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28 mars 2019
Sujet(s) à aborder: 








3:56 P.M.



Suzanne Lohnes-Croft


THE CHAIR: Order. The Committee of the Whole on Supply will now come to order.


The honourable Government House Leader.


HON. GEOFF MACLELLAN: Madam Chair, would you please call Resolution E11.


Resolution E11 - Resolved, that a sum not exceeding $4,638,526,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.


THE CHAIR: The honourable Minister of Health and Wellness.


HON. RANDY DELOREY: It is a privilege when the citizens elect members to this Legislature and I am pleased to rise and introduce the Estimates for the Department of Health and Wellness for the 2019-20 fiscal year.


I thank you for the opportunity to speak about the important work being done by the department. I want to acknowledge the many qualified public servants who work within the department every day to deliver on our mandate.


As with the many qualified and hard-working front-line health care workers, staff in the department take the responsibility for the continuous improvement in health care services to heart. With me are two officials who will help us take a closer and no-nonsense look at the department’s budget. Joining me are Ms. Denise Perret, the Deputy Minister of Health and Wellness; and Mr. Kevin Elliott, the Chief Financial Officer for the Department.


Madam Chair, the Department of Health and Wellness has been guided by the key health care priorities of our government. We are investing in the next generation of health care to better meet the changing needs of Nova Scotians. We are focusing on access to collaborative primary care; improving mental health and addiction services; reducing wait times; reducing and modernizing the health system; improving home care and continuing care; and, instituting electronic medical record initiatives.


There has been progress, Madam Chair, and I want to confirm our commitment to continuing these initiatives. We have not reached the summit of our efforts, there is indubitably more work to be done. We have heard loud and clear from Nova Scotians that health care is their top concern. We have listened to the people who work daily in our health care system and the Nova Scotians who rely on it. After the identification of operational priorities, we identified priority investments that mirror these priorities.


I would like to reveal some of the investments included in this year’s budget. We have increased the budget for health care by $271 million this year to meet the needs of Nova Scotians. That is a 6.2 per cent increase, Madam Chair.


We are investing to improve access to primary health care. We are investing to improve access to mental health services and supports, we are investing in more support for those who need care at home, and we are investing in orthopedic surgeries because as the wait lists go down, the quality of people’s lives improves. We are investing in modernizing health care facilities in Cape Breton Regional Municipality and Halifax, which were ignored by previous governments.


Madam Chair, we are investing in healthier people and communities. Sustainable effective change to our health care system takes time. It is a large, complex and interconnected system, with many stakeholders. Nova Scotians expect us to work thoughtfully and together to ensure the system meets their needs. Creating a more, modern collaborative and evidence-based health care system means taking deliberate action. That is what we’ve done since 2013 and it is what we, as a government, will continue to do.


Our top health care priority is improving access to primary health care. Access to primary health care is top of mind, for this government, for many Nova Scotians, and for colleagues on all sides of this House. Budget 2019-20 will ensure there are strong collaborative primary care teams across the province. We are increasing funding for these teams by $10 million this year and, in total, we will spend $27 million annually on this imitative.

We have also created a nurse practitioner education incentive and are adding 25 more seats at Dalhousie University over two years, which will help ensure we have new and experienced nurse practitioners in our communities across the province.


This year, we will also see the 10 new family practice residency seats - which were announced last year - open at Dalhousie University Medical School. We’ll fund 15 new residency spaces for specialty medicine positions at Dalhousie University Medical School, as well. It’s important to note we are the only province that is expanding its training of family doctors and specialists.


Recruiting doctors is a collaborative effort. For example, staff from Nova Scotia’s Office of Immigration, the Nova Scotia Health Authority, and the Nova Scotia College of Physicians and Surgeons recently traveled to the United Kingdom to recruit one-on-one with doctors there. International recruiting has brought 20 family physicians and five specialists to the province since beginning just last year. The Practice-Ready Assessment Program, a new program designed to assess internationally trained doctors, began in February 2019.


Communities across our province are also involved in recruitment. Places like Lunenburg, Digby, Pictou, and Amherst are working hard to connect with doctors, specialists, nurse practitioners, nurses, and other health care providers. These community organizations are working closely, and in partnership, with municipalities and the Nova Scotia Health Authority, as well as front-line health care workers. The work they do is having results and the work they do is valued by this government.


That’s why we are providing $200,000 to help communities in their efforts to attract health care professionals because the doctors who are looking to move to Nova Scotia, they’re like you and I when we look for a new job. Before making such an important decision, they want to know that it’s a good place to raise a family. They want to know they can grow as a professional in a modern health care environment and they want to know if there are job opportunities for their partner and recreational and educational opportunities for their children. Community members are the ones who know the best way to present themselves and their potential to newcomers. They work with municipalities, businesses, and health care professionals to show off the place they are proud to call home.


The Dalhousie medical residency program in the Annapolis Valley, Cape Breton, and southwestern Nova Scotia have been successful in recruitment for that reason. We have also created a new clerkship program for medical students starting in Cape Breton. This will allow students to get a feel for what practicing in Cape Breton could be like and the kind of lifestyle it offers. The Nova Scotia Health Authority and government have a number of incentives to help new doctors come to Nova Scotia, whether full time, part time, or locum. More than 120 potential newcomers have visited communities in the province to see what life in Nova Scotia is like and we are focused on our doctors who are already here, as well.


Government also has incentives to encourage doctors who practice here to take on more patients. These efforts have resulted in more people having access to a family physician or nurse practitioner to provide primary care services. More than 75,000 Nova Scotians have found a family physician or nurse practitioner to provide primary care services over the past two years. Data from Statistics Canada shows that 87 per cent of Nova Scotians have a family doctor or nurse practitioner, ranking the province fourth highest in the country for patient attachment. Overall, since last April, 125 new doctors have started working in communities across the province - 57 family physicians, and 68 specialists.


Madam Chair, we know the work is not done, but we are showing progress. It is critical work, as we are competing with many other jurisdictions for doctors and other health care providers.


The way that people receive primary health care now is different. I can go to a pharmacist or a nurse practitioner for some types of care or advice; I don’t always need to go to my family physician. Many health professions from nurse practitioners and pharmacists to paramedics have expanded their scope of practice and they can provide a broader range of good quality health care to Nova Scotians.


Having all our health care practitioners and professionals working to their full potential scope enables family physicians to focus on those patients that require their expanded scope of knowledge, experience, and skill. We are building a modern health care system where all these health care providers are working to their optimum scope of practice in a collaborative and patient-focused way.


Our health care system must also reflect how doctors want to practice. That’s why we are investing the additional $10 million to enhance and strengthen collaborative care teams across the province.


When health professionals work together supporting each other, they can take on and deliver care to more patients. We want to support doctors, nurses, and other health care professionals to work in a way that they believe will offer the best health care to Nova Scotians. For some, that means a more traditional practice, yet for many new doctors and other health care providers, the answer to expanding access is to practice in a collaborative primary health care system team.


I’ve spoken to many students, medical residents, and others who are very enthusiastic about this model. By having nurses, dietitians, mental health clinicians, social workers and others working as a team, they can see more patients and provide a broader range of services and expertise.


Each collaborative team works a bit differently. Some practices have all the providers under one roof, and others are affiliated and connect regularly. It is not a one-size-fits-all model. The many medical professionals I’ve spoken to say this model works well for them. It helps them achieve a work/life balance, it helps them support their patients, it helps them with recruitment, and it allows the flexibility to meet specific needs of their communities, and it is our hope that this model will help attract new doctors, nurses, and other health care providers to come to Nova Scotia.


Madam Chair, our goal is to have the right mix of health care professionals working to their optimal scope of practice, seeing the right patients in their communities at the right time.


We are also providing $4.6 million more for emergency health services, or EHS, to meet the growing call volume and costs for ground ambulance services across the province. We know that the ambulance system is experiencing increased call volumes and we have asked our partners in emergency care, the Nova Scotia Health Authority and EMC, to implement changes to reduce ambulance wait times. We can expect to see improvements in the next couple of months.


We are investing in improving emergency departments, as government will expand the emergency departments at the IWK, Cape Breton Regional, and Glace Bay Hospitals to better meet the growing demand at these hospitals. We are also putting more resources into emergency departments to better manage the services they provide. In addition, the Halifax Infirmary will be part of a unique project to put an MRI adjacent to the emergency department. This innovation will mean that patients will not have to travel far for this diagnostic procedure and doctors will have faster access to critical information.


There is also funding to further projects to improve access to dialysis. There will be newer, expanded dialysis services in Glace Bay, Kentville, Halifax, Dartmouth, Digby, and Bridgewater as part of this initiative.


I’d like to move on and talk to you now about other priority areas for a few moments. This year we will invest $295 million in mental health and addictions treatment, including services for those living with mental illness, payments to physicians, and medications. This is an increase of more than $30 billion since 2013.


Our priority for mental health is improved access, Madam Chair. We are committed to working with the Nova Scotia Health Authority and the IWK to determine how we can deliver services most effectively, building on existing, and introducing new ways of delivering mental health and addiction services.


We need to focus more on how people want to receive these services, especially young people, and the role technology can play in increasing access to these services. The popularity of the Kids Help Phone Telephone and Live Chat Counselling service is one such success story, as are the online mental health tools that are being used by post-secondary students, that we launched last fiscal year.


We are expanding our adolescent outreach services and SchoolsPlus because youth need to have supports where they are - in schools that are in their communities. The Nova Scotia Health Authority is about to launch a central intake service for mental health and addictions to ensure people know where to get access to the mental health services that they need.


Madam Chair, this central intake process will provide one entry point into a range of options available to Nova Scotians. The system will triage and connect Nova Scotians to services like individual and group therapy; specialty diagnostics and treatment; e-mental health options and other providers.


We need an integrated central intake process to assist Nova Scotians in navigating through the range of options available through various organizations and service providers. Improving mental health and addiction support services for Nova Scotians will continue to be a key priority for me and this government.


Older Nova Scotians have told us that they want to live in their homes as long as possible, Madam Chair. That’s why we have invested heavily in in-home care, significantly reducing wait times for this service. We have added $16.8 million in this budget to support home care which has a total investment of $283 million for this coming fiscal year.


We are also implementing the recommendations of the expert advisory panel on long-term care. We are providing $5 million over two years to do so. So far, Madam Chair, we have spent more than $2.5 million to help the sector treat and prevent pressure injuries. The new mattresses, cushions and lifts will help staff provide the best care for residents and do so in a safe way for the staff.


Our government is committed to improving safety and the quality of care in homes across the province. We are looking at all aspects of continuing care, including long-term care beds and staffing, to understand how to meet the current and future needs of our aging population. We are working with proponents in Mahone Bay and Meteghan to finalize details for new builds and more beds in those communities.


Madam Chair, government will also build two new facilities in the Cape Breton Regional Municipality, providing 120 beds in the communities. This is part of the CBRM Health Care Redevelopment Project.


Earlier this week I announced the Cape Breton Regional Hospital is getting a new emergency department, a new critical care department and a new cancer centre as part of this once-in-a-generation project. This project will help ensure Cape Bretoners have access to quality care in modern, state-of-the-art facilities, for generations to come.


Madam Chair, Dr. Orrell, who is the project senior medical lead, says the project will have a significant impact and I quote:


The people of Cape Breton will have more consistent health care delivery with expanded specialized services, more long-term care beds, and new community health centres that offer the services people need on a daily basis. Newer, more modern facilities will help with recruiting and retaining doctors. Redesigning the health system in this region is long overdue and the redevelopment project will modernize health care delivery now and for the future.


We will be updating the residents of Cape Breton in the coming weeks and months on the care facilities, new community health centres for North Sydney-New Waterford, and other elements of the projects. Government will invest $156.9 million this year on the CBRM Health Care Redevelopment and QEII New Generation projects, Madam Chair.


[4:15 p.m.]


The QEII New Generation project is the largest health care project in Nova Scotia’s history. From new and renovated operating rooms to relocated cancer services to the construction of a new community outpatient centre and more. This project will transform how some of the province’s most specialized health services are delivered. The master planning for this work is progressing well.


I’d like to share an innovative program that we have launched as part of the Cape Breton redevelopment. Under the community-based paramedic program in CBRM, paramedics and telecare nurses coordinate with home care and other services to provide care after a patient is released from hospital reducing return trips to the emergency department and supporting earlier discharge from the hospital. This program began rolling out of the Cape Breton Regional Hospital emergency department in December 2018. The program has been warmly welcomed by participants with one client saying and I quote:


The paramedics arrived, and I immediately felt reassured. I had peace of mind knowing that someone was that close. They made sure that they had the right medication and even called the doctor to make sure I had peace of mind knowing that someone was that close.


This government has invested more money every year to help Nova Scotians on the wait list for orthopedic surgeries, particularly hips and knee surgeries. Since 2013, more than 14,000 hip and knee surgeries have been completed, helping Nova Scotians who have been waiting longest. Government has added $2.2 million this year bringing the annual total investment to $17.4 million. These investments will support the work of the Health Authority to strengthen orthopedic services and the investments to date have resulted in more surgeons and anesthetists, nurses, and other health care professionals being hired. The ongoing investments will continue to support pre- and post-surgical services to improve outcomes for patients.


We continue to move forward with our digital health strategy. One Person One Record will support health care providers who provide care to Nova Scotians in family practices, hospitals, pharmacies, and in the home. Modernizing Nova Scotia’s clinical information system will streamline health data. This is a game changer for digital health and is part of our modernization effort. Currently, we have many technology systems used by our clinicians and support staff to provide patient care across the province. Many of these systems are unable to share information between each other in a timely manner, which leads to inefficiencies and frustration for both patients and care providers. We are investing to change that.


I am also proud to serve as the Minister of Gaelic Affairs in Nova Scotia and our government recognizes the importance of Nova Scotia Gaels, the Gaelic language, culture, and identity. Indeed, just earlier this morning, I recognized two young Nova Scotians who are actively studying about their Gaelic culture and language, and have actually initiated a program to take this information to schools across the province. In the past two years, they have managed to visit 215 schools reaching thousands of other students to learn and share information about the Gaelic language and culture. Supporting Nova Scotia Gaels is the key focus of the office of Gaelic Affairs. An estimated one third of Nova Scotians have connections to the language, culture, and identity of Gaels in the province.


When we introduced the Culture Action Plan two years ago, we understood the importance of sharing our stories because they help us understand who we are, where we come from, and where we want to go. In this spirit, the office of Gaelic Affairs assisted in facilitating the MAGIC initiative that fosters cultural identity awareness, understanding, and sharing between the Mi’kmaq First Nations and two early ethnocultural communities in the province, the Acadians and Gaels.


Our government is committed to include the language, history, and culture of our founding cultures, including the Gaels, in teaching from Grade Primary to Grade 12. In an effort to strengthen Gaelic culture awareness and build upon Gaelic identity, Gaelic language learning is at the core of our work with the Gaelic community and essential to several of our initiatives - Bun is Bàrr, for example, which is the transmission of Gaelic culture and language from one generation to the next. This model of intergenerational learning demonstrates innovation and strengthens communities by imparting elder-based perspectives, knowledge, and skills to the learners of the next generation.


The fosterage program is an intermediate and advanced-level Gaelic language learning program for Nova Scotians interested in participating in Gaelic language and cultural mentorship programs.


We also have Gaelic intensive immersion programs that assist in advanced Gaelic language acquisition and use. Opportunities to participate in Gaelic cultural expression and build a healthy and stronger sense of Gaelic identity.


Another exciting program, Madam Chair, is Language in Lyrics, a partnership with Cape Breton University, Beaton Institute, Highland Village Museum, and the Digital Archive of Scottish Gaelic to assist in cataloguing, digitizing, transcribing, and facilitating access to the Gaelic songs of Nova Scotia. The resulting song collection, Madam Chair, will be used to create a future dictionary of Nova Scotia Gaelic.


To help our educators, community members and Nova Scotians tell the story of Nova Scotia Gaels through their community, language, culture, and heritage. Our office is currently finalizing Gaelic Nova Scotia, a resource guide for the Department of Education and Early Childhood Development for Grades Primary to 8 and will provide access as well to other Nova Scotians. We’re also strengthening the office and looking at new ways to support Gaelic language and culture.


I want to acknowledge and thank the many volunteers, organizations, ambassadors, educators, and the elders in our Gaelic community who work tirelessly to share the story of Nova Scotia Gaels and to share their culture and heritage and Gaelic language with all Nova Scotians. We will continue to reach out to the Gaelic community to ensure their voice is heard and is reflected in government’s work as well as to help ensure our Gaelic heritage and culture is protected, celebrated, and continues to thrive. Tapadh leat.


Madam Chair, in closing, health care spending makes up 42 per cent of Nova Scotia’s provincial budget. For every $10 the province invests, about $4 is spent on health care. That’s a significant investment, but a necessary one. This year, the Health and Wellness budget will increase by more than 6.2 per cent, to a total of $4.64 billion. It is my responsibility and the responsibility of my department to make sure that we spend taxpayer money wisely in ways that will improve the health system that Nova Scotians rely on each and every day. We are focused on our priorities and on achieving positive results. There is much to be optimistic about.


I want to again take a moment to reiterate my thanks on behalf of the government and all Nova Scotians to the thousands of dedicated health care professionals across the province. These are the people who work tirelessly every day to help Nova Scotians get, and stay, healthy. They are the doctors, the nurses, clinical specialists, paramedics, pharmacists, and many other health care professionals on the front lines day in, and day out. I want them to know that they have my personal thanks and the thanks of the Government of Nova Scotia.


I want to thank all of those volunteers who belong to hospital foundations or give up their time to help their communities get excellent care. We recognize their efforts, and we appreciate them. Madam Chair, I would be remiss if I didn’t also recognize those volunteers who support and sit on our community health boards, who work to understand and provide the information that best reflects the needs in their individual communities.


With that, Madam Chair, I’ll conclude my remarks. With the assistance of Ms. Perret and Mr. Elliott, I’ll be pleased to answer questions from the members of the Legislature.


THE CHAIR: The honourable member for Pictou West.


KARLA MACFARLANE: It’s an honour to stand in my place and be able to begin the process, which I believe will be a number of days of asking questions, but I do want to thank the minister for his comments and as well for his colleagues for being here and for the work and dedication they do provide all year within the minister’s department.


I don’t plan to have a long preamble; I want to start right in with questions. I know there are a number of my colleagues over the next few days too will be planning to ask a number of questions. Before I begin with my questions, I do want to take this opportunity to extend my sincere gratitude to all allied health care professionals in our province, who are working beyond their means to try and provide a health care system that is, right now, not sustainable. They are working extremely hard in working conditions that are not acceptable. Morale is down from paramedics to nurses, to long-term care facilities, individuals that work in those facilities, I hear from them quite often.


One of my very first questions to the minister: Does he believe this government has been responsive enough to what would be the very obvious health care challenges that are facing this province and the difficulties everyday Nova Scotians are experiencing when they go to either find a doctor, when they have to go to an emergency, when they have to find a long-term care bed facility for a loved one?


RANDY DELOREY: Just a quick question on a point of order. I don’t recall from last year’s Estimates, we only do it once a year.


When responding during the committee, is the protocol still referring to the Chair or directly to the members?


THE CHAIR: Through the Chair. I will let the conversation flow though.


RANDY DELOREY: Always through the Chair. Thank you. I wanted to get that one right before I started.


To answer the question, yes, if I didn’t believe that we took those concerns seriously then I wouldn’t be doing my job. We listen - me, staff on the front line - to Nova Scotians, whether as patients who reach out and provide their experiences and as well front-line health care workers.


As I said in my opening remarks, the health care system is extremely complex. This is my third different department that I’ve been serving in, I’ve had the privilege to serve in. People often ask me about that experience and it is which ones you prefer, what the differences are, and health care is by far the most complex. The complexity is because of the many layers, almost like an onion as you peel back the layers, the complexities, the interrelationship between health care professions, different types of care. We talk in this Legislature all the time about primary care access and the member asks, are we doing enough?


We talked last year quite extensively during Estimates and through our legislative settings about primary care access. In almost every Question Period, questions from members of the Opposition usually at the start of the month would ask me about the 811 Need a Family Practise List and how there are many more Nova Scotians waiting to get access to primary care. Since we’ve started this session, I haven’t had those questions because for the last four months the investments that we’ve been making in the previous year have seen a reduction in the past four months of people registered in our Need a Family Practice List.


To answer the member’s question, yes, I believe we’ve been listening, yes, that’s what has been guiding our decisions to invest in priority areas across the province like collaborative care practises - another $10 million this year to bring the investment to $27 million over the past few years. That’s ongoing investment to continue the improved access to primary health care services. We know those investments and that improved access to primary care can reduce the pressure on our emergency departments as well.


[4:30 p.m.]


More recently, as the members would know, we’ve been working extensively with the Heath Authority and EMC, who provides our EHS ambulance services, to improve the services in the hospitals, including the transfers of ambulances from paramedics to the hospital; those ambulances can get back on the road and reduce that transfer time, so we have ambulances back in their communities, where they should be, to respond to the next emergency. These are things that we’re doing because we are listening to the front lines and we’re working with them to improve the system and we’re investing to do so as well.


KARLA MACFARLANE: The minister spoke that health care is complex, I don’t disagree with him on that. That is so, so very true, but I would have to say that’s probably why I am so grateful that we have an Auditor General in this province that pays attention to the Health and Wellness department.


Recently, in the follow-up report from the Auditor General just this week, his office indicated that the department and NSHA both agreed to tell Nova Scotians what to expect from their health care system, as well as improve communications on services that are offered at the VG site in Halifax. To date, however, neither recommendation has been completed. I’d like to know if the minister can explain why they haven’t been done and perhaps what the minister thinks people’s expectations in Nova Scotia should be.


RANDY DELOREY: The member referenced the recent update report from the Auditor General and, indeed, the member’s correct. There are still a number of items from previous reports that are outstanding. If you look at that benchmark that the Auditor General is using about targeting and expecting about 80 per cent of the recommendations to be completed within two years, I believe if you look at the three-year mark, we’re at about 80 per cent. We’re about a year behind in terms of rate of completion, generally, for Auditory General recommendations.


Again, noting that when the Auditor General makes that assessment of an average across government of meeting 80 per cent, as the member herself acknowledged, health care is complex - probably the most complex part of the government. It’d be somewhat understandable that, given the extra complexities within the health care system, achieving all of these recommendations that come from the Auditor General - they’re important so we want to take the time to make sure we get them right. When we’ve committed to an Auditor General’s recommendation, that means we take the steps and we work towards achieving the implementation.


I think if you look at that same report, it does show that at the three-year mark, we are at about the 80 per cent. The Auditor General’s general over-arching expectation of government would be that we hit 80 per cent at the two-year mark, so that would suggest we’re about a year behind on the implementation, but we do work for each and every one of them.


As far as improving communications, I can advise the member just a couple of weeks ago, as one example, steps were taken to improve communications and provide more information to Nova Scotians, specifically around long-term care which we’ve highlighted as a priority for this government - because we’ve heard from Nova Scotians about improving quality of care and transparency in that area.


We announced that we’re providing reports now online for the Protection of Persons in Care Act based on our facilities that are covered by that.


We’ve also recently moved to a digital licensing tracking system which will allow us to begin reporting and providing online information about those licensing processes and the inspections that take place. We expect that to be online by the month of May.


As well as part of our wound care policy that we rolled out, we have in that reporting requirements that allow us to, for the first time in a standardized way, begin reporting on pressure injuries or wounds as they are often referred to publicly, within our long-term care services. That’s just one example, three or four different types of new reporting information that we’re making available to Nova Scotians, that at no other time had been available in this province.


KARLA MACFARLANE: I find it difficult not to be looking at each other. I think it’s innate with all of us that we just want to look at each other but I’m continuing to do my best.


THE CHAIR: That’s perfectly fine.


KARLA MACFARLANE: Okay, thank you. As the minister indicated and admitted, they are one year behind so I would like the minister to acknowledge what he would project would be reasonable timelines to catch up. As well, perhaps, I think there is a huge communication problem.


I wonder if the minister could elaborate whether or not he thinks the department and the NSHA have problems communicating with Nova Scotians and getting their mandate out to them and having them understand more about education awareness of the different projects that are being undertaken by the department.


RANDY DELOREY: Again as I mentioned, the report that came in last year, I believe, that highlighted from the Auditor General the need to do better, to communicate better and get more information out to Nova Scotians - I think I mentioned just a few items specific to continuing care. The member, Madam Chair, has delved in more broadly into the acute or primary care system.


I think some improvements we’ve made since then - the member may note just last week or the week before that the Health Authority was up in Cape Breton. This is their second open community meeting to listen to people directly, with the chair and board members having a meeting in the community to hear from stakeholders and community members about their concerns. They spoke to the media and so on as well, to talk about what they’ve heard to provide that information. That’s information they’re hearing directly at the board level and share that with their staff.


Our redevelopment projects and the engagement that is taking place there - these are some of the most extensive changes that we are making in our health care system, literally within generations, and we have websites to provide updates and information there when we reach significant milestones.


I personally have been here in Halifax along with the Premier and to Cape Breton as well - myself and my colleagues from Glace Bay and Sydney there - to bring the information directly to the communities as to what milestone we’ve achieved to deliver.


Again, we’re working to collect more information, be more transparent and accessible, receive information from communities, leverage technology and the media to distribute information out to Nova Scotians, as well as the many meetings we have with other health care stakeholders to get information to them - whether they be unions representatives or medical associations.


In the Fall, I went to all four hospitals in the CBRM area and had open meetings with the physicians there, to hear from them but also to provide information to them as well. Again, we’re working hard to get information out to Nova Scotians in the health care system and more broadly.


KARLA MACFARLANE: During last year’s Estimates, my colleague from Cumberland North raised the issue of federal tax changes that would directly impact doctors practicing in our province. After this year’s budget was tabled, Doctors Nova Scotia observed that New Brunswick has taken the step to ease some of the tax burden for doctors and make the province more competitive to other provinces across Canada, with regard to physician recruitment. They were encouraging us to look at that and see the steps they took, but we are a little dismayed to see that we are not following suit here in Nova Scotia.


Why is the department only marginally increasing funding for recruitment efforts, particularly when we look across this whole province and especially when we look at Cape Breton? We say that there are X number of doctors who were recruited, but we know there was probably double that who left, if not more. If the minister could address that concern?


RANDY DELOREY: I thank the member for the question. Indeed, there were some changes made federally and there were a lot of discussions last year about what that would entail.


What we know is that here in the province, one of the things we did around that time last year was increase the office rate for physicians providing primary care. We increased it to about $36 for an office visit. Just last week I read an article - I think it was in the CBC news online - where British Columbia recently completed some negotiations on their master agreement with physicians. In that article, it made reference that B.C. office visits are $30 per visit versus Nova Scotia’s $36 per visit.


As I recall, there were many concerns being raised before about the rate of compensation in Nova Scotia, so that is just one example where we’ve provided opportunities within the last year. Those are ongoing commitments and investments in our physicians. More broadly than that, as the member may be aware, we are currently at negotiations with Doctors Nova Scotia to address the areas of compensation for physicians in the province.


I don’t think the floor of the Legislature is the place where I should delve into the details of those discussions while they are ongoing. When negotiations are complete, the agreement will obviously be public, but until then I will not be delving into details there.


I use the example that we have increased compensation for physicians over the last year. That continues into the current fiscal year and is part of the increased costs of the delivery of health care, because we are paying more for physicians as they meet patients in Nova Scotia providing those primary care services.


KARLA MACFARLANE: I thank the minister for his answers. One of the concerns we have from what we are hearing from doctors is the pay model that’s used here in Nova Scotia. I know that New Brunswick and P.E.I. are doing much better at recruiting doctors right now.


[4:45 p.m.]


I am wondering two things: Has the minister ever collaborated with these two provinces on perhaps collectively coming together for recruitment and retainment efforts, and perhaps he can answer if he is considering looking at a different pay model that would be more encouraging for doctors to come to this province?


RANDY DELOREY: As I mentioned in my previous question, we are getting a little bit close there when we talk about the payment models. This would be the type of thing that we’d be discussing at the table with Doctors Nova Scotia as part of the negotiation for the updated master agreement, which is the agreement that covers the overarching compensation framework and rates for physicians in the province.


I guess what I can say is through the negotiation process, we do receive proposals that would come forward from physicians, through their bargaining agent, Doctors Nova Scotia. We certainly are aware of discussions.


I made reference to the article that I read coming out of British Columbia. The essence behind that article was actually a physician in British Columbia making reference that they did not believe that the results of the updated agreement in that province went far enough to enhance or modernize the compensation framework.


To that end, perhaps I’ll just articulate for members of the Legislature who may not know the different overarching payment structures. I can talk perhaps a little more generally so people can understand, rather than the specifics of what is taking place within our negotiations.


Actually, it’s interesting with the Nova Scotian connection here just with Allan J. and the introduction of Medicare. When he passed last year, someone tweeted a link to the Hansard of his debate and remarks when he was introducing the legislation. I found it quite interesting on two fronts: one is that it was historical information that allowed me to understand what was happening in health care systems across the province and expectations and that there were concerns being raised, and the compensation model and framework was part of that.


What was abundantly clear back then in the late 60s was that physicians wanted to continue to be compensated as they had been - as independent businesses. That’s why our health care system, and broadly across the country, has what is referred to as a fee-for-service payment model. Our physicians who provide a service then get paid a fee for that service. The master agreement that I referenced negotiates what fees are associated with what services that are being provided.


Historically from pre-Medicare days, when physicians and health care was a private service, they would set a fee for the service they provided to the public like other businesses. When the public health care system came in, really what changed was government was then going to pay on behalf of citizens. The government would negotiate what those fee rates would be, so it’d be standardized, at least within each of the provinces, the provincial jurisdictions which govern health care per our constitution.


That, by and large, stayed the same for decades. But, in the last 10 or 15 years, there has been an evolution, and a shift to and an interest in, a different form of payment. As I said, fee for service would be almost like commission-based. The more work you do, the more compensation you take in because you get paid per patient visit or per patient service.


With the change, people then moved to more of a salary-based approach. Some physicians have started to say we prefer to have a set salary, so we know how much revenue or income we’re going to have for the year and then government can set how much work they expect us to do for that salary. In Nova Scotia we call that an alternative payment plan, or APP.


We now have a situation in Nova Scotia where we have about 1200-1400 family physicians, and I believe somewhere in the vicinity of 200 of those physicians that are on alternative payment plans. I’d have to look up to get the exact number, if you want, I could do that, but I believe it’s approximately 230 physicians working on alternative payment plans out of the 1200-1400 family physicians that we have in the province.


More recently, since I’ve become Minister of Health and Wellness, some of the physicians that I’ve spoken to - even before negotiations began, and these are not necessarily physicians who are directly involved with Doctors Nova Scotia - have started talking about a third payment model called a blended capitation model. That’s sort of a hybrid model whereby there is a base set fee that physicians would be paid with the added incentive opportunity to continue to earn compensation above that through more of a traditional fee-for-service model.


So, again, we talked earlier in the first couple of questions about the complexity of health care. Here we are just talking about one health care group of professionals and how they get compensated, and yet there are three and in fact a fourth model of compensation that takes place which is the Academic Funding Plan, or AFP, which takes into account those physicians who also provide education and research within our health care system. There’s a third model of compensation that comes into plan, so three active ones right now and certainly some doctors out there interested in a new model to come in which would bring four.


That’s just the complexity within one profession in multiple models and what makes it even more complex is that I can find doctors who would advocate for all of those models, and for those who advocate for one particular model, I can find you another doctor who’s going to criticize that same model. That is one of the things that makes managing and administering the health care system so complex. It is one of the things that makes, with all due respect, the role of the Opposition so easy to find someone willing to criticize the decisions and the directions that we make as government, because you can always find someone within the system who is not going to like the decision or the direction that we take because there are so many different models, so many different perspectives.


They are all legitimate concerns and perspectives, but our role as government is to then solicit all of the information we have and attempt to make best decisions for the current and future state of our health care system and that’s what we’re doing.


We have been investing heavily in collaborative care practices. Again, I’ve met physicians on the front line who have told me they don’t like that model. When CBC around January or February of last year hosted three panels - one in Sydney, one in Halifax, and one down in the Yarmouth area - the first session had three panelists, two physicians and a former health care administrator on that panel.


Interestingly, when the two physicians did their opening remarks, one started speaking and they indicated they were a traditional fee-for-service physician and essentially not a fan of the APP funding model in collaborative practices. Then it moved to the second physician who said, well, I actually work in a collaborative practice on an APP program and I believe this is the right model for the improvement and the delivery of health care services. So even at that one public session, it just illustrated how there are different views out there.


We have to work to understand those perspectives. That’s what we are doing. When we were in Halifax and I was sitting on the panel and one of the physician panelist members articulated how one of the concerns was their voice is not being heard, and at that time, and I reiterate this now to the members in the Legislature here is that I do listen. Unfortunately, when we make decisions, if the decision doesn’t align with the perspective that’s been brought forward by an individual or a certain group of individuals, the assumption is that I didn’t listen, hear or understand the perspective they brought to bear.


I assure you I have listened, I have considered, I have contemplated. It doesn’t mean that I always agree and again, if I had agreed there, then there is another cohort of people within that same health care system who have been advocating for something else and they would have been the ones out there saying that I wasn’t listening to them. When you’re hearing different perspectives someone is not going to be happy with the decision you make, and that’s the complexity that we have.


I know the question - just to reiterate and conclude here - was about the compensation models. I use that information just to illustrate to the members here how complex it is, the different models that are out there, four different payments, three that are in play right now in Nova Scotia, fee for service, traditional, most physicians get paid; alternative payment plan, it is the new evolving model that’s been around for 10 or 15 years; and AFP which is for the academic funding plan for those who are teaching in the medical school and researching; and, then, what we’re hearing about now more recently, although not in play, is the blended capitation approach.


It’s very complex. We are at the negotiating table and as Doctors Nova Scotia - the bargaining agent for physicians - brings their proposals to the table, we, as negotiators would do, would receive, consider and make decisions we believe are in the best interests of meeting the needs of the agreement.


KARLA MACFARLANE: I want to thank the minister for that answer; it was very detailed. I promise that my question will not be 10 minutes, but I do appreciate that because it was explained.


Following up with what I know the minister will be familiar with, probably about a year ago when we had discussions, out of those different models I can see that the minister is accommodating many different opinions on how doctors feel they should be paid.


I want to go back to the walk-in clinic in New Glasgow, where we have two wonderful doctors: Dr. Elliott and Dr. Park, who are doctors with their own private clinic. They would be on a fee-for-service payment throughout the day. In the evening, they open up their walk-in clinic and provide a service to people like me who don’t have a doctor.


Now there are people who go to that walk-in clinic who do have a doctor but, because the line-up is so colossal over at the emergency department, they find themselves going to the walk-in clinic. Sometimes Dr. Park and Dr. Elliott can see anywhere between 50 and 75 people in an evening. But they are not getting the same fee for service as they would in the daytime; if I went to them in the daytime for the same issue, they would be paid more than what they would be in the evening - for the same issue.


It’s frustrating to see that doctors are not being compensated for the same service that they might have provided earlier in the day; particularly in a case in Pictou County where we have thousands of people without doctors. I know the minister is familiar. I want to ask the minister: Does he believe that is a fair system?


RANDY DELOREY: Again, I’ll be a little bit sensitive to delve into the specifics of the individuals, so I’ll talk a little more generally to respect the situation. To the extent that the member indicates, I am aware - I even met with those physicians as well, just to give you the indication of how aware personally I am and how serious I took the concerns that were being raised by these physicians.


As the member would know, this change in compensation took place around this time last year. This was part of our nearly $40 million investment that we made to change the way that family physicians are compensated. It was outside of the master agreement. As I said, we’re currently in the negotiation of the master agreement so the master agreement had already established what the compensation would be for family physicians and office visits through that structure.


Yet, we understood the number one priority coming in - and my mandate as minister when I was appointed in June 2017 was very clear - primary care is one of the three main priorities to improve in my tenure and time.


What I was hearing was there were challenges around compensation. One of the first questions raised by the member this evening was the notion of taxation, essentially part of compensation for physicians. Within that information and understanding better how things were working, we did engage with Doctors Nova Scotia to open up the master agreement, the fee schedule outside of the negotiations.


We had no legal obligation to do so, but we were responding to what we heard from physicians who said that it will serve us well if you compensate us more than what we negotiated in the 2015 master agreement. We said okay, what does that look like? Doctors Nova Scotia came to us with a proposal.


The proposal said if you want to improve the health outcomes, if you want to reduce the pressures in emergency departments and you want to attach more patients to primary care providers, you need to compensate us more for those visits.


[5:00 p.m.]


As I had indicated earlier, that increased the compensation for comprehensive primary care services where you have an attachment, because we know that having an attachment to a patient does provide a better relationship for the physician and the care being provided to the patient.


It was Doctors Nova Scotia representing physicians throughout the province that indicated, if you want to achieve those better results you need to differentiate the fee structure for walk-in services and the comprehensive office visits. So, the decision to apply the increase only to comprehensive office visits and not to walk-in clinic services was actually part of a proposal that was brought to us by Doctors Nova Scotia, who represent and are the bargaining agent on behalf of physicians across the province.


Again, this goes back to my earlier response to the member which highlights exactly how complex the system is. There are always differing views and perspectives out there within the system, and any time we make decisions, those decisions that are made.


To delve in a little bit into the rationale that went behind the proposal, when you look at the nature of the office visit, many times the office visits in the walk-in clinic are - I’m going to this simplified term that some people may get upset - transactional in nature. They’re much quicker, often, to move through. A physician who receives the base rate - I think it was $32 or $33 per visit - at a walk-in clinic, which is what was negotiated in the 2015 master agreement, would continue to get that. Nothing was taken away from them. They would continue to get that fee.


What we did is increase the fee paid for those providing the relationship and attaching a patient to a practice. That’s the difference when you go into your physician and you have the office visit. You can see this in the data, that an office visit in one of those practices where we have an attachment - I would have to look this up, but I believe the data that I saw is something like a 15- to 20-minute average office visit, whereas it’s about five to seven minutes in a walk-in clinic.


You’re actually seeing two to three times more patients in a walk-in clinic because they’re less complex than the time you spend when you have that comprehensive relationship in your office. If you do the math on that, if you are averaging five to seven minutes per visit in walk-in clinics across the province at $32 or $33 per visit, how many visits can you process, versus the comprehensive relationship at $36 per visit that take between 15 and 20 minutes?


I hope that clarifies why there is a discrepancy there. Again, in summary, it was the proposal that was brought to us from Doctors Nova Scotia representing physicians.


KARLA MACFARLANE: I thank the minister for those answers. I just find it really discouraging that these doctors have worked in our community for decades and are really due to retire, who want to retire, but know and feel that they can’t because of the lack of doctors in our community.


I just really want to take this opportunity to give them a shout-out because they have saved - a lot of calls that have come into my office - people who have chronic diseases, people who have a couple of weeks or months left, dying with cancer. If it wasn’t for Dr. Park or if it wasn’t for Dr. Elliott to take them on, they would have no one. I just feel that it’s a bit of a slap in the face for them when they sincerely are just trying to fill that gap, fill that void that we as citizens in Pictou County right now are experiencing.


I don’t see any improvement being made in Pictou County. I’m told that perhaps the Town of Pictou is receiving a physician this July. Currently, right now in the Town of Pictou, Pictou West, really, we have really one and a half doctors. Now we’re told that we’re getting one in July. I’m just wondering if the minister can quickly confirm that before I move on to my next questions.


RANDY DELOREY: For Pictou West I believe there is one, but I’d have to double check that with the NSHA to confirm this data. What I have for information is that since April 2018 there have been in the Pictou broader area two family physicians recruited: One in Pictou West, but what I am not sure of is if that is the one who has started or if it’s the July start date; and one in the New Glasgow area, as well as four specialists that would be working out of Aberdeen Hospital just since last year.


In addition to that, we have also hired seven new nurses to work in the area. Three nurse practitioners in the New Glasgow-Westville-Stellarton area and two family-practice nurses in that area. In the member’s community in Pictou West, there are two nurse practitioners who have been hired there to help with the delivery of primary health care services.


There are four collaborative practice teams in the Pictou area: two in the New Glasgow area, one in Westville, and one in Pictou. I believe, based upon our 811 need of family practice list, that in the last two years more than 2,600 people in the Pictou County region have been identified to have found a primary-care provider, again in the past two year or so.


Again, I hope that was helpful information for the member.


KARLA MACFARLANE: I am going to move on, but I would like to have confirmation if Pictou West at the Pictou Clinic is getting a doctor this July. I don’t know if it’s rumour and I can’t seem to get confirmation from NSHA, so I would like if the minister could get back to me within the next week and let me know if that is true, that we will be seeing a new doctor for July.


Looking back on the 2018-19 priorities for the Department of Health and Wellness, I see they are basically the same, if not identical, to the 2019-20 priorities. I would say that most people in my constituency, and I know others across this province, would question how much progress has actually been made on those priorities over the last year. For me personally, and I think a lot of my colleagues feel the same, I believe that week by week we are seeing things getting worse in some areas.


I am wondering how the minister accounts for the decline really in primary care delivery, for example - even when his government claims it’s a priority to fix, but we keep seeing this primary care declining.


RANDY DELOREY: I will certainly endeavour to answer the member’s previous question to just verify the recruitment or start status for the physician in her community and we can probably do that off-line. You won’t have to bring the same question back.


On the question around our priorities - indeed, priorities for government, really - which then become mandates for ministers and then into departmental priorities - have been very clear. The priorities in our 2017 campaign as a government for health care were focused on three major areas: primary health care; mental health and wellness; and continuing care.


It wouldn’t be surprising that these are very important areas for all Nova Scotians. It’s what we have heard from all Nova Scotians as citizens and I believe Nova Scotians as health care providers would agree these are very important areas for us to focus on as a government to make the necessary investments and, in some cases, changes that will see the structural changes, if necessary, to improve the system and the delivery in these areas.


While the priorities remain somewhat consistent, I think that’s because Nova Scotians still expect us to continue to make improvements. Of all fields or industries, health care is one that historically is built upon a model of continuous improvement. That is to say that primary care will always be an important priority area to see improvements within our health care system. That’s how we get better in the health care field with investments and research that identifies conditions earlier. That provides new advanced treatments to have better health outcomes because we’re continuously looking for opportunities to improve. Any government that doesn’t continue to have a priority area there, even though they’re making positive steps and progress - I think the citizens and the health care providers will continue to want governments to continue to challenge themselves to do more, to do better.


To the member’s question of, do we think we we’ve made progress or accomplishments in those priorities - I would say yes, we’ve made progress. Have we accomplished the full objectives in the priorities? No. If we had, if we were finished, they would not carry forward to be a priority into this fiscal year. Just for example in the primary-care space, some of those accomplishments that we’ve seen through a number of initiatives, like our international recruitment program with immigration stream brought in 25 physicians and it’s only about a year old. Our recruitment almost evenly split between family physicians and specialists, upwards of 120. Working in that was looking at our incentive programs and rearranging and listening to people about how do we make these work better. The programs exist: tuition relief, relocation funds, start-up and debt relief programs, supports for residents. These are all initiatives we have in play to help support physicians to relocate or move and establish their practice here.


As I said in my opening remarks, we also recognize that other health care providers play an important role in the delivery of health care and primary health care - in particular, nurse practitioners and the role that they play in the collaborative practice space. Knowing that, if you’re going to be expanding the opportunities for nurse practitioners to practise in the province, you probably want to also expand the training opportunities so that you have more nurse practitioners to fill those positions. We’ve added 25 seats through the Dalhousie School of Nursing that allows registered nurses, RNs, to go and upgrade their skills to become nurse practitioners, so we have more nurse practitioners available in the province.


The member inquiring about improvements to the residency program. We know the 10 additional family physician residents that will be coming online in July. The matching process is underway, but the residents will be in communities on July 1 starting their residencies. Six of the 10 have been dedicated for the Northern Zone from Amherst in Cumberland County down through Truro and Pictou areas. This is the first time we’ll have family practice residency programs being delivered out of those communities.


I would encourage the member to perhaps have a conversation with the member from Yarmouth or the member from Clare-Digby about the family physicians in that Western area and the southwestern Nova Scotia area and the impact it had on the recruitment.


When I went down there, and I met with the residents in Yarmouth and had the conversation - I believe it was a two-year program, so five residents in each of the two years, I think about eight of them were at the meeting either in person or via phone. When I asked, how many are you are from Nova Scotia and I think there was only one or two out of the eight or nine that were participating; this is first and second year. I then asked how many of you are interested in staying in Nova Scotia? Only one or two had indicated there were opportunities they were pursuing elsewhere. The majority were interested in staying in Nova Scotia.


What was more interesting to me was that a few months later, I read a report from Maritimes Resident Doctors, which is the residency association, which indicated somewhere between 75 and 80 per cent of residents stay where they complete their residency and that data that they reported is roughly was consistent with that informal poll of residents out of the Yarmouth program.


[5:15 p.m.]


To the members in the Legislature that represent communities in the Northern Zone, Cumberland, Colchester, and Pictou Counties, I think they should be very excited about what the future holds having 60 per cent of our new family residents being delivered in their communities. They should see recruitment and retention improve, not to mention the fact that having these residents, they’re providing care while they’re there doing their residencies. It’s care that’s being supervised by other physicians as well, but those young residents in a couple years’ time have a high probability of staying in those communities as well.


KARLA MACFARLANE: I thank the minister for those answers. It’s a good segue into my next question because I see in the budget that we’re putting $200,000 aside to support doctor recruitment in communities as part of the cultural innovation fund. Pictou County has already taken a step forward in the right direction to form a committee. A number of individuals in the Pictou County area came together, and over a year, we finally were able to develop a model where we would hire a health care navigator and with financial contribution from the county, as well as all the towns.


So far, the rollout has been very positive and the individual, Nicole LeBlanc, who’s taken on that role is an incredible person and I know that we’re already seeing positive effects from this. But when the budget came out, I was able to message Nicole right away and tell her about the $200,000 funds there, that we need to tap into that right away. A few calls were made, but we haven’t had anyone return our calls. I’m hoping that the minister can elaborate and expand, so I can have a finite answer as in who does she need to speak to in order to apply for some of that funding.


RANDY DELOREY: I’m so pleased to hear the excitement the member opposite has for this new program. Our work to distribute and establish the applications and the process for distribution of those funds will begin as soon as we get through the budget process. Right now, the budget is what we’ve introduced to the Legislature here. This is our plan of how to spend the money, so we look forward to getting through this process. We’ll have a vote on the budget and we’ll be able to work to distribute those funds, so I don’t have the definitive answer the member is looking for. What I can say is we’ve identified the funds and the reason we identified the funds is because we heard from these communities.


I’ll just backtrack a little bit - the member for Cumberland North might be interested in this response, too. From the day I was appointed, the member for Clare-Digby spoke so highly about the work that was being done in his community, in the Digby-Clare region, where that model of municipal leadership and community leadership came together to help with the recruitment in what historically has been a difficult area to recruit people to.


To be perfectly honest, and I know the member from Clare-Digby will agree with me - I don’t understand as it is an absolutely beautiful part of the province. The lobsters are almost as good as those coming off the Northumberland Strait. (Laughter) Everyone in a fishing community, they all have the best, but I know the member from Pictou West agrees with me that the Northumberland Strait lobsters are the best in the province. (Interruption) Yeah, I know. Anyway, the member for Clare-Digby has spoken so positively when I was down in that region. I’ve met with the group and they’ve talked about how effective it’s been.


A few months after I was appointed, probably within six months, I received an invitation from municipal representatives representing the Cumberland municipalities and I was up there and met with them. It was a crazy, rainy day - I remember I got soaked just walking in the building - but it was a great conversation. They were talking about, what can we do, we want to help. I talked to them about it and recognized and they recognized the role and the responsibility for investment in health care as the province is, but I said, you know what, look at what they’re doing down in Clare-Digby - the municipality taking a leadership role to help when the recruiters come in.


The Nova Scotia Health Authority has been responsive when these groups have come together with leaderships in the health care system and the local recruitment teams to come to them to talk about the opportunities to connect and work with the local communities. Lo and behold, the municipalities in the Cumberland area, Amherst and Cumberland, did establish one as well. A few months later, Pictou came together and established one. Lunenburg has one. Antigonish is doing some work in that space now and I’m sure that there are other communities that I haven’t even heard from.


Fast forward, and - I know that the Nova Scotia Federation of Municipalities actually has this on the radar, Madam Chair. I know this because I met with the president of the federation and it was one of their priority areas, talking about what and how municipalities and communities can work with. But they also raised one of their concerns and the concern was that the province was somehow expecting municipalities to pay for recruitment and I didn’t want that expectation to be out there. That is not what my expectation was of communities. When I talk about the role that they play, I would say it’s through their time.


As I said in my opening remarks, it’s the community members who know and can introduce people to the community in a way no one else can. They know why the lobsters on the Northumberland Strait are the best lobsters. (Interruption) Oh, the member for Argyle-Barrington must have heard, he’s coming in for a point of order. Yeah, he knows, too. He came in to second that. But it is the members of the communities that know their communities best, and so it is these groups - organized and led by community members or municipalities in many instances.


That’s what this fund is for. I want to get out and connect with those groups that are there and talk to them about how we think that the money can be best established . . .


THE CHAIR: One minute.


RANDY DELOREY: . . . and spent.


THE CHAIR: Oh, I had 24 okay, okay.


The honourable member for Pictou West.


KARLA MACFARLANE: Thank you, Madam Chair, and I’ll just confirm I have until 5:32.


THE CHAIR: One minute and 30 seconds.


KARLA MACFARLANE: Okay, thank you very much.


I recognized with the minister’s remarks that this is a good investment of $200,000, but we’re definitely going to probably need more as we move forward and other communities come on board. I’m sure this number was projected with the thought of those communities that have already established these organizations to help with recruiting and retaining.


We’ve made it clear with our organization that the individual navigator, it’s not her responsibility to have to recruit. It’s a provincial responsibility and the NSHA should be helping out a lot more and that’s the bottom line. They really need to be helping more.


What has happened, and it is a positive move because I do think we all have a responsibility in our communities to give back and do what’s best - I think Nova Scotians feel that, okay, now our municipal tax dollars are going to fund these organizations. And yet, it’s because of the lack of the job that’s supposed to be done by NSHA is not being done. So there’s a lot of pressure - okay, we’ve got to pick up the pieces here and help out, which I think as Nova Scotians because we are great people . . .


THE CHAIR: Order. Time has elapsed. We’ll move on to the New Democratic Party.


The honourable member for Cape Breton Centre.


TAMMY MARTIN: Thank you for the opportunity and to allow us to ask some questions about such an important topic. As everyone is aware, health seems to be the hot topic in Nova Scotia and for a very good reason because there are so many concerns all across the province, from Yarmouth to Glace Bay.


Again, I’d like to thank the minister and his staff - the much-missed Mary, equally replaced by Tracy, who has now been replaced by Michael. We’ve always had great success with all of your staff and we truly appreciate everything that they do for us. When we call, they respond, and we really appreciate that. Although what goes on in this House may not reflect that, we truly appreciate that when somebody’s in crisis, so I’d like to start off by saying thank you, especially to your staff.


We’re talking about doctor shortages and how we fare across the country. On the basis of salaries alone, and I know individual salaries are confidential, but I’m wondering how we compare across the province. A recent study by CIHI compared compensation, but Nova Scotia couldn’t take part because we didn’t have the proper data to send them; we have no idea where we sit in that comparison.


So, first of all, I’m wondering: Why don’t we have the right information that we can provide to CIHI, and where do we compare? Newfoundland is at about 275, PEI is 297, and New Brunswick is at about 336 and I will table that document. If we could have some information on how we compare to the other provinces.


RANDY DELOREY: My colleagues wonder why I don’t mind estimates even though I’m here for the next couple of days. People wonder, when I have to spend so much time on my feet, why it’s not something that stresses me out. I think it’s the nature of the discourse and the dialogue as the member from Cape Breton Centre mentioned. This is a great opportunity during Estimates to have more of a conversational interaction.


I do want to, on behalf of my team, both the beloved and missed Mary - who did find new opportunities and I certainly wish her continued success - and also Tracy and Michael who happen to be in the gallery. I just want to let the member know for the record, and I apologize for taking the time to do this, but Michael joined the team in the Fall and his number one stressor coming into Estimates was wondering whether or not anyone was going to acknowledge him because of Mary’s attention that she got last year. I thank the member for doing that - I think you just made his month. (Applause)


To that end, it’s not just our executive assistants, although they play an important liaison role. We have the entire team of people in the department and the Health Authority that come together, as the member mentioned when people are in crisis, to respond. I think this is an important message for the people of Nova Scotia to understand how the members of the Legislature and Executive Council work with their departments.


[5:30 p.m.]


Some people think that politics and politicians and government, if you are of a particular political stripe, when the government of that stripe is in office, you will get service, and if you’re not, you’re out of luck until your turn comes around in government. I think what the member had just indicated, she realizes that in fact that’s not the case.


When a Nova Scotian is in need, they reach out to their local MLA regardless of the political affiliation. They reach into the department, ideally through the minister’s office, to make contact and help navigate. We understand what a Nova Scotian needs, especially in the health care system, we really do. A Nova Scotian is a Nova Scotian and all political Parties, whomever has the privilege to stand in my place, will do their best and I have the utmost confidence that any member in this Legislature, their team would do the same. I do thank the member for that and I want, on the record, thank all the staff throughout the health care system and partners who help us help those Nova Scotians who need it.


To the member’s question, though, about the CIHI report - I’m familiar with the report, it just came out about a month or so ago. I believe in the discussion with the member from Pictou West, one of the questions that I spoke at length about was about compensation, so I won’t go into it again. I spoke about how complex the complication is about the different forms of compensation and if I recall that CIHI report and the section that we didn’t have the data to provide, I believe it was specifically about the AFP or the Academic Funding Plan physicians.


It’s not all the data around compensation; it’s specifically to those that are the academic funding model. That is a more complex funding model. As we were preparing the data to submit, we take our responsibility to ensure accuracy of data. As the deadline was approaching, we weren’t confident in the accuracy of the data that we had, so we were doing more work around that.


We’re quite confident we will have the data submitted in the next CIHI round, which I think is in the fall, September or October, we would expect. We expect to have our data in place for that time. It just happened that we discovered some data quality concerns and we’d rather have accurate data than having inaccurate data submitted to such an important comparator. That’s all that happened there.


TAMMY MARTIN: Would the minister be able to provide those comparators without the AFPs?


RANDY DELOREY: Two things, I believe, and I’d have to double check the report, which the member obviously has the report I think would be able to do it as well. But I believe the comparators for all the other ones should already be in the report, except for the AFP category. As I noted, we’ll be submitting the data for that in the September round of the report.


The other thing I want to note for the benefit of the members is that the CIHI data, it does have lag time. It’s usually about two years’ old. I just want to draw people’s attention when making references or drawing conclusions as to the state of the data. It’s about trending and work, but it doesn’t necessarily reflect the current state.


For example, even in September when all the data’s out there, the data doesn’t reflect the increased investment we made for our family physicians and providing comprehensive primary care, which was a significant investment we made just last year. Almost $40 million to provide additional compensation opportunities through the comprehensive family practice base office visit rates, as well as other incentives for either technology or taking unattached patients into their practices.


I just wanted to highlight that, as people look to the CIHI data. It’s important data. It provides an important role, but there is approximate two-year lag time in that data so it’s not necessarily comparator to the present situation.


TAMMY MARTIN: One of the recruitment techniques, I believe, is that Nova Scotia is a wonderful place to work and it’s beautiful, especially in Cape Breton. However, I do hear from so many doctors that the work-life balance is terrible. There is no work-life balance - they’re on call 24-7. There may be only two doctors in that specialty, they may have 4,000 patients that they have to attend to, plus their emergency hours and their hospitalist shifts.


On the basis of salary alone, do you think that we can compare, that we even compare to other provinces in Canada when in 2017, as you said, the reports lag - the average was $321,000-ish for an FTE for a doctor? Aside from our beautiful landscape, are we comparing at all in salaries.


RANDY DELOREY: In terms of the compensation, again as just one example that I gave as a reference, our updated compensation for comprehensive family practice care that we increased the rate to $36.00 per visit, around this time last year, and then I referenced that news article. Unfortunately, I don’t have it with me to table but I’ll endeavour to download it.


I wasn’t planning to speak to it today, but I believe it referenced a $30 office-visit rate in the most recent British Columbia master agreement. So when you ask how we compare, we pay $36 to a physician if you go in to visit them today and if you go visit that position in BC, they get paid $30 for that office visit based upon that information. So I think we compare fairly well on that example.


The member made reference and used the terminology “salary” - I want to encourage the members to just be careful with the utilization or the expectation. We can talk compensation but as in my conversation - and I won’t again reiterate it all here unless people would like to hear it again - with the member from Pictou West when she asked the question around compensation, I outlined the differences.


So again, most physicians in the province that provide, particularly in the family physicians, are compensated through what is known as fee-for-service. So, they get paid per service they provide. So, the more services they provide, they get paid at a particular rate. So, a physician who sees 30 patients in a day on fee-for-service would get paid 30 times $36.00. A physician who sees ten patients would receive ten times that amount. So, their compensation would be very different depending on how many patients they see in a day because that’s how they would bill.


There is the other category that I mentioned but far fewer physicians, only about 10-15 per cent I think of our physicians, are on the alternative payment plan which would have a set base salary compensation with a certain number of visits they’re expected to see within a day. That’s where you talk about, you know, the rounds at the hospital or other services they’re expected to provide to the community.


So again, it gets very complicated to even do comparisons but with the data and the recent investments we’ve made, we’re quite comfortable to say that certainly on an Atlantic Canadian perspective we are compensating and competitive for the investments and the opportunities for physicians to earn the compensation for equivalent amount of work.


In Nova Scotia as they would in our sister Atlantic Provinces, as I’ve mentioned earlier, we are at the negotiating table on the master agreement. That’s obviously one of the key questions to be raised and delved into with the parties at the table, as to what that compensation framework and rates would be going forward.


We’re certainly committed to working, as I think our investments last year show, ensuring that we do have a competitive compensation framework. At the same time, we’re focused on ensuring that those investments go towards comprehensive care for our citizens because, for us as the government paying for the public health care system, our primary concern is the outcomes of the health care, and that’s what we’re paying for.


The primary concern of Doctors Nova Scotia is that physicians get compensated for the work of their members. That’s what we’re negotiating at the table, to find out what is the right amount of compensation for the health outcomes that the people of Nova Scotia require. We’re at that table working through that right now.


TAMMY MARTIN: With all due respect to the minister, I understand that B.C. is at the lowest part of the pack in compensation comparators. But based on the most recent update of the Physician Resource Plan, I understand that we’ll need 997 doctors to replace retiring doctors by 2022, and 182 to meet the increased demand by population factors. I would ask the minister if he could correct whether those are the current numbers as the minister knows them.


From those numbers, we understand that 506 need family doctors, 459 to replace those retiring, and 132 to meet the demand. Based on physician recruitment through the NSHA, I understand that 138 have been recruited. Are we on track to replace the physicians who are leaving through recruitment and retention over the course of the next couple of years?


RANDY DELOREY: Again, it’s a difficult conversation to delve into in a short period of time because, as I said in my opening remarks and in one of the earlier responses, I highlighted the complexity of the health care system. One of the reasons we have different compensation models is because we have different types of physicians and practices.


The question that came forward is a general question about the entire system. The reality is there are certain areas like specialties such as psychiatry, for example, for which there are challenges across the country in recruiting. Supply and demand are different or more challenging for some specialties. So when you’re asking whether we’re on course to meet our numbers, if you’re just talking numbers, we could recruit a whole bunch of doctors in specialties we don’t necessarily have a demand for and because there are more of them available, we could get a lot to just meet the global number.


What’s critically important to us, as I said in my previous response, is that our priority as government - and our health authorities through their mandate - is to ensure we have the right complements because we’re concerned about the health outcomes and the care that’s being delivered. So, we want to make sure we have the right complements of health care providers in the right communities.


So, if you’re just talking global numbers, let’s look at it this way. The data shows that per capita, Nova Scotia has the most physicians per capita in the country. That’s pretty significant when it comes to primary care and attachment to primary-care providers. Nova Scotia has the fourth best attachment rate, according to Stats Canada, in the country, so we’re talking globally.


I say that, and I know the member can get up here and give me lists of her constituents who don’t have a family doctor, and other members can do that as well. That’s right. But again, if we’re talking globally and these global numbers, Nova Scotia is punching pretty well for its size. Again, we do this per capita analysis, but that doesn’t mean there are not certain communities that are facing more challenges, either with family physicians or certain specialties, than others.


I’m happy to advise the member that based upon our 811 Need a Family Practice Registry, the Eastern Zone - which Cape Breton is part of - actually has the lowest percentage of the population unattached that are looking for family physicians. They are at, I think, about three per cent while the provincial average is about five per cent of the population. So for being attached to a family physician, the Eastern Zone is doing well. Again, as I said in my opening remarks, it doesn’t mean we don’t have more to do. It means we’re making progress. We’re making changes. We’re trying to improve the situation. That’s what we’re doing.


[5:45 p.m.]


Our goal for the investments, as the member mentioned, somewhere between 120-130 physicians who have been recruited since April of last year, roughly split between family physicians - I think about 55 or 60 family physicians - and slightly more specialists who have been recruited to the province since April of last year. Very, very excited that 25 of the physicians recruited came through the immigration stream, which is a brand-new stream that was just designed and implemented last year, about a year ago. That’s the first year. People didn’t know about it.


I’m very pleased with my colleague the Minister of Immigration, and I know she’s very pleased. They work in partnership with us, the Nova Scotia Health Authority, and the College of Physicians and Surgeons to go to the U.K. and regions who can be licensed in Nova Scotia, to let them know, hey, we have a program that you can get your citizenship and residency faster. That’s had a positive impact as well.


There are a number of variables that we work on for our recruitment. I think we’ve done better in the last year than we did the year before for total recruitment, and we look forward to continuing to improve our recruitment initiatives, including working with communities and municipalities. We have $200,000 to help support municipalities and community groups. I think my first trip down to Cape Breton, there was actually a group that wanted to come in because the business community - I think the member might remember, I don’t know if it was the chamber or another business group, but they partnered to develop a website and video targeted to the community for physician recruitment. An amazing initiative - community led and community driven, with some information from the Health Authority, but not really necessarily investment.


As I said to the member for Pictou West, we recognize that it’s the Nova Scotia Health Authority’s responsibility for recruitment. So for those groups that are out there working in their communities, working with and supporting the Health Authority in the province with these recruitment initiatives, we want to make sure that we provide some skin in the game and resources, to let them know that their work is appreciated. We want to make sure we provide that. That’s that $200,000 program that we’re launching this year.


I look forward to finishing our Estimates debate and passing the budget so that the department and the Health Authority can connect with those organizations and figure out the best way to roll out that program.


TAMMY MARTIN: To be clear - I guess I wasn’t clear, and I apologize. We were looking at family doctors specifically, and if we were on track to meet those targets, and that’s across the province.


I guess I will agree to disagree with the minister, because those people in my community - one of them being my daughter, who wasn’t even on an 811 list - people are just tired and fed up and they can’t be bothered. I believe that there is a lot of wiggle room in those numbers.


With the improvement the minister says about the 811 list - that we’re down to 3 per cent, I believe - the ER visits at the Cape Breton Regional Hospital have increased by 120 per cent for those patients presenting without a doctor since 2013 - 120 per cent since 2013, without a family doctor. That is a significant amount of increase, but that’s just an aside. I just wanted to make those couple of comments.


Talking about recruitment and retention, with rural Nova Scotia being a very significant part of that, I want to ask the minister: Are there any specific or certain programs that are out there for rural Nova Scotia? We’ve talked in this House about one specific doctor who wanted to work part-time in Sydney but wasn’t allowed, so she packed up and left. We know that in Digby, two doctors wanted to work together and that didn’t work out. They were serving 9,500 residents, and they left.


I’m wondering if the minister has any exceptions to the rule when it comes to rural Nova Scotia and how we recruit and retain, because what happens in Inverness or Shelburne, I would say, is completely different than what happens in HRM. I think we need to involve the doctors in those decisions and involve the doctors in what they need in order to provide these practices to make sure that they and their families stay in our communities.


Is the department looking at that, or does that exist, that there are certain perks and/or agreements to keep doctors in rural Nova Scotia?


RANDY DELOREY: I guess just on the point that the member and I agree to disagree on, I’ll just provide one more piece of date, then, perhaps to help - I don’t know if we’d call this a debate at Estimates. That’s what it is, Estimates debate, so I guess it’s a debate, so we can rebut each other’s positions.


I was using the 811 list. Number one, I guess, before I rebut, as an encouragement - I would encourage the member’s daughter to register. It doesn’t mean that she can’t continue to try to find family practice services on her own, but by being registered, when the NSHA becomes aware of someone, the name gets submitted. I would encourage her to register if she’s not, and on frustration for the time waiting - again, if it’s an option, and you want to get connected with a family physician or a family practice - I guess I’ll retort perhaps with simply, what’s it going to hurt? It takes two minutes to call up or go online to register, and then the system will work to make that connection.


The data that I would use to rebut, if the member is using that example to say, well, everybody who may not have a family physician may not be registered on 811. Let’s take that at face value and accept that as a truth, but then let’s use the national data that shows that the national average of unattached patients - I believe the last time I saw it, it was about 17 per cent. I believe in Nova Scotia, that unattached data is at about 10 per cent or 13 per cent. I think we’re at about - I think 87 per cent of Nova Scotians are attached. So that would be 13 per cent that are unattached, if you use that data, but that’s against a national average of 17 per cent, I believe. Some jurisdictions are actually over 20 per cent unattached.


So when I mention that we’re fourth in the country, it’s based upon that national data of 87 per cent. I believe that was Statistics Canada. I don’t have it with me to table, but we’ll look to grab that and table it. What we have registered - and I guess to explain the discrepancy between the 811 registry and that Statistics Canada data, we know that not everyone is looking for them, for different reasons. I’ll use myself as an example.


When I was in my early 20s, graduated and went out to the workforce, I left my home community, moved elsewhere. In fact, I moved out of province for about six or seven years that I was in that location. I remember being surprised to get an email, a blast email from HR saying, there’s a new doctor in the community if you want to sign up. For me, in the inbox and out it goes, but I noticed all of my colleagues rushing around to register for this family physician, and they’re coming over to me saying, “Did you call, did you call?”, and I’m like, “What would I call for? Like, I go to the doctor once every four years.” It never even dawned on me to do that. In my early 20s I wasn’t looking for a family physician, because it wasn’t something on my radar.


We know that are many people who just aren’t looking because they’re not thinking about it. That covers that gap, that they’re just not looking, but we know the people who do register are very concerned and want to be attached. They would be a priority area, and so we know that’s probably one of the more efficient ways for us to attach patients to primary care services.


The member referenced family physicians specifically for recruitment, said about 60 of them for the recruitment. It gets very complex because it’s not just family physicians we’re recruiting. We’re focused on improving primary care access. So, in addition to those family physicians we’re recruiting, we’re also recruiting and bringing in nurse practitioners, family practice nurses, and social workers; they’re being added to our collaborative practice teams so that we’re actually able to do more with a team of family physicians with family practice nurses, nurse practitioners, and social workers. As a team, they’re actually able to do more with those doctors.


Again, back to my earlier comments this evening, it gets very complex very easily and if you just measuring one variable, you’re not looking at all of the other things that we’re doing. I guess, perhaps if the member wants to see if our recruitment and retention and our efforts to improve access to primary care are improving, look at how we’re doing.


For the last four months, we’ve seen fewer people registered on the 811 Need a Family Practice Registry. It took us a year and a bit before we started to see improvements. That’s understandable for the first year. We had never been tracking, in Nova Scotia, people looking for a family physician; we didn’t have the data to know which communities had greater needs. We implemented the list.


When my colleague, the current Minister of Communities, Culture, and Heritage was in my position, he worked with the Health Authority to get the list established, and then people had to become aware of it to register on it. We know that list continued to grow. People argued that government was doing something wrong because the list grew every month when the reality, more likely, is that people were just becoming aware and we didn’t know what the original demand was, to the member’s point.


Now we’ve stabilized and are starting to see improvements in the list - in part because we believe that people are aware of it and have registered and know to use it now and, in part because of the investments we’ve been making in primary care access to make those improvements. Through our compensation initiatives, we have increased them; our collaborative teams initiatives, I think that the care that we’re providing is on the right track. We’re going to continue work and invest in those areas to improve that access.


TAMMY MARTIN: As an emergency room nurse and an alum from St. FX - which is one thing we have in common - she should know well enough to be on the 811 list, for sure. I’m just reiterating that some people just can’t be bothered. What I was trying to get at was if the recruitment efforts for rural Nova Scotia differ from that of other parts of the province.


RANDY DELOREY: I apologize that I did cover a lot on the others. I’ll go directly to the point this time.


Historically, most of the recruitment programs were only available in rural parts of the province. One of the things we discovered when we started actually tracking the demand and the need for family physicians was that, like our population, about half of the need for family physicians was actually in the Central Zone, in an urban area. The access to primary care services, and the attachment rate, was half of the demand here. So we made the decision to open up some of the incentives that we have for recruitment and retention to the urban areas in the Central Zone, because all Nova Scotians, rural and urban, need access. The data that we were seeing showed that it was roughly distributed around the province for those demands and we made that available.


Some of those incentives that we have include: an initiative for international medical graduate residency positions - I believe we have three or four of our residency seats reserved in Round One of the matching process for international medical graduates. If an international medical graduate is attached to that residency, they do have to provide a return of service to the province. The Physician Tuition Relief Program, I think that’s somewhere in the vicinity of $120,000 - $130,000. There’s Return of Service Bursaries for Family Medicine Residents; a Clerkship for International Medical Graduates; Debt-assistance Plan.


All of these programs, where we provide financial support to either new, or new to Nova Scotia, physicians come with a return of service. Depending on the amount of the benefit that they choose, it could be anywhere from two to five years for the physicians to come onstream.


[6:00 p.m.]


That said, we also realize that there are certain other areas which have different challenges - for example, the emergency department challenges in staffing them and keeping them even open and having sufficient staff to even maintain the community emergency department open.


We’ve brought in new programs and incentives that we do target to certain locations through an emergency department premium and a locum premium that we’ve changed to help address those issues. We’ve seen - those changes, I think, came in place late August or early Fall and we’ve seen uptake at hospitals.


I think we’ve seen somewhere in the vicinity of – I’ll have to look up the number, but we’ve seen over 60 - and this is all from memory and I’ll look it up to be sure - could be upwards of 200 shifts that have been covered just in the last six months or so where people have taken advantage of these programs.


In fact, just since August of 2018, 222 days – I’ve just verified in my notes – 222 days as of March 19th that shifts have been covered and those physicians took advantage of these programs that were targeted in some communities.


TAMMY MARTIN: Specifically, I wonder a couple of things. First, can the minister provide us with those recruitment details for rural Nova Scotia - and just a couple of asides from the minister’s comments.


I recently spoke to a locum doctor at the Glace Bay Hospital, originally from out West, who told me that he loves to come to Cape Breton to work, but he is not coming any more because they only now pay him for the days that he works. Before they used to pay him if he came here for two weeks and if he worked for 8 days, he would get paid for two weeks. They used to cover his travel and now also he used to get his hotel, his accommodations covered. So, his accommodations are now only covered for the nights or the days that he is working in the emergency room. He is no longer going to come to Cape Breton because it costs him money to come to work.


I think that is a huge discrepancy and I think it is a huge issue because we have lots of locum doctors, or lots of doctors who are willing to come and do a locum, but they won’t come when it costs them money.


I’d like to just say again - and I know we can’t talk about specific people - when the minister is talking about international medical graduates and that there are assigned residency seats, I will say again that Dr. Billy MacPherson in Glace Bay, of whom I’ve sent several people his email and resumé, there is an un – is it unfilled? - yes, there is an unfilled seat in Inverness in the residency program. Let’s just say that he is willing to go anywhere so that he can fulfill the last leg of his journey on becoming a doctor.


Clearly, there are certain issues surrounding recruitment for rural areas. I guess my question is: Why are we changing the rules midway?


Why are we not – I think it’s unfair to have a doctor come and do a locum and not cover their entire stay, especially when, for example, he was working at the Glace Bay Hospital and now Glace Bay Emergency has been closed more than it has been open in 2019.


RANDY DELOREY: In terms of the international medical graduate residency option and matching, and I know the individual the member raised - those three or four spots, I guess just a little bit of information on that and I won’t forget this time because I’ve written it down, the locum piece. I will make sure I get the two responses out.


On that one, again, just how the residency program works. We’re part of the national attachment for residency. It gets managed nationally through the CaRMS program. That means jurisdictions with medical schools indicate how many residency spaces they can provide, it goes into the pool and then nationally it gets advertised and says these residency spaces for these disciplines, whether it’s family physician or specialty areas, and candidates, medical school students who are reaching the point to begin their residency look through that and they say - they are individuals, they make personal decisions, where do they think they want to go, so geography is one of those things that might come into play.


Some people may really want to work in Atlantic Canada, some people may really want to work on the West Coast in Canada and do their residency there, so there is a personal choice on geography. That’s one factor.


The other is what area they want to study and receive the training in. In some cases, the specific training opportunity may exist in only one part of the country or another. So, depending on what variables the individual medical student, potential resident, has when they identify their priority area, so they list. It could be one, it could be fifteen opportunities.


Now they do have to pay when they register for each of these opportunities when they list, Madam Chair. If you list only one option and you are not the best candidate, then you are not going to get that one option matched, but if you list fifteen, maybe in one of those fifteen you are the best candidate to match.


It is extremely competitive, Madam Chair. Nationally you can find articles unfortunately out of parts of the country where medical students have attempted unsuccessfully to receive a residency placement, and in some cases the pressure has been enormous. I believe just last year, I remember reading an article about a young man who actually committed suicide based on the pressures and three or four attempts over three or four years to get the placement that never materialized.


It is extremely competitive, it is extremely stressful for those medical students and residents who are attempting to get connected, but it is done nationally. We recognize that the competition and that there are other potentially qualified candidates which is why in Nova Scotia we expanded - we expanded both the family physician and the specialist areas, by ten and fifteen respectively.


It is a significant increase. As a ratio of medical seats to residency seats, which is a common ratio utilized by residency associations and the medical associations, Nova Scotia is again way ahead of national - I believe we are the highest ratio of residency seats come this July - residency seats to medical seats in the country, which means we are providing the most opportunities for people here to get in touch. The problem is that people are actually competing with everyone across the country.


Priority in the first round of the CaRMS match across the country is for students who are studying in a Canadian medical school. So, Dalhousie students in the first round have a - I guess the question would be: Would it be fair for international medical graduates to have an equal opportunity - someone who studied outside of Canada have an equal opportunity at a residency seat - as a student who did their medical studies in Canada?


The way the CaRMS works is it says no, we think that if you went to medical school here that you should have the opportunity to do your residency training here. So, the first round of making the matches, Canadian medical students do have preference, with some exceptions, like Nova Scotia, I believe we have three or four of those seats we do reserve for international medical graduates who can apply. We will reserve them for international medical graduates, so there are some reserved seats that are available. But again, with only three or four seats out of about fifty or sixty, it’s a very competitive spot to get filled.


What we cannot do, Madam Chair, is pick an individual Nova Scotian and say we like you, sir or madam, and so you get a residency seat. If I revert back to the beginning, and the thank yous and that early dialogue, I don’t think anyone in this House wants a situation where politicians are deciding who gets in and who doesn’t in such a highly competitive program. That’s why we have a program that is administered; it has been administered for many years; it is nationally available; and it is system-based - preferences of the individual medical students matching with the needs of the medical schools and the residency training opportunities.


So that’s why, and it is very unfortunate when people don’t get matched. I talked about that at the first round. On the second round, international medical graduates - for example, in Nova Scotia, I believe they completed the first round in February, and I think there were four family physician residency seats that were not filled. In the second round, international medical graduates have equal access to the seats as Canadian medical graduates. The main thing is for people to apply and try to get those seats to get the training they need. That’s the way the program works.


The second question that the member has asked was about the locum programs. Again, with the Health Authority, the work that they were trying to do around the locums was to look at whether the compensation rate being provided is fair and equitable to meet the needs. That was the efforts around some of those changes. When I talk about the enhanced locum rates, it was because they were looking around and saying the rate itself was not adequate or perhaps not fair, either based upon supply or demand for a particular field or in a particular community.


That’s where some adjustments had been made in the program. They are paid, and again in the change - for example, they have changed so, as the member said, they’re paid for the days that they are worked and also with their per diem and up to $500 on that travel. They were paid the days that they were worked per diem provincially, up to $500 travel, and the per diem was $150 per day. The new incentive program has doubled the travel from $500 to $1,000, and all days here get the $150 rate and 100 per cent of their accommodations. The shift is that provincially we have only initially paid for the days worked and the per diem up to $500 for travel at a per diem rate of $150 a day. That’s the old program. The new incentive is $1,000 for travel - that’s double the travel - all days are paid with the $150 per diem rate, and we cover 100 per cent of the accommodations.


Perhaps when the concern was raised, it was before the changes were made. If the member has the contact info, maybe they want to reach out or encourage the people who know the individual who brought the concern to her attention to let them know that they should check out the updated locum program.


TAMMY MARTIN: Thank you, minister, for the clarification.


I understand from some of my colleagues that a community group was working in Dartmouth to recruit physicians. They were given an hour to speak to the person and after the meeting was done, there was some gatekeeping done. I’m wondering if the minister could talk about how there seems to be prevention in place from community groups working with and/or to recruit doctors to their specific communities.


Are you aware of this practice and can you explain why the NSHA may be involved in preventing community groups working with the recruitment and retention of doctors?


RANDY DELOREY: I’m not aware of that issue; I have not heard of it either specifically or generally as a concern. In fact, several times today, we have talked about the positive role of community groups working with physicians. We have talked about the fact that we recognize the valuable role that they play and why we have committed $200,000 in the budget this year to help support the work that those groups do.


[6:15 p.m.]


In all of my experiences where I’ve had awareness, I know in my community of Antigonish, which actually is perhaps less organized than many of the other communities - like, again, I say the Clare-Digby region has been very involved and engaged; the Cumberland North region; I know in the Amherst area, very involved; Pictou more recently; and Lunenburg. These are the ones that I know of as very involved. In Cape Breton, as I said, the community group and business units came together right out of the gate in 2017 to help with promotion. I’ve never heard where there is - to use the member from Cape Breton Centre’s terminology - gatekeeping in that access.


In fact, again, I’ll just use my office as an example. Unfortunately I’m not always able to be in Antigonish to meet potential recruits and also I’m a little bit sensitive - I don’t want potential recruits to think the minister’s giving unfair advantage in the recruitment process. However, my constituency office does work with the recruiter, has reached out and said if you want someone local - whenever the recruiter has site visits in Antigonish, the recruiter notifies my constituency office. She then goes out and connects with municipal representatives. The mayor, the warden or other councillors usually show up to meet with the prospective recruits and, in fact, all of the feedback I’ve ever heard has been very positive.


If the member has more details about that or knows the group that was having the issues there, she could perhaps maybe have them contact my EA, and we’ll look in to see what the specific situation was and if there’s anything to it we will - again, we believe and support the work that these groups are doing because we think it’s fantastic. The feedback from prospective physicians has been very positive. The recruiters I’ve spoken to at the NSHA appreciate the work of these community groups because they’re more informative and more passionate than any recruiter who doesn’t live in a specific community could ever possibly be, with that genuine communication about their community and the potential of the community for someone who might consider moving there. Unless you live there, you can’t replicate or emulate the genuineness and the sincerity that community members can.


That’s why we really do support the work they’re doing and if there is some gatekeeping going on - as the member called it, Madam Chair - we’ll certainly work to understand what the circumstances were. I will suggest this as a possibility though, having been involved previously in recruitment initiatives and things, sometimes the schedules are very tight for those prospective physicians. They may only be in town for a day and they may just have to go elsewhere, because when they come they try to get as many visits in and groups to be seen, because it’s not just the community members, they want to meet the other staff and tour the facility. So, it might just be that the scheduling was very tight in that specific situation, rather than some form of gatekeeping.


I’ll let the member know, one of the things that happens in my hometown is that the councillors just offer the individuals their contact information. If the physician wants to follow up with the community group they can do so, and that allows those types of relationships to establish and develop naturally that way. Again, if the member is aware of a group, perhaps it was just that they had a very tight schedule to adhere to, especially if it is a travel day to have to get to the airport it might have been quite rushed, and they might not have had the time to explain that fully.


TAMMY MARTIN: To the minister’s point, to be clear, this community group wasn’t provided with any contact information. They were pulled in to develop a relationship and hopefully encourage physicians to stay there, but then in the end weren’t provided any contact information. I would be happy to follow up and provide that information to the minister’s office.


Doctors in communities are taking themselves off the emergency roster or giving up providing inpatient care. Recently we talked in the House about 20 hospitalists who resigned at the Cape Breton Regional Hospital. According to a recent survey conducted by researchers at Acadia, 50 per cent of doctors reported experiencing symptoms of burnout, and I suspect that number has gone up since the survey.


The researchers characterized the state of the physician workforce in Nova Scotia as fragile. I’m wondering if the minister would agree with that characterization and to the reason that so many, especially at one time, 20 physicians resigned from their hospital as physicians in the Cape Breton Regional Hospital.


RANDY DELOREY: To the question of physicians and indeed perhaps more broadly other health care professionals - burnout is a conversation I have with health care providers and/or their representatives and the concerns around that. The member for Pictou West brought to the floor this evening an example of two physicians in her community that I think would illustrate an example of the concerns that the member for Cape Breton Centre now is bringing up.


What I can advise the member is that, for example, when I was down in Cape Breton in November and went to her community in New Waterford, in North Sydney, Glace Bay, and at the Cape Breton Regional Hospital - I sat and met with really an open invitation to the physicians in the community to talk. I mean, my focus of the conversation was to talk about the redevelopment project but, of course, I didn’t close the door on other topics of conversation and certainly had the opportunity to hear from physicians first-hand in that area, which again I think many concerns are reflective of concerns raised by physicians elsewhere and what we’re doing when it comes to inpatient care. We certainly commit to it.


In fact, that’s where the hospitalist program developed from was hearing from physicians who are concerned about hospitalist services in our regional hospitals and the fact there wasn’t really a hospitalist program at all. So hospitalists as a program and compensation model is actually relatively new in a Nova Scotia context and having kind of a formalized program for our regional hospitals is new.


Not to get into too many details here, but I can advise the member and members of the House that the notion of in-patient care in community hospitals is a topic of concern being raised by Doctors Nova Scotia on behalf of their members at the negotiating table. I’m not going to delve into details there other than to say that it is something that is at the table and one that we’ve been actively engaged in. It’s a concern that I’ve heard of, heard from, and those, I think, are having.


Again, I don’t want to delve into it but, again, I’m optimistic through the negotiation process we’ll come up with a solution to address those types of concerns.


TAMMY MARTIN: Thank you, and I appreciate the efforts of every health care professional and everybody in the system from housekeeping right up to the CEOs because I think we need to remember that in health care it’s more than just allied health professionals and doctors. We also have many support services that keep our health care and hospitals going and, without those services, we would not be able to provide the health care that we are presently enjoying.


Having said that, I do believe now at this point that all health care professionals are facing burnout. All health care professionals, regardless of their job title or their salary, are facing challenges and difficulties that have never been faced before in health care. Everybody is working more than . . .


THE CHAIR: Order. Time has lapsed for the NDP. We will return to the PC caucus for one hour.


The honourable member for Pictou West.


KARLA MACFARLANE: Thank you, Madam Chair. I commend the minister and his colleagues for being powerhouses here and going through these hours.


I think when I had finished off on my first hour, I was beginning to speak about primary care and collaborative practices. I would like to just go back to the budget for a moment and what was announced in the budget with regards to the increase of $10 million to further develop collaborative care teams to make it easier for Nova Scotians to see a doctor or primary care clinician. That brings that total to a little over $27 million.


I’m wondering if perhaps the minister can give me a breakdown, on a regional level, of where that $10 million is to be invested.


RANDY DELOREY: I don’t have the breakdowns available for that. Again, this is the budget at the start of the fiscal year. The commitment is that we will be using the money - or rather, we will be making the money available - through the Nova Scotia Health Authority to hire and help either expand existing or establish new collaborative care teams.


One of the exciting things that gives us confidence that they’ll be successful in moving forward here is that this is a continuation of multiple years of our commitment to really develop and bring the collaborative care practice opportunities, collaborative teams, to the Province of Nova Scotia. What we’ve seen is multiple years of investment and, through that investment, learning how to establish these teams efficiently and effectively to meet the community needs.


A little more than a year ago, in January 2018, the Nova Scotia Health Authority’s request for an expression of interest from health care providers closed. If I recall correctly, there were over 100 responses to that expression of interest from practices to develop teams or expand collaborative practice teams. That represented over 400 physicians who would’ve been party to those teams looking to establish and receive some supports, which would be investments in health care providers to join the team funded by the Health Authority - nurse practitioners, family practice nurses, social workers, and occupational therapists, in some examples. The interest was there.


At last count, we have somewhere in the vicinity of 70 to 80 collaborative practices in place or being developed in the province. This is less than the number that had expressed interest, but the work will continue. They have a list of groups that are interested in this. The decisions on where and when exactly they’ll roll out hasn’t been established, because the Health Authority would need the money approved and then they can go out and implement.


I guess the point is that they don’t know where they’re at yet, until they go out and actually start implementing. They need the money in this year’s budget. They’re going to get that now, and then they can go out and continue working with the health care professionals who have already expressed interest to then get them established. Individuals or groups may be at different stages of readiness, and then again, for those communities and timing, of course, the recruitment. When you identify if a team’s going to have a family practice nurse or a nurse practitioner, social worker, or what have you, you obviously have to put in the recruitment time to fill those positions as well.


[6:30 p.m.]


I know the member had a specific question about the locations, where they are at. I don’t have the specific locations but the extra details I provided there was to give the member comfort that we have every confidence that the Health Authority will be able to successfully invest that extra $10 million and develop and expand those collaborative practice teams throughout the province in communities that need access to primary care.


KARLA MACFARLANE: Just to clarify, the $10 million would be dedicated to actual physical bodies. Okay, and I see the minister nodding. So if that’s the case, with regards to Pictou West, there is going to be what we understand, and I will be looking for clarity on this - we are going to have a new collaborative care centre located at the rotary in Pictou.


Initially we were told that would be ready and opened for July. I’m wondering if the minister could elaborate on what’s taking place there. Are there any details around who actually has the contract to build it, who actually owns the building, or will own the building? Again, out of this $10 million that we are speaking of, will there be any of that money put towards this new collaborative care centre in the Town of Pictou?


RANDY DELOREY: I’ll have to dig into that request on specifically that collaborative practice team. As I mentioned in my previous response, we’ve identified the priority of improving primary care access. We identified the policy position that we believe collaborative care teams are an important means by which we can improve primary care access to services throughout the province, and we provide the investment to deliver on those policy priorities.


The Nova Scotia Health Authority is the organization that is working with the physicians and the health care providers in communities across the province. I don’t have the specific details on each and every one of those collaborative practices that may be in the works. What I can do is, I’ve taken the note and I’ll get back to the member. I know it’s important to her community, so we’ll get that information and get it back.


I’ll just add it to the list, I think similar to the question the member asked earlier about that physician and confirmation of a start date in July.


KARLA MACFARLANE: I thank the minister for that answer. My understanding though is that the province is no longer hiring practical nurses to work in collaborative centres. We have this investment: Can the minister confirm if there will be any family and practical nurses hired within this new investment, when we understand that actually they are not hiring them anymore. In fact, I believe that the last one was hired for the Amherst area.


RANDY DELOREY: That shouldn’t be the case, that there’s no more being hired. What these collaborative teams are made of is a variety of health care providers: nurse practitioners, family practice nurses, social workers and other allied professionals potentially.


For the most part, I think if you look at what has been developed in collaborative practices since March 2017, there were over or about 130 health professionals to support these collaborative teams. That breakdown across the province is about 48 nurse practitioners, 66 family practice nurses, four LPNs and a dozen social workers. As an example, it’s actually the collaborative team bringing physicians as well as these other health professionals together to provide those more comprehensive health care services.


As teams get developed, as teams expand, I think perhaps what may have occurred or transpired for the member’s concern - again, we dedicate the money. The Health Authority is not able to hire when they run out of money so, again, it may have just been a timing question of establishing and developing collaborative care teams that they would be putting in place. Again, they would prioritize the communities. We want to target communities with need and the ability to service the community with the primary care services, but again, that’s what this investment is going towards is establishing those collaborative practice teams.


I’ve just outlined what’s been done with the $17 million that has been invested to date. It is predominantly the hiring of those support teams within the collaborative practices and so we would expect that the funding we bring forward would be going towards, again, the support services needed to get these collaborative teams off the ground. They would be hiring nurses and other health professionals.


KARLA MACFARLANE: In Pictou where we will have a new collaborative practice centre right now in our old clinic that doctors are practicing in now, there is one doctor who is fee for service.


Everyone is being moved out to this new collaborative practice and there has been some concerns around whether there will be permission for this particular doctor to move as well because he is not under the same pay model.


I just want to know if we can have confirmation that in this new building there will be room for this doctor to practice along with the colleagues he’s been practicing with, some for decades?


RANDY DELOREY: As I mentioned previously when the member was asking about this specific site, I’ll have to engage with the Nova Scotia Health Authority to gather that information.


I’ll get back to her, either myself or someone in the office or the NSHA, with that information directly to the member because I know that would be important to her and her constituents.


KARLA MACFARLANE: Sticking on some issues around Pictou West, lately we’ve been having a number of individuals come in to my constituency office and obviously when people come through the door they are either coming because they have not usually good news to share with you, but a lot of them have been coming through lately and saying that they’re hearing that we’re getting a dialysis unit or expansion, actually. I believe we have four units right now currently in Pictou at the Sutherland Harris Memorial Hospital.


I know that over the last couple years I’ve asked the question many times in this Chamber about an expansion to that unit in Pictou. Of course, the answer is usually, well, we’re looking into it. There’s going to be a review. There’s a number of places across this province that are in demand, as well, and I agree. I understand that.


I have a number of constituents who have to travel to Halifax, Truro, Antigonish, and the list is quite long. Obviously it is more conducive to be in their comfortable environment and surrounded by loved ones when they’re having dialysis.


I heard the minister speak earlier about an investment being made and I think I heard there are expansions happening in HRM and Bridgewater. I am hoping the minister can just list again those areas in the province where there are expansions happening and if he could update me on the status of Pictou.


RANDY DELOREY: I thank the member for raising the question. Just for the record, I’ll start with the information that I think will disappoint the member. There aren’t any updated plans for expansion in the Pictou region. Similarly, her colleague from Argyle-Barrington will be disappointed that there aren’t any additional plans there either.


The member did ask where we are having expansions: the Halifax Infirmary site will be adding six additional dialysis chairs; Dartmouth General, adding six dialysis chars; Bridgewater establishing a dialysis unit with a dozen chairs; Kentville establishing the six additional chairs; Digby with six; Springhill, I believe, as well with five; and Glace Bay with six chairs being added.


So for the commitments that have been made thus far, we’ll be increasing the number of dialysis chairs across the province from 150 to just under 200 chairs, so that’s a fairly significant increase.


The work to develop and or expand these dialysis units does take time, for the design and getting the construction bids out. We know we made the announcements a while ago in many of these communities and as I’ve said before, our focus is on getting these established. This was based upon a review that was done several years ago, so my focus right now is to get these sites and these chairs up and running, get those extra roughly 50 chairs into our system and then at that time we can see how the system demand and travel times has changed, and see what else we need to do.


The other thing that I’ve certainly been focused on, looking at and engaged in is not just the expansion of the dialysis chairs in the hospitals, but also in the homes. It’s not a system for every Nova Scotian; not everybody has the circumstances and the ability to use and participate in home dialysis. But when you think that you may require a dialysis treatment of somewhere in the vicinity of four or five hours every day, three or four days a week, and you go into a hospital facility for that treatment - if you could do that overnight in your home. The way I understand the home dialysis treatment works is, not only do you remove the travel time but you also are able to have the treatment while you sleep. You get to reclaim your days.


I see that and the information I’ve received, not that it’s eligible for everybody, the nature of the specifics and the oversight required - certainly that’s an area that I think we can optimize that as a delivery mechanism to improve the outcomes and really, the lifestyle for those Nova Scotians requiring dialysis. I do think that there’s a lot of potential in the home dialysis space to optimize the experiences for those for whom it is eligible.


KARLA MACFARLANE: I want to go to the salaries and benefits for the department. I see that there is an increase of 5 per cent in the budget and I want to know what accounts for this increase and the details around that.


RANDY DELOREY: Just out of curiosity, can you advise what page you’re on perhaps, if you are going to specific items in the budget document.


[6:45 p.m.]


KARLA MACFARLANE: I don’t have a page number.


RANDY DELOREY: Okay, Madam Chair, if I could just take a moment, I will just grab the document. I think we have found it here.


Probably the biggest contributing factor there is the salary, wage increases that come onstream for this year as part of their compensation. Some of the compensation goes to positions that have been filled that would have been previously vacant throughout the system. Again, along with salaries, any of the benefit compensation through there. That’s really where the increases would be coming from there. I think the largest part would be attributed to just annual incremental compensation on wages and benefits.


KARLA MACFARLANE: Sticking to budget numbers here, I’m seeing the budget amount for fee-for-service for physician services has declined approximately nine per cent year over year. I’m wondering what accounts for this decline. Personally, to me, when I look at this, I think perhaps the province is moving away from that payment model, and it could be based on the fact there are fewer physicians practising overall, but I’m not certain. When I look at that, I would think nine per cent, year over year, is a pretty big amount, so there has to be an obvious reason why we see that decline.


RANDY DELOREY: The member would be correct. In this particular year, the reduction in the estimated total compensation through fee-for-service. But as I had mentioned in our first round of discussion with the member earlier about the complexity and the different compensation models, the member may note that there’s an increase in compensation and a different model known as the APP that is also estimated to be taking place.


The province isn’t necessarily driving these choices in the models that the physicians are looking to engage in. It’s what I talked about earlier, I believe, when I tried to provide a little bit of a history. The fee-for-service model, which does make up most physicians in the health care system. Particularly in the family practice side of the health care system, those providers historically have been fee for service. The APP is a newer model only representing, I think, somewhere in the 10 per cent or 15 per cent of physicians - around 200 out of 1,200 or 1,400 family physicians. So we are seeing increased interest in that model and then, as I mentioned before, there are new models that they’re even interested in changing.


I guess an example specifically is about 258 APP contracts that we do have and that’s a number that’s been growing over the last number of years. Essentially it seems younger physicians are coming out looking to leverage and participate in this type of compensation model. And again, as we’ve said before, we’ve been responding to the interest and the needs because it helps with our recruitment and retention, recognizing that not all physicians subscribe or think that that’s the best form of compensation.


We do have to attract and retain the young physicians and provide an appropriate compensation model that meets those expectations. But again, the actual compensation framework and how things go forward is really a question for negotiations with Doctors Nova Scotia and the updated master agreement and we’re actively in those negotiations right now. So, what we see today may or may not look like the compensation structure that plays out into the future based upon those negotiations.


KARLA MACFARLANE: I thank the minister for answering that and it somewhat answers my second question that I was going to ask with regard an increase when I look at APPs. I see that it’s increased roughly around 37 per cent, year over year, and I believe the minister somewhat, you know, explained why. And this could be for good reasons and particularly if it’s something that attracts our youth to stay here and hang their hat and practice here that’s great but, in seeing this and it’s quite a large percentage, I’m wondering if he can confirm or has the department looked at what that projected number or percentage would be for next year.


RANDY DELOREY: I guess as far as detailed projections, of course it should be asking questions for the budget 2020-21 and we’re delving into the 2020 budget. Suffice to say, as I think my concluding remarks to the last question, the compensation framework this year may or may not look the same next year.


To the member for Pictou West’s first round of questioning in the first hour, when she first raised the question of compensation frameworks and new models or new approaches, I made reference to a new model beyond the current fee-for-service, APP and AFP - the concept of what some people describe as a blended capitation or blended cap model of compensation. Again, negotiations are ongoing. What, where, or how the negotiations conclude for the next master agreement have yet to be determined.


It’s hard to be doing forecasts there when we haven’t concluded our negotiations as to what the compensation frameworks and models will be based upon the new master agreement, so we continue to focus on our recruitment and retention initiatives. Part of that is responding to market conditions in the workforce planning that gets done. We know we have needs for physicians, both family physicians and specialists, and so we’re taking steps in a variety of different ways to recruit, retain, and fill those vacancies and will continue to do so to ensure we provide the care that Nova Scotians need in partnership with our health care providers.


KARLA MACFARLANE: Thank you. I want to switch over to emergency health services and the investment of $4.6 million that’s being made. It’s definitely necessary with the growing concern around call volumes and of course the cost for ground ambulance services across this province. I think we often hear about what’s happening in the HRM, particularly because of the facilities that are here, but this is something affecting us provincewide.


I’m hoping that the minister can walk me through what the $4.6 million will actually be invested in. Are we looking at more paramedics? Are we looking at more ambulances? Nova Scotians need to know what that breakdown is, in order to believe that there is going to be … this investment will actually start solving some of the challenges we’re facing.


RANDY DELOREY: I believe about 25 - 30 per cent of the increase relates to the contractual inflationary pressures and work for services within the contract and the additional 70 per cent relates to increased - the contract for calls works on a band or a stepped approach so when we buy, we buy blocks of responses from EHS - so the increase is predominantly based on the previous year. We had so many additional calls, so we pay for the anticipation of those calls in the next fiscal year.


There are 1,250 calls in what we call a band. We don’t pay per call, we pay per 1,250 calls, so for every 1,250 calls we have to pay the price for that. Now if we used only one of them, we had to pay for the full thing. I think we have about eight bands or so - between five and eight bands, I think, of increased demand for next year and that is what we’re paying for predominantly.


Madam Chair, I’ll try to explain it again. The majority of the increase is going to pay for the calls, and the anticipated increase in calls based upon the previous year. The way we calculate how much we pay in the contract is not based on each individual call but on bands of calls and each band is 1,250 calls. We are increasing, I don’t know, eight or so bands that we’re adding to the contract because we anticipate - based on last year - that we will need that much additional support from EMCI, the EHS ambulance service provider.


That’s really predominantly where the money is going towards. Some of it is going towards contractual, inflationary and other services provided in the contract. So things like fuel increases, CPI, CPP, EI rates and so on all contribute to the inflationary pressure part of that increase.


KARLA MACFARLANE: A couple of questions to that answer. How many bands do we have overall? As well, I guess I could ask with an answer to that question - I’m just wondering what kind of consultation actually occurred with EHS, the paramedics and hospital staff with regards to this $4.6 million investment, to determine that investment actually?


[7:00 p.m.]


RANDY DELOREY: The reason I took a little time on my calculator there to figure out the numbers. This wasn’t about consultation to establish the investment. The way we establish our estimate for delivering EHS services, we look at last year’s, or the current year that’s ending actuals and the projected calls that we receive and pay for because it’s a utilization-based program or service being provided. So, we pay for the actuals.


When we see that in the current year it’s approximately 140 bands or about 176,000 calls that came through - that’s in the current year, we’re forecasting to have the same number and that’s why there’s an increase from what the budget was in last fiscal year, because we’re expecting to have more EHS calls just based upon the current year ending, actual calls that have come through.


KARLA MACFARLANE: Obviously this $4.6 million is to make improvements, and so with that I’d like to know how the minister and his department plans to measure these improvements.


RANDY DELOREY: There are a couple of things going on to improve the workflow and the work environment for paramedics.


The first one, from what I’ve heard and probably the most important one, is improving the transfer time; that is, how long it takes when an ambulance shows up at a hospital to transfer the care of that patient from the paramedics to hospital staff. Once that transfer takes place, the paramedics can turn around, get in their ambulance, and go back out to the community.


We’ve had conversations here in Question Period in this Legislature, and I think possibly even late debate, and I think even one of our first Health Committee meetings was specifically on this topic. It is one that I personally have taken an interest in and a serious focus and have given the engagement and direction to the Health Authority and EMCI who provides the EHS ambulance services to get together and find solutions to this. I believe some of those details were outlined at the Health Committee, so I won’t reiterate those details, but the direction has been very explicit for dealing with it. The Health Authority and EMCI have been working and engaged for a bit of time on root cause identification and some ideas of how to improve.


I’ve used the example - one I’ve referenced frequently - the Dartmouth General’s transition process where they have nurse and paramedic staff hired in the emergency department to receive patients from paramedics, so the paramedics can get back out and the patients are still monitored and observed by health professionals, and the ambulance is able to get back out into the community more quickly. That’s just one example of the type of improvement.


In addition to that, that’s one I wanted to make sure of, because it was what seemed to be the most frustrating part and it also contributed to some of the other challenges, like the overtime challenges. The member for Cape Breton Centre in her questions last hour made reference to burnout and the impacts of some of the pressures and challenges, not just for physicians but other health care providers like paramedics who say that’s been the feedback - this offload transition experience of being tied up at a hospital when they get a call, either for a transfer or an emergency call, and waiting an extended period of time - sometimes hours - to successfully transition.


We know that there are instances where paramedics have spent their entire shift at one hospital location. I understand the impact - I represent a community that’s outside of metro, so think of a situation where there’s a transfer from Antigonish St. Martha’s Hospital and somebody needs to come up to Halifax for cardiac care. They bring the patient up, if it’s not an acute active heart attack situation. So, the acuity, they do need to get the services in Halifax, but it doesn’t have to be instant service. So, based upon the other demands on the emergency department they may be waiting for that transfer to officially take place, for the bed in the appropriate room to be open once the paramedics arrive. If they wait for many hours, then they still have a couple of hours to drive back home to complete their shift.


I’ve heard that from paramedics and not just in Antigonish - people from the Valley and other communities, Cape Breton as well. So that’s why they say some of those pressure points, if we can get the off-loads and those transfers of care taking place more efficiently - you know, even in talking with the representatives from the paramedics union, they believe that that will address a significant portion - not everything, it’s not solving all of the concerns and problems, but it will be the one that has the biggest impact.


In addition to that we have had, since the Fall, an external party, Fitch & Associates, that has been conducting a review of our EHS ambulance system. So, we expect that report this Spring, which has done a detailed analysis. So, to your specific question of: What are all of the things you’re going to do? We’re really going to be guided. We know we’re getting this report in the Spring that will help guide some of the additional improvements we’ll be targeting.


Again, I want to highlight that I did hear from paramedics, I didn’t want to wait for the Fitch & Associates’ report because of the obvious concern and the importance of addressing the transfer of patients from paramedics to the hospital to get those paramedics back out in the communities. So, we initiated and directed the Health Authority and EMC to deal with that even before we got the report, because it’s just the right thing to do.


KARLA MACFARLANE: I’m glad the minister mentioned the Fitch report because that was going to be my next question.


I just want to know if the minister can confirm the cost of the Fitch report, as well as why did we feel that we needed to go to an American-based company to have this report conducted. As well as knowing that this report was requested to be done, knowing that we would be looking in this report for guidance and solutions, has there been any determination of putting money aside to perhaps accommodate some of the recommendations that will be in this report so that they can be implemented?


RANDY DELOREY: For the cost of the contract, I believe it is about $130,000, thereabouts. As far as - sorry, let me repeat, Madam Chair, in case people didn’t catch it, I believe $130,000 is the cost for the report, in Canadian dollars. I will double check to see if that is Canadian or American currency, but if it is American you would be looking at another $45,000 or so, I think, at recent rates. Anyway, that’s the rough cost of the contract.


The member’s second question was: Why was this firm selected? An RFP went out in August of last year, so it went through the RFP process to secure a company to provide the service. Again, as the member would know, with various trade agreements and so on you need to respect the competition by doing so in RFP process and respecting competition from outside of the province.


We get reciprocal access for companies in Nova Scotia so they have opportunity to bid on work in other jurisdictions as well, both across the country and in other parts of the world based upon our free trade agreements. Again, it’s reciprocal - you have to allow companies from other jurisdictions to bid on your work to give the companies in your jurisdiction the opportunity to bid on work in those jurisdictions. That’s why another company -a non-Nova Scotia entity - would be able to bid and, in this case, ultimately win the contract. And I will confirm to the first question - it is $130 Canadian, not American.


The question about funding for other initiatives - really without seeing the report, it is hard to estimate what the investments would be. We will see the report, evaluate the recommendations, and make decisions on prioritizing the implementation. As a department, we’ve done the long-term care. The most recent report that I received is the long-term care expert report.


As we know, the report recommendations broke it down into kind of short-term, medium- and long-term objectives to target. That’s kind of whether the writers of the report break down the recommendations that way or not. Often that is the way government has to operate. We have to look at recommendations. Some are things that may be structural and take multiple years to implement, while other things may be quick to implement.


Without knowing the report, it is very hard to estimate. We would be ultimately pulling a number out of a hat. We will get the report, we will do an assessment and see what those recommendations are, what costs may be required, and we will budget and manage that accordingly.


KARLA MACFARLANE: Last year, the department listed One Patient One Record and MyHealthNS as a priority. This year that priority has been slightly modified to now be called Digitalization and Data Analytics.


Could the minister explain the need to switch out those specific priorities so that we have broader terms of why that happened? As well, since we are on that subject, the budget included $800,000, an increase actually to the digital health services, including MyHealth. We know that some people have had some challenges with this, but I am just wondering, with the increase in funding will that be delivered immediately or is it going to help people navigate it easier - could the minister explain that?


RANDY DELOREY: Off the top I am going to apologize. I missed the last part of the question, but I can answer the first part, if the member is okay coming back for the very last comment.


On the other hand, I am also going to apologize in advance. The member has hit on a topic that is near and dear to my heart. I could speak at some length about digitization, given that my first career was actually in the IT sector, so, I will do my best to keep it short.



A little bit of friendly chirping going on…


THE CHAIR: Just over 20 minutes.


RANDY DELOREY: Yes, yes, I’ll keep it short. Why did we switch from two specific items to a broader definition? The reason is because we actually have a lot of work going on in the department, in the health authorities, and in the health care system around digitization and analytics. OPOR and MyHealth remain two massive and most important pillars within that space, so although they are not explicitly in the name, the fact of the matter is that we did have other important digital initiatives that we believe should be acknowledged.


For example, Panorama is a program that we invested in recently and continue to work with in the public health space. It’s a system that allows us to, in the Public Health division to monitor and respond if there is an outbreak or an epidemic that occurs in our province.


[7:15 p.m.]


Having a system like that that can digitize and track allows the Public Health officials across the province to more quickly communicate and access the information. For example, a few years ago, when we had the SARS outbreak and so on, all of the communication - or much of the communication, as I understand it - and tracking was being done, and it’s all paper-based forms being filled out.


In order to provincially keep an eye and manage and monitor that, information is being tracked and faxed back and forth, and to collate all of that information was, again, all manual process, which takes more time. So in simplistic terms, if you picture how the Panorama system allows the Public Health officials on the front lines to collect and enter the data into the system, it’s already collated and the centralized Public Health staff are able to see how things are responding and outbreaks or incidents across the province almost in real time, or possibly actually in real time. It’s a new tool for Public Health.


From a Public Health perspective, it also allows tracking of vaccinations, Madam Chair. I don’t want to speak for the member, but based upon other types of questions that she’s raised in the House, I believe she would have concerns about or an interest in vaccination and the notion of antivax movements. It’s in the news quite a bit. I assume the member is familiar with that area, and I know that side of things. The Panorama system does now provide the opportunity to track and monitor Public Health vaccinations provincially in a digitized system, with the ability to then expand out


Again, why are we talking digitization? Because Public Health tracks the vaccinations that Public Health does in our schools or in our Public Health offices, and doctors track the vaccinations that they do in their own office computer systems, which are called EMRs, electronic medical records.


Well, the province is also going through a massive upgrade or migration to new EMR systems across the province - another initiative that’s ongoing. Through the whole OPOR process, the goal would see our hospital systems using a single system across the province, which would then be integrated with the EMR systems that are in our physician and primary care provider offices and our Public Health system for Panorama and then the patient portal, which is MyHealthNS, so that everybody can see the health care information for the individual. That’s the systems side of the digitization.


The analytic side is for health care providers and clinicians when they’re evaluating the data. Those are the analytics that go on to say how we are doing in treatments for certain things. Earlier this year, there was a lot of talk about reporting on information and how we are doing with service X or service Y. Well, when we have these digital systems in place, the ability to report more accurately and more efficiently both internally for clinicians and also publicly, where and when appropriate - these systems will help do that. That’s why we’re calling it data digitization and analytics, because it’s both. We want to digitize. That helps us get the data we need to then do the analysis and the analytics to help inform how we can do things better and deliver better care to Nova Scotians.


KARLA MACFARLANE: I could see the excitement in the minister’s speech there with regard to that, and I appreciate that information. However, the second part that the minister asked if I could repeat is that the budget actually includes an $800,000 increase for digital health services, including MyHealthNS.


I’m wondering if the minister could explain what specific enhancements are being made with MyHealthNS, what will be made with that funding, when it will be delivered, and, once again, is it something that’s going to assist Nova Scotians?


RANDY DELOREY: I thank the member for restating the question again - I apologize that I missed the detail there. Predominantly, the increase of about $800,000 - the vast majority of it is the two projects that I talked about, Panorama and MyHealthNS.


For Panorama, it’s really an investment to get some of the modules of that program implemented this year. Part of it is the lab integration for investigations - I guess that’s what the module is called, lab integration for investigations. That is being rolled out and expected to be completed this summer. Again, it’s just adding functionality to the Panorama system. The Panorama system is only about a year or two old in the province, and we’re rolling it out in stages. This is a new module providing additional functionality for the public health system. It’s just a new module, a new piece of functionality being brought into the public health system, which is called Panorama. That’s just under $400,000.


For MyHealthNS, the system is up and it’s live. Our fee structure, compensation, is based on utilization. It’s based upon the vendor reaching milestones in both physician and patient participation, signed up and registered. This is the anticipated cost associated with higher utilization of the platform.


KARLA MACFARLANE: The budget for digital health actually came in around $200,000 lower this year. I’m just wondering what accounts for that lower amount this year.


RANDY DELOREY: Here we are talking about, as I mentioned before, the different main health platforms, and we’re talking about the EMR platform - electronic medical record - which is the computer system used by physicians and primary health care providers, predominantly. In my earlier remarks on this theme, I mentioned that the EMR were in a migration stage because the product that was used by most physicians in the province, called Nightingale on Demand - that company was purchased and they were ending that particular product stream. That information came out about a year or year and a half ago. As a province, we recognize we have to work with physicians to migrate to a new product.

Work was done there, and different product options are available. I think there’s two main competing products that are available for physicians to migrate to. One of the things is just the changes in the licensing agreements between the old, traditional Nightingale on Demand and the new model. That’s where changes in the cost structures come into play. Again, the work of migrations is taking place across the province.


The member remembers about this time last year when we brought that $40-million incentive to bear. One of the streams in that investment we made was to encourage physicians to migrate and provide some increased compensation to help with the transition from their current EMR to the new one. There are aspects of that, so costs are really going down and then recoveries to the Department of Health and Wellness based on the way that the licensing agreement was under the old system versus the new one.


As fewer people are on the old Nightingale system, and more people are going on the new systems - again the way the licensing worked, we carried the license for Nightingale on Demand and got compensation, so basically physicians paid us. We had a flow through to the vendor because we bought the licenses. In the new system it just goes direct to the vendor, so you are seeing these changes in both the bottom line on this particular line item.


KARLA MACFARLANE: I just want to know, I can’t find in the budget where One Patient One Record falls into the budget. Can you just tell me what line that is in?


THE CHAIR: Order, time has elapsed. We will move on to the NDP caucus for the remaining time. We are finished at 7:56 p.m.


The honourable member for Cape Breton Centre.


TAMMY MARTIN: Continuing on with the doctor crisis, recruitment retention, and or those who may have left, I wonder if we could talk a little bit now about the doctors who have left the NSHA over the past couple of years.


While the incentive program that the government introduced in 2018 may have improved patient attachment, there have been some unintended consequences for doctors taking those patients off the 811 list - it’s resulting in longer wait times to see a family doctor. I’ve had a constituent who sadly was in a car accident in May and couldn’t get in to see her family doctor until the first week of July, so there are definitely some perils with this.


I wonder if the minister could tell us how many family doctors have left practice in each zone, in each fiscal year, for 2018, 2017 and 2016.


RANDY DELOREY: I don’t have the detailed breakdown of that information with us here, for those years. As we are working through the budget details, that’s the information that we have here for preparation today - I don’t have that data that the member has requested.


TAMMY MARTIN: I would ask if the minister could prepare that document or have it prepared and send it to our caucus office for review.




TAMMY MARTIN: Continuing on with residency, I’d like to talk to the minister now about the increase in residency seats at Dal. While expanding the residencies is a good thing, can you tell us specifically where these residency seats will be located, and what work has been done with supervising physicians on the ground to receive these new residents.


RANDY DELOREY: For the family physician residencies, as when they were announced last year that they would be coming - and you have to announce them a year in advance so that CaRMS, the national body, would know to include them. Again, it takes a lot of preparation time for this to work, so of the 10 new family residency seats: six of them would be in northern Nova Scotia; two in Cape Breton; one in southwestern Nova Scotia; and the last seat was reserved for a family medicine resident who is looking for additional clinical experience in a particular area, to enhance services to a community. For example, if there was a physician looking to expand their expertise in mental health and addictions, this would be a seat that would be reserved for them.


[7:30 p.m.]


To the 15 specialty seats that were committed as per when we announced, the areas include: emergency medicine; core internal medicine; general internal medicine; child and adolescent psychiatry; adult neurology; obstetrics and gynecology; critical care; geriatric psychiatry; ear, nose and throat; head and neck surgery; dermatology; and hematology. The decision on those specialty residents was done and established based upon information and discussions, and data and analysis around the current and anticipated needs and specialty areas. This included discussion with clinical departments throughout the province and current vacancies that we’ve seen hard to fill.


I think that my colleagues would recognize that often, in particular, you’ll see multiple references to psychiatry. Recognizing the fact that psychiatry is a highly demanded area of specialization in the health care system, not just in Nova Scotia but across the country, we recognize that to fill that important gap by adding the additional seats would be a positive move in that direction. That’s why and how we came up with those sites.


As far as the work for establishing residency seats, the residency training program has been established for a long time. It’s really administered and managed by Dalhousie Medical School. They have the expertise and the experience to work with what are called preceptors - those would be the supervising physicians on the ground in communities that would be supervising these residents, whether specialty residents or family physician residents.


At Dalhousie Medical School, these systems have been in place for many years. They have the expertise and as far as the consultation and working with those preceptors, the supervising physicians, the process would be the same. Nothing’s changed. Government has just provided and worked with the institution and the Health Authority to provide the funding and commit to funding these residency seats. The delivery of it would be their responsibility, and the processes that are in place for the new ones, the same as they are for the existing ones.


TAMMY MARTIN: I’d just like to clarify with the minister then: Are these seats that were announced last year or are these additional new seats that we’re talking about?


RANDY DELOREY: The announcement that we would be adding these seats was made last year in the 2018 fiscal year. However, the main cost for delivering the residency seats - you have to announce the seats at least to CaRMS a year in advance, so publicly essentially. So we had to announce, and Dal Medical School let CaRMS know that they would have these additional seats in July of last year. The CaRMS system could then be updated throughout the summer so that when the application process opened, either late Fall or early in January, for potential residents to apply, people would know that these residency spaces exist.


The matching process takes place around January through to around this time. I think the first-round finishes in February or early March and then the second round is kind of ongoing. There are interviews and things; it’s not just a paper exercise but potential residents travel the country going to these medical schools to have interviews, visit the sites, and so on.


All of that work takes place in the winter or early Spring. The matches that are established, the residency positions, actually start on July 1st of this fiscal year. Yes, we announced them last year, but the cost incurred to deliver the programs start, because the residents start, on July 1st of this year. I hope that clarifies for the member why we announced last year, but the funding is recognized this year.


TAMMY MARTIN: I’d like to talk now to the minister about rural Nova Scotia and being able to attract residencies and doctors to rural communities and retaining the residents once they finish their training.


We hear from many doctors that once they are finished their training, they up and leave, take a position somewhere else in the province, so we are curious.


How many family medicine residents finished their training last year? How many took up a position in this province? Are we tracking them as they finish their residencies and what would that look like? Would the department or the NSHA chat with them, if they choose to leave, or do they do an exit interview, as we’ve talked about before?


RANDY DELOREY: An important question raised. I don’t have the specific data details exactly as the member inquired, specific breakdowns across the province. However, what I can advise the member is that Maritime Resident Doctors is the organization that represents residents in the Maritime provinces, which is predominantly the program here in Nova Scotia, but they also have seats in New Brunswick.


In the Fall of 2017, that organization did put out a report, and I have seen essentially the same data reflected in some other reports that I’ve read nationally, that somewhere in the vicinity of 75 to 80 per cent of residents stay in the province, in the community where they’ve been recruited.


I think the data was reported provincially, so it says that they stay in the province where they trained. Whether or not it was in the specific community wasn’t clear. I will add to this the anecdotal information that I’ve experienced in my engagement and conversations with residents and/or new physicians.


For example, I mentioned earlier this evening my discussion with residents in Yarmouth back in 2017. They have a family medicine program that is a two-year program with five seats, so there would be 10 residents at any given time in that area of southwestern Nova Scotia. I think about eight of them were present at the meeting I had, either in person or on the phone. When I asked, only a couple of the residents were actually from Nova Scotia, so most of the residents who were matched to those seats were actually from another province.


THE CHAIR: Order. Can we have a quieter Chamber, please.


RANDY DELOREY: Thank you, Madam Chair, and thank you to my colleagues.


They only had a couple of them that were from Nova Scotia. The majority of the residents were from other provinces. An important question for me because I knew even early in my tenure that recruitment was an important objective. Family medicine primary care was one of my main mandate items coming from the Premier and it is a platform commitment for us as a government.


I ask the question, particularly for the second-year residents, who’s interested in staying for opportunities because I knew there were opportunities. The vast majority of them said yes. With an opportunity, we want to stay here. That said, they also highlighted some of the things they thought could be done better for recruitment.


The website wasn’t very good, they said, compared to other jurisdictions. They’re out there looking, and they said the information is in too many different places to track it down. The NSHA responded and developed a new website to centralize the information that is available.


The application process is complex, they said. In other jurisdictions it’s more streamlined. What that means is you need to apply to the College of Physicians and Surgeons for licensing, you need to apply for your position with the NSHA, and so on. If there are incentives, that works through the department.


Work is ongoing between the Health Authority and the College of Physicians and Surgeons to streamline that. We’re asking the same information from different organizations, let’s only have to ask it once.


I think this government has a fairly good track record, as has been noted by my colleagues in other departments, around red tape reduction, the work that Fred Crooks and his team have been doing in administrative red tape reduction. This is what applies here as well, and I think that’s going to help us as well with our recruitment side.


Again, I think the data from my ad hoc inquiry of the residents in Yarmouth aligned with that 75-80 per cent retention rate that I saw in the data from our doc. So, subsequently, I continue to use that data because the report aligns with my anecdotal information in Nova Scotia context, so that’s what I expect and anticipate.


The other piece that shows this, and again that’s at the provincial level, but in the community level, I was down in the Valley and one of the meetings I had was with a new physician; a physician who had just completed the residency but committed to start work in that community.


Lo and behold I walk into the meeting and it ends up being someone, I didn’t know them, but based upon their - last name it’s Nova Scotia -, Madam Chair, I had to inquire, any chance you are related to so and so, who happens to be in my community? It turns out this young physician is actually from Antigonish.


I’m a newly-minted Health and Wellness Minister, obviously disappointed that an Antigonisher is starting work in the Valley, as a physician. So, I had to ask, we have needs, it’s a great community in Antigonish; the best place in the province if I do say so myself. The individual who has strong family ties, family still there, explained to me how they made their decision. It was because they did the residency in that area; there were, actually, I believe about three of them doing their residency in the same general community area and they had gone through medical school together.


So, it is this cohort - I don’t want to call it mentality - cohort approach that this group of physicians worked through the challenges of studying and training to become physicians, together. They felt that staying together allowed them to feel confident and comfortable at a very exciting, but also, scary time in their careers. Like anyone who starts a new career when you finish your training and then you are out there on your own, it’s a scary time, so they said they wanted to stay together.


The other thing they said was, this was where we did our residency. We already have our relationships with the other physicians in the community; with the specialists in the community; with the other health care providers, like lab techs and others. They were established and could hit the ground running, so given that there was opportunity, they chose to stay. Those are just my experiences.


To the member’s question, what do we do: Really it just naturally occurs that these residents establish their roots because they’ve been in these communities for multiple years. They’ve built the networks and it’s easier for them to stay if the opportunity exists. Again, we try to match and that’s why we expanded to the Northern Zone, because there’s high demand, high needs in those communities and they don’t have the option. There are opportunities in the Valley and in Yarmouth and up in Cape Breton for residents. Those options didn’t exist anywhere along the Northern Zone, so we provided them.


In addition for the specialists - we’ve heard this with specialists in other parts of the province, because Halifax is where the medical school is and with lots of specialty opportunities, residents all seem to congregate in those specialty areas in the Metro region. The experience and the requests from specialists in other parts of the province - indeed, I’ll note one of the psychiatrists who I spent a lot of time working with, from Cape Breton, on the challenges with psychiatry. It was one of the recommendations made by Dr. Milligan that he felt could help improve and strengthen the psychiatry services in Cape Breton, for recruitment and retention and stabilizing, addressing some of the burnout being experienced, was to have residents actually coming to the community.


We worked with this. We worked to say you know what, we’re adding these specialty seats that physicians want, and the specialists want. But we want to make sure that we work to ensure that there’s a rotation component that ensures that residents get exposed in other parts of the province, and other communities, so that they have the opportunity to experience what the rest of the province has to offer and not just here in Halifax.


We’ve been taking steps to actually strengthen and enhance the potential of getting these residents out to other communities, outside of the core centre here, which has historically been the place that they congregate, and then end up staying. We’re hopeful that these approaches will be beneficial for the whole province.

[7:45 p.m.]


TAMMY MARTIN: Now I’d like to chat with the minister about the consequences of doctor shortages. I mentioned before about a constituent who had quite a wait getting in to see their family doc, as an unintended consequence of this new benefit for taking on new patients.


I’d like to read off some stats that the percentage of emergency room department patients not attached to a primary care provider at the Dartmouth General went up to 217 per cent from 2013 to 2018; at the Valley, the number was relatively flat until 2018 when it jumped by almost 3000 patients overnight, representing a 264 per cent increase in visits from patients that weren’t attached to primary care; and as I said earlier, 120 per cent at the Cape Breton Regional Hospital.


We’ve heard from constituents who are complaining and worried about not being able to have access to timely medical care, which is a huge issue. Being attached to a family practice or primary care provider is essential, but timely access is of the utmost importance.


I guess I’d like to ask, in the minister’s opinion, how long should it take for somebody to get an appointment with their family physician, and is there a benchmark so we can compare where we are across the rest of the province or across the rest of the country? Do we have a reasonable expectation for what it is before you would actually be seen by your family doctor - is there an accepted number that’s out there?


RANDY DELOREY: I guess to the second part of the question first, just so I don’t forget it, I’m not aware of any benchmark or standard in terms of visit turnaround time in the primary health care space. However, we’ve talked about this a lot. It’s about access to primary care and access is about both of those variables. Having access not just to the primary care providers, but to the care that those providers provide. That’s, in part, why there’s this move to collaborative care practices.


Even though physicians may bring on and attach more to their practice, we’re providing them the supports and other health care professionals who can work with them to provide care so that they can see more patients through that practice as part of a collaborative team. Ultimately, it’s about having the right care being provided by the right provider at the right time.


We are at a time of transition. The growth, from a policy perspective of these collaborative care teams, has been something that’s been evolving and consciously part of a policy under this government.


Although there have been collaborative teams across the province before, we’ve taken a focused effort and an investment to support this. The training that health care professionals receive is more team-based, which obviously would explain why the newer generation of health care providers disproportionately seek out opportunities to work in a collaborative team environment because it’s the way in many cases they’ve been trained. In order to have a health care system that responds and meets the needs of patients, we also have to have a health care system that responds and meets the needs of the health care providers. Again, team-based collaborative teams are part of that effort and that’s why we’ve adopted a policy. It’s why we’re spending over $27 million this year, an increase of $10 million to expand the access and the number of collaborative practices.


This notion of again access and the timeliness of it - again, it’s difficult to say what it should be, Madam Chair, because with health care as I’ve said in the beginning in my opening remarks, it is a complex system. Depending on the nature of the health issues, that could affect how urgent you would need that to see that care and that’s why our health care system is designed and built with different entry points and ways to access health care services and really in a tiered method of health care delivery.


For example, we provide 811 Telehealth services, which are predominantly targeted towards low acuity, opportunities for citizens to have their health care questions answered by registered nurses, who have the training and the expertise to assess verbally. As a father with young children, I remember our first child and being a frequent user of Telehealth services. I can never remember what is the temperature that you’re concerned about and want to go to the doctor for when your child has a fever. As a young parent at the time, it used to stress me to no end when my child would have the fever because I never knew when is this something I should be concerned about.


I loved the Telehealth service because I knew I could just give it a call and the nurses would explain it’s this temperature, so give them some infant Tylenol, wait a little bit. If you see the temperature come down, then you know the Tylenol or Advil is working and you don’t have to go to the ER. But if after a couple of hours, if the Tylenol or Advil didn’t work, you know what, then you want to go. Or if the temperature is well above the 40 degrees Celsius, you know what, that’s the time. Get into the emergency department and have the child seen, if I recall the clinical advice. But it was the 811, the Telehealth services, that address that. I would say there was only once out of the times that I called, and it’s usually for my child, that we went into the emergency department.


On a more serious and what could be perceived as a more serious condition, my wife had a miscarriage and we used the Telehealth service not knowing given the symptoms that were going on whether this was something we should be concerned of or not. The nurse did a great job to walk us through and explain what was happening, that there wasn’t really an option at that stage and to see. If certain symptoms or conditions gave some thresholds and things to monitor, go see your family physician the next day or the day after. That’s the process that took place and we went through that process.


So, like I said, the 811 system has certainly served me as I am sure it served other Nova Scotians to provide direction and health care services, particularly those of a lower acuity. Then, of course, it’s the family physicians and primary care providers that you can access by if you’re attached or walk-in clinics in communities that have them for afterhours service or if you are unattached. Indeed, some Nova Scotians don’t even realize there are other health care providers that have a scope of practice, like pharmacists who can provide certain services like flu shots that they are able to provide to Nova Scotians throughout the province. If you want your flu shot in the fall, you can search out other health care providers.


Finally, and I want to stress this point, Madam Chair, that as you walk up that stream of acuity and the need of your particular health needs at a particular time, if you have a health care emergency, if your symptoms are severe, call 911. We have a lot of conversations here, we read about it in the newspaper where there are challenges in our health care system. We talked earlier this evening about the transfer times and the pressures on paramedics, but call 911. If you talk to the paramedics, you talk to the nurses, you talk to other health care workers who are highlighting their challenges, they still tell you to get to the emergency room if you have an acute emergency. The health care system is there for you, they will triage you, recognize those symptoms, the criticality of it and they will get you the care and deliver those services and get you through the system, so you get the care that you need in an emergency situation.


So, I want all Nova Scotians to take those steps . . .




The time allotted for consideration of Supply today has elapsed.


I recognize the honourable Government House Leader.


HON. GEOFF MACLELLAN: Madam Chair, I move that the committee do now rise and that you report progress and beg leave to sit again.


THE CHAIR: The motion is carried.


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


[The committee adjourned at 7:56 p.m.]