evidence says. It's not necessarily a no, it's just not right now. Certainly, the advocacy is appreciated, because it allows us to have different conversations.

 

This is an important issue, and I appreciate the member opposite bringing folks, and I had a great chance to speak to people yesterday. But really, in this venue, there's been no business case put forward to us for that.

 

I'm really not in a position, nor I think is any health minister, to change clinical pathways here, but it does allow us to ask better and different questions when we have an opportunity to speak to the clinicians, which is what we'll do when we take that opportunity when the House rises.

 

THE CHAIR: Order. The time has now elapsed.

 

The honourable member for Bedford Basin, with an hour for questioning.

 

HON. KELLY REGAN: Really, I do have an hour?

 

THE CHAIR: No, I stated it that way because when we pick up tomorrow, you will be able to finish. Right now, we are ending at 7:45 tonight, so you have 31 minutes and 43 seconds.

 

KELLY REGAN: All right, and I will be sharing some of my time with another member in the House along the way.

 

We were in the middle of a question, but then you answered it. Does the minister need a break? Okay, we'll take a five-minute break.

 

THE CHAIR: We will take a five-minute break.

 

[7:13 p.m. The committee recessed.]

 

[7:18 p.m. The committee reconvened.]

 

THE CHAIR: Order. Order. We will now resume.

 

The honourable member for Bedford Basin.

 

KELLY REGAN: We know a lot of the money that we've seen allocated in this budget . . . (interruption).

 

THE CHAIR: I apologize, but order. Order. I ask that the conversations in the gallery stop. Thank you.

 

KELLY REGAN: We know a lot of the money that's been allocated for the health budget this year is dealing with - sorry, I'm just going to . . . (interruption).

 

THE CHAIR: No. Please. No. No conversations in the gallery so that we can hear what's happening down here. Thank you.

 

KELLY REGAN: Sorry, folks, I don't have a really loud voice. A lot of what we see in the health budget is reacting to the current crisis and the situation, right? The health care crisis. We don't see a lot new around prevention. It may be just because we haven't heard what all is in the budget, but I was wondering if we're doing some more things around prevention than have previously been announced, number one.

 

The other thing is, I guess - and the minister did allude to it earlier, a bit, talking about the age of our doctors. In our conversation, we talked about that.

 

We know from Doctors Nova Scotia that in the next 10 years we're expecting to see a lot of doctors retire. I think I'm the tail end of the baby boomers. I always thought I was Gen X, but apparently I am not. I was quite disturbed to find that out, but apparently I'm a boomer, which is annoying because I used to blame them for everything.

 

A lot of folks who are of my vintage and a little bit younger may be thinking about retirement in the coming years. I was wondering: (a) can the minister talk about new preventive measures; and (b) I guess an ounce of prevention about the doctors leaving, and perhaps she can speak a little more. She has spoken about it a bit, but a bit more.

 

MICHELLE THOMPSON: I apologize in advance, because I love to talk about this. Health promotion and prevention is absolutely a key component. Solution 6 actually asks us and compels us to look at how we change the factors that affect people's health and well-being. I always say - I've probably said this before in Estimates, and I know it sounds a bit cheesy, but I really mean it: I am the minister of the health care system, and all of my Cabinet colleagues are the ministers of health and wellness, because every single one of them represents a determinant of health. Economic development matters; what happens in environment matters; what happens in education matters; what happens in finance matters. All of those, if you look at them, correspond to a determinant of health.

 

When we're strong, across government, in terms of how we support people and having strong and vibrant communities, then we will have strong and vibrant people. So there are a couple of things. Of course, this is the work of Public Health, and obviously somewhere around the vaccine-preventable diseases, of course, we continue to do work in that space.

 

I do want to talk about a really important initiative, though, called the Canadian Nurse-Family Partnership Program. It's a new investment; it's an incredible program. It's between Nova Scotia Public Health, the Nurse-Family Partnership. It's a very well-established program. It really looks at the importance of early childhood development. It starts prenatally and looks at the first 1,000 days, which are really an essential time in a child's life.

 

We also look at some of the work that's happening around poverty reduction across government. We look at the school food and nutrition program, the school lunch program that will be implemented, we look at the $10-a-day daycare, but we look at this program in particular as partnering a registered nurse with a family that is deemed high-risk. It is a voluntary program. In the short term, we connect parents to resources and community supports. In the medium term, there's programming that can reduce - it's really about families setting goals with that nurse, and supporting folks in achieving those goals. That could be maybe getting a GED, as an example, if that's what a parent needs. It could be looking at housing solutions.

 

It improves outcomes of pregnancy through supporting prenatal health. It improves children's subsequent health and development by supporting parents who, in addition to the Enhanced Home Visiting program, which is a layperson approach to supporting parenting and attachment in the home - this program is a professional registered nurse.

 

I did have outcomes, but I think I gave them to the Minister of Community Services. The Nurse-Family Partnership has proven the following positive outcomes: 48 per cent reduction in child abuse and neglect, as a result of the program; 56 per cent reduction in ER visits for accidents and poisonings in childhood; 50 per cent reduction in language delays at age 21 months; 67 per cent fewer behavioural and intellectual problems at age 6; 32 per cent fewer subsequent pregnancies in the home; 82 per cent increase in months employed for parents; 61 per cent fewer arrests of the parent; and 59 per cent reduction in child arrests by age 15.

 

It's a hugely significant program, and we don't talk about that stuff. I think as a former Minister of Community Services, you can really appreciate the impact that this program is going to have. It is in a test-and-try. It's in the Eastern Zone. There's a lot of fidelity with the program. The registered nurses have just been trained and onboarded, and they are accepting their first referrals right now. It is really exciting. If you ever have a chance, there are great videos. It's Nurse-Family Partnership. It talks - one of their taglines is “Better Worlds Start with Great Mothers.” Really, this is around supporting people - enabling people - to be great mothers because everybody wants to be a great mother. It's the barriers that we face in order to do that.

 

The other thing I would also point to, which I mentioned earlier, is the partnership, as an example, that we've recently started and announced - yesterday, I believe - with Novo Nordisk Canada. So, 37 per cent of children in Nova Scotia are overweight or obese. We know that 67 per cent of Nova Scotians, 12 years of age and older identify that they have one chronic disease.

 

Again, when we look at Novo Nordisk, they're going to contribute $1.5 million, and we will match that to a $3 million pot and work across sectors - municipalities, government - and also with businesses and innovators to look at ways in which we can improve and prevent childhood obesity, and also attach that to economic development. In Denmark, it's called the Lighthouse Consortium on Obesity Management. It's just in Denmark. We're the first jurisdiction outside to participate. They look at marrying health and wealth.

 

We're really excited about that partnership. It's in the infancy stages.

 

I could stand here all day and talk about the wonderful things that happen, but those are two key initiatives that I think will have a significant impact on our families and our children and on our parents in Nova Scotia.

 

KELLY REGAN: I thank the minister for that answer. I don't know if I've spoken since she's been elected, but I always loved that program Call the Midwife. To me, it shows what can happen when a government implements a social program that can change communities. Having the right interventions at the right times can make all the difference to families.

 

As the minister probably knows, my eldest daughter gave birth in November, and they were in the NICU. She had the benefit of having a week and a half with those NICU nurses, where these days, you're out the door in 24 hours. She'd had a C-section, and she was checking herself out because she wanted to be down in the NICU with the baby. But I said to her: You are getting the benefit of some really great advice that you wouldn't have had if the baby hadn't come early. It was one of those happy accidents. I felt that she felt more equipped to handle new motherhood at the time.

 

She wouldn't be a candidate for this particular program, but it did remind me of the old MABAL nurses whom we used to have back in the day who would go visit at home. Are we looking at anything like that? I do think we send people home. I know that there are social workers who will come around and come make a visit. But I must say, I was pretty convinced that I knew everything about breastfeeding a baby, having done it for years, and then I had my third, and that kid wouldn't latch. I was so grateful that the MABAL nurse came to the house and showed me what to do with him. And we got things going. It would have been a very different . . . So what is available for new moms right now? That's what I'm wondering.

 

MICHELLE THOMPSON: A lot of the questions that you have are very much frontline, so it would be operational. I can just tell you that the IWK Health Centre, of course, would have a variety of clinics to support moms. Public Health restarted their postpartum contact since the pandemic. Of course, they were redeployed for obvious reasons around pandemic preparedness and intervention. Those programs are beginning to stand up more and more. We do have an enhanced home visiting program, as well, where the public health nurse and community members can refer families, particularly moms, to have some parenting support, just in terms of organizing the home and your life and trying to manage everything, and the things you can let go and the things you can't.

 

Those are a number of things that are happening. We know that those first thousand days, those first seven years are so, so important in a child's life, so really looking at intervening and supporting families. Again, across government, what are the things that we can do to make sure we have healthy moms, healthy babies, good attachment, and that we reduce any of the barriers that may be causing stress. If you're preoccupied with other things, it's very difficult to engage in a meaningful way.

 

And giving people information: I remember learning that the last hour of the day was the most important hour in a child's day, and I thought, Oh my God. Oh no. That's the worst hour of the day for me. So really trying - if we know what we need to do, then we can, but we don't always have that information, particularly if there's been a break in our own parenting relationship. A lot of work is happening around those first early years in order to support.

 

I would say, arguably - I talk about it all the time - the EDI data that we collect at school entry really is a baseline that we have year over year. Maybe we haven't fully implemented that as an evaluation tool, but I do think there's merit in looking at what is the possibility around some of the EDI data and how it trends. Working with education is really important.

 

[7:30 p.m.]

 

KELLY REGAN: I have some questions here. Medical technologists: I'm hearing we don't have enough, that it's a big issue right now. Quite frankly, across the health care system, what we are hearing from any number of players within the health care system is that we don't just need pharmacists, we need pharmacy techs and pharmacy assistants.

 

It's as if the success of the CCA program has kind of sucked up all the people who might have gone into other things, whether it's pharmacy tech - we're hearing from dentists that we don't have enough dental hygienists, dental assistants, et cetera. We are hearing that there's a dearth of people in those roles - med techs, lab techs, all of those. We're hearing big issues and just simply a lack of personnel in those. If the minister could speak to that.

 

MICHELLE THOMPSON: While we do focus primarily on some of those, maybe the higher number of folks - we talked about nurses' positions, paramedics, et cetera. We do know that there are a number of medical lab therapists, radiology technicians, et cetera. There is work happening around training folks. We do have an agreement with the Michener Institute of Education at UHN to support some of those allied health care professionals.

 

In regard to pharmacy technicians, we do have a good relationship with the Pharmacy Association of Nova Scotia, as well as the college. Pharmacy technicians, of course, go through a program at NSCC. Pharmacy assistants can be trained in pharmacies. Looking at how we bridge assistants to technologists in order to alleviate some of the workload on our pharmacists, that work is ongoing.

 

Again, looking at how we can expand scopes, we are looking at the seats available. I would also say it is difficult in some places. There are publicly funded positions for dental hygienists, perhaps, or pharmacy technicians, but a lot of the competitive wages, et cetera, sit in private industry. Pharmacies are private. Dentists' offices are private.

 

We do have to work with industry to better understand the challenges in order to increase the seats and do some workforce planning with them. That work is in the preliminary stages around some of those privately employed individuals.

 

KELLY REGAN: I'm now going to cede the rest of my time this hour to the member for Cumberland North.

 

THE CHAIR: The honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: My questions will be focused on Cumberland North so the people of the area can have answers to some of the questions they've been asking me.

 

I'm wondering if you would be able to let us know when the new hospital in Pugwash will be open. I know there have been some delays. Will there be any physicians hired to work at the new facility?

 

MICHELLE THOMPSON: The facility in Pugwash is a Department of Public Works project. I would get you to ask the minister, when she's up, about some of those details.

 

In terms of physician recruitment, it is ongoing. There is a lot of work that's happening in Cumberland.

 

I'm just looking for a recent letter.

 

There is a lot of work that's happening. As you know, you have a recruiter specific to Cumberland County who is there. The recruitment process has evolved immensely over the past couple years at every level, but it will take time to realize the fruits of that labour.

 

Recent approval by the Department of Health and Wellness of positions in the area is helpful. For training of physicians, there is a new contract with the Department of Health and Wellness and physicians that has proven to be very good in terms of supporting not only family medicine, but also specialists, hospitalists, ED doctors, et cetera. There is some work happening now with them.

 

There are several things that are happening, and as I said - I think it's Dr. Gradstein who is the recruitment person in your area. She's doing a great job working with a doctor in Truro. The complement - I don't have off the top of my head. I know there are efforts to recruit not only to that specific site but also to Cumberland County in general.

 

ELIZABETH SMITH-MCCROSSIN: I will refer those questions to the Minister of Public Works when she comes up.

 

Unfortunately, Dr. Gradstein has had to resign as a recruiter due to the lack of physicians. She's gone back to full-time clinical, so we have no recruiter any longer in Cumberland. That is a concern, too, that we may not have a recruiter who is making sure that we have our needs - that someone is advocating for us. That's the challenge when the zones are so big. You're competing with Pictou area and Truro area. I am concerned that we've lost our recruiter.

 

I'm proud of her. I have a lot of respect for Dr. Gradstein. She's filling a gap because we've lost two more physicians going to Ontario: one of our anaesthetists - they're a husband-and-wife team - and one of our family physicians. It's left a gap in our hospital schedules, so Dr. Gradstein is going to fill that.

 

Minister, I do have a couple of questions specific to the Cumberland Regional Health Care Centre, and I just want to acknowledge the incredible staff that we have at all of our hospitals. Certainly, Cumberland Regional has gone through a lot of challenges over the last couple of years, and a lot of strains have gone on there. I do want to say thank you to each and every person who works at Cumberland Regional.

 

Minister, there was an announcement in December of 2020 by the former government for an ER expansion and a 12-bed dialysis unit. I'm wondering - again, that may be something that the Minister of Public Works will respond to, but I was looking also for an update on that ER expansion, and a timeline for when the dialysis unit will be built as well.

 

I'll give another question, in case that is also going to be deferred to Public Works. One of the things that we had been working on was trying to bring access to Cumberland for chemotherapy for our patients. About three or four years ago, several of us in our community had asked for when this expansion happens at Cumberland Regional - the ER expansion - could room be allocated for a cancer care unit on an outpatient basis? Our vision was that we would be able to administer systemic chemotherapy at Cumberland Regional, because we were the only regional hospital in the province where all of our cancer patients had to receive systemic chemotherapy, either in Halifax or in Moncton. Everyone had to travel.

 

Our vision for that space was also that people could have virtual appointments with their specialists instead of having to travel, especially if it was just a quick checkup. Travel costs are so much for our residents. As well, our vision for that cancer care area was for focusing on prevention, so having an area where you could have clinics for skin cancer detection; we could have a dermatologist come in and do clinics on people who were concerned about some moles. You could have well woman clinics and so on.

 

We had some good news a while ago, and that was that the Nova Scotia Health Authority had allocated funding for a cancer care physician to be able to administer chemo even before we got the expansion of the ER department. We were all so pleased about that. Through the help of Dr. Gradstein, we were able to hire a physician to do that, but then, just recently, we heard word that there were delays in implementing this cancer care. I don't know the details of what's caused the delays. I had heard that it had something to do with it not being the right equipment.

 

I'm wondering if the minister would be able to provide an update on that. We do have the physician, and we certainly have the desire in the community so that our patients with cancer diagnoses don't have to travel for their chemo. I'm wondering if the minister might be able to update that.

 

[7:45 p.m.]

 

MICHELLE THOMPSON: The design is under way for a 12-station dialysis unit. As the member knows, following the flood in 2022, there was a renovated ED that was opened, which included redesigned registration space, new triage space, private observation rooms, et cetera. We do know that the design is ongoing, and it will inform the cost and the schedule of the project. We just really have to wait for that piece to fall into place, and if the member wants to ask another question, we're just waiting to hear about the cancer care.

 

ELIZABETH SMITH-MCCROSSIN: If the minister could also clarify that there will indeed still be an ER expansion, because I wasn't 100 per cent sure, just with the minister's comments there. We did have - after the flood in the emergency room, you're right, there was definitely some good work that was done, but it's still too small.

 

In fact, the first week after the ER opened, the doctors had to put - there was a stickie on a closet that said, “exam room.” They had to use the closet as an exam room for a patient. So, it's definitely too small, and I know the medical lead, Dr. Aaron Smith, is well aware of that.

 

I guess I could ask a question about staffing. I did bring this up with the Minister of Advanced Education, and I'll just maybe ask if the minister would be willing to advocate for this as well. We've continued to have a real shortage of staffing, specifically for registered nurses in Cumberland in general. And of course, the whole Northern Zone doesn't have any educational opportunities for RNs. I had asked: Would the Minister of Advanced Education consider working to change that?

 

So, for example, Yarmouth has a satellite site for RNs through Dalhousie University. We certainly would have willing partners, I know, at the NSCC campus in Amherst, where there's currently a practical nursing program. That would certainly help long-term planning for RNs. A lot of people who want to become an RN decide to travel to Moncton, because it's only 45 minutes away and they can continue to reside in Cumberland County and then come back home and work.

 

But again, one of the concerns under the other department is that these nurses do not qualify for the Nova Scotia Student Loan Forgiveness Program. Even though they are Nova Scotia residents, Nova Scotia taxpayers, and they come home to work, they're not qualifying. I believe that discriminates against our Cumberland County nurses. I'm wondering if the minister would be willing to advocate for an RN program to be established in the Northern Zone.

 

MICHELLE THOMPSON: Just to say that the emergency department is part of a design phase, that new ED.

 

There are a number of opportunities. I would say, currently, we would be looking at things like bridging. As you mentioned, there's an LPN program in Cumberland at the NSCC, and in Springhill - is it Springhill? I think it's Springhill. So, we would be looking at opportunities to bridge those folks to registered nurses.

 

I know that there are a number of programs that will allow people to do that. Certainly, the way people learn now is very different, and some people want to be able to continue to work in a casual capacity. So, there would be opportunities potentially, for LPNs to transition to registered nurses through online modalities. I know StFX has an online program as well. Also, there would be opportunities for CCAs to bridge to LPNs.

 

I certainly can't commit to having a registered nurse program in that area. We've expanded seats. We need to make sure the seats we currently have are filled. So it wouldn't be fair of me to signal that that would be something that we are considering in this budget, because it's not. We'll continue to assess the situation, but I do think there are opportunities for both . . .

 

THE CHAIR: Order. That concludes the subcommittee's consideration of Estimates for today. The subcommittee will resume consideration when the House again resolves into Committee of the Whole House on Supply.

 

The honourable Government House Leader.

 

HON. KIM MASLAND: I move that you do now rise and report progress.

 

THE CHAIR: So moved. Carried.

 

[The committee adjourned at 7:50 p.m.]