HALIFAX, FRIDAY, FEBRUARY 21, 2025

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

11:42 A.M.

 

CHAIR

John White

 

THE CHAIR: The Committee of the Whole on Supply will now come to order. It is now 11:42 a.m. The committee must rise to report to the House before the hour of adjournment, which today is 5:00 p.m.

 

The honourable Deputy Government House Leader.

 

MELISSA SHEEHY-RICHARD: Chair, would you please call the Estimates for the Minister of Health and Wellness.

 

THE CHAIR: With approximately 40 minutes left in the Liberal time, I recognize the honourable Minister of Health and Wellness.

 

HON. MICHELLE THOMPSON: Chair, I just wanted to take a moment to introduce Barry Burke, who is with us today. He is the Executive Director of Finance for the Department of Health and Wellness. Also, Dan MacKenzie is back with us today. I did want to acknowledge that Mr. Burke is here.

 

THE CHAIR: Welcome. Thank you for all that you do for us.

 

The honourable member for Timberlea-Prospect.

 

HON. IAIN RANKIN: My questions will be surrounding the Bayers Lake outpatient development today. I hope to get some detailed answers on some of the questions. Of course, it's an important project for my constituency because of where the building footprint is, but also many surrounding communities, and also, indeed, for a lot of the province because of its desired location. It's an important project that I supported. At the time it was announced, we were the only political party that supported it, but in fairness to the minister, of course, she wasn't in the Assembly. I know the government is very supportive of that project now and has done significant work there to expand services, and there are questions around how that expansion is going, how the services looked when it opened just over a year ago, and how it's looking today.

 

Maybe a general update would be helpful on the operational performance at the Bayers Lake outpatient centre.

 

[11:45 a.m.]

 

MICHELLE THOMPSON: Some of the information is coming in as we're going to be talking with the team. It's a very successful spot. I can tell you that in 2024-25, there have been around 23,000 X-rays; 6,300 ultrasounds; 1,650 MRIs; almost 1,500 bone density exams; and 6,000 ambulatory care visits per month are happening from that space.

 

An addition to that facility is the relocatable MRI that is there, which has been very helpful as well, as it increased capacity, particularly in Central Zone. There is also the subject about - I know I'm sure we'll get to parking - the ease of parking and the brightness of the space, so there is a lot of positive feedback about that facility.

 

IAIN RANKIN: One of the opportunities that was brought up right after it opened is the ability to house primary care teams. Of course, that's of great interest to many Nova Scotians who are not attached to primary care. The minister would recall that she did write a letter - this was some time ago - to say that there would be two physicians added to the complement there. She did clarify there were concerns that this would be simply moving an existing primary care team from the Kearney Lake clinic over and not an incremental new opportunity for taking patients off the list. But she clarified that it was anticipated there would be 1,350 new patients attached in the process of adding those two family physicians to the complement.

 

My question - because I asked this back in September 2024 - to the main contact I had at the centre, Kristen Goldsworthy, was whether this indeed happened. I was then directed to a couple of other people. Kolten MacDonnell then directed me to somebody who was, I think, in charge of the data - the chief data officer's team - to facilitate an update later that month. I kept asking a fairly direct question - follow up, follow up - whether this happened. This was half a year ago. I am really hoping that I can get a specific answer on whether the 1,350 new patients came to fruition - if those two physicians were hired at least. What do primary care offerings look like at the outpatient centre? I'll table that letter in case the minister wants to see what she said back then.

 

MICHELLE THOMPSON: I'll get back to you about that. Just to confirm, we don't have it at our fingertips. I also would like to add - which I should have mentioned in the first reply - that there is an operating budget of around $23 million annually for that facility.

 

IAIN RANKIN: I would really appreciate that answer in writing - a description of what exists for primary care and how many patients are at the clinic. I think it was the intent to be able to service unattached patients as well, either through the virtual care referral program or potentially even having the opportunity for walk-in visits. I'm wondering if the minister has any comments on if there is service happening now for unattached patients, and if not, maybe I could get that in that same correspondence when that's ready.

 

MICHELLE THOMPSON: To respect the member's time, I think we'll get back to you about that, so you can keep going.

 

IAIN RANKIN: I would appreciate it if I could get all of these answers in writing. It's pretty important to watch the progress of the development and what's happening at this huge opportunity we have, the physical space.

 

It was also mentioned that there would be urgent care and extended hours offered. A lot of times, people think of the outpatient centre as the Cobequid Community Health Centre or something near to or off the Cobequid Community Health Centre, which was talked about when the approvals were going through, but it doesn't have that extensive scope of services. People have the option of either going to emergency a lot of times with their acute care needs or to the Cobequid Community Health Centre. If there was an opportunity for that urgent care with both attached and unattached patients - which I believe has been the long-term intent at the centre - I'm just asking the question: How is the progress going in being able to offer extended hours at the centre, acute care in any shape or form, whether that's known as urgent care or emergency care, at the Bayers Lake Community Outpatient Centre?

 

MICHELLE THOMPSON: It is a primary care centre, which means that if a patient needed to be seen in person, they can be referred there. It's not an urgent treatment centre as far as I know. We're just trying to get a bit more information for you. I know that wherever possible, we are looking at the expansion of evening and weekend access, but it is a primary care clinic.

 

IAIN RANKIN: I note that you mentioned ambulatory care visits. Maybe you can expand on what those are if there's no urgent care being offered. What does that mean if there are ambulatory visits? Presumably, it's patients coming in in an ambulance. Maybe she can clarify.

 

Maybe it's helpful to break down - since you have your finance people - what the $23 million op ex might reveal, if that could be broken out - where those expenditures are going, and what services.

 

[12:00 p.m.]

 

MICHELLE THOMPSON: We'll get some more information about the specifics. Ambulatory care actually services our patients who can walk in. They can get the things they need. That could be IV therapy. It could be a dressing change. It could be removal of a lump or a bump - those different types of things. Dialysis, in theory, is ambulatory care: You go in and you come out. Those would be the types of services. There are 6,000 visits, so I don't know if we would have the exact breakdown of all of those, but those would be the services around that. People would need to present themselves there, and then they would be booked appointments - IV antibiotics, maybe iron, those types of things that people would need through intravenous. It's not urgent. It's not an injury or an episodic event. It's actually care that they receive on a scheduled basis to manage a condition.

 

IAIN RANKIN: Speaking of ambulances, I did write the minister recently. There was an older gentleman who was lying down on the side of the road in the Prospect area for over two hours waiting for an EHS response. I won't get specific on that case, but this is a recurring pattern in rural HRM, especially in this area of the Prospect Road, Peggys Cove - a loop well beyond what I represent. The ambulances are stationed pretty far away. There have been multiple requests and petitions on trying to get EHS stationed - like a depot - on the Prospect Road. I'm just wondering if there is any appetite to look at stationing ambulances in a place like Bayers Lake, which has infrastructure already there that could accommodate ambulances. Is there any other strategy around rural HRM in terms of having response times come down by having those EHS vehicles stationed much closer to where a growing number of Nova Scotians are living?

 

MICHELLE THOMPSON: I'll start a little bit. It may not be exactly what you're looking for, but we can drill down if it's not.

 

The previous model from years ago that we had - there were bases, and people were attached to bases - has really evolved. We would be talking about a system status plan. EHS units are a provincial resource. They wax and wane. As you said, sometimes they're staged, but they would not routinely be staged. It would always be changing. It would be changing based on dispatch and the medical communications centre. There are a couple of static units that are quite remote in the province, but it's really not the model currently.

 

There are a number of things that have happened around EHS, which I think are important to highlight. First of all, the health human resources related to paramedics has certainly improved - covering tuition, supporting them. Emergency medical responders, as well, have been quite helpful - helping to extend paramedics, the transport units - all trying to put capacity back in the system.

 

The other thing that happens really routinely is when someone calls 911, of course, the emergency support that they have starts immediately for emergency care. We also have physicians and nurses now at the medical communications centre so that people can be triaged. In fact, we do have a video link that physicians are using a bit. We're going to get more advanced with it so that they actually can send a link. It's a GoodSAM camera. It allows physicians to actually see what's happening in the field to support intervention for patients. That work has been happening. There's a new CAD system, which is dispatch in the ambulances, which will also further support their ability. It's a more modernized communication system.

 

We do know that there are some waits. I can't speak to that case particularly, but there are a number of cases where perhaps a spare single paramedic unit would be dispatched. Now we have them particularly in HRM, not quite as far out as all the rural HRM, but actually a single paramedic responds to a call. They assess the patient and decide what's required - transport to the hospital. It is an advanced care paramedic who provides that care, and, of course, they have access to medical communications as well.

 

We know that there are still some wait times. The system can be strained. The call volume, actually, is fairly significant. We're working really hard, where possible, to divert people away from the emergency rooms. People call 911 for lots of different things. I'll have to check the number, but the majority of calls are low-acuity calls, so really allow the system to be able to respond to patients' needs in a very different way. Always, if there is a high-acuity call, those ambulances that are responding to lower-acuity calls would be redeployed always to go to those.

 

It's moving and changing all the time, based on the needs, but there has been some real progress made in terms of putting ground ambulance hours back into the system through different diversity in the units, and also with the plane that we're able to fly folks from Sydney and Yarmouth. I think it's 12,000 hours of ground ambulance that have gone back into the system.

 

The improvements are there. We know that there are times when there is an issue. Any time that happens, if we're made aware of it, we can interrogate that. The department has really moved from a contract manager to a regulatory entity and is really very well connected now, monitoring and making sure that response times are improving. If there is a particular case, we can certainly have that interrogated, for lack of a better word, and look into it and have either the department or EHS respond to the person.

 

IAIN RANKIN: With that particular case, there were questions around why the volunteer fire department that's very close by should at least be notified and then come and see - I'm not in that field, so I don't know. I know there are issues of when someone's on the ground and you don't want to cause any more damage to their back and things like that, but I'll leave that correspondence and the minister can answer me in due time.

 

Going back to primary care access, especially in this area that I have the most interest in, we are probably the fastest-growing region in the province, between Timberlea and the Bedford West areas. We do have, I think, probably more primary care access than most places because it is a desired place for people to practise. The Timberlea clinic was one doctor when I became an MLA, and now they have at least four, with nurses. The Hatchet Lake clinic existed as a collaborative care centre before I was an MLA, and they were really pioneers in how collaborative care centres work with nurses. Then there are two clinics in Tantallon at the edge of my area that service people out into St. Margaret's Bay. So that's four standup collaborative care centres with doctors and nurses, presumably all working well.

 

I'd like to understand if there is any data on how many total doctors are at these clinics that I mentioned, how many family practice nurses or nurse practitioners, and any detail on how many patients are actually taken in. Where I'm going with this is that I still somehow get calls from people in the Timberlea area who aren't attached. I know that doctors do have the choice when they go through the 811 list. I just find it odd sometimes that people can be on the list for several years, despite all the success we've had recruiting doctors to these collaborative care centres where they want to practise. Then others who come in, move into Timberlea, and they're attached right away.

 

I think there's some picking and choosing going on, but to start with, I need to understand how many doctors we have - it's hard to get this detailed information in a medium like this, but at least I'll try - in terms of doctors and other complemented staff at Timberlea, Hatchet Lake, and the Tantallon clinics.

 

MICHELLE THOMPSON: You won't get it today, but we can have a look. There are a couple of things I'd like to highlight. I just want to speak briefly about the comment on the fire departments. I'm wondering if it is a volunteer fire department. Yes. So some volunteer fire departments are, and some are not, designated as medical first responder departments. I can't speak to that one in particular, but we worked really hard with the medical first responders to try to enhance their training - making sure that they feel supported by the emergency and public safety response. We have invested over $1 million in training for medical first responders, supporting that access and sometimes transitioning departments to medical first responders. Dispatch would not send someone there if they didn't have the appropriate training or if they weren't willing to do that. It just depends on the preference and also the volunteer workforce in the department.

 

In regard to the folks who are on the Need a Family Practice Registry, it is really important if you would ask folks if they updated their information either through e-mail or on 811. There is no picking and choosing anymore. When new HR resources come into the system, they are given a panel of patients. That is obviously balanced, if we want to make sure that nurse practitioners, physicians, et cetera, have a manageable caseload. So 1,350 for physicians is kind of the median number. It can certainly go above that, but if they have a very complex care assignment, it may be a little lower than that. Of course, we need a balance of folks who are going in for immunizations and wellness check-ups and all those things and are relatively healthy, up to and including ongoing chronic care.

 

That would be my first thing: Are they making sure that they are on that Need a Family Practice Registry? They can verify their information either through email or actually calling 811 to verify that they are there, that they have information. It's really important, if people's conditions change, that they notify 811. It's been hard to get that message out a little bit. We've tried through a variety of channels, so certainly, that would be very helpful.

 

Sometimes, if you are on the Need a Family Practice Registry and you need support for a time-limited situation such as a pregnancy, for example, we do have an unattached baby clinic where infants and neonates are seen. We've been able to attach some individuals to diabetic education centres as well, as an example, so they continue to get care, and then look at what the best opportunity is for them. Just to encourage you to tell folks to make sure they are on that list, make sure their information is updated, and we will get some information about the complement.

 

I don't know if they are going to give it to us as people or FTEs. You could have five FTEs and 15 people doing it, so I will see what we can gather up for you.

 

IAIN RANKIN: I appreciate the advice and, as I said, Timberlea is doing very well. A doctor recently left, and I think there is a locum there, but for some reason there are newly approved physicians there.

 

I will ask about Tantallon, though, because it happens to be - it's not my doctor, but someone in my family - when you go there, there is signage saying: Contact your MLA because of wait times. It's a practice that takes weeks to get in to book your appointment.

 

We met with the Nova Scotia Health Authority. The former MLA for Hammonds Plains-Lucasville did as well. It was an interesting meeting because there was a nurse approved at the other Tantallon clinic. This might refresh some memories for staff. It's known as the Crossroads Family Medical Practice in Tantallon, but there are two adjacent clinics operating at the same time. It was said to us that they were approved at the wrong clinic. One of the clinics actually had an approved - I think it was an RN, but I could be wrong. It could have been a family practice nurse. But that approved incremental nurse was allowing one clinic to have a better operating system. Then the other clinic has to absorb nurses and doctors, and the older model had to absorb a lot of the cost of the salary of their nurse, who was helping them take on more patients.

 

Maybe I'm refreshing some memories around this clinic. For that Tantallon clinic, the Nova Scotia Health Authority was supposed to go and look at approving another nurse. I'm wondering if I can get an answer as to whether that happened. This would have been over a year ago, but it was a very important issue. I think the member for Chester-St. Margaret's was very interested in it as well because it was kind of the area where all three constituencies connect. The question is: Was the Tantallon Community Medical Clinic able to get their extra nurse approved by the Nova Scotia Health Authority?

 

[12:15 p.m.]

 

MICHELLE THOMPSON: We'll get some information, but one thing I would like to circle back to is the way we talk about attachment versus access all the time. Even though some people are attached, their access may be limited as a result. I would just let you know that there is a physician hotline where physicians can call primary care and signal that they need some support. There are practice optimization teams.

 

I go back to the success of the Dalhousie Family Practice - initially feeling that they needed to decant patients. The optimization team are industrial engineers and very senior and experienced administrative staff who go in and assess the practice, help understand where some of the backlog and clogs are, and help improve the practice. That's not a criticism in any way, but you open a practice with a clientele. If you've been in practice for 30 years, your patients are all 30 years older by the time you're ready for retirement - as you are yourself.

 

It is a resource that's available for physicians, and I really do encourage physicians to call that number. We want to help. We want to make sure that they have a good practice environment and it's manageable for them. It feels quite overwhelming when people can't get appointments.

 

There has been some success, as well, with physicians who have gone from regularly booking appointments to same-day/next-day access. I think, particularly if you're fee-for-service, it probably feels a bit worrisome to see that your schedule is empty next week, but we all know that same-day/next-day access, or you have opportunities for that, it actually has shown in many practices to improve the flow for patients. It's a big change. If they don't have current involvement with the primary care group, that might be a really good resource for them. I can certainly get the number for the member.

 

IAIN RANKIN: I'll just finish up with that request in writing to look at the Timberlea Medical Clinic, the Hatchet Lake Medical Clinic, and the two Tantallon medical clinics. If I could get the existing complements that are there today, what's approved and maybe not filled as a vacancy for primary care providers and their support teams - whether it's nurses or other allied health professionals - and if possible, the number of patients who are attached at the clinic level for those areas so I could look at how it's going in this immediate area. They all operate a lot differently. That's why it's kind of challenging to see it happening without any information. The doctor who has been there forever - since I was a kid, my doctor - takes on 4,000 or 5,000 patients. The doctors who work with him - significantly fewer patients are attached. Once he's gone, I wonder what the plan is to deal with those thousands of patients who are coming off.

 

In my next round, I'll have some other questions around a more high-level look at the collaborative care centres and primary care access, and the ages of physicians that we have and the plan to bring more physicians in. I really just wanted to get a sense on the local level of the access to primary care and how the Bayers Lake Community Outpatient Centre can help with all that, given all that opportunity you have there.

 

I look forward to getting some of the answers in writing on those key performance indicators as it relates to primary care. I appreciate the minister's time so far.

 

MICHELLE THOMPSON: I thank the member opposite. I would just put a plug in. If you're concerned that your physician is going to retire, it's really helpful if we know that. Physicians are independent practitioners, of course, and we can anticipate a potential retirement, but some folks work later, and some folks are ready to retire earlier.

 

I will say that in my community, the physicians who have retired have been able to work with Nova Scotia Health, and as a result, very few people have gone on the Need a Family Practice Registry. It really is a runway of 18 months or a year. Also, we're providing opportunities for those physicians when they transition out of practice - for mentorship in some cases, but also, perhaps there is something that he would like to do. Maybe he would like to do virtual care or a mobile unit, or something that would just extend his practice a little bit longer but not have the same demands and responsibilities of a practice.

 

If you would just encourage your physician to maybe reach out. We want him to be successfully retired when he's ready. We want him to feel good about it, and if he has a little left, we would love to help him find a place to put that. It's good, and he can tell all his friends too. We've got a spot for him.

 

THE CHAIR: You have two minutes and 15 seconds left. Pass it over to the NDP? We will do one hour now with the NDP.

 

The honourable member for Halifax Armdale.

 

ROD WILSON: One suggestion I could suggest, if it's not - with the senior physicians, they could become a teaching site. Teaching is the best recruitment. Get him or her a resident. I'm retirement age now. You want a doctor who's younger than you are.

 

Thank you very much. Thanks for yesterday. I'm wanting to follow up on a couple of questions regarding access to women's reproductive health care, regarding surgical therapeutic abortions in Nova Scotia. I know - from the feedback I got from colleagues - they're not available in the Eastern Zone.

 

THE CHAIR: Your tapping is being picked up through the microphone.

 

The honourable member for Halifax Armdale.

 

ROD WILSON: Sorry. Thank you. I don't know if surgical therapeutic abortions are available in the Northern or Western Zones. Do you know if those services are available?

 

HON. MICHELLE THOMPSON: There are abortion services available in Northern Zone, and I'm fairly confident they're in Western Zone, but we're just double-checking. The provincial self-referral line - when patients phone, it helps people navigate to the service that is most appropriate for them, whether that's medical, surgical, the type of supports that they would require. There are other spots. There are none in Eastern Zone currently.

 

ROD WILSON: Yesterday, we both had the question of whether there would be capacity in the Eastern Zone. I spoke with colleagues about whether there is capacity in the Eastern Zone to do surgical therapeutic abortions and they said, definitely, yes.

 

I want to put it in the context that we see restrictions on abortion in the U.S., and that restriction is not only to a therapeutic abortion but also an incomplete miscarriage, or a spontaneous abortion. Here in Canada, we treat them with what we call a D&C. In the Eastern Zone, if a woman has an incomplete miscarriage, 12 weeks or - it doesn't matter - they can get access to a D&C. However, if they request a therapeutic abortion at six weeks, they can't get that. So there is the capacity and there are the facilities.

 

The other thing I would note is that since medical therapeutic abortions have come along because of access to medication, the number of requests for surgical therapeutics has dropped because access is better through medication. But there is still a need for surgical therapeutic abortions.

 

I asked my colleagues. They said they've had very amicable conversations with the site leads at St. Martha's Regional Hospital and Cape Breton. Their feedback is that this is a political landmine - no one here wants to touch it, and it's going to have to be a decision made by the Minister of Health and Wellness or the Premier.

 

I'm not surprised by that because in 2018, as a Medical Assistance in Dying provider, we came to heads with St. Martha's Regional Hospital. As you know, there's an historical relationship. St. Martha's Regional Hospital was previously run by a religious order, and sometime in the 1970s or the 1980s, the running and the governance transferred over to whatever the health system of the day was called.

 

There is a historical document that suggests the religious order still has some oversight in governance. That was a huge barrier for people requesting Medical Assistance in Dying - because of the historical document and the religious oversight. In those days, we were taking people out of St. Martha's who were nearly dying and requesting MAiD, to New Glasgow. That was a lot of push and shove, but there was a resolution that came that people could get medical assistance in dying at St. Martha's.

 

There was an understanding that because of this document, St. Martha's could do whatever they wanted and didn't have to abide by the Nova Scotia Health Authority guidelines, or even the mandate of the Nova Scotia Health Authority and the Department of Health at the time.

 

I'm wondering - and it's probably one of those elephants in the room - is there potentially a barrier for women accessing surgical abortions because of the cloud of these historical documents of religious oversight of what care gets delivered at St. Martha's?

 

MICHELLE THOMPSON: I think to do this question justice, I really do want to talk about the legacy of the congregation of the Sisters of St. Martha. They are an incredible organization in our community. They minister all over the world.

 

St. Martha's Regional Hospital was founded by the Sisters in 1906, and it was operated by them for 90 years. We talk about the R.K. MacDonald Nursing Home because of a very generous donation in 1957 from R.K. MacDonald and his wife, Mary, but in fact, the Sisters of St. Martha mortgaged the Motherhouse in order to build the long-term care facility in our community and actually ran it for a number of years. So the debt we owe the congregation of the Sisters of St. Martha for the love and care they have provided to our community for over 100 years is incredible. Not only did they provide care, but they also trained thousands of health care workers.

 

[12:30 p.m.]

 

Of course, I'm a graduate of St. Martha's. I arrived there in 1990 - one of two Protestant girls. I stuck out like a sore thumb when I got there. They knew exactly who I was. They trained thousands of nurses, laboratory techs, X-Ray techs. I really just can't underscore that the legacy of the Sisters goes beyond that. Of course, they have been incredible leaders in issues like farming, homemaking, health care - I mentioned the hospital and R.K. MacDonald Nursing Home - teaching, social work, spirituality, and justice. Certainly, incredible leadership in our community, and more broadly, when things are really hard in community - perhaps for those who are practising Catholics - the Sisters walk right towards that. I think about all of the people they have accompanied in very, very difficult times. Right now, I know they are involved in housing and food security. Really, reconciliation is top of mind.

 

I could not stand and talk about St. Martha's Regional Hospital without talking about the firm and compassionate presence of the Sisters over 100 years in our community and throughout the world. I am not fully prepared, so I may not have done them justice.

 

The Sisters pulled back from managing the hospital in 1996. Then it was transferred to the Eastern Regional Health Board, and in 2015 the hospital became part of the Nova Scotia Health Authority. Right now, the hospital is no longer managed by the Sisters. There is no governance by them, but there is a Mission Assurance Agreement, which was signed in 1996. It does remain in effect and continues to hold up some of the Catholic tenets that identify the mission of St. Martha's Regional Hospital are upheld through that agreement.

 

In regard to services, the Sisters have always found a way to lean in and compassionately care for the community. MAiD is now offered at St. Martha's Regional Hospital, and when a procedure is medically indicated, people have access to it in the community, as we mentioned before. It extends past community. The Sisters are not, in any way, promoting that there would be a barrier to any care for patients. Their motto is actually that the “Sisters of St. Martha is a nursing school with science, service, and sanctity.”

 

That Mission Assurance Agreement is in place. It requires Nova Scotia Health Authority and the Mission Assurance Committee to think creatively sometimes about how to support individuals in the community, but that agreement is still there. It is reviewed on a regular basis. I'm not sure when it's up for review again, but medical assistance in dying is available in Antigonish.

 

Reproductive health is available. I worked in ambulatory care clinics where vasectomies were offered. I know people who have had their tubes tied. If a procedure is medically indicated, it would most certainly be provided by the staff at St. Martha's Regional Hospital.

 

ROD WILSON: That is really helpful. I do applaud and recognize them. As someone who was Protestant born in a Catholic hospital because my mother felt that a Catholic hospital was better, I appreciate the hard work of the Sisters of St. Martha who are still very much involved in community and fundraising.

 

From what I'm hearing then, there is capacity to provide it. It's a publicly funded hospital. I am not hearing any real barriers as to why surgical therapeutic abortion couldn't be completed at St. Martha's Regional Hospital. Is that fair to say?

 

MICHELLE THOMPSON: This is not a political discussion. There is an agreement in place with Nova Scotia Health Authority and the Sisters of St. Martha in the Mission Assurance Agreement. It is around surgical capacity. I am not in any position on the floor of this Legislature, regardless of my background as a health care provider, to make operational changes to Nova Scotia Health Authority.

 

There is no commitment I am going to make here today in regard to that. I need to speak with Nova Scotia Health Authority. There are obviously a couple of conversations with singular clinicians, which provides one perspective, but it certainly is not a 360-degree understanding of what's happening there. So no, I will not commit to anything here today.

 

ROD WILSON: I think it's fair to say that it is a publicly funded hospital that has public services, and what we are hearing is that there are barriers to care - that if somebody is in Cape Breton Regional Hospital or St. Martha's Regional Hospital, they have to travel to Halifax. I use the analogy that that five-hour distance, which may be normal to us, if we were looking at other jurisdictions, it could be the equivalent of crossing three state lines to get access to care.

 

I'm certainly willing to help, but I think it's something that women are asking for. It's rare but it's valuable. Physicians are there to do it. I hope we can move forward and make access to reproductive care where it's needed and not ask women to have to travel to Halifax at a really stressful time.

 

I would like to move on, unless you had anything you wanted to say about that. Okay. I want to move on and follow up. My passion, as you know from Question Period the last few days, is really around the access to emergency care. I want to tell you a story to put it in context.

 

I got really frustrated and quit medicine in 2021 and took up flying. Then I felt guilty, so I came back in 2022. I did not return to primary care, but started doing emergency across the province, and that's how I got familiar with Canso. About two years ago - I go for a weekend, a Friday to a Monday, or usually finish off Monday mornings at 8:00. I was about to leave. It was 8:15 a.m. The ambulance came in. A person came in - a young 60-year old, I like to say - who was having a heart attack.

 

We treated to the best of our ability. The person did not improve as expected and needed to be in Halifax to go to a cath lab asap. Normally, it would have been great because there would have been the EHS, but of course in Canso there was fog six feet thick, so EHS couldn't land. Then the next solution - and the patient was deteriorating - was to try to go to Antigonish. The EHS could not land there because of the fog.

 

Then we made a decision that the patient had to be transferred to Port Hawkesbury to meet the helicopter. As resources go, we would have normally sent that patient in an ACLS advanced care paramedic. There was none at that time, on that shift, in Canso. The nurses, like a lot of emergencies, were new and didn't feel comfortable going. So I had to make the decision to close the emergency, hop in the ambulance, and drive like heck to get to Port Hawkesbury to meet the ambulance.

 

The patient did okay, but not great. I tell that story, not in blame, but had I been gone half an hour later, what would have happened to that patient? I don't know, and I don't expect you to know. I guess what I'm concerned about is that that was two years ago, and Canso remains closed as we sit here. These are the kinds of things that keep me awake at night - and it is closed until the 5^th.

 

I wonder sometimes whether I'd be a bit more valuable there than here. That remains to be seen. I'm really going to keep advocating and probing for more. Yesterday, I had asked about how many emergency physicians we would need in five years. If I heard you correctly - and I was getting tired so I may not have - you didn't have available numbers at that time.

 

I also appreciate the fact that there are many different types of physicians. There are family docs with a lot of experience; there are family docs with an extra year; and then there are the five-year family docs. The reality is that we have so many closures, particularly in rural areas. It's often a combination of nursing shortage and physician shortage.

 

If we don't change, if we stick to what we're doing now and try to staff all the emergencies across the province, and provide emergency care in every community that has an emergency - do you have any more thoughts as to how many emergency room scope of practice physicians we would need to keep them open?

 

MICHELLE THOMPSON: As I told the member yesterday, that analysis is under way in the department. Again, we go back to that emergency care does start - there have been changes. He said that 2021 was when he worked there last. There have been a number of changes that have improved the emergency care system writ large. It is not uncommon. I have worked in rural hospitals as well. Physicians and nurses from hospitals transfer patients to the next regional site. It is very difficult when weather rolls in across our province. We need to look at fixed-wing - Port Hawkesbury is one spot, New Glasgow is another where fixed-wing can fly - working closely with Halifax emergency room physicians and specialists to take over care.

 

First, people should call 911. Thrombolytics can be given in an ambulance. If a hospital is not there, the system allows them to go to the most appropriate spot. Also now, with different levels of emergency - the member opposite used the example of a heart attack - there are also things that would automatically bypass emergency even if they were open. A big trauma, as an example, would bypass a smaller hospital site. Someone who is experiencing symptoms of a stroke, with the Code Stroke guidelines that are involved, would go past a smaller hospital that did not have CT scan capacity.

 

Each individual patient is looked at in terms of the acuity and the resources closest to them. Now, with the Doc in a Box, they are able to support primary care and advanced care paramedics in providing the care that's required to patients as they are moving toward the next available helper.

 

Just because an emergency room is sometimes closed doesn't mean that, if it was open, a patient wouldn't bypass there anyway. If a patient was having stroke symptoms in Canso, they would not go to the Canso hospital. They would come to St. Martha's so they could have a CT scan.

 

I just want to be clear for folks that it's not that there's no care in these communities. There is care in communities. I don't think we can underestimate the care and the scope of practice that paramedics are able to offer. Now, with the added support of physicians, registered nurses, and advanced care paramedics in dispatch, the ability for them to be able to provide more care is a result of that. There has been progress made.

 

In some places, we do have planned closures, and we worked hard to create an environment, based on the human resources we have, to anticipate closures. ED closures occurred most often in small EDs, but we're open 87 per cent of the time for their planned opening - really have seen an improvement. Again, if you had one or two physicians in a community, and somebody got sick or we had an incident in a small community unexpectedly - a physician had an injury - it caused some disruption in care until we were able to work with local surrounding communities in order to provide locum coverage. This is ongoing work that's happening.

 

Also, the skillset - in the old days, our GPs were able to leave offices, manage inpatients at hospitals, manage their clinics, manage emergencies in their small hospitals, and sometimes deliver babies. All these things around this general practitioner have really evolved and changed over the last 30 years quite significantly. Skillsets are a bit scarce in some areas. Just because you're now a GP doesn't mean you're necessarily able to work in an emergency department, and sometimes those physicians don't feel that they want to work and have that responsibility. It really has, from an HHR perspective, become more complicated.

 

[12:45 p.m.]

 

We look at the data around why communities and how communities are utilizing former emergency rooms. We have had very good success in a number of spots around the province where we have urgent treatment centres. Urgent treatment centres allow people to go for lower acuity issues, as well as injuries, fractures, some lacerations, et cetera, or assessment of maybe cellulitis, things like that, which wouldn't require them to go outside of community to an emergency department at a regional facility.

 

The urgent treatment centre model has been very effective. People are very pleased. They have been able to see a lot of people as a result and off-load some of the emergency for lower-acuity issues.

 

We know that the majority of transfers that happen now with EHS are not those high-acuity calls but, in fact, lower-acuity calls, which allow them to be moved to a different place or a different provider in the health care system.

 

I will go back to the fact that we are looking at in-market recruitment, working in South Africa, working in Australia, looking at some of the pathways for individuals to come and work in Nova Scotia - people who have similar experiences, the rural, the training, but also the morality that we would see in some of these countries would be parallel to ours as well.

 

We are looking at the emergency rooms of the regional as well as how we expand physicians' time through physician assistants and a variety of other folks, nurse practitioners, et cetera. I know some of the facilities have virtual emergency care as well.

 

There have been a number of things undertaken to provide support to communities. I don't think we should underestimate the important work of our emergency services. When calling 911, your care does begin immediately with dispatch and the ability to get treatment and advice in terms of how to manage.

 

Now, with more technology - the CAD system, as well as the camera system - we are constantly increasing our capacity to deliver medicine, particularly in rural communities in a different way.

 

ROD WILSON: I was last in Canso just before the election - so in October. I was supposed to be there this week, but things change.

 

You are right, there have been some changes. One of the most positive changes was up until - I can't say within the last year - there was often no emerg, not even an ambulance in Canso. Sometimes they were in Sackville because of a deferral. I understand there is now a crew base.

 

One of the challenges is that that crew is not always an ACLS and can't do the pre-hospital thrombolytics so it's kind of grab and run.

 

A question on recruitment. Again, I'm kind of a concept guy so I'm not hearing how many we need but I'm hearing a recruitment plan, so it's all probably good. How do we recruit if we don't know how many we need in a skillset? That's one of my first questions.

 

I know the government has made significant investments in recruitment of paramedics, I think from Australia. My second question linked to that is: How has that been and how many vacancies are there in EHS for either primary care paramedics or advanced care paramedics?

 

MICHELLE THOMPSON: In regard to the emergency department vacancies for physicians, in March 2024, we had 293 physicians. We are now up to 319 emergency room physicians as of December 2024. If we look at the vacancies, we will say that there are about 8.4 vacancies required. In regard to paramedics, we had 135 vacancies in December 2023, and we now have only 43 vacancies for paramedics.

 

ROD WILSON: Excellent. Are you familiar with the emergency data tool called NEDOCS? NEDOCS is the National Emergency Department Overcrowding Scale. It is used in EHS. It's been used since 2020 in this province. It's a very valid tool. It measures many things. It measures how many people are in the department, how many people are - the time waiting to be seen. I'm not sure how often it is updated. It measures how many people are in each emergency department across the province waiting to be admitted. I believe there are four levels. People use it slightly differently. I think the maximum level when there is no more access - because every bed is full of admitted patients - it goes to Code Red.

 

I'm surprised you are not aware of it because it is a good tool. But my friends and colleagues tell me, in the four years that it's been used, there are daily occurrences when it's a Code Red, not just in the city but in other places, because when they monitor and upgrade that tool, there are 30 - every bed in the department is full or there are only three beds. I am going to ask you to get back to me on this. Are we okay to continue? Okay. Has there been any change in the NEDOCS, particularly in the scoring, over the last year? Are there goals attached to that that we could aspire to?

 

THE CHAIR: I'd just like to take a moment to remind the member to direct the questions through the Chair, not to the minister directly. Thank you.

 

The honourable Minister of Health and Wellness.

 

MICHELLE THOMPSON: There are two versions of NEDOCS that are used: one for tertiary and one for community EDs in the province. It is used for over-capacity levels and surge forecasting. This is at the operational level, and it is used by the Nova Scotia Health Authority on a regular basis. It is calculated every day, and so it changes based on the situation in front of the folks. Yes, it is used by Nova Scotia Health Authority, and it is used by the operators.

 

ROD WILSON: There is lots of data in that tool, and there are lots of really smart minds better than mine who know how to use that data. Are you aware if Nova Scotia Health Authority or your department - the member's department - actually have done analytics on NEDOCS to help with patient flow and bed flow and to show where there might be areas for improvement?

 

MICHELLE THOMPSON: I'm trying not to be insulted on behalf of this incredible team at the Nova Scotia Health Authority, Department of Health and Wellness, cyber security and digital security. Are we aware? Do we do analytics? I'm sorry, my heart rate's up. Of course we do. We have more data and analytics than we've ever had before.

 

These are intelligent, capable, smart people. This kind of condescending, “Do you?” Of course we do. Of course they do. They are so on this, every single day. They live it. They know what the capacity is. They have a C3 program now that sees every single bed in this entire province. They are working with EHS. They are working with acute care. They are working in community.

 

The data and the analytics and the predictive nature - just because I can articulate it here, doesn't mean that I'm the only brain in the room. This is an incredible team with 35,000 employees who work every day to serve Nova Scotians. So I just find it incredibly insulting that - do we know? I mean, I don't know if that's the right tool. I have experts that surround me, and I get to speak on their behalf every day. I apologize that I can't do it as articulately as they can.

 

There has never been more data in the system. There has never been more shoulders to the wheel. There has never been more technology trying to understand how to best serve Nova Scotians, and so I just have to put that out there. If I don't have the minutiae of the information, which nobody can have, unless you have them sitting in front of you. I just - I'm trying not to be triggered, but it is very, very insulting.

 

ROD WILSON: I'm glad you brought up the staff. It's tough working emergency, as anybody who works emergency knows. It's really tough. My colleagues, both nurses and physicians, across this province are really demoralized. They don't feel like things are getting any better. Again, maybe they're on the front line, they don't see the big picture.

 

It brings the question of how demoralized staff are feeling, and not just doctors, physicians, paramedics. What, if anything, can operations or someone do to actually acknowledge that Because we're going to lose people from burnout. Not even burnout, but just that moral injury. I'm open to what thoughts you have on that. I know people are probably going to leave their careers early because they feel like they're drowning and overloaded and are just feeling sunk.

 

MICHELLE THOMPSON: I appreciate the question very much. I'll go through some of the emergency and urgent care improvement plans that we've been implementing over, I would say, about 18 months. I'll just go through them and perhaps there are particular questions that the member opposite has, but hopefully this will be somewhat helpful.

 

What I would say is that if we start from the waiting room, we have improved support for patients while in the emergency department waiting rooms. There are now 100 waiting room care providers and patient advocates working in 12 of the emergency departments and the IWK, most particularly the busiest ones. They support patients in the waiting rooms. It can be very barren to be in an emergency department waiting room for a very long time. You don't really know what's happening - you're not really sure.

 

The advocates and the waiting room care providers are seeing patients, they're supporting them. They're also a reassurance to the folks who are actually in the department trying to manage all of the different situations that are in front of them. They know that there are people out there with their eyes on those individuals and can signal really quickly if there's a change. Those have been implemented.

 

Expanding multi-disciplinary emergency department models - so 10 emergency departments have a nurse practitioner, a physician assistant. They have also been increasing the number of roles of allied health care professionals, like social workers and physiotherapists. There is an emergency room in the province that has a physiotherapist who works there, and is able to see people who present with soft-tissue injury or potential factures, et cetera, and can do some early work and actually order X-rays to expedite that. That is a model in an emergency room that's under way.

 

[1:00 p.m.]

 

Again, we talked about the recruitment. It is a specialty. There's no question about it. It's a specialty area. Not everybody feels great when they work in emergency departments.

 

We do know that we do have novice practitioners as well. We have novice nurses, RNs and LPNs who are coming into that environment. A lot of work is happening around inter-professional learning and mentorship support to really help these novice nurses as they gain knowledge and experience, because it does take a while.

 

Particularly in some of the rural sites, they're really high acuity but you don't see many of them. You might only see one or two arrests in a year in a smaller facility. So we're looking at how we invest in simulation across the province. I know that in the Eastern Zone in particular - it's the zone where I live - the simulation program has been really essential in order to keep people's competencies up. It's one thing to have the skill; it's another to have the competency. A lot of work has been happening around making sure that people have that opportunity.

 

We are using some travel nurses in our emergency departments because of the specialty of the work. We do have to rely on some travel nurses to work in that area.

 

There's also - I'm just looking for it now - the float MD work that's happening. There are additional hours. There is a formula that was used historically to look at the number of hours available to emergency rooms. We do know that there are times when it's not adequate. There are additional physician hours available, particularly in the rural areas, the rural regional hospitals, to support physicians at those really constricted, congested times, offering virtual care in EDs and urgent treatment centres. Sometimes your triage score is lower, and that means you need to wait longer. It can become very frustrating, very upsetting. We're looking at rapid assessment units wherever we can. IWK Health Centre has had incredible success with their rapid assessment zone and it's really starting to identify where we can off-load some of those individuals, get them seen quickly, and move on.

 

In terms of the zones themselves, the ED managers, and then the director of ED services, meet with staff on a regular basis. I know we have seen some gains in certain departments. In the emergency at my local hospital, I know that 18 months or a year ago, the vacancies were quite significant. Through recruitment efforts and attracting travel nurses and folks to actually join the team, the nursing vacancies have been reduced. That has not been the case everywhere. Where we see high vacancies, we really do need to lean in from a culture perspective and understand what's happening in that emergency. What are the situations that are causing that? Is it an overall issue in community around nursing supply, or is it a community-specific issue?

 

There's so much work happening. We want people to feel supported.

 

We had an ideas contest about things that would help. We really do need frontline staff to generate ideas. Wherever it's possible, we will implement those things. Small tweaks can make a really big difference. If there are people who are feeling that they have something to offer - that there's a solution they think we haven't tried - they can talk to their director of the department if it's a physician. Nurses can obviously speak to nurse managers. In my experience, chiefs in emergency department, chief physicians, and nurse managers work side by side in order to create a positive, strong team environment. I would encourage those folks to make sure that if they don't feel they're being heard - I know the CEO and Dr. Boutilier would say - to email them directly.

 

We want to hear from people. We want to make it better. We have invested a lot of money and a lot of time. We know things need to change, but the outflow is really what's essential. We're waiting patiently for those long-term care beds to come online. We know that they'll be coming online as soon as they're able. We're looking at ways we can transition people to community, looking at the transition care units that are across the province. I know that we have opened some beds at Strait Richmond Hospital, as an example, to try to support individuals who are medically stable. Also, we're caring deeply for our elders in our community - that they don't feel they are a strain or a burden on the system. They deserve care. They've worked and contributed to communities for their lifetime.

 

We don't want anyone to feel guilty about being in a hospital. This is a situation that was long predicted. We knew that these folks, our Baby Boomers, were going to age and that we would have this, and it was never planned for.

 

We have this as a situation we're in. There's no stone being left unturned. We really do need community capacity, and we continue to work on that.

 

ROD WILSON: I'm sure the Minister of Health and Wellness works 24/7 and there's not a lot of time in your day. I would suggest a very low-yield but high time for a minister would be - if a minister of Health showed up in an emergency department and said: How are you doing today? That would have a huge impact and probably get the member or someone some votes. “How are you doing, I'm the Minister of Health and Wellness, how are you?”

 

THE CHAIR: Order. I mentioned once already about the table tapping. Now I'm going to explain why it's so important. The folks in Legislative TV are listening with headphones on, and the transcribers are listening to every word. We all look for those Hansard records. We look for that. So they're listening very intently and I really do have empathy for them listening.

 

When your microphone is on, it's really picking up the tapping. I would say it at the end of your time, but right now with your microphone on, I don't want you tapping the table with your hands or even with your pen. It's really blunt. I don't know if you are aware of it because your hand is there. Please just pay attention to the folks at Legislative TV.

 

ROD WILSON: Thank you for that. My apologies - I'll put my pens away. I do recognize that there are lots of things that have been done and are being tried and pivoted. If I could make a suggestion - I think I would feel more reassured about, as an emergency doctor and also Nova Scotians, is some type of consolidated, even conceptual high-level plan. What does success look like for emergency medicine in 2030? What are the goals and deliverables we want to achieve?

 

Give me some aspirations. Give me some hope that I can celebrate with you as to what emergency care in Nova Scotia looks like in 2030? What are our goals? Much like I was talking about yesterday about primary care - and maybe every emergency department can't be open 24/7, given the restrictions. Maybe they can with good recruitment. What does success look like? Get me excited. Get me inspired and wanting to feel that success is on the way. Your thoughts?

 

MICHELLE THOMPSON: Our emergency rooms across the province are quite strained. What we find with population growth and a more complex patient population is that many of the departments just really don't have the physical capacity to support some of the care that is required.

 

I will draw the member's attention to - you can speak more to the Minister of Public Works in regard to these projects.

 

There are a number of redevelopments under way, like Central Zone master planning. We're looking at the Halifax Infirmary; we announced it this week. It's going to double the size of the emergency room. But it's not just the size. It's the ability to have better, bigger, brighter, more modern spaces, and making sure that we have technology and the ability - not only for today or when it opens, but into the future, future-proofing our ability to continue to implement new technologies and have bright spaces.

 

The Cape Breton Redevelopment project is under way, as well.

 

Cumberland Regional Health Centre in Amherst will have a new emergency room that will also support 12 hemodialysis stations in that redevelopment.

 

What's essential to understand about the work that happens, part of the reason - people sometimes criticize that it takes a long time. If you had the opportunity to hear Dr. Christine Short speak the other day - there are over 40 clinical teams, as an example, that are looking at how to best redevelop: what is the space they need, and what are the services they need. They're very engaged in that process.

 

Similarly, as I list these projects, I want people to know that the frontline staff are so important.

 

The former Minister of Public Works and I had the opportunity to tour the IWK redevelopment, which is also underway for their emergency room, and the mock-ups of the rooms. Different teams come into these emergency rooms, and they run a simulated event so they can make sure this facility has what they need and is set up properly.

 

They gave the example of a tower. They had set it up a certain way. After a couple clinical teams had come in, they decided the tower was in the wrong spot. Very cheaply, in this room, they are able to move that tower and re-run those simulations to make sure that it's meeting the needs of the health care providers, which is essential.

 

The IWK Emergency Department redevelopment: The substantial performance date is 2026.

 

The South Shore Regional Hospital, Bridgewater: There are a number of things that are happening there, including a renovated emergency department, expansion of ambulatory care, and 12 new dialysis stations.

 

The Yarmouth Regional Hospital approved their redevelopment of their space. We've also approved SPECT there.

 

We're looking at how we support into the future. We need modern facilities. We need modern technology. We need to make sure, of course, that we have a multi-disciplinary team in the emergency room: social workers, pharmacists, as I mentioned. There's been a test-to-try with a physiotherapist. We're looking at physician assistants - our first class of physician assistants started a year ago - and how they work, not only in primary care but in the emergency room, nurse practitioners, and rapid assessment zones.

 

For us, the redevelopments create the space around the function of the team. We will continue to do that work. There are a number of others across the province that we continue to look at and see where they are in the design phase. While we want to do them all really quickly, we also have to realize that, financially, we need to make sure we can stage these over time so we can do them but also workforce - this isn't like going in and remodelling your bathroom at home. This is medical grade equipment; this is medical grade requirement.

 

We know when we go in and start tearing down walls and doing things in hospitals, we need negative pressure, et cetera. It is not a simple build. A lot of expertise is required in order to build these facilities. I think the gentleman from Plenary PCL the other day said, “We do this all the time, but expertise is a very narrow group of individuals.”

 

To assure folks who are working across the province in emergency, there's education that's important, there's equipment that's important, and there are facilities that are important. The work that we do around the compensation through our contract negotiations is also another important piece of that.

 

ROD WILSON: That's great, and that is truly excellent. The physical investment in capital project in emergency is great. Having been through two emergency redevelopments in this province in the last 28 years, the risk is if we don't have the people. I remember when Dartmouth was rebuilt once or twice ago, we had double space, and we ended up having fewer beds than nurses because of nurses.

 

[1:15 p.m.]

 

The anger rate went up because the expectation was that if we had a new build, we would be faster, when in essence, despite the planning, we just didn't have the people. I just caution that we're going to need the people for the new builds. The new builds will attract people, but it's not always going to be reassuring.

 

I just have to say, I get calls every week, even this morning: Could you come here for two days? Could you come to do a 12-hour shift this weekend? As you're probably aware, but I just have to emphasize it: Every single emergency department in this province is hanging on by a thread. Yarmouth is doing scheduling a couple days in advance. Amherst, I believe, is hanging on. I can only say that it's a crisis point. I'm sure you hear that, but I just have to echo from the front line that it really is. People feel like they just can't keep on doing it.

 

I would very much help. If you haven't met Dave Petrie, who is an emergency doctor here and probably an expert in systems planning, he would be a great resource as well.

 

THE CHAIR: Could the member please state if there was a direct question there, or if he's asking for a comment?

 

The honourable member for Halifax Armdale.

 

ROD WILSON: No, that's just a comment. I'm actually willing to give up my four minutes. I'm running out of steam and need some lunch. I'm sure my colleagues might benefit from a break as well, so I don't need to talk if I don't have to.

 

I'd also like to start on some other issues, but not with just four minutes left.

 

THE CHAIR: Thank you.

 

We will now take a recess.

 

[1:17 p.m. The committee recessed.]

 

[1:23 p.m. The committee reconvened.]

 

THE CHAIR: Order.

 

The honourable Minister of Growth and Development.

 

HON. COLTON LEBLANC: Thank you very much, Chair. With the few minutes remaining, I want to take the opportunity to thank the minister for answering questions from the Opposition.

 

I've got to say, in my time here, I've never seen Opposition this early in the game of Estimates throw in the towel and stop asking questions of a minister who's been peppered with questions and, I've got to say, doing a great job.

 

I do want to give the Minister of Health and Wellness the opportunity to share more for the benefit of the House some of the amazing progress that we've done as a government in our first mandate, particularly in a field that I come from. I know the member opposite was asking questions about the pre-hospital EHS system. I have a lot of passion, but I know first-hand that the actions of our government are paying dividends and are working, so I want to give the minister - if she can explain a little bit more on that file.

 

HON. MICHELLE THOMPSON: It's always my pleasure to stand up and talk about emergency health services - such an integral part of our health care system. I have a deep respect and care for paramedics across the province. In my career, I have always said I have my own memories from my health care experience, but I was never in a position where I saw who didn't come in.

 

So I understand deeply that paramedics, firefighters, police, and tow truck drivers are on the very front lines of the care that is provided in community at difficult accidents and emergencies.

 

I would like to highlight a couple things. I'm happy with the paramedic training and tuition investment. We've invested $6.83 million to date, which has had an impact of 180 new emergency medical responders, 150 new primary care paramedics, and 45 new advanced care paramedics - really supporting. As I said, the vacancy rate in paramedicine has really reduced. Being able to negotiate a contract with paramedics has been essential.

 

The air medical transport service LifeFlight plane has saved over 12,300 hours of ground ambulance time as of December 2024. The member for Argyle and I had an opportunity, when we toured the hospital in Yarmouth, to stop in at the paramedic base and to see the plane. We got to tour it and see it. It's an incredible opportunity. It also gives primary care paramedics a different opportunity to use their skills and support patients. We had a primary care paramedic say she never thought she would have this opportunity to be in the flight program. It was a great visit.

 

The addition of a nurse to the Medical Communications Centre - 16,590 9-1-1 calls were redirected to the Medical Communications Centre nurse for triage and support since November 2022, which is an incredible achievement.

 

The establishment and the hiring of the emergency medical responders: That program - we anticipate that we'll be able to hire 180 EMRs over the course of 2025.

 

The successful recruitment missions to Australia: 11 ACPs in 2024.

 

THE CHAIR: Order.

 

The honorable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: It's been a while since I've done this, so I'll try to get in the groove.

 

I've got a few questions, and I'm not sure if the minister and the staff have answers to some of the questions that I have because some are very specific for the hospital facilities in my area. Some of the questions are broader in scope, so they'll probably be easier to answer.

 

I'm wondering if there's anything I ask that they don't have the answer to today, if that's something that they'll be able to provide the answers in the future.

 

I'll start with some small things; they are more specific. I understand if the minister doesn't have the exact answers today.

 

In Cumberland North, the area that I represent, we have two acute care facilities: North Cumberland Memorial, which is brand new - we're so grateful to have that - as well as Cumberland Regional. One of the things that our cancer navigator had identified, about three years ago, was that Cumberland Regional was the only regional hospital in the province that didn't administer systemic chemotherapy, which meant that all our patients had to travel for treatment.

 

Thankfully, Nova Scotia Health Authority and our patient navigator worked together and were able to hire Dr. Rondeau part-time, as well as a nurse, to be able to administer chemo at Cumberland Regional so that all our patients won't have to travel to either Halifax, Truro, or Moncton.

 

However, what I've been told is that, while we have the physician and the nurse, which is a rarity, we don't have the equipment - that the hood that's required to mix the actual pharmaceuticals for the chemo hasn't been able to be installed yet at the hospital.

 

I'm wondering if the minister would either have the information or be able to get the information for our community of when we can expect the installation of the hood so that chemo can be administered to alleviate the travel costs and strain on patients and families in our Cumberland area.

 

[1:30 p.m.]

 

HON. MICHELLE THOMPSON: That chemotherapy hood is operational and in use, apparently, right now.

 

ELIZABETH SMITH-MCCROSSIN: That is not what, unfortunately, they have been telling me, but I will ask to see if I can even ask the question while we are having the conversation so I can let the minister know. That's great. As I have identified at other times on staffing, the nursing vacancy rate is a major problem. I know it's not just at Cumberland Regional, but I want to make sure that I am bringing the voices of the people I represent here.

 

I know the nurses at Cumberland Regional are feeling extremely defeated, very overwhelmed, very stressed, and certainly now that they have been mandated to take patients in non-traditional patient areas meaning physical areas of a hospital. For anyone listening who doesn't know what that means, a non-traditional bed area would mean a patient is being put in an area that isn't necessarily equipped with all the things that a nurse would normally have access to to take care of a patient, whether it be oxygen, suction equipment, even an electrical outlet to plug a bed in.

 

When you are a nurse, you sometimes will position a patient in Fowler's or another position and that is part of an actual nursing intervention, and when there is no electrical outlet where a stretcher or a bed is, they even can't do that or not even being able to plug in a crash cart. A non-traditional bed area also often doesn't have a Code Blue button, meaning that there could be delays if and when the patient were to crash and a code is called.

 

All of these factors are contributing to an astronomical amount of stress put on our nurses because they want to be able to provide good, adequate care. That, accompanied by the vacancy rates - the fact that they don't have enough staff makes things even worse.

 

One of the positives, let's bring a positive into play here. One of the positive things that is happening in our area is that the Government of New Brunswick had been working with Beal University out of Maine, and they worked together for about three years. Thankfully, just in the last couple of months, Beal University has opened a new campus at Sackville Memorial Hospital, which is only 10 minutes from our Nova Scotia border and they are going to be doing an intake of 40 students six times a year. That is a lot of registered nurses who are going to be graduating from Beal University right next door. It's an accelerated course and so it is only going to take about 30 months. So we are really hoping that some of these nurses who graduate will come back and work in Cumberland and work here in Nova Scotia.

 

The reason I am bringing this up is twofold. One is that we need to make sure we capitalize on this new registered nursing program that is so close to us. I have been told by someone in the Nova Scotia Health Authority that they've been working with Beal University on making sure there is clinical practicums in Cumberland County - the nurses can come and do practicums in our hospitals - but when I spoke with Beal University, that hasn't happened yet.

 

I'm wondering if the minister might be able to work with people in Nova Scotia Health Authority to make a commitment to work with Beal University so that some of their students are able to do the practicums in Cumberland County. Where you do your practicum is often where you get hired and where you want to stay. You develop relationships, you get comfortable, and you find out if you want to be an obstetric nurse, a medical surgery nurse, an emergency nurse, ICU, or community. I'm wondering if the minister would be able to look at making a commitment to working with Beal University.

 

Also, would she be willing to work with the Minister of Advanced Education to ensure that the Nova Scotia Student Loan Forgiveness Program starts becoming available for Nova Scotians who study outside of our province? I know the Premier is talking right now, a lot, about these inter-provincial barriers. We live and breathe them every day in Cumberland County, and they're so obvious. This is one that I've brought up quite a few times in the last three years, and it still hasn't been fixed.

 

There's no question that the nurses who live and work - they're taxpayers, they're Nova Scotia taxpayers - in Cumberland County, and some even in Colchester and Pictou, and who study in Moncton and now will be studying in Sackville, in my opinion and in their opinion, should be eligible for the Nova Scotia Student Loan Forgiveness Program. All those questions I want to bring forward to the minister, all for the purpose of trying to help alleviate the nursing shortage and improve the vacancy rate for registered nurses in particular in Cumberland.

 

MICHELLE THOMPSON: The leadership team at the Cumberland Regional Hospital is working toward looking at innovative ways to support and recruit RNs and LPNs. The overall vacancy rate at Cumberland sites has stayed consistent in 2024, and we'll continue to monitor it in 2025. LPN vacancies improved in Cumberland by about 2 per cent between April and December 2024. The RN vacancies have improved by about 8 percentage points in the same time frame. There are strides that are being made.

 

In terms of the retention piece - looking at a very innovative thing that happened in the Northern Zone specifically - it was talking about stay interviews, trying to understand the reasons why people stay, and what are the ideas that they have that would support other folks in staying. It is a very busy site. There are a number of opportunities for people to work in different specialties throughout the hospital, so really looking at those stay interviews.

 

The Northern Zone - specifically Cumberland Regional Emergency and the ED at North Cumberland facility - plans to implement a permanent full-time multi-site position for RNs as well, which will support care in the community. Nurses continue to be in place at the regional hospital to augment Nova Scotia Health Authority staffing as required.

 

There are some other advancements in community around other health care professionals as well. There is some work happening with partnerships in place with UNB and Beal University to help strengthen placements. We also have to remember that we do have a number of learners, and that is part of a limiting factor. We need to make sure our internationally educated nurses have opportunities for mentorship from senior nurses and experienced nurses, as well as students. That work is ongoing.

In the broader sense around nursing recruitment and retention, recruiting health care professionals has been top of mind. We have the Office of Health Care Professionals Recruitment. It was one of the most pressing issues and continues to be since 2021, working with partners across the health system to bring more nurses into the system. These efforts have added hundreds of nurses, as well as more nursing seats, across the province. We're proud of that.

 

Since 2021, the government has provided $4.7 million per year in funding to employers, the largest portion of which goes to the Nova Scotia Health Authority. This funding supports educational and professional development, orientation, and mentorship initiatives that foster recruitment and long-term retention by enabling nurse career progression and professional development, which is a really important point. Career progression is an option for some individuals. We know that LPNs will sometimes bridge to RNs, and RNs sometimes bridge to nurse practitioners. So there aren't necessarily net new people into the system, but the skillset is and that new designation, so we encourage those programs wherever people see that that may be the correct path for them.

 

In 2021, Premier Houston guaranteed all new nursing graduates in the province a job right through to 2026 in order to demonstrate just how valuable and essential nursing is to our health care system. Nova Scotia Health Authority has hired 119 new graduates from Nova Scotia nursing programs since September 2024 - a great influx of new graduates into the system, which we're really pleased about.

 

In 2022, the government provided funding to expand the nursing seats. There are now 143 new permanent Bachelor of Science seats: 63 at Acadia, 28 at CBU, 26 at Dalhousie, and 26 at St. F.X., and 300 new permanent LPN seats at the Nova Scotia Community College - a significant investment.

 

I think what's really important too, when we talk about people having to maybe leave their communities for a little while in order to get education - certainly not able to, you know, train all the time in our communities - the important part is that there are jobs in every community in this province for health care workers. When we think about the economic potential of having people being able to work in small communities - they don't have to leave when they're involved with health care. I say that health care today, we think about physicians, nurses and paramedics, but really, data analysts are health care workers today. We have power engineers working in a number of the hospitals across the province. Really, with an organization the size of Nova Scotia Health Authority, it's unbelievable the opportunities for people.

 

When we did community consultations - I think we did 24 of them across the province in communities - we talked to folks who attended to really encourage people to go into health care. Whatever their passion and gift is, we assured them that there's a place in health care for them.

 

The key priorities of nursing recruitment and retention really are around financial incentives: job offers to Nova Scotia graduates, a comprehensive nursing strategy, expanding access to education, and career development opportunities. Based on the annual registration data, there are 23,500 nurses licensed to practise in Nova Scotia and 17,000 of these nurses are employed in Nova Scotia, with an increase of nearly 1,500. Some of the gap is actually related to the Patient Access to Care Act. Among those licensed to practise but not employed, 1,000 were from outside Canada, internationally educated nurses; 1,500 reside in Canada but did not list an employer; and another 4,000 reside in Canada and listed at least one employer but only reported working for employers outside of Nova Scotia.

 

Also, there are strategic international recruitment markets for nurses from India, the U.K., the U.S., Australia, the Philippines, and the Caribbean, with international outreach campaigns and partnerships. The Nova Scotia nursing strategy - the government has provided $4.7 million per year in funding to employers - the largest, of course, goes to NSHA - for educational, professional development, all of those different things. It includes the RN education incentive and the NP education incentive, which provide financial support for nurses pursuing further education, which I mentioned before.

 

In July and December 2023, agreements were signed with unions representing most of the province's nurses. Examples of compensation increases - a 12 to 17 per cent increase for licensed practical nurses; 15 to 21 per cent for RNs; and 21 per cent for nurse practitioners - really competitive wages, and increases to existing incentives such as shift premiums and new incentives for preceptorship and reassignment.

 

I also mentioned in the Chamber in the last couple of days that there was recently a nursing conference that was held here at the end of January. I had the opportunity to attend and speak to the participants. There was a nursing student from B.C. who came over and identified that the incentives we have here are very generous. As a student nurse in B.C. recognized, there were things about the climate, as an example, that perhaps were more appealing, but when they looked at the benefits and the pay and the package and the willingness and the welcoming of Nova Scotia, they were torn about which coast they wanted to live on, which is really encouraging to hear because you think these big provinces have a bigger population, and sometimes you think they have more to offer. In fact, the student recognized that we really were leaders.

 

[1:45 p.m.]

 

In 2023 and 2024, there were targeted incentives for nurses. There was the $10,000 thank-you bonus. We also have a great program that sits in Finance for more opportunities for skilled trades. This returns provincial income tax paid on the first $50,000 of earned pay for workers under the age of 30, and that was extended to nurses, which is great.

 

We also have the L'nu Nursing Strategy. Indigenous People are under-represented, of course, in Nova Scotia's nursing workforce. Mi'kmaw nurses are about one half per cent of the total registered nurse population. The L'nu Nursing Strategy is led by Tajikeimɨk, and it seeks to address the gap by creating a supportive pathway for Mi'kmaw and Indigenous students in Nova Scotia's Nursing Program.

 

That program is led by the incredible Dawn Googoo at Dalhousie University. She is originally from We'koqma'q. She has spent some time at StFX, is an incredible asset to our province, and has been an absolute champion for L'nu nursing. I had the opportunity to teach her sister in nursing school when I did some time at StFX. The L'nu Nursing Strategy offers a comprehensive plan covering recruitment and transition into practice and ensuring the long-term sustainability of Mi'kmaw and Indigenous nurses in Nova Scotia's workforce.

 

We did talk about the student nursing offers. We talked about education and career development. Nursing has never been more top of mind in the province than it currently is. We want to make sure that nurses feel appreciated. There is work happening to make sure that nurses are involved not only in patient care but also in the planning and the systems. They are leaders throughout the health care system. There are a ton of us in the health care system. We outnumber every other health care professional, and so the scope - making sure nurses across all designations work to the fullest of their scope. The Patient Access to Care Act allows us to do that.

 

Working with the colleges, if nurses identify new opportunities or ways in which they feel the scope of practice can grow, through the colleges and with the Department of Health and Wellness, we can change scope of practice now by doing an OIC. Cabinet can hear directly from the Department of Health and Wellness and the colleges around what the capabilities of nurses across the three registered designations are in order to support expanding scope and providing care to Nova Scotians.

 

There's lots on the go. There are other things that are happening in the Department of Seniors and Long-term Care, and there is some work happening in Addictions and Mental Health as well, to support nurses and make sure they have good job satisfaction and see that there is really a diversified career path for them.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister for that answer. Thank you to her and everyone in her department for all they're doing for registered nurses, LPNs, CCAs, and all health care members here in the province.

 

Going back to some of the questions that I had asked, I get contacted by a lot of nurses around the province. I don't want to take away from the rest of the province, but I do want to make sure I represent the people who elected me. Specifically, I do want to go back to Cumberland - it's not just Cumberland - Colchester and Pictou. The three counties in the Northern Zone don't have - specifically don't have - a registered nursing school.

 

If someone was to live in Colchester, they could possibly drive to Halifax. If they lived in Pictou, maybe they could drive to StFX. For most people living in Cumberland, if they're not able to move, driving to a school to become a registered nurse is pretty much impossible unless they go to Moncton and now Sackville, which is going to be even closer. Unfortunately, they are punished. Even though they are Nova Scotia taxpayers and want to work in Nova Scotia, they are not eligible for the Nova Scotia Student Loan Forgiveness Program. It's not fair, and I didn't hear the minister respond to that.

 

It is interesting, and I am sure the minister would agree with me on this. I'm not sure why nurses aren't being treated fairly on it, because when the government came out with the free tuition for paramedics, there were quite a few paramedic students from Cumberland County who studied in Moncton - because, again, there's no school in Cumberland - who were all denied the free paramedic tuition from the Nova Scotia government.

 

I contacted the minister at that time for the paramedic students, as well as the EHS, and they fixed it right away. Every paramedic student who is studying in Moncton is able to get the Nova Scotia government's free paramedic tuition, but our nurses continue. It seems to be discrimination against nurses in particular.

 

I'm happy for the paramedic students, and I'm glad that my advocacy worked on their behalf, but I do really feel strongly that our nurses should be treated fairly. Now that we're going to have this university accelerated program for registered nurses at Sackville, N.B., it's even more important. It really could help our vacancy rate.

 

The minister did mention some positives: the vacancy rate for registered nurses is up 8 per cent. That is true. It was 30 per cent and now it's 22 per cent, but 22 per cent is still a pretty high vacancy rate. If you are a nurse and you are working at a 22 per cent rate, coupled with a capacity of over 130 per cent, you can imagine the working conditions and why they are having such a hard time. Anything we can do to alleviate that, I think we should be trying to do.

 

I recently had a meeting with a couple of what I could call rock-star nurses; they are Ph.D. and just the top tier. They actually helped me to prepare for Estimates. One of the things they asked me to ask the minister is: How much is the government saving by having such a high vacancy rate of nurses in the province?

 

I want to make sure that the minister doesn't take the question the wrong way. It's not ethical to purposely have a vacancy rate to save money in a budget, but it is a valid question to ask. When the nurses did propose that this is a question I ask, I did think it's a valid question to ask when we are doing Estimates, looking at the budget. I'm going to ask that question specifically for Cumberland, knowing that we did have a 30 per cent vacancy rate and now still have a 22 per cent vacancy rate.

 

I don't know what it is around the rest of the province, but what does that look like, financially, for the province? What kind of savings are there in the budgetary process with such a high vacancy rate?

 

MICHELLE THOMPSON: I think it's important for people to understand that there are no savings associated. Vacancies, actually the majority of them, are from expanded programs. When you think about things that nurses are able to do, programs that we've expanded, not only are we trying to staff but we're also trying to expand programs in various sections of the health care. So there are no savings.

 

When we have a vacancy and it's filled, and we don't have a person in that line on a regular basis, we're filling that vacancy with overtime or with travel nurses, so there's nothing being saved. Over the last number of years, salary bases increased at Nova Scotia Health Authority because of (1) the expansion of programs and (2) a reliance sometimes on travel nurses. There are a number of things that are under way, but there are no savings being realized by vacant positions. I don't want that to circulate.

 

Providing options for people to be seen in different environments. If we're opening, as an example, in that area, a 12 bed dialysis unit, of course, there's going to be additional staff required in order to do that. If we're looking at primary health care collaborative teams, of course, there's going to be more staff required to do that.

 

There's nothing being withheld. There's been more money spent in health care in the last four years than there has been in 30 years. People should not think, at any point, that there is being any resource held back in order to save money.

 

ELIZABETH SMITH-MCCROSSIN: I don't know if the minister wants to respond to my comments or questions about fairness for the nurses with regards to the - the fact that the paramedics were granted free tuition to study in Moncton, but that our nurses weren't. I'm just not sure if the minister - I had asked that twice.

 

MICHELLE THOMPSON: There are no nurses in the province of Nova Scotia who are getting free tuition that I'm aware of. It's not a program that's being rolled out. I do have my hands full in health care. I have a lot of things that are happening. So around the provincial student loan program, those questions are best directed to the Minister of Advanced Education. This book is thick and wide, and I work really hard to work across departments in order to support a variety of different folks. But that's really not something that I can take on.

 

I know that the minister was asked a similar question in Question Period this week, and he did commit that he was going to look into it. I trust him to be able to do that. So really, right now, I don't think there's any role for me in terms of starting to look at Advanced Education and their mandate.

 

ELIZABETH SMITH-MCCROSSIN: I'll follow up with the Minister of Advanced Education on that. The only reason I wanted to ask is because I know when I did ask the minister for help getting the paramedic tuition, we were able to get that done.

 

I will just add one last point on that. I know that the nurse managers who work in Nova Scotia Health Authority, under the department's purview, have been advocating for this as well. They have been struggling with the nursing vacancy rates and they believe 100 per cent that this would help with the vacancy rates. I just didn't know if her advocacy would also benefit Nova Scotia Health Authority staff who have been working to try to get this to happen as well.

 

I will mention that I did get a response about the hood, just to go back to my very first question about the cancer hood. Yes, I guess it is installed now, but now the staff are being told it will not be until September that they can use it. Because now they are looking at other things that are in the way. It's disappointing, but eventually we will get there.

 

I did want to bring up one other point, and this is something the minister may not be aware of. The minister did bring up one of the positives, the internationally trained nurses, and how the College of Nursing looked at their curriculum - I believe it was seven countries - and approved that any nurse who came from those countries would be able to get their nursing license easier than - it's very, very difficult for people.

 

They spend a lot of money, and they come here to our country and oftentimes it takes two or three years to get their nursing license. So I am aware of nurses, and I'm not going to break confidentiality, and I don't want to say or do anything - I want to make sure the minister knows this. I don't want to say or do anything that would in any way jeopardize them getting hired, because that's not fair.

 

However, they have come to me because they've been told they can't be hired and won't be hired by Nova Scotia Health Authority, and that Nova Scotia Health Authority has made changes recently that they are no longer doing the bridging program - it's paused for internationally trained nurses. I was actually told that face-to-face, as well as in an email. I have it documented in an email from a Nova Scotia Health Authority staff, and I was told that face to face.

 

[2:00 p.m.]

 

The concern I have goes back to my nurses - I say “my” nurses - our nurses and our patients in Cumberland and across the province who are struggling to work with high vacancy rates and over-capacity. We have nurses who are licensed in our province, so they have their nursing license from one of those seven countries. Technically they should be able to be hired. Whether you are an internationally trained nurse from India, or a new grad from Dalhousie or St. F.X. or CBU, if you have your nursing license - I don't understand why Nova Scotia Health Authority won't hire these nurses and mentor them, based on their needs.

 

Even if you are a new grad who studied here in Nova Scotia or in Canada - and the minister is a nurse so she would - we both can think back to when we first started. You are terrified and you need mentoring. It's very, very important, whether you are a new grad or from another country. You are nervous and it takes a long time - I always used to say: You don't know what you don't know - and it takes a long time to really gain your confidence, especially in acute settings.

 

I do want to bring this up. I don't know how much money is being spent by the Province right now or how much is budgeted for the bridging program here in this budget. I wonder if the minister wants to comment on that or give any insight on what the plan is moving forward, to restart that bridging program, or maybe they're going to start a different program to help support and mentor the internationally trained nurses, keeping in mind that they are licensed. These are nurses who have obtained their Nova Scotia nursing license but are being told that they are not being hired by Nova Scotia Health Authority and they want to be.

 

MICHELLE THOMPSON: The bridging program that has happened for internationally educated nurses certainly is still under way. There are still people in it, and it is a test and try. The reason I say it's a test and try is because there's this cohort of individuals who came through that program. The learnings from that really inform the path forward, so there's still a number of individuals in that.

 

There have been some learnings from that situation - understanding, as an example, what the English language requirements are. When you work and study in English, it could be very different than conversational, as an example. Really digging down and understanding when people have a protracted period of time in that bridging program, what exactly the barriers were that they faced.

 

We recognize that there are people who do have licences. We need to make sure that first of all, while internationally educated nurses trained as nurses, the practice environment can often be very different from the country in which they were trained. We need to make sure that the patients are safe, that the staff are safe, and that they have the supports that they require.

 

There's nobody new being accepted at this moment, but there are people who continue in the bridging program. We're looking at the best and the most appropriate place, based on the skills and abilities of those individuals, for them to work in the system and contribute to health care. There is a bit of a change, but we do really need to have a robust evaluation to make sure that program is as efficient as possible.

 

Similarly, when we did the practice-ready assessment program for physicians, we had a lot of learnings over the years from that program and now have, as a result, looked at the PACE clinic, which allows us to do competency-based assessment in a different way.

 

All to say that the number of internationally educated nurses is increasing in the province. We want to be very supportive of them. We recognize that the college has been able to acknowledge their training, and that there are some equivalencies there. Now it really is about making sure that the practice environment is one they're familiar with and feel confident in and that we have the actual resources. Those learnings are being evaluated now. There are still some people in the bridging program, and there will be more to say about it in future.

 

ELIZABETH SMITH-MCCROSSIN: Thank you for that response. I'll share with the minister some of the comments of these - I call them rock-star nurses who I had meetings with to try to prepare for today.

 

Some of their suggestions were for the Nova Scotia Health Authority to consider that these are nurses with a Nova Scotia nursing licence. The fact that they are from India or another country - it's actually discriminatory if they're taking that into consideration, because they have a Nova Scotia nursing licence. That's something to consider. These nurses who have contacted me haven't even been given an interview. There's been no establishment of what their skillset is, because they've not been tested, but they have a Nova Scotia nursing licence. Whether they trained - wherever - in Canada or another country, our regulatory body here in Nova Scotia has deemed them to be safe to receive a Nova Scotian licence to practise.

 

It's not a defined licence. It's not like, you have a licence to practise in long-term care but not acute. No. They have a Nova Scotia nursing licence. It's something that needs to be considered: Is there discrimination based on origin or country or language, considering that there's been no assessment done? There's not even been an interview in many cases.

 

I think this is important to consider. We have a nursing vacancy rate that needs to get filled for patient safety and for the safety of practice of our nurses who are currently practising. I didn't mention earlier - it's public knowledge, but - recently the vacancy rate of 22 per cent was 30 per cent. These are frontline staffing positions, often. Not always, but often.

 

Recently, we lost 12 nurses from our medical (inaudible) - 12. The direct reason that most of them gave was because they felt they're not being listened to, of patients continually being placed in non-traditional patient areas. They don't feel it's safe to practise. Because of the fact that it keeps happening, they feel like no one's listening, and they're quitting. They are moving to other places within Nova Scotia Health Authority where there are vacancies, so we're not losing them to another province - sometimes we are.

 

That's why I tabled in QP today the document that was sent to me by a few nurses. It seems like even though the nursing union was involved back in November and said to Nova Scotia Health Authority staff: You can't keep doing this to our nurses; it's not safe for them, the practice did stop for a period of time, several weeks. The nurses felt safe again, and then the practice started happening again. Now it's actually a policy that was sent on February 14 - both at Cumberland Regional and Colchester - saying that the nurses have to receive patients in these non-traditional patient areas in the hospital.

 

This is one of the reasons that I am asking a lot of questions today about nursing, hires, vacancy rates, education. I do think that if the Nova Scotia Health Authority is refusing right now to hire nurses in Nova Scotia who have a Nova Scotia nursing license, I believe the nurses who are not even being given an interview actually could look at taking legal action.

 

Why are they not even being given an interview? They can't say they don't have the skills or there's a language problem because they haven't even been given an interview. They just see that they're from another country and they're saying they're not eligible for the bridging program, and we're not offering that to them anymore.

 

This is a concern to me and it's not fair to the nurses who have contacted me who have moved here from other countries in hopes of practicing and becoming a registered nurse. Now they are a registered nurse and now Nova Scotia Health Authority is not offering them a position.

 

I think this is important to look at. I know we're talking about budgetary and it's Estimates, but this is all part of our budget here in the province of Nova Scotia.

 

I did want to say one more thing about that. Also with regards to whether it's a new grad nurse - I just want to reiterate I mentioned it a little while ago - but whether it's a new grad nurse or a newly-licensed nurse who came from another country, Nova Scotia Health Authority - any employer - has a responsibility to provide mentorship and fill any educational gaps that may be there.

 

My question to the minister is: Does the department need to look at - or would the minister look into - if there are deficiencies within Nova Scotia Health Authority that there are not enough staff educators? Is that maybe the underlying reason why they are not willing to hire some of the nurses who have a Nova Scotia nursing licence but may be from another country? Is there lack of staffing for nurse educators?

 

Every hospital - for those who don't work in hospitals - has staff. In every hospital, their whole job is to support the nurses who are already working. Whether it's making sure they feel comfortable responding to codes, making sure they know how to properly do an IV, any of those skills. If there's new equipment that comes to the hospital, that staff educator would be responsible to make sure that everyone is educated on the new pump that just arrived, that kind of thing.

 

Is there a need to look at maybe hiring more staff educators for our nurses? The question I will tie in with that is: Can the minister find out how many nurses have applied to Nova Scotia Health who have a Nova Scotia nursing licence - maybe one of these internationally trained nurses - who hasn't been offered an interview? If the minister isn't aware of the answer today, which she may not be, is it something she would be willing to find that answer for?

 

MICHELLE THOMPSON: I think it's really important - there's a lot there. When we look at bringing new nurses into the system, there's a variety of ways in which nurses come in, of course. Sometimes we have people who return to service; they've been off for a period of time, they re-enter because they've been off.

 

[2:15 p.m.]

 

We have a number of new graduates, and the mentorship program is a big focus for us. Certainly, internationally educated nurses have contributed significantly to the care of Nova Scotians and we want to continue to do that. We worked with the college, and I think we just have to realize that there is a way. I was an internationally educated nurse. I worked in Scotland for four years and I had a registration, but I didn't understand the system. You would think that health care is pretty uniform, but it actually wasn't.

 

I saw Nightingale units for the very first time. I had no idea what they were. I got in a lot of trouble because even some of the words that we use here that are part of our vernacular are not socially acceptable over there. I won't use those here, but just very simple words that are just part of regular conversation here were actually quite offensive over there. It actually took me a fair amount of time to settle into a system. One of the things I didn't understand - we actually had to wash and change the beds. I also couldn't understand how all of the charge nurses and all of the nurse managers in the hospital were Sisters.

 

Of course, again, back to the language, I couldn't understand how there were so many nuns working in this hospital because the only Sisters who I had been exposed to, of course, were the Sisters from St. Martha's. I came to find out, probably about five weeks after I started my job, that that is just exactly what the United Kingdom refers to as their charge nurse - that they are the Sisters. It did take me a really long time to settle in and I think, despite the fact that I did have a license, I think my competencies took a long time to come up and I would have really appreciated having an entry to practice opportunity for me.

 

In Nova Scotia, we've worked really hard to welcome Nova Scotia nurses. People with nursing licenses who are educated in other countries but similarly we want to make sure that yes, they are eligible for licensure, but we also want to make sure that they are feeling supported in their practice. I would also say that when we think about the nursing workforce and we talk about the expanded role, we can't really - we have to balance. We have to move things forward incrementally.

 

I can't imagine that we would take the most experienced nurses all the time. We have increased Nova Scotia Health, and IWK has increased their inter-professional learning and mentorship programs, but we have to realize that every time we take a nurse away from the bedside and move them into different roles, it is not a new person into the system. It actually is just kind of spreading around the resources that we already have.

 

It has been challenging for us not to move too quickly to deplete a workforce in a particular area. I think shift work, after you've been doing it for a long period of time and you have a lot of expertise and wisdom, it is very enticing for people to be able to move into different roles and support more novice nurses or nurses who are coming in from other areas to socialize them to the system. I would say that there is lots of work that is happening. When I think about new graduates, I think about the senior nurses who helped me when I was a new nurse. I had a lot of knowledge but not a lot of experience.

 

I remember working a night shift in a long-term care facility and trying to figure out with a wrench how to turn the oxygen cylinder on. I had never really understood how much like a torpedo they look like until I had a wrench in my hand at 20 years of age trying to get some oxygen out of that. I actually had to call maintenance to come in and help me because I was petrified that I was going to cause an explosion in the nursing home. Those mentorship opportunities are so key in order for us to do that. We want to give people opportunities.

 

The test and try that we have done with internally educated nurses has actually been very well received. It makes sure they are familiar with equipment, and make sure they are familiar with the hospital and all of those things. I think it would be disrespectful not to support individuals to come in to a new system, if we have the capacity to do that and so the learnings have been important. The bridging program is an essential piece. We have to evaluate and make sure that we understand what the feedback is directly from the participants. What would have been better for them?

 

Maybe what we could do differently, and also where folks are needed and working in community around the recruitment efforts that where if you come in through a bridging program, where else might you want to live, and making sure that we have a system where we look at where individuals can be matched. Are there opportunities for us to create communities of practice so that people maybe have a preferred community that they want to live in?

 

There have been a number of things. We've been working with the Department of Labour, Skills and Immigration. We've been working with the college. We've been working with Nova Scotia Health and IWK and the continuing care sector. We have a number of individuals who have worked in our system for a really long time and contributed, particularly in continuing care, maybe initially as continuing care assistants, perhaps as licensed practical nurses. So really looking at providing an opportunity for those individuals who are in the system, the opportunity to use their skills to the highest scope.

 

I don't think there's anything that's awry here. I think it's very incumbent on the operators to make sure that people have the supports that they need when they come in. Whether they're a new graduate, re-entering practice after a number of years, internationally trained. I know I certainly would have benefited from that - even just as simple as equipment.

 

These are protracted periods of orientation at times, but really are committed. We know that internationally educated nurses are part of a recruitment strategy that we have. It's one lever. The college has been very, very proactive in this space, and the work that they've done has been very helpful. We get updates on a regular basis at the Premier's summits, where he meets with health care workers.

 

From those conversations, it has really allowed us to look at how we credential folks in a different way - how we do competency-based assessments. When we have health care workers who arrive from Ukraine, who came unexpectedly - who came from a war-torn country, where their credentials weren't available - they just simply were not available. Perhaps the university or their place of training was no longer in existence. How do we understand the competencies that these individuals have? How they contributed in their home hospitals and home environments. Then how can we transition them into practice here, to the best and highest use?

 

We've looked at other areas where internationally educated health care workers have come in and they haven't been able to fully credential. As an example, we've been able to work with them, specifically around clinical associate and clinical assistants programs. There are so many different avenues for people to come into our system. We've increased the number of seats that are available. We've looked at extending people's careers by giving them novel opportunities to work, through mentorship, maybe through mobile units, through different care environments.

 

We're expanding teams across the province. We're expanding different opportunities, such as the dialysis that's going to be going into the member's local hospital. So as we do this, we have to incrementally increase the workforce. But we need to do it safely. We need to make sure that the folks we're training in Nova Scotia are floor ready, and that they feel supported in their practice.

 

We need to make sure that internationally educated nurses are supported in their practice. We want to make sure that while their education and abilities on paper seem to be equivalent, we really need to make sure, for the success, not only of themselves, but the system, that they really are in a position that they are not going to misunderstand or do something that may cause them to put their license in jeopardy. It is a worry. Not for all, but for some folks.

 

We see that with novice nurses - making sure there's a supportive environment. We see that ourselves, always trying to make sure that our skills and competencies are where we need them to be. Making sure that there's specialty training available to nurses that have a particular interest in a particular area.

 

There's no one cookie cutter approach. Our patients are complex; our technology is changing; educational requirements are different; competency-based care and assessment is really an important part of this. I just want to assure the member that there are so many things happening in a supportive work environment in order to create practice environments where people feel welcome - that they are supported.

 

The last thing we want is for someone to come into a job and feel overwhelmed. We've heard that from our own nursing students in some of the nursing schools. We've heard that from internationally educated nurses. That's some of the feedback. It's very overwhelming to come into a system. We will continue to work on that.

 

I also want to comment on the overcapacity, again. We appreciate that there is a number of facilities that do go into overcapacity, and we are looking at where we support different units in being able to provide care. Unfortunately, when there's overcapacity, we have to look at the acuity of patients. The overcapacity in the emergency room is also a very big concern. The most acute patients are in an overcapacity situation, but - if we have to go into overcapacity - where throughout the system are the most stable individuals in hospital to do that? That is a clinical decision. We work with clinicians, but there are zones of accountability, and we are seeing that.

 

Previously, overcapacity happened in emergency, but very rarely did it happen in the hospital. When you think about that, the acuity and risk in an emergency department is often a bit different than the acuity, perhaps, in some other units - not all. We really have had to look at that from a perspective of a system. If we are in the unfortunate position of overcapacity, where is the best and highest use of individuals, skillsets, and safety? All of that is taken into consideration. It's done on a daily basis, on an individual basis for patients so we understand their acuity and also the supports.

 

I want to assure the member that everybody is working hard in order to make sure. Again, I'm so proud of the work that's happening in the Department of Seniors and Long-term Care and the investments our government has made in long-term care facilities. The folks who work in the sector have been saying for a long time that we need more support, and that long-term care - we needed the expansion not only of the workforce but also of the ability to care for seniors. When we formed government, we were fortunate to be able to be in a position that we're able to invest heavily in long-term care for the first time in a number of years. It's taken some time. There have been challenges around supply, workforce, and all those things, but we'll start to see those new beds come onboard. Incrementally, we will see overcapacity improve.

 

Also, we have to look at our community programs. The Minister of Seniors and Long-term Care and I talk about that often: What are the opportunities? Now that we are considering how best to move forward with the Remedy, there are a lot of conversations that happen about the provision of care in community and patient choice.

 

There's lots happening. I am hopeful that this will make a significant difference - having cross-departmental work that happens - and I look forward to what's next.

 

THE CHAIR: Order. It will now be the turn of the NDP for the next 60 minutes.

 

The honourable member for Halifax Armdale.

 

ROD WILSON: I've recently been involved in teaching the physician assistants, which is a great asset to our workplace. I advocated 20 years ago to bring physician assistants to Nova Scotia, so I'm happy to see they're here.

 

The concern I hear from the students in the program is will they have a full-time job. My question is: Are the physician assistants guaranteed to have a job, and are there any conditions attached to those jobs in Nova Scotia?

 

[2:30 p.m.]

 

HON. MICHELLE THOMPSON: In this fiscal, there is $3.5 million associated with that. The physician assistant models are being implemented in multiple settings. Areas of practice would include emergency departments and orthopaedics, as well as primary care.

 

There are lots of people who are interested in physician assistants. I believe the cohort is at 24. I don't anticipate there being any difficulties for those individuals to find work. We have requests throughout the province, especially with the collaborative care teams. There's definitely an opportunity - the pilot program that's happening now with physician assistants in emergency departments. We're fortunate to be training our own workforce. They should feel very confident that there will be a place for them to work in Nova Scotia.

 

ROD WILSON: Where does the minister see the physician assistants being deployed, in terms of rural versus urban? Will the graduates of the program have a choice in their location?

 

MICHELLE THOMPSON: I just mentioned possible practice environments for physician assistants. There will be opportunities in emergency departments. It was part of the emergency department improvement plan. Primary care is a particular focus. We know there have been some physician assistants who've been hired in collaborative practices throughout the province and are doing well and enjoying the work. In orthopaedics - we know the earliest trial or test-and-try that was in the province was, I believe, with orthopaedics.

 

As we expand practices, there will be opportunities for individuals. We can't tell people where to go and work. There's no return of service that I'm aware of with any of these individuals. This is new. They'll be trailblazers. They'll be breaking ground. We'll be looking at all those different practice environments. There are a number of vacancies, so people will get to choose and apply to those vacancies as they wish. If they maybe aren't successful with their first choice, maybe they'll try a second vacancy and see if maybe they'll try a different type.

 

I don't want people to feel concerned in any way. We know, as we continue to build these teams around access and attachment and looking at the opportunities in emergency departments across the province, that there will absolutely be work for this class.

 

ROD WILSON: I'd like to discuss virtual care. How long is the contract - I'm not sure if it's Nova Scotia Health or Health Nova Scotia - with Maple? What are the deliverables attached to that contract?

 

MICHELLE THOMPSON: The cost of Maple is around $23 million a year. That contract goes until August 2026. There's a variety of different deliverables. They provide over 700 primary care visits per day.

 

There are those individuals who are unattached, who get what we would call full care. So integration, if there need to be tests ordered, any of those different types of things - just more comprehensive care as a primary care provider - and also the ability to refer into the primary care clinics, if required.

 

As the member will know, if you are seen virtually by a provider and they feel that you need to be seen in person, there's an opportunity for them to refer you to an in-patient appointment so you can be assessed in person by a different clinician. That's part of it.

 

Then of course, we expanded that with YourHealthNS when we opened up two appointments for every Nova Scotian who is attached, on an annual basis. Those are more, I guess, basic. Obviously, there's auditing that's being done around those visits.

 

There were 79,266 unique visits overall, with full care - almost 200,000 visits, but 79,000 of those were unique individuals - and an additional 83,000 visits through the app, people who would get basic care. It is a comprehensive service. It leverages Nova Scotia's providers, physicians and NPs, and we need them to be available.

 

I don't have the contract in front of me, and I'm not sure how much of the information is proprietary, so I'm not actually sure what I'm able to provide to the member. The contract is evaluated on an ongoing basis, and certainly as that contract comes to a close, we will be looking at what the conditions are in terms of giving people notice and posting our fees, et cetera.

 

ROD WILSON: How many Nova Scotian family doctors and nurse practitioners are employed through Maple, the virtual care program?

 

MICHELLE THOMPSON: We'll have to get back to the member. We don't have that readily available. It will take a long time. So he can either wait or ask a different question. It's up to him.

 

ROD WILSON: I'm happy to receive that information whenever I can. Piggy-backed onto that is: How many nurse practitioners are working exclusively for Maple and not providing other services outside of their Maple contract?

 

MICHELLE THOMPSON: That's not at my fingertips either. I don't have that, so we'll have to find it.

 

ROD WILSON: I am told that Nova Scotians with primary care providers can pay to access Maple as a separate private care route. Does the minister have any feel or scope for how many Nova Scotians who have primary care providers are accessing a pay-for-use virtual care?

 

MICHELLE THOMPSON: The team can correct me, but we would not have a line of sight to the business operations of Maple. If there are people who are paying privately - we don't keep tabs on private companies in terms of who or what they're doing.

 

ROD WILSON: Two performance questions I have. I have had heard from both patients in emergency departments and other family doctors - who are relatives - that unfortunately one of the challenges with Maple is we've had seniors call and make an appointment and get some heavy news, like they have cancer or their pathology came back, and it was a shock in the moment. They asked for follow-up and were told to call back and get another appointment, but it wasn't necessarily with the same provider.

 

[2:45 p.m.]

 

So on that note, I'm wondering if the minister has given any consideration on how we might reduce that episodic, but significant discussion of care through the contract with Maple?

 

MICHELLE THOMPSON: I don't have anything to tell me, other than anecdotal information, that that's happening, so it's hard for us to track that.

 

Certainly, if the individual is unattached, then that individual - if the clinician is seeing them virtually, who has ordered the tests, who has done that, they are really responsible then to - that person, seems to me, needs to be seen in person. I don't think that's a policy. I actually think that would be the clinician who is choosing in that moment. There are pathways for patients to be seen in person. I think that's news. People should be supported, particularly if they're getting a very heavy diagnosis.

 

I think it's very difficult for us to measure that. What I would encourage anybody who is unhappy with the care they get is to reach out to the Nova Scotia Health Authority's feedback line and share their experience. I know that's difficult. It's the way in which we can get to the bottom of it and be able to track the incident, whether it's a situation that's happening across a number of different providers, if it's particular to a single provider, those types of things.

 

Our expectation as primary care providers - there's a standard of practice and code of ethics that everybody is held to. The expectation would be that they would handle a situation compassionately, that they would use the opportunity to refer that patient to in-person care, rather than providing a heavy diagnosis over the phone or virtually or however that would work.

 

I don't know that that's happening in terms of statistical analysis. I'm very sorry if people are experiencing that, but it's so important that we understand it, so we can improve the quality. If it is a single or a couple of primary care providers, then we really do need to dig into that a little bit more to better understand what's happening and make sure that it's not a clinical practice issue.

 

ROD WILSON: Is there capacity within the virtual care and the contract for someone to - rather than have a different provider each time, to book a series of appointments with the same provider so they could get that diagnosis but also have a follow-up conversation about next steps - very similar to what we saw in the mental health program suggested by the minister? MindWell, is it? Maybe five episodes or a certain number of encounters? Is there capacity within Maple to have that consistency?

 

MICHELLE THOMPSON: I would say that is not necessarily a current application. Again, if somebody felt that a patient required ongoing care, there is an opportunity to refer to those primary care clinics. Certainly, we've seen that in the hospital visits that I do. There are primary care clinics where patients are followed for extended periods of time, until a new provider is added to the community, and then they can graduate to a more permanent health home, as an example. But while they wait for that permanent provider, they are seen in a clinic.

 

Sometimes it's locum physicians who move through those primary care clinics, but the clinic itself holds the information, and it is staffed by people who they are familiar with and who they recognize. That would be one option.

 

The other thing that is important to note is the primary care clinics that happen in pharmacies, particularly in local pharmacies. Even if not in the primary care clinic itself, the scope and role of pharmacists, writ large, in the province is pretty significant. One of the things that they are able to do to support people who maybe are not currently attached - or even if they are attached - we know now that they can do some work around anticoagulant therapy, and there are opportunities for them to manage hypertension. There are a variety of different things that pharmacists can do. That's another suggestion I would have for patients. There may be an episodic issue or perhaps you're concerned about something, but checking in with your local pharmacist and utilizing scope of practice to the best of their ability, they'll tell you what they need.

 

If you are attached, physicians and pharmacists often have a way in which they can communicate. Physicians will often accept pharmacists' calls in their office just to make sure. We are moving toward a time when their records are shared, but in the interim, Nova Scotians have all that information on their phones. They have their diagnostic results, they have their medications, they have their recent visits - all those different things. That is an enabler to help patients navigate.

 

I say to patients all the time that the most important person on their health care team is them. I am the most important person on my health care team. I may access different people in order to support my wellness. It is really important that patients feel empowered, that citizens feel empowered to see a clear line of sight into their diagnostic imaging, have a list of their medications, understand who and why they're being referred to - a variety of specialists or other practitioners.

 

I would say they can certainly make an appointment with Maple, but there would be opportunities to be seen at a primary care clinic if that was required.

 

ROD WILSON: How is virtual care being evaluated? Any early lessons learned that the minister could share?

 

MICHELLE THOMPSON: There is a full evaluation that's happening now. That's happening through the Nova Scotia Health Innovation Hub. We do know that, as an example, the present satisfaction rating for virtual care is 4.7 out of 5 - very positive results. That full evaluation is under way now through the Nova Scotia Health Innovation Hub.

 

ROD WILSON: That's good to hear. Will that evaluation be released once it's completed?

 

MICHELLE THOMPSON: I would say parts of it are. I don't want to commit on the floor that all of it would be. I'm not sure what's proprietary because of that single provider. I think there will be things that definitely would be public facing. I think there will be things that are learned and ways to improve the program, but I don't know if the full report will be released. I can't really commit to that.

 

ROD WILSON: My understanding - but I'm not sure I understand the language - the Minister of Health and Wellness is the sponsor of PHIA or certainly the lead. I stand to be corrected on the language.

 

With the expansion or the changes to PHIA in March of last year - correct me on the date - does that extend to the data in Maple? Does the minister then have access to get whatever data is collected through the Maple private delivery system?

 

MICHELLE THOMPSON: Yes, the Minister of Health and Wellness is a custodian for health system data across the whole system. That would include Maple virtual care, but it is subject to PHIA - as a custodian, subject to PHIA - so that information is protected. It is only aggregate data used for system planning.

 

As I said yesterday, there's no ability without informed consent for me to be able to see individuals' - there's no need, as a custodian of that, to do that without consent. As an MLA, sometimes I have consent to reach in and speak with people on behalf of patients, but as the Minister of Health and Wellness, I don't have access to records. I'm bound to the regulations and legislation of PHIA, as well as a custodian.

 

ROD WILSON: Another PHIA question: Although it speaks to mental health, it's more a PHIA question, so it's not, I don't believe, a question for the minister responsible for the Office of Addictions and Mental Health.

 

The question is: With the rollout of the new program of universal medical care, is it fair to assume that PHIA will apply to that data from those paid-for private encounters with psychologists or counsellors?

 

MICHELLE THOMPSON: PHIA encompasses personal health information. It doesn't matter if you're a publicly funded custodian, private - you're deemed a custodian. PHIA applies to anybody who holds personal health information. Whether someone's publicly funded or privately funded, the expectations of that custodian are the same.

 

As a Health and Wellness Minister, there would be aggregate data around utilization, perhaps, et cetera, but again, the fearmongering around reaching into people's records, reading them, and all those things - it's absolutely not on the table. It's not what this is intended for. The role is around system planning.

 

Again, without consent, there's no record that I'm able to look at unless I have express consent from an individual or their substitute decision maker.

 

ROD WILSON: I raised the question. I'm certainly not fearmongering.

 

In the days after that, I was contacted about the news release. I was contacted by about 50 psychologists. I asked them: Were you at the table? More importantly: Will PHIA apply, because you're now going to be paid by public funding?

 

It could just be aggregate data. They were completely surprised and a bit taken aback. It may be something that requires a bit of further education as part of that rollout. That's why I bring it forward.

 

Moving on to Pharmacare: Other provinces have entered into an agreement with Pharmacare. Where is Nova Scotia with an agreement with federal funding or a relationship with the federal government for Pharmacare?

 

[3:00 p.m.]

 

MICHELLE THOMPSON: As I mentioned on the floor earlier this week, I think in Question Period, we are in active negotiations. I had an opportunity to have a face-to-face conversation with Minister Holland, who's the federal Minister of Health. We had a discussion about a couple of things, and that was certainly included in our discussion, and then again at Federal Provincial Territorial Health Ministers' meetings the following week.

 

The officials in both departments are working at understanding where the opportunities are and where maybe some of the barriers are. It's really important. The money that comes with the bilaterial agreements is much appreciated and important. We recognize that it's for a limited time, so part of the work that also has to be done is for us to understand the costs, and while it is covered, the sustainability of the program. That's not to put a damper on it, but it is part of the due diligence. We need to make sure that it is a program that's sustainable moving forward.

Those discussions are happening actively now. We do feel that there is an urgency around some of the things that are happening in Ottawa. Those conversations will continue.

 

ROD WILSON: Can the minister tell us - on that agreement, are there any deliverables that come from the federal government that the Province may agree or disagree with? Or is there anything that the Province may want to include that's not in the deliverables from the federal government for the Pharmacare agreement?

 

MICHELLE THOMPSON: We're in active discussions right now. There's no other information I can disclose.

 

ROD WILSON: If I may, I would like to ask a specific question. Will IUDs, oral contraceptives, and hormone therapy for gender-affirming care be included?

 

MICHELLE THOMPSON: Again, active negotiations. It's very difficult for me to be able to disclose any of the information. We are working really hard to get the best deal that we can for Nova Scotians. I really can't share any information about that.

 

ROD WILSON: I certainly echo the minister's concerns about some sense of urgency, given what's going on in Ottawa. Does the minister have, within the best of their ability, a goal and a time frame to get this agreement signed?

 

MICHELLE THOMPSON: Nobody's dragging their feet. We appreciate the situation in Ottawa, and we know that we want to do the best we can, so it's under active discussion.

 

ROD WILSON: Looking forward to it, and if there's something we can do to help, that would be great. Kind of a more upbeat and curious question: The Premier's contest to find health care ideas that didn't cost money claimed to bring in over 2,000 ideas. How many actual items came from the 2,000, and how many of those have been implemented?

 

MICHELLE THOMPSON: I'm just trying to pull the details of the contest back in my head, so I might have to double check a couple things, but certainly there were over 2,000 submissions from frontline health care workers. If memory serves, it was a raffle, so if you put your name in, whether your idea was chosen or not, you were eligible for a cash prize, which was really great, and then there were ten that were chosen, which was always part of the original idea and pitch of the ideas contest.

 

The first one was a text notification system for appointment reminders. As you know, we're working with that. The program was tested in beta, and we know that we did have a time difference issue when it was launched. That is under way. That's being worked on right now. They're just doing a little bit more testing, so you can expect that one to be completed soon. The description of the next one: “Electronic appointment letters. Provide patients the option to receive appointment letters by email instead of posted mail. This would save money, reduce no-shows and missed appointments and reduce waste.” That's currently being actively worked on.

 

“Allow for audiologists to send direct referrals to ears, nose and throat physician specialists instead of making patients go to their primary care provider - their family physician or nurse practitioner - to get this done.” That's actually complete. That was completed in January 2025. “Expand scope of practice for continuing care assistants.” The idea that was pitched was: “Support continuing care assistants to work to their full scope of practice. For example, let them take vitals. This change would reduce the pressure on nurses, who can spend that time providing better patient care.” That is part of the scope of work that continuing care assistants would do in long-term care. That is happening and is currently under way in a variety of practice areas across Nova Scotia Health Authority.

 

“Install screens or monitors in all emergency departments that show publicly available wait times, public health information, and other related information about what a patient should expect in the emergency department,” and that item is complete. “Enable hospital caller ID.” It seems so simple, but that was really a tough one because there are so many different places that would come up as Nova Scotia Health Authority. Folks said often it would come up as no caller ID, and the assumption - as all of us make - is that it's a spam call or a telemarketer, et cetera, so that actually was a bit tough, but they got that done in August 2024. “Stop using emergency departments for pre-operative blood work. For patients scheduled to have a Monday morning procedure, it creates added pressure in emergency departments.” This was completed in August 2024.

 

“Online pre-registration for a patient in advance of their surgery. This would allow patients to pre-register online by sending them a link to fill out a form in advance of their surgery or specialist appointment. This will make intake for nurses working in clinics or pre-operative settings faster,” which is a really great idea. We are very close to completion. We expect that by end of fiscal.

 

Registration App for Patients: “Develop a registration app; patients enter their information; it generates a QR code; clerks can then scan this on arrival for their appointment. It would save time, remove data coding errors, and would be linked with a new e-referral initiative.” That is currently under way, and we are hoping that, over the course of the Spring, this will be fully implemented.

 

“Allow patient to cancel diagnostic imaging appointments online.” If you book a diagnostic imaging appointment, MRI, ultrasound, et cetera, you should be able to cancel online.

 

“Give patients the option to cancel these appointments.” That action is complete as well.

 

Very successful, really good ideas - but there were ideas from many individuals or certain departments that, even though they didn't make the short list, folks went on to implement themselves because they generated a lot of discussion in the unit. If they weren't chosen, they spoke with managers and had discussions about it, so we know that it generated some meaningful change at the front line. People were empowered to participate and do that.

 

ROD WILSON: For as long as I can remember in the last 28 years in Nova Scotia, there's been a constant tension of people who are seeking out-of-province care and out-of-country care, and sometimes end up cashing in their GICs to seek that out. We've heard some recent examples of that. Is there a process for applying, approval, or adjudication of out-of-province care and out-of-country care before or after the care has been provided?

 

MICHELLE THOMPSON: Yes, there is a process in the department. With a referral from a relevant Nova Scotia medical specialist, Nova Scotians may be able to access out-of-province and out-of-country services if the medically necessary service is not available within Nova Scotia. The potential care pathway and the related requirements are set in Hospital Insurance Regulations.

 

The out-of-province and out-of-country program has been administered on the Department of Health and Wellness's behalf by Medavie Blue Cross for several years. Upon receipt of an application, the medical service's insurance consultant - which is a physician contracted by Medavie - determines the medical eligibility for coverage while the Department of Health and Wellness Benefits Eligibility Branch determines if all administrative requirements have been met.

 

[3:15 p.m.]

 

Nova Scotia's requirements for out-of-province and out-of-country pre-approval align with the other jurisdictions across Canada, but Nova Scotia is unique in offering some financial assistance for travel and accommodations when out of province or out of country. This has been pre-approved. Most other jurisdictions do not provide any travel assistance, or the assistance is limited.

 

Under the provincial Travel and Accommodation Assistance policy, coverage would include travel fares at $1,000 round-trip; a 12-trip limit annually is capped; personal vehicle, so gas receipts reimbursement. There's also a short-term accommodation of $125 a night that's capped at $1,500 a month, and long-term accommodation of $2,500 a month.

 

This program is utilized for a variety of different things. In 2021-22, there were approximately 63 people approved for out-of-province care and 12 out-of-country. In 2022-23, there were 105 people who received care out of province and 13 who received care out of country. In 2023-24, there were 117 people who received care out of the province and 21 individuals who received care out of the country. That's a bit of an overview of the program.

 

It is important that people have the referral from a relevant Nova Scotia medical specialist. Nova Scotians may be able to access out-of-province care, but we need to make sure that it's medically necessary and it's a service that's not available in Nova Scotia.

 

ROD WILSON: Just so I'm clear, if I understood, there's a process and the application process is through Medavie as the vendor. I just want to make sure I understand the right process. My question is: Who has the official signing off or approval of that? Does Medavie approve of it or does somebody within the Department of Health and Wellness, or the minister? Who gives the final sign-off?

 

I realize some of these are expensive, really high-dollar claims. If Medavie is the process, who has the final signature and approval?

 

MICHELLE THOMPSON: The application - the Medical Service Insurance, the medical consultant - determines the medical eligibility for coverage. We want to make sure that it's clinically indicated. Then the Department of Health and Wellness benefits eligibility branch determines if all administrative requirements have been met. It's Department of Health and Wellness in the end.

 

We don't do that unilaterally. We want to make sure that there is a clinical lens applied to the application.

 

ROD WILSON: If a submission is brought forward, it's reviewed and it's denied, is there an appeal process?

 

MICHELLE THOMPSON: Historically, it has been contact with a patient or the person applying for services, but because of the way things are changing in terms of the number of requests, et cetera, and different things that people are looking for, we are in the midst of formalizing a more formal appeals process.

 

ROD WILSON: I have several experiences of this with patients, and one of the frustrations in the past - I can't speak to recently - is that when a claim was denied and it came to the Minister of Health and Wellness's office - this, again, was four or five years ago - it was: “Claim denied,” no reasons provided. When the patient or their family member reached out and pursued it with phone calls, wanting to know who made the decision and what evidence was used, they were told: “Oh, we can't disclose that.” Or it was just: “The decision was made.” That really was quite unfair.

 

The burden was really put on the patient or the caregiver to do the research, to find the location, to find the sources. When one patient actually discussed that with somebody in the Department of Health and Wellness, they said: “Oh, I've never heard of that.” So the burden was very much on the family and the patient to do the literature, do the research review, which requires a high literacy level.

 

I guess my question to the minister, whether it's for consideration now, is: Could the decision-maker actually provide reasons and references as to how the decision is made?

 

MICHELLE THOMPSON: Yes, there have been some changes in this past year that explain to people why things have been declined if they are declined, but a number of people actually do receive care as the numbers suggested in the note.

 

ROD WILSON: If I could ask that when that process is completed, and if there's an appeal process, that it's on a website. People tend to be searching for who to contact, what the process is - and are really looking for a clear pathway.

 

Not to throw away the towel in my last four minutes this time, I'm going to start with a new conversation. What was the average length of stay in the last fiscal period in hospital in Nova Scotia, and how does that stay compare to any standard or any goal?

 

It's a big question, but it's a high-level question versus breaking it down into surgical-medical. There are metrics in terms of average length of stay, there's goals, benchmarks, and recommendations. Can the minister speak to goals versus real data in terms of average length of stay in a hospital in Nova Scotia?

 

MICHELLE THOMPSON: Yes, there are a number of metrics that are looked at on a regular basis: 29.4 per cent of patients in Nova Scotia Health Authority acute care units stayed longer than 28 days, which essentially has been static, although it was reduced a little bit from last year. Also, we measure the length of stays. The ED benchmark for length of stay is now being met about 59 per cent of the time, with a target of 70 per cent. Certainly, over the last five months, the length of stay in the ED - that's where we've seen the most improvement.

 

I will also talk a little bit about what's leading to that. Of course, we talked about C3. I mentioned the accountability framework, but also SAFER-f. I don't know that we've really talked about SAFER-f yet. It's a set of best practices for adult inpatient units. SAFER-f really has a focus on improving patient flow, preventing unnecessary waiting, decreasing length of stay, and improving patient outcomes. What we know from the implementation, SAFER-f improves compliance with estimated date of discharge and it reduces length of stay and reduces ALC patients.

 

The SAFER-f units, because it is a big change management associated with it, have a lower acute occupancy by an average of 5 per cent. SAFER-f units have higher estimated date of discharge compliance by a rate of 3 per cent, and acute SAFER-f units have fewer long-stay patients by just under 1 per cent. It's really been an effective program. When you couple that with the Care Coordination Centre, it's really had a significant impact . . .

 

THE CHAIR: Order, please. The time has expired for the NDP. Next up is the time slot for the Liberals. I understand it will be the Independent member.

 

The honourable member for Cumberland North.

 

ELIZABETH SMITH-MCCROSSIN: I was just going to offer the minister - I don't know if she wanted to finish her comments from that last question before I started.

 

HON. MICHELLE THOMPSON: That's alright. I think I'll have lots of opportunities. I'll finish the next time.

 

ELIZABETH SMITH-MCCROSSIN: I have one more question to do with nurses. Chair, this actually may not be for the minister. She'll let me know if this is better directed to another minister. If so, I do apologize. The Nova Scotia Nurses' Union's latest collective agreement settled in June 2024, and retroactive compensation for NSNU members dated back to 2020. Registered nurses who work outside of the union setting, non-union settings, they only received three months retroactive.

 

Our understanding is that there's legislation in the province for equal pay - if you do equal work, you should receive equal pay. A lot of registered nurses were not pleased that they didn't receive the same retro pay as registered nurses doing the same work that are part of the union.

 

[3:30 p.m.]

 

This disparity is particularly concerning given that all nurses, in long-term care for example, do perform the same work and fulfill the same roles, yet only the NSNU-affiliated nurses received the retro pay. I'm wondering if this is something the minister could speak to. Would she be willing to advocate for all nurses to be treated fairly for compensation in that regard?

 

MICHELLE THOMPSON: That is a question for Labour and Advanced Education.

 

ELIZABETH SMITH-MCCROSSIN: Thank you to the minister. I'll direct that there.

 

Some of my questioning earlier on was around nursing vacancy rates, but also in relation to capacity rates and capacity levels in our hospitals, specifically placing patients in non-traditional patient areas and the concerns around that for patient safety as well as nursing standards being met. I'm wondering if the minister could speak to accreditation in relation to these concerns. All our hospitals have to be accredited.

 

I'm wondering: Is this something that the accreditation process looks at - the percentage of patients who are placed in these non-patient bed areas? In relation to this, does the department have a plan to look at how many acute care beds Nova Scotia currently has and how many we should have based on not only our population but the demographics of our population in relation to CIHI standards? There are a couple questions in there, but I'm wondering if the minister could respond to those.

 

MICHELLE THOMPSON: A couple things there. Of course, Accreditation Canada I don't think would necessarily endorse hallway medicine or hallway care. I also think that if they're in hospitals across this province and across this world, they recognize that it's happening. So what Accreditation calls jurisdictions and facilities and organizations to do is really around understanding the population and planning for the future. I don't have the Accreditation standards, but I can't imagine that they would endorse it.

 

They also recognize that there has to be system planning done in order to address the current population and health care needs. There are projections. There is a lot of work that is happening around projected trends and population growth. As a result of that, we also know that we're going to need upwards of about 600 beds by 2035 centrally in order to support the needs of Nova Scotians. Why central is important is because it is a provincial resource. When people come to the city from outlying hospitals, they really do need tertiary and quaternary care and have access to specialists and diagnostics that maybe are not available in some more rural sites.

 

Part of the work that's being undertaken - we're looking at redevelopments across the province. I outlined some of those earlier today - to look at the growing utilization of health care services, and also looking at what can be decanted into community: Where are the places that we can safely and respectfully care for individuals?

 

One of the projects, as an example, that I'm very fond of - I saw it on a trip to Denmark - was the “chemo to go” concept. For certain blood cancers, you can come in, get your medication and go. What the patients we were able to talk to described is that instead of sitting there with everybody being sick in a room, you actually get your medication and you go out and you live and you cut your grass and you pay your bills and you have lunch with your friends. So really that whole mind-shift - really looking at where the places are that we can extend care and normalize care in community is an important issue.

 

There are future phases and master planning happening in the Central Zone to look at exactly that. They're looking at the services, looking at disease burden across the province and across different types. There's a variety of information and community profiles. There's a number of things that are happening. The stronger and stronger we get with data and the analytics associated with it, the better able we are to plan throughout the province but also looking at where the care will be provided and what services should happen where.

 

There are a lot of people who have more experience with data analytics, collection, and those types of things, and then also understanding target population. We know that 37 per cent of children in Nova Scotia are considered overweight or obese. We also know that 65 per cent of Nova Scotians aged 12 years of age and older have one or more chronic diseases. So while we also have to plan for people who require care throughout the system, we have to look at health promotion and prevention activities as well. We all inherit body shapes and sizes. It's not really about that, but we know that we live in obesogenic environments. What are the things that we can change that help us live healthier lives? How do we gamify things for kids? How do we create movement?

 

The projections not only tell us about utilization, but they also give us insight into target populations. Accreditation Canada would say that is some of the most integral work you can do in system planning. That work is also under way. Understanding communities, understanding disease burden, understanding ways in which we can work with stakeholders.

 

We have a great program, a partnership with Novo Nordisk around Lighthouse, looking at childhood obesity and ways in which we can prevent it. The outcomes and the initiatives have to be tied to an entrepreneurial or an economic driver, because health is our wealth. We need a healthy population in order to have a healthy, vibrant and prosperous community.

 

Lots of work is happening in that space. It's probably my favourite part of the job, really, just the fullness of the system and understanding how the system is functioning. The wellness of Nova Scotians is really an important part, not only of Nova Scotia Health Authority, but also of the department.

 

ELIZABETH SMITH-MCCROSSIN: It is interesting work, for sure. I believe what the minister had said was: 600 beds by 2035 in Central Zone. I've got a couple of questions, but I'm wondering if this similar kind of work is being done in the other zones throughout the province - Western, Eastern, and Northern.

 

If yes, are there plans under way to add more acute care beds? I'm not sure, but does the minister know where we stand here in Nova Scotia for the number of acute care beds in relation to what CIHI would recommend for a population in our patient demographic? Where do we stand right now and into the future? Do we have enough, based on what they say we should have, or are we under?

 

I know we are over-capacity, but I also know there are a lot of factors with that. Even at Cumberland Regional, 12 of our beds are transitional. They're not acutely ill, medically ill patients - they're transitional beds taking up space in our acute care hospital. Those are all people who are either waiting go back home or waiting for long-term care. I'm wondering if the minister can speak to that, as far as whether planning is being done or under way for the other zones. Of course, I'm representing Cumberland in the Northern Zone.

 

I also have an add-on question to that. I'm going back again to the patients who are being placed in non-traditional bed areas. This isn't really sustainable. I've had people come to me concerned about whether we're going to be able to meet accreditation standards in the future - not just our hospital, but all hospitals here in Nova Scotia - based on what's currently happening. Knowing that we're consistently between 120 per cent and 140 per cent capacity, are there plans under way now to somehow, magically, get us more acute care beds?

 

I know we have some local people who have shared some good ideas. We have some conference rooms. Do we really need the conference rooms for meetings that happen once a month and could those be transitioned into some acute care beds? Right now, we have patients in hallways, end of hallways. In some situations, there are no electrical outlets for beds, as I've already mentioned, and other equipment.

 

To continue in this way, knowing that we're putting patients at risk, and also expecting our nurses to perform in conditions where they themselves have said time and time again, that they cannot meet standards of practice. I think we have a responsibility as a department, as a government, to make changes, not wait 10 years. We really need changes now. I'm wondering if there are any plans under way to try to get more acute care beds where needed - definitely in Cumberland Regional - as urgently as possible.

 

[3:45 p.m.]

 

MICHELLE THOMPSON: I think the assumption is always that we need more acute beds - we may need some moving forward - but what we actually need are beds in long-term care, and we need opportunities in community. It isn't only about acute care. As an example, transitional care facilities. There will be 178 additional beds associated with transitional care, which will free up beds in acute care settings. It isn't just about acute care beds. In an ideal world, there would be an occupancy rate of about 90 per cent, which would allow people to move through the hospital freely, but we need to make sure we have respectful and appropriate care for individuals who are in hospital longer than 28 days.

 

The work that's happening in the Department of Seniors and Long-Term Care - it would have been wonderful if that work was started 10 years ago, but it wasn't. In the last four years, we have worked tirelessly to invest in long-term care beds and in home care - things that support people in transitioning out of hospital.

 

I know the Minister for Seniors and Long-Term Care will be thrilled to talk about the programs and the test-and-try that's happening around the CAPABLE program, making sure people have things they need like grab bars and ramps, et cetera. There's a carpenter on that team to make sure people can transition home, because sometimes the biggest barrier is the physical environment.

 

It's not only about acute care; it's also about prevention. When we look at target populations, as I said earlier: What are the things that we can do? As we get more nuanced in our data analytics, how do we work, for an example, with municipalities and schools? We say: These are the things that we want to try to tackle as a community, so we don't need so much health care.

 

When we talk about our partnership with Novo Nordisk, they have a huge social responsibility component, because they say they're always going to be able to make enough medication; that is not their issue. Their issue is around stopping the people who need the medication. Looking from a whole-health system approach, what do we do, up to and including prenatally, with people? How do we move people through the system? Yes, we need acute care beds, but we also need other opportunities for patients to be cared for in the right place at the right time.

 

As I said, this is an exciting time in health care. Looking at new models of care, SAFER-f has really had an impact in terms of people staying - we have early mobility teams in hospitals keeping people on their feet, keeping them conditioned, and making sure they are fit to go home after an acute stay in the hospital.

 

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

 

The honourable Deputy Government House Leader.

 

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

 

THE CHAIR: All those in favour? Contrary minded? Thank you.

 

The motion is carried.

 

The committee will now rise and report its progress to the House. We will go to recess, and we will return around 4:00 p.m.

 

[The committee adjourned at 3:48 p.m.]