HALIFAX, FRIDAY, MARCH 29, 2019
COMMITTEE OF THE WHOLE ON SUPPLY
THE CHAIR: We will continue with the Estimates of the Department of Health and Wellness.
The member for Cape Breton Centre, for 30 minutes.
TAMMY MARTIN: Thank you, Madam Chair, and I’d like to thank the minister and his staff for being here again today. You’re going to have a long, arduous day, I am sure, of questions and answers because that’s what is important.
First off, I just want to confirm or clarify if the minister would confirm for us, the 6 per cent increase in the Health Budget, that that is a result of the funding investment in the projects for Capital Health, QEII, and Cape Breton. I’d like to confirm with the minister that this is not a 6 per cent increase across the board to benefit program services and such other than in Cape Breton and the QEII.
HON. RANDY DELOREY: I acknowledge - how the member referenced it - an arduous thing. I beg the member’s patience as we continue our discussions to go through the details here of the budget to install confidence, I guess, in our constituents.
To the specific question around the percentage of budget increase – yes, the budget increase does include investments into the capital grants which represent about 2 per cent, and the remaining 4 per cent is towards health care actual spending costs in the health care operational system.
TAMMY MARTIN: I thank the minister for that answer, and I’d like to move now to the long-term care recommendations.
Madam Chair, $2.2 million has been invested or put aside for investments into mattresses, cushions, and slings to prevent bedsores, which we are very happy to hear about because bedsores continue to be a significant issue in long-term care.
My question to the minister: Could the minister tell us how many mattresses, cushions, and slings were purchased with this money and where can we see it in the budget - could he point us to the page?
RANDY DELOREY: I thank the member for acknowledging the recommendations and the efforts we’ve been taking as a department to enact and make improvements in the quality of care for residents in our long-term care facilities and, indeed, the investments are not just for the residents, but for staff as well.
Just to clarify the investments that have recently been announced, the announcement I made just over a week ago, or about a week ago, was a $2.2 million investment in the mattresses, but it is about $1.6 million that went towards the mattresses and equipment for pressure injuries or pressure wounds. The other about $800,000 of that $2.2 million went towards ceiling lifts or lifts within long-term care residences which are designed to facilitate the movement of residents from, for example, the beds to wheelchairs and vice versa. It is a combination investment.
As far as the specific number of mattresses purchased, the purchases haven’t taken place, but that announcement was funded from the 2018-19 budget, so that means the expenditure of $2.2 million has been made to the partner, the Canadian Red Cross.
That organization we provide the money to, they have an equipment program already in place with our long-term care facilities, for example wheelchairs – and not just in our long-term care facilities, but for community-based programs as well.
Because they already have the relationship for equipment and the logistics network for distribution throughout the province, we felt the most efficient and effective way to procure and distribute this equipment was by funding the Red Cross. The Red Cross is going through the process of purchasing and distributing to long-term care facilities across the province.
We don’t have an exact breakdown of the number of mattresses and specific pieces of equipment because that is the work that’s ongoing with the Red Cross and the long-term care facilities, but I assure the member that the resources, the equipment, is being purchased to be distributed across the province to all our long-term care facilities.
I believe there are 17 or 18 facilities getting additional lifts and, again, that is better for the residents and the employees.
I just want to clarify for the member that the announcement and the $2 million that I had announced publicly, in partnership with the Red Cross, was from the 2018-19 budget, so those monies have to go out the door in the fiscal year for the budget. The upcoming year is the additional money that we have allocated for the other initiatives, to initiate the work and other recommendations within the panel - the expert panel for long-term care review.
TAMMY MARTIN: I thank the member for that answer and I am glad to hear that there has been an investment in lifts, because my first term in this Chamber I expressed my concern and displeasure to the minister that the manor in my community had to actually raise money so that residents in the long-term care facility at Maple Hill Manor could be lifted and moved appropriately and without injury. I would hope that some of those lifts are going to the facilities that were fundraising for them.
In that long-term care recommendation, there was $2.8 million to implement the recommendations by that panel. I would like to drill down on that a little bit and find out what specifically this money will cover, aside from dealing with bedsores and mattresses and the lifts.
I’d like to find out if there is an increase to staffing and, if so, when will we see that?
Which homes will receive the increased staffing and what will that look like to have increased staffing numbers, because we all know that those godsends of long-term care workers are working short-staffed all the time, and over and above their call of duty.
Which homes will specifically see an increase in staffing and where can we find that in the budget?
RANDY DELOREY: In fact, there is actually quite a lot going on and, indeed, not limited or restricted to just the response to the recommendation from the long-term care panel.
I’ll go into more detail there, but I do want to bring to the member’s attention that things like the lifts we discussed briefly and the importance of the lifts. There is also something that we’ve taken, as a government, a concerted effort to look at, and that is the safety for employees. We’ve seen an unfortunate trend of increasing WCB claims and injuries within the long-term care sector. That triggered us to work in collaboration with the Department of Labour and Advanced Education and the WCB organization to implement some initiatives to help implement training, education programs and, again, additional equipment.
So, just for the member’s reference, there was additional training last year of about a half a million dollars that we spend on that. We’re spending about the same this year for more training within our long-term care sector, but also providing additional support for equipment and work around non-violent crisis intervention and programs like that. That’s all being done outside of the investment we highlighted. This is just part of our workplace safety action work taking place in the sector, and for the upcoming year, 2019-20, it’s a little over $1.5 million that we have targeted there. The $2.8 million that I believe we highlighted in the budget’s additional investments for this year is on top of that $1.6 million new money, an additional which is targeted towards the recommendations from the long-term care panel.
So, some of the things that, obviously, are being focused on there, we’ve already talked about things like pressure injuries. One of the themes that was highlighted in that panel, the member talked about staffing, and that is one of the areas that has been recommended, the workforce. If you look into it, a lot of what was recommended there was about workforce planning and doing research to better understand the current workforce, the training program that is available and how individuals are introduced to the long-term care environment, to make sure that the experiences in the education programs properly prepare them because the information from the panel highlighted that a trend that seems to be appearing from the information they gathered, was people leaving the field after only a short period of time of experience. Obviously, it’s sometimes challenging work, the shifts and so on.
So, one of the recommendations is the research. In the short term, focus on investments that were being made around staffing, is around the work with LAE and the community college around curriculum and program delivery, around things like how we promote and attract employees to make more workforce available. I know there have been conversations in the Legislature before, Madam Chair, about challenges for recruitment and filling shifts, and that has got to be Step 1 in the staffing side of things and we need the available workforce to do that, particularly with the CCA qualification.
So, that’s the area from workforce planning that would be focused on with our investments. I think the member may be going towards - I know it certainly seemed to come up in the questions after the report was released, the notion of increased staffing levels in terms of the ratios and things like that.
That’s not the stage that we’re at right now in the short term with our work on the recommendations from the panel. Again, I’ll encourage the member to go back to the expert panel report, they very clearly recognized the short- and the longer- term initiatives. So, we’re still working on those short-term initiatives to get things up off the ground that will help us achieve the longer-term recommendations that have been identified, and this money is helping us do just that.
TAMMY MARTIN: To be quite honest, people have been talking about this issue for years, Madam Chair, the fact that while the minister talks about training and working with LAE, the fact of the matter remains that staff are tired; staff are exhausted; and staff are injured. That’s why people are leaving these jobs, because they’re working short-staffed. I’ve talked to many nursing homes who haven’t had their staffing ratios increased or changed in over 20 years.
The dynamic has greatly changed, and I would suggest that the recommendations of this advisory panel - we have paid to look into long-term care - has said that this is one of the issues. I would suggest that we invest in staffing immediately.
We are currently working short-staffed in long-term care every day of the week. We all know that the first sick call is not covered and patients who are in long-term care are arriving there much sicker. They need help and our staff in long-term care facilities need help.
My question to the minister is: Is there a real commitment or plan in this budget to increase staffing and/or beds in long-term care?
RANDY DELOREY: Indeed, there are some short-term recommendations and actions being taken. For example, I will direct the member to Recommendation No. 1.1, Action in the report, and that is to hire additional LPNs to support our residential care facilities in the province. That work is included and under way and is one example of bringing more health care workers into our continuing care space.
We are working with the Nova Scotia Centre on Aging to do the research around staffing model mixes; that’s the mix of workers who provide care to residents in our long-term care facilities. That is work ongoing.
As I’ve talked about growing and expanding and addressing the availability of individuals, particularly of the CCA designation, to be trained and available to work in our workforce. One of the recommendations was - I believe there was a question earlier this week that was directed to my colleague, the Minister of Labour and Advanced Education, we will be working to provide bursary funding to be administered through the Department of Labour and Advanced Education as part of the work to encourage more citizens to register to take the CCA program being offered in the province.
These are examples of work that is ongoing, focused on the employees, and the hiring, and ensuring we have the appropriate people providing care who are available, as well, in our facilities.
We take the recommendations very seriously, I take the recommendations very seriously, and we are moving forward on them. As I’ve mentioned, that does include the hiring of some additional staff, both on the research side and, as I said, specifically per Recommendation No. 1.1.
Remember, this is just a first step of the work that we are doing, targeting the short-term recommendations. That builds the foundation for being successful with the long-term recommendations made by that panel.
TAMMY MARTIN: Now, today we are getting somewhere. We’re finding out some good stuff, one of which is that we are going to hire some LPNs for long-term care facilities, which I think is great news and I hope that happens today, but we’ll take it.
Talking about long-term care and the budget, it’s hard to determine just where certain items are for recreation or for diet. When we talk to dietitians in Nova Scotia, they say that the diet of a person in long-term care absolutely affects their level of care and whether they can prevent or, if their health is strong enough, to resist bedsores, infections, et cetera.
I am wondering, we have talked many times in this House, and I have talked to many long-term care facilities, which say that they feed our seniors on $6 per day.
Has this government invested in or included any dietitians in discussions to find out if we can actually feed somebody a healthy, sustaining diet for $6 a day? Have they set their standards around information that has been provided to and adhered to from dietitians in Nova Scotia?
RANDY DELOREY: Indeed, we recognize the important role that nutrition and diet play in our province in long-term care facilities. That’s why we did institute increases with targeted funding that would be directed and only to be utilized by long-term care facilities to go towards the dietary needs and improvements and recreation. That was important funding.
Again, we recognize as a province that the role of nutrition in our province is important. That’s why we also expand and invest in our breakfast programs to provide healthy starts to the youth of our province, which helps them attain better educational results, because we know that they’re available in our schools throughout the province. We do, as a province, recognize the role nutrition plays.
As far as the role of dietitians, again, our long-term care facilities do, I believe, have dietitians assess and determine what the menus will be for the long-term facilities in the province.
Have I explicitly engaged a dietitian to answer the specific question that the member asked? No, but we do have dietitians in long-term care facilities who do assess and provide the menu options within our facilities across the province.
I will go back to the reference of the recommendations of the panel and the work that is ongoing to assess and ensure that we do have the right mix. If there is a need for broader nutrition, nutritionist or dietitian supports in our long-term care facilities, that would be, I think, something that we would determine through that broader review of ensuring we have the right mix of professionals providing care in our facilities across the province.
TAMMY MARTIN: With all due respect to the minister, $6 a day. I can’t imagine how that can provide healthy nutrition for anybody, let alone an aging, ailing senior in one of our long-term care facilities.
I’d like to ask again if the minister could go into some more detail about, if the minister knows for sure that is adequate funding to provide a sustainable, healthy menu for seniors in our long-term care facilities, and if the government isn’t engaging with a dietitian at the Department of Health and Wellness, how do we know that?
RANDY DELOREY: I thank the member again for the question and, of course, it is important.
As I explained in my last response, this government recognizes the importance of nutrition and the investment there. That is exactly why we increased the budget allocation specifically targeted towards food within our long-term care facilities a couple of years ago to ensure there would be more funding available to our long-term care facilities to increase and respond to the dietary needs of residents.
Again, as far as having the assessment and determination of the qualified individuals like a dietitian or a nutritionist, they do work in our long-term care facilities to assess and prepare the menus, to provide the food options, and menus for residents.
I will refer the member back to the mandate of our expert panel that conducted a review within our long-term care facilities because I think the concern being raised by the member, let me phrase it this way, the concern being raised by the member seems to be whether or not the food budget is adequate to ensure the quality necessary and the care and meeting the nutritional requirements of residents in long-term care facilities.
As the member knows, we did have an expert panel convened that conducted a review of our long-term care facilities and this wasn’t an area that was flagged by that panel as a priority concern. There are a number of areas that have been flagged as concerns, but the member continues to bring up the questions about the dietary food budget allocation.
I will restate that we’ve increased that investment, which we are maintaining our budgets going forward, and we are targeting where we need to focus to improve the quality of care for long-term care facilities. We are really taking the guidance and direction from the recommendations of the expert panel, and that wasn’t one of the areas.
Again, we do have nutritionists and dietitians in our long-term care facilities. So, to the member’s concern asking if anyone is looking at this or reviewing it. Indeed, they are, right on the ground in these facilities.
We did increase the budget to help them respond to increased needs with the targeted funding, and again, broader quality concerns and opportunities to improve the quality of care provided to our long-term care residents. That is where we are taking guidance and are focused on the recommendations from the expert panel.
TAMMY MARTIN: While I appreciate there was money put back into the long-term care budget, I have to respectfully disagree with the minister because that money was cut from the long-term care budget and a portion of it put back only after much public outcry about cuts to programs and services provided to our long-term care residents who are in long-term care homes in Nova Scotia.
That is how this came to be. There wasn’t an investment. The government put money back that they had taken out in a previous budget.
I’d like to move on now and talk about alternative level of care. Going forward, I will say ALC.
We know that it is costing about $1,300 a day, according to the Auditor General, to keep a patient, who is an ALC patient, in a hospital bed. We also know that the resident or the patient is being billed $250 a day.
I know in my constituency I had someone who was living in a hospital for over nine months. She couldn’t get a long-term care bed and she had nowhere else to go. When I asked the minister responsible for seniors this morning, she was living in a hospital without the facilities or the services that are provided by a long-term care facility, who is making up the difference of the costs associated with an ALC patient? Is it the Department of Health and Wellness? Is the rest of the funding or expenses going to Continuing Care? Department of Health and Wellness? The NSHA? And, how much does the minister know, how much have we spent in 2018-19 keeping residents in ALC beds for upwards of nine months?
RANDY DELOREY: While I can respect the member’s assertion on certain topics where we, I believe it was phrased, agree to disagree, I think perhaps this is an area, again, for clarification. I suspect the member will come, possibly at the end of this exchange, conclude that we, again, agree to disagree. At least we can do so respectfully.
The thing I want to clarify first with the topic of ALC or alternative level of care for you, Madam Chair and others, is an ALC, someone in an alternative level of care bed, is not automatically a person waiting for a long-term care facility. I think that’s important to note.
When we talk about the date of the people in hospital beds designated as alternative level of care, that does not mean they are specifically waiting for long-term care placement.
What it means is that they have been medically discharged, but there is something that needs to be put in place to allow them to go. It could be a residential care facility, a long-term care facility, or it could be their own home that just needs to wait for home care to get put in place.
There are a variety of reasons why someone may be in an alternative level of care or ALC bed in the province. So that’s point one, that when we’re talking ALC, 100 per cent of those beds are not taken up by those waiting for a nursing home placement.
THE CHAIR: Order, time has elapsed for the NDP. We will turn it over to the PC caucus for one hour.
The honourable member for Kings North.
JOHN LOHR: I thank you for the opportunity to speak as the Mental Health and Addictions Critic. Clearly this is the first time there has been a Mental Health and Addictions Critic in the Legislature of Nova Scotia. I think it’s a signal from our caucus of the importance of mental health and addictions in the overall budget to the Province of Nova Scotia, to the people of Nova Scotia. It’s a signal of our intent, I think, to have a separate mental health and addictions minister if we were to be in government. Clearly, nearly a $300 million budget would make this one of the larger departments in the provincial government.
Clearly, what we are seeing is a dramatic increase in the demand for mental health and addictions services in the province. I know the minister knows that. I’ve said it before in the Legislature, my belief that one of the reasons we see increased demand is simply the overall stress on the health care system itself. People see the emergency department, the ER, as a primary place to go and get emergency mental health services. The ERs are backed up because there isn’t room in the hospitals for the ER patients who need to move on to a more significant level of care or be admitted into hospitals. In many cases, there’s not room there.
The overall stress in the health care system has caused continued stress in mental health services, particularly in our young people. As the minister knows, as a parent, you are only as happy as your least-happy child is, and it’s incredibly stressful, particularly in youth mental health.
I do recognize there has been an $11.7 million increase, I do want to acknowledge that and the minister taking that on and doing that. I guess maybe what I would say to start my time in Estimates here is to just sort of ask the minister to go down through and outline what that increase is.
RANDY DELOREY: Again, I think it’s a good day in the Legislature when we do reach a consensus and a shared recognition of priorities and important areas. I think that goes to show that our democratic system works; that regardless of political affiliations or Party lines, we all hear from our constituents, from Nova Scotians, the needs and the concerns of individual Nova Scotians, youth, their parents, or whomever. We hear them and we hear similar concerns, similar stories, regardless of our constituencies and which political affiliation the elected member may have.
Again, I’d like to thank the member for acknowledging his Party’s interest and concern and commitment around the mental health and addictions. I know it’s one we’ve heard from the NDP as well, and again it’s one our government shares.
As the member noted and again, I thank him for acknowledging and outlining the commitment we’ve made and the increased investment around mental health. The increased investment this year is, in fact, a continuation of our commitment from when we came into office to continue our efforts to improve access to mental health services. You know, it doesn’t take much digging to see we have disproportionately focused our efforts on youth. The rationale for that though, Madam Chair, I know I’ve spoken to some people about that and someone one time said, well, that’s great about youth but what about the adults?
Well, if we do a better job identifying mental health challenges that our youth face, identifying them earlier, where the research does show when people are apt to have mental health challenges in their lives, they often first present themselves in adolescence. The research also shows that, like with many health conditions, the earlier you can identify, the earlier you can start intervention and treatment and the more productive and healthy lives individuals can live. Again, making that comparative between one’s mental wellness and their physical. To that extent, that early identification, intervention and prevention are critical. That’s why we’ve been investing there.
What that then allows us to do is for those youth, the goal would be that you don’t see them entering crisis stage as much, which reduces the pressures in that part of our system. So, the investments, though on the surface are targeted towards the youth, the impact on our overall mental health system that we will see over time is the reduction, so that it does serve, improve, and strengthen the supports being offered throughout our entire mental health system.
To the member’s specific question, he wanted just some examples of investments we are targeting this year. One is investments in First Nations’ mental health, providing funding for child and youth mental health and addiction clinicians within First Nations communities across the province. That is an important investment. We believe and recognize that challenges with mental health and addictions exist around our province. Unfortunately, we also recognize that our First Nations’ communities often disproportionately have challenges present in their communities and these investments allow us to help provide provincial resources within those communities to help respond in a culturally sensitive and appropriate way, right on the ground.
As I believe we’ve spoken about this previously, there are investments in the adolescent outreach model program in the province, we more frequently refer to it as the CaperBase model expansion. So, that has expanded out to other schools in the Northern and Western Zones. I believe the investment allows for supports at about 41 schools throughout the province. Additional schools on top of those, that have been historically serviced by the CaperBase program in Industrial Cape Breton region.
Within the IWK they are working hard with the Nova Scotia youth mental health and addictions treatment network. So, they’re working to provide a high priority topic in educational training opportunities and webinars, to provide access. The Nova Scotia Health Authority is expanding their clinical staff throughout three hub zones in the Eastern, Northern, and Western Zones, to bring in 10 clinicians that include resource navigators, social workers, and psychologists throughout parts of the province.
We’ve talked, I know the member for Truro-Bible Hill-Millbrook-Salmon River has raised the question in Question Period, as has my colleague, the member for Colchester North, around SANE services and the role that that can play for victims of sexual assault, and how having these services in the community can have positive mental health outcomes based upon the impacts of the incident. We have announced the expansion not just for the Truro location and Colchester but also up to Cumberland as well to strengthen access in the Northern Zone after last year having put in place in the Western and the Eastern Zones of the health care system. They’re continuing the work to bring in the central intake system.
The member referenced emergency departments as a place where people go, but telecommunications, traditional telephone links, and other digital platform links continue to play an important role in access for people. The research does show these platforms can and do provide valuable supports to people when they are in need. They help navigate, and the goal of having a central intake obviously is one of the most frustrating experiences people have, not just with the mental health side of things.
I think in any part of any system, when you go to reach out for help and you’re told, we don’t have the help or the support that you’re looking for, and then being sent off to try to find your way again. I think in particular in mental health and addictions, the first step is clearly recognized as the most difficult. The first step for an individual suffering is recognizing they actually need help. In both mental health and addictions situations, we know people often wear masks and they hide. They hide the conditions that they’re suffering through. Central intake is to help avoid that type of situation, so that when you come in, the people on the intake side will help ensure they direct and get the individuals connected to the right resources at the right time rather than just sending people back out to the community when they need to look for that support.
These are things that we have been getting recommendations on. We have had a number of experts, Dr., now Senator, Stan Kutcher made many recommendations to us as a government. He’s very well-renowned, particularly in youth adolescent psychiatry services. We’re continuing to exercise and invest in these areas. Again, I could go into some others, but I don’t want to take all the member’s time.
JOHN LOHR: I do agree with the minister that many times people hide their condition. I think that one of the most important things that we can do is de-stigmatize mental health and try to make it as straightforward as any other health service. I do appreciate the increase in the budget of $11.7 million.
I do want to ask a specific question about the budget, and that’s on Page 13.11, Supplementary Information, Other Programs, Mental Health and Addiction Services. Last year, the estimate was for $11,175,000. The forecasted actual is $8 million, and it shows a further decrease for other programs down to $8.27 million. I’m just wondering if the minister could explain what those other programs were in that line item.
RANDY DELOREY: What that change reflects is predominantly where the departments have budgets allocated to us, when we have programs, as they mature sometimes we transfer them out either to community or to the Nova Scotia Health Authority. When we transfer them out, it’s just shifting the budget allocation. I assure the member in this case, that change is predominantly driven by the transfer of programs from one budget area to another but maintaining them. Some examples include mental health community-based supports, a program that we had was about $1.6 million, was transferred to the NSHA and IWK crisis service programs for crisis service expansions.
We had the budget as it operationalized, it gets transferred from the department line item into the budgets as it operationalizes and gets up and running, then we move it into the Health Authority budgets. That’s where the big part of that was. Programs that we were planning and working on, and as they’re getting out there in the communities and executed by the Health Authorities, becomes part of their operational budgets this year. I just gave you a couple of examples, but that’s the type of thing that took place in that change. We still continue to invest, and invest significantly, and increase our investments overall in mental health and addictions.
JOHN LOHR: My curiosity about that line item relates to, I know that your department gives small amounts, in the overall scale of things, to organizations like the Schizophrenia Society of Nova Scotia, Eating Disorders Nova Scotia, Talbot House, Freedom Foundation, Marguerite Centre, I’m sure. Is the money that is sent out to these NGOs, is that included in that line item right there? And if not, where does it show up?
RANDY DELOREY: I guess this is appropriate for all members in a general sense. There are grant programs, some that the department holds and many that the Health Authorities and even our Community Health Boards in communities across the province, that there are grant opportunities for health-related programs. Within the department, the majority of our grant programs are held under the Public Health space. I’m not sure off the top whether the specific line items for - the member mentioned the Schizophrenia Society, for example, which I can say I was proud, I think last year or the year before when I came in as Minister of Health and Wellness, it’s one of the first times the province had really supported with a significant grant for that organization, recognizing the great work that they do, like many of the other organizations.
Again, to the specific question. The majority of our grant programs are in our Public Health space. There may be some grant funding in that line item, but it depends on the organization. I just don’t have the list of which organizations have received grant funding in each of the line items under the mental health program, or the Public Health one.
JOHN LOHR: So, I guess I would like to request of the minister that the consolidated list of those organizations that received money could be provided or tabled at a later date. I do believe that is something the minister should have.
I will say, and the minister may not realize this or remember, as it was before his tenure as minister, I believe it was in 2013 or early 2014, in fact funding from the provincial government to eating disorders was cut; the funding from the province to the Schizophrenia Society was cut. If money has been put back there, and I believe that is the case, it was reinstated.
I would like to say, in general, that I believe these NGOs provide incredibly effective service and incredibly good value for money, from the point of view of our province - for the price of half of an FTE, they do an incredible amount of work. In fact, one would be Talbot House and I know their funding has not increased in 10 years.
I would like to ask directly: Is there any indication or any inclination on your part, Mr. Minister, to increase funding to these - Talbot House, Freedom Foundation of Nova Scotia, Marguerite Centre - in view of the incredibly good work that they do?
RANDY DELOREY: I think the two areas to respond to, first, is about the list of the organizations that receive support and funding. For grant programs they are annual, so they do get published, the full list, as part of Public Accounts, I believe in Volume 3 of the Public Accounts documents. Public Accounts is usually published by the Department of Finance and Treasury Board. My colleague, the Minister of Finance and Treasury Board, usually tables in late July or early August those lists, as part of the final closing of the books.
One could look at Volume 3, they would see the 2017-18 list of grants and organizations. The 2018-19 Public Accounts, as I said, will be later this summer but it would have the full list published there.
The second part of the member’s question, I believe was around organizations like Talbot House. I don’t have the specific breakdown at that level of detail here, but I will look into the specific rate and compensation over the last couple of years and what the budget is for this coming year.
I do believe that broadly speaking, there was, a year or two ago, some review around supports for some of those organizations. I think there were some changes in the funding formula model. How that specifically related to Talbot House, I’m not sure but I’ll get that information and share it with the member once I receive it.
JOHN LOHR: I do want to make a statement in support of the abstinence-based programs that are offered by these - Talbot House, Freedom House, some of the other organizations, Marguerite Centre.
As the minister knows, and I do believe there is space for both, there is the methadone - there are the other types of treatments for addictions - methadone and other drug-based treatments. But there are these abstinence-based programs and in my travels, I’ve heard indication or the feeling, and maybe that’s not correct, but the sense that these abstinence-based programs are being asked to incorporate methadone as a treatment option in their program. It’s clearly against their basic philosophy.
I just want to make a statement in favour of that. I believe we need both types of treatment, but I don’t believe you can blend them. I would like to hear the minister’s comment on that concept.
RANDY DELOREY: The member, I believe, is correct in acknowledging that there are different, I’ll say opinions, as to the best clinical approaches to treatment programs, in this case an addictions space.
I can advise the member that the clinical advice and information that is being provided to me through the clinicians within the Health Authority and the department, and I can assure the member when I meet particularly on topics of mental health and addictions, and I’m sure he can verify this in his conversations with members, I do take these meetings seriously. I delve in and I take a critical approach to information when it’s presented to me. But there has been a significant amount of evidence and research and really a transition in practice now being recommended for addictions treatment models.
There is a recognition that community-based service delivery is what the research is showing is resulting in better, or even the best, outcomes for the long term of patients. This is research.
You know, we are all individuals and, as with cancer treatments or other types of health care treatments, individuals may respond differently but the health care system is often designed around the evidence that shows the best treatment options, and best outcomes, for the majority of the population in the program.
I will acknowledge that I’ve been advised of different approaches and models. But certainly, the strength of the evidence, and the information around community-based delivery of programs and those outcomes, seems to be the direction. There is a growing body of evidence that those outcomes are stronger than what has been the historical, traditional focus on abstinence-based program delivery. Again, that’s from a variety of addiction areas that that research and information has been growing in the last decade or so.
JOHN LOHR: I understand what the minister is saying, and I respect that there are many differing opinions likely on what the best outcome is. I can tell the minister that I am personally concerned at the number, the rapid increase in the number of people on methadone. I realize that that’s likely a better alternative than being on an opiate; I would certainly say it is. I do believe that the goal of being truly drug free is a worthy goal and should be an option available if a person wants to take that route.
I asked the minister not that long ago in this House about the rising black market for methadone. I was told of, and this is you know, to say this even is difficult - but the fact that people take the methadone, are observed to swallow the methadone, and then go outside the clinic and regurgitate that methadone. And then that goes on the black market. You can’t make that up.
I can’t prove that that’s happening. That’s the anecdotal story that it is happening. I’m very concerned about that; very concerned about the fact that it is extraordinarily difficult to get off methadone treatment. I believe that the average length to wean a person off, to truly be drug free, would be several years to get off methadone addiction, itself.
So, I know that with methadone treatment there is intended to be a certain amount of counselling about lifestyle changes. I’m concerned that some of that is not happening. That it’s simply methadone, and the rest of the treatment package that’s meant to go with the methadone treatment, is maybe not happening.
I wonder if the minister would comment on that. Does he believe that they are doing an adequate job for counselling and all the other things; for preventing the black market and for controlling what’s happening with methadone?
RANDY DELOREY: As the member acknowledged in the concerns raised about methadone, I guess, black market - when we last spoke, there are processes to ensure that it is supervised when consumed.
As the member acknowledged, the anecdotal information that he has brought up, it’s not information I’ve been able to verify. Sometimes there may be individual instances, but whether it represents really a broader type of problem, and that’s one of the challenges, I think, and one of the things we need to be careful of. I think that with the information that gets presented to us, and as I mentioned in my last response, how I try to take a very critical approach to the information, even if it’s coming from staff or others. I think I’m becoming known as kind of a devil’s advocate.
Perhaps I was influenced as a child with public service announcements. There was one the member may recall, the house hippopotamus. It’s still on TV every once in a while and is really targeted towards children to question the information they see on the TV.
I think it serves us well as members of the Legislature to also assess the information that comes to us with a critical lens, to help ensure that when we are making our decisions and advancing causes, that we are doing so based upon the best evidence and information.
I’ll just restate that the evidence is growing around harm reduction and the direction here for the treatments. From a provincial perspective we haven’t - for those community organizations providing programs like Talbot - we haven’t intervened to prevent their abstinence-based program.
So, even though I’ve talked about what the clinical evidence and things going on, we allow the community groups to continue to provide their care and deliver their programming the way that they have established. I think that is an important thing, as well, to note for the member that we continue to fund those programs. Programs, particularly in the area of opioid addictions, the framework that was developed was an evidence-based framework. It has really five prongs or five approaches to it.
One is to continue our work, to understand the issue we’re presented with. There’s a big focus on prevention, so this would kind of align, I think, to the member’s belief that abstinence is a good treatment program.
I think we will both agree that prevention is the best source. If we can prevent people from being exposed to particular substances, you’d avoid the risk of misuse and addictions that may come from the use.
Prevention is one stream that we focus on investing and supporting, and then harm reduction. That’s the piece where the evidence shows reducing the harm has positive outcomes.
I guess one of the things the evidence that has been presented seems to be showing is that while abstinence-based programs do serve individuals, when they look at the long-term effectiveness, they see a lot of reoccurrence in the abstinence-based programs.
I think that’s where the research has been focused in on. It’s not the short-term treatment, but the long-term outcomes of an abstinence-based program versus a harm reduction type of approach to treatment and support.
The member raised concerns about the length of time to go through methadone treatment - the outcomes, when I’ve spoke to physicians who participated in methadone prescribing and working with patients in need, honestly, the way they’ve described patients that come in and then move on to the methadone program, is nothing short of transformational.
When a patient presents at that stage - one of the reasons why it’s sometimes challenging to get physicians to work and support methadone treatment is because of the state of patients when they come in looking for help - as we talked earlier, we want to work hard to make sure that when they do come through a door, whichever door it is, that we do provide the care.
So, we’re supporting on education. We’re building a network of those physicians who do work in this area to be available to other physicians who may have a patient in need. They can reach out and, through peer support clinically, ensure that they get the appropriate treatment options presented to them. We’ve been investing heavily there.
So that helps us with treatment, as well as prescribing practices. We know there have been changes nationally around opioid prescribing practices. We encouraged that as well. When people start evaluating where a lot of the challenges here came from, actual prescriptions have been part of it.
The fifth path that we’re focused on investing and supporting is work within the criminal justice and law enforcement space. To help the justice system to better be informed and able to respond appropriately for individuals with an addiction, that sometimes leads to criminal activities. It allows for some awareness of that as well.
JOHN LOHR: There may have been many who have called for an increase in, or reinstatement of, the overnight detox program. I know that it is not totally gone, but it’s largely gone. As the minister would be aware, detox can be lethal. It’s very dangerous and can have some health issues. Is there any plan to increase the number or the spaces for overnight detox in our health care system?
RANDY DELOREY: I’m not aware that the NSHA has plans for expansions. But what I can advise the member is that I’ve been out and meeting with representatives, both administrative representatives for mental health and addictions, but also when I’m in communities. When I did my first tour around the province going to hospitals, including down in the region that the member represents where they have a very successful addictions treatment program - it’s one that stands out to me because that’s where this whole conversation of the inpatient detox versus community-based treatment was first introduced to me. It was not something that I had been aware of and, in that meeting, there was actually a fairly extensive conversation that I had, to really understand.
I did the tour of the facility and understood the changes they were making and the evolving growth of community-based programming and same-day services to be there to support people. They explained how that has resulted in the reduced need for inpatient detox because they were seeing better outcomes, longer-lasting positive impacts on the patients requiring care.
But they also went in and spoke in great detail about how both patients and indeed, family members and friends are challenged by this transition in their clinical care program, because it is challenging. I had a conversation recently with someone who asked me if I’ve ever observed somebody going through detox, and I haven’t.
This individual, in some fairly graphic detail, explained, and I certainly hope that I never do have to observe that.
So, I can understand and appreciate why loved ones working with their loved one, whether it’s a family member or a friend, who reaches the point that they’re willing to either ask for or accept help, would be searching for inpatient treatment options.
Yet, the clinical work and evidence that has been a growing body of evidence seems to come back that it would be out-patient based.
To the member’s comment or point about, I think you mentioned, that it can be harmful. There can be some clinical outcomes, I believe the member stated about the risk of death in some detox situations. That’s why they’re not disappearing that. Even if they present, when they do their clinical assessments and I have to rely on those trained professionals on the front line when they do their assessments, that they are doing that and determining if this patient is in need of inpatient detox, that they will bring them into the acute environment and ensure that they have the services.
When I did that tour, even though the clinicians on the front line spoke very positively - they spoke in detail about the evidence that led them to adopt this model and approach; they also started talking about how it had been utilized for the last couple of years and they were starting to collect their own data and seeing that it was aligning with the evidence, kind of the academic evidence, from other jurisdictions and, their results were really aligning with that as well which is what encouraged them to say that they were on the right path - they also did assure me that they were not eliminating inpatient beds there, that inpatients would still be available, or there would still be the option, when it was deemed necessary for those patients.
So, I guess that’s that piece I hope the member also recognizes, that the supports are still there, but it’s a clinical decision as to what path of treatment would be pursued.
JOHN LOHR: I appreciate that the minister has had more wide exposure to this whole situation than I have. So, my question is: Can the minister tell me what the rate of success is for people who are truly - who go on methadone or another drug-based treatment - who are one, two, three years later actually off of all drugs and are truly drug free. What is the success rate? Can the minister share that?
RANDY DELOREY: I don’t have the specific rates here with me, but I’ve made the note. We’ll make sure I get that back to the member as to the specific literature and the rates that are assessed there.
JOHN LOHR: I appreciate that and I know there’s a political rule never to ask a question you don’t know the answer to and I don’t know the answer to that question I asked. I would truly appreciate knowing what the actual, true success rate is.
I want to change the subject to suicide. I know it has been over 10 years since the government has studied suicide and attempted suicides and the rates and so we maybe don’t really know where that is going. But is the government intending to study suicide and attempted suicides?
I know that it has been out there that we need to have a study of that again – it has been out in the public domain. So, I’m wondering if there will be an investment made in that type of a study.
RANDY DELOREY: I thank the member for going here. He’s correct. There was a recommendation by Dr. Stan Kutcher in June of 2017.
One of the first actions, literally, first actions I think within a week or so of being appointed minister, where I asked him if he would assist me in responding to a particular situation in the province. He did, spent a few days, and did a detail and came back with a number of recommendations. One of them was, as the member noted, it has been a very long time since the suicide prevention framework had been assessed and reviewed, and I don’t recall the exact language of the recommendation, but it was effectively to do an updated suicide prevention framework that was evidence-based.
In fact, I’ll let the member know this work is ongoing now. It’s not something that I’m planning to do; it’s something that is ongoing now. That work on the suicide prevention framework started with work inside of the department where we wanted to understand what the approach is that we want to take in this, and part of it is collecting. Dr. Kutcher’s recommendation was very clear, he wanted evidence-based.
One of the things we did as a starting point, the World Health Organization has a bit of a framework out there and some information, so we went to that model as a starting point to look at an approach, and brought that in.
More recently we actually reached out and requested – I personally – we sent out letters to some experts in the field. That was, again, another piece of Dr. Kutcher’s recommendation, that we do this work evidence-based, but have some experts actually helped the department do the review. I did reach out to a number of expert psychiatrists, and others who have expertise, both in adult and youth, recognizing that the triggers and/or symptoms or, I guess, signs may be a little different.
We wanted to make sure we had representation. I think that was the late Fall just a few months ago, that we did hear back from some members and staff who have been meeting with them to look at the work that has been done.
The broad framework piece is nearing completion, with then work to be done through this year to really put a lot of meat on that skeleton framework that we have nearly completed.
I am very proud to have had the opportunity to be the minister to work on updating this and I have taken it very seriously. I know sometimes we want work like this to be done yesterday. My executive assistant gave me this expression just earlier this week and – how did he put it – when’s the best time to plant a tree? They say it was 20 years ago. When is the second-best time to plant a tree, Madam Chair? It’s today.
While we can debate whether or not the work on the suicide prevention framework should have been done earlier or not, the fact of the matter is I’m very pleased that we have the work well under way. I look forward to implementing that framework and the positive results that I hope we achieve, and the lives, in fact, which is ultimately what we are trying to do, is save the lives of loved ones across this province.
JOHN LOHR: I can tell the minister that the best time to plant a tree is definitely in the Spring or the Fall; but it’s always the right time to invest in the future and in bettering our society, so, I understand what he’s saying.
I know that one of the critical pieces of mental health issues is to get an actual diagnosis. For someone who is suffering a mental health issue, the first and most critical step is to be diagnosed, and diagnoses are done by psychiatrists.
We have a shortage of psychiatrists in the province and I am just wondering if the minister would share - I know that they would have that information – how many psychiatrists we are actually short in the province and how we are addressing that.
RANDY DELOREY: Unfortunately, I don’t have the specifics. The Health Authority does manage the operational and specific recruitments, so they would be tracking that.
I apologize that I don’t have the information here with me for these Estimates, but I don’t think it will be too difficult for us to get the information and we will make sure we pass it on to the member.
What I can tell the member is, again, number one, we recognize the fact that psychiatry in particular is a field where we do have vacancies and a need to recruit more. We recognize that.
Just an example, when we talk about the 15 residency spaces, a multiple of those positions, I think three, maybe four of them, are various psychiatrists. I believe there is youth adolescent, an adult and a geriatric. I’m doing that off the top of my head so if I am mistaken, please forgive me, but I believe, off the top of my head there are at least those three out of 15 residency sites that have those trainings in place here.
In addition to that, we recognize there are certain parts of the province where the need is greater. There are parts of the province where we do have an adequate supply and there are other parts of the province where it has been harder to recruit and get people to either move or stay, to provide those services. Again, we’re trying to deal with short and longer-term access.
Some of the things we’re working on is trying to encourage psychiatrists with their specialties, who may be physically located in the Halifax region, the central region, to help leverage their expertise and distribute it out to the other parts of the province. That is with both the Nova Scotia Health Authority and the IWK.
One of the ways we’re doing that is to try to grow and strengthen access to video conferencing. If the psychiatrists feel that they need to stay in the core central region, it doesn’t mean that they can’t provide the service in another community. So, you have a local professional with the patient and they are able to consult and work virtually like that. So, there’s growing those efforts.
We’ve also modified the compensation framework for psychiatrists, I guess to strike a balance. There were some concerns brought forward by some psychiatrists, district psychiatrists that we have, that they felt that their compensation was a little bit off from AFP psychiatrists. We recognized that and did make some adjustments to strike a better balance for them. That will help with our recruitment as well as our retention.
One of the other recommendations was to develop more supports for those psychiatrists we do have. The role of a clinical assistant, I believe is what they call it, which is someone with medical training but then can have some further specialization, to be there to support those psychiatrists; much like a resident support to a fully-licensed psychiatrist.
I believe in Cape Breton there are two, who if they haven’t started, they have already been identified, so they are starting very soon, in April, I believe for their training to complete. It’s about a three-month training process. Then they will be in Cape Breton.
There are two more slated for Truro, I think. They will be coming into their training a little later in the Spring or early summer.
So again, recognizing that the Northern Zone in particular, and the Eastern Zone, and I know that down at the Western Zone there are some challenges as well; but I want to assure the member that we do know the psychiatrist recruitment and retention is important. We’ve been taking steps there to increase the training opportunities and other steps.
Also, on some of the recommendations we got, in the meantime, we can move faster and have additional supports for those psychiatrists we do have, to help ease the burden. What we are really trying to do is increase the access for those patients who need those services.
JOHN LOHR: In fact, minister you hit on some things there. I mean it’s a very crushing moment for a family in Cape Breton to be told, in order for their child to have mental health services they’ve got to go to Halifax - an extraordinarily difficult circumstance. I assume that is happening from northern Nova Scotia, too. I’m not so sure about that. I’m very concerned.
From speaking with medical health experts in Cape Breton, I know, there’s possibly 10 to 12 psychiatrists short in Cape Breton. In fact, when you look on the website, the advertising for physicians, there are only four positions advertised. I’m very concerned about that. I realize when you fill a position, you don’t necessarily have to take the ad down. But I’m very concerned about the lack of psychiatrists, as clearly a driver in actual treatment and diagnosis that we don’t see them there.
I know the minister mentioned prevention a moment ago. I am concerned. I do agree that prevention is the best step in terms of addictions. I’m just wondering if there’s any inclination on the part of the minister or the government to raise the age for cannabis use to 21. I know there’s a bill before the Quebec Legislature, a government bill, right now to raise the minimum age for cannabis to 21. I know the minister is aware of the connection between cannabis use and psychosis.
One of the beliefs - and we see this in the increase in vaping in our schools - is a 19-year-old will buy something for a 17-year-old and pass it on. A 21-year-old, just because of the changes in life there, even though it’s only two years’ difference, is very much less likely to buy something for a 17-year-old and hand it over.
Is there any inclination on the part of the government to raise the age for using vaping products and for using cannabis to 21?
RANDY DELOREY: I thank the member for the inquiry. In fact, since we have been in government, we have made several modifications and strengthened our Smoke-free Places Act and corresponding legislation. Specifically, towards tobacco, we brought in the first rules around e-products, basically ensuring what we saw as good positive tobacco legislation, to expand it to include other forms for that reason through this work. Again, our cannabis legislation is only about a year old, really, so a lot of work had gone into that and evaluations.
At this point, there are no plans to make adjustments. The program just started up. Again, the legislation is about a year old. The implementation started in October, so it has only been a few months of use of cannabis.
We know that the federal government’s path is having other cannabis-related products that could come on stream. As part of our review, we will be looking again at what changes we need to do to respond to those additional products in a changing environment within the province. At this point, there’s no legislation changes to the age of access for tobacco, cannabis, or alcohol.
JOHN LOHR: I know there’s widespread concern across the province, in fact, I have a couple of letters here I could table from concerned citizens, about the state of our schools and the state of mental health care in our schools. I know that in the beginning we started talking about the investment the province was making in the 41 schools.
I’m just wondering what the plans are for the high schools across the province to see increased psychiatric or mental health services in those schools. I know that Dr. Stan Kutcher had a plan for schools for mental health literacy. Is there any plan to implement that Stan Kutcher program in our schools?
RANDY DELOREY: There are multiple initiatives, Mr. Chair, around mental health and addiction-related services in our schools. The member referenced curriculum work. I’m sure you are well aware as to the status of the curriculum review and implementation. As per that recommendation, that work is ongoing and updated curriculum around mental health and wellness into our school systems; as far as more clinical access, there’s that educational portion . . .
THE CHAIR: Order, this round has finished. We will now move to the NDP.
The honourable member for Halifax Chebucto.
GARY BURRILL: I’d like to direct a couple of questions to the minister about long-term care facilities, nursing homes. Thinking about the situation as we’ve been discussing in the House, the situation of people waiting for placement who are in the so-called ALC category.
I think it’s often the case that when this subject is discussed, one of the things that is striking to people and doesn’t immediately accord with their sense of right and wrong, is the fee structure by which people are paying as they would pay were they in the home, during a period when they are still not in the home. That they are, in fact, the only people in the hospital who are paying.
I wonder, has the department, during this period when we know that we have a high percentage of high ALC people - and we’re going to have them for some time; if we decided today to build many nursing homes we’d still be quite a while before we were moving those people out - has the government given any consideration to charging some kind of a differential fee structure so that when people are in the ALC situation they weren’t paying in the same way that they anticipate paying when they once get into the nursing home?
RANDY DELOREY: I thank the member for the inquiry. Just a little bit of context there, I know the member is obviously very clear but I’m not sure about the other members, Mr. Chair. The fee that he would be referencing would be what is recognized as the accommodation fee, not anything related to medical services and treatments. Certainly, in my time over the last not quite two years, that has not been something that has come up as a suggestion; it’s not something that I’ve contemplated.
We’ve obviously been doing a lot of work in our long-term care sector with a lot of focused initiatives, and also within our hospital system for patient flow and discharge improvements. Again, I’ll reiterate something I said earlier today in response to a question about alternative level of care, is just to remind members, that an alternative level of care placement in a hospital does not automatically mean that the individual is waiting for a nursing home.
There are individuals in alternative level of care beds where their needs and their placement in those beds relate to other needs. There are some for whom it is waiting for a long-term care placement, but there are many for whom it is just a disconnect between their medical condition at that time and another situation.
I had a resident with very high needs. I’m not sure of the specific medical condition but required ventilation. Historically, parents provided and there were some changes in the home environment and they weren’t able to care for the individual at their home. There wasn’t a medical necessity to be there, but again, the only real option was for that, and it was a short-term placement. We were able to then adjust, through other programs that we had with the parents, adjust to the circumstances of their life to help transition the individual back from a hospital ALC setting into a home setting.
GARY BURRILL: I thank the minister for his reflections on that subject. I want to keep thinking for a moment about the ALC situation.
I take the minister’s point that it is not the case that ALC means automatically that one is waiting for a nursing home placement. Yet, I think it would be fair for the minister to acknowledge that most people understand this category as one in which a majority, in which a plurality of people in it, in fact, are waiting for placement in a nursing home.
I would like to give the minister an opportunity to clarify his remarks just by asking, does he, in fact, acknowledge, I’m hoping, that the plurality of people in ALC are people waiting for long-term care placement, despite what he has said that there are others in a variety of categories in that category?
RANDY DELOREY: I apologize for the delay. I’m just looking at the data and I don’t have it quite laid out in the way the member has asked the question. I am going to work to get the specific figures to verify. If you just put a little asterisk by this statement, but from memory I believe it’s somewhere in the, if about 20 per cent plus or minus are ALC beds allocation, about six per cent are long-term care. So, it’s less than half who would be awaiting long-term care placements, if I recall that data correctly.
If you look at the amounts and the references to something in the vicinity of 20 per cent of ALC beds, the beds are ALC, that six per cent of beds are looking for long-term care. Six out of 20 would be, somewhere a little over 30 per cent, I think, maybe of ALC would be waiting for long-term care.
Again, I am doing that off the top of my head. I am putting the request in to verify that data, though.
GARY BURRILL: Further to the question, as I’ve understood the numbers, they would be somewhat higher than that; somewhere between 30 and 50. I’m interested in the clarification.
The other point I was trying to make is does the department acknowledge, does the minister acknowledge, that this component of ALC, those waiting for long-term care placement, comprise a plurality of the ALC category, which is the largest single category we have in that ALC nook?
RANDY DELOREY: Again, just the data I had off the top of my head would show that it represents about one-third, I think, a little less than one-third of the ALC beds, if that data is correct. Again, I will look to verify that.
Whether that is the single largest category of ALCs, I don’t have that data at all. What I can tell the member is certainly we want to improve the flow of patients throughout our hospital system. That includes the transition for people waiting for long-term care, whether they are waiting in home, in community, or in a hospital.
We have seen that for our hospital ALC patients waiting for long-term care, the last time I saw the data, it did see a reduction I believe somewhere in the 30 to 40 per cent in the number of people waiting; but also, an almost equivalent reduction in the amount of time that people are waiting.
So, this situation with people waiting, whatever the ratio, the fact is the steps we’ve been taking - the work to improve the efficiency of our long-term care placements - we have seen, since we’ve come into government, a reduction in both the absolute number of people in our hospitals waiting for long-term care placements, in these ALC beds, and also for those who are waiting, they are waiting less time.
While I appreciate the member and his colleagues’ concerns, we do have this discussion throughout Question Period on a number of occasions. We are seeing improvements, but we do still have more work to do.
GARY BURRILL: I thank the minister for that explanation. I am still thinking about long-term care facilities but not so much about the ALC side of it. I’m thinking back to five and a half years ago when the present administration came to power. At that time, amongst the nursing homes of the province, there were 11 that had been identified as needing to be completely replaced. That was a list that was in the life of the department at that time.
I am wondering, is the minister aware of that list? Is that a list that he continues to evaluate or work with, the 11 nursing homes that were, in 2013, slated for complete replacement?
RANDY DELOREY: I believe reference to some announcements by the previous government late in their mandate about some changes has been discussed during Question Period before, so I am certainly aware.
What I can advise the member is we as a government, and our commitment around continuing care, is genuine and sincere in terms of ensuring that citizens get access to the care they want and need.
As we came in, our priority was around the home care side - that part of addressing the challenge would be infrastructure, but part of it would be process and alternative options. The data very clearly showed that the length of stay in our long-term care facilities, relative to kind of national averages, is much longer.
It means that in our jurisdiction, the beds don’t free up quite as frequently as in other jurisdictions. What we discovered was a contributing reason for that was that we didn’t have a strong enough home care option, so we really invested heavily there.
What that meant is, to know where and how - when you change the system and the flow of care provided to residents - then you need those investments and those changes to come on stream, stabilize, and then you can do the evaluation.
The resident flow and information, as I think the caucus members have referenced before, in things like changes in acuity levels in our long-term care facilities, which they have attributed to the growing investments in home care. If you are able to stay home longer, and I guess the member’s caucus has acknowledged and recognized that with those investments in home care, it has changed the landscape in our continuing care space. Because of that, we’ve had to re-evaluate and delve into the data and the information to understand if that information continues to reflect where and how we want to move residents in our long-term care facilities.
We are, as I’ve said previously, getting to the point now where infrastructure options are there. We saw it in the redevelopment in Cape Breton, that if we’re looking at care in a region, that they should be part of that assessment and so that’s what we did. It’s why we’ve come up with an expansion of long-term care beds in New Waterford and North Sydney and, as was referenced in the budget, we’re engaged in discussions around replacements and exploring opportunities for expansion of homes in Mahone Bay and I believe, the Meteghan area.
So, we are making progress and information informing it is, again, what our profile as a province looks like, not just today, but what we’re anticipating that to look like going into the future.
GARY BURRILL: I’m thinking about that list of 11 facilities and one of them, in particular, I’d like to ask the minister about, that’s Shoreham Village in Chester. It is, as I’m sure the minister knows, a facility that has not very far short of 100 residents in it from around mostly Lunenburg County, although there are some there of course from other parts of the province.
The minister, I’m sure, knows too that there was a plan the province came up with for a comprehensive renovation that would address what are at this stage, very major infrastructure issues at Shoreham Village. The plan that had been in place was one that would have allowed those renovations to go forward without having to have a significant displacement of the people who live there.
So, this plan that has been brought forward, the board at Shoreham Village has been waiting for some considerable time for a response from the government on a request for a funding commitment to help them move forward with those infrastructure upgrades. Having recently had a chance to look at the facility in Shoreham Village and look at some of the concerns about the infrastructure, I was personally, as I think the minister would be, quite alarmed about the things that the board is calling attention to with the state of the building itself.
I’m wondering if the minister, just thinking about this request that has now been on the table some time from the board at Shoreham Village, if the minister could just give some characterization and reflection of his thinking about where the government is on the hope for redevelopment and reinvestment at Shoreham Village?
RANDY DELOREY: Mr. Chair, I thank the member for raising the concerns there of the board for Shoreham. What I can advise the members, actually just within the last week or so, one of my senior staff in the department in the continuing care team was down to meet with them. I haven’t had the opportunity - as the member knows, spending a bit of time here in the Legislature with him - to get briefed on the results of the discussions that took place with them down there.
Again, just to let the member know, Mr. Chair, it is on the radar and as I’ve noted, the senior staff in the continuing care team were, I believe, down to meet with representatives within the last week or two.
GARY BURRILL: Mr. Chair, I want to thank the minister. That meeting in Chester I hadn’t been aware of. That’s good to know. It’s good to know that those conversations are taking place. I wonder, if I could further ask the minister if he could give some sense of where those hoped-for renovations are in terms of the department’s screen?
I think there’s a general sense amongst the board, one that seems very reasonable, that the moment has passed to be kind of on the “long-term, someday chronic” list. That the moment is really present, maybe past now, when this situation needs to be on the, “oh my heavens we better deal with this right away” list. I wonder if the member could give some characterization of where Shoreham Village’s necessary renovations are in terms of a sense of urgency and immediate priority for the department?
RANDY DELOREY: Mr. Chair, I guess on the one hand I want to assure you, the member, and all members that those urgent capital requirements and maintenance that are needed - there are programs and grants that we do flow to respond to any of those emergency types of situations that are ongoing, and do for Shoreham Village or any other facility to make sure those are addressed.
As far as moving to the notion of a full-on replacement, as I mentioned to the member, we had senior staff down there a week or two ago. I haven’t had an opportunity to connect and get the update from the team and those discussions to see where that’s at, but again, I can assure the member that since we had staff down there before the question came to the floor of the House, I hope he can take me at my word that we do recognize and we’ve been listening and responding to the board.
GARY BURRILL: Thank you, Mr. Chair, and I’d like to thank the minister for his being attentive to the questions I have raised.
I’d like to yield the rest of my time to the member for Cape Breton Centre.
THE CHAIR: The honourable member for Cape Breton Centre.
TAMMY MARTIN: Thank you, Mr. Chair. I’d like to go back to ALC beds for a few moments. We often hear that ALC beds are really not a bad place to be and that patients like them, but that just entirely isn’t the case. I’m going to read a few statistics.
The average total length of stay in Nova Scotia last year for someone who has been designated ALC and who is awaiting placement was 61.5 days. The national average for ALC length of stay for people awaiting placement elsewhere is just under 10 days, and I can table that document. We are at six times the national average because we don’t have any flexibility in our system to take people on immediately to get them out of the hospital. We haven’t built that capacity and are unable to do that. I know that a percentage of those patients are waiting for home care, like the minister said earlier, that they’re waiting to go home, but the figure I’ve cited, 61.5 days on average, includes those people as well.
Furthermore, our rate of ALC as a percentage of total in-patient cases is also well above the national average. Less than 5 per cent of in-patient cases across Canada are ALC. In Nova Scotia, more than 20 per cent of our hospital bed days were taken up by people waiting to be placed elsewhere. I would like to reiterate that more than half of the people waiting in hospital in an ALC bed are waiting to be placed in long-term care.
I would like to ask if the minister believes, or if the minister would acknowledge, that the reason we have so many ALC patients waiting is because we have a lack of capacity in our health care system to manage patient flow?
RANDY DELOREY: Thank you, Mr. Chair. I believe, without looking at it, that the data table that the member tabled is a document that was tabled in a previous Question Period. Having reviewed that, I believe the data from the CIHI report that was used as the source actually represents data from 2012, thereabouts. It’s a 2014 report that has two-year-old data because CIHI has about a two year lag time, so the actual source data would have likely come from 2012.
That said, I appreciate the comparison on a national basis. But if we do look at how we’ve done as a province with waiting for long-term care in both instances, whether a citizen is waiting for a long-term care placement in the community or in a hospital, in both instances, since 2013, the number of people in the province waiting is smaller. There are fewer people waiting today either in hospital or in community than there were when we came in. The wait-list has gotten smaller in both instances.
We acknowledge that many of the challenges we inherit as a health care system, we did inherit. As we’ve heard and as I’ve articulated before, in many instances health care providers acknowledge that the pressures and the challenges are both reflective of national trends but also reflective of many years, even decades, of policy decisions and approaches.
We have been recognizing and responding and, as I’ve referenced, the improvements that we’ve made in reducing the wait times. We’re going to continue those efforts. We talked to the previous member, in response to the questions about the fact that we do this work and part of it was investments and focus on home care.
Mr. Chair, we do recognize, as we’ve mentioned in the budget already, the investments in expanded long-term care capacity in Cape Breton but also the work in the Meteghan and Mahone Bay regions as well.
TAMMY MARTIN: I guess we’ll go back to “respectfully agree to disagree,” Mr. Chair, because in our opinion and in our estimation the reason the long-term care bed waits have gone down is because the rules have changed. Sadly, in some of those cases, some patients have died.
I would now like to talk about the new beds that the government is talking about, specifically in New Waterford, Northside, Meteghan, and Mahone Bay. But they are not in the budget, so they won’t be started this year.
I’m wondering if the minister can talk to us about why they are not in the budget this year and when they are going to break ground, and I will reiterate another question that I’ve asked several times in this House - if the minister could please give us the locations, even an address, of these new facilities.
RANDY DELOREY: I will ask perhaps for the member’s patience just a little bit longer - the camera can’t see, but I’m not sure if I’m going to get that patience.
The truth of the matter, I guess from the one front in terms of budgeting, is that the work that is ongoing around planning, particularly for the Cape Breton region, does have budget allocations for work there for the overall Cape Breton redevelopment project, which the projects apply to as well.
As I’ve articulated in response to the member - and this is why I ask for her continued patience - the work to do the assessment and determination of what’s needed, as well as the locations, is all part of work that is under way.
When I was in Cape Breton earlier this week, on Monday, with the announcement, there were some questions about the communities of North Sydney and New Waterford. As I indicated, we are making progress. The budget showed that we were making progress, even in the area of long-term care. We’ve locked in on the fact that what we’ve seen for numbers there in the long-term care - there’s more work being done in terms of the overall primary care services and what that will include.
The work has been progressing very well, Madam Chair. I can assure you and the member of that. As soon as we come to a conclusion and make those decisions - as we did in Cape Breton at the Cape Breton Regional in Sydney, we went to the community to make sure that we communicated that when we had the information and the decisions.
What I hope the member and hopefully her community members realize is that in June of last year, when we first announced the Cape Breton Regional development, we announced everything as one big project, a lot of work that was going to be done. What I wanted to highlight, and I hope our actions have shown, is that we’re not waiting until every piece of the puzzle is complete to share information and progress. But we do have to get to a critical point of information to bring to the communities as we go forward.
We didn’t wait until we had New Waterford and North Sydney and Glace Bay projects complete to move forward and initiate the RFP for the Sydney efforts. So as we get to those critical juncture points we have - as I’ve assured the member all along since last Fall, or even last summer, when the member would’ve asked - we will be sharing the information. We will be letting people know. We just don’t have those final decisions yet, but there has been a lot of progress, and I look forward to having them in the near term.
TAMMY MARTIN: Specifically, because we’re still talking about long-term care - so not the new community health centres just yet - to be clear, I’m hearing from the minister that they’ve talked to people, that the government and minister visited the communities. I’ve talked to several people, and I’ll say again, several doctors, who have not been included in these discussions. I understand that the meeting that took place on Tuesday night was limited to acceptance from an email application.
Regardless, Madam Chair, my first concern and hope is that these facilities will be operated on a not-for-profit, that they will not be private long-term care facilities. That’s my first concern, and I would like for the minister to clarify that.
Next, I would also like to know why it has taken so long to get here. We’ve been talking about the lack of long-term care beds for a long time. There has not been one new investment - not one new long-term care bed invested - since this government took office in 2013, in its sixth year now.
As a result, I believe that we are living with the consequences. We are seeing the backups in emergency rooms with EHS and with health professionals working way beyond what they should be. I believe that this is a result of the lack of investment, so just to be clear, I’d like to confirm that it’s going to be a not-for-profit, it’s not going to be a private corporation. And why has it taken so long to get here?
RANDY DELOREY: I thank the member for the questions. To the first question, about what the operation model will be, again, that is a part of the review and the analysis that’s ongoing. When the decision is made - and I will advise the member, in all sincerity, that a decision has not been made in terms of the operation, because we do need to have the full functional approach defined.
Again, the progress of the work that was ongoing, as that comes forward with recommendations, decisions will be made, and we will bring those decisions back to the community. So when we know, we will be letting the communities and the member know.
In terms of engagement and consultation for the Cape Breton redevelopment project, Madam Chair, I guess what I can say is that I don’t think the capacity to have 100 per cent of people spoken to and engaged is realistic. I think the member was at the announcement on Monday, there were clinicians on the front line. These are not departmental or even necessarily directly NSHA administrators. These are clinicians from the community who were standing up as leaders, like Dr. Kevin Orrell and Dr. Brake, who have taken leadership roles to advocate for their areas and the work. Then you do have a project team that’s out there engaging with health care providers and having meetings.
I believe Mark LeCouter, who’s one of the leads, talked about hundreds of meetings that have taken place since June in the area. I myself, as I’ve mentioned previously in this House, Madam Chair, was in Cape Breton. I went to all four hospitals in November, I believe, or early December, and had essentially an open invitation for physicians. My intent in going was to focus on what their thoughts were in the early stages and engagement on the work efforts. I did hear from them on that, as well as on many other items of concern and input from those physicians in Cape Breton. I found it very informative and appreciated the time they took to share their thoughts and insights with me. There is a lot of engagement.
The member made reference to a meeting in Cape Breton on Tuesday night. I’m going to make an assumption and maybe help clarify for the member, I don’t believe that meeting was specifically related to just the redevelopment project. I believe the meeting she may be referring to is a meeting of the Nova Scotia Health Authority’s board, so it was a board meeting. That’s part of their public engagement in hosting board meetings in communities in each of the zones throughout the year. This happened to be the one that was taking place in Cape Breton and I believe I saw some media coverage of it that indicated that they did have some public engagement, but that’s part of the board process. I wouldn’t be surprised if the redevelopment came up, but I wasn’t privy to or part of that particular meeting, but the chair and board members would have coordinated that.
To the member’s question of why did it take so long to get to this point where we as a government are beginning to move forward on our commitments to expand long-term care facility beds, when we came in, a big part of what we’d heard as a government was that our seniors really, in many instances, wanted to stay at home as long as possible. We could look at the data and see that on a national basis we performed very poorly in relation to how long our aging population were staying at home versus long-term care. That is, you could look at the length of the time that residents stayed in long-term care facilities and they were staying much longer in Nova Scotia than in many other jurisdictions. So this data aligned with the awareness that people wanted to stay home longer if they had the right supports in place. So the policy position we took was, we need to invest and maximize the opportunities for people to stay where they want to stay, in their homes or in their community, as long as possible.
We made significant investments, year over year, to address wait-lists in our home care services, expand access to it, to provide those opportunities. Again, the NDP caucus has acknowledged in some of their questions that the investments and the improvements made in home care has impacted the long-term care sector. In questions that would be framed around the acuity level that has gone up as people are staying at home longer, that’s something we’re aware of, but we had to get the investments out there first. Where people would be staying at home longer would mean they’re staying in long-term care for shorter periods of time, which means the beds that we do have would be more efficiently utilized for long-term care placements. With those investments that we put up, it does take time for those shifts to come forward and stabilize within the overall continuing care system, so that’s why it takes time. We had to put the investments in, see the system re-stabilize based upon those new investments in the home care space - how that affects both in home care and the continuing care space - and in our long-term care settings. As that has stabilized, we are able to now do an updated assessment around the demands and the needs for long-term care services, both currently and into the future.
Really, it’s because of the efforts that we’ve been putting into the home care space, we wanted those investments to stabilize in our system, so what we were analyzing and making decisions about is the current state with a better, more efficient home care environment space because that’s what the new continuing care environment looks like today.
TAMMY MARTIN: I just wanted to clarify for the minister, that I was talking about meetings across the province, not just Cape Breton. We’re talking about long-term care and about the investments that are in New Waterford, Northside, Meteghan, and Mahone Bay, so it’s not specifically just to New Waterford.
What I hear the minister say, Madam Chair, is that the government came to this decision to invest in long-term care beds in these communities because of examining what has happened over the last number of years. I guess I’m not wrong to assume that there’s justification now that the minister believes wasn’t there before, even though there have been significant numbers of people waiting for the last number of years, six or so, for long-term care placement. But going forward with some of the current existing facilities, in a document we tabled this week, we know of facilities that are falling down around them.
I would like to ask the minister, and specifically we tabled pictures of pipes where it didn’t even look like they were pipes. I don’t really know what was in the picture. Madam Chair, what is the minister’s plan to sustain and upgrade and make sure that the facilities we have now are going to be the facilities we continue to have and house our long-term care residents?
RANDY DELOREY: I have an update from a previous question that has just come in. I’ll just respond to that if the member for Cape Breton Centre would indulge me responding to her colleague’s earlier data.
Based upon 2017-18 data, what I’ve been advised is that three per cent of the hospitalizations were taken up as patients for ALC beds and 50 per cent of those were waiting for long-term care placements, just to clarify.
I guess to the question that the previous member for the NDP had asked about, does it represent the plurality? I guess at about 50 per cent it would be the single largest group designation for the ALC.
The other thing to note is that the median length of stay of ALC patients in that year was 28.5 days, at that particular point in time for 2017-18. That’s the previous year’s data, as opposed to the current, but we’re just finishing up the year now. So median length of stay in 2017-18 was 28.5 days for ALC beds and about three per cent were ALC in the system.
To the member’s question now, Madam Chair, the question was around, I apologize to the member, I was trying to catch the other data first.
TAMMY MARTIN: Thank you, Madam Chair. I won’t go into the preamble again but just about upkeep.
RANDY DELOREY: I do apologize, I do thank the member. She did jog my memory there quickly. The question was how we respond to kind of emerging or emergency maintenance or capital requirements. We do provide funding. In fact, we’ve seen additional money provided. We do provide one-time funding, when necessary, to respond to these emerging and emergency types of situations for maintenance or capital within our long-term care facilities.
Just one example, I believe in the previous year I think we put in about $4 million in one-time funding for things like capital equipment, preventive maintenance and, in addition to that, some leadership training within our long-term care facilities.
TAMMY MARTIN: I’d like to talk now with the minister about the caregiver allowance that his department provides or that the Department of Health and Wellness provides. First of all, I would appreciate any information the minister could provide on how that $400 a month was calculated and if the department is collecting any stats and who is receiving that? Whether it be men or women, if they’re providing care to loved ones or family members. And, if not could we, at some point, have those stats?
RANDY DELOREY: I believe we are one of the few jurisdictions that actually has a program like the Caregiver Benefit program. I’m pleased we expanded that program in February 2018. Just for those members who aren’t familiar with the program, it is $400 a month that’s made available to eligible caregivers as a means to acknowledge that caregiving assistance, which is usually a family member or a friend providing care in the community, this is an acknowledgement of the efforts that they are making.
In some instances, governments choose to do tax credit types of things where it only applies to reduce your taxes payable. We felt that a caregiver benefit that provides monthly income to individuals was a more efficient way to acknowledge and recognize the care and the support they’re doing.
For recognition of the caregiver, it really just has to be a resident of the province and provide 20-plus hours of assistance a week to a care recipient. They do have to be an adult, aged 19 or older. The work then is in large part for the care recipients that are low income but also have to be assessed for some clinical eligibility criteria. The enhancements we brought on stream last year were an expansion to the clinical assessment so more of the Nova Scotians who have needs and are being supported by a caregiver would be eligible to have this funding.
To the member’s question about a gender breakdown, I’m not aware of a gender breakdown analysis for those who would have them. I can advise the member we’ve seen significant growth in the program. Essentially since 2012, the program utilization has effectively doubled. With the program and the dollar amount we’re getting out to twice as many people today as of March 31, 2018 than there were in March 31, 2012 because of many of these changes.
TAMMY MARTIN: I thank the minister for that response. However, I’m curious, for those that are caring for loved ones at home who are not employed and get hurt caring for their loved one because as the minister has said, keeping people at home longer is causing more difficulty on the caregivers because those loved ones are more difficult and sometimes harder to care for.
Does the province have anything else that’s available? If you are an unwaged worker, you will not get WCB. If a loved one gets hurt caring for their loved one, does the province have anything available they can provide to that caregiver?
RANDY DELOREY: I thank the member for the question. Really, I think what the member is looking at are insurance programs to respond to injuries. While I’m not aware of any program in the caregiver space for that type of response, as the member noted, in a workplace environment, WCB, Worker’s Compensation, is the program for workplace injuries sustained in the workplace.
What I can advise the member is that we certainly understand and value the role of caregivers and the care and support they provide to their loved ones. That’s exactly why we have a Caregiver Benefit, to acknowledge and recognize the important service that they do provide to their loved one and how that service does provide benefit to the province; so we invest in them.
One of the things that we are engaged in, in some of our investments throughout the system, is a pilot. One of the things I know the member had spoken about last night, Madam Chair, is around burnout within the health care professions; I think we had the conversation which said many professions, and we believe that applies to caregivers as well. We’ve heard that from associations and individuals that represent caregivers.
So, we’re working on a pilot to help with the mental health strains and pressures for caregivers; programs, and also some investments around equipment, expanding home care equipment options. So, investing about half a million dollars to enhance the home lift program, and that’s to provide equipment in a home to help with moving patients to reduce the risk of injuries in some instances so, really on the more preventive side.
From the post, working on the mental health side, but not to the member’s question specifically about physical injuries; I’m not aware of any programs or insurance programs that fit that description.
TAMMY MARTIN: I’d like to just go back and question the minister again on the $400 per month, because while that is beneficial and helpful - and I know many that are happy to receive it - when your work is cut in half, how did this number come to be?
Is this an adequate amount of money for someone to give up half of their income, let’s say, or all of their income to care for a loved one, that we can expect Nova Scotians to live off of? What consultation has been done to come to $400 and do we really think that $400 is enough?
That’s the first part. The second part, I believe I heard the minister mention a pilot program, if the minister could detail what he means by that and describe the pilot.
RANDY DELOREY: To the first question, which I guess, she did ask that exact question earlier and I didn’t quite respond specifically to it. So, I’ll try to be more succinct this time, Madam Chair.
The $400 rate pre-dates me, so I am not sure, Madam Chair, specifically where the rationale of that rate came from. What I’ve done since I came in was, we had made a commitment to expand the home Caregiver Benefit. When I looked at it, I was able to secure a commitment from my colleague, the Minister of Finance and Treasury Board, to put towards an enhancement of the program, and had to make a decision as to where or how we felt that investment would be best received, or best distributed.
The decision that was made, was we could either increase the dollar amount or we could spread the dollar amount over more people providing care. As I had mentioned almost a year ago, in February 2018, we announced the expansion and the expansion was so that more people are eligible rather than those who are eligible having more dollars. That, Madam Chair, is the difficult decision making that is the responsibility of governing. You know, we have a certain amount of dollars to invest in our province and our citizens. I’ll reiterate again we are one of the only jurisdictions in this country that even acknowledges through a program like this the important role that caregivers play in supporting their loved ones. So, again, we wanted to expand it as I’ve mentioned the number of recipients of the program has essentially doubled since 2012 and I think this is a good thing because more people are becoming aware of the program and we’re able to support those people.
I’d also like to highlight and note to the member there are a number of other things that we are doing in this space to help people at home. There are investments in home adaptations that the DCS worked in last year. The investments around home accessibility and accessibility and safety for paediatrics, so ramps and services like that for safety measures for children. I mentioned previously continued increased investment in the home lift program that the department has. There are some respite programs through DCS for families.
This pilot, which was the second part of the member’s question, is a pilot we’re running through an organization called Strongest Families Institute. Strongest Families Institute provides a number of support programs in the province and we’ve looked to them to work with us to develop and deliver a program to support caregivers. The service that they provide is tele-based, so either phone or web-based, I’m not positive. I have to double check which of the two platforms or if it’s available on both as they roll it out. Again, as the program pilot ramps up, of course there will be more communication about that, so that we do get people who are eligible for access and we look forward. Again, Strongest Families Institute does have quite a positive track record with the programs that they deliver in the province and we expect to see positive outcomes from this pilot program as well supporting our caregivers.
TAMMY MARTIN: Thank you, Madam Chair, and I guess I’d just like to finish up with asking the minister if there is a specific reason why we’re not collecting the data on who would qualify for this or who would collect this because I believe that it could help with gender-based health issues because predominantly we see women caregivers looking after elderly parents, et cetera. So, I’m curious, if that’s not something that’s done now if it could be done in the future and provide us with that information and, as well, just as a follow-up, if somebody had been caring for a loved one and never applied, is that something that you look at going back to or is it just like is it an application and it’s effective the day of application is guess is my question.
RANDY DELOREY: Madam Chair, I guess I’ll answer the first question first with respect to retroactivity. I don’t believe there’s any retroactivity in the program. I think retroactivity is a challenging thing in this space where the program and the assessment criteria are based upon the status of an individual at a point in time. So, I guess just to show how that would play out in real terms, if you only apply today, the client, the loved one, would be assessed today but we wouldn’t know - if you’re looking to go back and you may have been providing caregiver services back say a year or two before that - were they in the same of level of need and would that individual have been eligible historically?
Because this is a kind of clinical assessment type of eligibility for the program, it’s really not possible to verify in a retroactive way whether the client, the loved one, would have been eligible for the program at that historical point in time.
As an MLA I did have a situation where I was excited and was able to introduce some family members to a program - that’s where I actually discovered as an MLA and not as minister . . .
THE CHAIR: Order, please. Time has lapsed for the NDP. We’ll move back to the Progressive Conservative caucus for one hour.
The honourable member for Pictou West.
KARLA MACFARLANE: I’m pleased to be standing in my place again today and follow up on where I left off yesterday. I thank the minister and his colleagues for being here again with us today.
I want to start with new information that was from MQO. Research shows that 66 per cent of Nova Scotians want to see more programs that help with regard to health care. Actually, health care had topped the list of concerns amongst Nova Scotians in every single region in this province. Just to give some of those stats: 79 per cent in Halifax, 93 per cent in Cape Breton, 85 per cent on the mainland, saying it was an area of great importance for future provincial investment.
My question to the minister is: What specific new investments that were made in this budget does the minister feel confident will reduce those percentages for us next year?
RANDY DELOREY: I thank the member for the question. I guess specifically to respond, I think the member, as all of us would realize, is health care is and has been for some time a priority area. Whether it’s in the headlines or not, I think every election one realizes the top priorities for Nova Scotians include health care, education and our roads. These are the priorities.
Let’s take a look at the budget historically and the distribution of investments that are made. What is the distribution? Top distribution of resources, over 40 per cent, goes to health care, then education, then DCS investments for community services. These are our priorities for Nova Scotians; I think, indeed for all Canadians that health care would be a priority area.
I mentioned in our discussion last night, I believe the notion that our health care system is really built upon a philosophy of continuous improvement. We can say that from a clinical perspective, but I think also from a policy perspective. There will always be interests for more, to do things better. It’s incumbent then on governments of the day to do so.
We’ve outlined and highlighted many items, but whether or not that will reduce next year, Nova Scotians’ interest to see more done in health care, I don’t think any amount of investment would result in Nova Scotians ever coming out and saying that that’s not a priority for them. I think every time you go out and talk to Nova Scotians they think that health care is top of mind because it affects us all.
KARLA MACFARLANE: I noticed the budget for digital health in 2019-20 has been reduced by 14 per cent. I’d like the minister to explain why the reduction; how does this align with the department’s priorities for improved digital health services?
RANDY DELOREY: I believe the impact there relates predominately to the Nightingale EMR system and the transition off that system.
Historically, the vast majority of electronic medical record - EMR - systems, which are the digital systems used predominantly by primary care providers and family physicians in the province, were on the Nightingale system. That system was purchased by another vendor and that vendor decided they were no longer going to maintain that software product and gave about a two-year transition period for clients to move off it.
Last year when we announced the almost $40 million investment towards physician support and compensation and incentives, one of those areas was actually a program to encourage physicians to migrate off of Nightingale On Demand onto a newer software platform, one that would be well positioned for future use and integration with our OPOR direction that we’re moving in.
What happened in that transition is the Nightingale On Demand model, the province owned the licences, we purchased the software on behalf of physicians and we worked with the vendor, and then physicians who chose to use the software would pay the province. As physicians are transferring from Nightingale On Demand to other products, they are entering into a relationship and a licensing directly with the vendor. What you’re seeing is our revenue, which is really just flow-through from physicians to pay for licences that we then purchase from the vendor. As physicians are transitioning off Nightingale On Demand onto a different product, they are no longer paying the province for access but paying that money directly to the vendor and the province is essentially out of the equation, so you’re seeing less money come in, but you’re seeing less money go out, as well. That covers the majority of that reduction in the digital health space. It’s really just a licensing flow-through on electronic medical record systems.
KARLA MACFARLANE: I thank the minister for his answers. Looking through the budget, I don’t see where One Person One Record actually falls into the department’s budget, so I’m just wondering if he can point to what line in the budget that falls in and how much did the department spend on consulting services for the One Person One Record? So just One Person One Record, where does it fall into the department’s budget?
RANDY DELOREY: Mr. Chair, if you and the member would indulge me for just one second. Her colleague asked a question earlier today, one that I promised I would get back to and the information has been provided, so just to put it on the record if the member’s okay, I’ll answer that first.
The question was about a psychiatry vacancy in the province. The data I have is currently, the vacancies are eight in the Northern Zone, 11 in the Eastern Zone, two in the Western Zone, and seven in the Central Zone. So those would be psychiatry vacancies currently reported by the Nova Scotia Health Authority.
THE CHAIR: That was by the member for Kings North, right?
RANDY DELOREY: That’s correct, Madam Chair. That was in response to a question from the member for Kings North and I noticed the member for Pictou West did take the note so, I’m sure that’s good for the member for Kings North.
To the question of OPOR; because of the stage that we’re in, and we’ve had a few conversations in Question Period, a few members have brought up the question and the size of the OPOR project. It is large, and it is in the procurement stage. As those negotiations go on, you don’t want to put your hand on the table and disclose exactly what you think you’re going to pay for that as the licensing and the project work goes on. We’re in that evaluation stage of the RFP but the work is continuing and ongoing, but it wouldn’t be in the province’s best interest to be disclosing the exact dollar amount that we think would be going to the vendor. Again, the vendor hasn’t been chosen, so those negotiations aren’t complete yet either because the RFP evaluation between the vendors that have submitted, is still ongoing.
KARLA MACFARLANE: Thank you for those answers. I’m just curious, though, what departments besides your own department will be involved in this procurement, the stages going through? I’m hearing lots of concerns around security. I’m just wondering if the Department of Health and Wellness is working with the other departments in government to ensure that there will be strong security functions within this system once it is developed.
RANDY DELOREY: The work that is ongoing, the member for Pictou West is exactly correct, this is a complex system with many players, and it spans across multiple departments and government entities.
In particular, OPOR will be a system that is implemented and serves both the IWK and the Nova Scotia Health Authority. Both of those organizations are stakeholders and are involved in the steering committee and governance work that’s ongoing.
The consultations and change management that would take place, are taking place and will be taking place inside of those organizations for whom the system is going to serve.
From government itself, we rely from a procurement perspective on our Internal Services division, Procurement Services that they provide, because we do have as a government, a central procurement agency. Internal Services provides the logistics and work through Procurement to ensure that the procurement process is above board and following best practices; ensures that we are following the rules and our obligations as a government to procure services, software in this case.
The other aspect of Internal Services that provides support for is their IT knowledge and expertise that they have through ISD under the IT arm of those services. They are obviously involved for their technical expertise with government.
Within the governance structure, we do have representatives from both Health Authorities - the Nova Scotia Health Authority and the IWK - as well as ISD and the Department of Health and Wellness.
We have executive steering committee levels with representatives from each of those organizations. To ensure we have full governance, there is an oversight committee which I have implemented for this project and IT services. That actually has me and the Minister of Internal Services, as well as the Chairs of both Health Authorities.
We want to make sure that those of us responsible for the governance of the operations are also on top of and maintained and updated from a governance perspective for the work that’s ongoing.
There are the operational levels, as you would expect for any of these projects, with representatives in the executive teams at the appropriate levels of steering committees and then the necessary operational committees as the work goes on. We also have oversight at the governance level with board chairs and ministers as well, to ensure we stay up to date.
KARLA MACFARLANE: I’m curious to know how much the department spent on consulting services in 2018-19, and what is budgeted within this budget? I can’t seem to find the stats on that, thank you.
RANDY DELOREY: The amount is just under $1.5 million that we spent last year. Again, as we engage in terms of the budgeting process, the details around these and the services would relate to kind of the procurement process, as it evolves. We update the funding we put in as the services are procured and delivered. Again, that’s what we spent in the last fiscal year was just about $1.5 million around the RFP process.
This is a very large, complex system, and we’ve been making significant progress now with the RFP.
I don’t have the breakdown in terms of what is actually consulting. That is not consulting. It is just the expenditures around the RFP services. I don’t have a breakdown of consulting services as a line item.
KARLA MACFARLANE: I just received the summary of departmental writeoffs for 2018-19. Looking at all the numbers of departments, there are quite a few of them. In particular, Health and Wellness had close to $3 million.
My question for the minister is: Could the minister elaborate on what those writeoffs were and give me a breakdown to account for that number of close to $3 million?
RANDY DELOREY: The largest variable or contributing factor at about 85 per cent, I believe, is EMC ambulance fees.
These would be the fees when a Nova Scotian would have to pay a fee for an ambulance service. In cases where people are not able to pay, it does ultimately get written off when that is not an option. About 85 per cent of it is actually ambulance fees that go uncollected.
The other two areas that drive it are premiums in the Seniors’ Pharmacare Program. Again, not collecting those particular fees and sometimes what that relates to is a timing issue within the program, when they come in or leave programs, and the amount of premium being paid.
Sometimes someone passes away and there will be the expectation of fees and premiums being paid. We’re not going to necessarily force that payment that sometimes comes up.
The other one is physician billing. Sometimes, when there are audits done, there are repayments in consolidation of those physician payments that need to be made. Sometimes, for various circumstances, those go uncollected, as well, but those would be a very small portion of the amount relative to the ambulance fees.
I just want to note that the ambulance user fees are relatively consistent from year to year in terms of the size and scope of it in this year’s writeoffs versus previous ones.
KARLA MACFARLANE: Yesterday we spoke about the $200,000 investment in doctor recruitment and we were speaking about how positive it is. We are extremely happy that we can look forward to, especially in Pictou County, our group hoping to tap into some of that funding.
What I read today, as well, is there is $200,000 that is going to support doctor recruitment under the Department of Communities, Culture and Heritage.
There are discussions and I am just wondering if the minister can confirm if these are two different amounts or are they the same? Who is actually administering them? Because it looks like there is $200,000 in the budget right now. Communities, Culture and Heritage is next door in the Red Room, but yet we have it as a line here in the Health and Wellness Budget. Is it a total $400,000 or is it $200,000 and it’s in the Department of Communities, Culture and Heritage because it’s going to be administered by that department? Could the minister please confirm?
RANDY DELOREY: Madam Chair, in terms of the budgeting alignment it is a community-based initiative so the funding is flowing through the Communities, Culture and Heritage program but this is a scenario where, as government, we have been working hard to take down silos between departments to ensure that we operate effectively.
We don’t necessarily want to have community groups that when we established Communities, Culture and Heritage as a central place for community-based grant programs we reduced the number of departments that you need to go through to provide supports. But from kind of a policy perspective and the influence over the kind of criteria, we worked with Communities, Culture and Heritage to ensure that the utilization of that fund does again go towards these community groups but that meets the objectives of the department and the NSHA for supporting recruitment initiatives.
What types of things do we expect that to go towards? Some of it obviously is to leverage initiatives that are already under way in communities, so that they can continue and possibly expand those services. Being able to mobilize other forms or initiatives that can bring together community partners to develop more welcoming initiatives, like these existing ones that are in place, facilitating support for collaborations that take place in the communities and, again, assistance to really delve in and identify and support and promote unique assets in communities that might be of particular interest to physicians or prospective physicians and their families. Things like that are what we are really thinking about, it’s just how do we promote and support these organizations as they work.
As I said, it is ultimately a Communities, Culture and Heritage budget item, but it is working with DHW because this is really targeted towards a health-related priority.
KARLA MACFARLANE: Looking at Let’s Get Moving, a program that there’s an investment of I believe $2.5 million. Obviously, this is a great program. I’ve had a few people contact me about this program. It’s obviously to create more activity and inclusion and a healthier population within Nova Scotia. This includes a new Active Communities fund with a total of, I think, around $900,000 or close to $900,000 for physical activity grants.
I’m wondering, could the minister break down who can tap into that money? I had a couple of schools reach out to me wondering if there are applications or grants for them. Could the minister just confirm who can actually tap into it?
RANDY DELOREY: The Let’s Get Moving program is actually a program under Sports Nova Scotia, which is under the Department of Communities, Culture and Heritage. While I think it got highlighted in some budget documentation under the title of Healthier People in the Communities, because the program does support healthier communities, the actual program is under the sports and recreations side of the government, which is a division within the Department of Communities, Culture and Heritage.
So, I wouldn’t have the information, but it would be information or questions on that program to direct towards the Minister of Communities, Culture and Heritage, where that program was developed and will be delivered.
KARLA MACFARLANE: I thank the minister for that answer and we will follow up with the Minister of Communities, Culture and Heritage on that.
I want to know if the minister can elaborate a little bit on the INSPIRED Program. We know this is certainly a program that is fairly successful and working very well for those who are facing the challenges of COPD. A couple of things I would like to know about it, just sort of a brief description of the program. Where exactly in the province is the program offered and when will the program be expanded out to other areas within the province?
RANDY DELOREY: The program that the member for Pictou West was referring to, the INSPIRED COPD Outreach Program, as she mentioned is to support patients or residents, citizens, who have the COPD condition. It’s really an outreach program to bring the support professionals together around the individuals to help support them. It has been very well received and has seen positive outcomes. It really focuses on home-based education based upon the needs of the individual patient or resident with the condition. That’s the information on how to care for their lungs and the medications that they may be on, how to use inhalers and home oxygen, if necessary - just overall how to cope with the particular lung disease that they are facing.
This work may include a COPD action plan for the individuals and that can help manage when there are acute flare-ups in the condition, but it also helps the citizens navigate the health care system to gain access to other programs and services that may also be helpful for them. These are things that are involved, and it is a no-cost program. It does provide services in the home, so those care providers do go out.
The information on the specific locations, I don’t recall off the top of my head. I know that for people who are interested there’s a lot of information on the website, as well as contact information to both learn more about the program and find out how to register. I believe right now, the Central Zone, as well as Cumberland County in the Northern Zone and Cape Breton have COPD programs. For the Central Zone, I believe areas like Halifax, Dartmouth, Sackville, East Hants, and the Eastern Shore have opportunities to participate.
Although I said a moment ago that I didn’t have the list of sites, the information has just magically appeared for me here - those sites again, most of the Central Zone, Cumberland County, and Cape Breton for accessing the program, it is information on the website and I would encourage Nova Scotians, as the program does have positive outcomes. There’s actually a great video that was developed by the group showing patients and health care providers who spoke about what kind of impact this program has had on their lives.
I don’t know if I’m going too far here to suggest that the program is transformational or not, but certainly the anticipation of participants is very positive health outcomes for themselves. I encourage people, if they can get to the website, to do a quick Google search on INSPIRED COPD in Nova Scotia. It does give a lot of the information and the contact information for the coordinators of the program. So, you can find out if you live in an area that might have access directly to it or not but, again, there’ll be lots of other supports they could provide to you even if they don’t get the home-based support. From an informational perspective, there’s lots of information there on the website around the entire program as well.
KARLA MACFARLANE: It is a wonderful program. I’m hearing a lot of positive comments on it, obviously a positive impact on those who are accessing this program. I think we need to expand it. I think it’s a program that shows - it’s about preventive measures. It’s also about individuals with these chronic diseases being able to maintain their condition within their own home which, in turn, reduces the overcrowding at our emergency rooms.
I have a two-part question: I’d like to know if the minister believes there are other chronic diseases that this program should be implemented and, as well, what is the total cost of the entire program?
RANDY DELOREY: As far as the line item cost for the program, the program is run through the Nova Scotia Health Authority, so it actually is a line item through their detailed budget. Again, when we’re working with over $4 billion between the department and the Nova Scotia Health Authority, most of the detailed line item budget details are on the department’s piece, which I don’t have all the detail with me from the Nova Scotia Health Authority at that level of detail - and I apologize that I don’t have that.
What I can say is we certainly recognize as a province the role of chronic illness and the pressures that chronic illnesses place in parts of our health care system. It’s why we’re working hard to expand and enhance the primary care access for Nova Scotians. We know many Nova Scotians do have chronic illnesses and having a strong primary care support team in place helps with the chronic condition, but also other health care conditions and circumstances that may occur. It really aligns with the notion of health care providers coming together to provide the necessary supports like the INSPIRED program. It really is very similar to the way collaborative practice teams operate as well - again, having the right health care providers providing the right care to the citizens of Nova Scotia.
There isn’t, that I’m aware of, a specific plan around direct expansion, but in the overarching goal of the government and the Nova Scotia Health Authority around continuously improving our health care system, again, looking at opportunities to engage and expand and improve the efficiency and outcomes of all of our health care programs, that is a priority area, one of many within the system. But our investments have been focused on some other key priority areas, particularly in the primary health care and mental health spaces, they have been our top priorities and that’s where it has been targeting the majority of our health care investments, and then of course the infrastructure initiatives as well.
KARLA MACFARLANE: I can’t say enough about the program and I hope within the coming year we will see this program expanded. I think it’s definitely one program that has shown that it definitely is solution-focused and it’s helping lower the overcrowding that we see in our emergency departments. I hope we will see that program expanded into other chronic health care conditions that could use this type of program to monitor people with chronic conditions.
I’m going to move on, and I think I came in earlier just as the minister was perhaps answering my colleague the member for Cape Breton Centre, but I did want to ask about the $2.8 million this year which brought it to a total of $5 million to implement the expert panel on long-term care, particularly including the wound care service and coordination and staffing, and we all know that there would be air mattresses included in this. I’m just concerned whether there was a provincial competitive process used to determine who would be supplying some of these items such as the mattresses and that?
I understand the Red Cross, I just really would like to know, are they the single provider or was there anyone else who had an opportunity to discuss supplying these types of equipment?
RANDY DELOREY: Madam Chairman, I thank the member for her interest in this particular area. It is an important area that I think all members in the Legislature have talked about in the past and that is, you know, care within our long-term care facilities, specifically here talking about initiatives around wound care or pressure injuries and steps that can be taken to reduce the prevalence and also reduce any progression of pressure injuries in our long-term care facilities.
As far as the investment that was announced the other week, we have a contract with Red Cross already in place to provide equipment within our long-term care facilities, the provider for things like wheelchairs and walkers and so forth. It’s actually through that contract that we just added another piece of equipment, which are the mattresses and equipment for pressure injuries, and felt this is important because that’s a provider who already has the logistics and services in place to deliver these types of equipment. It’s really just an addition of a piece of equipment to the work that the Red Cross is already providing as a distribution arm of equipment to our long-term care facilities. That was why the introduction of an additional vendor or a different vendor would mean then long-term care facilities would be dealing with multiple vendors through the logistics of moving equipment in and around.
The Red Cross has certainly a great track record of serving the province, and I guess the third variable at play was, given the urgency and the need to roll these out, again, going through the current existing provider of equipment to our long-term care facilities, we felt appropriate, so it did go directly to the Red Cross.
KARLA MACFARLANE: Madam Chairman, I’d like to know if the Department of Health and Wellness actually tracks the cost of medicines that are given out in long-term care facilities.
RANDY DELOREY: Madam Chairman, I guess from a departmental perspective the funding that we expend on pharmaceuticals and drugs for seniors we provide that through our Nova Scotia Seniors’ Pharmacare Program. That program that tracks the cost and the expenditures is done at the program level. It doesn’t distinguish or track, or report on I guess, based upon the residents. It’s really about that program. So, it’s not broken out based upon long-term care facility or home delivery. It’s just the Nova Scotia Seniors’ Pharmacare Program.
If you look at it from within long-term care facilities themselves, some residents may use the Seniors’ Pharmacare Program, or they may have private programs in place so it gets kind of complicated. I’m not aware that we track the data specifically the way the member has requested it, which would be, I believe, looking for the total cost of pharmaceuticals distributed in long-term care because it is the individual residents in long-term care facilities. It’s their medicine and again, if they are members of the Pharmacare Program, the government expenditures are through the Pharmacare Program and that, Madam Chair, is tracked at a program level. We have not, to my knowledge, ever broken it out to say these members of the Seniors’ Pharmacare Program reside in long-term care facilities and these ones don’t, I don’t think we’ve ever sliced or looked to slice the data that way.
KARLA MACFARLANE: I often hear from seniors who are out of pocket that are in long-term care facilities and families that are assisting them with their medication. So, I just want to confirm with the minister, is it a concern that we’re not tracking how much money is being spent on drugs within our long-term care facilities? I’m more concerned, I’m hearing a lot of concerns around opioids so I’m just wondering, do we have any idea, or can we find out what percentage of total drugs are opioids that are being used in long-term care facilities?
RANDY DELOREY: Let me phrase this properly, I suspect or think the rationale, and the member can correct me, my interpretation of the rationale of the question about tracking the amount of money spent is not a concern of the financial side for the provincial expenditures, but it seems rather a question more about the volume of pharmaceuticals and drugs being delivered. So, more of a quality-of-care question than a financial one. That’s my interpretation, Madam Chair, after the member asked the follow-up question and provided a little more context.
When it comes to the quality of care for seniors - but, Madam Chair, I would not restrict our concern or interest in this regard to our long-term care facilities - I believe this would apply to seniors across the province. I think the question that the member is really trying to delve into is one of overmedication within our senior population and the extent to which that is a challenge or problem.
The government does have programs available to seniors to do prescription drug reviews, to help review and assess the medications they are prescribed. One of the challenges that occurs, I believe as I understand the situation, when you have co-morbidity, or you have multiple conditions as a citizen, you may go in, be treated, and provided medication for the first condition you have. Time goes on and if it happens to be a chronic condition you have all these medications, you go in and have symptoms and you have a second condition and so you get medicated for that. I think what ends up happening is over time, all of a sudden, you have a very large number of prescriptions for various health conditions.
It is, I believe, and I’ve been advised, that to do reviews intermittently from time to time is a good thing, because you can assess to make sure a patient is on the right medication, not just for a given specific condition, but the broader totality of the conditions the patient is being treated for. Again, I think this is part of that debate and question we said the other day when we talked about the difference in types of funding models and so on. That’s what people argue about, which model of compensation is better. A fee for service, which proponents argue is more efficient because you see more patients, and others for the salary-based APP program which says we spend more time with patients and they would argue would be more apt to do full, total reviews of the prescription needs of a given patient.
Again, I will summarize and say that we do have options for seniors for prescription reviews and that would be the piece that would be, I think, for the people that should be concerned and shows that we do have concern to make sure that our seniors are receiving the proper medications for the conditions with which they are afflicted, and make sure they have the right medications for those conditions.
With respect to opioids, there has been a lot of work around opioids and benzodiazepines. That is part of the work that we do, monitoring those prescriptions. Again, not just for senior population, but across the board.
We do, as a province, have a prescription monitoring system - this is the Nova Scotia Prescription Monitoring Program that tracks the utilization and monitoring of drugs.
In that tracking, it is actually used to provide information to the prescribers and pharmacists, but it also allows us to see alerts pop up that will help with auditing of prescription practices, either on the patient or prescribers to see if there are any concerns that may pop up if we see that patterns of prescribing or prescriptions show up.
For example, you hear stories and the notion of opioids as addictions develop - individuals who go to multiple providers to secure multiple prescriptions for essentially the same condition. Through the drug monitoring program, we are able to flag and identify that so interventions can be made to avoid multiple prescriptions of tracked drugs like opioids to the same patient.
Also, there are occasions where individuals have been seen to prescribe inappropriately. It is, by and far, I think, the minority of situations, but it is a risk and a concern we do have. So, this system allows us to track the prescribers as well.
If we see practices that seem out of the norm, the appropriate oversight committees can go in and evaluate those practices and perhaps provide better education to ensure that prescriber practises follow the clinical best practices.
KARLA MACFARLANE: I thank the minister for those answers. I’d like to move on to asking the minister: What is the policy for medical cannabis in long-term care facilities?
RANDY DELOREY: If you will indulge me, I’d like to answer one of the member’s previous questions first.
The member had asked about the cost of the INSPIRED program. I’ve just confirmed that it is about $1 million per year invested in that program.
As far as the long-term care facility policy, I’ll have to double-check this. I will speak as an MLA because I did have this question come to me, and I am doing this by memory of a constituent case.
I believe the policy is to allow the consumption of medical cannabis or products as clinically necessary. What I don’t recall, because there are different forms in which it can be taken, is the overlapping of smoked or vaped product and what the policy stipulates there.
Knowing that there are other forms for consumption of medical cannabis, the consumption of it, I believe, is enabled or allowed in long-term care facilities. What I don’t recall is if it’s a broad provincial policy or if it’s site-specific policies with respect to what would be inhaled products like smoking or vaping. I don’t know if there’s provincial oversight on that or if it’s site-specific policy development.
KARLA MACFARLANE: I’m going to stay on this topic. The Nova Scotia Government signed a tax-sharing agreement with the federal government with regard to recreational and medical cannabis because they’re treated the same actually. They’re taxed the same. I’m just curious if the minister is comfortable in collecting tax revenue from patients, seniors, that are spending money for the use of medicinal cannabis for pain.
RANDY DELOREY: Sorry for the delay, Madam Chair, and to the member. I was just trying to think back to my previous portfolio and getting asked a taxation question here. Just trying to dig in to determine what the taxation policy is on prescription drugs. I don’t recall, but what I can advise the member is the distinction between medical cannabis and prescription drugs is medical cannabis is not a prescription drug in the traditional sense. It’s actually not truly recognized through the medical process of evaluating and determining drugs for clinical use.
The establishment of the medical cannabis stream of product line was something that was established through the court system, and not through a clinical drug review process. So, medical cannabis does sit out in the medical community and in the drug community as something a bit different than, essentially, all other prescription pharmaceuticals. I’m asking some questions of the finance folks just to verify this, but I suspect the taxation variances, or the likely variances on taxation, for medical cannabis likely relates to its classification, which is done at the federal level in terms of whether it is a pharmaceutical drug or not. I suspect if there’s a variation in how medical cannabis is treated for taxation purposes relative to other pharmaceuticals, I believe it relates to the fact that it doesn’t have the same clinical classification as other pharmaceuticals. That would be something that falls to federal jurisdiction, and not the province, for that classification of cannabis versus other pharmaceuticals.
KARLA MACFARLANE: Look, there’s a number of Nova Scotians that have health conditions such as cancer, MS, fibromyalgia, and all kinds of different health conditions that individuals rely on the use of cannabis to relieve pain. Does the minister believe that it is right to be charging those individuals federal excise tax, then provincial excise tax, and sales tax, then taking 75 per cent of it back, as a province - does the minister believe that it’s okay that we’re putting three different taxes on cannabis for medicinal use?
RANDY DELOREY: What I would first like to do is clarify the earlier question about long-term care policies and cannabis - I have confirmed that it is actually site-specific policies. That’s why I said I was speaking in terms of my role as an MLA and my experience with a provider in my community. I have verified it is site specific and perhaps that is why I think some members’ ears certainly perked up when the member asked the question originally, because I think people were hearing different types of stories and policies and that’s the reason why you would see something different, because it is a site-specific policy around the consumption of cannabis in long-term care facilities.
In terms of taxation policy and the approach by which medical cannabis is taxed and cannabis in general is taxed, that’s a taxation policy question I think best directed to the Minister of Finance and Treasury Board who is really responsible for our taxation policies and work. I’ll continue to maintain my focus on the delivery of the health care system and services.
KARLA MACFARLANE: Looking at the wait time, Nova Scotians continue to wait longer than most Canadians for hip replacements and that wait obviously got a lot longer in 2018. I know the minister knows the numbers better than I do, but I want to ask the minister: What does he believe specifically in this budget is going to reduce the wait times for hip replacements in this province? I believe that we’re backlogged by 3,000 or 4,000, so if the minister could specifically address what is in this budget that will reduce that number within the next year.
RANDY DELOREY: In this budget what we’re specifically doing is investing $17.4 million this year to support additional surgeries, as well as prehabilitation services, to help us, as per the plan to improve orthopaedic surgeries, the number of surgeries we could provide and deliver.
What we’ve done is taken that plan that was developed by physicians and clinicians brought to us last year - it was announced I believe in October 2017, so it has been active for just over a year, a year and a half and we’ve seen improvements. We’ve had about 4,000 additional surgeries. We’ve hired additional orthopaedic surgeons, with the money we hire and cover the cost for additional anesthetists for the surgery, as well as the necessary support teams required to support the work of the surgeons and the anesthetists in both the pre- and post-habilitation services.
The prehabilitation services, Madam Chair, was one of the key points in the recommendation by the clinicians, recognizing that if we do more at the front end, before the surgery, the outcomes after the surgery are much better. That’s why as part of this we’ve been investing and developing the prehabilitation services, so these investments, the $17.4 million, just part of that program delivery is about ensuring that we can continue to deliver the prehabilitation services which will help ensure that we have fewer of the people who receive the surgery having to come in for another surgery later, so we have better outcomes on the back end. So we see fewer readmissions or having to do a surgery a second time because they’re actually better positioned and the surgery lasts longer. That’s something that will help as well, but this is fairly new. It has only been operating for the last year or so.
We have seen some improvements, as I mentioned earlier today, and tabled a report that noted that for hip fracture repairs we are doing quite well, even on the national stage - 96 per cent of those hip fractures from emergency situations are getting the surgery within 48 hours, which is kind of the target area. That relates to a national average of only 88 per cent of patients getting that surgery in the recommended 48 hours.
Again, I’ll restate, we’re at 96 per cent.
THE CHAIR: Order. Time has elapsed for the PC caucus. We will move over to the NDP caucus with Ms. Roberts.
LISA ROBERTS: Thank you very much, and thank you for this opportunity to ask a few questions. I am going to be asking about the harm-reduction framework and getting an update on that.
I was looking at the documents that are available online. In March 2017, $1 million was committed, and then I saw further mention of a $1.38 million commitment in multi-year funding at some point in 2018.
I wonder if you can clarify for me, first of all, what the budget is for the harm-reduction framework in 2019-20. I’m not sure where to find that in the Estimates.
RANDY DELOREY: As the member would notice, we’re still digging into the vast amount of details to get the specific line item that she has inquired about. As I’ve done previously, I think perhaps to keep things flowing, we’ll keep looking for that rather than consuming all of her time.
I do want to let her know that the investments we’ve been making have had very significant and real, positive impacts for Nova Scotians. I think we’ve had somewhere over 120 reversals from the Naloxone kits that we’ve been distributing. Those are reported reversals of overdose across the province in the last year or so. Those in Public Health monitoring this have indicated they believe that that’s under-reported - obviously the stigma associated with overdose is quite high, so they believe it is under-reported, those 120 reversals that have taken place as part of our Naloxone investments, as part of the framework initiative.
I think we’ve had around 7,000 kits distributed, resulting in potentially over 100 or 120 lives potentially being saved as a result of these investments.
In addition, the other real highlight and significant piece of the Naloxone would be the methadone treatment. A year ago, we had a wait-list of over 200 people - I think somewhere in the vicinity of 250 to 275 people - waiting to enter methadone treatment programs. Through our investments and targeted expansions of the methadone treatment services, the last time I checked, that wait-list was somewhere around 20 or 30. So we’ve reduced it by about 90 per cent through last year’s investments alone, and we’re continuing those investments. We’re really proud of the progress we have made. The budget is somewhere in that $1 million range, from recollection, but I do want to get the correct dollar amount for the member.
LISA ROBERTS: As the minister knows, community-based partners are a very important part of the actual rollout of the harm-reduction framework. I had understood that there was some leftover money, some unspent money in the framework budget for 2018-19. I wonder if you could confirm that, confirm its amount, and whether that amount will be rolled over into the harm-reduction framework budget for 2019-20.
RANDY DELOREY: I apologize to the member. I think the reason I couldn’t find the other information is it’s not in the book of materials that we have here. We seem to be missing a page of details. I do apologize to her for that. We have a note in to staff in the office, so I’m sure we’ll get it before we’re done here.
As far as underspend, we do have the page that shows our variance, which is somewhere around $400,000 or $500,000 less that was spent than we had anticipated in our budget. The reason for that was the delay in things getting rolled out when we had established it. I believe we probably budgeted in terms of this amount of money for the total year, and again, when the budget year starts, it does take some time to get the programs rolled out. It was just delays in some of the programs.
We’re quite confident that the cost estimate of the service delivery was accurate. It just took a little longer to get started, so the underspend at the end of this fiscal year, 2018-19, was based upon not spending the money at the beginning of the year, not based upon anything other than that. The rate of spending was right. It just didn’t start as early in the year as we had anticipated.
As far as whether money rolls over or carries forward into the next fiscal year, it doesn’t. That’s not about this program or anything else. The fact of the matter is, as a government or any organization, you have an income or revenue and expenses, and at the end of the year, the books close, and then you start the next fiscal year over again based upon the revenues and expenses that are incurred. There’s not really this thing at the end of the fiscal year. At the end of the day, there’s a consolidation that takes place throughout all of government. There are some areas in our government that spent more than was budgeted, because unexpected expenses and things come up, and there are certain areas where we spent a little less than what we anticipated. This is an example of where we spent a little less, but of course, money was spent on other items broadly within government.
It’s not like cash that’s sitting there ready to be spent in the next fiscal year. Unfortunately, it doesn’t work that way, as much as I think we would all enjoy having a little extra to be able to put toward those programs in this fiscal year.
LISA ROBERTS: I’ll look forward to further details in terms of the actual budget for this fiscal year, which I guess starts over the weekend.
In the August 2018 update, there was reference to a harm-reduction implementation team. In the initial framework document, there was reference to a leadership team, with a list of individuals named on that. Can you just confirm, are the leadership team and the harm-reduction implementation team the same folks? Is it that group that will decide on the spend, the actual programs in 2019-20?
RANDY DELOREY: I believe the way things worked was really the important role that the teams played in the development of the framework, that there’s a leadership team in place that represented both health services and also even Justice as part of the team services, because of the framework, the five pillar areas, one of them is in the Justice space as well.
So recognizing this bands both the health and justice services, that leadership team was in place, and then there were some subteams underneath as well in the various areas like harm reduction, so it’s not that it’s necessarily separate teams or what have you. The leadership team was there to establish the framework and the directions, and now that we’ve committed to these theme areas, these approaches, that’s where the focal point is.
The leadership individuals, though, are still obviously part of the work that gets done. Really, the framework is there to now guide the work that department and Public Health officials are doing in the delivery of care and services, and it helps inform and influence the direction that we take when making policy decisions and investments that we do in this area.
LISA ROBERTS: In the August 2018 update, there was reference toward the work of the harm-reduction implementation team toward a safer consumption model. Certainly, as the minister and the deputy would know, there has been a great deal of work done to put together a proposal for an overdose prevention site. In fact, there was a protest outside this House just a couple of days ago that highlighted that, in spite of great investment and many reversals thanks to the rollout of naloxone, there were also 60 deaths last year as a result of opioid overdose.
Where is that work toward a safer consumption model? I did see a reference somewhere else in the framework to a safe consumption site. There’s a slight difference between a safe consumption site and an overdose prevention site, many of which have rolled out across the country, but there is not one in Nova Scotia currently. Can the minister update me on what people can expect to see on that front?
RANDY DELOREY: I thank the member for the question, and of course for her ongoing interest - and very genuine, I might add - genuine and sincere interest in this particular topic. I believe we have spoken on a few occasions about this topic, and her advocacy and desire for government to move forward is duly noted, Madam Chair.
What I will highlight is the context, and perhaps provide some clarification. The work - and in fact, this really started when we rolled out the framework, because there were people in the media who asked the question around overdose prevention or safe consumption sites, whether that is part of this. The Chief Medical Officer at the time had indicated, well, the framework, these are the main focal points for the program.
The first year it was around naloxone kits and getting that up and running. Then last year it was focusing on getting the methadone programs up and running and out there and seeing that work. While that work was going on, as the member noted, they would be evaluating and looking at the appropriate responses for Nova Scotia Environment to help inform the policy, the direction. There hadn’t been policy decisions around this area and so no decisions have been made and a full kind of, I guess, detailed report that would help inform a policy decision as to whether government would entertain and move forward with proposals and funding support for this type of work or not. That information hasn’t come to me in complete form that we’ve been able to establish and make a final policy decision, which, of course, the policy decisions have to be made and the investment decisions flow from there.
So, the member, Madam Chair, made reference to a proposal that talks about a proposal for a safe consumption site or an overdose prevention site in the city and that a lot of work was done on that. I think as I’ve previously articulated to the member in some of those conversations we’ve had on this topic outside of the Chamber that before we can make decisions on specific proposals we do need to have the policy decisions in place. So, it’s just a little bit of putting the cart before the horse. It’s not a judgment on the merits but it’s hard to judge the merits of a specific proposal for funding when we don’t have a policy position established yet. So, the last time I had a briefing on this topic, I did request from the staff additional information. Again, the information I’m looking for is more in a policy context, not any specific proposal or application because I need to have the policy position established first.
The other thing I think that’s important to point out to members is that the regulatory framework around the sites is established and administered and set by the federal government, Health Canada, and they changed the rules in the last year or so, which actually allows organizations or interested parties to apply for the necessary approvals from the federal government without going through the provincial government. So, while it is our position that we need to establish a policy position that helps inform our investment decisions, there is nothing that prevents third parties in the Province of Nova Scotia that feel strongly about these programs to obtain approval from the federal government to move forward with establishing this type of program in their community but again what’s necessary is for policy decisions to be made. Those policy decisions set the direction and help inform the investments.
Just because I did get the information now, since we’re talking about investments, the investments around the opioid program here for 2019-20 is broken down into three main categories predominantly. We have budgeted to invest $1.8 million; the naloxone program at about $600,000, and the harm reduction initiatives at about $1.4 million, which is a $3.8 million investment, and I believe that’s an increase of $1.4 million from the 2018-19 budget. So, again, as I started my discussions here on this topic indicating that this is a government that takes very seriously the concerns being raised by the member, by the community, and also acknowledges the stigma and how challenging it is for community members, either individuals that have an addiction themselves or an opioid use disorder themselves, and families of loved ones because there is a stigma associated with drug use, certainly to the point of overdosing.
The member made reference to some people in the community that came to the Legislature and I want to assure them that their voices have been heard; really stressing the fact that, not just that they’ve been heard, but I acknowledge that the stigma may leave them to believe that their voices don’t get heard.
I can sincerely say that their voices are heard, and I think the efforts we’re making, not just in policy documents or frameworks that we shelve but in dollars to execute. I referenced earlier, over 120 reversals from the Take Home Naloxone Program; a reduction of the wait-list for methadone treatments by over 90 per cent. These are positive outcomes based upon how we’ve been prioritizing.
As a government, we have to make choices and focus our priorities, but it’s the policy decisions that help us move forward and influence those things. At this point we’re still working to get the full picture of information, so I can move forward and make a policy decision. That point then would be the time where we would have a better position to entertain or consider any proposals that individual groups may wish to bring forward to government, if they’re looking for investments in those types of initiatives.
LISA ROBERTS: I confess I’m having a moment where I’m maybe still a baby politician. I am finding it hard to understand exactly what in this context it means to make a policy decision. When you have a budget which clearly - thank you for those numbers - shows an increase of investment, so there’s already a decision to support harm reduction through programs. Obviously there’s intention to spend the money. I just wonder if you can clarify for me just a little bit more, what does it mean to make a policy decision and who makes the policy decision? What is that substantively?
RANDY DELOREY: In this specific context the member was asking about overdose prevention sites. This is a model of care and service delivery that doesn’t exist in the province and hasn’t historically. It is, as the member referenced, a model of care that has begun to take root in some other jurisdictions. That means those jurisdictions have completed their evaluation of information and evidence and have concluded on their policy position that they would support initiatives in that space.
As a government, as you review information and you make policy decisions, those decisions are influenced by many factors. Some of the factors are on the programs themselves and we need to have the comprehensive full picture brought before - at least the way that I operate when I’m working with the department to make a policy decision, I want to have the picture brought before me.
I’ve spoken earlier today with the member for Kings North about my role as a critical assessor of information that’s brought to me by staff. This is on anything, and I advise staff and others, frequently, that when I ask challenging questions people shouldn’t interpret those either as being supportive or unsupportive of a policy position being brought forward to me. What my responsibility is, when evaluating the information being brought to me by staff, is to ensure that there’s a critical assessment; to ensure we’ve done all of our due diligence to make the best policy decisions on behalf of the people of Nova Scotia.
On this particular file, and this particular case, the information that was brought to me was incomplete. I asked some critical questions; the answers weren’t there. I’ve asked for more information to come forward to help support the position and the information. So that we can assure all Nova Scotians, when we make a decision on our policy, whether this is a key area that will be pursued within the province or not. As the member knows, there are many things that can and are being done to help improve the situation and save lives in this area. We’ve demonstrated that, and when we’re talking and looking at this, even to the point of advocacy, really what we’ve seen so far in the province is advocacy in one particular part of the province, but as a provincial government we have to look at this and say, okay, is an initiative like that in the best interest in the province as a whole? Or is it an investment in one particular part of the province?
These are the types of things, as examples, for the member to help clarify why there hasn’t been a decision made yet. It’s because the information that has been brought to me to date was, in my assessment, incomplete. I’ve asked for further information and I want to clarify for the member there is a distinction between an application or a proposal. A proposal for a specific implementation and a broader assessment of the policy itself and saying is this a type of program that we want to pursue? And that’s the question that has to be asked and answered before we start evaluating and assessing specific proposals there. That’s just, again, a little bit of cart before the horse that we need to make that full policy decision.
I think what happened in this case, I believe, is that, and rightfully so, staff and other people in the community recognized our government’s policy position broadly around opioid use disorder improvements and saw that, rightfully so, through the work that was done on the opioid action framework. What I think may have transpired is people assumed that all ideas that came forward would then get approved, but we’ve been investing a lot of money in this area and supporting a lot of programs and having very good success in them. We do have to make sure for these ones, particularly ones that are completely new, do get an appropriate critical assessment and decisions being made.
LISA ROBERTS: Maybe in another conversation outside this Chamber we can have a conversation about how policy can be shaped by pilots. I understand that the particular proposal is for a pilot project, and of course, with a pilot you don’t actually have the forever across the board policies figured out.
At the same time, I know the minister is aware, as I am, that there are voices of concern in the community as well as many voices of support. In my last minute, I appreciate hearing how community voices can best be heard moving forward.
RANDY DELOREY: I think, really, a lot of work has already been done, particularly on this file, we have staff engagement. I believe there has been a lot of engagement with community voices. As I said earlier, I assure the member and those advocates and community members, their voices are being heard. This isn’t about voices being heard or not heard; this is about having the appropriate data and information on my desk, so I can make decisions about how we move forward
THE CHAIR: Order. Time allotted for consideration of Supply today has elapsed.
The honourable Deputy Government House Leader.
KEITH IRVING: Madam Chair, I move that the committee do now rise, report progress and beg leave to sit again.
THE CHAIR: The motion is carried.
The committee will now rise and report its business to the House.
[The committee adjourned at 3:09 p.m.]