Health - Committee Room 1 (42609)
HANSARD
NOVA SCOTIA HOUSE OF ASSEMBLY
STANDING COMMITTEE
ON
HEALTH
Tuesday, May 14,
2024
COMMITTEE ROOM
Public-Private
Partnerships in Health Care
Printed
and Published by Nova Scotia Hansard Reporting Services
HEALTH COMMITTEE
John A. MacDonald
(Chair)
Danielle
Barkhouse (Vice Chair)
Chris
Palmer
John
White
Nolan
Young
Hon.
Kelly Regan
Rafah
DiCostanzo
Gary
Burrill
Susan
Leblanc
[Hon. Kelly Regan was
replaced by Braedon Clark.]
In Attendance:
Judy Kavanagh
Legislative Committee
Clerk
Gordon Hebb
Chief Legislative
Counsel
WITNESSES
Nova Scotia Health
Authority
Derek Spinney,
Vice-President of Corporate Services, Infrastructure, Chief Financial Officer
Department of
Health and Wellness
Kim Barro, Associate
Deputy Minister
Colin Stevenson,
Chief, System Integration
Nova Scotia Health
Coalition
Alexandra Rose,
Provincial Coordinator
Nova Scotia
Government and General Employees Union
Sandra Mullen,
President
Doctors Nova
Scotia
Dr. Colin Audain, President
Pharmacy
Association of Nova Scotia
Allison Bodnar, Chief
Executive Officer
HALIFAX, TUESDAY,
MAY 14, 2024
STANDING COMMITTEE
ON HEALTH
1:00 P.M.
CHAIR
John A. MacDonald
VICE CHAIR
Danielle Barkhouse
THE
CHAIR: Order. I call the meeting to order. This is the Standing Committee on
Health. I’m John A. MacDonald, the Chair and the MLA for Hants East.
Today we’ll hear from witnesses regarding Public-Private
Partnerships in Health Care.
Just
a reminder to put your phones on silent. I’ll now ask all the committee members
to introduce themselves for the record by stating their name and their
constituency, starting with MLA Clark.
[The
committee members introduced themselves.]
THE
CHAIR: For the purposes of Hansard, I’ll also recognize the presence of Chief
Legislative Counsel Gordon Hebb and Legislative Committee Clerk Judy Kavanagh.
I’d
like to welcome the witnesses. I’ll start by going from left to right, if you
could just introduce yourself. Then we’ll get into opening remarks.
[The
witnesses introduced themselves.]
THE
CHAIR: I’m going to allow opening remarks. Everybody, due to the number of
witnesses, realize to keep your remarks preferably two minutes or under.
I
guess we’ll start with Mr. Spinney. Do you have opening remarks?
DEREK
SPINNEY: Good afternoon. Thank you to the committee and everyone for having us
here today. It’s an important time as we all take care of health care here in
Nova Scotia.
Our
focus at the Nova Scotia Health Authority is always on providing top-quality,
safe patient care. To do that, there are almost 30,000 employees here at the
Nova Scotia Health Authority, and last year our budget would have been over $3
billion. We take that amount of stewardship extremely seriously and work every
day with our employees, who are very proud to do what they do, to provide
service to Nova Scotians. Their commitment to patient care, innovation, and
quality improvement means that we are always refining models of care, trying to
find new ways of doing things, being creative, and trying to find the best
solution for each and every person we see every day.
Neither our government nor our public would be satisfied if
we set our sights only on what we can achieve internally. This is one of the
reasons we have created the Nova Scotia Health
Innovation Hub, as just one example. It brings together partners from many
areas to create solutions for Nova Scotians. That’s why, where appropriate, we
will partner with the private sector to expand and enhance the care that Nova
Scotians need and deserve. Any such standards must meet our quality and care
standards, and that’s very important for us. That’s a non-starter, if you will.
That’s non-negotiable: the care and experience being at least equivalent to
what would be provided in a Nova Scotia Health Authority setting and at no cost
to our patients.
Private delivery is simply a means to improve the economy,
efficiency, or effectiveness of the services that we provide. The best-known
example of this would be the operating room capacity that we purchased and use
at the space next to Dartmouth General Hospital,
best known as Scotia Surgery Inc. The civic address
there would be 18 Acadia Street.
Through many years and three different governments, both
patients and surgeons have been very pleased with the quality and timeliness of
care that we have been able to provide through that venue. Most recently, the
Nova Scotia government has purchased and invested in the facility, enabling us
to make more use of those ORs for a wider range of procedures.
Our newest such partnership is with HealthView
Medical Imaging here in Halifax. Faced with long wait times for MRs, scans, and ultrasounds, we are pulling every
lever we can to expand access. We are adding new machines, replacing older
ones, and investing in technology that will, for the first time, allow us to
move MRI technology to areas of need. It only makes sense that we would
simultaneously take advantage of technology that already exists and is staffed
to provide more of the same service. Where we see additional opportunities to
augment the skills and resources of the Nova Scotia Health Authority to provide
better, more timely care to Nova Scotians, we will pursue them. I look forward
to your questions today.
THE CHAIR: Ms. Barro.
KIM BARRO: Thank you, Chair, and fellow committee members,
for the opportunity to discuss public-private partnerships in health care.
I want to begin by stating that in Nova Scotia, we believe
in our publicly funded health care system. We also believe Nova Scotians
deserve the best health care in the best facilities, improved access to care,
and the tools that will enable and support them to access care closer to home.
Our commitment to the public health care system is evident
in the investments we’ve made: investments in new and strengthened
collaborative family practice teams, primary care clinics, urgent treatment
centres, virtual care, mobile clinics, and community
pharmacy primary care clinics, just to name a few. We’ve invested in
physical infrastructure like new clinics, emergency departments, long-term care
facilities, a new medical school in Cape Breton, and critical health
infrastructure.
We are investing in innovating and modernizing health care
with digital solutions like One Person One Record, YourHealthNS
and eReferrals. We’re also investing in people. We are doing new and different
things to remain competitive in the current market to recruit, retain, and
incentivize health care professionals to work and live in Nova Scotia. As an
example, we recently announced 30 paramedics from Australia who are coming here
to work.
We are following our strategic plan, Action
for Health, to transform health care in our province, and it’s not a
journey we’re on alone. Managing our health care system is a constant balancing
act. We must ensure the system is flexible to meet the needs of our province as
other factors around it change - factors like an aging population and a growing
population. We’ve topped one million people and we’re still counting in this
province. Factors like high demand for skilled health care professionals - we
address these and other challenges in investing and working with community
groups, health care partners, and with the private sector.
As a province, we’ve maintained public-private partnerships
in health care for decades now. Publicly paid surgeons have used privately
owned operating rooms for low-risk day surgeries. More recently, more than 1.5
million COVID-19 vaccine doses were delivered through privately-owned
pharmacies in Nova Scotia. VirtualCareNS is
supported by Maple, a private virtual care provider.
Nova Scotia Health Authority has an agreement with them to deliver the service
to Nova Scotians for free.
These and other arrangements have allowed us to provide
patients health care faster, fairly, and equitably. We don’t enter into these
partnerships lightly. Any public-private partnership must add value to our
health care system and come at no extra cost to patients or the Province. There
is no queue-jumping or preferential treatment in our partnerships. Contracts
are negotiated to ensure we receive the best value for Nova Scotians, which
comes down to more than just a dollar figure.
We have pressures across the health care system that need
to be relieved sooner rather than later. Public-private partnerships add value,
allowing us to deliver more care, faster. As the health care landscape changes,
we will need to be even more adaptable to face the challenges and the
pressures. We will do that by continuing to invest in our publicly funded
health care system and seek opportunities to strengthen it with partnerships
that help deliver the care that Nova Scotians deserve. I look forward to taking
your questions.
THE CHAIR: Ms. Rose.
ALEXANDRA ROSE: I’m here and I’m happy to represent the
Nova Scotia Health Coalition. We’re an organization dedicated to protecting and
strengthening our public health care system to ensure that all Nova Scotians
have equitable access to the health care that they deserve.
Although we recognize the need for
innovation in this health care space in Nova Scotia, as we continue to face
unprecedented times of backlogs and wait-lists within our health care system,
the Nova Scotia Health Coalition is happy to be a part of this discussion. It
is imperative to recognize potential pitfalls and challenges inherent in
blending public and private interests within the health care landscape.
Justifications for choosing P3 delivery
often include: giving the greatest certainty for work to be done on
budget and on time; P3 delivery offers more government flexibility for
continuing with the rest of its capital plan for other projects such as schools
and roads; risks associated with large infrastructure, such as health care
redevelopment and maintenance, are transferred to private corporations; and P3
delivery offers the best value for money. All sorts of past P3 projects abroad,
in the rest of Canada, and here in Nova Scotia have proven that these
justifications are often untrue and inflated in favour of P3 delivery. The
critical analysis of these justifications has led to P3 delivery being proven
to be more expensive, less accountable, and a riskier option than more
traditional models.
Thank
you for inviting me here today and I look forward to participating in this
conversation.
THE
CHAIR: Ms. Mullen.
SANDRA
MULLEN: As president of the Nova Scotia Government and General Employees Union,
our union represents over 37,000 individuals who help deliver many of the
programs and services people depend on. In the last 10 years, the livelihoods
of many of our members have come under attack with the use of public-private
partnerships. In many cases, these partnerships mean the loss of public sector
jobs. Generally, these contracts are positioned as being done as a cost-saving
and efficiency solution. While it makes for an interesting story, the facts
don’t often check out. In fact, these partnerships are usually done outside the
scope of an open and transparent process using what’s called an alternative
procurement process.
This was the case for nearly 100 unionized workers when the
Province wanted to contract out the work of converting personal health records
from paper to electronic. The government claimed it would save money and be
more efficient to contract the work out. The union took a deep dive into the
business case prepared by the Nova Scotia Health Authority and found that many
of their claims were not accurate. The union prepared its own response to the report, titled A Matter of Trust - A Review of NSHA’s
Quiet Plan to Hand Control of Nova Scotians’ Health Information to an American
Company.
The union discovered a discrepancy in the claim of cost
savings and found that in the early years of the contract, there would be no
cost savings but a cost increase due to payments required to be made to
impacted staff that was not accounted for. In addition, the decision to
contract out the complete management and control of every private hospital
record for every Nova Scotian to a U.S. company was a matter of critical public
interest and was not part of the public disclosure. With the recent privacy breaches
throughout health care and the civil service, it makes sense to make sure that
these security concerns are fully explored. In the end, NSHA pushed the pause
button on the private contract and those 91 people kept their jobs.
The main point here is that public-private partnerships
have an illusion of cost-saving and efficiency but because they are often done
away from public scrutiny, they can be damaging, cost more and may not be in
the best interests of the public. No one should ever have to FOIPOP a
public-private contract. This is one example of the many that demonstrate how
short-sighted these kinds of contracts can be. If used, they must undergo fair
and open scrutiny.
I look forward to your questions.
THE CHAIR: Dr. Audain.
DR. COLIN AUDAIN: Good afternoon. It’s my pleasure to join
you today. I am Dr. Colin Audain, the current president of Doctors Nova Scotia
and a staff anaesthesiologist based in Halifax. It will come as no surprise
that Nova Scotia’s health care system is under significant strain, with aging
human health resources and patient populations. Nova Scotia also struggles with
long wait-lists for services in many areas. Family medicine shortages and lack
of access are straining the system. Until we stabilize the health care system,
we should carefully consider how we use these limited resources.
Doctors Nova Scotia firmly believes that access to health
care in Nova Scotia should be based solely on need and not on an individual’s
ability to pay. We believe in a publicly funded health care system that best
reflects the values and needs of Nova Scotians. Doctors Nova Scotia is not
opposed to private sector involvement in delivery of services as long as those
services remain publicly funded and accessible to all. Nova Scotians should not
have to pay for health care services from their own pocket. We need to
stabilize primary care in the publicly funded system so that all Nova Scotians
have good access to the care they need, and this will relieve the pressure
across the system.
THE CHAIR: Ms. Bodnar.
[1:15
p.m.]
ALLISON BODNAR: Good afternoon. Thank you for the
invitation to speak today. There’s a lot of attention lately on the
privatization of health care, yet I’m not sure that everyone agrees on what
public versus private health care is or necessarily the underlying concerns
around it. In Canada, we’ve never really had a fully public health care system.
It has always been a mix of publicly and privately funded care. While care
provided within a hospital setting is generally provided at no charge to
patients and considered public, many other critical elements of our health care
system are not.
Psychological care, dental care, prescription medications,
ambulances, physiotherapy, optometry are paid by the patients, or if they’re
lucky, their private insurance. Other parts of our system are publicly funded
but privately delivered: physician clinics, pharmacy walk-in clinics, some
surgeries, virtual care, the Family Pharmacare Program. Even though these
providers are small and sometimes large, their funding comes directly from the
government. Patients do not pay for those services and regulators in government
have oversight.
What is it that we are worrying about? Leaving aside
arguments about the Canada Health Act, I would
suggest what we should be concerned about: access. Our system needs to ensure
that all residents have access to health care based on need - equity. As a
Canadian, we take pride in our health care system and hope that it provides
equitable access to care. We must not enable a system that allows patients to
bypass publicly funded care by paying for privately available care. We need to
create a system that is available to all, regardless of an ability to pay.
Cost: We should not be paying more for care by one location
or by one provider than another. This means ensuring that services and service
providers are appropriately compensated, and work environments are appropriate
to retain staff. The concept of travel nurses and private relief agencies is a
race to the bottom for our public health care system, and standards of care. We
need to ensure that providers are providing the same standard of care
regardless of how they’re funded. They must enjoy the same standards of
practice, and we need our government and our regulators to enforce those
standards.
Regardless of how a provider is structured or how their
salaries are paid, we need to ensure that there are standards and oversight in
place to ensure that there is access, transparency, equity, equality, and
cost-effectiveness in every service provided.
THE CHAIR: In this thing, we have 20 minutes, 20 minutes,
20 minutes for each caucus, and then we’ll divvy up the rest of the time in the
lightning round. We’ll start with the Liberal caucus. MLA Clark.
BRAEDON CLARK: Thank you, everybody, for being here this
morning. I just have a few questions, and I believe - if I’m wrong, certainly
whoever is best suited to answer - but I believe this might be a question for
Mr. Spinney, related to the development of the YourHealthNS app. I’m just
wondering: Do we know to date how much the Province has spent on the
development of that app?
DEREK SPINNEY: I believe that the information provided
before was that it was $12 million.
BRAEDON CLARK: Is that essentially a set figure at this
point, Mr. Spinney, or are there ongoing costs related to that as well?
DEREK SPINNEY: There would be ongoing costs, for sure. It’s
not a static environment. We continue to both plan and develop new applications
of how best to use that for Nova Scotians. One of the examples of that is the
trial that’s under way right now, for instance, where Nova Scotians can see,
through the app, their primary health care record and what we have in
electronic format from their hospital stay - blood tests, for instance. There’s
a trial under way right now with a limited number of primary care facilities
that are participating. That information has been brought together and made
available through the app, so that’s one example of what we’re doing with it.
BRAEDON CLARK: From a procurement perspective, Mr. Spinney,
would these additions or new projects - pilots, whatever they might be - are
those all contained within an original agreement and then added onto, or are
there separate processes depending on the project? How is that playing out from
a procurement standpoint?
DEREK SPINNEY: The primary care records being joined with
the acute care records through the trial is through the arrangement of the
vendors that were involved at the beginning. There’s no new procurement for a
new thing through that app right now.
BRAEDON
CLARK: One of the things that I’ve heard the Premier and others talk about a
lot is how many downloads there have been of the app. That’s one piece of the
puzzle, but another thing that I think would be more valuable - we all have
dozens of apps on our phone, and we don’t use many of them. They just sit there
on Page 4 of your app screen, and you forget about them.
Does
the department track not just downloads, of course, but use? Do we know, you
know, 20 per cent of users are using it X number of minutes per day? Do we have
that kind of data? And if we do, what does that look like, generally speaking?
DEREK
SPINNEY: Two answers. Yes, is the first one. Perhaps we’ll take that away to
give you a fuller answer as well to share more with it. But just as examples of
some things that we’re seeing through there, as you said, number of downloads
of those health records, for instance, is one. We’re well over 20,000 now
through that, and this is only in the trial period. We’re quite pleased with
that uptake - over 200,000 downloads of the app so far.
Both
of those numbers, I think, aren’t new to the panel here today. In addition to
that, at one point - I’m probably a few weeks out of date now - there were
about 100 interactions a day with the chatbot, trying to determine where best
to find care - many of those being diversions from the ED, of course. In
addition to that, we see between 400 and 500 virtual-care visits being
provisioned through that app, through the service, every day.
BRAEDON
CLARK: I appreciate that, Mr. Spinney. Perhaps we can do this during committee
business, but it might be helpful for the committee to write and ask the
department. It would be helpful to see that breakdown. I do think there’s - as
I say, downloads are one piece of it, but use is really important. Thank you
for that.
Just
to switch gears here a little bit: Dr. Audain, if I could just ask you about -
obviously the meeting is about public-private partnerships, and as Ms. Bodnar
said, it’s true that health care in Canada has always been a bit of a mixed
bag, in some cases, between public and private services. In Nova Scotia today,
there’s a lot of use of Maple as an option for people. I’ve heard from
constituents and others who have used it, and many of them see value in, and I
see why they do.
From
your perspective as a doctor and representing Doctors Nova Scotia, what are the
challenges, I guess, of accessing care through a service like Maple? Obviously,
we understand the benefits in terms of immediacy and so on, but what are the
challenges, especially when you’re not just dealing with a simple prescription
renewal or a one-off case? What do you see from a clinician’s perspective that
could be a challenge in the use of that kind of service?
COLIN
AUDAIN: To answer your question, virtual care as a concept has been very
helpful. It’s something that we’ve leveraged more since COVID-19. It allows
patients who might not otherwise easily be able to get to a hospital or maybe a
specialist because they live in rural places in the province have access to
care that they might not otherwise easily have.
To
your specific question about a service like Maple, in my mind it serves as an
opportunity for people to have access. It’s a bit of a band-aid solution, in a
way. Ideally, what we’d like to see is attachment to primary care providers,
and that’s not what Maple provides. When you look at the number of Nova
Scotians who don’t have access to primary care at all, I think it’s a very
important service to get access for more patients.
BRAEDON
CLARK: Dr. Audain, I’m not sure if this is a fair question or not, but it’s
something that we’ve heard - that people using Maple might often say: Well, I
had an appointment, but I was just kind of referred on to a specialist, and it
was not a waste of time, but I didn’t get exactly what I wanted.
Is
there a sense that, when you’re using a service like Maple, you might be
getting referred on to someone else more often than you would if you had
attachment to a primary care physician with whom, in many cases, you have a
long-standing relationship? Do you have a sense of that at all?
COLIN
AUDAIN: I don’t know if I can say that you’re referred on more often with
Maple. I don’t have any data to support that one way or the other. Certainly,
there are going to be lots of instances where even if you have an in-person
appointment with a family doctor, for example, it will end up with a referral.
It’s possible that there may be more referrals in the virtual environment
because you’re not able to do the same type of assessment that you might need
in some instances. It’s possible that the referral rate is higher, but I can’t
say one way or another if that’s actually true.
BRAEDON
CLARK: Just a question for ADM Barro, if I could: You mentioned in your opening
comments OPOR, One Person One Record, which is a really important initiative
that has been in the works for many years. It’s very difficult, expensive, and
costly. I’m just wondering: Does the department have a timeline or a goal for
when we will be able to say with confidence that we’ve achieved it and we do
have One Person One Record in Nova Scotia?
KIM
BARRO: We do have a timeline for OPOR. There are several milestones that need
to be met along the journey. The biggest significant one is January 2025 - I
would defer to my colleague Derek - with a launch in Dartmouth General
Hospital, and then it goes from there in terms of all the other facilities, et
cetera, to come online. At the moment, we’re on target to meet those deadlines.
Once that gets in the queue, we will be able to see the benefits of OPOR.
THE
CHAIR: MLA Clark, did you want to check with Mr. Spinney on the date? She
referred that he would have . . . (interruption).
BRAEDON
CLARK: Yes, sure.
DEREK
SPINNEY: The date is sometime next Spring. I’m not going to say January. One of
the things that we’ve learned from others who have done this and the partners
that we’re with is they make sure that we’re doing it appropriately as we go
through. To that end, they bookend months in which you try to implement
something. They don’t try to get that specific because it really depends on
where you are in the journey making sure that all your work flows and the drug
formularies and all of these things are actually in place.
At the same time, it becomes very specific to the site.
When you enter a site - the Dartmouth General Hospital, as ADM Barro just
mentioned will be the first site - we need to make sure that the site is ready
for us at the same time. It really comes down to even the day of the week. When
we do that - typically it would be a Friday or early Saturday morning - and
making sure that the number of surgeries and everything else that’s going on in
the hospital and all those schedules have been adjusted appropriately too.
That’s a long way of saying that there’s a lot of planning
that goes into it, but it is next Spring for sure. To expand a little bit
further on when we will be available to say we have One Person One Record, it
is a rollout across the province. This has never been done before, as far as we
can tell, working even with Oracle, our provider. This has never been done,
that a whole province - one large system, where we have 39-plus sites - will be
going live. We’re actually doing it over two to three years, where sites will
come on, I’ll say, one at a time or shortly thereafter. The IWK Health Centre
is in the top three. I can’t remember right now if it’s the second or third. It
will take us some time to get across the entire province because of the sheer
magnitude of what we’re doing in Nova Scotia.
BRAEDON CLARK: I’ll pass the microphone over to my
colleague from Clayton Park West.
RAFAH DICOSTANZO: If I can start with a question to Ms.
Mullen regarding the travel nurses and the capping of hours that was announced:
I just want to know how that has worked so far, if you have any information. We
know that other provinces have tried it, and it hasn’t been very successful. Do
we know how many hours or what has happened since the capping? If you can
highlight that, please.
[1:30
p.m.]
SANDRA MULLEN: That’s a good question. We speak of this
between our colleagues at NSNU. While we both
lobbied strongly for reducing the use of travel nurses, we also have yet to see
the full impact. We know they are still being used across the province. That is
because of an extreme vacancy rate still existing in many aspects of health care,
long-term care throughout the province.
I believe at a previous meeting, my counterpart from NSNU
spoke on why not allow the nurses in this province to be able to travel within
the province to provide coverage where coverage is needed. To be clear, it is a
private for-profit situation we’re talking about and public health care, and
the private for-profit nurse agency has shown the exorbitant amount of money
paid on behalf of that situation. Perhaps we could have used monies to fund the
programs for nurses here in this province and allowed the students in this
province to take those programs at a far reduced tuition, if not even free, to
make a commitment to work here in this province.
We applaud the fact that they’re reducing the hours, but
we’re not yet ready to be able to fill those positions. It’s clear these
private nursing agencies are a private for-profit organization, and this is why
we want to see more transparency on these agreements - because we’ve had to
really explore and dig deep into that.
RAFAH
DICOSTANZO: Thank you for that answer. We know that in December, there were 350
travel nurses working throughout the province. I don’t know if Ms. Mullen has
the information or if the associate deputy minister would have the information.
Do we know how many travel nurses are currently working in Nova Scotia, and has
that number reduced since the cap? What was the reduction?
KIM
BARRO: I’m going to defer to my colleague, Colin Stevenson.
THE
CHAIR: Mr. Stevenson.
COLIN
STEVENSON: I don’t have a number that’s different from the 350. I think our
estimate is still that it’s approximately 350 or in that range of people who
would be agency nurses still working at any given time within the health
system. I won’t disagree with Ms. Mullen’s comments about the desire to
actually create the investment within the health system itself through people
working full-time within the Nova Scotia Health Authority, IWK, or within
long-term care facilities. It’s certainly the emphasis and the importance that
we’re placing around a lot of the workforce strategy within the health system.
Investments within seats, training and support development, mentorship, trying
to recruit and support people to come from out of province or out of country is
certainly where most of the investment and the priority will be.
We are seeing some impact on that, and Mr. Spinney may have
numbers similar to what I understand. I know within the past year, I think the
Nova Scotia Health Authority and the IWK have actually seen a reduction in the
vacancies within the health system by just over 400, which is substantial, and
great to see that some of those strategies are already starting to pay off.
We’re optimistic that path will continue, and the number of agency nurses will
continue to decrease.
RAFAH DICOSTANZO: Do we have any figures of what have been
used up to the announcements of the cap? Since then, what is the reduction in
the dollar value that we have seen?
DEREK SPINNEY: We can certainly get that. We meet literally
every Friday on this. I just don’t have it in front of me, so we’ll blame the
lack of a number on my memory as opposed to really having one. That’s a great
question, and we can bring that back to the table.
RAFAH DICOSTANZO: Appreciate to have those numbers. Thank
you.
My next question will be for PANS, if I may. We know that
we have a shortage - we’re going to have even more shortage of pharmacists. We
know we have some already, and we definitely have shortages in pharmacy
assistants and pharmacy technicians. What have you seen from government to help
reduce, prevent - or increase the number of enrolments in those fields? We met
in the last committee meeting, and you’ve announced those. Have you seen any
change in enrolment or number of seats, or some incentives? Just like for the
CCAs, to have higher salary for them so it will encourage more enrolment for
pharmacy assistants and pharmacy technicians, and pharmacists as well.
ALLISON
BODNAR: We’ll start at the pharmacist level. As you know, we haven’t filled
those classes since the Pharm D program came into
effect. Part of that relates directly to the tuition. It is now the same cost
as medical school, so the return on investment on the other side is
substantially different.
We’re still looking at things that can be done from a
policy perspective. I can say that there is a standing committee that meets
regularly on pharmacy human resources specifically, and looking at what policy
levers can be implemented from student loan programs, loan forgiveness, and
tuition support in return for contracts of service and things like that. There
is some work under way. I wouldn’t say - there’s not been a policy change at
the pharmacist level, but there is a lot of work being done for multiple
groups. Dalhousie University, I think I can say, is optimistic about filling a
class this coming Fall, so that’s good news.
At the technician level - we still see very few enrolments
at the technician level, unfortunately. One thing that has happened that is
going to help us in that area, however, is the implementation of a bridging
program to enable experienced assistants to bridge to become a technician. That
took a couple of years, but the approvals and all of that happened, and the
first class was launched in March. We have three full cohorts that started in
March, and another three full cohorts already enrolled for June. Probably a
fourth will fill. That will bring us in the neighbourhood of over 300
technicians on stream within the next 12 to 16 months, which then begs the
question of assistants.
There is no formal training, per se, for assistants. You
can come in after high school. Lots of kids work in high school and then carry
on. Still looking at what opportunities we have as a system to encourage that. What
I can say is that the bridging program is one way to do that - people who come
in as assistants, who know they have a career path beyond that.
Again, there’s a lot of work - policy work, there’s
workplace work, there’s remuneration work. All of that has to happen to
solidify that workforce for the long term.
RAFAH
DICOSTANZO: If you can give us, in a very short - what are the numbers that
you’re hoping to get, whether it’s technicians or - do you have a plan of
numbers that you hope to . . .
ALLISON
BODNAR: We’ve estimated that we have a deficit of about 500 pharmacists and
pharmacy technicians over the next couple of years.
THE
CHAIR: Order. Sorry about that. At the end of the 20 minutes, I have to do
that.
Next
is the NDP. MLA Leblanc.
SUSAN
LEBLANC: Very interesting discussion so far. I have lots of thoughts and lots
of questions, so I’m going to try to stay on track.
My
first one is for the NSGEU and Doctors Nova Scotia. We know that there aren’t
enough health care professionals. We just heard an example from pharmacy, but
we know it’s across the health care continuum that we’re low on professionals.
With
the increasing prevalence of private health care clinics or agencies, as we’ve
just talked about with agency nurses, have you seen - and I know you have, Ms.
Mullen, because you’ve just talked about it - the movement of skilled
professionals from the public sector to the private sector?
SANDRA
MULLEN: Exactly that. There are identified over 1,000 vacancies in health care
in this province. We represent almost 15,000 who work in health care. In
immediate health care, that’s 160 different jobs within the system. None of the
procedures can take place without the support of our health care folks.
They
are leaving for private organizations. When you talk about Scotia Surgery Inc., they are working in hospitals on
the public side, and they are seeing that the folks who have been referred to
these outside agencies are usually the easy ones. But any complex recovery from
any of these private situations are referred back to the health care system -
the public health care system - so they’re seeing what they have to deal with -
exactly.
The private system is again making offers to these folks,
taking them out of the public system, which makes our public system very
difficult to work in - staff shortages, cause of a number of issues within the
workplace. Just like the travel nurses, the morale that has been put in that
workplace because your travel nurse is paid far more on an hourly basis than
the nurse who is working full-time as a resident here in Nova Scotia living and
paying taxes here in this province. It’s very challenging for those folks, and
absolutely why they are against that. While we welcome the reduced hours to
that, we need to collectively - and we are doing our part across the country to
push that. If we can all eliminate the agency part of it and the discrepancy in
wages and all of those things - but it’s definitely a pull.
SUSAN
LEBLANC: Dr. Audain, do you have any . . .?
THE
CHAIR: I apologize.
SUSAN
LEBLANC: It’s fine if you don’t, because I have lots of questions.
COLIN
AUDAIN: What I would say to that is anecdotally, as an anaesthesiologist, I
have seen nurses whom I work with leave to go to other places, but from a
physician point of view, I would say there are fewer options to work privately
just because of the way things are generally funded. Because not everything is
funded by the public system, you will see movement of people, but more what we
see, I think, is, if you use family physicians as an example, if you’re trying
to prioritize primary care, family physicians have a lot of different places
they can work in the system. Although it’s all publicly funded, if the priority
is primary care, those are the things you need to try to work towards and
incentivize. Otherwise, people make decisions to go to other areas of health
care.
SUSAN
LEBLANC: Right, and I would imagine virtual care is possibly an example of
that. The virtual care situation - in her opening remarks, Ms. Bodnar said -
and I think Mr. Spinney also said that we need to make sure that with
public-private partnerships there are no costs to patients, and that people
aren’t paying for health care that is otherwise available publicly. I would say
that in the case of Maple, for instance, I think that’s going against what
you’re saying in that case.
For instance, I have a family physician, but I get my two
free Maple appointments, and so I used one of them. If use a second one, then I
understand - this has not happened to me - I will be offered an opportunity to
pay for a subscription to Maple, and I could do that instead of going to my
publicly funded family physician, which is exactly contravening what you’re
saying should be happening.
My question for the Department of Health and Wellness is
about Maple. The contract with Maple to deliver virtual care was initially put
in place to serve those on the Need a Family Practice Registry.
We know this. We’ve heard from Dr. Audain that it is a band-aid solution. Is
government funding for this type of private health care a short-term measure
that we can expect to be phased out after we get our ducks in a row in terms of
providing attachment to primary care? Is there a timeline for how long we can expect
to be paying for Maple while we are providing attachment to every person in the
province?
KIM
BARRO: What we would say is that virtual care is absolutely here to stay, that
it’s very important that people have all different kinds of access to primary
care practitioners. There are lots of people who would rather utilize primary
care through a virtual care approach than having to - maybe they don’t have a
car. Maybe they don’t have something that would enable them to get to a
face-to-face. What I can say is that if you utilize VirtualCareNS, which we
have a contract with Maple to do, then if you need to see a face-to-face
person, there’s a pathway to being able to do that.
[1:45
p.m.]
We’re not looking at a timeline to wind back virtual care.
We actually feel that it’s benefiting patients in terms of access to primary
care practitioners, and we’re building the appropriate pathways so that if you
meet a primary care practitioner through Maple and you need some other type of
service, like a face-to-face or specialist, that those pathways are built. It’s
not expected to be out of the envelope of services that Nova Scotians can
expect to receive.
SUSAN
LEBLANC: I just want to follow up on that. I hear you, and I know that I have
benefited from having phone call appointments with my family doctor during
COVID-19, for instance. It was awesome, and we know that for so many people,
it’s the way to go. What we’re saying is that a publicly provided system of
accessing your doctor or primary care provider whom you are already attached to
is very different than the system we have right now with Maple, which is: I
don’t have any attachment, I’m in a real bad state here, I need some help, and
so I’m going to use this system.
For me, when I used my system, I had a lung thing. I was
really sick, and I needed some puffers, but I wasn’t going to get to my doctor
for three months, so it was perfect for that moment. But if that happens to me
again and again, I have to look at other ways of accessing primary care.
I would like to know if you see that there is a difference
between those types of situations. Yes, it’s here to stay. It’s an important
form of accessing your primary care provider, but it’s different from filling
in the gaps while we wait for everyone to be attached. I could word that
question another way. My question also could be: Do you see, and does the
department see or prioritize attachment for every Nova Scotian - permanent
attachment, as in to a clinic or a person - maybe not a person, but a clinic -
in Nova Scotia? Is that still a priority of this government?
KIM BARRO: Yes, it’s absolutely a priority of this
department to ensure that all Nova Scotians have access to primary care
practitioners.
SUSAN LEBLANC: I said attachment, not access.
KIM BARRO: Sorry, my apologies. Yes, I understand it’s
different. They’re actually attached and have the ability to continue to access
through that attachment. I’m going to pass it over to my colleague Colin
Stevenson, as he might be able to talk a little bit more about how virtual care
works in that space.
COLIN STEVENSON: To expand a little bit on ADM Barro’s
comments, from a design of the primary care system and where we’re certainly
trying to go within the province, I think your comment is completely accurate.
We’re really focused and continue to be focused on ensuring that people are
attached to the system. That is the priority for us within the province and the
work that we do with the Nova Scotia Health Authority, with primary care
leadership, with Doctors Nova Scotia, and others as to how we actually ensure
that that’s going to occur. That can look different for different people.
Ultimately, you still want people to be able to get access
to the right provider in the way that makes the most sense for them and that is
based on that provider relationship. We do support virtual care and many
different means, as ADM Barro has talked about - VirtualCareNS - to provide
access to people who don’t have as easy access to a regular primary care
provider. We also have a virtual emergency care and virtual urgent care, all of
which are actually helping to support the delivery of care in their respective
environments.
Ultimately, we want to make sure that we’re finding that
balance between how people are accessing through virtual and in-person care.
The policy in place within the province actually does require any virtual care
provision of service to have a direct pathway to in-person care when it’s
required. It’s intended to govern and align with what the standards of care are
for the health profession, through the College, so it aligns with that, but
there is an expectation that anybody providing virtual care understands and has
a pathway to refer somebody to in-person care when they require it.
SUSAN LEBLANC: A question for Nova Scotia Health Authority:
Around the Winter holidays between December 24th and January 1st,
the available hours for VirtualCareNS were limited for those without a primary
care provider but unlimited for those with a primary care provider. Can you
explain why there were different degrees of availability between the two
groups?
DEREK
SPINNEY: I’m going to return the favour to my colleague Mr. Stevenson.
(Laughter)
COLIN
STEVENSON: Just to make sure I understand the question, I believe it was: Why
would there be a difference between access for people unattached and attached?
SUSAN
LEBLANC: Yes.
COLIN
STEVENSON: Okay, thanks. There is a difference between the two services. The VirtualCareNS program for unattached is using the
Maple platform but it’s delivered by Nova Scotia providers, so they’re in
the province. They actually require coverage by those providers in order to
deliver to that population. The virtual care for individuals who are attached,
your two free if you want to take advantage of that as a service, is actually
based on a partnership agreement between Maple as an organization and their
broad national bench of providers and the Nova Scotia Health Authority.
If
the VirtualCareNS schedule - if they didn’t have a
full slate of providers at that time and able to provide that slate of service,
then they could have had a break in service - which could be unfortunate and
doesn’t often occur - but that doesn’t restrict anybody from being able to
access the full bench through Maple for that limited service across the
country.
SUSAN
LEBLANC: Thank you for providing that explanation, but that does beg the
question: What is the rationale between providing or offering people these two
free? I’ve already explained that I’ve used it, and it was convenient because
it takes a long time to see my primary care provider, but I could have just as
easily, I guess, or almost as easily gone to a walk-in or a mobile clinic. It
feels like it’s an advertising scheme. It’s a way to get you hooked on this
very convenient thing because you’re right - the provider I had was from
Calgary and I never realized that there was a difference between them. What is
the rationale?
COLIN
STEVENSON: I think your example is a very good one. It is intended to actually
help provide people with access to care who might not have an option with their
own primary care provider. What they would see as what’s available to them is
maybe going to an emergency department, as one example. Many of the services or
the intention is low-acuity, low-risk care that could be satisfied through that
type of service - that is the best place for it. It helps to ensure that we’re
not overburdening other parts of the system. That really is the intention
around it.
We do know that people who use virtual care services and
people who are using the pharmacy walk-in clinics - we know that there actually
is a reduction in their visits to the emergency department. They are actually
closer to emergency department visits as to anybody who’s attached to a
provider. We are seeing a value and a benefit associated with these virtual
options and the community pharmacy clinics where it’s actually helping to
unburden other parts of the system where we need them to be there to support
higher critical care requirements.
SUSAN LEBLANC: Can you table that information, the data
that you’re referencing? Is there something that you can table? That is
interesting to me. Do we know for sure that because somebody went to a pharmacy
clinic, they didn’t go to the emergency? Do we have numbers on drops? I wasn’t
aware that our number of visits to emergency rooms had dropped substantially
since these programs have opened, so I’d love to see that data. That’s just
Part A.
Part B is: On the Nova Scotia
Health Innovation Hub website, it’s noted that many of the virtual care
appointments delivered through Maple subsequently did result in in-person
visits. Can you clarify what that means? My colleague asked a question, and I
think he was suggesting that they resulted in referrals to specialists, but I’m
wondering if you can speak to the number of people who use Maple and then are
referred to an in-person primary care visit?
DEREK SPINNEY: Yes, and we’ll get more specific numbers to
you. I’m going to give you a range, though, just to paint the picture. Between
10 and 20 per cent of the time, when the 400-plus people a day I mentioned are
using virtual care every day on the unattached list, between 10 and 20 per cent
of those were not being able to resolve their question in that session.
What we then do is we provide them the pathway - someone
mentioned earlier - into one of the primary care collaboration centres. You’ll
start to hear us use words like “health home,” for instance. This is to your
earlier question about connections and attachments, I think is the word you
used. Trying to help people understand how they’re being attached to the system
and to a place where they can call back. They may not get the same physician,
but I’m going to say people know them there because it is their health home.
Their record is there. We understand that.
Between 10 and 20 per cent of the time, they’re referred to
an in-person visit. We place them, take care of that for them, make the
appointment at the primary care place, and then they can go in and see somebody
in person. From there, they may end up being referred to a specialist as well.
That’s the pathway as it is right now, yes.
SUSAN
LEBLANC: Thank you, that’s helpful. Back to the data question. I’m wondering if
the department or the Nova Scotia Health Authority has developed any metrics to
ensure effectiveness. What are all the things you’re looking at to know that
this is working, basically?
THE
CHAIR: Mr. Spinney or Mr. Stevenson. Which one?
DEREK
SPINNEY: I’m going to start and then quickly hand it off. We absolutely do. One
of the things is we’re very data driven. Our chief data
officer is actually sitting behind me, so I’ll put in a commercial for Mr.
Murphy as well. Yes, we do, and the Innovation Hub has evaluation teams
that go in and look at this. Unfortunately, I don’t have those six or ten metrics to actually share with you today
with the values, but I think that’s something great that we should submit back
to the table because there are absolutely key performance indicators that we’re
tracking to make sure we’re actually hitting the mark.
THE
CHAIR: MLA Leblanc, do you want Mr. Stevenson?
SUSAN
LEBLANC: No, that’s okay. Sorry. No offence. (Laughter) Guess I’ll just quickly
ask with the time I have left in this round - again, many of you talked about
the importance of quality of care in your opening comments. For things like
pharmacy appointments, or perhaps virtual care, or even travel nurses, how do
we make sure that the quality of care is there? Are there audits done? Are
there checks and balances in place? What is happening to make sure that people
are getting the care they deserve and need?
KIM
BARRO: First of all, all of those practitioners that you mentioned would be
regulated health professions. They actually have, through their licensure, the
expectation of quality of care within the standards and ethics, and all of the
pieces that would back them as regulated health professions. I can’t speak to
the contracts specifically around those, but I would say that in terms of
public protection for practice of care, that would be the relationship of that
person if they had a complaint back to their college, and that should be
followed up. So that’s one - we would hire licensed professionals in all of
those instances to ensure quality of care.
THE
CHAIR: MLA Leblanc with five seconds.
SUSAN
LEBLANC: Thank you so much for answering my questions.
THE
CHAIR: MLA White.
JOHN
WHITE: My questions are to the department and to the Nova Scotia Health
Authority. We realize that the province is facing an aging population,
population growth, and of course, the shortage of health care professionals. I
just wonder if you can take a few minutes to explain how the province is
adapting to these challenges, and more specifically, how the public-private
partnerships are a solution to any of this.
KIM
BARRO: I’ll take a kick at it, and I might invite my colleagues after. Just a
step back - we’ve always had public-private partnerships. In terms of our
relationship with doctors, it’s always been through a public-private
partnership. Many doctors are incorporated, so this is not new.
To
address the issues of a growing population, the aging population, and the fact
that we have a shortage of health care professionals, we need to utilize the
assets and the infrastructure that public-private partnerships enable us to do.
It’s a wave of the future - that we really have to capitalize on all of the
assets that we have in Nova Scotia. As an example, the relationship with HealthView Medical Imaging, where we’re buying more
MRIs and other diagnostic imaging, enables us to address the huge wait-lists
that we have. I’m sure you know that we’re also receiving clawbacks from the
federal government because we’re allowing HealthView Medical Imaging to operate.
This way we’re actually buying more seats, addressing the wait-lists and
probably satisfying the federal government’s requirements for ensuring that we
have publicly funded - we can’t stop a company like HealthView from operating,
but what we can do is enter into a partnership that allows us to buy the assets
that we need to address the concerns at no cost to the Nova Scotian. We are by
no means entering into any public-private partnerships that require the public
to pay out of pocket for any of these services. We’re utilizing that asset as
opposed to building and costing us more to build that type of infrastructure.
HealthView has it already and we’re buying assets from them, as an example.
[2:00
p.m.]
JOHN
WHITE: When some people hear public-private partnership, they assume it means
privatization of services and unequal access. I’m wondering if you can help
clarify how it actually works.
KIM
BARRO: A private service would be one that is not paid for by government or
under our provincial health services plan, which is MSI. There are lots of
examples that were already mentioned of those services - dentists,
optometrists. There are many services that lie outside our medical insurance
plan, but the government also provides some of those services in other publicly
funded settings like hospitals, et cetera. It’s a really complicated landscape
in Canada. I think we’ve already mentioned that. It sometimes leads - because
some folks like better accessing private care from a dentist or what have you -
if they’re lucky enough to have health insurance, then they get that. If
they’re not, they may not. That really leads to inequitable care.
Our
investments here in Nova Scotia are to really ensure that we have a robust
enough publicly funded system that’s addressing the needs of Nova Scotians.
That would be in the bucket of what you typically would not have to pay for -
things that you would experience in a hospital setting or a physician’s office,
et cetera. Privatization would mean that people would be paying out of pocket
for services, and they would potentially be queue-jumping. That’s not what
we’re doing with public-private partnerships.
When we enter into public-private partnerships, we’re
ensuring that there’s equitable access to all using public funding, as I said,
to augment the assets and the resources that private companies have and making
sure that it’s equitable and fair so that we’re levelling the playing field by
increasing more access points, more services to Nova Scotians that we need to
do more quickly. Public-private partnerships enable us to do it faster but
we’re still maintaining the principles of the Canada Health Act, which means
that our citizens are not paying out of pocket for those services.
JOHN
WHITE: Would it be fair to say that the Province is using public funds to
provide equitable access to services for all?
KIM
BARRO: Yes, we would always be using public funds to ensure that - what we’re
using public funds for is ensuring more equitable access to services.
JOHN
WHITE: I’m going to pass it over to my colleague MLA
Young.
NOLAN
YOUNG: ADM Barro, in your opening remarks, I think that you had mentioned about
public-private partnerships - you mentioned pharmacies. I think of the pharmacy
that’s across the street, the pharmacy clinic in Shelburne that seems to be
taking a tremendous number of people through. I’m wondering if you could tell
us more or if you could even elaborate more on this partnership.
KIM
BARRO: I think it’s a really important partnership for access to care in Nova
Scotia. Pharmacists are one of the most accessible health care professionals
that we have, and so by entering into a partnership with the pharmacies and
increasing what they can provide to Nova Scotians, it’s actually increasing the
services that Nova Scotians get. It stems back to even - the PACA legislation that we passed last Spring enables
increased scope of all the professionals. The professionals are now able to and
we’re working towards making sure that all health care professionals are
working to maximum scope - all the things that they’re able to do - and that
legislation also enables us to bring in others from different parts of the
world or Canada with no barriers. We’re using that as a way to get more
practitioners in.
The pharmacy example is that we have ensured that
pharmacists are working to maximum scope, and that we are publicly - we enter
into a relationship where we can provide public funding to enhance that. It’s
all about making sure that we’re using that private asset in a pharmacy
situation to ensure we have more services that pharmacists can do so that Nova
Scotians get more care faster.
NOLAN
YOUNG: I’ll ask this question to Mr. Spinney, and perhaps the Department of
Health and Wellness may want to comment. You mentioned health homes. It rolled
right off your tongue. If you could break it down - just explain what a health
home is. How does it work? What does it mean for patients? in simple terms.
DEREK
SPINNEY: The way that we access care is changing, as we’ve all talked about.
There are different ways, whether they be virtual care, whether they be
expanded scope, whether they be the more traditional way of a primary care
setting where you go in and see the same family physician time and time again.
However, as all of that evolves, what we’re learning together is that it isn’t
so much that you need to see the exact same person all the time. What you need
access to is somebody who understands your situation, understands the system,
and can help you navigate through it so you can get the best care possible.
That’s actually the goal.
We’re trying to sit back and look more at what the intent
is. The intent isn’t to see the same person. So what we’re trying to work our
way through right now is better articulating that to the populace, and also set
up the organization accordingly, so that when people come in - whether it be
through virtual care or potentially otherwise - if you’re not attached to the
same family physician all of the time, that you are attached to a health home
that understands your situation. They understand the help that you need, and
they understand the system, and how to help you navigate through that.
Throughout
the province - I don’t have the numbers here, but happy to provide them - we
have an extraordinary number of primary care collaboration centres already in
place that are busy seeing patients every day. As I mentioned, 10 to 20 per
cent of the time that the folks who don’t have a family physician - the same
family physician - when they call in through virtual care, they’re sent to
these health homes. That’s in effect what it is. We’re trying to do a better
job of explaining that in new ways to folks so that they can understand they
are cared for. That is what we’re trying to accomplish - they just may not see
the exact same person all the time. We’re trying to make that distinction
between the real goal of the situation, which isn’t to see the same person but
it’s to make sure I get the care I need, when I need it, and I have somebody
who advocates for me, and can take me to the place I need to go next.
NOLAN
YOUNG: One more quick one, if I could. Okay, here. We’ll throw it to - come
back to Mr. Spinney, I guess, or the NSHA. The Nova Scotia Health Authority has
several private partners to deliver health care agreements - they have several
agreements with, sorry. If you could just tell us more about the agreements
that you have in place, and the impact they are having on reducing wait-lists
and improving access to care.
DEREK
SPINNEY: As you mentioned, there are numerous - somebody said it well at the
beginning that private partnerships are not new. They’ve been around for a very
long time. It’s really making sure that we use them in the best way for Nova
Scotians - not do they exist or not. To that end, just one of the examples, I
guess, that we’ve been doing over the last little bit is our agreement with
Varian.
Varian is a global leader. They have the market share - the
70-plus per cent market share - in the world with cancer care radiation
equipment. We’ve been using that equipment here for some time. Dr. James Robar is a world-leading expert with it,
doing amazing things with that. Well, we entered into a 10-year agreement with
them to do a few things - one of which is to provide Nova Scotians the latest,
greatest equipment. So on January 4th of this year, the first person
in Canada to receive treatment with the new Ethos units
with HyperSight Imaging was done here in Nova Scotia, which is pretty cool
- and beyond cool, I guess, to explain the magnitude of that. What would
typically have taken 20 sessions of radiation can now be done in five. It’s
amazing what it can actually do.
Something else that they’re in the process of doing with
this right now is opening a global software development office here in Nova
Scotia with a minimum of 60 people who will be in that office to work through
some imaging software together. We’re actually going to be able to participate
in that. The cancer team will do a better job of explaining how all of those
things are impacting the wait-list and the care that people are getting, but I
think that paints the picture a little bit.
In
the case of 18 Acadia Street, otherwise known as Scotia Surgery Inc. - but we
really shouldn’t be using that name; that’s a company name that is not the
facility that the government now owns - we’ve seen the number of surgeries for
the Nova Scotia Health Authority in the past year increase by a couple of
hundred. We’re over 500 a year now where we were just over 300 a year ago. So
it’s a significant increase there, and some really great patient experience
comments are coming out of that facility, as there always have been. This has
been 15-plus years. This isn’t a new thing, except the government now owns the
facility to really gain access to that.
People
often ask: Why can they do it? Why is that different? Why can’t we do it? Well,
we can do it. We are doing it with them. One of the things, for instance,
that’s taking place there is it really becomes a centre of excellence for
particular types of surgeries. Somebody mentioned earlier that sometimes it’s
the easier ones, and the harder ones go elsewhere. Well, the easier ones should
be cohorted into one place so that you can become really efficient and that you
can get more people through it. Those are two of the examples that we’ve been
up to, with more if we had more time, perhaps.
NOLAN
YOUNG: I’ll kick it over to MLA Palmer.
THE
CHAIR: MLA Palmer.
CHRIS
PALMER: This is a great conversation so far. I’m madly taking notes here, and I
have so many different thoughts that I’m formulating as I’ve been listening to
our witnesses today. The only thought that’s really come to my mind a lot is
that if we really want to build a system that’s truly patient centred and
patient focused, I believe it’s our responsibility to leave no stone unturned
to provide the most equitable, best access we can for patients. I think that’s
what we all agree that we need to do, right?
One of the best examples of public-private partnerships
that we’ve seen, and that’s been touched on here so far, is the community
pharmacy primary care clinics. I have a couple of questions for Ms. Bodnar, and
maybe the associate deputy minister would like to give her thoughts as well.
Just a bit more specifically, I had the privilege of having the Premier in my
area last week, and we visited a community pharmacy primary care clinic in
Greenwood. We had a good chance to hear what’s happening there and the access
that’s creating. Ms. Bodnar, could you talk about how especially in rural areas
those community pharmacists and the government are working together to fill
those health care gaps, and talk about the future potential expansion of that -
how we can continue to work with community pharmacy primary care clinics going
forward?
ALLISON
BODNAR: Sure. I think people would be surprised. Those clinics have now
delivered in just about 15 months over 160,000 services to Nova Scotians, and
that’s across the entire province. We have clinics in Yarmouth, Shelburne,
Greenwood. We have clinics in Sydney and Chester, and otherwise.
These clinics are creating access that didn’t exist. When
we look at new points of access in the system - whether that’s mobile care,
virtual care, even urgent care - these clinics do more than all of those. These
are a really important element of the system. They’re important for patients,
for the system, and for the providers. If we want to keep providers - and I
mean all providers, whether that be pharmacists or nurses or physicians - they
have to want to go to work every day. They have to want to get up and provide
that care.
These clinics utilizing pharmacists to their full scope of
practice are making our members proud again to do what they do. I think that’s
going to not only keep our pharmacists here but it’s attracting pharmacists. We
were just in London over the last few days, and we had 142 people express interest
in coming and wanting further information. We’ve had 14 people through our
expedited process licensed here in Nova Scotia since January and another 29
files opened. What we’re doing here in Nova Scotia is world-leading, and it’s
making a difference to patients, the system, and providers.
[2:15
p.m.]
CHRIS
PALMER: I have spoken to many pharmacists who have said the same thing. They’ve
been wanting to do more in their scope for so long. They are just as much -
they are not allied health care professionals. They are just as much
professionals as anybody. I have had those conversations with those pharmacists
who are really happy that they have the ability to use their full scope now,
for sure.
This
idea that we have these public-private partnerships that we’ve talked about -
it’s not like privatization, where we’re getting people to pay with a credit
card or anything like that. I take that pharmacy care clinic in Greenwood. The people down there aren’t walking in the door after
they get an appointment and saying: Someone is going to profit off me today.
They’re saying: My child has an appointment for their strep throat. I’m glad I
have access to that service and primary care.
To
your point, it is a success story, I know, in my area. I have two community
pharmacy primary care clinics, and they are really well received.
I
do have a question that I think I’d like to ask the Department of Health and
Wellness. The government’s added a lot of new health care professional seats in
different professions and is building up the infrastructure. Could you speak to
the partnership with our post-secondary institutions, and talk about how those
seats will help create more sustainable health care professionals going
forward? Could you speak about that?
KIM
BARRO: Yes, it’s really important to build as many seats as part of our
recruitment strategy, making sure that we’re accessing all Nova Scotians who
are eligible and want to go into those health professions by increasing the
seats.
The other important thing we’re doing with those seats is
ensuring that we have seats that are guaranteed for our First Nations and our
African Nova Scotian Black populations, so that those populations will see more
practitioners who look like them. That creates a better safe environment.
We’re really pleased that we’re able to increase the number
of seats, and that we paid attention to those elements of equity that are
really important as we build our health care professional infrastructure in
Nova Scotia. I think we’re doing a good job there.
CHRIS
PALMER: How much time, Chair?
THE
CHAIR: Fifty seconds, assuming you don’t do much of a preamble.
CHRIS
PALMER: Am I known for that or something?
Again,
I just want to reiterate - and maybe Ms. Bodnar could touch on this, and maybe
I’ll just ask in the next round when it comes around. For those rural areas,
just to maybe expand and talk about the significant role and how we were able
to see how we were going to use pharmacies in the experience of COVID-19 and
during the pandemic time, and how we used the pharmacies to help us in
vaccinations and different things like that, and how that maybe created the
template for how we could work with them going forward - if that makes any
sense.
THE
CHAIR: Ms. Bodnar with 12 seconds due to preamble.
ALLISON
BODNAR: I think we’ll maybe address this after, but obviously 1.5 million
vaccinations in one of the only health care centres open during COVID . . .
THE
CHAIR: Order. The next round will be seven minutes.
It
will be the Liberals.
RAFAH
DICOSTANZO: If I may go back to OPOR, I have a burning question, honestly. All
we heard today is about all the access points, whether it’s pharmacy, whether
it’s virtual care - and all of this is wonderful, but when we decided on OPOR,
we did not include them. The people who are using these access points because
they don’t have a family doctor are the ones who need it the most. It’s been
three years now for some of them without a family doctor, and they’ve had no
record. They show up at emergency, they show up at a pharmacy, and to me, it is
a liability to the doctor in emergency, to the pharmacist, not knowing their
record. But this government spent $360 million and did not include them. How
did that decision come about, and why?
DEREK
SPINNEY: I’ll start. I’m certainly not the decision maker, so I’ll defer to
others on that part, but what I can say, I think definitively, is that nobody
was excluded. We simply said that we needed to start, and we needed to start
with the acute system.
I
suspect - again, I defer to other decision makers - but that is the natural
extension of where we go with this. We just simply needed to start with the
acute system. Then rolling it out to those other things I think makes 100 per
cent sense. In fact, I think that’s how we deliver a health home that I talked
about earlier. We need to be able to have access for others through that
system, and I don’t think anybody’s going to disagree with that. I think it’s
really about trying to get there as fast as we can. That is the change that
will take place through data that the minister spoke about the other day at the
Halifax Chamber of Commerce luncheon as well. In
order to deliver on that, we need to do exactly what you just said. We need
those other avenues included in One Person One Record.
RAFAH
DICOSTANZO: I believe the announcement said that OPOR is over 10 years, that
$360 million. If you can just tell some timelines so that first you’re starting
with this, and that’s going to take 10 years. When will we have the
pharmacists, the virtual care, and everybody else? Will that be 20 years? What
are we looking at here before we have access to our records?
DEREK
SPINNEY: I obviously don’t have a specific time with that, but just to comment
on the 10 years, the rollout across the province throughout the 39-plus
facilities we have takes three years. The 10 years includes the continued
support and evolution of that and the partnership with Oracle. It isn’t a
10-year implementation. The implementation period is actually much smaller than
that. I think you’re asking exactly the right questions, and I think that those
are the things that need to be determined over the next while here as we
implement because I think those are the right next steps. It’s just a matter of
the sequencing of those things, yes.
RAFAH
DICOSTANZO: I think we need to be honest with our population as to when they
expect to have that with their record. Another thing that surprised me was when
the $360 million was announced with OPOR with Oracle. Not even a week later,
there was another announcement of $120 million for the cancer as a different
software with Varian. To me, I said: Okay, if OPOR is not good enough for
cancer - the whole point of OPOR is to unite 80 systems together. That is just
within the hospital system. We have 80 systems; we are trying to do one. Then a
week later, we spent $120 million on a different system with a different
company. How can you explain that to me?
DEREK
SPINNEY: One of the things that One Person One Record is aiming to achieve is
bringing all those different systems together, like you just said, and it’s an
extraordinary number which makes it so complex. By virtue of having that
number, it shows that we’re not dependent on only one system. There are other
systems involved.
In
the case of Varian, as part of the announcement that you’re talking about
there, we determined that we would be able to start providing cancer patients
their electronic cancer record - I’ll say now - immediately. We don’t have to
wait for a three-year implementation. The Province made the decision to engage
with them to get that rolling now, fully understanding and appreciating that it
could integrate with the OPOR system, and that’s what we’re seeing right now.
In many of the hospitals in the province, you’ll start to
see - if you haven’t already - some posters on the walls talking about ARIA oncology information system and some software
that you can use that allows you as a cancer patient to log in, see your cancer
treatment plan. You can do your scheduling and interact with your care
provider. That didn’t exist, and we didn’t want to wait three years for that.
We’ve done that now, and that’s being implemented and rolling out through the
province. That’s why. It wasn’t in contradiction to something; it was simply
much faster to be able to start a piece of this journey, and not at the expense
of that larger system because it would be able to be integrated.
RAFAH
DICOSTANZO: I’m still a little puzzled that the Varian system is faster and
delivered much faster, but we didn’t choose it for the rest of the system. It
doesn’t make sense to me that there is a system that is faster and has achieved
more than OPOR, and we went with it after we announced OPOR. I don’t know how
you can square that one.
THE
CHAIR: Mr. Spinney, 12 seconds.
DEREK
SPINNEY: A much smaller group - here are 50,000 people in Nova Scotia with
cancer, and it’s not the one million populace that we needed to deal with the
80+ system. That’s the 12-second answer.
THE
CHAIR: And it was 11 seconds. You did very well. MLA Burrill.
GARY
BURRILL: Ms. Rose, it’s been said here a number of times this afternoon that P3
arrangements have always been with us - nothing new - so it’s only a question,
not whether or not we’re going to have them but how we’re going to use them. I
want to say that I don’t think that’s the question at all. I think the question
is: With the very serious problems we have in our health care system -
wait-times to access all different forms of care - is the best path the path of
contracting private-service-providing entities to provide the services we need?
It seems to me that is the question that’s in front of us. I wonder if you
would speak to the coalition’s position on that question?
ALEXANDRA
ROSE: The coalition’s position is we do believe in strengthening our public
health care system, not in the form of contracting it out to private providers.
Sorry, could you repeat the second part of that question?
GARY
BURRILL: Yes. Is the best path the path of turning to private service providing
entities, agencies, companies to deal with the big problems that we have? Is
that the path that we ought to be on?
ALEXANDRA
ROSE: We think no, it’s not. Ultimately, these processes - I mean, it does
range whether we’re talking about private hospitals, or different centres, or
travel nurses, or Maple and the virtual care. All of those vary greatly. Some
things, of course, have always been private, but we do believe that the better
option for Nova Scotians to get the care that they deserve is to keep it in the
public system and strengthen the public system instead of opting for more
expensive options that don’t always provide the solutions that they do. I mean,
it would be great if they did, and if they did, maybe I would be out of a job
for everything to work super smoothly the way it does. I think, realistically,
we should be looking at reinvesting in our public health care system.
GARY
BURRILL: I’m thinking back a couple of years to the position that the coalition
took about the partnership with Maple when it was first entered into. The
coalition was a very clear voice - this is the wrong direction we should go. Is
this still the coalition’s position, and given the couple of years’ experience
that we’ve had, have you been led to change that, or is it something that’s
modified, or do you still think that this is the wrong path?
ALEXANDRA
ROSE: We still stand by that; things should be kept within the public system.
In saying that, obviously it’s no one Nova Scotian’s - we don’t blame them for
obviously accessing the Maple app. I use it myself; I don’t have a family
doctor. I’ve only lived here for a couple of years. Largely, we do believe in
keeping it within the public system as just an overall statement.
GARY
BURRILL: Then related to that, I wanted to ask you: What is the coalition’s
thinking, then, on the Nova Scotia Health Authority’s partnership with Think Research Corporation in the development of the
YourHealthNS app?
ALEXANDRA
ROSE: It remains kind of the same as the - it would depend on a whole lot - we
would love to see the Nova Scotia Health Authority develop it on its own, but I
think that’s a little bit unrealistic when we talk about developing an entire
app. That obviously takes a lot of time and a lot of money, so of course we
understand that different routes have to be taken.
[2:30
p.m.]
GARY
BURRILL: I want to purse the same question in a different form, Ms. Mullen, to
you. I guess it’s important to be clear on the fundamentals of this. The union,
not very long ago when the QEII redevelopment began, said that the P3
arrangement was like taking money for our health care and turning it into
another yacht for a CEO. Can you expand on why the union thought that, and is
that still the union’s position on using P3 as the backbone for the expansion
of the health care system?
SANDRA
MULLEN: Definitely the union still believes in publicly funded, publicly
delivered health care. We’ve seen a number of issues go by the wayside that
were in a private, for-profit partnership. We’ve seen projects fail. We’ve seen
projects not completed, not even started, under that route. We have our members
who work directly within those systems seeing what happens when there is a
private for-profit system come in to try to deliver services. Whether that’s
just the day-to-day service within the organization, whether it’s laundry,
they’re bringing it back in house because they know - I do believe the employer
knows that our members do a better job of delivering services.
It’s definitely our position to continue along. We lobby
with both the Nova Scotia Health Coalition and the Canadian
Health Coalition, which is offering and working towards the federal
pharmacare program - that will help keep folks out of the ERs, which again is a
prevention model. The dental care being offered to seniors and to youth - those
are all preventive measures that are publicly delivered.
I
have seen the opposite of the Maple where Maple is coming in and being offered
to employees of post-secondary as a benefit package that they have to pay for.
It is similar to an advertising scheme that yes, you get two free, but your
next trial is like Columbia House Records and you’re going to be paying
forever.
GARY
BURRILL: Then I want to ask you, Ms. Mullen and Ms. Rose, do you have concern
with the expansion of the role of private entities in dealing with our
problems, that this is leading us on a path towards a two-tier system?
SANDRA
MULLEN: I do believe that’s exactly where we’re heading. The very reason we
want to see some transparency on these contracts - to be able to show Nova
Scotians that it is a benefit should not be difficult. If it is for the public
benefit, it should not be hidden.
CHAIR:
Order.
CHRIS
PALMER: I just want to go on the record and say I actually bought 20 Columbia
House CDs for 99 cents once, so thank you for bringing that up. (Laughter) Ms.
Bodnar, could you finish your answer about the experience of the pharmacies
during the pandemic and how that provided an example for future partnerships?
You were answering that question.
ALLISON
BODNAR: Absolutely. I think we started with the fact that when many
organizations were closed and access to care was limited during the pandemic,
all of the pharmacies remained open and the pharmacy staff there. I think the
public’s relationship with pharmacies started to change a little bit when they
recognized the skill set and the services available, and that has just
translated into a bigger demand and bigger interest in building on that
relationship.
These are community health practitioners whom even patients
who are unattached to other health care providers are often attached to. They
have a wealth of information and history on which to build and provide care and
provide that navigation to other parts of the system. Since that time, we’ve
been able to open these clinics. We’re focusing those clinics in areas of
highest need. I think the previous committee testified as to how those
selections were done based on the registry and ensuring that they were spread
throughout the province. I think it’s just something to continue to build on.
Again, I’ll reiterate most of primary care is delivered
through private entities - publicly funded through private entities - whether
that’s physicians or dentists or optometrists or pharmacists, it’s the only
care in acute facilities. I think we need to ensure all of the things we talked
about before: access, equity, transparency, cost, standards of care. If we can
do that, how the money flows, I think, is a little less relevant than ensuring
we have those standards, cost-effectiveness, and access.
CHRIS
PALMER: I’ll pass it on to my colleague.
THE
CHAIR: MLA Barkhouse.
DANIELLE
BARKHOUSE: Dr. Audain, you’ve been so quiet over there I think I’ll ask you.
What
do you think of partnerships like Halifax Vision
Surgical Centre where surgeons can use their facilities to cut down on
surgical wait times? How do you see it helping doctors provide better and
faster service?
COLIN
AUDAIN: Sorry, I’m not sure if I completely understand your question.
DANIELLE
BARKHOUSE: Halifax Vision Surgical Centre is allowing surgeries to take place
in their facilities. I’m wondering how you - well, it cuts down on the surgical
wait times for anyone needing that service. I wonder how you see it helping
doctors provide better and faster service for patients.
COLIN
AUDAIN: My understanding of Halifax Vision is that it would fall into a similar
category as Scotia Surgery Inc. As far as I know, those services are still
publicly funded. It would allow more patients to receive eye care that they
otherwise wouldn’t be able to receive if they were just waiting on their
ophthalmologist to be able to treat them in the hospital system.
Does
that answer your question?
DANIELLE
BARKHOUSE: I guess, sort of. I’ll just move on because we’re down to 10
minutes. I’ll move on to the next one.
THE
CHAIR: Three minutes.
DANIELLE
BARKHOUSE: Of course. Three minutes.
How
do you anticipate partnerships like this to further improve efficiency and
effectiveness of health care delivery in Nova Scotia?
COLIN
AUDAIN: I think that for me, most of these partnerships that we’re talking
about are still, I would consider, publicly funded in that the patients aren’t
having to pay out of pocket for these services. I would also caution that
they’re there to allow patients to have access to services that they’re
otherwise struggling to have access to.
To
my earlier point, in instances where patients have no access to a physician at
all, it’s better to have access rather than no access. But the ultimate goal
should be attachment. The idea of a health care home is what, ultimately, we
should be striving for, in that it’s a collaborative model where the patient’s
information is in one place, and it’s not scattered in different silos around
the province. We should still be striving to utilize health care workers,
whether it’s pharmacists or nurses or nurse practitioners, to their full scope
of practice, but not in this way where it’s in silos and not integrated, in a
way.
It’s
important that we have these measures right now, so that people have access
that they otherwise wouldn’t have, but we shouldn’t lose sight of the long-term
goal to provide attachment to everybody in a way that should be a standard of
care.
DANIELLE
BARKHOUSE: I think we’ve heard this from the department in regard to doing home
care and trying to - One Person One Record, things like this - I think, from
listening to you, kind of nails that all down to what you would like to see
happen.
I
would like to know if you could explain to anybody - these millions of
listeners out there today - how NSHA and the Department of Health and Wellness
work together to come up with decisions regarding how they spend their money on
what kind of public health funding. So that would be to the ADM.
KIM
BARRO: We work very closely together to ensure that we’re on side, so that
NSHA, who would be the operational arm of the health system, would understand
what they need in that space. What we work through is business cases where they
would express what they would need and for what benefit, et cetera. Then the
department would work with that submission. Actually, it’s the ultimate
decision of Treasury Board and Cabinet sometimes to ensure that that’s what
government wants to invest in.
We
have a system where we work very closely. The health authority comes up with
the type of initiatives . . .
THE
CHAIR: Order. That ends all the questioning. We’ll go for closing statements. I
will start with Ms. Bodnar. Do you have any closing statements?
ALISON
BODNAR: Just quickly, again, I think we really need to understand the concept
of private versus public health care, and really focus in on those elements
that I mentioned earlier. I think if we could ensure access, equity,
transparency, cost effectiveness, and standards of care, then we will have
achieved the health care system that we want.
COLIN
AUDAIN: Thank you again for the opportunity to participate today. It’s an
important topic, and what we want is to ensure that Nova Scotians have good
access to care. When it comes to public-private investment, we must step
carefully. Private sector involvement should complement the goals of the public
system for primary care and other specialty services, including universal
access, connection to a health home, continuity of care, and so on. It should
not come at the expense of equitable access for Nova Scotians or create health
human resource challenges for the public system. Ideally, we need to stabilize
primary care in the publicly funded system, so all Nova Scotians have good
access to the care they need. This will help relieve pressure on the system.
SANDRA
MULLEN: To elaborate on that again, we want to stop the exodus of staff to
these private organizations. Whether it’s an agency or whatever, private
practices are taking our members away. The other side of it is - we reiterate
the fact that it is private for-profit, and therefore while they may not be
paying for those services out of pocket, they are paying it with income tax.
Here in Nova Scotia, it is their cost, so we also need to make sure that those
agreements are transparent and accessible to show the members of this province.
ALEXANDRA
ROSE: Thank you for having us here today as well. Ultimately, while the Nova
Scotia Health Coalition stands by keeping our public system fully public or as
public as it can be and introducing the parts that are private back into the
public system or into it for the first time, public-private partnerships are
clearly here and perhaps here to stay. For that, we would love to focus on
transparency with the public, and also putting resources into keeping services
and employees back into our public system to benefit all Nova Scotians.
KIM
BARRO: I would like to thank everyone for the very important topic today. I
would just like to reiterate that we believe and continue to strengthen our
publicly funded health care system. We believe that robust and transparent,
equitable partnerships with private industry is one way that we can ensure
services that Nova Scotians need and deserve faster.
DEREK
SPINNEY: Thank you for the opportunity today. I really appreciate these
sessions. The transparency - what we’re all striving for - couldn’t agree more.
I’d like to publicly thank - for the millions that are tuning in, I heard
earlier - all 30,000-plus people working at the Nova Scoita Health Authority
every day. We are very proud of the work that we do. We’re proud of our teams,
and we’re grateful for the opportunity to be helpful.
THE
CHAIR: Thank you. This concludes this portion of asking questions. What I will
do is recess until 2:48 p.m., and then we’ll be back to deal with our business.
We’re in recess.
[2:44
p.m. The committee recessed.]
[2:49
p.m. The committee reconvened.]
THE
CHAIR: Order. We have some committee business. On April 26, 2024, we had a
letter from the Department of Health and Wellness written in response to a
request for information made to the Office of
Healthcare Professionals Recruitment during the March 19th
meeting. It was forwarded to everybody. Does anybody have any comments?
RAFAH
DICOSTANZO: Just to thank Judy. She did a lovely job with our letter.
THE
CHAIR: She always does a great job.
RAFAH
DICOSTANZO: Yes.
THE
CHAIR: Next item: This is a reminder. At the last meeting, I reminded everybody
that we will be having an agenda-setting meeting on June 11th. Each
caucus is asked to ensure they send the list of proposed topics to the clerk by
Wednesday, May 29th.
July 9th: There is a proposed alternative
witness to represent Nova Scotia Health Authority’s Cancer
Care Program if the topic is the Cancer Screening Programs. I just want to
remind people we’re coming up to Summer and we’re having some issues with
getting witnesses. (Interruption) The approved witnesses are Cancer Care Program senior medical director Dr. Helmut
Hollenhorst and senior director Jill Flinn. They may not be available in
July or August and have asked whether other senior staff and medical leads
could appear in their place. What’s the committee’s view on that? If we decide
not to do that, then we’ll have to try to figure out what the July topic is.
RAFAH
DICOSTANZO: I’m just trying to remember what other doctors were - what I was
interested in is Dr. Siân Iles. Is she coming in or
is she one of the ones who is not coming?
THE
CHAIR: No, the two are Dr. Hollenhurst - whose name I probably said wrong - and
senior director Jill Flinn. Those are the two who are unable to come in July
and August . . . (interruption).
JUDY
KAVANAGH: These two can come.
THE
CHAIR: It’s the two doctors from the Nova Scotia Health Authority who are
unable to come in July and possibly August. Anne Yuill from
the IWK Health Centre is able to and Dr. Siân Iles is able to. The question is:
Are we fine with those two?
SUSAN
LEBLANC: I think if they’re senior staff and working in the Cancer Care
Program, I think that would be fine. It might be nice to see if we can get one
who is administrative and one who is a clinician, if possible, but I think
senior staff is great.
THE
CHAIR: Agreed? It’s agreed. The next meeting is June 11, 2024, 1:00 p.m. to
2:00 p.m., agenda-setting. Is there any other business? Meeting adjourned.
[The
committee adjourned at 2:52 p.m.]
