HANSARD
NOVA SCOTIA HOUSE OF ASSEMBLY
STANDING COMMITTEE
ON
HEALTH
Thursday, January 19, 2023
COMMITTEE ROOM
Funding for Public Health in Nova Scotia
Printed and Published by Nova Scotia Hansard Reporting Services
HEALTH COMMITTEE
Trevor Boudreau (Chair)
Kent Smith (Vice Chair)
Chris Palmer
John White
Danielle Barkhouse
Hon. Brendan Maguire
Rafah DiCostanzo
Gary Burrill
Susan Leblanc
[Trevor Boudreau was replaced by Melissa Sheehy-Richard.]
In Attendance:
Judy Kavanagh
Legislative Committee Clerk
Gordon Hebb
Chief Legislative Counsel
WITNESSES
Department of Health and Wellness
Dr. Robert Strang
Chief Medical Officer of Health
Kathleen Trott
Associate Deputy Minister
Jennifer Heatley
Executive Director, Public Health
Nova Scotia Health Authority
Marcia DeSantis
Senior Director, Population and Public Health
Dalhousie University
Dr. Sara Kirk
Professor, School of Health and Human Performance
Dr. Katherine Fierlbeck
Professor and Chair, Department of Political Science
HALIFAX, THURSDAY, JANUARY 19, 2023
STANDING COMMITTEE ON HEALTH
10:00 A.M.
CHAIR
Trevor Boudreau
VICE-CHAIR
Kent Smith
THE CHAIR: Order. I call this meeting to order. This is the Standing Committee on Health. My name is Kent Smith. I’m the MLA for Eastern Shore and the Vice Chair of this committee, but I got a promotion today.
Today we’ll be hearing from the Department of Health and Wellness, the Nova Scotia Health Authority, and Dalhousie University’s Department of Political Science and School of Health and Human Performance regarding Funding for Public Health in Nova Scotia.
I would ask everyone to please put their phones on silent. I would also now like to start by asking all the members of the committee to introduce themselves, beginning with MLA Sheehy-Richard.
[The committee members introduced themselves.]
THE CHAIR: For the purpose of Hansard, I also recognize the presence of Chief Legislative Counsel Gordon Hebb and Legislative Committee Clerk Judy Kavanagh.
At this point in time, I’d like to officially welcome the witnesses for joining us today. I’m going to give everyone the opportunity to first introduce themselves, just for the purpose of the record. Once everyone has introduced themselves, then you’ll have the opportunity to offer any opening remarks, if you have any. We’ll begin with Dr. Kirk.
[The witnesses introduced themselves.]
THE CHAIR: I believe at least one or two of you have opening remarks. Apologies. Dr. Fierlbeck.
[Dr. Fierlbeck introduces herself.]
THE CHAIR: If I miss you in the future, I’ll try to avoid that as much as possible. Dr. Strang, I believe you have opening remarks.
ROBERT STRANG: Before we turn things over for questions, I would like to provide a brief overview of Public Health and Public Health funding in Nova Scotia. It will be important to distinguish between Public Health and the public’s health in this discussion.
Public Health is the formal part of the health care system that focuses on maintaining or improving the collective health of communities or populations as opposed to providing individual care. The core functions of Public Health are population health assessment and surveillance, chronic disease and injury prevention, health promotion, health protection, environmental health - in Nova Scotia the responsibility for the function of environmental health is with the Department of Environment and Climate Change - and emergency preparedness.
Public Health works in these areas primarily though multi-partner collaboration and community mobilization and engagement, often with the role of providing epidemiology and evidence of effective interventions.
The issues affecting the public’s health are complex, interconnected, and multisectoral. There is not one single government department or agency that solely addresses the public’s health. To be effective in this work, Public Health - what I call big-PH Public Health - needs to be structured so that the core functions are integrated, that we have an adequate and appropriately-trained workforce and be positioned to work, and lead where appropriate, across departments and sectors. Doing so will allow us to effectively influence the overall health of Nova Scotians and the communities that they live, work, and learn in.
Since I began working in Nova Scotia in 1999, there have been two times of significant investment in Public Health. In the mid-2000s, after a comprehensive review of Public Health, there was a substantial restructuring and growth of Public Health, what I call public health renewal 1.0. Currently, we are in Year 2 of a three-year fiscal investment in Public Health along with significant restructuring to create a provincial public health system, and that’s what I call public health renewal 2.0.
There have been investments at the Department of Health and Wellness, mostly in surveillance, Medical Officers of Health, and emergency management capacity, and my colleague Ms. DeSantis will provide an overview of investments that have also happened in Nova Scotia Health Public Health. As we move forward, I see opportunities for Public Health to contribute to advancing issues that impact the health of Nova Scotian communities and populations, and ADM Trott will have more to say on this.
I’d also like to touch on the delivery of some public health programs. There is a notion that all public health programs should be universal, but it’s not about having equal access for everybody to these programs; it’s about ensuring there is equity. In other words, there are families and parts of our communities that need more supports than others, so Public Health focuses from an equity perspective, not an equal perspective. There are social determinants of health that influence health outcomes, and by having targeted programs, services, and resources, we are able to optimize the health of those who are marginalized and vulnerable.
In closing, while we will always need to ensure that Public Health has the necessary structure and capacity, our primary focus should not be on this, or a specific budget target, but ensuring that we have sufficient collective attention and investment in the issues that will optimize health for all Nova Scotians. Thank you, and I will turn it now to ADM Trott.
KATHLEEN TROTT: Good morning, Mr. Chair, and members of the committee. Thank you for allowing us the opportunity to meet with you today. On behalf of Dr. Strang and myself, we are pleased to be here in attendance with Jennifer Heatley, Executive Director of Public Health, and representatives from the Nova Scotia Health Authority and Dalhousie University, to answer your questions on funding for public health in Nova Scotia. Each witness brings something different to the table, unique perspectives and ideas on public health, and how we can address some of the challenges our communities and Nova Scotians are facing.
Last Spring, we released Action for Health, a four-year plan to improve the health system. This strategic plan is divided into six key solutions that will transform our health care system. The work has certainly begun, but one of the key solutions is focused on the factors affecting health and well-being. This is critical to the sustainability of the health system, something that can’t be done overnight and not one that can be done alone.
The last few years have clearly shown what we can accomplish when we work together. The partnerships we have developed extend beyond those directly involved in health care and have been key in our response to COVID-19. The pandemic has highlighted our ability to quickly mobilize the resources we need to work toward a common goal. The same approach will serve us well in our continuation of delivering public health programming and services. We are committed to continued collaboration with our partners to maximize opportunities to strengthen the delivery and accessibility of public health for those who need it most. We have a lot of work ahead of us, but this work is critical and public health has an important role in the transformation.
I appreciate the opportunity to talk to you today about our work in public health, and I look forward to answering your questions this morning.
THE CHAIR: If you don’t mind just moving your microphone over a little bit closer to yourself, that would be great. Thank you so much.
Ms. DeSantis, I believe you have opening remarks as well?
MARCIA DESANTIS: I do. Similar to my colleagues, I would like to thank you, Mr. Chair, and fellow committee members for having us here today.
Dr. Strang and ADM Trott have provided an overview of Public Health and Public Health funding. Dr. Strang shared the core functions that we employ to achieve improved health of our Nova Scotian communities. Nova Scotia Health Public Health is organized to deliver on the Health Protection Act, as well as other Public Health protocols and standards developed by the Department of Health and Wellness. We employ a variety of Public Health professionals to work with partners and across sectors and services to achieve these core functions. We provide an array of programs and services that focus primarily on creating supportive environments where Nova Scotians can make the healthy choice the default choice where they live, learn, work, and play.
We also provide some individual supports and services for those who experience inequities to make health achievable for all. The focus of the program is across four distinct areas, which include health protection, Early Years, Healthy Communities, and public health sciences.
Dr. Strang mentioned that we are in Year 2 of a three-year investment in Public Health. During the early months of the COVID-19 pandemic, an urgent need for additional investments in Public Health was identified to stabilize and strengthen our workforce relative to our core functions. Year 1 saw increases primarily related to our health protection core functions. This, along with interim COVID-19 funding, has provided us with the resources to respond effectively to the COVID-19 pandemic. Year 2 has provided us the ability to expand some capacity in other areas such as Early Years and Healthy Communities.
Throughout the pandemic, our Public Health staff, along with staff from across the health system and beyond, were deployed to support our COVID-19 response, which shifted in its model to meet the ever-changing demands. We were adaptable and responsive. During this time, Public Health suspended all but our core critical functions, such as infectious disease case management and our immunization services. Our COVID-19 work continues, including investigating cases and outbreaks of COVID-19 in higher-risk populations such as those living in congregate settings or from equity groups such as our First Nations populations. In addition, we continue to support the COVID-19 vaccination efforts both through distribution of the vaccine to pharmacies and also through our outreach immunization clinics. Finally, we continue to support testing through our Public Health Mobile Units and the community distribution of rapid antigen tests. This is new and ongoing work for us compared to pre-pandemic.
Most Public Health staff have recently returned to their pre-COVID-19 core Public Health functions and we are in the process of restarting our suspended services. We can do this by relying on the temporary staff supported through interim COVID-19 funding. The enhanced funding in Public Health has also allowed us to expand our core Public Health programs and services, and the interim COVID-19 funding has allowed us to respond to COVID-19.
In closing, I would like to publicly commend our team at Public Health. Over the past almost three years, the staff have shown strength, resilience, and sheer determination to help keep Nova Scotians safe and healthy. They have far proven their value to the health of our population. Investing in Public Health is an investment in them and an investment in the future of the health of our Nova Scotians.
At this time, I will pass it back to the Chair.
THE CHAIR: Dr. Kirk or Dr. Fierlbeck, do you have opening remarks?
Dr. Kirk.
SARA KIRK: Good morning, everyone. Thank you for the opportunity to speak today about Public Health funding in Nova Scotia. The timing of this meeting could not be better. I see an opportunity for change, and I’m encouraged by the focus on the broader health system, not just on our sickness care system.
The introduction to Nova Scotia’s Action for Health plan acknowledges that there is no shortage of challenges facing our health system, that these challenges require monumental action and investment, and that action is needed on the factors that affect the health and well-being of Nova Scotians each and every day. Indeed, my research is focused on understanding and looking for ways to design supportive environments that keep our population healthy in settings like our schools and our communities.
The immediate challenges facing our health system include a growing population with higher rates of chronic disease - things like cancer and heart disease - and lower life expectancy than our Canadian counterparts. Nova Scotia also has an aging population that is more likely to live with one or more chronic diseases. For example, they may have heart disease or cancer and arthritis. Living with more than one chronic disease is linked to social deprivation, and people who experience social deprivation are more likely to live with one or more chronic disease. We’re also seeing chronic diseases develop at a younger age, which further increases pressure on our health care system.
As my colleagues have already noted, it is important to recognize that many of the factors that influence the health of Nova Scotians lie outside the domain of the health system. Poverty, systemic racism or discrimination, and precarious housing all impact health but have their roots in economic or social policies. These are the upstream social and structural determinants of health that shape the underlying conditions for our individual abilities to adopt health-promoting behaviours. They also disproportionately impact some communities more than others.
[10:15 a.m.]
I would expect you know this already. I suspect when you work with and hear from your constituents that you’re well aware of the conditions that they are experiencing and how those conditions profoundly affect whether they’re able to live a healthy life. Living in poverty or experiencing racism and discrimination or precarious housing is understandably stressful, and chronic stress itself increases the risk of things like heart disease or stroke, which, as I’ve already mentioned, are higher in Nova Scotia than the national average. It is all connected.
As we heard yesterday from Minister Thompson at the government’s press conference, we can’t keep fixing gaps in the health care system when they appear. Instead, we need to invest in working together to shape a healthy society in Nova Scotia. This means investing in a resilient and robust public health system.
It also means fixing the conditions that contribute to the poor health status of many Nova Scotians. To do any less is a disservice to our population. We must also ensure that every government department understands their integral role and their duty in enhancing the health and well-being of every adult and child in this province. Health and well-being are shaped more by the places and spaces where we spend our time than by the individual choices that we make.
We must better promote health in places where Nova Scotians live, learn, play, and work, as has already been said. Any delay in these actions for health is a delay too long. We are at a critical junction in our health system evolution. Creating the conditions to improve the health of the province must be a long-term goal, and that means a commitment and required investments beyond the life of one government and across multiple sectors and settings.
Inadequate funding for public health is a false economy. Research has demonstrated a return on investment of public health interventions of around 14 to 1. This means that for every one dollar invested in public health interventions, another $14 will subsequently be retuned to the wider health and social care economy. Evidence like this clearly demonstrates that prevention is better than cure.
Given the importance of public health approaches to disease prevention and addressing health inequities, and this impressive return on investment, there is a financial as well as a moral imperative for governments to increase their investments in promoting health and well-being across the life course. What I’m saying to you today is not new or novel. We’ve actually known this for years, but knowing and doing are not the same thing. The solutions to improved health and well-being exist, but we need to act on them consistently and resource them adequately.
With such a clear link between health and wealth, a healthy population means a productive, prosperous population, and that benefits us all.
THE CHAIR: Dr. Fierlbeck, do you have any opening comments?
KATHERINE FIERLBECK: For a few years now, we’ve been addressing health care within a context of crisis, but despite all the immediate challenges we have to address right here and right now - and I know that there are a lot - it’s nonetheless important not to normalize health care and public health specifically only as a form of crisis response. There’s a side to Public Health that, especially in the present context, is much less dramatic, and that side of Public Health is all about its responsibility to monitor the population as a whole, to observe, to analyze, to collect, to interpret data, to prevent, remedy, and mitigate problems before they balloon into bigger issues.
We’ve had to focus so rigidly on all the downstream fliers that we are perhaps in jeopardy of losing sight of the upstream causes that don’t have pathogenic components. The focus today is on public health funding in particular, and it’s useful to look at the Canadian Institute for Health Information data on this point. Obviously, COVID-19 has meant that Public Health spending everywhere has gone up tremendously to meet the crisis, but again, I want to focus on the less dramatic side of Public Health, the day-to-day things that Public Health used to do before the pandemic hit.
How well was Public Health in Nova Scotia supported in its day-to-day function before the pandemic? Just before COVID-19, for example, New Brunswick was spending about 4.5 per cent of its health care budget on public health, Alberta and Ontario around 7 per cent, Saskatchewan around 9 per cent, and Nova Scotia spent 1.5 per cent. If you want to look at this on a per capita basis, New Brunswick was spending about $200 per person per year, Ontario about $350, Saskatchewan and Alberta around $400, and Nova Scotia $80.
Now Public Health in Nova Scotia enjoyed a notable increase of up to 4 per cent of government health expenditure for a few years, as Doctor Strang noted, following the 2006 Public Health review. That went down dramatically again and before the pandemic, we were right back to where we were in 2004 at 1.5 per cent. The pandemic meant that this funding expanded dramatically, but we also know from historical experience that when the immediate danger recedes, so too does interest in public health funding.
There is an issue of overall public health funding, but I do also want to make the point that our focus shouldn’t simply be about the level of funding. It’s also about how this money is used, how public health services are organized, how partnerships are built and nurtured, whether there’s accountability and following through on program implementation, how programs are measured and monitored, and how accessible all this information is. There’s really no point in trying to run a health promotion strategy, for example, devoid of data, information on why the program was needed, where it’s needed the most, how well it’s doing, and why.
The population health surveillance function - forgive me - the somewhat more boring side of Public Health actually serves as the eyes and the ears of the health of the population as a whole. By having the resources to understand and monitor the health of the body politic, we know where most efficiently to address any inflammation before it ruptures, and without such information, we’re simply flying blind. Starving Public Health, as my colleague Dr. Kirk has already noted, is, in the end, a false economy. Investment in public health is precisely that: an investment. The returns may not be immediate, and I appreciate that this may perhaps be the very worst day in years to be talking about funding Public Health rather than things like emergency services, but as we’ve learned in Nova Scotia, it’s pay now or pay later. We build hospitals knowing that there is an upfront cost, and if we don’t want to be treating patients in yurts, we know that it’s something that we have to do, and Public Health infrastructure is no different.
THE CHAIR: Thank you, Dr. Fierlbeck, and thank you to all the witnesses for their opening comments. I will note that I’m sensing some displeasure with the length of time it’s taken to do the opening remarks, and I will say that we offer each witness about three minutes to do their opening remarks. We have six witnesses today. That would take us to 10:24 a.m. We’re at 10:22 a.m., so I think we’re perfectly on time.
The next section of this is the question and answer period. Each caucus is permitted 20 minutes to ask questions. After that, we gauge how much time we have left, and then we break it down to sometimes less than 10 minutes for each caucus. We will begin the question and answer session with the Liberal caucus. MLA Maguire.
HON. BRENDAN MAGUIRE: Thank you, Mr. Chair, and I appreciate everyone being here today. I’ll start out by saying that we are a university town. We have a lot of students who come to this city to seek higher education. In 2021, we heard the devastating story of Kai Matthews, who died of meningitis B in June, and recently, a Dalhousie student passed away, and now there’s a suspected case of meningitis B at Saint Mary’s University of a student who passed away. I would say one preventable death is too many, and Kai’s father Norrie is here today. He’s been advocating strong and hard for meningitis B vaccines. We do know that to get a meningitis B vaccine - it’s about $300, if not more depending on - and that is a cost barrier. That’s the reason why some people are not getting it.
We saw the importance of vaccines in the rollout of vaccines during COVID-19 and the response that it had here in Nova Scotia, and the deaths that it prevented, and the illnesses that it prevented. Why has our Province not covered the meningitis B vaccine?
THE CHAIR: Dr. Strang.
ROBERT STRANG: I think I need to go into a little bit of the science of meningococcal disease and meningococcal vaccines, so bear with me. We know, first of all, there are several different strains of meningitis, meningococcal disease, and we cover some of those with vaccines. Infants get a vaccine against meningococcal C. There aren’t vaccines for infants for the other strains. A Grade 7 immunization - everybody’s offered a quadrivalent vaccine against A, C, Y, and W strains. That quadrivalent vaccine does not include B.
There is a meningococcal B vaccine available. It’s a different type of vaccine. It’s not recommended by the National Advisory Committee on Immunization to have publicly funded programs for offering that meningococcal B for the broad population like we do with the quadrivalent vaccine. That’s for a number of specific reasons. It’s a different type of vaccine. There are many different substrains of meningococcal B and not all of them are protected by the meningococcal B vaccine, so if you immunize people well ahead of time of possible exposure, then you’re not sure you’re going to get protection against the strain that’s around.
When we look at the epidemiology of meningococcal disease, it’s a rare disease. It can have some fatal consequences, absolutely. My condolences to the families who have been affected in the last few years. But it is a rare disease, and some of that is we have infectious diseases that occasionally can create very rapid and catastrophic consequences, and we can’t prevent all of that.
We also know that who’s at risk for meningococcal B is very specific. We know that in all meningococcal disease, the highest rates by far are in young infants. Then we have a little bit of a surge in preschool age and Grades 4, 5, and 6, and then another bit of an uptick in younger adults. But it’s not all young adults. We know specifically who’s at risk for increased meningococcal disease: adults leaving school and going and living in congregate living settings. That used to be more military recruits. Now we see it most frequently - but still very rare - in university dormitories.
That’s simply - the fact is that about 10 per cent of the general population will have what we call carriers: They have this bacteria in their nose and throat. It doesn’t cause any infection. Each of them brings the substrains that are actually in their community, so when you bring people from a range of communities across Nova Scotia or from across the country into a university residence, what we see is increased transmission because of that congregate living setting and the rate of nasal carriage can go up to 20 per cent. It’s that very specific group: young people entering university, specifically living in residence.
For all that, the rationale - that’s why NACI says we shouldn’t - there is not good rationale for a publicly funded program for everybody. We need a very targeted program. No province publicly funds this. We certainly use meningococcal vaccine and publicly fund it for people who are at high risk when we have individual cases. Then we know it’s a meningococcal B strain. We use the vaccine for those close contacts, and when we have an outbreak, like we had an outbreak before Christmas, in a single residence at Dalhousie, we vaccinated very quickly all of the people in that residence because of the potential that they were at high risk.
We have started a conversation. On Monday I had a phone call starting a discussion with post-secondary institutions in Nova Scotia. They were very anxious to expand that from an Atlantic perspective. We will be moving forward. Public Health will be working with post-secondary institutions, and from an Atlantic perspective, on how we can work together to increase awareness of who is actually at increased risk and the availability of a vaccine, and also when the appropriate timing of that vaccine would be, and then also discussions of how we may work together to reduce cost barriers to that vaccine. Many universities are already looking at how through their university health plans and making arrangements with the vaccine manufacturers to reduce costs. Moving forward, we’re going to have those very specific conversations with our post-secondary colleagues.
BRENDAN MAGUIRE: I would ask that we keep our answers short. We have a limited time. I appreciate the detailed answer.
The conditions that you describe, Dr. Strang, about close contact and that, describes HRM to a T. People are living in dorms. They’re going to the bars. We react when there’s a death.
You did mention NACI and you said that NACI does not recommend that - the reason being that NACI does not recommend. NACI recommends that we fully fund shingles. They also recommend that we fund the flu vaccine for seniors, and yet we’re not doing that in Nova Scotia. My question is: If NACI is recommending shingles and the flu vaccine for seniors, we’re not doing that, but they’re not recommending meningitis B. We can’t have it both ways. That’s one of the issues that I have here.
[10:30 a.m.]
We are a very specific group here in HRM. We have students from all around, and the age of people who are coming to our universities are the age of individuals who are at the most risk, the highest risk for meningitis B.
I talked to Norrie about this. I had a close personal friend who was not in university at the time who caught it from going to a bar in HRM. We’re inviting students into HRM, we’re telling them to go into dormitories and close quarters, and then we’re also obviously asking them to go to restaurants and bars to spend their money, and this is how it’s spreading here in Nova Scotia. We do know that HRM, and Nova Scotia in particular, have some of the higher rates than other areas of Canada.
My question is: Even though it’s not happening right across Canada, why can’t we make an exception here in Nova Scotia, here in HRM, in our university-populated cities and municipalities and say these individuals are high-risk, these individuals are more likely to carry than anyone else, and one death is too many? Let’s fund this, let’s not rely on the universities, because we know the universities now are starting to roll this out, but let’s make sure that everybody gets vaccinated for meningitis B that’s in a high-risk situation, but also a high-risk age group, like we did with COVID-19. We’ve proven we can do it. NACI is saying no to this, but they’re saying yes to shingles and stuff, so we’re back and forth on what we do. I know it’s not on you, but we’re back and forth as governments on what we do and do not follow depending on NACI recommendations.
ROBERT STRANG: Two quick responses. Certainly both proposals have been developed for those two other vaccines you mentioned, and they certainly continue to be considered, along with a whole range of other cost pressures in the health system. They’re actively under discussion with all sorts of other things.
Around meningococcal B, we do not have higher rates than the rest of the country. We are not. Look at the numbers. It’s a rare event. Unfortunately, rare events sometimes happen, but we are working with universities. It’s a very specific, targeted group. You don’t get meningococcal B just from going to bars. That individual you mentioned must have had much closer exposure somewhere else. It’s a very focused, targeted vaccination program we have, and as I said moving forward we are working with universities to raise awareness.
Many of the universities are taking steps to reduce cost, and we’ll be at the table thinking about how we may, again, for a very specific, targeted group - it would be students coming into university first year, potentially those only living in residence. That’s who we should need to focus on, and how do we work with that group, knowing that many of them are in different parts of the country and they should be immunized before they even get here. That’s an issue about how you raise awareness and decrease costs. Those conversations will be ongoing.
BRENDAN MAGUIRE: My last quick question - I appreciate the clarification, Dr. Strang - is on the information piece. Part of this is the duty of Public Health to get that information out there, to make sure that people are aware of these issues. You said that you are working with universities. Are you also working with the general public on awareness around meningitis B?
ROBERT STRANG: There are other types of meningitis. All our vaccination programs - there is information about this disease that we’re vaccinating against as infants and again in Grade 7. Specifically on meningococcal B, there will be two main streams of our work. One will be information and awareness: How do we actually give students who are at the time and the situation when they’re at greater risk - make sure they’re aware of the recommendation for a meningococcal vaccine? The second line of work will be around how to reduce barriers, including financial barriers.
THE CHAIR: MLA DiCostanzo.
RAFAH DICOSTANZO: I honestly want to ask two questions regarding mental health, because I’m the critic for the Office of Addictions and Mental Health. I do have another question that has bothered me. I know you are mainly in charge of policy and the bigger picture, and today I heard a lot of things: we can’t fix gaps; we need to medicate problems; and the last one I loved even better - an inflammation before it gets erupted. I see an inflammation that is going to happen in a big way, and that is the 130,000 people who have no family doctors.
We keep giving band aid solutions. I see that Public Health is actually sending a mobile primary care clinic - that is a wonderful service but that is a band aid. It’s causing this big issue that I see: all these patients without doctors - where is their information going? Every time we send them to a mobile primary care clinic, every time we give them virtual care - these are all wonderful things, but they have no central information, and this information is getting lost.
I would be really upset as a doctor - it’s a liability to doctors to treat people without knowing their history. The history is being lost for all these patients, and no one is looking at the bigger picture of what’s going to happen in the future to those people. Then, we take the family doctors who now are doing virtual care and mobile care, and we have no central system to keep that history for those patients. It’s a liability for the patient; it’s a liability for the doctor.
Who is looking at this bigger issue and the policy, when you’re sitting together? Is Public Health involved in this?
THE CHAIR: Who is that directed to?
RAFAH DICOSTANZO: Whoever can answer - who’s doing policy in Public Health.
KATHLEEN TROTT: I’ll ask Dr. Strang to jump in here as well. The work of Public Health is not that directly connected to delivery of actual care with doctors. We’re really on more of that prevention side. We have loaned our mobile units that worked so well for us during the pandemic to help support some pop-up clinics for primary care access, but that’s not the work of this team. That’s on the primary care and acute side, so we can only speak to the Public Health component.
We do think we have a role to play in helping to really divert folks from having to get care. If we can invest in their health, then we’ll take more burden off the system. In the short-term, for primary care challenges, that’s not the solutions from Public Health.
RAFAH DICOSTANZO: I’m sorry, but this is a prevention, correct? This is a big problem that’s about to happen in a couple of years. We already have people who have been without a doctor for two to three years. Where is that information going, and how do the pharmacists or doctors who are treating them know what medications they’ve been on? What history do they have in medical issues that can cause a liability to the doctor themselves?
Who is looking at this bigger picture? To me, these are policy issues, and you are the policy people, so how come you’re not looking at this?
ROBERT STRANG: Certainly, the integration of health information is not new and is an important issue. There is a whole initiative called One Person One Record - I’m sure you’re aware of OPOR - which is meant to do that. Legally, when people go to any clinical visit like that, there needs to be some clinical record created, so there would be there. It’s the integration of all that. That is not Public Health.
There are other parts of the health system - as I said, there’s a whole initiative of OPOR which is meant to integrate all these records together, ultimately. Public Health will contribute to that. We have our own information system that we use for our work called Panorama. Certainly, especially the vaccine records or part of that will be integrated into OPOR over time.
RAFAH DICOSTANZO: OPOR hasn’t been in any talk that I’ve heard recently, or in any of the solutions that were mentioned yesterday. We have issues that are going to develop even worse for emergency departments if they’re showing up at emergency without history. We have 130,000 people showing up without any health history, and no one is talking about that. Yesterday, that was not part of the solution. We’re just taking doctors from this area, putting them here - all Band-Aid solutions. That’s all I keep hearing.
I’m just going to leave it at that. I hope you guys can take this and help the department to come up with some solution before it erupts, before this inflammation erupts in the big way that I see.
My other quick question, if I may, is on mental health. This government has promised universal mental health, and we know that Nova Scotians are struggling. Is Public Health currently involved in the expansion of mental health services in Nova Scotia?
KATHLEEN TROTT: I’ll start off, and then ask Dr. Strang to come in. We do work closely with our colleagues in the Office of Addictions and Mental Health on many fronts that I’ll ask Dr. Strang to speak to, because it is very important and it is part of overall public health, absolutely.
There are some key areas where collaboration is happening and will continue to happen around the development of plans around Solution Six, around wellness, and really focusing on those Tier 1, Tier 2 levels around providing peer support, using activity, things like that. Those do kind of cross over from both a Public Health component and an Addictions and Mental Health component.
But there are specific things Dr. Strang is working on with the chief of the Office of Addictions and Mental Health around supportive housing and things like that. Rob, if you want to mention those.
ROBERT STRANG: We work very closely. There’s a lot of connection. When we talk about mental health, we talk about five tiers. The first two tiers, the bottom ones, are really outside of the health care system, and that is the work of Public Health. Then as you get the need for more specialized clinical - those are Tiers 3, 4, and 5, which are the mental health care system.
We do a lot of work in schools, for instance, through our Health Promoting Schools process. The work we’re doing around physical activity - there’s growing evidence that people who spend even 10 minutes a day walking outside in nature improves your mental health. We need to distinguish between people who have diagnosed psychiatric illness and need care from the health care system side, versus mental wellness, which is the broader population.
It’s no different from physical wellness, where all those factors that you’ve heard us talk about - socio-economic factors, what is our physical environment that promotes access to nature, walking, healthy food, social connection. That is the work that Public Health is involved in, which ultimately has a major impact on people’s mental health.
The other piece we’re working on directly is around people who have significant addiction and often combining addiction and mental health issues, who are often on the streets, homeless. Our opioid strategy in 2016 that we’re continuing to work on very closely with our colleagues in mental health and addiction - how do we actually address those who are most marginalized with very severe mental health and addiction issues?
The issue that ADM Trott mentioned around supportive housing is one that we need to pay more attention to. We know the evidence that if you provide those types of individuals with stable housing, you will get better outcomes from your treatment of their mental health and/or addiction issues. We’re working very collaboratively in those areas.
RAFAH DICOSTANZO: Thank you, Dr. Strang.
THE CHAIR: We will now switch to the NDP caucus for their 20 minutes, beginning with MLA Leblanc.
SUSAN LEBLANC: Thank you all for being here and for everything that you’re doing and have been doing in these - well, forever, but also in the last crisis years, as it happens.
First of all, I want to say that I represent a riding where there is a significant population of vulnerable people - lots of precarious housing. Yesterday in my office, I talked to my constituency coordinator - 13 people came in for help yesterday in one eight-hour day, and the first three at least were people who were being renovicted. The other day, there was a lady in who is a senior citizen who is literally couch surfing because she has nowhere to live. This is totally usual. This is happening all the time.
I want to say thank you for bringing attention to the social determinants of health. Precarious housing, poverty, little access to nutritious food - these are all things that literally will keep our population more healthy. You are the experts, you know this, but I just want to say that I see every single day the results of the inaction on that, the disinvestment.
[10:45 a.m.]
That being said, I want to ask this of Dr. Fierlbeck and/or Dr. Kirk. Someone mentioned the situation in ERs and how it’s strange that we’re talking about public health when we have this health crisis in front of us, but the fact is, they’re not disconnected. We know that we’ve seen the situations in ERs deteriorating over the last couple of months - including the highest number of deaths in the last several years, just last month.
I’m wondering if one of you could talk about how the investments in public health can have a knock-on effect on the health system as a whole. If we invest in public health, can you explain how we might see results in our emergency departments down the road?
SARA KIRK: Do you want to take this one, Katherine?
KATHERINE FIERLBECK: The connections between the day-to-day lives of Nova Scotians and the effects that we see in emergency rooms are very closely connected, but not directly. We know that if we have a serious accident, we go to emergency. But emergency departments are also filled with people who have chronic conditions that haven’t been addressed, who are dealing with issues that are a result of where they live, of their lifestyle, of the kinds of pressures that they have every day.
We also know that small numbers of people in Nova Scotia are responsible for a high proportion of health costs. We know that 5 per cent of the population accounts for about two-thirds of in-patient hospital and physician costs. We know that 1 per cent of the population accounts for about a third of these costs. It’s very useful - not to mention cost effective - to understand and address what’s happening on the ground in more detail.
As my colleagues have mentioned, a lot of this does get back to prevention, especially with seniors. If we can keep them moving, if we can keep them healthier longer, if we can provide a stimulating and supportive social environment, then you find a lot of the physical problems that they experience are mitigated. If we have a healthier older population, then they are less likely to go to emergency departments - especially if they don’t have primary health care.
It all is interlocking. If we take our eye off the wider, more indirect aspect of health and well-being, then again, we are going to end up sooner or later with more people coming into emergency departments.
ROBERT STRANG: If you don’t mind, I can build on that, just very quickly give a handful of very concrete examples where we could make a difference.
Certainly, everybody is aware we have a healthier population over time, but there are some areas where it would have an immediate impact, that we do continue to work at. One is vaccination. We had a flu vaccination program where yet again we have less than 40 per cent of the population choosing to get a flu vaccine. If we doubled that, there would be a reduction in people going to the emergency department. With vaccination, that comes down to people we publicly funded, we have big awareness around it working with pharmacies, but we need more people to get vaccinated.
There’s our work on road safety. A major driver of utilization of emergency departments is trauma, injury, motor vehicle crashes, other types of motorized recreational vehicles, which are often tied with alcohol use. They have a significant impact. We have worked in the past - and this is a great example of how we need to work collaboratively with the Department of Justice, with folks in the Department of Public Works, et cetera. How do we have a greater impact on reducing the impact from motor vehicle crashes? Alcohol and other substance use are major drivers of emergency room uses, so how do we work collaboratively in those areas to reduce the impacts of that, a safer use of legal and illegal substances?
Those would have very immediate impacts. Not to diminish the things around healthy eating and activity, which tend to have longer - the time span for impacts on hospitalizations and emergency departments is longer. There are some areas that are within the scope of the work of Public Health that with greater emphasis and attention could have direct and immediate impacts on emergency department utilization.
SUSAN LEBLANC: I really appreciate the reminder of the immediate things that we can be doing, too, and maybe post-meeting, I have a couple of other questions about alcohol use for you.
Speaking of vaccines, our uptake on the flu vaccine was quite low, and we heard you talk about this in the news and in public forums. Certainly, children’s vaccines have been very low. I’m wondering: We have in-school vaccination programs for, as you said, the Grade 7 vaccination program. Is there a new look at offering COVID-19 or a flu vaccine in the schools for children of a certain age?
ROBERT STRANG: We’ve looked at that and, really, we have a well-established route of access to both those vaccines. To actually have specific clinics in schools for those school-aged children would require a significant redeployment of Public Health and other resources to create those clinics when we already have well-established routes of access. Access is not the issue, money is not the issue - they’re publicly funded. We need to work with communities to raise awareness.
Where we have invested, and will continue to do in Public Health, is using our mobile vans and others. So we have with the COVID-19 vaccine - and we’re offering flu vaccine - gone into African Nova Scotian communities, and partnerships with our First Nations communities, to our homeless shelters, to disability workshops, et cetera. People who need more supports to actually get access to vaccines, we continue to support them. For the general public, I would argue that we have lots of already existing points of access. We need to work with communities to raise the awareness and the uptake of those opportunities.
SUSAN LEBLANC: I have to very respectfully disagree. I understand about the points of access, but in fact, I think that if we’re talking about a 40 per cent vaccination rate, then there’s obviously something not communicating. I honestly don’t think - as a person who works, and my partner works, I’ve got two kids. I tried to book them a COVID-19 booster the other day. I’ve said this before. Literally, I’ve tried four times. One time, we actually showed up at a public clinic, and then they were told they couldn’t get vaccinated because they’d just had their flu vaccine, which was not on the website, that information. Yesterday I looked to try to book them one, and the closest with - the soonest vaccine I can get is on February 11th in my community. I am telling you I do have a car, but I do not have time to drive my kids across the bridge in the middle of their school day to go to Tantallon or to Spryfield to get a vaccine for them. I could actually take the time to do that, but I am telling you, there are many, many people who can’t do that, and anyone who has a 9-to-5 job cannot get their kids out of school to get them a vaccine at 11:00. It may seem like there are lots of points of access, but in reality, there are not, and I speak as someone with plenty of access and plenty of ability to take a couple of hours off. I just really beg you to look at that again. Yes, thank you. That’s all I’m going to say about that.
Speaking of other kids, I want to say we have seen coverage lately of newborn babies who don’t have access to family doctors, and we’ve seen the positive effect of the mobile units, and I think the mobile units are really amazing, but it seems like the lack of access for newborn babies to family doctors is concerning. I’m wondering what the impact to general population health is of having no access to neonatal supports, and I’m wondering if there is a link, or you can explain the link, between the lack of access to early public health care and what we’re seeing in the IWK Health Centre and children’s ERs. Anyone.
MARCIA DESANTIS: As you have all discussed here this morning, we do have a lot of people without a family care provider. We know that our population has increased. We know that the rate for babies who don’t have access to family care has increased as well. We are working quite closely right now with the IWK and with primary health care. Predominantly, the infant immunization series is provided by family care providers. That’s the common route to get your primary series for immunization.
Public Health, even pre-pandemic, supported the provision of infant immunizations for those babies who didn’t have a primary care provider. We did that work collaboratively with primary health care through a couple of clinics here in HRM. We are back at the table with primary health care currently and the IWK, discussing how we can increase our supports to provide primary infant immunization for those babies who don’t have a primary care provider.
I think from the perspective of the mobile units - maybe I’ll speak for a minute on that. Early in the pandemic, we had an opportunity that was quite innovative, I would say, to look at alternate ways to provide service to those who wouldn’t otherwise have access at that time to COVID-19 immunization services. Predominantly, that was around access to COVID-19 testing. We did very rapidly stand up a fleet of our mobile units and resource them to go out to areas where there was limited access to testing, and also to support communities or institutions that had outbreaks, when they weren’t able to do the testing themselves.
We continue to provide that service with our mobile units in Public Health. We are looking to the future for what our vision will be for the use of the mobile units going forward. In the interim, we have loaned two of our mobile units to primary health care and are working quite closely with them. It was no small feat to build out a service delivery model that was mobile. It was very new to us, so we had a lot of lessons learned that we’re sharing with primary health care to support that work.
SUSAN LEBLANC: You did mention earlier that many of the public health programs that had been paused during the pandemic are back up and running. Can you be really clear and brief, if possible, about what services still remain on hold?
MARCIA DESANTIS: Early in the pandemic, we did suspend a number of our lower-priority programs and services - although equally as important - because most of our staff was mobilized into our COVID-19 response. Since then, we’ve established interim staffing to hold our COVID-19 work, so we’ve reassigned our core Public Health staff back to their programs and services.
Throughout the pandemic, we did not disrupt our immunization services for infants and children. That was something that was maintained as a priority under our plan. I would say we were in some ways quite unique in our ability to maintain that service level, in terms of that across Canada. Our earlier services - normally with postnatal, we do assessments and screenings of moms who give birth to understand some of the social factors or other factors that may influence the health and well-being of their infant.
We moved those to a high priority. We screened and triaged the highest-risk ones and maintained some level of contact with those. Those services have been restored now, so we’re actively back in our delivery hospitals doing that screening and working with those clients.
SUSAN LEBLANC: Just to clarify, it’s all back and running? There is nothing to do with Early Years or neonatal or any of that stuff with children that is still on pause?
MARCIA DESANTIS: Yes, we are back to our full suite of services. We are phasing it back in - meaning some of our facilities that we work with, we’re negotiating with them to get back in. We’re ready now to step back into that work.
SUSAN LEBLANC: Can you tell us when you anticipate that everything will be actually up and running, and you’ll be back in those places?
[11:00 a.m.]
MARCIA DESANTIS: We are actively in that work now. I would say 80 per cent of the population has our full attention. In terms of Early Years, I would say within the next one to two months.
SUSAN LEBLANC: Can someone tell me how many Public Health nurse vacancies there are, and are there other job vacancies in Public Health right now?
MARCIA DESANTIS: I can’t tell you explicitly how many nurse vacancies we have. Our vacancy rate is at about 12 per cent across Public Health total. That number is pulled from our posting data. There may be domino postings, which means it actually may be higher than it actually is. Approximately 40 per cent of our complement in Public Health is made up of nurses.
SUSAN LEBLANC: I’m wondering, Mr. Chair, if the committee could ask to get that exact data delivered to us after the meeting or within a week or so.
THE CHAIR: I can certainly bring that up during committee business.
SUSAN LEBLANC: Okay, thanks. Sorry. Do you want to go? (Laughter)
THE CHAIR: MLA Burrill, two and a half minutes.
GARY BURRILL: Perhaps we won’t have enough time to explore this adequately, but one aspect of public health that is important, and I think this current moment where we have this convergence of continuing COVID-19, the cost of living crisis, the ER situation, brings it to the fore. That’s the matter of paid sick days as a way of containing transmissible sickness. I would like to ask all of our guests today who would be interested in commenting on this what comments you might have about the importance of people staying home when they’re sick, and the importance of a paid sick day program that makes it financially possible for all working people to be able to do that.
ROBERT STRANG: There’s no doubt. I don’t know how many times I’ve said “Stay home if you’re sick” in the last two and a half years. I’ve also recognized that for many people, there are a lot of barriers around that: family barriers, work barriers. Certainly, the concept of how we make sure that people aren’t unduly penalized financially by staying home and not going to work is an important issue. Certainly, the policy levers, if you will, on that are not within the responsibility of Public Health. It certainly is an issue that we need to look at around - I wouldn’t just say financial, but what are all the multiple barriers that when people are sick, they actually feel they need to go and continue to work.
GARY BURRILL: Well, Mr. Chair, with just a few seconds left, perhaps we could return to this question and provide people from the department, if they wanted to elaborate on what Dr. Strang has said, an opportunity to do that, and then we could return to our guests from Dalhousie University to comment on this when it comes back to our opportunity.
THE CHAIR: Turning our attention to the PC caucus, we will begin with MLA Barkhouse.
DANIELLE BARKHOUSE: Ms. DeSantis, Public Health has played a key, important role during COVID-19, and you brought up the mobile units. You even made it to Little Tancook and Big Tancook, so thank you. You’re making it to the islands. Can you speak to other ways that Public Health works across the province that we and our constituents may not be familiar with? For example, I was one of the very first Healthy Beginnings: Enhanced Home Visiting Initiative nurses back when the Province first started the program. Is there anything that maybe we don’t know of?
MARCIA DESANTIS: I’ll start by saying our services are quite broad in terms of the scope about the work that we do. We’ve talked a lot about, and we all know a lot about COVID-19, and our case, and contact, and outbreak management where it comes to COVID-19, and we do similar work with all of the other notifiable diseases that are reportable to us. In addition to that, and it’s been touched on briefly, we do provide harm reduction supports and services to some of our needle exchange community organization partners. We also, of course, provide immunization services that are broadly done throughout our school-based immunization program and provide those supports to babies who don’t have care providers.
In terms of our other supports and services, in Early Years, for example, we do work with new parents to do screening and assessment, provide referrals to parenting resources and supports. We provide breastfeeding supports, as another example. In our Healthy Communities work, which I think is one of the areas of focus that maybe is least well known - it’s what we were talking about here today. It’s that primordial prevention work, really, in terms of trying to identify those social determinants or structural determinants of health and work to influence change so that people have an environment in which they can make healthy decisions. We do that work around injury prevention, food security, homelessness, and housing.
Those are all broad pieces of work that we do, and of course the driver of all of that is really understanding the health needs of our population. We do that through gathering evidence and surveillance to look for areas in which there may be barriers to services and care and supports that may be physical but are often more discrete than that. By that I mean when we look at some of the root causes of poor health, it’s how we identify what those are and bring in supports and services to those groups using an equity-based lens.
DANIELLE BARKHOUSE: Ms. Trott, how do other areas of government, including other partnerships and stakeholders, support Public Health’s overall goal?
KATHLEEN TROTT: A lot of the work of Public Health is done in partnership across government departments. As we think about looking at the social determinants of health, there are many other departments that have programs that actually contribute to that as well.
Specifically for Public Health, we work with the Department of Environment and Climate Change, because they coordinate the assessment response to reported or suspected health hazards in many settings. So there, our inspection arm actually is part of the Department of Environment and Climate Change.
We know the work of the Department of Communities, Culture, Tourism and Heritage, for example, has a large focus on not only sport and recreation and physical activity - but also arts and culture and community development kind of overall play an important role in social determinants.
More specifically, the Department of Labour, Skills and Immigration is working toward safer workplaces for Nova Scotians. The Department of Education and Early Childhood Development is working toward that $10-per-day daycare, which is an important piece. The Department of Municipal Affairs and Housing is working to ensure that Nova Scotians have access to safe housing. We’re working with the Department of Community Services on childhood poverty - working very closely on some solutions there. Even the Office of L’nu Affairs, as it supports the social and economic well-being of communities, and the Department of Seniors and Long-term Care around aging populations.
As we think about some planning ahead around Solution Six in the Action for Health plan that’s focused on broad health and well-being for citizens of Nova Scotia, these are the folks we’ll be bringing to the table to be convened to hear about what they can be actioning. As well, we work together to try to create a healthy Nova Scotia for citizens.
DANIELLE BARKHOUSE: Dr. Strang, how does Public Health identify and respond to diseases or viruses?
ROBERT STRANG: There is an international kind of network where any emerging disease would be identified. I’ll use the example of COVID-19. We first became aware of something unusual happening with a respiratory illness in Wuhan, China at the end of December 2019. Our lead on that is the Public Health Agency of Canada, but I know my medical officers and I - there are listservs and other things (Inaudible) that we all get this kind of intelligence gathering about an emerging disease.
In Canada, Public Health is the one part of the health care system which actually has an organized structure to facilitate collaboration between provinces, territories, and the federal government - the Council of Chief Medical Officers of Health, as well as the Pan-Canadian Public Health Network. So, we have regular mechanisms that information about an emerging disease - whether it’s an infectious disease or something else - is shared.
Once that’s on our horizon - I think COVID-19 is a good example - we then start to communicate to our health system partners, including primary care physicians, primary care pharmacists, et cetera, around this emerging disease, what they should be looking for, if necessary, what laboratory tests should be done, all those kinds of things. That could happen not just with an emerging disease. If we have a reoccurrence of measles in another part of the world, that may increase the risk of it appearing here in Nova Scotia. We’ll do that communication for the health care system.
Ultimately, there are requirements for notifiable diseases to be reported by people in the health care system and, if necessary, we would add a new disease to that list of notifiable diseases to require its reporting. We have done that for COVID-19, so that’s kind of how the system works.
Global intelligence - we get early alerts, and then we work appropriately across the health system to make sure health care providers are aware, whether it’s a re-emerging disease or just a reoccurrence that might have a greater chance of appearing here in Nova Scotia, or a true, newly emerging disease like COVID-19.
DANIELLE BARKHOUSE: That made me think of a few more questions, but there are four of us, so I’m going to share the time. I’ll pass off to MLA Palmer.
THE CHAIR: MLA Palmer.
CHRIS PALMER: Welcome everybody - good morning. This has been a fascinating conversation so far. I’m sure, like myself, people watching this today are learning an awful lot about the work that you do.
I’m going to just direct a couple questions around the funding that’s been happening. Before we do that, I just wanted to confirm a couple of things I’ve heard.
Dr. Kirk, in your opening comments, you made a comment that with proper funding for Public Health, we could see a return of investment of about 14-to-1 for outcomes with a well-funded Public Health. Dr. Fierlbeck, you had mentioned in your opening statement that pre-COVID-19, Nova Scotia was drastically behind other provinces in its Public Health funding. Dr. Strang, in your opening comments, you made the point of saying that we’re in Year 2 of what you call public health renewal 2.0.
Just wanting to confirm some of those comments, my question is in regard to funding. We’ve seen an increase in investment to Public Health in the last year, approximately $12 million. I was wondering if Ms. DeSantis or Ms. Heatley - or anyone on the panel - could speak to how those investments have been made, and how they’re affecting communities. Maybe in rural communities, like the one I represent.
THE CHAIR: Ms. Heatley.
JENNIFER HEATLEY: That new investment has been across a number of areas. Dr. Strang spoke to the core functions of Public Health, and what we’re really focused on with that investment was really making sure we had what we needed across those core functions. I think Ms. DeSantis will speak to exactly what was done in the Nova Scotia Health Authority.
Within the Department of Health and Wellness, that additional investment went to increasing our complement of medical officers of health. Those are Public Health specialist physicians who are placed across the province. They are in all zones and would be reporting in to Dr. Strang’s office.
The additional investment also went toward hiring more epidemiologists within the Department of Health and Wellness. It was spoken to earlier about the importance of good data and our ongoing surveillance to understand what’s happening in our communities, and that is exactly what those folks are doing. They’re monitoring the health of the population. They are the folks behind all of the COVID-19 reporting that you see every week and all of the data that we’re producing on our website, as well as working closely with the epidemiologists at the Nova Scotia Health Authority.
[11:15 a.m.]
The other area I’ll touch on around that investment is that there’s new resourcing to establish a public health emergency preparedness program within the Department of Health and Wellness. That is new for us. We obviously have worked closely for many years with our emergency preparedness colleagues, and now with this new investment we will have staff who are fully dedicated to public health emergency preparedness specifically - working closely, of course, with our colleagues at the Nova Scotia Health Authority and the Office of Emergency Management and the Department of Environment and Climate Change.
I’ll pass it over to you, Marcia.
MARCIA DESANTIS: With our enhanced capacity funding, in Year 1 - which was the fiscal year ending 2022 - we predominantly focused on increasing our complement around our health protection work. We had implemented our Panorama surveillance system and realized that we didn’t have the capacity we needed to fully implement and use that system in its intended manner. Our first-year enhancements were predominantly in the area of health protection: adding Public Health nurses, Public Health investigators. We also built a training and quality assurance team, which helps us bring consistency in quality to our work.
In addition to that, we also added epidemiologists to our complement and some additional communications support, and also some pharmacy practice assistants. The volume of vaccine that we’re distributing each year has drastically increased, so we increased the number of staff for that.
This fiscal year we have focused more around our Early Years core program staff. We’ve added additional community home visitors. These are staff who go out and work with new parents and families who require some additional supports. We’re working with Tajikeimɨk right now to actually increase enhanced home visiting in our First Nations communities. We’ve also hired a few additional Early Years Public Health nurses and we do have a planned expansion of our youth health centres that we’re getting ready to fill.
CHRIS PALMER: Ms. Trott, you had talked about some of the collaboration and work with other departments and the work that Public Health does. My question specifically, this time, is about the work between the Nova Scotia Health Authority and the Department of Health and Wellness and how it all works together with Public Health to come up with the decisions regarding Public Health funding. Can you talk a little bit more about how that works?
KATHLEEN TROTT: I’ll start, and then maybe Jennifer Heatley could jump in here as well. We do a lot of planning together. We work so closely with our partners. Really, it’s about understanding where the needs are and then working together on assessing what the possibilities could be and developing business cases and bringing those forward for review and for budget consideration. I think it’s really important that we’re focusing on what those shared goals are and what the highest priorities are and coming together.
We really do work quite closely together on that. Our folks at NSHA are on the ground and seeing people every day, so we certainly take what they’re seeing and hearing out there as really important as we think about what new programs could be and how we would proceed with funding.
THE CHAIR: Ms. Heatley, did you have anything you wished to add?
JENNIFER HEATLEY: Building on what ADM Trott said, we work extremely closely with the Nova Scotia Health Authority to identify priorities and move things forward, as ADM Trott noted. Especially coming out of COVID-19, we are in a bit of a rebuild mode right now, and we’ve established a new governance system. We have a Public Health steering committee, which includes many of the folks here at this table, as well as subcommittees focused on the core functions of Public Health so that we ensure that our Department of Health and Wellness staff, as well as our Nova Scotia Health Authority staff, are in ongoing communication and planning together.
We are two sides of the same coin, so we’re ensuring that we are setting priorities together and working together effectively as a system.
CHRIS PALMER: I appreciate your answers, and thanks for being here. I’ll pass it over to my colleague MLA Sheehy-Richard.
THE CHAIR: MLA Sheehy-Richard with three minutes, 38 seconds.
MELISSA SHEEHY-RICHARD: I wanted to jump right in and pick up on some things that we talked about earlier in relation to the Public Health mobile units. Ms. DeSantis, this is probably to you, and more in particular to how they were utilized during COVID-19 and in fact they’re still being utilized for both testing and vaccines. You alluded to something about what they might be doing in the future. Can you go into a little more detail about that for me?
MARCIA DESANTIS: The work of the mobile units right now stays focused closely around our access to COVID-19 testing as it continues. I would say this is one of the areas where we are finding ourselves more in rural areas throughout the province, and that’s really based on accessibility. We do a lot of mapping to determine whether or not certain communities have access to testing. The work of the mobile units currently is still primarily focused around COVID-19 testing. We are expanding our work with our mobile units to include immunization, both for COVID-19 immunization and in some areas where there might be less access to flu vaccine, provision of flu vaccine. I did mention earlier we are working closely with primary health care right now to support their pop-ups, their mobile clinics that they’re running.
In terms of vision going forward, we are expected to maintain our current service provision for COVID-19, and we are actively involved with research and innovation, doing evaluation of our mobile unit outreach work which will help us understand what worked well and what maybe could use some tweaks moving forward. I think the long-term vision for Public Health is: How could we bring supports or services to communities that may be underserviced that fit within the scope of Public Health? I would say we’re still learning; we’re still actively providing the services that we’re expected to provide with those, but we are looking now toward the future of the mobile units.
MELISSA SHEEHY-RICHARD: I’m in a rural constituency and I know that my office gets notified. You’re in good communication with me, so we try to share it on our pages - anything, even if there’s one within travelling distance, but for the general public, if they are - are you sharing information about how to find these with schools, or is it primarily website-related? How does that word get out?
MARCIA DESANTIS: The mobile units are - the information around where they’re going, dates, times, locations is all posted on our website and shared broadly. We do work closely with some of our municipal partners, as well, and with our libraries. They have been another great partner in this work with us. We share that information quite broadly through social media, predominantly.
MELISSA SHEEHY-RICHARD: Thank you for your answers. We’ll move on to the next round of questioning, Mr. Chair.
THE CHAIR: The second round of questioning: Looking at the time, we should have about five minutes per caucus which will take us to about 11:38 a.m., a couple of minutes for wrapping up and closing remarks, and then on to committee business. Five minutes for the Liberal caucus starting now.
BRENDAN MAGUIRE: First of all, thank you all for being here today. I will say that in regard to access to vaccines, I think a big part of it - and we’ve got a lot of smart people around the table here - is I think there’s a bit of vaccine fatigue, maybe, in the general public. I know that’s something that you’re fighting desperately to overcome.
I want to thank you for, quite frankly, giving us the best - literally the best - COVID-19 response in the country. I know that a lot of you were recognized, and some of you weren’t, but you did a hell of a job, so thank you for everything you did and know that you are appreciated.
The one thing that I will say is that we know that - and I just quickly wanted - we know the high-dose flu vaccine for seniors is available in seniors’ homes, and NACI does recommend that it be available for all seniors over the age of 75. I’d just like to know, does Public Health agree with this recommendation, and will this recommendation be fulfilled?
The reason I want to bring this up is because listening here today, I’ve heard a lot of encouraging things about cooperation, but more so about being proactive. Dr. Strang and a few of you touched on 10 minutes of exercise a day and eating healthy and limiting the amount of alcohol you consume. We’re seeing all this in the media now and we’re hearing about it, and it’s something that really could help take the stress off our health care system. Preventive instead of reactive health care, I think, is one of the ways and one of the things we need to be concentrating on.
When it comes to something like the high-dose flu vaccine, this is a potentially proactive measure for seniors. Is it something that Public Health agrees with, and is it something that we will see in the near future?
ROBERT STRANG: As I said earlier, we certainly have put proposals forward in the budget process. Governments have to make lots of decisions around priorities, so it’s there, and we’re anticipating some kind of decision on that. That’s out of our control at this point.
BRENDAN MAGUIRE: I hope that the government does see the importance of that. An incredible job was done during COVID-19, rolling out the information and getting access to vaccines and really getting into those communities - and in some cases keeping that infrastructure in place, especially in communities where there may be a natural distrust of government and Public Health. I applaud you all for that. I think the general public hasn’t seen that kind of work that’s happened.
We know that there is vaccine fatigue. Right now, what is the uptake in the number of flu shots this year, and it is higher or lower than in past years? Do you correlate that with vaccine fatigue from the last few years? What can we do as leaders to improve that?
ROBERT STRANG: Just looking at the data, up to as of January 10th, our overall population coverage for flu vaccine was almost 35 per cent, basically within what we typically see, 35 to 40 per cent. If I’m recollecting correctly, we had 60 to 70 per cent for community-living seniors over 65, and we had over 90 per cent coverage for those in long-term care facilities.
What we see this year is exactly what we’ve typically seen: very low uptake in flu vaccine in young children, and the other concerning group is pregnant women, where there’s a lot of room for improvement.
We continue to work in our partnership with both family physicians and pharmacists. I think pharmacists, we’ve been doing that for about 10 years now, and that’s been very successful in terms of promotion of flu vaccine, substantially increasing the opportunities through pharmacists - seven days a week, evenings, all those things. Across the country, for people in my position, nobody has a really good answer to how we actually make people pay more attention to influenza vaccination.
Your question was, what can we all do? If I can be bold enough to say, all of us in this room are in leadership positions. First of all, as an example, are we all getting a flu vaccination? Are we making people aware that we are getting a flu vaccine? I think we also have to promote that vaccination is not just for ourselves, but it’s for our communities, and really push that message about how we care for each other by getting vaccinated.
THE CHAIR: Order. We’ll move to the NDP caucus.
GARY BURRILL: I would like to ask Dr. Kirk and Dr. Fierlbeck - and then after that, if other members of the department would like to add to what Dr. Strang has said - to comment on the importance of paid sick days so that working people can afford to do this important thing of staying home when you’re sick, as a means of supporting the health of the public.
SARA KIRK: I’ll give it a go. I think that’s part of the social safety net that we need to be thinking about and how that interferes and interacts with our health system. I personally think it’s something that we absolutely should do. I think it’s along the lines of again, anything that’s to reduce poverty. All of those things are social and structural determinants of health and things that we should be investing in. We know that that will actually support people and also prevent the spread of infection. Obviously that’s what we saw with the COVID-19 pandemic - infection spread by people going to work when they’re sick.
[11:30 a.m.]
I think it’s certainly something we should be doing in terms of addressing the upstream causes of the causes that we’re dealing with.
KATHERINE FIERLBECK: The policy framework surrounding paid sick days is a bit complicated because it does encompass both private and public sectors and it’s, again, very specific to the kind of work being done. Because this is 2023, for example, my teaching now includes a virtual link so that all those who feel contagious have the option of joining virtually.
Of course, most kinds of employment don’t have that option, so the optimal level of support for those who really need it has to be addressed more precisely. We really have to be focusing on those who are the most vulnerable and who are working the low-income jobs and don’t have a choice of joining virtually.
GARY BURRILL: Dr. Fierlbeck, in your introductory comments, you were making a number of comparisons to where we stand on Public Health funding in Nova Scotia - per capita spending and percentage-wise. In the comparisons you were making, our situation didn’t seem altogether stellar.
Could you characterize a little more maybe precisely, where are we in the pack of the 10 provinces? Also, could you perhaps speak to - and maybe Dr. Kirk could speak to this as well - what might be some of the things that we would look to do if we were in a stronger funding position in Public Health, that we’re not doing now?
KATHERINE FIERLBECK: I haven’t looked at all the provinces in great detail, but I would say we’re close to the bottom, if not at the very bottom. It’s not simply about the amount of funds that we’re getting - it’s also the way that the funds are allocated.
Comparatively speaking, next to Nova Scotia - which I’m pretty sure is probably dead last when it comes to Public Health funding - Quebec spends the least on Public Health, and that’s because it implemented a 30 per cent reduction in Public Health spending a few years ago. This was premised on the idea that you could centralize many functions of Public Health and save money that way. Many provinces have centralized their health governance, but is centralization too pat a solution?
Public Health has a number of functions, and the problem is that one size does not fit all. The pandemic certainly showed the utility of a top-down, structurally tight model of operation, but zoonotic protection and disaster management is not the only function of Public Health. As we know, the non-medical determinants of health also play a major role, so it’s also critical to understand what’s happening from the ground up.
Centralizing everything at the top, which may have worked fine during COVID-19, means that we’re going to have to start thinking about what’s happening at the ground level. Again, a key function of Public Health is to act as the eyes and the ears of the health of the population. We have to be careful not to think about saving costs by centralizing too many functions at the highest level of government.
THE CHAIR: Dr. Kirk, there’s only 20 seconds left, if you’d like to . . .
SARA KIRK: I actually want to go back to the point that MLA Palmer raised, querying the 14-to-1 ratio return on investment. That return on investment is actually higher when you start thinking about things that government can do. Legislation, for example, increases that return on investment.
THE CHAIR: Order. Apologies, Dr. Kirk. I don’t mean to be rude.
We’ll move to the PC caucus. MLA White.
JOHN WHITE: Ms. DeSantis, earlier you spoke a little bit about the school-based immunization program. I wonder if you can take a few minutes to tell us about the benefits of that program to rural communities.
MARCIA DESANTIS: The school-based immunization program is offered in Grade 7. It’s one of our universal programs, meaning it’s offered in every Grade 7 school across the province. There are four vaccines that are offered. It is given in two time periods, so there’s a Fall piece of that work and then a Spring piece of that work. The benefits of having a school-based immunization program that’s fully accessible or universal, so to speak, is that we can provide that service to everyone in the province who wants to partake in it.
During COVID-19, in the very first wave - in the Spring of 2020 - we did defer that because schools were closed, so there was no audience in which to give vaccines. We did run a Summer catch-up clinic to get those students back on track with their immunizations, and we were able to preserve that school immunization program throughout the rest of the pandemic.
JOHN WHITE: My next question is for you as well, Ms. DeSantis. I know it seems kind of obvious, but your work is extremely broad, as you’ve explained today. Can you tell us what effects COVID-19 has had on the work of Public Health, and the impacts you see going forward?
MARCIA DESANTIS: In the earlier days of the pandemic, all of our complement, all of our staff were redeployed and reassigned to focus on the COVID-19 pandemic. In fact, we worked across the health system, and even through government we had staff come and support some of the work we did throughout the pandemic.
Throughout the pandemic now, we’ve established interim teams with the COVID-19 funding that we’re receiving to hold that work, which has allowed us to reassign our staff back to their core programs and services. That means we’ve stepped back into those areas that were deferred during COVID-19 and restarted those programs and services.
I would say that it was not an easy time for our staff. It was very demanding; it was an ever-evolving situation. We worked very closely in the Nova Scotia Health Authority with many of our partners to redesign pathways to care and models of service delivery. Our other programs and services that were deferred, we are now actively recovering our staff and restarting those programs.
JOHN WHITE: I have a question here for you again, Ms. DeSantis. I’m wondering if you can expand a little bit further on what the Early Years and Healthy Communities investments consist of?
MARCIA DESANTIS: Maybe because we’re short on time, I’ll focus on one particular area. With the Early Years, I think we’ve talked a fair bit about it, but with our Healthy Communities investment, we’re looking to expand our youth health centre services and supports.
Part of our enhanced capacity funding includes additional resources to move into more youth health centres across the province. That work is done under a health promoting schools approach, so it addresses a lot of the issues we’ve talked about today in terms of injury, physical activity, and access to healthy, safe, affordable food in our school programs. That investment will actually grow that program to areas of the province which haven’t previously had that service.
THE CHAIR: MLA White, 37 seconds.
JOHN WHITE: I won’t have a question for you. I do want to express my gratitude for the panel coming in today. If anything, you’ve broadened our knowledge on the broad work that you cover. When you think of health care, you think of, I’m sick, I’m going to the hospital, but what you folks are doing is absolutely amazing. I don’t know how you keep your head around it, to be honest with you, so thank you very much for doing what you do.
THE CHAIR: At this point in time, the question and answer period is over. I will offer the floor for any of our panelists and witnesses who have closing remarks.
ROBERT STRANG: Thank you very much for the opportunity, and thank you to my colleagues from Dalhousie for joining us. Maybe I’ll just build on MLA White’s comments. We like to say that we need to talk about health in all its broad dimensions - physical, mental, emotional, spiritual health - and all the factors that ultimately contribute to health, not just about health care. I think that’s the key point we’d like to leave you with. Investing in Public Health so we have the appropriate resources and capacity to fulfil our role, as well as investing in a broad range of initiatives - some of which have been touched on today - that are outside the health care system and that impact the health of the public, are fundamentally necessary to create a sustainable, publicly funded health care system.
We need to turn down the demand tap, and Public Health needs to be positioned and resourced to be a leader in those conversations: broad, multi-sectoral, multi-departmental conversations about decreasing the demand for health care. We fundamentally need both parts: transforming the health care system and investing in health.
We will be investing in Year 3 and in fiscal year 2023-24 of an investment in Public Health, and I see that the way moving forward from there is Solution Six of Action for Health that gives the opportunity for Public Health to work with other departments. I would argue every government department has a role in some way, shape, or form in improving or impacting the health of the public. That cross-departmental, cross-sectoral work that we will be engaging in under Solution Six will identify specific areas for action and investment, both in terms of Public Health capacity and more broadly, in terms of initiatives that will improve the health of the public.
I will end by just saying - I gave a few examples of this - the impacts of this aren’t all long-term. They can be short-term as well. One example that I didn’t give earlier was we know that when we made indoor places smoke-free, the research very quickly showed that doing that significantly decreased the rate of heart attacks, the number of people with heart attacks who were appearing in emergency rooms. That is one example of a health promotion approach which actually can have fairly immediate impacts on health care utilization. It is both short-term and long-term, these investments. Thank you for the opportunity today.
THE CHAIR: If anyone else has any brief closing remarks, in the interest of time, we’d like to keep them brief, please and thank you. We’ll go to Dr. Fierlbeck first and then Dr. Kirk.
KATHERINE FIERLBECK: Public Health funding historically is linked fairly directly to crises. From the 2003 SARS pandemic to Walkerton to H1N1, funding is often channelled to Public Health when people are scared. When the crisis is gone, there is a paradox in Public Health funding, which is that the better that Public Health functions in getting things working well, the more likely they are to lose the funding to more immediate health care issues, largely because of political pressures.
Please don’t forget about Public Health, even when the crisis settles down. If you ignore what’s happening at the upstream end of things, you’re always going to be desperately trying to put out fires at the downstream end.
SARA KIRK: I will be brief. I just want to follow on from a point that my colleague Ms. DeSantis talked about, which was around health promoting schools. I leave you with a good news story, because we have been working in schools across the province with a focus actually on rural communities. Actually, MLA Maguire might even remember the funding that we received back in 2019 to do work to engage students and youth in promoting and enhancing their school environments. We are getting some great outcomes from that. I would love to talk to you about it in a different venue, but our youth have a huge role in actually addressing some of the issues that we’re facing in our health care system.
THE CHAIR: On behalf of the committee, thank you to all the witnesses for appearing today, and thank you for the good work that you do keeping Nova Scotians safe and healthy. You’re now free to go. I would suggest that we take a 60-second recess just to allow the witnesses to gather their belongings and head out.
[11:44 a.m. The committee recessed.]
[11:46 a.m. The committee reconvened.]
THE CHAIR: Order. I’ve reconvened this meeting of the Standing Committee on Health.
GARY BURRILL: I move that the hours of meeting be extended in order to accommodate dealing with the entire agenda, including the NDP motion under any other business.
THE CHAIR: There is a motion on the floor to extend the meeting. Any discussion on the motion?
CHRIS PALMER: I have to respectfully say that I would be opposed to that today. A lot of us on this side of the table are rural MLAs. I know, myself, I’ve been here for three days on different committees, and I have meetings in my constituency that I have to be back for, and I scheduled it to be on time for our meeting today. Being gone from my constituency for three days, I feel it’s important for me to be back for my meetings. I have to respectfully say that I will not be supporting that.
THE CHAIR: There is a motion on the floor. Any further discussion?
All those in favour? Contrary minded? Thank you.
The motion is defeated.
We’ll move to committee business. Item No. 1: the January 16th letter to the Chair from MLAs Leblanc and Burrill requesting additions to the January 19th meeting witness list. The results of the email poll did not lead to a unanimous decision. Is there any discussion on the correspondence? Hearing none, we’ll put a checkmark beside that.
Item No. 2: the January 17th email to the Chair from MLA Smith-McCrossin requesting an urgent meeting. Any discussion on that? Seeing no discussion on that correspondence, we will move on.
Next, the January 17th email to the Chair from the Liberal caucus stating MLA Maguire’s intent to make a motion at today’s meeting.
BRENDAN MAGUIRE: I’m just going to put the motion on the floor, Mr. Chair. Due to the ongoing issues Nova Scotia is facing with access to emergency care in this province, the Liberal caucus is making a motion to call an emergency meeting with the topic being access to emergency care.
We would call for the following witnesses: Karen Oldfield, CEO and President of the Nova Scotia Health Authority; Jeannine Lagassé, Deputy Minister of the Department of Health and Wellness; Dr. Kirk Magee, department head and NSHA Central Zone Chief, Charles V. Keating Emergency and Trauma Centre; and Dr. Andrew Lynk, Chief and Chair of Pediatrics at the IWK Health Centre.
We want this meeting to take place as soon as possible, and happen within seven days of the motion being passed.
THE CHAIR: Any discussion on the motion?
CHRIS PALMER: Respectfully, the idea behind an emergency meeting is very, very apparent - some of the things that have happened at different spots in Nova Scotia. We are in a crisis. We are in an emergency. To suggest that it’s just happening recently - news flash, we’ve been in an emergency health care crisis for a long time.
Some of us have recognized it and we’re acting on it. Just this week, yesterday, the Health and Wellness Minister and the CEO of NSHA had a press conference, and they spoke to a million Nova Scotians outlining the plan for emergency revitalization and what we’re going to do. The need to have them appear before this committee, I don’t believe - they’re just going to tell us the same thing. I guess I’d recommend to my friend opposite that it may be better use of the committee to have a topic selection for another agenda-setting meeting to put a topic out that would be an evaluation of the plan being put forward by the government, by the minister yesterday.
They’re meeting with constituents and people all over the province, very transparent, and they are addressing the urgency of it in communities from one end of the province to another. I would just say that it would be more use of the committee, and we might even bring it up as a topic to do an evaluation of the plan being put in place right now. I would say that this side of the table would be opposed to an emergency meeting.
THE CHAIR: Any further discussion on the motion? There has been a request for a recorded vote. I will ask the clerk to record the votes.
[The clerk calls the roll.]
[11:51 a.m.]
YEAS NAYS
Hon. Brendan Maguire Melissa Sheehy-Richard
Rafah DiCostanzo Chris Palmer
Gary Burrill John White
Susan Leblanc Danielle Barkhouse
Kent Smith
THE CLERK: For, 4. Against, 5.
THE CHAIR: The motion is defeated.
Moving on. I believe it’s MLA Leblanc.
SUSAN LEBLANC: I believe the clerk has circulated a motion that we would like to table right now. People across the province are concerned about their ability to access emergency care. This is a years-long crisis, as our colleague has just said, and it has seen renewed urgency since the tragic deaths of Allison Holthoff and Charlene Snow.
The Nova Scotia Government and General Employees Union represents staff at the Halifax Infirmary, many of whom are at their wits’ end. They came together and assembled a list of 59 straightforward suggestions to improve emergency care at the Halifax Infirmary. Some of the suggestions are as simple as replacing the pay phone in the waiting room with a free phone that people can use to call their family while they’re waiting for many hours - sometimes more than eight - or make sure that there’s food available at all hours. Others are also simple and would make a big difference in the recruitment crisis, like covering nurses’ parking and providing retention bonuses.
Unfortunately, the government has yet to respond to this very well-thought-out and very specific letter. My motion is this: I move that the committee write to the Department of Health and Wellness in support of the staff at the Halifax Infirmary and ask that the department please provide a written response as soon as possible.
Mr. Chair, this is a very simple motion. I believe it is our job as the Standing Committee on Health to respond to such pieces of writing and suggestions that come forward in the public. I ask the whole committee’s support of this motion. All we’re doing is asking the department to provide a written response.
THE CHAIR: MLA Maguire, is your discussion on this motion?
BRENDAN MAGUIRE: Turn on my microphone. Mr. Chair . . .
THE CHAIR: MLA Maguire, please don’t speak that way to me.
BRENDAN MAGUIRE: I asked you to turn my microphone on.
THE CHAIR: MLA Maguire.
BRENDAN MAGUIRE: I asked you to turn my microphone on so I could speak.
There are two motions that have been put forward at this committee. I didn’t get a chance to respond to the vote, even though my hand was up. What I will say is this: What was said yesterday in public by Karen Oldfield and this government was a plan that had no chance of recruitment. We are going to support . . .
THE CHAIR: Order.
BRENDAN MAGUIRE: We are going to support the NDP’s . . .
THE CHAIR: I’d like to keep the discussion on the motion that is on the floor.
BRENDAN MAGUIRE: You’re not giving me a chance to respond. You’re trying to . . .
THE CHAIR: If there is discussion on the motion that is on the floor - MLA White.
BRENDAN MAGUIRE:. . . ignore as Chair my hand being put up to have a discussion . . .
JOHN WHITE: Thank you, Chair.
BRENDAN MAGUIRE: Your job is not to ignore . . .
JOHN WHITE: To the NDP caucus, who are listening while this meeting is actually in order . . .
BRENDAN MAGUIRE: . . . listen to the members and allow the members . . .
THE CHAIR: Order, please.
BRENDAN MAGUIRE: You chose to - just wait. You chose to ignore my arm . . .
THE CHAIR: MLA White.
BRENDAN MAGUIRE: I have a right to speak in this committee. Just because you don’t want to hear what I have to say doesn’t mean you can ignore me.
THE CHAIR: MLA White.
BRENDAN MAGUIRE: Like you’re ignoring Nova Scotians on the health care . . .
JOHN WHITE: To the NDP caucus, we value the motion you put forward. What I have to say is that I am concerned who the letter was addressed to and that the Department of Health and Wellness was not just cc’d on the letter. I don’t know if you can clarify that today or not.
What I would say to you is that I would support a motion with an amendment, and it would read this: That the committee write to the Department of Health and Wellness and ask that the department please provide a written response to the letter sent by the NSGEU listing 59 suggestions to improve emergency care at the Halifax Infirmary as soon as possible.
To clarify, (Interruption) the difference is that it’s not “in support of”. Personally, I do not know what the 59 recommendations are. I value their opinion, absolutely - they’re frontline workers. We do, but we can’t support something we don’t know. If you folks would support that amendment, we would vote in favour of it.
THE CHAIR: Order. We will vote on the amendment proposed by MLA White.
All those in favour? Contrary minded? Thank you.
The amendment is carried.
We will now vote on the amended motion to write the letter.
All those in favour? Contrary minded? Thank you.
The motion is carried.
Any additional business? I will note that the next scheduled meeting for this Health Committee is Tuesday, February 14, 2023, from 1:00 p.m. to 3:00 p.m. with the topic being the delivery of the 4.1 hours of care per resident in long-term care. Witnesses shall be the Department of Seniors and Long-term Care, the Office of Healthcare Professionals Recruitment, the Nova Scotia Nurses’ Union, and CUPE Nova Scotia.
If there is no other business - MLA Maguire.
BRENDAN MAGUIRE: I want to go back to what just happened here. I had put a motion on the floor, and the motion was voted down by the Progressive Conservative government. I was not given an opportunity to respond. (Interruption) Just wait, you don’t have to listen. The Chair took it upon himself to ignore me as a member of this committee. I have a right to be on this committee. I have a right to speak, and I have a right to respond to a motion I put on the floor.
I just want to say that the way this committee is being run, allowing individuals to have a half-hour to speak, biting into the time that we have to ask questions, to not allow extensions every single time we’re in this committee. The government votes down extensions to allow us to continue to sit here and deal with committee business.
Now, an elected person on this committee, elected by the people in their community to be a voice and who has questions about a very important subject and topic, was completely ignored. The Chair did not even look in my direction and then said . . .
THE CHAIR: Order, please.
BRENDAN MAGUIRE: I’m not finished speaking. I have the right to speak.
THE CHAIR: I understand you have the right to speak. The criticisms that you’re offering are unfair, in my view. If you have criticism over the chairing, the appeal process is to write to the Speaker and appeal any decisions that are made in committee, so feel free to take that option.
BRENDAN MAGUIRE: I’d like to continue. You interrupted me . . .
THE CHAIR: MLA White.
JOHN WHITE: Thank you, Chair - a good Chair at that. Since we’re talking about management of this meeting, I would like to recommend that when somebody is recognized to speak and their microphone is on, that the rest of the committee members stop and let me speak. My microphone is on right now. Thank you very much.
The Chair has recognized me, and if we’re going to have a functioning group and a committee that’s working, mistakes happen. If the Chair has missed you, that’s a mistake. If that’s what happened, so be it. That does not give you the right to disrespect the Chair or myself, who’s also an elected official, to sit here and speak.
THE CHAIR: Order. Thank you, MLA White. I apologize to MLA Barkhouse. I offer you the floor.
DANIELLE BARKHOUSE: I’d like to make one statement. MLA Maguire, as you can tell from earlier, because I’m sitting here watching the whole thing, our Chair does not have to look you directly in the eyes. I was watching - MLA Leblanc raised her hand first. No Chair can read minds. We were not aware, I am sure, that she was going to put her motion forward. I think it’s just totally inappropriate to go on like this. It’s just political soundbites, and there’s absolutely no need for it.
THE CHAIR: Order. This meeting stands adjourned.
[The committee adjourned at 12:00 noon.]
