HALIFAX, MONDAY, MARCH 26, 2018
COMMITTEE OF THE WHOLE ON SUPPLY
Ms. Suzanne Lohnes-Croft
MADAM CHAIRMAN: Order. I call the Committee of the Whole on Supply to order.
The honourable Deputy Government House Leader.
MR. KEITH IRVING: Madam Chairman, would you please call the continuation of estimates for the Minister of Health and Wellness.
MADAM CHAIRMAN: We will continue with the estimates of the Minister of Health and Wellness.
The honourable member for Cape Breton Centre, you have 42 minutes remaining.
MS. TAMMY MARTIN: Thank you, Madam Chairman. Today I’d like to start off talking a little bit about mental health. In the Budget Speech, the Minister of Finance and Treasury Board announced $2.9 million more for mental health services. I would like to ask the Minister of Health and Wellness if he could break that down and explain how it will be spent and where we’re going to see it.
HON. RANDY DELOREY: Of the $2.9 million increased investment, on top of the almost $300 million that we do invest towards mental health services in the province, $1.1 million is earmarked for 10 additional mental health clinicians. We’re looking at five adult and five youth/adolescent clinicians. That is on top of the investments we expanded there in 2017-18, but it is part of our commitment to hire 35 clinicians, from our government platform.
In addition to that, we have about $800,000 for the IWK Telehealth Outreach. This is part of expanding the $700,000 investment from 2017-18 to move and make the expertise of the IWK mental health clinicians more available across the province through the use of technology. In addition, we’re looking at $523,000 for First Nations child and youth clinicians, these are annualized now from investments to cover the costs of these positions. Then organizations like the CaperBase expansions in Northern and Western Zones is about $518,000. Those four initiatives total $2,941,000.
MS. MARTIN: Thank you to the minister for that answer. Of the new 10 positions that you’ve mentioned - five youth and five adult - where will the youth and adult clinicians be located and what facilities will they work in?
MR. DELOREY: At this point of the budgeting process we recognize the needs of mental health clinicians throughout the province. Our partners with the Nova Scotia Health Authority and IWK and others exist to deliver these services. At this point in the year we’ve allocated the budget, this money will flow through to partners to deliver the services. We haven’t identified with them the specific communities, but we have no doubt that these additional resources will go to Nova Scotians to provide services that are needed.
Again, we don’t have the specific locations identified now - we create the budget and have identified that we have the money available. All of us in this Legislature know the need is available within the province. We’ve identified, made the financial resources available and will work with our partners to make sure they get put to use in Nova Scotia.
MS. MARTIN: Hiring these new 10 mental health clinicians - what will be included in their scope of practice and what will be the training and/or requirements they require in order to do this?
MR. DELOREY: As with the specific location, the specific scope would be built based upon the job posting when it becomes available, but in a general sense the nature of these positions would be your community-based clinicians. You’d be looking at services and supports that could be anything from social work, psychologists type of supports that are being provided. We know we have a number of psychiatrist positions that are already posted and available, so we know we have vacancies there that we’re working to support. These would be in addition to those vacancies; these are new outreach community-based clinician support, again, more on that social worker, psychologist skill set, but the specific job postings will come as the specific postings are identified and customized to each community when they get rolled out.
MS. MARTIN: So, in order to access these new mental health clinicians, will they have to go through mental health and the whole referral process and the waiting, or is this going to jump over that process?
MR. DELOREY: Again, it would depend on each specific situation. There are circumstances where these positions may be attached to a collaborative care team, for example, as part of delivery in the community space. They could be attached to a third party provider or they could be part of the Nova Scotia Health Authority within a setting for delivering services.
I think in terms of how the service would be accessed by community members in a particular community, again we’re still working through those specific details with our partners as part of the rollout.
At this stage, at the beginning of the fiscal year, we go through the budget. This is step one where we, as a government, identify the financial resources we have available to roll out. We certainly, as part of my role as Minister of Health and Wellness, made it known that when I came into office one of my top three priority areas was mental health. That’s a priority shared by the government and, I believe, by all Nova Scotians and all members in this Legislature, we need to do more.
That’s why when we were working to put together a budget for the Department of Health and Wellness I advocated to ensure we continued to expand our investments there. These positions fit within that scope, but we do work with our partners as far as the front-line delivery. We announced the budget, we don’t necessarily deliver and provide the budgets that we have available with the partners wholly. We certainly engage them to find out what type of needs they anticipate and we work to prioritize and get the funding available.
Again, the very specific parts of getting the positions posted and in the communities and how they’ll be rolled out and, thus, accessible will be part of that work that we’ll be doing with our partners in the coming weeks and months.
MS. MARTIN; So briefly, just to focus on something the minister said there, what would be an example of the third party provider?
MR. DELOREY: The Nova Scotia Health Authority would be a third party from us, but other providers would be like CaperBase, an organization that provides - we provide and fund positions. We have resources in women’s health centres, the Antigonish Women’s Resource Centre in my own community, Madam Chairman. These would be examples of third party organizations which funding does flow sometimes through the global Department of Health and Wellness budget, but a significant portion of what is recognized in the government’s budget under the Department of Health and Wellness really flows through to our partners at the health authorities, the Nova Scotia Health Authority and the IWK, and some portion of the funds that flow to our health authorities do flow out and they support third party organizations out in the community, as I said, CaperBase would be an example, women’s resource centres like the Antigonish Women’s Resource Centre in my own community, do receive some funding for some counselling type services and supports as well.
MS. MARTIN: Thank you to the minister for that answer. The minister mentioned that mental health, some of the funding would be part of the collaborative care teams going forward. I have a couple of questions in relation to that statement. From what I understand, typically, Bachelor of Social Work employees are those who would be providing the mental health services at the collaborative care centres.
I guess I’m trying to get at what level of service that any patient of a collaborative care team would be able to receive from somebody who has a Bachelor of Social Work as opposed to a Master’s in Social Work?
Actually, we’ll go with that first and then I’ll follow up.
MR. DELOREY: A couple of things. I think I used the example that it could potentially - it didn’t mean that the positions would be necessarily rolling out through collaborative teams. Certainly, our investments and commitments to collaborative care teams is a separate commitment and investment. When I used the example that clinicians in the community could be providing supports through collaborative teams, I was using that as an illustration of the delivery of mental health services by clinicians in the community, not necessarily, because again, the decisions as to where and how these 10 positions are going to be rolled out haven’t been made yet.
So, Madam Chairman, I just wanted to make that clarification, that it’s not that these 10 positions will show up in the collaborative care teams. We do have other funding specifically towards collaborative care teams, which could, again depending on the makeup and the proposals for those practices, may include those services.
To answer the question about qualifications and the role of social workers in regard to collaborative care teams, Madam Chairman, what you see with your social workers often, we recognize the role of social determinants of health, the role that sometimes help navigate the systems and supports in that regard is a role that social workers and people with a social work background are able to provide.
So, helping to navigate systems, helping to make sure that individuals receive, and are able to connect with the appropriate supports, whether they are health-related or sometimes, again, if you tap in to the underlying social determinants, it may be income, and supports that might be provided from some other departments, like Community Services, housing and others, that may be affecting one’s, you know, whether it’s mental health or addictions, or other broader health conditions that they may have. That’s the role that we see, I believe, in a large part, much of the work of the social workers attached to primary care teams in the community have a tendency to play and interact with the patients and the health care providing team.
So, it’s that nature of the role - and the other thing to note is there are master’s programs around mental health services as well, within social work, where it has more specialization. So, it’s not to say that these positions are necessarily limited or restricted to individuals with a bachelor’s degree, more broad training in social work, but also, certainly, some positions may be posted again, depending on the needs in that community. It may require further education, and may require at times a master’s degree. As I said, we’re trying to be flexible in the rollout of our collaborative care teams, we’re trying to work with and understand the needs within communities, and the teams that are coming together to deliver those important primary care services for Nova Scotians.
MS. MARTIN: So, having said that, I would ask then, would the minister agree, or confirm, that if a patient is accessing a collaborative care centre they are not actually receiving therapeutic counselling services, so then still will need to be referred to mental health within the NSHA, and then going through, as an example, the 353-day wait in Cape Breton?
MR. DELOREY: Again, the nature and the supports that are needed depends on a case-by-case basis and the underlying causes and needs of the support. So, for example, if in a hypothetical, and I’m loath to get into hypothetical situations, but if an individual’s anxiety and stresses are found to be heavily influenced based upon financial pressures, housing insecurity, or what have you, then addressing the underlying cause of that housing insecurity, or what have you, may very much directly go towards the support that the individual needs to address their mental health condition and challenges.
So, I disagree with the member, Madam Chairman, to suggest that if they were to receive care and support by someone with social work, as a member of a collaborative care team, that the services they provide do not have a direct impact on the care that they may require.
MS. MARTIN: To clarify - I wasn’t questioning the level of care that a Bachelor of Social Work could give, but should the care require more intensive treatment, then I guess my point is they would still have to go through the referral process to mental health within the NSHA and wait possibly 353 days in Cape Breton.
MR. DELOREY: I thank the member for that clarification. So, to that regard in terms of if the level of care does exceed the scope of the training of a particular social worker and/or the nature of the needs expand beyond that scope, of course there may be a need to escalate to individuals with a broader scope or more specific scope of practice around aspects of therapeutic services.
But, Madam Chairman, to some degree, depending on the makeup of the collaborative practice in that case, there may be other team members who can provide those services within the team, whether it’s the family physician or others within the team, perhaps a psychologist as part of the family practice team, so that is an aspect.
Again, anticipating that the member may say what if the needs of an individual client, patient, exceeds the scope of practice of that psychologist, well, of course, then it needs to escalate and eventually, Madam Chairman, yes in some cases the needs may require the services of a psychiatrist and indeed, in some cases, one could say well if it’s a general psychiatrist, perhaps those needs extend and you need a specialist, a youth psychiatrist with specialties in youth and adolescents. All of that is theoretically possible and that is the way the system works - you try to maximize the scope of practice at each level.
What I want to highlight, though, for the member opposite because she continues to reference the wait-list for specialized services, is how the expansion at the base level can identify and provide supports to many Nova Scotians who do not. So, I’m just flipping the member’s question on its head and saying rather than hypothesizing about those Nova Scotians who need the higher level of support, let me flip this on its head and illustrate how, by providing collaborative teams and providing clinicians, whether social workers or others, who can provide those supports, by volume we’ll be serving many Nova Scotians who can receive the level of support they require, which do not require the supports of higher level scopes of practice.
In doing that, Madam Chairman, is where we will see Nova Scotians reducing the pressure on those upper-tier specialties and therapeutic services, and thereby reducing and serving and providing the services the people need earlier, with people who have the appropriate scope of practice, we can reduce the pressure then on those more specialized areas. Again, it’s all about interrelation and looking at the services as a system as a whole and how they interact.
Again, I just want to flip the member’s scenario and a hypothetical situation on its head and show how by treating more people earlier in the system, we will actually be reducing the pressures on the system up higher.
MS. MARTIN: Thank you to the minister for that. Yes, I completely agree that broader help is absolutely pertinent in assisting all facets of this health care crisis. However, as a rule, will collaborative care centres provide therapeutic counselling?
MR. DELOREY: One of the things early on in the development, back in 2015, of the Nova Scotia Health Authority when they started engaging in conversations with health care professionals about a more formal approach to collaborative practices throughout the province, it’s my understanding as the MLA for an area - because I engaged in some conversations with local physicians so this is not something that came to me through my role as minister, but as an MLA - that those initial conversations spoke about, for lack of a better terminology, a “cookie-cutter” approach to collaborative practices.
Each practice will, to the member’s question, I believe you used the language, as a standard practice or would they have these services - that was what was originally being designed, a cookie-cutter approach that every collaborative practice will have this many of this position and this many of that position and that would build a collaborative team.
Madam Chairman, what feedback was received from clinicians on the front line and communities across the province was that a cookie-cutter approach to those services was not necessarily appropriate; it was not the right way to move forward. That flexibility to allow teams to understand the needs of their community, to understand the strengths and the weaknesses of the team members that are there, that is how to build a collaborative team. So, that level of flexibility, such that teams will step forward.
So, there is no, as I think the member used language along the lines of “as a standard practice,” there isn’t a standard practice in so much as defining and requiring it, but certainly we recognize in the potential for scope of practice and skills, and services delivered, it is an option for collaborative teams to pursue, and engage in pursuing services. Again, that could be through social workers to provide some of the social determinants and navigating services, and possibly with others to partner and provide other types of therapeutic supports.
MS. MARTIN: I’d like to ask the minister then if you can table the 50th and 90th percentile wait times between first-choice appointment and admission to mental health community-based services?
MR. DELOREY: I don’t believe I have that specific detail here with me, Madam Chairman, but we’ll look into what information we do have to pass along to the member.
MS. MARTIN: I thank the minister for that, and I would expect his answer will be along the same lines, so if I could put this on your little sheet of paper as well - if you could table the percentage of patients admitted to the mental health community-based programs within six weeks of their first intake appointment.
MR. DELOREY: Madam Chairman, and I’m just jotting down some notes there. So, I just want to confirm, the first question was the 50th and 90th percentile for therapeutic services from their point of request, from their first appointment; and the second one, I was just trying to write that down, so if I could just ask the member to please repeat the second question - sorry.
MS. MARTIN: No worries - table the percentage of patients admitted to mental health community programs within six weeks of their initial appointment, their initial intake appointment.
MR. DELOREY: So, just to confirm that I’ve jotted that down correctly - the percentage of intakes that have received their community program access within six weeks from their initial intake appointment. Just to confirm, if the member could, what her definition from the intake point, just to make sure that I have that, is that from the first call to a crisis centre, an emergency room presentation or with a family physician, just want to know where exactly the line is for the start, because to pull that type of data might become challenging because there are many spots - that’s one of the things we are working on with the central intake system, Madam Chairman, to have a single point of entry for the mental health clinician.
So, that work is continuing with the amalgamations of processes and policies across what were nine boards formerly. So, they have much of the work done to standardize the approaches and the forms, and some of the technology in the back end to ensure the system is coming through.
That work is continuing; we think it’s an important part, Madam Chairman, of the delivery of consistent, efficient, and effective mental health services across the province, the work is continuing and ongoing. So, again, the ability to fully establish that, unless we clarify perhaps a little bit on what we mean by the intake appointment, whether or not we will be able to get exactly what the member is asking, but we can look at the data we have and get as close to what she’s looking for as possible.
MS. MARTIN: So, in the first question, it was between their first-choice appointment and admission to mental health community-based services. The second one was the percentage of patients admitted to the mental health community-based programs within six weeks of their initial intake appointment.
I’d like to continue and talk about the mental health strategy and the milestones on our journey. So, according to the milestones, the mental health and addictions system is operating with a capacity of 41,000 Nova Scotians - that was based in 2014-15. That means 66 per cent of people in Nova Scotia are in need of care or support or accessing these services.
So, I’d like to ask the minister, what is the mental health strategy and when will we see mental health service delivery to this province? As stated in the milestones report, it’s not a strategy, the goal of the milestone is to create a health service plan in conjunction with the IWK, government, and other health sectors. The report does not contain however a finished product, and we recognize that they also stated that things will not change overnight, but in order to improve the quality for Nova Scotians a mental health strategy needs to be invested in and initiated.
So, I would like to ask the minister if he could explain the strategy and when and where we can expect this?
MR. DELOREY: Madam Chairman, I thank the member. This is actually a very important question and I appreciate the opportunity to take a few minutes because there are actually two different initiatives that the member has brought up here. One, she made reference to the Together We Can Strategy, which, again, I’ll publicly recognize was brought in under the previous government, the New Democratic Government - I believe the current NDP House Leader may have been Minister of Health and Wellness at the time that came in.
One of the things that that strategy, in reviewing not just the work and the initiatives that were being done, was there was a lot of work on the front end of identifying some of the core principles and themes of why and what is needed in mental health broadly, and in looking at that there’s a lot of work that was done in that, a lot of consultation and really what held true in I believe 2012 or 2013 - yes, I can’t remember exactly which time of year when that was introduced but it was either 2012 or very early 2013 when that was introduced - that it holds true today, we find much of that work holds true.
Where you see evolution is within the Together We Can Strategy identifying some milestones and specific initiatives that were invested in and steps taken to move the yardstick, so to speak, on very specific actions because that’s what I think, that that strategy - little bit oversimplification here - has a really strong foundation built on the principles and the underlying kind of mission and vision for mental health and that holds true as much today, I believe, as it did when it first came out, and then it had some very specific action items associated with it.
What I can say, Madam Chairman, about that document is that we continue to invest in these initiatives and move forward on those action items identified. Many of them become embedded then into the operations of mental health services throughout the province, which is a good thing - but do they necessarily continue to be then action items once you’ve pulled them, if you put them in and they become part of your operations?
What we also know - and I’m going to just step sideways a little bit - since then in addition to continuing the work on the Together We Can Strategy, my predecessor, the current Minister of Communities, Culture and Heritage, the member for Kings West, established a mental health advisory panel for the minister. That panel did a lot of work, made a number of recommendations, very specific recommendations, about action items that the government should pursue. So, those are some other action items that are not necessarily reflected. They still are reflected in the themes and the principles of the strategy but they are a different set of action items and principles.
In addition, we know that when I first came into this role there were circumstances that resulted in reaching out to Dr. Stan Kutcher to look at a very specific unfortunate situation in Cape Breton. He engaged with community and health care professionals in that region and came up with a number of recommendations, some specific to Cape Breton and some that were more broadly associated to the province as a whole, very specific, task-oriented action. Those in and of themselves I wouldn’t stipulate represent a strategy.
The work that is ongoing in the department is really looking at bridging the Together We Can Strategy and really updating the actions portion of that to be established as the strategy for the province on a go-forward basis. Again, recognizing the principles and themes rather than going out and spending a huge portion of time to redo work that has already been done that we believe still holds as true today as it did under the previous government, keep that foundational piece but update the actions portions of it.
That work and review is under way and we’ll continue to focus. I think it’s the type of thing where to be most effective we continue to recognize that as we progress in some areas, we do continue to take the time to look at and evaluate what’s going on and what other things can be done to move forward.
We’ve been doing that work, both under my predecessor and myself, to identify - I know the members are anxious to see a specific something they can call a strategy document, but again our focus has been taking action, moving on these things. We weren’t waiting to embed a new formal strategy document to take action on some of these initiatives like recommendations to look at central intake processes, expanding supports in our school system. We didn’t want to wait until we had a formal document; we’re taking those steps now but it doesn’t mean we can’t further embed into that document.
The second piece that the member brought up was the NSHA’s work around mental health and their plan. That’s more operational as to the NSHA initiatives within mental health space. Although related and there’s overlap perhaps in some of the specific action items that may influence and provide direction to the NSHA, their document was not meant to replace or override, but rather to run in parallel initiatives.
I hope that clarifies for the member the difference between the document she was referencing from the NSHA and the Together We Can. Also, I hope it provided some insight that in fact the Together We Can and the work around that initiative is ongoing. It does help, but it also is evolving, more like a living organic document whereas we get more recommendation and feedback from experts, as I said the minister’s panel on mental health, Dr. Kutcher in his investigation in Cape Breton and those recommendations - all of these serve to help guide us in the decisions and the investments we make in mental health services.
MS. MARTIN: I’m pleased to hear the minister say that it’s a living organic document and that evaluation is done. I wonder, could the minister provide us with a report from the evaluation from the Together We Can Strategy, as well as provide us with a list of who served on the minister’s panel?
MR. DELOREY: The list on the panel, I believe it’s public, I’ll have to pull the full list of names, I can certainly pass that along to the member. I can say it is co-chaired by Dr. Stan Kutcher and Starr Cunningham, both very well known in the mental health space in Nova Scotia, for their work, technical and advocacy and awareness building. In addition, the membership is made up of individuals - I won’t list all of the names because I don’t have them all off the top of my head.
The members do make up, some with clinical expertise, technical expertise, there are representatives from community - individuals who represent individuals who actually have mental health conditions, self-identified to provide input from the patient perspective - there are representatives from our health authorities, so it really brought together a wide range of stakeholders that represented the interests.
When I talk about the review of the Together We Can Strategy, that is really my review and the work that I was doing in reviewing the document. It is not, what I would say, a formalized review, as the member would be expecting. This is my assessment of the document saying that those foundations do rest very solid - so working with the deputy to really say I know that as we are running into the final year of what would be the Together We Can Strategy, from the duration that was identified in the document.
I think questions similar to this came up with one of my colleagues, the Minister of Finance and Treasury Board, when talking about the gambling strategy. The minister mentioned in that question from QP last week that, although the strategy has a time period associated with it the guidelines identified did not change, and following those practices and guidelines are still in effect.
Just because a document was initiated and said it would take a particular period of time - that’s why what I was hoping in my previous response where I highlighted that although we as a government didn’t stipulate something formalized that says this is a Together We Can, Version 2.0, it didn’t stop us from actually pursuing getting information, being engaged with experts and being engaged with community professionals to learn more, to get that information, to get those recommendations, or to take those action initiatives.
You can see some of those recommendations reflected in the approach where we are targeting investments. Community-based mental health was a big part of it, and youth-based mental health initiatives were a big part of recommendations that have come in.
All of those are things we know are identified and we’ve been pursuing. To my point, if people are looking for something more formalized, the work that I was saying is consolidating - okay, what are the items that we’ve taken that are now fully operationalized - really, just part of the way that we operate in mental health services, and what are those things that we still have work to do that we can associate.
We know we are tracking internally the recommendations and trying to pursue and take steps towards them, but we will line those up and keep them moving forward.
I do have some of the other members – to the member’s previous question – Dr. Stan Kutcher and Starr Cunningham are the co-chairs. Dr. Allan Abbass, Nancy Beck, Joe Bishara, Sharyn Chapman, Sara Ramsay, and Todd Leader were all members on that Minister’s Mental Health Innovation Panel.
MS. MARTIN: I have a few questions left on mental health, but I really don’t think we have the time to get into them yet, because they are pretty important.
I’m wondering if you could maybe tell this House if there are mental health grants that still exist – who would be receiving them and what is the amount? Particularly – well, not particularly, I’m interested in all of them, but I was very disheartened to hear from a group in Cape Breton – Bereaved Families of Cape Breton – that they have absolutely no funding. The valuable services that they provide to bereaved members of our community are at risk of closing. I guess I am looking for some justification for where money goes, if there is any money, to any mental health grants and what they are.
MR. DELOREY: Certainly, we do continue to support and have grants to support mental health organizations across the province.
As is the case with many mental health programs, a grant is an application-based initiative, so as applications come through and get reviewed, funding decisions are made.
I am quite familiar with the organization that the member referenced and I know that it is an organization in the member’s community. I know the work they do and how important that is to community members, and thus, the MLA for the region, for the member.
What I may suggest though, Madam Chairman, is that the details surrounding that specific organization, the member may wish to pick that conversation up offline with me, as opposed to one here, as I note there’s only a minute or two left in this round of questioning. I’d certainly be happy to fill the member in on those details that are pertinent to her community and continue those discussions.
I can assure her that the organization has reached out to the department. Staff have been in touch with the organization for a number of months, working with them on their funding. I know they had received grant funding in the past for some programming and some initiatives that they were to pursue so that’s when it came to my attention. We certainly hope and wish them the best of success in getting these programs from the grants that we provide to them off the ground.
We recognize that bereavement services can have impacts and, Madam Chairman, as they relate to mental health, I’ll just let the member know that in 2013 during the campaign, mental health, I’ve spoken before in this Legislature, was an issue that was very near and dear to me. It came up in Antigonish. One of the examples or situations was where actually a good friend, a colleague of my wife and one of my son’s friends from sports teams, her father was struck with a significant bout of depression. This depression, as it went through the process and was diagnosed, turned out to be a delayed response to bereavement and grieving for his spouse who had passed away two years earlier, so I do recognize the impacts on mental health.
MADAM CHAIRMAN: Order. The time has elapsed for the NDP. We will turn it over to the PC caucus.
The honourable member for Kings North.
MR. JOHN LOHR: Thank you, Madam Chairman. Mr. Minister, it’s a pleasure to have a few moments to ask you questions. I guess the first one I would ask is if you want a five-minute recess. No, none of that? Okay, good.
The first thing I would like to ask about of course is I would say that I guess we recognize the profound importance of the health care certainly in our budget and in terms of our population, and people are very interested in this file and it profoundly affects their lives.
I have spoken about dialysis before in this House and the Valley Regional Hospital, so I’m just wondering, Mr. Minister, if you can give us an update on where dialysis is for the Valley Regional Hospital and what we can expect so my constituents can know what to expect.
MADAM CHAIRMAN: I’d like to remind members in the Chamber to keep the chatter down, please.
MR. DELOREY: Madam Chairman, I thank the member for his question. The Valley Regional Hospital in Kentville was one of the dialysis sites identified when the review, based upon information and feedback from a renal committee and going through the capital process, so I know this has been work that’s ongoing. The first phase was a design.
In the 2018-19 budget we have $5.7 million allocated for the construction of the site. If you haven’t seen ground broken, you should see it in the not-too-distant future. The funding is there. That’s the stage the project is at - the design has been done, it has been signed off and construction would be under way, or nearly under way, at that Kentville site.
MR. LOHR: I thank the minister for that answer. I guess the next question would simply be, is there a breakdown on what the money is being spent for - what part of that is the actual machinery and what part of that is the construction of the physical space? That would be the question.
MR. DELOREY: Madam Chairman, so, two answers to that question about how much is capital equipment, that would be the physical chairs and the equipment that performs the dialysis versus the, I’ll say, the bricks and mortar, so equipment versus bricks and mortar. So, the two answers – one is the details that I bring forward are more traditional income statements that show our expenditures, you know, year over year as opposed to at that level of project detail, but the other side of that coin is we do know we have a number of dialysis projects ongoing and committed in the province that there may be some sensitivity to disclosing at too finite a level of detail how the project costs and costs for pieces of equipment because we will be tendering for some other sites as well.
As the member may know, in this year’s budget we have the $5.7 million in construction for Kentville; that’s a continuation of the about $3 million that went towards construction last year. So, there’s that work, and there’s another $4 million allocated in 2018-19 for the Digby dialysis, but then we have three sites, the Halifax Infirmary, Dartmouth General Hospital, and Glace Bay Hospital, which all have money allocated in this fiscal year for the design work. So, again, just where our fees for the construction work and work will be ongoing are coming up for some other sites, we don’t necessarily want to get into that space, hoping to get the best value for Nova Scotians through the tendering process.
MR. LOHR: Madam Chairman, I guess I would ask the minister, is there an expected number of chairs that will be available or a range of chairs that will be put into Kentville - does he have that information?
MR. DELOREY: Yes, Madam Chairman, I do have that information. So, for the Kentville site which is Valley Regional Hospital which is in the Western Zone of the province, currently there are no dialysis chairs available and it will be a 12-chair expansion. So, those will be 12 new chairs providing services to people in that part of the province.
MR. LOHR: Madam Chairman, the second project I guess for Valley Regional Hospital or that area that I would like to ask about is the hospice. I know that design work is being done. As the minister knows, the fundraising was done some time ago. I believe the design work is in progress or nearly done. The site has been selected which is near Beacon House. I’m just wondering if the minister can shed any light on when ground will be broken on the hospice or when the plan is to have the hospice operational in the Annapolis Valley.
MR. DELOREY: Madam Chairman, I’m just going to make one more comment on the dialysis and then I’ll answer the question about hospice at the Valley Regional Hospital.
I just wanted to note I made reference to the 12 chairs. I know that was the question and of interest to the member, but for the interest of other members, if I may expand, those 12 new chairs, they will be part of 53 additional chairs. So, of all of the sites that I’ve already mentioned across the province, really, we’re expecting an expansion of 53 sites. So, of the 53 across the province that have already been announced and committed to, 12 of them will be at the Valley Regional Hospital in Kentville and that 53 chairs is an expansion of the - I believe we’re looking at the existing, we have about 150 chairs across the province with an expansion of 50 additional chairs.
So, to the hospice site as part of the provincial hospice program - we know that Halifax and the Valley Kentville site are proceeding, and we expect the Kentville Valley site to be completed some time in the summer of 2019, so probably still another year or year and a half away from completion of that particular project.
MR. LOHR: Okay, I appreciate the answer. I think there’s an expectation in the Valley that construction will begin on the hospice this year and these things don’t normally take that long to build or it’s not that big a build - it’s not huge, by any means. Can the minister elaborate on why we expect it to be finished in 2019, maybe give some insight on why not 2018?
MR. DELOREY: I don’t have the specific details of how quickly the project work could theoretically be done, based upon the design and the commitments and the fundraising that has to go in. I think the member would know there are a lot of variables at play, again lining up the fundraising commitments or lining up the site and then the work and the tendering process.
I don’t have specifics, I’ll check in with the project team from our side and perhaps pass that on to the member after I get that update from staff.
MR. LOHR: I guess if I can make that a request that I do get an update on that specifically from your department. I don’t know, I realize the minister can’t know every single thing going on in health care but the reality is the fundraising. The community did their share of the fundraising, it was completed four or five years ago - or more. I realize the minister may not be apprised of that. The community would not take well to hearing that there was still more fundraising to do; it has been done for quite some time. So, I just point that out.
If I can request that an update on the hospice be given, with detail, I’d really appreciate that. Thank you - I see the minister nodding his head.
Another issue in the Annapolis Valley which has really bitten in the last six months is the doctor shortage. I think we’ve been privileged, or blessed maybe, that we have not really felt that doctor shortage in the Annapolis Valley that some regions have already been experiencing for a number of years. We have been relatively okay in the Kings County area of the Valley anyway, I will say that.
But, in the last six months, as the minister would be aware, I think there has been an estimated 10,000 who lost their family doctor and it has caused some heartbreaking circumstances. I’m wondering if the minister can shed light on what specifically he sees his department doing to solve the issues of the doctor shortage in the Annapolis Valley.
MR. DELOREY: Madam Chairman, I can tell the member that when I was touring the province in August and September one of the stops I had was at Valley Regional Hospital. One of the meetings that took place included one with a new recruit, a new family physician who had recently completed her residency and had committed to staying in the region to practise.
The reason I make note of that particular case is to show the success and how much people do value the Valley region and the support of the community and their colleagues. This individual happened to be from Antigonish so I think the member can imagine how a Health and Wellness Minister going around the province, talking to people about physician recruitment, to find out that someone from my hometown was choosing the Valley over Antigonish. (Interruption) The member lives down in the Valley, he says spend some more time down here and I might understand - but I assure the member that if he spent some more time in Antigonish that he would understand why I don’t think I would come to that same conclusion, but we all do value it.
What I will tell the member is that having the conversation with that physician, she certainly highlighted two things that really contributed to her decision. One was, as I’ve said in the Legislature before, consistent with information that I’ve stated before that I learned from residents and part of it was she had done her residency program in the area so really spent two years or so working and building relationships in the community, professional contacts and so on. There was a comfort level with continuing and the opportunity to stay and practice, so I think that is a contributing factor.
For the member and others to be aware, when I talk about these residency programs and the value of having residency seats in parts of the province outside of metro, when a physician practises in an area they are more likely to stay in that area for a number of reasons - they are already established, they spent two or three years with that training, building professional relationships and personal relationships, and so on.
The other thing for this particular physician - she had indicated that there were three or four of them in her residency cohort who, within a year or two, were all finishing up and working in that area, and positions became available for all of them. It wasn’t just one, but I think there were actually four, who within not too much of a time period difference, established themselves in that community.
Part of that relationship was, I was not going to be alone as a new physician coming to that community. We are going to be a team; we’re going to be here to support each other for the long haul, so there was an advantage. Also, within that community, some of those new physicians who have come to town, in a way, have come to town as a cohort and are committed to that community. These are young physicians committed to the community and committed to their practice.
Those are the things that I know the community has to help them with their recruitment. We know that there was a recent article talking about a nurse practitioner - the member asked about family physicians, but the nurse practitioner was talking about how welcoming the Kentville area was, as well. These are all things that are important to the recruitment, specifically to, in this case, the Valley region, but anywhere in the province.
As far as the province, we are doing a number of things working with our partner, the NSHA, that does the actual recruitment of physicians across the province. We’ve expanded our residency program. There’s a commitment there that we’ve indicated because we know 75 per cent of residents tend to stay in the province, so with those additional seats we will see more physicians training and thus staying in the province.
Not to mention the fact that we are the, or one of the, only provinces expanding residency seats across the country, which draws some attention in a positive affinity. I know the members opposite often like to highlight the negative publicity that comes out and is often articulated in the province about the challenges in our health care system, but this is a positive one that is being recognized by people across the province saying that Nova Scotia recognizes the value of residents and the role they play in their training, and that we want them to continue to provide service after they finish that training. I think that is something that will serve the area for the member and across the province, as well.
We recognize our incentive programs need to be more flexible, so we have made them more flexible for people. We’ve been more flexible with physicians choosing where they practise and, more recently, we’ve committed about $40 million towards programs and compensation initiatives for physicians.
On top of all of that, we also recognize that as important as physicians are, primary care services can be provided by other health care professionals – folks on collaborative care practices - expanding those. We are investing more money in that this year.
We are going to get primary care, and we will continue to invest and work with our partners through all health care professions, including physicians in the Valley, but right across the province.
MR. LOHR: Is there a plan to establish a collaborative care model at Valley Regional or in Kentville?
MR. DELOREY: I will direct the member’s attention to - I believe it was March 5th or March 8th - when I made an announcement updating collaborative care practices across the province. In that announcement I did make reference to two sites in Kentville that would be receiving nurse practitioners and, I believe, family practice nurses, as well. There will be two family practice nurses and two nurse practitioners.
MR. LOHR: Another issue which has come up, Mr. Minister, which you may or may not know, is that we have a number of doctors in our community who have come from, not from the Dalhousie University program, but from a school in the Caribbean called Saba. Saba is an island, but there’s a medical university, and in fact there are a number of medical universities in the Caribbean. We’ve been particularly well-served by these, and I know these doctors and I know that there are some issues sometimes, getting residency spots for Saba doctors, or international doctors, and there’s some frustration that the system seems to be more geared toward Dalhousie than to these other schools. Yet, I can tell you, that in our community they are very highly thought of, the doctors from Saba.
I’m just wondering if you could comment on that, and what do you see your department doing to create more openings for these doctors who are from other schools, or the Caribbean?
MR. DELOREY: The training and credentialing, it would work in that order, of physicians and health care providers is in some ways, you know, simple in theory, but more complex in practice I guess, Madam Chairman.
So, what the member is asking about is international medical graduates. He used a specific example of one particular school in one particular area, but the process wouldn’t be restricted any different for that site than other international medical schools. So, for the benefit of all members, just to talk a little bit about what the process is, and that background is important, Madam Chairman, because it helps to understand why what would seem to be simple solutions are not simple to implement, because it could have unintended consequences.
So, I can understand the member’s question, and the question that he likely receives Madam Chairman, from members in his own community, especially if there are community members, youth from the community who may have attended a school at one of these international sites, as to why they can’t come home to get their training, and if they did get their residency training somewhere else in the world, why they can’t come home and practise.
So, it is important to understand a bit of the background; I’ll try to do that at a very high level. First of all, the credentialing and licensing of physicians in Canada is done at the national and the provincial level. So, really, it’s at the provincial level where it officially takes place, and it’s done through a self-regulated body called the College of Physicians and Surgeons. That is the same in all provinces across the country. However, Madam Chairman, within that space there’s also a national organization that works to ensure that these colleges actually work and have expectations that are consistent, and they recognize the credentialing of each other.
One of the ways that they go about doing that, Madam Chairman, is through the training programs that exist; the medical schools and residency training programs are actually coordinated nationally.
So, in fact, although Nova Scotia has a Dalhousie Medical School that provides medical education to students, and then also has a residency program to provide the training after students graduate, I’ll say the classroom portion of their education, the residency seats that are funded and made available are part of a national pool of residency seats. So, as part of the effort to ensure the medical education and training are consistent across the country, they are part of a national pool of residency seats.
That process ensures that people, potential resident students who are applying for their residency, put in their preferences, they identify their preferences, provinces through their medical schools, identify the nature of the residency seats, whether they’re specialist seats and how many in each specialty area, as well as family practice seats that they have available, and they put them in the system - and it’s like a matchmaking service.
They go through a few rounds; where they have a match on the first time through, then a resident is assigned to a seat, but a student at Dalhousie isn’t guaranteed a Nova Scotia residency seat. They apply and if they choose Dalhousie, or Nova Scotia as their first choice and things line up, they get that seat, but if they choose to go to another province and they line up as a preference, because maybe that’s where their home province is, they could be applying there. Just like a Nova Scotia student who may have attended school in Ontario or Quebec, may apply to have their residency seat filled in Nova Scotia, and they would have an equal opportunity.
Residency seats, as I said before in my response to recruitment, many provinces in recent time have been actually reducing the number of residency seats across the country. Nova Scotia is one of, if not the only province to be expanding residency seats, because we recognize the importance and the opportunity that this provides.
So, that’s kind of the fact that there’s not an easy mechanism. As I said at the top, the reason for understanding how it’s related as, you know, the provincial residency seats but the part of a national program, if we were to, as a province, say we want to take full ownership and manage our own residency seats. I just play that scenario out for the members of the Legislature, Madam Chairman. Imagine if we were to do that.
It’s kind of like, perhaps, NAFTA negotiations a little bit. Right now, we have free trade of residents across the country, if we start to do that we would become a bit protectionist, and if we were to do that, then the question is, would the rest of the provinces in the country recognize students that are trained in Nova Scotia? Conversely, would Nova Scotia’s College of Physicians and Surgeons, as we start to become more protectionist and going off on our own path, would Nova Scotia continue to recognize other provinces’ training programs if you started to diverge?
So, these are some of the risks in what I believe would be unintended consequences of an overly simplistic response to say we pay for residency seats so we should make sure Nova Scotians get those seats. Well, every other province could start doing the exact same thing, and where would we stand then? We would be limited to only Nova Scotia students from Dalhousie as opposed to the broader national and international market.
So, I know that was a lengthy response, but it is a complex process. We recognize where we can move levers in that space to try to make Nova Scotia more attractive, provide more opportunities for both Nova Scotia students, national students and, with additional seats if there’s capacity, international students to fill those residency seats as well.
MR. LOHR: I appreciate the lengthy answer. I know it was a rhetorical question, where would we stand then, but where we stand now isn’t all that great either, Mr. Minister. So, where we are standing is with 100,000 residents of Nova Scotia without a family doctor. So, where would we stand then? I don’t know, but where we are standing is not that great either.
So, I do want to hand it over to my colleague the member for Sydney River-Mira-Louisbourg, but I want to ask one more question.
I met with some constituents, some people from Yarmouth this past week. Lyme disease is a huge issue down in Yarmouth, it’s getting worse in the Valley floor. Just driving here today I was talking to a constituent of mine who has Lyme disease, he has been one of the people who has gone to the U.S., he is getting his drugs that he needs and have altered his life, literally saved his life, coming across the border. I know this is about medical protocols.
Can the minister tell me - I know he’s aware of the issue - can the minister tell me what’s being done to bring the U.S. treatment plan into Canada? I just want to put it on the record. My friend who was going to the U.S., I said to him, what does it cost you to go to the U.S. and do that, and he said it’s about a $2,500 bill and that gives him three months’ worth of drugs - $2,500 was about $500 worth of travel, and seeing the doctor in the U.S at about $1,500 to $2,000 worth of meds.
So, we’re talking about $1,500 to $2,000 Canadian, was keeping this guy alive for three months, changing his life. Really, and the evidence was right there in front of me, I knew what he looked like before, and so it’s not super expensive to follow this U.S. protocol too. I just want to put that on the record. I was shocked at how inexpensive it was compared to many things we treat.
So, that would be my final question, I would just like the minister to explain what’s going on with Lyme disease in Nova Scotia - will we ever get U.S.-style treatment plans?
After that, Madam Chairman, I’ll hand it over to my colleague for Sydney River-Mira-Louisbourg.
MR. DELOREY: Indeed, Lyme disease as often transmitted by blacklegged ticks, Madam Chairman, and it’s really the growth of these ticks that carry the disease that is leading to the growth and the prevalence across the province, and in parts of the province in particular. So, this is a situation we’re aware of, particularly through our Public Health Office. We do a lot of promotion both between us with our partners at Department of Natural Resources to draw people’s attention particularly as we move into the Spring and summer seasons to dress appropriately, to wear light colours so that you can see if you have ticks on you, tucking in your socks and so on if you’re going to be in longer grass and vegetation which is where you’re likely going to potentially get the ticks on your exposed skin.
As far as the treatment protocols, we follow Canadian national guidelines for the treatment protocols. Again, you know, research and researchers as well as the policy arms of government work together. We work as members of the federal-provincial-territorial Ministries of Health to review emerging information and evidence in a wide range of conditions. This would be no different but at present we adhere to the national guidelines and standards in Canada for treatment.
We continue to pursue education initiatives with physicians as the condition itself becomes more prevalent in Nova Scotia to get earlier detection and begin treatment processes. So, that work is all ongoing and, as with other conditions, as new evidence and research comes forward, as part of a regular course of action we nationally have bodies that come together and review those options, and as far as specific drug treatments, of course, Health Canada has a process to allow particular drugs to be enabled in a Canadian context and, from there, there are drug reviews to assess the efficacy of those drugs and negotiations that take place to actually get them on provincial formularies. But again, at present, it hasn’t progressed to that stage looking at Lyme disease. There’s been a lot of work to get the Canadian national process approach and we’re proud, I think, to follow those guidelines and standards and treatment protocols.
MR. CHAIRMAN: The honourable member for Sydney River-Mira-Louisbourg.
HON. ALFIE MACLEOD: Thank you very much, Madam Chairman, and I want to thank you for the opportunity to ask a few questions of the minister relating to health in the Province of Nova Scotia and I welcome his staff here tonight to these informative talks that we are having.
I would like to pick up on something my colleague was talking about and that was residencies. During the March Break, I had an opportunity to talk to a few doctors from the Cape Breton Regional Hospital and my understanding is - and I stand to be corrected - my understanding is right now there was, at that point, 60 residencies across Canada in the program you were relating to, that hadn’t been filled. Four of them are actually on Cape Breton Island. There are four residency programs that are not being filled there.
So, my question is when you have a situation like that, is there nothing that we can do as a province to make sure that at least someone who wants to move back to Nova Scotia and wants to live in Nova Scotia could be placed into a program like that if there is such an opening. My understanding from the doctors that I spoke to was that, indeed, not in recent memory do they ever remember a time when there were four residencies open in the regional hospital in Sydney.
MR. DELOREY: Madam Chairman, I thank the member for the question. It’s an opportunity to talk again a little bit about the residency program and the matchmaking process. It’s a little bit like - I don’t know what the member’s favourite sport is, it’s hockey, football, (Interruption) oh, he likes the blood sports. He says politics. I don’t know where to go with that one.
These residency matches is kind of like the draft process in professional sports teams - there are multiple rounds that take place. My understanding is the first round is what’s completed at this stage. In a previous question - I won’t restate because I know the member was listening to the background on the matching of residents where the residents themselves identified their preference and schools that have seats available. So, my understanding is, for this year, they’ve done the first round but it’s natural to go to the second round to try to make matches. If two parties, the prospective resident and the residency seats that are available, didn’t line up then they go to second choices on both grounds. So, that’s the reason that I think at this point there may be some vacancies across the country, including in Nova Scotia. My understanding from Dalhousie is they are quite confident on the second round that they will have no problem filling their vacancies.
The other thing is that as the process goes, international students, I understand at times if they meet the criteria and the programming, are considered as well for some of those residency seats. But again, it does go through a step-down process, just like filling job vacancies which I used the analogy of sports and the draft process, which takes multiple rounds.
MR. MACLEOD: I would say to the minister that I’m not much of a sports fanatic but I do know that in every draft round somebody is picked. There is never a draft round that somebody isn’t picked when you are doing that. I don’t know if that’s a good analogy for you to be using or not, but they are picked.
So again, we know we have a number of people who are interested in coming to our province to serve the people of Nova Scotia. I guess my challenge with the answer is this, Madam Chairman, if we do the same thing over and over and expect a different answer, a different response then indeed that is called the definition of insanity. So, if the box we’re using right now isn’t working and we have an issue where we need doctors for the Province of Nova Scotia, would it not make sense, Mr. Minister, to look outside the current box and try to find a way to make this situation work for people who are educated and want to practise medicine in Nova Scotia?
MR. DELOREY: I thank the member for the question. I guess a couple of responses to the points that were just made, for the member opposite. First of all, like those rounds of drafts in the sports picks, Madam Chairman, people were selected in the first round and people will be selected again in the second round, as is also the case in those sports drafting processes. We will continue to make those matches to get qualified candidates to fill those seats.
The member’s assertion that the residency process is not working, I think is quite misleading. What the member is suggesting is that we’re not filling the vacancies in the residency seats, Madam Chairman. That in fact is happening, the member himself referenced in opening remarks, I believe, that Nova Scotia hasn’t had in Cape Breton the vacancies and that’s correct. I think when the residency match process is complete, those residency seats will be filled. As I’ve said before, I believe the data out of the Maritime Resident Doctors, from the Fall of 2017, indicated that about 75 per cent of all residents who train in Nova Scotia stay in Nova Scotia.
If the member thinks that’s a process that’s not working, we filled the residency seats we have. Seventy-five percent of those residents who train here in the Province of Nova Scotia stay in the Province of Nova Scotia, providing those health care services to Nova Scotians. Madam Chairman, recognizing the success of that match process and that these residents, wherever they happen to come from, nationally or internationally, when they come here and they train here, they stay here.
We recognize that and that’s why we continue to expand our residency program, unlike other provinces, which is only drawing more attention to the availability and the strong calibre of the residency program, the Dalhousie Medical School and, more important, I think it is recognized by those medical students and those potential residents, the commitment that the Province of Nova Scotia and the Government of Nova Scotia and the people of Nova Scotia have to residents and medical professionals to come to practise and to stay and serve the people of Nova Scotia, providing top-notch medical care.
MR. MACLEOD: Thank you, minister, for your attempt at an answer; I appreciate it very much. The reality is there are 100,000 people in Nova Scotia who probably wouldn’t agree with that answer because they don’t have a family doctor.
I’m going to move on to another topic because one of the challenges now under the new health care system is that more and more services are being centralized back to Halifax, services that at one time we had in areas like Cape Breton and Yarmouth and Amherst. What we see happening is that people are having challenges getting the services they need.
Recently the government took quite a bit of pride in the fact that we have two new helicopters for transferring patients and actually that is a good news story and I really appreciate the fact that we do have that. I also understand that we have at least one fixed-wing aircraft.
My question to the minister is, with these types of resources that we have, with the distance that people need to travel in order to get specialized services in a central area like Halifax, has any consideration ever been given to actually stationing one of the helicopters in, say, Sydney and one in Yarmouth? Currently you need a helicopter to leave Halifax, fly to Sydney, pick up the patient or patients and bring them back. If you had it in Sydney, that would cut down the response time and should, indeed, actually help the chances of survival, depending on the type of emergency there is.
I would like to know if, indeed, that has ever been considered, and if it hasn’t been considered, I wonder, would the minister ask his department to look into such a situation?
MR. DELOREY: I thank the member for the question. Indeed, the question is as much a suggestion as a question. I guess a couple of technical points, staff who do look at the establishment and how equipment like the helicopters and fixed-wing aircraft are deployed in the province, have looked at this question and they highlighted a couple of critical points. One is around the helicopters being stationed together, the processes. Although there are two helicopters, one is in use at any given point in time, so one is there for active service.
The other one is there as a bit of a backup, as was noted when we launched the two helicopters. Often there’s maintenance requirements around helicopters and so on and it ensures that we’ll always have a helicopter for ready service and action and response as opposed to two independent helicopters that are active for duty. So the proposal of one at one end of the province and one at the other, flying into Halifax, isn’t the nature of the services that we are procuring.
We do have two physical helicopters available, but again at any one time operationally it’s designed for a single helicopter.
The other thing to keep in mind, Madam Chairman, is that particularly at those two end points of the province, in fact the fixed-wing aircraft is more often used to service those distances because the fixed-wing aircraft is faster to provide services over the longer distances, so again that is a piece of equipment, the fixed-wing aircraft, that does go out of the airport in Halifax to serve.
I think there are some other operational aspects that are part of that. Often specialized teams that provide those services also provide supports within hospitals. They have specialized paediatric teams and so on from the IWK that may join the teams, depending on if there’s a paediatric type of flight that may be called into action. So again, it’s setting the flight teams up where we have that level of expertise to get the right team on those flights, whether it’s through the helicopter or the fixed wing, get them out to the communities as fast as possible with the right teams to provide that care in an emergency situation, to get back to Halifax, continue providing that care right through to the hospital setting.
Again, I believe it has been considered, the technical merits of it, as the feedback and the information provided to me didn’t warrant that type of configuration though.
MR. MACLEOD: Interestingly, a study by the Canadian Journal of Cardiology recently showed that if you live outside the Halifax area, you are twice as likely to die after a heart attack. When I put this type of solution forward in trying to cut down the amount of time it takes to get patients to the central location, what do we say to a person who lives in Yarmouth or in Sydney that if you have a heart attack - and this is the medical society that is saying this, it’s not the Opposition, it’s the doctors who do this type of work - that you are twice as likely not to survive if you are in Sydney and have to come to Halifax for survival, or if you are in Yarmouth or Amherst or Bridgewater, twice as long.
I’m just wondering, how would the minister respond to that without looking at utilizing the resources that might be available in a different way?
MR. DELOREY: Indeed, part of the ongoing and continuous improvement efforts that take place in the delivery of health care services processes that have been in place before my time as minister, Madam Chairman, working with experts in a variety of different clinical roles within the province, we rely on that advice and recommendations.
Indeed, the member may be aware - my understanding as it relates to cardiac and other blockages like strokes and so on, that indeed it was working with experts within our health care profession, partnering with our paramedic providers, that identified processes to put in place that actually have dramatically improved the survival rates by changing the process by which patients are delivered and getting them to the sites matching the nature of the condition and the symptoms being displayed as the paramedics bring them to the appropriate sites, to the best-matched facility to provide the care and services.
There have been dramatic improvements as a result of that, Madam Chairman, through the process and whether it’s on the cardiac side or other parts of our health care system - Cancer Care Nova Scotia is doing an evaluation of cancer services, particularly around radiation and others within the province. We look forward to that report and feedback; we’re continuously looking for opportunities to improve our health care system.
To the member’s previous question about the use of specific pieces of equipment, I’d like to remind the member that those pieces of equipment, the fixed-wing aircraft and helicopters, are not solely utilized for cardiac patients. These are used for a wide variety of health care needs for Nova Scotians from one end of the province to the other. These are for emergency health care services, not just utilized for cardiac patients.
Again, while the member may see a path where it may provide support and improved cardiac outcomes for some communities, the member ignores the consequences and potential negative impacts for many other emergency patients who may require those services that are best served in the configuration that is currently set up.
Again, when we’re trying to design our systems and health care system from one end of the province to the other, we’re looking at the whole province and all health care needs. We try to maximize the value and the outcomes for all Nova Scotians, for all conditions and scenarios that may come up. That’s the way that it is configured right now, Madam Chairman.
The member asked if I had received any review or consideration. As I said, staff had looked at considering it and, per my previous response, explained why the fixed-wing and helicopters run out of the airport in Halifax.
MR. MACLEOD: I take great exception, Madam Chairman, to the minister saying I am ignoring and not paying attention, that there are other things happening besides cardiac issues. I’m not ignoring it - it may be his side of the table that is ignoring it. But for him or anyone else to tell someone who lives outside the boundaries of the HRM that your chances of suffering and dying from a heart attack are twice more likely to happen when you are outside the region than when you are in Halifax, I think that’s something the minister should be taking into consideration.
Nobody is suggesting that’s the only issue that needs to be taken on a helicopter, no more than anybody would say that that’s the only issue you would take in an ambulance. By the way, when you have an island like Cape Breton and you have 17 ambulances lined up because they can’t get a bed, because they can’t deliver their patients into the hospital, does that mean I am not taking into consideration that situation? I would take great exception to the minister saying that we do not care about other things that happen to people, and I believe I am owed an apology by that minister for that statement.
MR. DELOREY: Madam Chairman, I don’t believe that an apology is warranted there. What I was referring to was in the context of the question that was brought forward, that the member’s question ignored the other variables that would be at play in the decision-making. The member asked a very specific question about redistribution of fixed-wing and helicopter aircraft within the province, and (Interruptions)
MADAM CHAIRMAN: Order. The minister has the floor.
MR. DELOREY: . . . asked a very specific question about the configuration of the deployment scenarios of fixed-wing and helicopter aircraft that provide emergency services. What I was explaining to the member is that the situation in choosing the configuration and the services being provided goes beyond just the one example that was cited in the question, and focusing in on a single service and one piece of data, Madam Chairman, that didn’t take into - I use the term “ignore,” because that would be the situation. If it didn’t take it into account, it’s ignoring the other variables at play in the specific question that was brought forward. That was the context.
If you go back and look at the record, I don’t believe that at any point I suggested or accused the member of not caring. I think that was part of what was stated in his frustrated response there. I didn’t make any reference to suggest that the member doesn’t care about the situation or the care provided to members.
Again, if the member looks at the record, I was very clear that the situation, what was being questioned, ignored a very pertinent aspect, that in a very specific question asking if, for cardiac services, the care and the configuration of our fixed-wing and helicopter services represented something worth looking at or if I had looked at that as an option for reconfiguring.
Again, Madam Chairman, the specific context being used and cited to justify that question was specifically data around cardiac survival rates. The member didn’t provide any information to delve beyond the question of cardiac services. In making the reference to ignoring - in the context of ignoring the data, is exactly what I said. I said the member was ignoring the fact that these emergency services provided to Nova Scotians by our helicopters and our fixed-wing aircraft do exist to provide services besides just cardiac.
When the province, the Department of Health and Wellness, and our partners with the Health Authority, with EMC and others, look at how we best utilize and deploy our resources across the province for services - they would include cardiac, they would include mental health services, they’d include emergency services, trauma, and others - we need to make sure we can deploy our resources in the most expedient and efficient way possible.
As noted, the member’s original question was asking about helicopter services and whether helicopters should be stationed one in Sydney and one in Yarmouth, serving from the ends of the province into our central region, where the tertiary and quaternary services are being provided at the QEII Health Sciences Centre and the IWK for maternal and child or adolescent care, specialized services. What I highlighted were a number of variables that came into play.
Madam Chairman, I wasn’t ignoring other aspects. I was merely attempting to enlighten the member opposite as to the fact that these services in many cases take into account more than just the equipment, the machinery, the helicopters, and the fixed-wing aircraft that provide these services to Nova Scotians. They also take into account the specialized team members who provide these services, who in some cases are providing those specialized services with teams in the hospital that sometimes need to be drawn upon to be deployed out there with those helicopters to ensure that the patients, whether they be youth or specialized areas, have the right experts on that aircraft, whether it’s the fixed-wing or the helicopter, to provide services for the trip from the location that they are deployed to, back to the city, so that they are continuing to receive that care in these aircraft to maximize the likelihood and chances of survival, because that obviously is what the objective of all people working within our health care system is, from one end of the province to the other - providing the best level of care that we can provide to Nova Scotians.
Madam Chairman, that’s why we continue to invest in primary care services in all parts of the province. We continue to recruit for specialists across the province, including in Cape Breton. When we talked about opportunities for expanded specialist services and residency seats, we recognized the need in Cape Breton, so we commit those resources to Cape Breton to ensure that we have people trained, and more likely to stay and provide those specialized services at the Cape Breton Regional Hospital to service that population.
We would love to see those services being provided with more specialized services, whether it’s cardiac or - we know there are a number of vacancies in psychiatry in that region as well. We continue to work diligently to recruit and fill those positions, again recognizing that the people of Cape Breton deserve to get that care. That’s why these vacancies are being recruited actively. We want to see them filled to make sure they get those services, so that they don’t have to necessarily be transported either by ambulance or by aircraft.
Madam Chairman, the services we continue to provide, we know we have a top-notch emergency service in the Province of Nova Scotia, recently celebrated - I believe it’s the 25th Anniversary of the amalgamation of the paramedic ambulance service in the Province of Nova Scotia. This was built upon a program that I believe started over in Ireland, which actually has a tieback right to the member’s question about cardiac care.
In fact, it was recognized that in Nova Scotia, and I’m sure the member opposite remembers this - he may be surprised to know that I remember the days as well - when the ambulance services were being provided by funeral parlours. Perhaps it was different in Cape Breton, but that was certainly the case in my hometown, where the funeral parlours were providing the ambulatory services. I always questioned, even as a younger individual at the time, whether there was a potential conflict of interest in having the funeral parlour drive you to the hospital, but it is a reality of what the emergency services system was just a short 20 or 25 years ago.
We, as a province, took a very strong leadership role – again, as the member mentioned in his question or preamble, that listening to the experts at opportunities to improve the system is, in fact, what this province is well-known for; working together collaboratively, listening to our experts, providing feedback and advice to recommend how we can improve the care provided, to improve the system, to deliver top-notch health care services to Nova Scotians.
That care, as I said, in the paramedic space, makes Nova Scotia a leader not just in North America, but throughout the world with our emergency services. This care is provided through our paramedics and our ambulances, and has expanded to include the fixed-wing and the helicopter services as well, Madam Chairman. These services - I believe the fixed-wing aircraft can be flight-ready and in the air within 10-15 minutes. It’s about a 45-minute flight down to Cape Breton to service people in the member’s community.
Madam Chairman, this is extraordinary service providing care to Nova Scotians to get them, when needed, back to our tertiary, quaternary care services provided by the QEII Health Sciences Centre and the IWK, depending on the nature of the incident, and the needs of the patients in question.
Madam Chairman, as we continue to look at opportunities to improve our emergency services, I know one of the member’s colleagues asked last week about the effectiveness of the EHS system, and their success rate at meeting their contractual service level agreements to show up within a certain amount of time to provide the care. As I mentioned at that time, the EHS system has been working quite efficiently and effectively throughout the province to meet those care needs.
We know there are some challenges in the system, particularly with some off-loads at some ED sites, to get those ambulances to have their patients accepted in the emergency rooms by hospitals, so we can get those ambulances back out, serving the people of Nova Scotia. But even with those challenges that we recognize and are working to improve, that turnaround across the province, even with those challenges, we know that EHS has been doing very well at meeting their service-level agreements to ensure that Nova Scotians get the emergency care they need when they call 911.
We have a long history of top-notch care. We continue to see the expertise of those paramedics providing that emergency care across Nova Scotia expand their scope of practice. We’re seeing them step up to be innovative, to provide exceptional services to Nova Scotians. We’re seeing it in areas like palliative care, Madam Chairman. One wouldn’t think that the care of paramedics and the services they provide, where you traditionally think of them, again, just 25 short years ago, as someone with a driver’s licence to drive an ambulance as fast as they could to get someone from the site of an incident to hospital to receive health care.
Now we’re seeing highly-trained paramedics, skilled paramedics, who receive training, and their scope of practice has broadly expanded. The equipment they have access to in the back of an ambulance has broadly expanded. They are able to provide amazing health care services to Nova Scotians at the point of incident, whether that’s an accident, a trauma-type emergency, whether that’s a health emergency, like a cardiac incident or stroke - all these things are being provided by our paramedics.
I know there are a number of paramedics in the Legislature this evening. All of that to say, I know the member’s question was requesting an apology from me for making reference to his question ignoring certain variables. I stand by the statement that I made, the question that was asked ignored certain aspects that should have been considered.
MADAM CHAIRMAN: Order. Time has elapsed for the Progressive Conservatives. We will move on to the NDP caucus.
The honourable member for Sackville-Cobequid.
HON. DAVID WILSON: Thank you. Maybe a little advice from one former minister to a minister that could lead to much more time in the House when you answer like that, Madam Chairman.
I appreciate some time from my colleague, our Health and Wellness Critic, to allow me to ask some questions, specifically around some areas that are of deep concern for me, and always of interest.
I want to start by asking a little bit about the Cobequid Community Health Centre. I don’t know to what degree, and how deep down, I could get some of the answers to this, but we’ll ask it anyway. We know the initiative from the government for the redevelopment of the QEII is ongoing, and a significant amount of funds are going towards moving out services from the QEII - the old VG site, the Centennial Building - out into a new clinic in Bayers Lake, but into other services, the Dartmouth General renovations going on. I’ve always been one to advocate for services, and increased services, at the Cobequid Community Health Centre. I’ve been very fortunate to be served by that facility myself, but the residents of my community have benefited greatly from that site – both the former site and now the current site that has been there for, I think it might be, since 2006 or maybe 2004, somewhere around there.
The site where we currently have the Cobequid Centre was built, and it was under the Progressive Conservative Government that moved forward with replacing the old site, which was originally an old liquor store in Sackville. The original building had the Liquor Corporation - I don’t even know what the name of it was at the time, but that’s what was there - and then it moved into the Cobequid Centre after those health clinicians in the community pushed to have an emergency department in our area.
The new site was chosen - it’s actually the former site of the old Correctional Centre that was housed in our community. The government owned the property at the time, and I’ve always said it was a good move to go to a site that the province owned. They didn’t have to pay for the land, unlike more recent decisions where we’re going out into the community and purchasing land.
I would hope at the time it was a good move. One of the things they did do for the Cobequid Centre when they built the facility was to allow for it to be built onto, to expand. Having that vision at the start is extremely important because I’m sure that many are aware that if you want to build things bigger or add on, often if you don’t have that pre-planning done from the start, it is difficult to do.
The Cobequid Centre is meant to expand higher up, or even back in behind where the current facility is, there’s enough land there to do that. I’m wondering if the minister could give any update to those who use the Cobequid Community Health Centre and all the facilities there, if that is going to be in the mix of the redevelopment. Will there be expanded services provided there that will no longer be provided, say, downtown at the old VG or the Centennial Building?
MR. DELOREY: I guess the member, even though a former paramedic by trade - my previous response made reference to my recollection of what paramedics or ambulance drivers used to be like, here is a member is flashing back to a time where I don’t remember, and I think that’s the time of medicinal alcohol, I think is what he was referencing to the former site, perhaps. Maybe I’m mistaken.
Specifically, to the member’s question, we do know and recognize the great work the teams are doing in the services being provided at the Cobequid Centre. I don’t think that’s in question by any member in the Legislature. The member’s question is about looking for expanded services, obviously something that the community members would be interested in.
We do have the QEII redevelopment project. We know there are certain aspects that we’ve announced as we’ve moved on. A lot of expansion and growth at the Dartmouth General, some outside, in Hants County. We’ve also got work recently announced at the Halifax Infirmary. We do know there’s a lot more work to be done and as we get those specific updates, we do provide them to the public as to where expansion and where services are likely to be moved.
As of the present date, we don’t have anything specific aligned or announced for the Cobequid Centre, Madam Chairman. As the QEII redevelopment project proceeds and we continue with the rollout of announcements, we’ll be sure to let the member and his community know if there are going to be some expansions at that site.
MR. DAVID WILSON: I thank the minister for that. I think the most important thing is to ensure it is not off the table for those expansions, when the Nova Scotia Health Authority is looking at moving services out of the current site, that this site is one that is very much in the discussion.
If you look around at other jurisdictions across Canada, for example, it’s pretty rare that you’ll see a new hospital built downtown. They realize that access to health services can very much be given a little farther from downtown cores of a city, where the cost of the land is usually cheaper, but access could be better. If you look at the Cobequid Centre, it’s in a junction where you have Highway Nos. 101 and 102 meeting before you come to the city, and it’s a great location. It has transit, it has parking opportunities, and it has room to build, so I emphasize that I hope we see expanded services out there, and that the Cobequid Centre is very much in the mix with any future movement of services.
I’ll ask this because I know it’s always - and I don’t know if a colleague of mine has mentioned it yet or not, is there any talk about expanding the hours of service of the emergency department there? I know that under our government, we moved to midnight so it currently is now open 7:00 a.m. to midnight. I’m just wondering, is there any discussion on the possibility of moving those hours?
I’m not saying go 24 hours, but potentially maybe 24 hours on the weekend or at peak times, when we know the congestion we see around the city at the other hospitals. So,
I’m just wondering if anything has come across the minister’s desk on the discussion of maybe extending those hours in the future?
MR. DELOREY: I thank the member for the question. There haven’t been any formal recommendations or proposals around that type of expansion that have made their way up to my desk at this point.
MR. DAVID WILSON: Thank you for that answer, minister. I want to go to an area of concern and that’s EHS, the paramedic service here in the province. We know that, especially over the last four or five months at least, we’re hearing about the sheer volume of calls and responses that our paramedics are attending to, and the backlog that we see at our hospitals on an ongoing basis.
I know that it’s the first that I can recall that the union that represents the paramedics has started a kind of social media campaign called Code Critical that had been given updates of when units are depleted around the province and I haven’t seen that, as I said, in all the time I’ve been here in the House, in the Legislature for almost 15 years. That indicates there is very much an issue out there - really, a crisis - when you see and hear from the medics who are trying to bring these issues to the forefront.
I have to say they are nurses, paramedics, doctors, they are busy working and they don’t tend to get too involved in trying to bring awareness around how busy they are. But when it comes to a point where we are seeing the sheer numbers of ambulances delayed at our hospitals, you know that something needs to be done.
I know the minister has been questioned over the last number of months, and through the last few weeks in the session. I believe the minister indicated that he had requested some input, a look at what’s going on. I am just wondering if the minister could give us an update on what has been going on with those delays, and the department’s response to that.
MR. DELOREY: I thank the member for the question. Yes, the member is correct, it is something that I have asked to be looked into on two fronts, Madam Chairman. On one front, as the member mentioned, there is some activity trying to draw attention through social media to certain circumstances. In fact, I know that we received information looking into this. I think there were questions posed in this Legislature about that situation in Cape Breton from one of the member’s colleagues, where there was a claim during Question Period about no coverage in Cape Breton.
I reached out and found out that in fact - this is a note I received on March 21st, referring to allegations about the status in Cape Breton on March 20th, and around the 2:00 a.m. point in time. It was highlighted that there were 19 ambulances on duty at that time, eight of them were stationed and active in industrial Cape Breton, so the Cape Breton Regional Municipality. It was noted that between 2:00 a.m. and 3:00 a.m. on that date that there were five emergency calls, active calls, so five of those eight ambulances in industrial Cape Breton were active. So, there were three ambulances in industrial Cape Breton, and 11 other units available throughout the broader Cape Breton Island, to respond to emergencies.
Again, I guess it’s just to point out that my understanding, as I’ve asked to look into some of the allegations being made through social media, I’m being provided with direct data and information that contradicts many of those allegations. Unfortunately, I don’t necessarily have the data at my fingertips to respond as quickly as allegations can get made sometimes on social media, but that’s the information that was referred to me.
I’ve been advised verbally - I believe there were some allegations again last night or this morning, a similar situation about no ambulances being available in part of the province. I’ve asked. I haven’t been given this level of detail before getting to the House this afternoon, but there was an indication that the data that was supplied through social media was not necessarily an accurate reflection of the availability of emergency services across the province. That’s one piece about active, available ambulances in the system, in parts of our province.
The other question that was asked about was relating to off-load times specifically, and it is something, when I first became aware of it in the Fall, to look into this and see what and how we can do things different and better. I’m hopeful that in the coming weeks I’ll get some feedback and recommendations that we can look at advancing to bring some improvements to what really amounts to patient flow throughout the system. I do look forward to getting that information and those recommendations from the professionals who provide services and know the system best.
MR. DAVID WILSON: Thank you, Madam Chairman. So, I’m wondering with that information, if the minister would be willing to provide the House those call volumes and the stats that he refers to, because I know he gets a report from EHS. Whenever the minister requires one, they’ll get one. Would he be willing to make that public - the last three months, for example - just so we can look at and understand it better? I think residents are mature enough now to be given that type of information. There are jurisdictions across Canada and North America that do provide response times and those kinds of stats on issues. So, I’m wondering if the minister would be willing to provide us the last three months - the response times, call volumes for our ambulances across the province since the start of the year.
MR. DELOREY: Thank you, Madam Chairman, and we’ll take a look at that. I believe there’s a similar question, not exactly the same, from a member of the Progressive Conservative caucus through Estimates - slightly different, but as I work to pull the data together, I could possibly knock off both of these requests, to serve both with a single data response.
MR. DAVID WILSON: I appreciate that. I think it would go a long way not only for the residents but for the medics themselves, who are on the trucks, who are working their butts off every day, and many of them are waiting long, long hours at our hospitals - as I said, I appreciate that. I hope the minister does that, and I hope with the compiling of that information, that maybe we’re at a point in time where that information should be available to the public, and it shouldn’t require the Budget Estimates or a freedom of information request to do that.
I know in the budget, there has been an increase of $6.8 million for ground ambulance, $5 million of that for what has been indicated as call volume, and $1.8 million of that for an increase to meet the EHS contract. From my understanding, the $5 million is a contractual requirement because of the increased call volume. So, EMC runs the ambulance service on behalf of the province, through EHS, and there is a contract signed, and it’s my understanding that if the call volume goes up and reaches a certain band within that contract, that it triggers additional funding.
I’m just wondering if the minister could indicate if that’s the case, the $5 million is because of the increase in call volume, and the contract that the government has with EMC that that $5 million is owed to EMC because of the contract, and I hope that it means increase in number of ambulances that we may see in the province.
MR. DELOREY: I thank the member for providing the background details so I don’t have to. That is essentially how the contract is established. The additional increase in funding is designed to address increased call volume. It is part of the formula in the contract for funding, and again, as far as the number of ambulances, where they are situated, the service provider has to ensure they provide the services within service-level agreements we have established and we have to pay for those services.
That is the nature - we are seeing increased demand on our services and we’re making the funding available.
MR. DAVID WILSON: Thank you for the answer. What we hope we see is an actual increase in the number of units and the number of ambulances. As the performance-based contract is in place, EMC is required to meet call volumes. They are supposed to meet call times and response times, and they can be penalized if those times are longer than what is set out in the contract. There are a number of areas, if you are downtown, in a city - I think it’s eight or nine minutes, the average response time - and the farther you get out to a more rural area, they are allowed to have a longer response time. That’s only common sense, because you can’t have an ambulance on every street corner.
I’m wondering how the public can be reassured that the additional $5 million is going to go to ensuring that - for me, that means more ambulances on the road, it has to. It shouldn’t just be going into EMC’s coffers. How can the public be reassured that that $5 million is being spent wisely if it’s due to the contract? In that contract, is there a requirement for EMC to put out additional ambulances, because of the additional $5 million?
MR. DELOREY: Again, the goal and the objective we have as a province is to ensure that we provide health care services. The theme of the questions right now is emergency health care services provided by EHS, the ambulance side of the health care system. Again, they have obligations to provide a certain service to Nova Scotians, which is to make sure they get ambulances in place to respond efficiently, to provide that care to Nova Scotians in an emergency situation, whether it’s trauma or other health care-related - cardiac or other - situations that manifest themselves.
To my knowledge, and I’ll double-check if it’s different, and I’ll clarify for the member, but off the top of my head, to my knowledge, there’s no obligation as to where the resources are spent to provide the care and services, but they do have the service-level agreement requirements to continue to meet those service levels and delivery of emergency services.
MR. DAVID WILSON: I hope the minister can get back to me on that. What the concern is - especially for the medics out there - their concern is with the additional money, if there aren’t the additional units being available, the pressure on them is going to increase. No matter what the transfer delays are, they are concerned if the trend continues that the increased volume that we see is not going to slow down, and it’s going to put even more pressure on the current units. I would hope that won’t be the case and that we’ll see additional units. I’ll be making sure I follow up with the minister.
The $1.8 million for the EHS contract, maybe just specify exactly what the $1.8 million is for.
MR. DELOREY: The shortest way I can answer the question - although, if you want to delve in a little bit further, it’s not a 100 per cent answer but very quickly - it is essentially inflationary pressures, fuel cost increases, workers’ compensation, CPP, and cost pressures like that. If the member would like, I can break down the makeup of the cost, or if he’s happy with the response, it’s essentially inflationary pressures.
MR. DAVID WILSON: He doesn’t have to state them all, but if he wants to just provide us the breakdown of that $1.8 million at a later date, we would appreciate that.
Actually, not to get away from the ambulance services, I’m just wondering if the minister could provide us with the number of calls that ambulances responded to last year, within the year. I know there is a list given to him. I don’t know if he has it on hand. He could also provide that with the call volume. If possible, we might be able to see the start of the year in that, if the fiscal year is the end of March, if the minister does have those numbers.
MR. DELOREY: If it’s okay with the member, I’ll list off the details of the numbers now, it saves us knocking these out later. We’re looking at an increase around fuel costs of about $266,000. Again, some of those fuel costs might be fuel price, but if we have increased call volume, we would be expecting an increase of fuel consumed as well.
We’re looking at CPP/EI premiums at about $210,000, Workers' Compensation Board costs around $792,000, and around CPI, we’re looking at just about $424,000. Some expenditure things, just in addressing a 2016-17 payment piece of $162,000, so that gives $1.8 million – well, actually, $1,854,000 is the actual total.
To the member’s specific question about call volume in 2016-17 - recognizing the year isn’t totally completed yet - we have just under 162,000 calls responded to, that’s 161,940, I believe. So, what we’ve seen is an increase of about 6 per cent in call volume over the previous year, but the cost per responding to each call was actually down by just about 2 per cent, again, with an increased volume managing the price amount, cost per call was a little bit more efficient than it had been the previous year.
MR. DAVID WILSON: I thank the minister for that. There hasn’t been any change, I wonder if the minister could indicate what the user fee is for an ambulance call, and will there be any adjustment for this year?
MR. DELOREY: We’ve made no policy changes or changes to the ambulance fee, the user fee side, for this year. I’ll dig through the notes to see if it’s the same as it has been for the last number of years. If the member wants the specific amount, I’ll have to take a minute to look it up.
MR. DAVID WILSON: Yes, if I could get that number I’d appreciate it. Also, there was a program introduced a number of years ago that allows for residents to offset that cost, or have their ambulance fee reduced or eliminated. I’m just wondering if that program is still in effect, and have there been any changes to that program?
MR. DELOREY: As an MLA, I know from before my time of that program. We’ve worked with constituents to participate and take advantage of it. That is a program we would continue to work with our partners to support throughout Nova Scotia, so no changes to that program either.
MR. DAVID WILSON: That’s definitely one program that is close to my heart, because I was the minister at the time we brought it in, but on a secondary note, too often, as a former paramedic, going to calls of very sick people and finding out that they didn’t call earlier because they have a stack of ambulance bills on their table, I’m glad to see that that program hasn’t changed and I know it’s well used. It may not be publicized as well as it should be, but it’s well used.
I want to turn my attention also to dispatch. Here in Nova Scotia, we have a great 911 system - if you have an emergency it’s the one number you call - and we have men and women who work in the 911 dispatch centre. What some Nova Scotians don’t realize is that we have an EHS dispatch centre, which, if you call 911 and say you have a medical emergency, you are automatically transferred to the EHS dispatch centre, which is in Burnside. They are highly-trained paramedics who provide care to those who call in. Not only do they get the units responding, and they can respond - fire, police, ambulance - but also, they give advice on the phone, just as you see in some of the new television shows. Being trained as a medic helps them do that, especially in the environment we had over the last few months, when you see a spike in call volume and a delay in response times in certain areas of the province. They are an asset.
I wonder if the minister would agree that that system we have is one that has been recognized around the world as top-notch - not only the ground and air ambulance, but our EHS dispatch centre is a key component of those different emergency response systems that we have, and have been accredited for a number of years. I’m wondering if the minister recognizes that and supports that system.
MR. DELOREY: I thank the member for the question. Indeed, as the member highlighted, and as I’ve mentioned earlier, even earlier this evening, the world-class emergency services - the member is right - our dispatch is part of that service being provided in an emergency situation to help guide people on the ground while they wait for the emergency service team, the paramedics, to show up.
The member may know that one of my colleagues on this side, the member for Hants West, is not only a former paramedic, but I understand from conversations with him, that he was quite active in establishing that dispatch model and that dispatch centre to get set up. He and I have had discussions about how it was designed, why it was designed the way it is, spoken very highly of it, so I am quite impressed with the information I’ve received to date about the model and the training of those paramedics. Again, as the member mentioned, paramedic-trained dispatchers are responding to those calls and helping walk people through emergency situations, based upon their training.
MR. DAVID WILSON: I remember the transformation of the system. Interesting, I was living it day-by-day, and the interesting thing was when EHS started - the amalgamation of the providers - but the dispatch centre started in both EMC’s office and dispatch were in - I don’t know if it was Sun Towers in Bedford, on the Bedford Highway by the Sunnyside Mall - that was part of our coverage area. We’ve seen, from day one when we saw a staff of two people in EMC grow to the system we have now.
I’m just wondering if I could ask the minister if we will see any proposed changes to how that dispatch centre works, and how the trained paramedics are hired to provide that care.
MR. DELOREY: I am remiss to shift back to an earlier question, but just so the member has it on record, it asked what the standard ambulance user fee may be. I believe it is around $146 for standard. There are some other - but the standard fee that a Nova Scotian would be most aware of and concerned with is $146.
Back to this theme of questions around the dispatch centre, Mr. Chairman, I wouldn’t anticipate any changes to that program. As I’ve mentioned in previous responses about our overall health care system, we certainly are always looking for opportunities to improve services, and how the evidence - we take feedback from people who work the systems, and that feedback is often quite helpful for us, sometimes for people looking at research and so on, but we also want to hear from people who are on the front lines, and that sometimes helps us guide us when we’re making final decisions around things. I wouldn’t anticipate any changes to that program at any time in the near term.
MR. DAVID WILSON: I want to thank the minister for that. I know the dispatchers who work hard will appreciate those comments.
An interesting note, on February 1st of this year, we saw the highest call volume in the dispatch centre. I think the previous number of medical incident numbers, or MINs, that they give to each call was 658, and I believe on that day they reached over 718 calls. So, not only the call volume for our paramedics and ambulance dispatch centres - and if you ever have a chance to go there, it’s an amazing work of art on how they manoeuvre the ambulances and the work, so I appreciate that.
One last bit on suggestions. I hope the minister, with his more recent comments about engaging those front-line individuals, will take the time maybe to pop into a couple of bases and engage with paramedics, and ask them first-hand what we can we do to improve situations. Social media, I would agree, can be good and bad, there’s good and bad in it, but I know more recently there has been a lot of discussion on what can we do, what can paramedics do, what can they suggest to try to improve the situation they find themselves in? It’s frustrating when you work a 12-hour shift and most of that is not in the community that you are actually working in but could be spent almost the entire time at an emergency department in a hospital around the province.
One of the things brought to my attention was Ortho Tuesday. In the northern region of the province, in the Aberdeen Hospital in New Glasgow, for example, it is where the orthopaedic surgeons, the specialists, see their ortho patients from the whole northern area - Amherst, the Truro area. It starts early in the day, when dispatch starts to dispatch units to the hospitals in that area, where they bring ortho patients to the Aberdeen. Often, they are required to do an X-ray first, then they’ve got to wait, and then they are seen by the specialist.
Often the medics are saying, there’s a perfect example of Telehealth that could be implemented that would reduce the requirement of an emergency ambulance crew. I’m not saying that it’s not important to see your ortho specialist for an update or a consult, but that could potentially be where we could help alleviate some of that pressure on dispatch, on the ambulance crews themselves.
I wonder if the minister is aware of Ortho Tuesday in the northern region? If not, would he endeavour to make sure that he inquires how NSHA could improve the use of Telehealth, so that we don’t have these long periods of time where an ambulance crew is taken out of their community to do a less urgent service of an orthopaedic checkup - that could sometimes be two, three, or four hours that unit is with that patient before they get back to respond to emergencies?
MR. DELOREY: Just to make sure that I have followed correctly, the two main theme question points - the first is that although he is not currently working in his former profession, I’ll take it as an invitation to go out and engage with front-line paramedics.
I’m pleased, Mr. Chairman, to advise you and the members of the Legislature that I have been out already to meet with paramedics in dispatch centres. When I talk about touring the province, often the questions that are coming are specifically about physicians and/or nurses and really that primary care health setting. The questions haven’t been as frequent about paramedics.
For me, it was very important to go out and meet not just with physicians and nurses. I did meet with some front-line paramedics as well. I met with nursing students and residents, and Maritime Resident Doctors representatives - as wide a range as I could to get exposure, especially in those early days. It was critical to understand and make those contact points and connections.
I would also like to advise the member - I’m not sure how long it has been since he has been an active paramedic, but I know he still has lots of contacts. It’s a very close family of health care professionals. I’ll say for the member’s benefit, whether I’m physically in a paramedic base or not - I do have a family member who works as a paramedic.
It’s not the infamous Darcy DeLorey - from the look on the member’s face, I think the member knows who I’m talking about. No, Darcy and I aren’t related, or certainly not closely related, and I don’t know if that’s better news for him or for me.
Coming from a smaller rural community, our family still gets together on Sundays for coffee and cookies and so on. I do have a family member who is a paramedic, and they are, especially since I’ve taken on this new role, more than willing to share advice and observations from the front line. So, I do get that, as well, whether I’m at a base or not. I’m happy to continue that engagement and that work.
In the second question, the member was asking about orthopaedics and the ability to use technology, perhaps to be more efficient. I’m happy to report that as a government, we certainly recognize the role that technology can play in advancing care to Nova Scotians.
We have a number of technology initiatives that we are working on for access for Nova Scotians as patients within the health care system - getting their information in their hands. Step one of that - the technology is deployed, but we are working to get it rolled out and more Nova Scotians signed up. For Nova Scotians to sign up, their physicians need to sign up. It’s the MyHealthNS platform that provides that opportunity, and is the central portal space for Nova Scotians to access their medical information, and indeed, to have an opportunity to interact digitally if their physicians subscribe to that functionality. We’re investing there.
The recent announcement with physicians provides some incentives as well to encourage physicians to adopt this platform and this technology, and to interact with the patients through non-face-to-face means. In 2018, for many Nova Scotians, especially the younger Nova Scotians, it may seem a bit archaic to have this conversation about non-face-to-face interactions for the delivery of services, when we know we can get banking and so many other services digitally. But in health care, this is actually breaking new ground in Nova Scotia.
We tried a program in the Master Agreement with the physicians to provide those services from the Master Agreement in Fall 2016. There were some challenges with uptake based upon the way the rules were crafted around the fee code. In the recent announcement we made, we have adjusted the way that we’re trying to encourage physicians. It was in partnership with Doctors Nova Scotia. It’s early days.
We’ll be rolling this out through April to encourage physicians to take advantage of non-face-to-face interactions. It could be telephone, but we’re also hoping that they’ll sign up and be using MyHealthNS as well.
That doesn’t go directly to the member’s question using the example of orthopaedics, but I just wanted to use that as the example to let the member know we’re certainly interested, Mr. Chairman, in deploying technology and leveraging technology to the best of our ability in the delivery of health care services for patients in Nova Scotia.
At this time, I’m not aware of the services and the rollout. We want Nova Scotians to get access, get on MyHealthNS, and get it out there and support our primary care needs. As for what the future may hold for opportunities in specialized care services like orthopaedics and others, there may be opportunity. But we need to get across the first hurdle, make sure the system is deployed, make sure people are signed up and have their accounts and access, and get the data in that platform and available. Then we can look at many new opportunities for how that can improve, and perhaps that includes specialized services.
We’re not there yet. But certainly with the advancement of technology and with input from other health care providers - I see that as potential in the future but not in the short term. We need to get this system up and running first.
MR. DAVID WILSON: I know the work has been ongoing for a number of years here in Nova Scotia. You just have to look back to some of the work Dr. Mendez was doing. It was amazing. I don’t know if the member was around, but I believe he may have updated some of the caucuses on his work. Here was this robot in the hospital in Labrador, and he started up while he was sitting there talking to us at a caucus meeting. It was going down the hospital hallways, and the nurses were saying, hello Dr. Mendez, as if he was there. I know it was a great loss to our province, the move to other endeavours in other parts of the country. I know there has been a lot of work in the province.
One thing, to put the minister out of his comfort zone a little bit, is maybe a suggestion that he would do a ride-along with a paramedic doing a 12-hour shift. They do them, and it would be an eye-opener for any Health and Wellness Minister to do that. It’s easy to go into a hospital to see how that all works but to get down into the weeds - I believe he has a bit of interest now. I think he’s asking, can I do that? He can do that. I know he can. Anyway, I hope he considers it because it is important.
A couple of other areas - I was hoping to hand to back to my colleague, but I have a couple of different areas to cover just quickly. I know one of the asks, and I believe it would have to come through the Department of Health and Wellness, was MSI coverage for international students. I’m just wondering if the minister considered it for this budget. Is it totally off the table, or could international students potentially see the government covering their MSI costs?
I don’t think you need to sell it too hard to know the benefits of our international students to our province and our universities. To offer that type of support to those students, I think would go a long way in maybe allowing them to stay here after they graduate, emigrate to our province. If you treat them in that way, I think a higher percentage of those students may stay here in Nova Scotia.
I’m wondering if the minister could comment if he considered it. Was it a proposal that they considered for this year’s budget? I understand it’s not in it, but is it off the table, or is it something we could work on to try to encourage the government to cover the cost of MSI for international students?
MR. DELOREY: I thank the member for his suggestion about a ride-along. I can assure the member that, if I had thought at any point to this point in time that that was a possibility, I would have signed up on day one.
The member may not realize this, but back in high school, in my senior year, I almost, and I mean very, very closely - I had all the materials to apply to SAIT. I think the member may know there’s a medic program out there in Alberta. That was high on my possibility of career paths actually. I guess I’ll disclose that, really, the only reason I didn’t pursue that career, as I recall, was that it was a two-year program, and I didn’t think I was mature enough to be a grown-up after two years. Instead I applied to St. F.X. and did a four-year program.
I was very interested and have been in emergency services - feel very strongly about that, the role and the importance of emergency providers, paramedics, in the province and, indeed, throughout the country. So if that’s a possibility, Madam Chairman, for me to do an actual ride-along shift with a paramedic, I would be happy to try to get that fit into my schedule sometime. Probably over the summer might be when it’s probably easier for me to get it fit into my schedule. (Interruption)
The member suggested a date which, if I controlled my calendar for that date, December 25th - but there are some powers that are higher than even ministers. They live in the same house. It’s not me who chooses the schedule for that day.
To the member’s other question about MSI coverage for international students, certainly this is something that I am aware that students associations have been advocating for. I can advise the member that, being an MLA who has a post-secondary institution - St. F.X. University, in case anyone didn’t realize, is located in Antigonish - I have met with student representatives, as I would with other post-secondary institutions. Often, they have local members who are part of the provincial organization and national bodies, like the Nova Scotia students association and the Canadian national association. I know this is one of the items they are advocating for, so I have had some preliminary discussions with my colleagues.
Although any expansion to MSI would be a provincial health budget item, I think from a policy perspective, it would really be driven by the students with Labour and Advanced Education - the Advanced Education side of things - through their discussions and priority-setting with students and what they want to move across as far as the global provincial budget. I think that’s where that conversation stands. So again, we’re aware of the requests from the students associations on behalf of their international student representatives.
As a government, we recognize the importance that these international students play, bringing vibrancy, bringing culture, and bringing perspective to our campuses across Nova Scotia but also the opportunity for those students to spend two to four years here in the province to experience what it is and have the potential to stay. That’s why my colleague the Minister of Immigration, early on in her mandate, established new immigration streams, to make it easier for international students who want to immigrate here to the province. She worked with federal partners to get a stream that accomplishes that.
We do recognize the importance of international students. We welcome them here for their studies, and we hope they take advantage of opportunities to immigrate and make a permanent home in our province.
Again, specifically to MSI, Madam Chairman, there have been some conversations. We’re aware of the request, and I think those conversations will likely continue.
MR. DAVID WILSON: I hope the government does look at that. I think it would be a missed opportunity for us if we don’t seriously consider that.
I’m going to jump back again about suggestions, to address some of the issues you see in front of you, especially with the amount of time that ambulance units are taking now to transfer care over to hospital staff. For those who don’t know, it’s not as simple as just responding to an emergency, picking up a patient, treating them, and delivering them to a hospital. Your work is done, and you hand over that patient.
The hospital has to accept those patients. Before that happens, that patient is still in the care of the paramedics. Often they are there, as I indicated earlier, for hours on end in our emergency departments, taking care of that patient until there’s room in the emergency department or in the hospital somewhere.
There was an attempt a number of years ago, and we have seen a similar kind of increase in call volume, pressures at our ERs, that had additional funding go towards the emergency department, especially at the QEII, which had an additional medic and nurse, I believe. Both worked together, and then it may have been a couple of nurses after that, and they would receive those patients. The paramedic could transfer care over of those patients, even though they actually weren’t in a hospital bed.
I know that was a short-term program. I’m not even sure when it wrapped up. I’m wondering if that has come across the minister’s table, a suggestion to try to alleviate some of the increased transfer times that medics are seeing at our hospitals across the province.
MR. DELOREY: That specific recommendation hasn’t come across my desk, so to speak. As I mentioned previously when discussing the off-load challenges at some of our hospitals in the province, I have asked staff to work with our partners to look at the situation, to evaluate where there are opportunities to look at the processes and make some recommendations back to me. It’s my understanding that I should be expecting to receive some recommendations in the coming weeks, and I look forward to seeing them. I won’t rule out the possibility that something like that is going to be included in the recommendations. But until I have the opportunity to sit down with staff, likely not until after we get out of the budget session here, which is taking up a significant amount of my office time - I do look forward to getting the recommendations and feedback, meeting with staff, and hearing their recommendations for what we can do to make some improvements in that area.
MR. DAVID WILSON: I want to quickly turn to an area of interest over the last little while, that’s the whole issue of the federal government legalizing cannabis. I know from my time in the department that our Chief Medical Officer of Health played an important role, especially on the alcohol file, around bars and establishments in the province on some of the concerns he has and the work of Public Health.
I’m wondering if the minister could indicate if there was any increase in funding toward the Chief Medical Officer of Health’s budget to work on public health initiatives or concerns that may arise from an increase of cannabis use within our population?
MR. DELOREY: We know that the work of the Medical Officer of Health and, indeed, the entire team in the Public Health Office provides a great service to Nova Scotians. Cannabis is one of the many roles that the office and the Chief Medical Officer of Health provide input and advice on.
Indeed our Chief Medical Officer of Health actually served on the national panel that did some work on this. I believe he chaired or co-chaired a committee nationally. So some of the work that was being done and the advice and recommendations would come from work and research that has been done at the national scale as well.
We don’t have a specific budget increase, but this is just the nature and the type of work that would be done in that office through their due course and work they do regularly.
MR. DAVID WILSON: I know we’re in our last few minutes. In the sale of lottery tickets, for example, a portion of the monies that come into Atlantic Lottery and our interest in it goes towards gambling addiction. I can’t remember the percentage of it. I don’t know if it’s 6 per cent.
Has there been any discussion of that looking at the cannabis file? I know it may be in another department, but the money should come back to the minister’s department. I’m thinking he might want to support this - a percentage of that money that is going to be taken in by the sale of cannabis going towards addiction, a Public Health awareness campaign that I think we need to have in the province. Has there been any discussion in that line? When we have it for one - lotto, gaming - would we not want to have it possibly for cannabis? We can do it right out of the gate when we start.
MR. DELOREY: As the member may know, it has already been announced that the sale and distribution of cannabis in Nova Scotia will take place through an existing corporation, the Nova Scotia Liquor Corporation. That is an organization that has been around for a number of years and will continue to provide sales and services, previously with alcohol and expanding into cannabis. There is no model or design like that in that organization. However, 100 per cent of the profits and the proceeds of the Nova Scotia Liquor Corporation do come back to the Province of Nova Scotia.
We in the Department of Health and Wellness certainly work with my partners in the Department of Finance and Treasury Board to ensure that we request the total amount of funding we need to provide programs and services to Nova Scotians. That includes increasing our investments around mental health and addictions.
Madam Chairman, you would know that we have continued to expand and increase our investments in that area. I would like the member to know that we have been very aggressive, particularly around the area of opioids, rolling out an opioid action framework. Within a couple of months of becoming Minister of Health and Wellness, we rolled it out. We have taken a number of very bold initiatives, expanding naloxone access publicly with our partners at the Pharmacy Association of Nova Scotia, community pharmacists, and also expanding methadone treatment across the province. We’ve managed to eliminate the wait-list in Halifax at Direction 180, and we’ll continue to invest in those services. Our commitment to mental health and addictions is very much alive and well in this province.
MADAM CHAIRMAN: Order, time has elapsed for the NDP.
We will turn it over to the PC Party. The honourable member for Pictou East.
MR. TIM HOUSTON: EMC is just ending, I believe, probably within a matter of days, a trial for power stretchers. They are lifting devices that help reduce injuries. I think these devices are used in many places in Canada. They are pretty useful for paramedics.
I wonder, as that trial comes to an end, is there anything in the budget that would provide funding to outfit every ambulance in the province with power stretchers and power lifting systems? Is there any funding that would be available to outfit every ambulance in the province with power stretchers and power lifting systems?
MR. DELOREY: As the member noted in the preamble of the question, this is a pilot initiative being reviewed and coming to conclusion. As would be the case when trying something new in our system, we want to evaluate and see what the results say. So we want to wait and see what recommendations come back from that pilot program, see what their experiences were, the pros and cons, and see how those recommendations come forward.
At this point, there’s no direct separate funding line for such an initiative that I am aware of, Madam Chairman. But again, as the program comes to a conclusion, we’ll see what recommendations come out from it.
MR. HOUSTON: I just wonder if the minister can maybe shed some light on the trial, how many ambulances it was used in and how long it went for, and then maybe give some clarity as to how long it might take to assess the findings of the trial.
If there’s no budget allocated in this year, that implies that there won’t be any ambulances outfitted in the current year unless there’s some manoeuvring of budgets. I’m a little concerned to hear that there’s no money allocated to outfitting the ambulances with this in the current year. Maybe the minister can give some clarity as to whether he expects it might take a full year to assess the results of the trial. What can we really expect going forward for this? It has been quite useful for the paramedics.
MR. DELOREY: I wouldn’t want to pre-suppose the conclusion of the review process under way. I know the member has highlighted that the technology is very useful, has had benefits, and so on, but we need to complete that evaluation to identify exactly where and how those benefits play out in the overall system.
Not only do we have to consider the potential benefits of that particular investment area, but we have to consider it in the context of all investment areas. So a review, in this case a very specific piece of equipment, we would have to take that under consideration with all the many competing interests within our emergency services for equipment needs and requirements and determine not only if that piece of equipment provides some value which it is designed to provide but also whether or not it is the best area, if we have capital funds available to go towards emergency services retrofitting and equipment or other equipment within our health system.
Again, we need to finish the review first and determine what the review outlines for the specific piece of equipment and also what recommendations may stem from that review. Once that is done, we have to consider that in the context of all emergency capital services and other capital requirements we may have in delivering health services to Nova Scotians.
Again, it does take some time, Madam Chairman, to make these assessments. The health system is large, and there are a lot of competing interests. We want to make sure that the money we spend is providing the best bang for the buck, so to speak, the best value in health care services and outcomes for Nova Scotians as we pursue these types of initiatives.
MR. HOUSTON: Just on that, I wonder if the minister can inform the House as to whether he has given staff some kind timeline to have the results of the analysis back. Is there a deadline for when we could expect to hear the results of the analysis of the findings of the trial?
MR. DELOREY: I haven’t given a direction as to when to expect the feedback from that review.
MR. HOUSTON: I know it is a priority for the minister, and I know it is for the paramedics, so hopefully it is something that is looked at in a timely fashion.
Does the EMC make a profit on an annual basis?
MR. DELOREY: That’s something I would have to look into. We provide payment, Madam Chairman, based upon our contractual obligations to our service provider for emergency services. I’m not sure, in terms of public disclosure and what information we may have on a third party organization, whether we have the information and whether I would be legally allowed to disclose it if I did have the information. That’s something I’ll have to refer back and just verify whether or not that’s something that can be done - (1) if we have the data and (2) if it’s something that, even having the data, I would be able to legally disclose to the member.
MR. HOUSTON: It’s my understanding that under the terms of the contract, EMC keeps 50 per cent of the user fees after 75 per cent of the fees have been collected. There’s some formula in there where they’re definitely keeping fees. They are definitely having revenue.
The reason I’m curious about their profitability is because I have heard it said that it’s a violation of the Canada Health Act for a private company to make money off the delivery of health care. This comes up periodically. Maybe years ago ambulances were merely just transporting patients, but certainly now, I don’t think anyone would dispute that there’s a lot of health care delivered in an ambulance.
Is the minister concerned at all that there would be a private company embedded into our health care system that is profiting from the delivery of health care in Nova Scotia? Might that be a violation of the Canada Health Act?
MR. DELOREY: There’s a couple of things to pull out from the member’s question there. The first is that even in the scenario provided, the member is talking about money relating to fees. That would be on the revenue side not necessarily profit, jumping to an assumption that there is a profit situation - just to clarify that piece of information.
I’m loath to do it - I often refuse to go down hypothetical scenarios, but if I was to go down that path, that this was about a profit piece of it, the fact is that ambulance fees and services are not covered by the Canada Health Act, Madam Chairman. There wouldn’t be a violation of the Canada Health Act for a service that’s not actually covered by that Act.
MR. HOUSTON: So just to clarify, the position is that ambulance services and the delivery of health care in an ambulance would be exempt from the terms of the Canada Health Act. That’s the position.
MR. DELOREY: That’s not quite accurate. I think there’s a very clear distinction in the way the Canada Health Act is structured. It’s not one that provides exemptions but rather one that stipulates what is covered. The services covered, in the simplest way, health care delivered in hospitals and in family practices are essentially the services that are covered at the highest level. The Act is defined as saying what is covered. It is not one that defines what is exempt but, rather, what is covered. So ambulance services are not a service that was identified in the Canada Health Act for coverage. It’s not an exemption - it was never covered.
MR. HOUSTON: I appreciate that clarification. I guess that still stands, but I want to ask the question anyway. As time passes, more and more care is delivered in the back of an ambulance - technology improves, training advances, and more and more health care is delivered. You can imagine the health care that might have been delivered in an ambulance 15 years ago versus what would be delivered today and only imagine what that is going to be two years from now.
Just to put a fine point on it, I would ask, is it the case that the Canada Health Act hasn’t caught up with the advances in the amount of health care that is being delivered in the back of an ambulance? It just hasn’t changed over time. I guess that would be the simplest way I can ask that.
MR. DELOREY: I have used the analogy of perspectives, I think, in the past, how people can look at things from different lenses. Whether it’s looking at a glass that’s half full or half empty, perspective is important for understanding. So the member’s assertion in the question relates to whether it’s a situation where the Canada Health Act hasn’t caught up or come into context. The other perspective perhaps is that provinces across the country recognize where and when services need to be provided to its citizens in the health care space - areas like ambulatory care as well as dental care and other examples - services we aren’t required or legally obliged to provide to our citizens through the Canada Health Act, yet we do.
From my perspective, it is rather a situation where provinces step up to the plate, recognize the needs and the demands of the population for health care services, and continue to invest in these areas. So don’t specifically relate it to ambulatory care and the advances and the growth of the program. We see that the province continues to invest in this area although - reverting back to the theme of the questioning - we’re not obliged to do so under the Canada Health Act. We recognize that it is an important service, one that is important to the delivery of health care for all Nova Scotians. That’s why we continue to make the investments and, again, are proud of the world-class emergency health system we do have in Nova Scotia.
MR. HOUSTON: I’m just curious - it’s a significant contract between the province and EMC. I would like to ask the minister, is he aware of any audits that the province may have done - maybe the Auditor General or someone - of EMC? I would ask the question both about a financial statement audit and about performance audits.
MR. DELOREY: I know that financial statements, like in most organizations, are audited annually. As far as performance audits, I’m not sure what the regular schedule is. They are done of the system, Madam Chairman. I’ll have to get back to the member as to the schedule, if it’s ad hoc or a regular schedule. I’ll have to cross-reference and just verify that for the member.
MR. HOUSTON: In terms of the fact that the ambulance fees and services provided in an ambulance are not covered under the Canada Health Act, I wonder, is there any other relationship between the province and EMC? Are they maybe being paid for services that don’t involve ambulance services?
Again, I’m still wondering about a possible violation of the Canada Health Act and whether EMC is profiting from the delivery of any other health care services besides ambulatory services. Are there any other services that EMC might be being paid to deliver in Nova Scotia?
MR. DELOREY: Again, since the Canada Health Act is the foundation of the question, to be clear, the Canada Health Act stipulates universal funding for services delivered in hospital settings and in family physician settings. Those are the areas where care is covered. That is what is covered and stipulated through the Canada Health Act. Although services have grown beyond that in many provinces in many different areas, those are the areas that are stipulated in the Canada Health Act.
Again, EMC’s primary service delivery is around the delivery of emergency services, paramedic services, through ambulances. As we discussed a little bit earlier this evening, that also expands and they provide some services around dispatch and things like that that relate to those emergency services. But again, these are services that fall outside of the universal funding system we have in Canada around the Canada Health Act.
MR. HOUSTON: The reason I was asking about the performance audit specifically is I think the contract with EMC would stipulate certain response times - nine minutes in an urban setting, 20 minutes in a rural setting. If those response times aren’t met, then EMC can be subject to fines unless they can justify the delay.
Is the minister aware of any fines that have been levied against EMC for failure to meet the stated response times? Have there been any fines levied on EMC that the minister is aware of?
MR. DELOREY: In my time over the last 10 months or so, I am not aware of any fines for failing to meet those service level agreements. If there are any prior to that, I would have to go back to look it up.
MR. HOUSTON: Would it seem reasonable to the minister that those response times have been totally met in every circumstance - nine minutes in an urban setting and 20 minutes in a rural setting in the past year? Would it seem reasonable? Knowing what we all know about health care in this province, would it seem reasonable that those response times have been met in every instance?
MR. DELOREY: I’ll make a bit of an assumption here, Madam Chairman. I believe that, given the nature of the member’s former career, he is likely aware of how service level agreements operate and that it is very seldom that 100 per cent is the standard to meet for any service delivery metric - certainly in the 95 per cent to 99 per cent area. These are service levels that are often established, but 100 per cent is not usually the standard. That is the case with these service levels here as well. It’s not 100 per cent of the time, Madam Chairman, but somewhere around 95 per cent to 99 per cent. I would have to double-check the specific ratios for each of the different metrics that are defined in the service level.
The member may recall that his colleague the member for Argyle-Barrington, I believe, last week asked a question related to the space and asked for some data about the service level response time. Earlier this evening the member for Sackville-Cobequid had a similar question, expanded a little bit. We’ll be endeavouring to pull a report that actually shows how the response time has been, and we’ll be sharing that information with the caucuses.
I have, though, inquired of staff about it at a few different points in time. Certainly we have heard concerns being raised through some social media campaigns about the availability of ambulances in particular parts of the province and also concerns being raised about ambulances that are waiting to off-load patients in the emergency rooms. As I have become aware of those situations for the first time I have generally followed up to ask questions about service levels. Again I have been assured and reassured that they continue to operate within the service standards defined in their contract.
MR. HOUSTON: I guess I would find it odd - given the circumstances that paramedics are facing, I find it odd that they could meet the service time requirement, to be honest. I’m just looking at some of the situations today - the backups, six ambulances outside and six inside and at this location, four inside at this location, eight outside at another location. When you look at the pictures and you hear the ambulances are backed up, it’s literally like they are backed up at a Tim Hortons. It’s pretty shocking to see the ambulances backed up outside the hospitals.
I would think it would be very, very difficult to meet the service requirements of the contract. Remember that the fine is not levied when they can justify the delay. I would think they would actually say that they have lots of reasons to justify the delay in today’s environment in pretty much almost every circumstance.
I guess if the minister is not aware of any fines that have been levied, I would ask it another way. Has EMC justified a failure to meet response times, had a situation where they didn’t meet them but justified it and didn’t get a fine? Is the minister aware of any kind of back-and-forth between EMC and the province where EMC is justifying the failure to meet the service delivery requirements?
MR. DELOREY: As I indicated, we’ll be extracting the data around the response and the response time data around the service levels to provide the members that report. When we have it, I think it will answer many of those aspects of the members’ questions.
Specifically, am I aware of those situations around justified delays? I’m not aware of that at this point in time since I have been in office.
MR. HOUSTON: I look forward to those reports.
My colleague was asking about transition off-load teams. I believe there is a transition offload team at Dartmouth General, with a paramedic who is on staff at the Dartmouth General and maybe a nurse as well. There’s some kind of transition off-load team in place at the Dartmouth General where they would transfer patients to a bed inside the emergency room while they are waiting for further care.
Is there anything in the budget, or is there any discussion about expanding those transition off-load teams to other hospitals across the province?
MR. DELOREY: I guess there’s two parts to the response. One is about the request I had for staff to go out, investigate, and come back to me with some recommendations on what can be done. I’m expecting in the coming weeks to receive some recommendations from staff who have been reviewing that situation and come up with some proposals that we may pursue. That’s the first one, as far as specific courses of action around that. That work hasn’t been completed. I haven’t received any of those recommendations at this point.
The other is specifically the question about the budgeting side of the equation. We engage and provide the funding to the Nova Scotia Health Authority for providing services. We know, in the short term, that patients are covered and receiving care, even if they are waiting in ambulances to be off-loaded. As proposals are coming forward, we provide a fairly significant budget to our health care partners in the Health Authorities. This would eventually, when the proposals are considered and implemented at an operational level, relate to an operational budget that we have provided to our Health Authorities, and we would expect them to provide care within budgets.
The expectation is that there would be an additional pressure based upon those recommendations. That would be a discussion to be had. But at present, we don’t have specific direct budget allocated for that, but we do certainly have money allocated to our Health Authority partners to ensure that care is provided throughout the health care system.
MR. HOUSTON: I guess my final question would be, is the minister aware of any other hospitals putting proposals forward or requesting a transition off-load team for their own facility?
MR. DELOREY: I’m not aware of any that would have come across my desk. I’m not going to say that just because it hasn’t come across my desk, it hasn’t been raised by officials at a particular site somewhere in the province.
I would say, especially if these conversations are being had, that I had requested a while back to have the off-load times and the off-load challenges investigated and looked into. I would not be surprised, Madam Chairman, if there are people within facilities around the province who would be looking for opportunities and coming forward or making suggestions. What they specifically are is the information that I am looking forward to hearing from staff as they have been talking to people to get the information and come forward to me with some recommendations. We look forward to seeing those recommendations, what makes sense, and working with our partners to try to improve the system flow, particularly around our emergency rooms.
MR. HOUSTON: I thank the minister for his responses. I’ll pass the rest of my time to my colleague the member for Queens-Shelburne.
MADAM CHAIRMAN: The honourable member for Queens-Shelburne.
MS. KIM MASLAND: Thank you to the minister for going through this gruelling process. It’s kind of appropriate that I have an opportunity to come in tonight to talk to you because I have spent since Friday afternoon at South Shore Regional with my grandmother. I’ll just say that the care she is receiving there from the nursing staff is amazing. We need to make sure that we can keep them supported doing the great work they do.
My first question to the minister is concerning opioid addiction and is something we talked about last year in Estimates. I know it is something that is very close in your heart, as it is mine, making sure we are helping people who are going through this process.
The government increased the financial incentive so more physicians would not go through the exemption process to prescribe methadone. The commitment to treat opioid addiction was recognized as very complex by NSHA so physicians specializing in this area were incented, through more generous billing fees, to prescribe methadone. However, the evidence shows that Suboxone is highly effective and more accessible because doses are not witnessed like methadone.
The complexity of the patient is the same in terms of treating opioid addiction, but there is no incentive to treat the patient with Suboxone like there is methadone . . . .
MADAM CHAIRMAN: Order. I ask the member to direct her questions through the Chair.
The honourable member for Queens-Shelburne.
MS. MASLAND: Madam Chairman, physicians are compensated for their visit, despite the opioid addiction, the same way they’re compensated to treat a flu or ear infection. My question through the Chair is, is there any indication that they will be making sure there is an incentive to prescribe Suboxone?
MR. DELOREY: A few things - I’m going to ask a general question, and maybe I’ll get a nod that might influence the response a little bit. Are there going to be further questions? Should I provide a little bit of broader feedback not just on Suboxone but on the broader opioid piece or narrow it and stay focused on just the Suboxone question?
MS. MASLAND: Just the Suboxone is fine.
MR. DELOREY: Recognizing that Suboxone is part of it, we have worked and even prior to my time in the role as the Minister of Health and Wellness - I know my predecessor brought forward some proposals around Suboxone as an option for being considered for delivering care. We continue to expand, as the member would know, supports out in the field for treatment. Yes, methadone is still that standard, but Suboxone is emerging and has some benefits, as I understand, clinically speaking.
In our opioid framework, we do make reference to looking at opportunities to review that funding around Suboxone. I don’t recall seeing a final proposal and the pieces around it. As the member would know, there are a number of stakeholders in changes to fee codes, in concert with Doctors Nova Scotia, as the bargaining agent for physicians and so on.
These things don’t always happen immediately. Again, we have a fairly comprehensive opioid framework that we rolled out in August last year. We have taken a number of steps around that. I can delve in further if the member wants, but the question was focused on Suboxone. It has been referenced in there as part of the path, but we’re not there yet as far as increasing fee codes around that at this point in time.
MS. MASLAND: I appreciate your work and dedication on this opioid addiction issue that we are presented with. My next question through you, Madam Chairman, is concerning the collaborative care centre in Shelburne, which is moving along quite nicely, which is lovely to see.
Shelburne residents have been under the assumption that the centre would be open as a walk-in clinic, especially for many who don’t have a doctor in Shelburne, but now they’re being told that you must be a patient of the doctor who will be practising at that clinic. My question through you, Madam Chairman, is, can the minister please clarify that?
MR. DELOREY: That’s not an area that has come up, the question of it being used as a walk-in versus a collaborative practice. The information that I have had is that the services there are for a collaborative practice. Really a collaborative context is not usually consistent with a walk-in context. I’m not aware of anything around the government releases or the Health Authority partners’ releases that would ever have stated - I stand to be corrected if something did come out at some point.
This is a project a long time in the making, so at some point there may have been some comment about walk-in, but in my experience it has always been referred to as a collaborative practice, a collaborative centre, and those have a tendency to mapping and matching people with primary care providers.
What we would be expecting - and certainly there would be some conversations about how this can work to reduce pressures within our emergency room and in other areas. That relates to our overall approach around collaborative practices providing care - not just with physicians, but pairing them up with other health care providers like nurse practitioners, family practice nurses, sometimes social workers. I think recently we even had an occupational therapist in one of the recent announcements - a 0.4, but it’s a start to see that there are expanding - not just the number of teams coming together, but also the variety of health care providers coming together as part of these teams to provide services.
We’ve had some conversations about social workers and the role they play. So even though it may be a collaborative clinic context and not a walk-in that some people might be looking at, by having collaborative care teams working together, the expectation is that they would be seeing and moving people through by getting patients seen by the health care professional most suited to the care that they require at a point in time, so that we can get more patients flowing through and that they work together collaboratively to expand their capacity as a whole team versus what individuals can do on their own. So that would be the expectation.
There may have been comments about reducing the demand and the pressure. I think it’s in that context. I’m not aware of any on the walk-in clinic side. If the member has information that shows that government has ever suggested or led, then I’m happy to review it, but my understanding was always collaborative practice, collaborative care. That was the model. We do think that will have positive outcomes for the care provided for members of our community, as well as for the team members. This site has been a long time coming, and they’re looking forward to seeing the doors open.
MS. MASLAND: That was absolutely my understanding too, that it was a collaborative practice, but I wanted to try to put some clarification on that for the questions I’ve been asked.
My last question is concerning long-term care. I have two long-term care facilities in the constituency of Queens-Shelburne, and the challenges are no doubt not unique to Queens Manor or Roseway Manor. With the number of seniors growing, particularly in Queens County, the need for these facilities is only going to grow greater.
The two facilities that are in the constituency of Queens-Shelburne are being utilized for a purpose that they were not designed for – over-capacity, very small rooms, lack of infection control. My question to the minister is, what is the long-term strategy - especially focusing on the fact that these two facilities in the constituency of Queens-Shelburne are not adequate to meet the needs within the communities?
MR. DELOREY: I thank the member for her question related to long-term care at the facilities in her community. As the member is likely aware, we as a government have really focused on a home-first home care strategy. We heard from Nova Scotians, including aging Nova Scotians, that where possible, their preference is to age at home and in their community as long as possible, provided they receive the appropriate supports and care.
We’ve invested very heavily since coming into office in that strategy around home care. I believe investments increased since 2013 toward home care types of initiatives somewhere in the vicinity of $65 million to $70 million over the past five years. The effect that that has had is that certainly we’ve been seeing more Nova Scotians being able to receive that care that they need in their home.
We’ve recently expanded the caregiver benefits so that there will be more Nova Scotians receiving that benefit. We recognize that not all care in the home is provided by professionals, but indeed loved ones - family members and neighbours, collectively loved ones - do provide important support to Nova Scotians as they’re aging in their community.
If I think of my own experiences growing up, my grandmother next door never drove, never had a licence. She grew up next door, so it was just natural that my parents and aunts and uncles would take her for groceries and medical appointments and all those things which caregivers do. That allowed her to stay in her home for much longer than she would otherwise have been able to do. So there is a caregiver program to recognize those family members and neighbours who may step up to the plate to provide that type of support.
Then as people’s needs grow there are, of course, the home care services provided by CCAs and the VON and other service providers across the province. Through those initiatives and around policy changes and initiatives to try to work and be more efficient in our long-term care space - so through a combination of all the initiatives that have been taking place since 2013 - we have seen a reduction in our wait-list for long-term care facilities by over 50 per cent - not just the number of people on the list, but also how long someone is waiting. So if somebody is on the list, they are waiting for less than 50 per cent of the amount of time that they would have five years ago.
I know we talked about how some people are waiting on the list from home in their community and others are waiting in hospitals. We’ve seen reductions in our hospital wait-lists as well - again, somewhere in the vicinity of 30 per cent fewer people waiting in hospitals for long-term care beds and about the same amount in terms of the reduction of time that they are waiting, so we’re getting those patients from a hospital bed to a nursing home more efficiently than we had been previously.
As we’re making all these changes and making these investments, we’re continuing our long-term - because that’s the specific question that was asked - around the longer-term vision around long-term care centres and facilities. We’ve been working to get these changes. We’ve seen a lot of improvements, so we want to make sure we see where that settles out, as it will influence the demographic data that we have to identify system changes, renewals, and new beds and so forth. We’re watching all of the data very closely and analyzing the demographic data, but we’re also assessing it in terms of the needs and the requests coming into the system.
All of that information is being actively looked at, and we’ll be moving forward once we get a full and firm confidence level that we’ve got the system in a spot where facility infrastructure is the next step in that process.
MS. MASLAND: I thank the minister for the response. I do feel that maybe the reason why the wait-list is not so long is because we are jamming seniors into facilities. If we want to talk about grandmothers, I know my grandmother was jammed in one of those facilities in Queens Manor. She had another person in a very small room with her, and while she was dying, another lady was asking for Cheerios beside her, behind the curtain. It’s not right and we do need to look at it further.
I understand where the minister is coming from. I could talk here forever about that, and I need to share my time with my colleague here, the member for Cape Breton-Richmond, so I’ll pass it on to her.
MADAM CHAIRMAN: The honourable member for Cape Breton-Richmond.
MS. ALANA PAON: Thank you for this opportunity to ask some questions to the Minister of Health and Wellness. I just want to say that obviously there are many members of this House who get up to ask a bevy of questions about health and doctors, nursing bed shortages, ER closures. I really appreciate having this opportunity during Estimates to be able to actually have a little bit more of an in-depth conversation or an in-depth opportunity to be able to ask questions. Question Period is so short that you very rarely get a response to your question.
In my area we have a wonderful hospital called the Strait Richmond. It is a regional hospital. We also have the St. Anne Community and Nursing Care Centre, which also has blood services and a local emergency room with just a couple of beds. I know my family has often taken full advantage of having that service at our fingertips, because as we know in Cape Breton-Richmond, if something happens to Lennox Passage Bridge, the St. Anne Centre is going to be your first and only place to get emergency services.
The bridge hasn’t been upgraded for quite some time. I hope it’s going to be in our capital plan for this year, but there’s still never a guarantee that that bridge is someday not going to close properly. Right now we’re down to a 20 kilometre per hour sign on it. It’s in pretty bad shape.
So it’s really imperative that we have an emergency room on the Island. It’s imperative as well, on a broader scale, that we continue to have emergency room services at our regional hospital, the Strait Richmond Hospital.
I would like to ask the minister, what is the plan going forward? I know we’re trying to recruit doctors. I know there are ER closures and shortages of doctors to take over the shifts at the ERs all across the province. I would like to ask the minister, what is going to be done to be able to turn this around for my community, for Cape Breton-Richmond? We’ve got the ER closed on more weekends than not at the Strait Richmond, and sometimes it’s the case as well at St. Anne Centre. How can we turn this around?
MR. DELOREY: I thank the member for the question - obviously a pressing question not just in her community, which in the Strait region the member would realize, obviously even under the old model of the health authorities within the family of the region under the old GASHA system - so aware is part of a community.
Some people think the Strait of Canso divides us, but I believe the Strait of Canso actually brings Guysborough, Antigonish, Richmond, and Inverness closer together in many respects. I don’t think a lot of Nova Scotians really realize that. They think of Cape Breton as an island separate from the mainland. I think the relationships, culturally and historically, between the Strait region communities suggest that it unites us - it doesn’t divide us, that Canso Causeway - the Canso Strait. The causeway is a linkage that makes the connection. Health care is no different through those areas.
Although the member is asking the question specifically for her community, it is reflective of questions being asked in communities across the province. The efforts really do stem from multiple areas. Of course, one of the biggest areas that we’re focused on is around primary care.
When we hear stories - and I’m not saying that this is limited to, but I’m saying a lot of stories that we hear about people waiting and wait times, you’re looking at volumes. If the volume is high in our emergency rooms, it’s because there are a lot of people waiting. So when you start to pull that apart, you start to realize that a lot of the people who are waiting in those emergency rooms may not have ever gone to an emergency room if they had primary care access in their community and had been able to schedule an appointment with their primary care provider.
That’s why our commitment and focus around primary care is a critical element and an important part of the initiative to help reduce some of the pressure on our emergency departments. As we do that and get the primary care being provided by our primary health care professionals through the combination of family physicians - the recent announcement that we made providing $40 million of investment directly towards primary care, family physician practices, to encourage them to take on more patients - particularly orphaned patients, who would be patients that aren’t currently associated with a primary care provider - to encourage them to adopt technology to provide more efficiency - you know those quick health care check-ins to get a test result reviewed, especially in the case where the test result may be negative, so there’s no issue to report and we don’t necessarily need to have a full waiting time in a doctor’s waiting room to go in and take a full meeting so that the physician can get paid. We have a new model now to make sure that the physician gets paid. It would be more efficient for the patient and more efficient for the physician as well.
These are just some of the initiatives that we have in place to try to improve that primary care side of things with physicians, because we know that they are a critical component of our primary care services.
Move over to another big pillar, which we’ve been talking about for a number of years - our collaborative care teams. That is changing the way that our primary care is delivered in communities. I won’t delve into the history of why this is the case, unless the member wants me to at a future point, but we’re bringing all of our health care professionals together so that we get our patients seen by the right health care professionals. Not all services need to be delivered by the physician. A family practice nurse or a nurse practitioner can do things within their scope of practice, so that should bring an increase to the volume of patients who can go through. As we see more of that taking place across the province, we should be seeing reduced pressures within our emergency rooms.
Now, that doesn’t address the other challenge, because some of it is challenges of wait times and backup within emergency rooms. The other question the member specifically brought up was about staffing. In Nova Scotia, predominantly, in many sites it is physician staffing in emergency rooms. This is a complex challenge. We have to continue to engage and work with physicians to try to understand exactly how and why the challenge is.
I assure you, Madam Chairman, the member and all members that the NSHA does work to find locums when they need them in communities across the province. That would be temporary filling of spots, vacancies for a weekend or a vacation, services that need to be provided, or shifts that are available. They work to recruit physicians who would work in those services. We are, in the health care system, in a state of transition.
In her opening question, the member noted that these challenges - getting emergency rooms, in some of our community hospitals in particular, staffed by physicians is a challenge across Nova Scotia. I suggest to the members here that it is a challenge faced by communities across the country and not just across the province. So the solution is, as we continue to evolve and move our health care system forward, that we continue to look at ways to operate differently to find these solutions.
I think our announcement last week shows that we are willing to engage and work with physicians and health care providers to find those new and creative ways to make Nova Scotia more attractive and to move forward in addressing these and other challenges in our system.
MS. PAON: Thank you, Mr. Minister. I do agree that part of the challenge here is obviously that we have a shortage in primary care physicians. We’ve been talking about it this entire session. We were talking about it in the last session in the Fall as well.
We lost a family physician in St. Peter’s very abruptly, literally overnight. In a 24-hour period she had closed her office, and being directly associated with and taking shifts at the Strait Richmond Hospital, it caused chaos in our constituency. You had times where you would go to the St. Anne Centre for ER services and they were closed there - this actually happened to quite a few people I know, including my own family - went on to the Strait Richmond Hospital and the ER was closed there as well, and then ended up having to go to a third hospital, St. Martha’s - a wonderful hospital, but it is 90 minutes away. That’s a long way to go when you are in an emergency situation - having a heart attack or whatever else is going on.
My question to the minister would be, not only were we left with 1,200 patients without a family physician - and I’m very happy to say I’m very proud of those physicians who are in the area. We have a couple of brand new doctors in the last little while at the Dr. Kingston Memorial Community Health Centre in L’Ardoise who have taken on some of those patients. The nurse practitioner actually took on some of those patients as well, so I appreciate what the minister is saying, that we have to get patients to the right areas and being seen by the right providers.
Is there an opportunity as well to look outside of the box as far as, if you have a place such as Cape Breton-Richmond, and it’s happening again all across the province, that have a shortage in family doctors, primary care physicians who want to take on an ER, and instead of closing them weekend after weekend - people don’t get sick just during the week days, they get sick during the weekends as well - is there an opportunity there to think outside of the box and, say, have a nurse practitioner taking on the role of the primary person who would be taking care of the ER?
I know it would probably take in having to do some policy changes, but these are extraordinary professionals. In fact, I have found out that there are at least three or four of them in the Strait area who are currently unemployed or underemployed. Is there an opportunity there to think outside of the box so that it’s not only a primary care physician who would take the lead at a community ER or a regional ER?
MR. DELOREY: In many ways, there are aspects of that where, again, the work of our primary care efforts - the member mentioned nurse practitioners who are working underutilized, or the scope of practice. Our hope is to see them really deployed and working in our primary care settings and our collaborative practices. They’re very much needed there.
As far as being willing to look outside of the box, we certainly are willing. I think Nova Scotia has a very rich history of being innovative when it comes to health care. Many people look at Nova Scotia and often talk about health care and only focus on talking about the challenges of health care in Nova Scotia, as I’ve stated even in my previous response and in other times in the Legislature.
The fact is, many of the challenges and the conversations we are having, legislators across the province and throughout history have had very similar conversations around challenges, particularly in rural parts of our community. But what doesn’t get highlighted as frequently and as often - particularly in a Nova Scotia context - is that for a small population, for a small province, geographically speaking, we are actually a very innovative province. We have a lot of things to be proud of in our research - COPD treatments that were developed here in Nova Scotia, I believe expanding in Cape Breton, have made the way across the country now as best practices.
Our EHS system design - our emergency response system - to be honest, when I looked at and learned more about the history, 25 years ago, it came from Ireland, where some of the initial design and research was done. We really took that and ran with it in a Nova Scotia context, and it has become a model for North American emergency systems.
So yes, as a government and as a province that spans any government in power, we do have a lot of innovation and creativity and thinking outside the box. I think it’s something we can be proud of. But for the specific recommendation, whether or not the nurse practitioners could replace physicians in that role, they could provide some services, particularly around primary care within their scope of practice, but it wouldn’t necessarily be providing a full emergency room. That relates to the scope of practice.
When people talk and engage in conversation about an emergency room, there are certain services that are expected in the delivery of that type of service. I don’t know that a nurse practitioner would necessarily be able to offer the full scope of services to allow a site to maintain a designation as an emergency room or an emergency department service. That would be one of those trade-offs of looking at something like that - maybe able to provide some after-hours services that can address within a scope of practice care, but it wouldn’t necessarily have an emergency department status, because it wouldn’t necessarily be able to provide all of the services expected - if that makes sense to the member.
MS. PAON: I’m cognizant that we only have a few minutes left. I’d like to turn to palliative care, which has become quite a large percentage of what the Strait Richmond Hospital offers now. There are quite a few people, including my own father, who was fortunate to be able to have and receive excellent care at the Strait Richmond Hospital in the last few days of his life in September.
We have an extraordinary palliative care physician within the area. You could make a phone call and he would be there in just a few moments. We’re now reduced to basically - and with nothing to say badly about the physician, obviously, who now comes to do palliative care, but he’s only there once every two weeks to do palliative care service. A person could be admitted to the hospital and have died before they would ever see that palliative care physician. It’s absolutely astounding to me that we would be reduced to having that sort of care for someone who is in the last days of their life.
Can the minister please speak to me about how it is that we went from having the opportunity for - and I know, again, only a few minutes left - having the possibility of services to die at home, services within the palliative care area? We don’t have a unit specifically at the Strait Richmond Hospital, but again, a large percentage of our people do go there for palliative care services.
We had an opportunity, basically, to increase the scope of services for palliative care at one time. Now it has been reduced to only a physician coming in once every two weeks. Can the minister please explain to me how he sees that this is just and right for people at the end of their lives to have only those services available to them at the Strait Richmond?
MR. DELOREY: As I understand it, palliative care services are a little bit different throughout the province, based upon the health authorities that were in place over time. That’s an area that continues to be looked at by the Nova Scotia Health Authority to evaluate and identify the appropriate model to be rolled out across the province to ensure some continuity in coverage and approach to that care.
Picking up and relating the previous question the member raised about thinking outside the box, again, an example of Nova Scotia thinking outside the box and leading the way is with our paramedics. There is a provincial palliative program that leverages the training and the expertise of our paramedics, who can provide some services across the province to people in communities, to have paramedics come in and evaluate and assess and work with palliative patients in the home, in the community. So there is a wide range of scope of services and practices, I believe, as the member referenced some changes in her community.
I haven’t received a formal report on this - just some conversations about the situation, as opposed to anything formal. I believe there’s some discussions about what - I think the member mentioned expansion requests that came into the program and then how that plays out. I think that’s really as much about timing and so on, that they are working as a Health Authority on establishing a provincial program, establishing provincial guidelines that ensure the same level of care and service for a palliative patient in one part of the province as another for those facilities providing service.
MADAM CHAIRMAN: Order. Time has elapsed for the PC Party. We will turn it over to the NDP.
The honourable member for Halifax Needham.
MS. LISA ROBERTS: I welcome this opportunity to ask a few questions. I’m going to be focusing on nursing homes and continuing care, so long-term care and continuing care. The Nova Scotia Health Authority publishes statistics of placement from communities. Do those numbers include people waiting in hospital for long-term care or residential care placement?
MR. DELOREY: As I look up the specific details, I want to clarify with the member, you are referring to the website information that is published by the NSHA? Just so I understand which piece of data I am referring to.
MS. ROBERTS: Madam Chairman, I am referring to the statistics that as of the end of January 2018, there were 1,078 people waiting for nursing home placement and 160 people waiting for placement in a residential care facility. So I’m asking if those numbers reflect people waiting in hospital or if they don’t reflect people waiting in hospital.
MR. DELOREY: I thank the member for that clarification. While I don’t have the - I think you said January 31st data, was it? I apologize, I think it was January that the member referenced. If the member nods that it was January that she was citing - I don’t have the January data in front of me, Madam Chairman.
I do have some data as of March 21st that I can share. I believe that the wait-list is the total wait-list, including hospitals. The reason I’ll say that is that effective the week of March 21st, we had a total wait-list of 1,163. What that wait-list was made up of includes a wait-list of 340 people in the community. Again, this is as of the week of May 21st, so 340 in the community. Did I say May? I meant March 21st - 340 on the wait-list in community; 163 on the wait-list in hospital; some community applications that are pending, waiting in the community were 609; and applications pending in a hospital would be 51.
Those pending ones may be around situations who have applied with a registration process and may be waiting in community for nursing home care, but you complete the process and may be waiting for a care assessment or financial decisions and aspects around their application. They are working their way through the various steps - breaking out the community versus hospital. Then those 340 and the 163 fully completed their applications, all financial pieces, the care assessments and so on, and then the 609 and the 51. There are some aspects of the application that are still being worked through, but we are recognizing them as part of the total wait-list - in this case, 1,163 for March 21st. The number is in line with the range that the member cited for January 31st.
I believe that when they are referring to the approximately 1,100 people waiting on the wait-list, it includes all members in home community or in hospital.
MS. ROBERTS: Thank you for those answers. What happens when someone on the waiting list receives a call saying that they have been offered a space in a nursing home or residential care facility? How long do they have to accept the offer?
MR. DELOREY: Madam Chairman, I apologize to the member through you. I can’t recall off the top of my head what the exact turnaround time is within that policy. I believe the policy is public. We’re just going to endeavour to look it up. I hope to get back to her before - but I might interject in a different question, if we want to continue as we reach out and try to pull the specific data.
MS. ROBERTS: As has been stated here in the House on numerous occasions, the wait-list has greatly decreased since 2013. I’d like to dig a little bit into how that has happened. My understanding is that to be placed on the wait-list an individual has to be extremely frail, needing a great deal of nursing care.
I would like to understand how that is assessed. Is it by the requirement for continuing care in the home, or is there any other metric by which a person is judged to be sufficiently frail and sufficiently ill to require being placed on the list for long-term care?
MR. DELOREY: I thank the member for the question. There are clinical practices or standards by which mental and physical or cognitive and physical capacity of individuals is assessed. Within these capacities, as part of the assessment, there are standard thresholds identified for placement care requirements, whether those are home care requirements or long-term care requirements.
I don’t know the exact threshold numbers used by our care coordinators who perform the clinical assessments that get conducted, so I’m not sure what the clinical level is for those assessments that are used as the thresholds for the placement into long-term care facilities.
I guess in a more general way, the nature of the care - and I guess from a practice basis - they would ideally be looking at a situation where individuals who need care, or are anticipated to need care - it’s not just about the immediate needs. The anticipated care that they would need that type of placement within six months is what they’re endeavouring to move the system toward, so that if somebody is expected, based upon their physical and cognitive requirements, to need care within a six-month time period, they would be people that they’re certainly prioritizing and trying to get into long-term care support services and nursing home or residential care facilities.
MS. ROBERTS: I wonder if the minister would be able to share - either now or afterwards - if the department uses a proprietary assessment instrument to assess long-term care need.
MR. DELOREY: My understanding of the approach that they use is one based upon clinical information. I’m not sure if it’s a proprietary approach that they use or if it’s just based on general research and policy development over time. Again, the assessment does relate to cognitive and physical assessment - that is, again, the current, but they also look at the needs that the person has.
I know the member asked if it’s based on home care. Well, it does take into account what the home environment is like for individuals. Two individuals may have two different levels of care. If one is currently receiving care or supports, they are in a better situation than someone who has no care and supports in their community at a particular point in time.
Again, if someone is receiving home care or home care supports - maybe they have a caregiver - that individual would have an assessment that with all of the services they have, are in a better position in their community than someone who didn’t have the same level of caregiver supports available to them. In that situation, they would obviously be prioritizing an individual who doesn’t have any supports in the community. Both would be going through a similar assessment process, but it takes into account the entire person and their supports. I hope that answers and makes sense to the member opposite.
MADAM CHAIRMAN: I would like to remind members to keep the chatter down. I know we’re getting close to the end, but it’s getting difficult to hear the two speakers.
The honourable member for Halifax Needham.
MS. ROBERTS: I wonder if the minister could share what percentage of total CCA hours are provided by for-profit providers versus non-profit providers of home care.
MR. DELOREY: I don’t believe I have that data right here at my fingertips. Knowing that we only have a few minutes left, I’ll make an asterisk beside that one, not wanting to defer the member’s questions.
MS. ROBERTS: We are coming down to just a few more minutes. I wonder if the minister has spent any time looking at the Auditor General’s Report from November 2017. In Paragraph 3.39 of that report, there were a number of concerns raised about the funding and contracts with home support service providers. The Auditor General’s staff interviewed five different providers, including both non-profits and for-profits. They raised concerns about the funding rates, issues such as not allowing for much staff education, not including anything substantial for staff travel, and having differences in rates between non-profits and for-profits. It noted then the “Health authority management also expressed concerns with the approach to funding and the need to work with the department on the approach to funding going forward.”
I would like an update. How are those concerns being addressed by the department at this time?
MR. DELOREY: I can’t recall exactly Paragraph 3.39, I believe the member raised, of the AG Report. But yes, to answer the first question, I am familiar and did spend time with the AG’s Report. That includes having conversations with the AG and his staff about the report to make sure that I fully understand and appreciate the recommendations that were being brought forward.
As far as the question, I think the member is really delving, from that recommendation, into the notion of training and education opportunities around funding and supports and within home care environments. Perhaps not fully, but with a few moments left, I know that we have had a number of investments that were made.
I’m going to revert back - as I said, I might interrupt to answer a previous question. I believe we were looking at the hours. I have 3 million total hours provided last year, and it’s about an 80-20 split: 80 per cent for non-profits and 20 per cent for-profit sites. I don’t have the math on that, but about 600,000 for for-profit and about 2.4 million for non-profit hours throughout the province.
We do recognize that in the workplace CCAs have challenging work, whether it’s in a home space or in a long-term care facility - which, let’s face it, is home for many Nova Scotians. It may not be their original home in their community, but it is their home when they move in. There have a few reports about educational opportunities and equipment requirements to help improve the health and safety side of things.
I know that’s not the specific area the question delved into, but I want to let the member know that we do recognize that there are a number of areas where we’re looking to improve the work environment for CCAs, in particular around their safety. We know the Workers’ Compensation Board has recognized that CCA health care providers do have one of the more challenging - and have more cases. We have received some recommendations, and we want to work to improve the situation with equipment, training, and supports for our staff in those facilities providing this very important service to our aging population.
I know that’s not exactly the whole aspect of where the question was, but it was, I believe, pertinent to the theme at topic.
MADAM CHAIRMAN: Order. The time allotted for consideration of Supply for today has elapsed.
The honourable Government House Leader.
HON. GEOFF MACLELLAN: Madam Chairman, I move that the committee do now rise and that you report progress and beg leave to sit again.
MADAM CHAIRMAN: The motion is carried.
The committee will now rise and report its business to the House.
[The committee adjourned at 9:24 p.m.]