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May 11, 2022
Standing Committees
Public Accounts
Meeting summary: 

Legislative Chamber
Province House
1726 Hollis Street
Halifax
 
Witness/Agenda:
Funding to Community-Based Health Organizations
 
Department of Health and Wellness
Jeannine Lagassé – Deputy Minister
 
North End Community Health Centre
Marie-France LeBlanc – Executive Director
 
Nova Scotia Association of Community Health Centres
Marie-France LeBlanc – President
 
Our Health Centre
Lorraine Burch – Executive Director
 
Sexual Health Nova Scotia
Leigh Heide – Provincial Coordinator

Meeting topics: 

 

 

HANSARD

 

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

 

 

STANDING COMMITTEE

 

 

ON

 

 

PUBLIC ACCOUNTS

 

 

 

Wednesday, May 11, 2022

 

 

 

LEGISLATIVE CHAMBER

 

 

 

Funding to Community-based Health Organizations

 

 

 

 

 

 

 

 

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

Public Accounts Committee

 

Hon. Kelly Regan (Chair)

 

Nolan Young (Vice-Chair)

 

Dave Ritcey

 

John A. MacDonald

 

Melissa Sheehy-Richard

 

Trevor Boudreau

 

Hon. Brendan Maguire

 

Claudia Chender

 

Susan Leblanc

 

[Melissa Sheehy-Richard was replaced by Danielle Barkhouse.]

 

[Trevor Boudreau was replaced by Chris Palmer.]

 

 

 

 

 

In Attendance:

 

Kim Langille

Legislative Committee Clerk

 

Gordon Hebb

Chief Legislative Counsel

 

 

WITNESSES

Department of Health and Wellness

Jeannine Lagassé

Deputy Minister

 

Tanya Penney

Senior Executive Director, Clinical

 

North End Community Health Centre

Marie-France LeBlanc

Executive Director

 

Nova Scotia Association of Community Health Centres

Marie-France LeBlanc

President

 

Our Health Centre

Lorraine Burch

Executive Director

 

Sexual Health Nova Scotia

Leigh Heide

Provincial Coordinator

Abbey Ferguson

Executive Director, Halifax Sexual Health Centre

 

 

 

 

 

HALIFAX, WEDNESDAY, MAY 11, 2022

 

STANDING COMMITTEE ON PUBLIC ACCOUNTS

 

9:00 A.M.

 

CHAIR

Hon. Kelly Regan

 

VICE-CHAIR

Nolan Young

 

 

THE CHAIR: Order. I’ll call the Standing Committee on Public Accounts to order. My name is Kelly Regan. I am the MLA for Bedford Basin. Just a reminder to folks to please place your phones on silent and to keep your mask on except for when you’re speaking. I’m going to ask my colleagues on the committee to introduce themselves, beginning with Ms. Chender.

 

[The committee members introduced themselves.]

 

THE CHAIR: On today’s agenda we have officials with us from the Department of Health and Wellness, the North End Community Health Centre, the Nova Scotia Association of Community Health Centres, Our Health Centre, and Sexual Health Nova Scotia regarding funding to community-based health organizations.

 

I’m going to ask the witnesses to introduce themselves, beginning with Deputy Minister Lagassé.

 

 

 

[The witnesses introduced themselves.]

 

THE CHAIR: I’m going to invite the witnesses to make their opening remarks, beginning with Deputy Minister Lagassé.

 

JEANNINE LAGASSÉ: Ms. Penney and I appreciate the opportunity to be here this morning to discuss community-based health organizations and the role they play in delivering a variety of health and other services to Nova Scotians. We are joined today by representatives of some of the many organizations working in communities across the province to deliver a variety of services. All of these organizations are committed to ensuring better care for Nova Scotians in their communities.

 

The Department of Health and Wellness provides funding to a variety of organizations that offer a range of health services, including primary care, addictions and mental health care, health promotion, and other social and community supports. As I am sure you’ll hear this morning, these groups often adapt to meet the particular needs in their area, and it is very important that government is nimble in how we deal with them. We know we can do better at this.

 

For today’s discussion, we are here to speak to the funding provided by our department, but many community-based organizations have long-standing relationships with other departments and government agencies that may also provide funding for other initiatives. We have heard loud and clear from frontline staff, our partners, and many others that we need to do things differently. The solutions to address long-standing system issues must be bold and decisive. We need to build new relationships between the traditional health care system, providers, patients, communities, and partners as we transform the delivery of health care.

 

The Province’s new Action for Health plan lays out a vision and a strategic approach that will move our system from problems to solutions. That includes working with our many community organizations in a more coordinated and thoughtful way to ensure we are maximizing our efforts and benefits to Nova Scotians.

 

As much as we are here this morning to answer your questions, we are also here to listen, learn, and then respond with action. The other witnesses appearing today bring unique perspectives and ideas on how we can address some of the challenges our health care system, our communities, and Nova Scotians are facing. We are committed to listening and working with organizations like those represented here today and with communities as we move forward. I look forward to today’s discussion.

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: My name is Marie-France LeBlanc and I’m the Executive Director of the North End Community Health Centre, as well as the Chair of the Nova Scotia Association of Community Health Centres. I’m pleased to be here today to represent both. Community health centres are not-for-profit organizations that provide integrated health and social services to communities. In this province, this approach looks different in every community. Some centres are big, some centres are small, and we all have very different programming. However, what is the same is that from a provincial perspective we all receive our core funding through the Nova Scotia Health Authority and none of us are funded for our administrative costs, for the most part.

 

I’m pleased that both my colleague Lorraine here and I were invited today as we represent very different CHC models and it’s good that together we can speak to both. The North End Community Health Centre celebrated 50 years last November. Over these years the organization has evolved and grown but it has never veered from its mandate to provide services for those experiencing poverty and homelessness, with a specific emphasis on African Nova Scotian and Indigenous communities.

 

We’ve also always maintained our philosophy of meeting our community where they are and providing appropriate services for their needs. This approach and commitment were born 50 years ago, when a group of physicians decided to bring their services to Gottingen Street here in Halifax. It is maintained today by over 65 staff who work at NECHC in three different locations, providing medical care, mental health counselling, nutrition support and supportive housing through a variety of programs: managed alcohol support, trustee services, social work, dental, judicial navigation, and much more. I’m happy to go into a lot more detail about our service offerings; however, what I wish to convey is that we are much more than a medical clinic, but rather we’re a hub where those experiencing poverty and homelessness can receive respectful, non-judgmental, culturally appropriate harm-reduction-based services, whatever the needs are and what those look like for them.

 

As well, I’d like to note that a big part of the mandate for community health centres is the advocacy work we do. At any CHC, that means advocating for changes in support to address the root causes of the social issues facing community: issues like systemic racism, inadequate mental health supports, food insecurity, marginalization, and lack of affordable housing. That is what we as a community health centre and the other community health centres in this province have done since the inception.

 

Yesterday I was asked what the one message was I wanted to convey as part of this. Somebody asked me if it was money. Of course money is always at the root of it, but what we really want to convey is that we are partners in the fight against poverty and homelessness and we are the experts. This was never better shown as part of COVID-19 when all eyes turned to us for solutions. What we need is to be at the table to make those decisions with government to help you better navigate those systems and we need to be funded to be able to do that. Thank you very much. I look forward to the discussion today.

 

THE CHAIR: Ms. Lorraine Burch.

 

LORRAINE BURCH: I’m pleased to be here to speak with you and hopefully work with you as time goes on. Our Health Centre is a community-based community health centre and as Marie-France said, it’s a hub for our catchment area of about 10,000. It is young compared to the North End Community Health Centre: It has been in existence since December 2016.

 

When you ask what gaps we address in the system, I’ll speak specifically about OHC. We have two walk-in clinics: One is a medical one and one is a mental health walk-in clinic. The medical walk-in clinic is run at our expense, because we use fee-for-service doctors and then we use nurse practitioners when we don’t have fee-for-service doctors, so we sometimes run a deficit, but we feel it’s a very big need in our community.

 

We have seen 12,000 patient visits in four years and if you do the math and figure out if all those people went to an emergency room, the cost to the province would be astronomical, so we’re doing it at a cost savings to the province. It’s something we have to continue. There are so many people without a family doctor.

 

The walk-in mental health clinic we are doing, thanks to some grants - one from Bell Let’s Talk and one from United Way for this pilot year and the second year we have funding from the Mental Health Foundation of Nova Scotia.

 

The other work we do is all about supporting the community work that is already being done and sort of networking with all the other people who are doing amazing work. We support the Chester interagency approach, which is a SchoolsPlus program; we have an IGNITE program; Youth in Action for Mental Health at the high school; we work with the Growing Friends collective and they do food security work. We partner with the Public Health Agency of Canada right now for a vaccine education program. We partner with many other organizations in our community. We support the work of Nova Scotia Health. We work closely with them on their recruitment and retention of family doctors. We’re happy to say that we’re part of that group now. Initially we weren’t, but now the culture has changed greatly, so we’re really grateful for that. Then we’re constantly recruiting for fee-for-service doctors, and when we don’t find them, as I said, we hire nurse practitioners - at our expense, because nurse practitioners cannot bill the public health system.

 

We rent space to Nova Scotia Health for 63 per cent of our building. They occupy it for all of their clinics - so primary care, blood clinic, opioid-use disorder clinic, diabetic clinic - and then their staff – Mental Health and Addictions, Continuing Care, and Public Health. But we do not get core funding, contrary - I mean, the model for North End is different. They were in existence long before us. I speak on behalf of the other community health centres: We do not get core funding from the Province.

 

We also rent space to groups like HearingLife and the South Shore Hospice Palliative Care Society and Shoreham Village, which is very close to us. But we want to say we’re much more than a building and a collection of services. We are a hub, and we are recognized as such by that, but we do not sit at government tables.

 

I’ll leave it there, because I know Marie-France spoke about that very eloquently. I look forward to the discussion.

 

THE CHAIR: Thank you. Mx. Heide.

 

LEIGH HEIDE: Good morning, everyone. Thank you for having myself and my colleague Abbey here today. We’re going to share our time, so I’m going to talk quickly. I’m the provincial coordinator for Sexual Health Nova Scotia.

 

SHNS is a community-based non-profit organization that encompasses a network of six sexual health centres across the province, including HSHC. The others are located in Sydney, Amherst, Pictou, Sheet Harbour, and Bridgewater. These centres all provide sexual, gender, and reproductive health services and support, and HSHC is currently our only centre that houses a full-time sexual health clinic. They provide all of these services on extremely low and precarious funding.

 

In 18 years, SHNS’s total operational funding from the Department of Health & Wellness has increased by only slightly more than $100,000 despite our best efforts to communicate the growing needs of our community and our centres. In 2021, our total operating budget was $291,000, with $210,000 allocated between our centres. The five rural centres operate with only one staff member each, and with a total annual budget averaging less than $50,000, these executive directors are making far less than a living wage and being forced to reduce the hours and service capacity of their centres, which of course impacts their community.

 

At SHNS we believe that all people should have access to comprehensive, inclusive, and affirming sexual, gender, and reproductive care when and where they need it. Unfortunately, this is not the case in our province right now. We desperately need change before we lose these essential community organizations.

 

THE CHAIR: Ms. Ferguson.

 

ABBEY FERGUSON: Thanks so much for allowing me to be here and sharing my time with SHNS. My name is Abbey. I’m the executive director of the Halifax Sexual Health Centre.

 

HSHC is an independent non-profit clinic. We are staffed by a team of health care providers who are committed to providing accessible and affirming health care services. We are currently classified as a boutique clinic by the Department of Health and Wellness, preventing us from accessing 23 per cent of the fee-for-service funds available to other primary care providers.

 

 

We receive extremely limited core funding grants. The primary way that our infrastructure - including rent, administrative costs, nursing hours, community education, and clinical supplies - is supported is by a high overhead fee taken off our physicians’ MSI billings.

 

The pandemic has exacerbated already-strained access to health care across the province due to the closure of in-person appointments, leading to delays and backlogs for sexual health services. Currently at HSHC, there is a one-month wait for pap smears, a 12-month wait for gender-affirming hormones, and a one- to two-month wait for IUD insertions. We are overburdened by patients without a family provider as well as those whose family provider is unwilling or unable to provide sexual, reproductive, and gender-affirming services.

 

I’m looking forward to chatting more.

 

[9:15 a.m.]

 

THE CHAIR: Thank you very much. We’re going to start the questioning round. Each caucus will have 20 minutes. I will just cut people off when we hit the 20-minute mark.

 

We are going to start the Liberal caucus now. It is 9:15, so you have till 9:35. Mr.

Maguire.

 

HON. BRENDAN MAGUIRE: I want to thank everyone for being here today. It’s an extremely important topic, especially with some of the stuff that’s coming out of the U.S. and other areas that we’re seeing now which is troubling.

 

I’m going to start with the deputy minister. Just a little bit off-topic. I wouldn’t say off-topic, but just so Nova Scotians know, how many confirmed cases of COVID-19 are there in Nova Scotia right now?

 

JEANNINE LAGASSÉ: I can get that number for you. I don’t have that off the top of my head.

 

BRENDAN MAGUIRE: Are you not receiving daily information? Are you not having daily meetings on COVID-19?

 

JEANNINE LAGASSÉ: I do receive daily numbers - the number for that particular day. I don’t necessarily see the rolled-up number every day, and I didn’t see it this morning, because the numbers weren’t out in time this morning before we came here.

 

 

 

 

BRENDAN MAGUIRE: When we talk about our health care system, this is a government that was elected on health care, to fix health care. We see the word has now changed. We’re hearing from partners here today, and in pre-submissions to the committee, that they’re underfunded, they don’t have the resources they need. Any particular reason why, in the latest health submission to the budget, the resources weren’t provided to on-the-ground organizations that carried most of if not all the weight during COVID-19?

 

JEANNINE LAGASSÉ: I would say that there was some funding provided to on-the-ground organizations through various grants that are done through both the Department of Health and Wellness and the Office of Addictions and Mental Health.

 

BRENDAN MAGUIRE: The issue with grants, though, is that they’re usually one-time, and that organizations like Sexual Health Nova Scotia are stretched thin, and the North End Community Health Centre, they have to divert resources from frontline to continually, year after year, apply for these grants, and Our Health Centre - sorry, I didn’t forget you. I don’t think that’s fair. I don’t think it’s fair when we lean so heavily on these organizations for the work in the communities. Again, my question is: Why did your department not submit - or a better way to put it, why were there no permanent funding increases for these organizations in the health care budget, which is what we were told it was?

 

JEANNINE LAGASSÉ: As we look forward, and some of the work that we’re going to be doing for Action for Health - I know you’re asking about this particular budget, but a number of things are going on at the same time. In Action for Health, we’re looking at the development of a community wellness framework. We’re looking at different models for primary care and how we’re going to fund them, and working with community organizations, various communities, like the organizations that are represented here today, in developing those frameworks and options.

 

I would say that going forward, it may be different than it is right now, but we still have to do the work to hear from community, listen to them, and engage with them to create longer-term, sustainable solutions.

 

BRENDAN MAGUIRE: The issue with that response is that these are organizations that have been long-term and sustainable. These are organizations that have been on the ground for decades. I don’t know if you’re telling me and telling the committee right now that you want them to do things differently when they’ve been doing things successfully for a long time.

 

We’re not reinventing the wheel here. We know that the resources and what they give to our community are invaluable, so by saying here today “We’re looking forward,” it seems like we’re leaving some organizations in the past. We’re leaving them behind. Really, if they don’t have the funding, and if they’re struggling day to day to try to raise funds, and find and secure funds, but at the same time the department is leaning on them to, let’s be honest, do more and more, especially during COVID-19, I don’t think it’s fair to these organizations.

 

Why do we have to reinvent the wheel when we have organizations doing it right for years and years and decades, where the department has applauded their work, and they’ve come back and said, you know what? Thank you for the recognition, but recognition doesn’t pay the bills. How about we get some funding, especially with the price- of-living increase? We’ve heard that some organizations aren’t paying their frontline people a living wage - their executive directors. If this was the government, and this was the Department of Health, and if someone within the Department of Health is an executive director, I guarantee they’re making a living wage and much more.

 

My question is: Why not trust the opinions and the experience of these organizations and give them the permanent funding they need instead of saying we’ve got to go through a process in order to get it, and at the same time these organizations are suffering?

 

JEANNINE LAGASSÉ: I do know that from a number of community-based organizations, we do currently have funding proposals in the department that are currently being reviewed. We’re not saying that we’re reinventing the wheel for these organizations. What I was saying was that we want to look at these organizations as a very important part of the primary care spectrum, and the other services that they provide. As we look across and create new models, the roles that these organizations play are very important, and how can we give them sustainable funding in the bigger picture of how we - because it’s not the only way that we deliver service, so we need to look across the system to ensure that we’re being fair and appropriate, and based on each community as well.

 

The same organization is not going to be the same for every community. We’re not saying these organizations have to do something different; we’re saying how can we make them sustainable, give them sustainable funding within the broader model?

 

BRENDAN MAGUIRE: What is the model? What are you trying to change to?

 

JEANNINE LAGASSÉ: That’s part of what we’re looking at here, but we’re looking at a whole bunch of different things. There’s primary care - a physician service office, as you would know it, to receive primary care. There’s also primary care you can receive at the pharmacy. There are other scopes of practice for other practitioners that we’re looking at. We’re saying what is right in a community with some consistency across the province, but are there things that we need to be doing differently?

 

I think we would probably all agree that we do need to be doing some things differently, so what are those things? There needs to be some planning and consultation that goes into that work before we have something ready to put forward.

 

 

BRENDAN MAGUIRE: Respectfully, you’re talking about collaborative care and expanding the scope of physicians, which has been - I will give credit where credit is due

 

-   collaborative care centres started under the NDP government. It was expanded under the Liberal government. We saw the expansion of the physician responsibility, so it sounds to me like a continuation. Same thing. This government has touted virtual care as a solution. Started under another government, it’s being expanded under this government. It doesn’t sound like there are any new ideas.

 

At the same time, these organizations are saying we’re doing the work for you at probably one-tenth of the price. We heard the Executive Director of Our Health Centre saying that because of their work, 12,000 individuals did not go into the emergency centre. I would dare say if they decided tomorrow not to take those patients, take those individuals, the cost of the health care system would be in the millions and millions and millions of dollars. We know that.

 

The relationship seems unbalanced, if you know what I mean. You’re asking for these organizations to do so much on a shoe-string budget to save government millions of dollars. They’re not asking for all that money back. They’re asking for a small percentage of it. While we’re waiting to do reports, and investigations, and look at different models, at the same time you’re relying heavily on these organizations to continue do to what they’re doing. Can you not see how that relationship seems a bit unbalanced?

 

JEANNINE LAGASSÉ: I don’t think I would say that it’s unbalanced. I would say that we’re working with them. I’ve said to you before, we have funding applications in from some of the organizations, and we’re looking at those, and those won’t necessarily wait as we’re working through things. If we have an application from an organization that requires funding for something that we’re able to accommodate, we will provide that.

 

THE CHAIR: Mr. Maguire, you have just over 10 minutes left.

 

BRENDAN MAGUIRE: The government may not say it’s unbalanced, and the organizations here today may not use those words, but the proof is in the pudding. The evidence shows that it is very unbalanced, that we’re getting exceptional service at a percentage of the cost, that government is relying on these services to help pick up the slack, help deal with wait times, and yet they’re not being properly compensated.

 

Can we commit here today that these organizations that have taken time out of their day to come here today, who are working themselves to the bone for not a lot of money, who could be doing a lot more on a lot less than what government does, will receive not grants but secure funding from now and into the future so that they’re not reapplying for grants every six months to a year?

 

JEANNINE LAGASSÉ: I do know that at least one of the organizations represented here today, I believe, has a meeting set up next week with the department to discuss a funding proposal that they have brought forward. I will commit to speaking to each of the organizations that is here today to discuss what they would be proposing and to see what the department may be able to accommodate.

 

BRENDAN MAGUIRE: I don’t think that was a commitment for funding but I think it was a commitment to listen, which is fine, but again I’ll say that listening - I think a lot of organizations feel like that has been the answer for a long time.

 

Listen, I’m not just pointing fingers. We know that Sexual Health Nova Scotia just said that over the last 18 years they received $100,000. That’s all three parties. This is the first time I’ve ever heard of that. That is absolutely embarrassing and, quite frankly, shocking. I don’t know how anyone can call them a partner at this point. It’s not a partnership any more. It really isn’t. It’s just not the best relationship when we’re relying on organizations to do all the heavy lifting and they don’t. They didn’t say it here today but you can feel it: They don’t feel appreciated by the government. They don’t feel appreciated by the department. Listening is one thing but actually putting the resources in

 

-  and I’ll use the Premier’s words - “a historic health care budget” - these individuals should be seeing historic funding increases.

 

Some of the other things I wanted to speak about were: We know that the health care platform has been removed online and been replaced with a new one. The platform that was submitted when in opposition and during an election, the platform that the PC Party put forward to fixing the health care system, has been taken down and a new, revised one has been put up.

 

One of the things the Premier ran on and the ministers ran on was 24/7 surgeries, access to 24/7, 365 days a year surgery. This would be the first of its kind in the world, I think. This would fall on the deputy minister and the Department of Health and Wellness to achieve.

 

How many doctors and surgeons are needed? I have friends and family members who are doctors and surgeons. We have some of the most renowned surgeons in their field living in my community. When I asked them about that, they actually laughed. They said, good luck getting me in 24/7, 365 days a year. So is this achievable? How many people would need to be hired to achieve this?

 

JEANNINE LAGASSÉ: I’m going to ask Ms. Penney to take this question in relation to the planning for surgical wait times.

 

TANYA PENNEY: We’ve been spending a fair amount of time with the Nova Scotia Health Authority’s Perioperative Network and their leadership across all four zones to figure out how it is that we can recover from COVID-19, from a surgical perspective, as well as to meet the national benchmarks for that. When it comes to setting up operating rooms right now, with the amount of deployed staff from a COVID-19 perspective that remain in place, we’re really trying to look from an HHR perspective and figure out how it is that we can pull those folks back to the perioperative world. Once that happens, then we’ll be able to do some planning around what it is that we need from an increased RN perspective - anaesthesia, anaesthesia assistant, surgery support. We really need to make sure that can get a level set and get back into what it is that we would call normal business, kind of post-COVID-19, before we can start to look at those sorts of pieces.

 

I will tell you that Dr. Greg Hirsch and Cindy Connolly from the network perioperative perspective at the Nova Scotia Health Authority are working 24/7.

 

[9:30 a.m.]

 

BRENDAN MAGUIRE: That’s great to hear, that at least somebody acknowledges that COVID-19 is having an impact on our health care system and society. I know that some feel like we need to get on with life as usual and that it’s not going to have an impact.

 

The question wasn’t “When are we going to meet the national benchmarks?” The commitment was 24/7 surgeries, 365 days a year. That was the commitment. It wasn’t meeting national benchmarks. It’s to be the first of its kind anywhere, I think, in the world.

 

Are the Department of Health and Wellness and the Premier still committed to 24/7, 365 days a year? Yes or no?

 

TANYA PENNEY: Yes, and that takes planning.

 

BRENDAN MAGUIRE: When can we expect to see it?

 

TANYA PENNEY: I think I alluded to it in the first piece. We’re really just in the initial stages of planning and trying to figure out how it is that we level-set from a staffing perspective and figure out then how it is that we need to be able to move forward toward the 24/7 surgical services.

 

THE CHAIR: Mr. Maguire, you have three minutes.

 

BRENDAN MAGUIRE: I’m just going to tell you what I’m hearing from health care professionals and surgeons: It’s never going to happen. It’s never going to happen. You’re going to have to double, triple, quadruple your surgeons and your anaesthesiologists, and I dare say that there aren’t a lot of anaesthesiologists graduating year after year after year, and those who are are in extremely high demand.

 

What is the percentage of staff increase you will need to commit to actually achieve 24/7, 365 day, and what is a time frame - a roundabout time frame - that Nova Scotians can expect to see 24/7, 365?

 

 

TANYA PENNEY: My apologies, I didn’t bring the periop strategy folder with me today. We can certainly try to get some of those answers for you. What I would say is that immediately, right now, we are focused on how it is that we ensure that we get surgical services back up and running in all of our surgical sites and committing to 2,500 surgeries in this fiscal year.

 

BRENDAN MAGUIRE: COVID-19 is still having a drastic impact on our wait times, on our surgeries, on our staffing level at hospitals. Just a quick yes or no.

 

TANYA PENNEY: Yes.

 

THE CHAIR: Ms. Penney, those details that you mentioned that you didn’t have with you, you can just send them in to the committee. Just address it to me and we’ll be able to share it with the members.

 

Mr. Maguire.

 

BRENDAN MAGUIRE: The issue we have with some of these promises is that we’ve got a massive backlog of surgeries, and not just surgeries but people coming in for tests. That’s going to have a huge impact on people’s lives. People who are waiting for colonoscopies, people who are waiting for prostate exams, people who are waiting for all kinds of different things that would be preventable and treatable if caught early. Right now, we know that people are waiting a long time for some of these basic tests. This is going to have a huge impact on the health care system and people’s lives, correct?

 

TANYA PENNEY: I feel like you keep just wanting me to give one-word answers. The short answer is “yes,” and then there’s an “and” at the end of it, which is how is it that we look at service deliveries? How is it that we try to increase HHR in places so that we decrease backlogs? How is it that we actually spend some time figuring out where it is that those services are needed most?

 

THE CHAIR: Order. Thank you, Ms. Penney. The time for the questioning from the Liberal caucus has elapsed. We now move on to the NDP caucus. Ms. Leblanc.

 

SUSAN LEBLANC: Thank you to all of you for being here. I just wanted to say first of all, especially to you folks who are representing community organizations, I have great respect for the work you are doing. I want to make a couple of general comments before I ask some specific questions, comments and questions based on your openings.

 

The first thing is that it’s shocking to me that our health centre has to apply for grants from Bell Let’s Talk and the other organization you said - the United Way - to run mental health walk-in programs. We heard from the former government and the current government that mental health was a priority in this province, so it does not make any sense to me that you have to go and ask for money from these organizations when we should be funding mental health walk-in programs. I think that the North End Community Health Centre would agree, although I believe there is some government-funded mental health walk-in, or there was at some point – the Pause program - was there not? That’s not an official question. We’ll leave that.

 

It is also befuddling to me that the North End Community Health Centre, which has been in existence for 50 years, doesn’t have admin cost funded. It’s also befuddling to me that Sexual Health Nova Scotia and the Halifax Sexual Health Centre have physicians working who are getting paid 23 per cent less than their physician colleagues because they are a boutique clinic and boutique services, when it’s all part of primary care. It’s just shocking to me.

 

We know there are 92,000 people on the wait-list for a family practice provider. That’s almost one in 10 people who don’t have a doctor or a nurse practitioner. We know that this has enormous effects on our entire health care system. We know there are no actual details in the Action for Health plan, although the deputy minister and Ms. Penney both referenced the action plan. We don’t see specific details in that plan about how we’re going to address the primary care problem. We’re lucky today that we have folks who are working on the ground.

 

I guess my first question for Marie-France LeBlanc is: When you say that you don’t have a seat at the table, or that you would like a seat at the table, because, rightly so, that everyone looked to your organization when COVID-19 happened, in terms of how a COVID-19 response can be rolled out and be effective, what would a seat at the table look like? What are you asking for and what are you getting?

 

MARIE-FRANCE LEBLANC: That’s an interesting question. A seat at the table is, how do you make decisions for our communities? For instance, at the North End Community Health Centre we still have the same complement of doctors today that we had 50 years ago - 4.25. We’ve been asking for additional physician services forever.

 

We finally got new funding for physician services from MOSH but it’s sessional funding, which again is not ideal. So we’re eating the cost of the administration in order to ensure that our doctors are paid appropriately, because we can’t get MSI funding. We have a location in Albro Lake which the Nova Scotia Health Authority, for free, comes and does a clinic there. They pay us nothing for that, so we run clinics at our expense, for the NSHA, because we think there’s a need for it. It’s an addictions clinic, it’s a pain clinic.

 

Similarly, there are tons of people who need doctors there. We can’t get an FTE to put a doctor in there, so we have the facility. If we were at the table, we could make the case for these things.

 

I don’t know about this application process and I don’t mean to throw the government under the bus, but we’ve never been asked for an application. We haven’t been asked for new funding. We have to go through the NSHA that then says, well, we don’t have the money from the Department of Health and Wellness. Then we go to the Department of Health and Wellness, and they say, go to the NSHA. It’s kind of a roundabout service, it’s not the right way to approach community health centres.

 

I’m not saying that anybody doesn’t want to help us. Everybody wants to help, everybody wants to be part of it - there’s just no system. We’re not at the table to make those decisions. Decisions are made and then we have to fit into those sections.

 

You asked about mental health services. Of course we applied for the same grants as everybody else does, and we do get those grants to supplement what we get because obviously there are not enough services. Our Pause: Mental Health Walk In Clinic, which is the same one that Lorraine now runs, is a one-off. What we need is counselling. What we need is supportive, continued, but we don’t have funding for those things, so we’re actually applying for another grant right now in order to supplement to do that, because we’re not at the table. If we were at the table having these conversations with the Office of Addictions and Mental Health, with the Department of Health and Wellness, with the Nova Scotia Health Authority, then there would be knowledge of what’s needed out there, there would be knowledge of what the services are that we’re providing, what the services are that need to continue to be provided.

 

That’s not to say that we’re never at the table. The Overlook, which is our new program, is a tremendous opportunity. That came through the Department of Community Services, however, not through the Department of Health and Wellness.

 

We need to be able to be used as the experts that we are when decisions are being made, not just when there’s a crisis, and oh my gosh, how do we do this? That’s great, that’s what we’re there for, but COVID-19 is a prime example. We never shut down. We were open the whole time. We also supported everybody who was in the hotel system, everybody who was in the shelter system, with the same people. We got United Way grants, we got other grants, but it was the same staff doing the same thing, and again, our staff complement has barely increased in 50 years.

 

The seat at the table means coming to us while you’re doing the planning, while you’re making the budgets, not after the fact.

 

THE CHAIR: Ms. Leblanc, you have just over 13 minutes.

 

SUSAN LEBLANC: The great point that you made just now is that you have to have a seat at the table, you have to contribute to the conversation while all the planning is going on. I think I’d like to ask Deputy Minister Lagassé, not to say that Ms. LeBlanc needs my advocacy here, because I think she knows exactly what she’s doing, but can we have a conversation here? Can you commit that the department will confer with experts like the North End Community Health Centre when making the primary care plan?

 

 

JEANNINE LAGASSÉ: I believe I’ve already committed this morning to have a conversation with each of the organizations that are here today. I would also say that I’ve spoken, I believe, already this morning to as we create our wellness framework, we look at our new models of primary care, that a very large portion of that work is community engagement. Absolutely we will be speaking with communities and organizations that deliver these services.

 

SUSAN LEBLANC: Excellent. This is a bit of a different question, but our billing code model is largely set up to incentivize family physicians to provide comprehensive care. This is important, but some gaps in the model are having an impact on Sexual Health Nova Scotia and on community health centres, as we’ve heard this morning.

 

From the Halifax Sexual Health Centre’s submission: Sexual health clinics have been labelled by the department as boutique clinics, and as such, physicians are paid less to perform services than a family physician would be paid in their office. This was instituted to incentivize family physicians to provide comprehensive care, but the initiative has not worked. We receive high volumes of daily referrals for all forms of sexual, reproductive, and gender-affirming care.

 

The referrals are made by family physicians who don’t want to offer those services and by patients who do not have or struggle to access their primary care providers. We have many patients who regularly travel into Halifax from rural locations, as they cannot find resources in their communities.

 

I’d like to ask Mx. Heide: Can you please elaborate on those challenges, and what changes would be needed to address this issue?

 

LEIGH HEIDE: I will elaborate a little bit, and then I’m also going to ask Abbey to, because part of the reason that I wanted to make sure Abbey was here today was to speak to the specifics of the Halifax Sexual Health Centre, because it is different, and the model is different, where they have a clinic, but I just want to say that our five rural centres, and I said this is in my opening, don’t have clinics in house. That is because they’re nowhere near the funding they would need to do that. That has always been our long-term hope and goal.

 

Sexual Health Nova Scotia has existed since 1974 in one form or another. We had many names. It’s always been our hope that we would have sexual health clinics similar to HSHC in all of the communities that we have centres in, and more, because there are huge gaps. We have no centre all the way from Bridgewater to Yarmouth. We have nothing in the Annapolis Valley. I would like to think that that’s not just a pipe dream and that there is hope that we can establish sexual health clinics in each of those areas that would be able to meet the needs so that people don’t have to travel. People shouldn’t be travelling on their own dime from Yarmouth to Halifax for an STI test and they are, every day, all the time, from Cape Breton to Halifax for a pap smear. I’m not exaggerating.

 

[9:45 a.m.]

 

I do want Abbey to respond in terms of the specifics, as you were talking about the MSI billing codes and the boutique system. I’ll let Abbey speak to that.

 

ABBEY FERGUSON: Yes, when the ME=CARE plan got put into place, we got labelled as a boutique clinic. That happened without any conversation with us at all. I am particularly able to speak to this because before I was the executive director, I was the med admin for five years with the clinic. I remember going to bill our regular evening incentive codes and then they were all getting rejected, and we could not figure out why that happened. It took several different calls to several different departments to figure out why we suddenly couldn’t bill that. We used to be able to bill different incentives, like evenings and weekends, and that has all been packaged together with ME=CARE, so because we cannot access that code, that means we can’t access any sort of incentive. That’s a big deal for us.

 

Our primary funding, or primary model, is by taking that overhead from physicians’ fees. Just imagine the difference if we got a 23 per cent boon to that. The idea that we’re classified as a boutique clinic is a way to say that we’re just seeing people in the same way that a walk-in is, which is not true. We have over 65,000 patients registered, and we see 10,000 to 11,000 every single year.

 

I did a report from our medical records system in March: The number of repeat patients in the past five years was over 11,000. So we’re seeing people repeatedly, particularly for gender-affirming care. We’ll see these folks every six months for the rest of their lives if they never get a primary care provider who is willing to do gender-affirming care, so it’s very impactful to us.

 

SUSAN LEBLANC: The Halifax Sexual Health Centre points out that a number of issues - the fee-for-service billing structure - and has proposed a couple of solutions: for example, reclassify sexual health clinics as primary care collaborative clinics, and pay a sessional rate for physicians providing gender-affirming care.

 

This question is for the department: It’s important to point out that these challenges would be greatly reduced with adequate funding to the community-based health organizations, but in the meantime, will the department make these changes? If so, when?

 

JEANNINE LAGASSÉ: It is my understanding that our physician services group has been having ongoing discussions about this. I’m not sure if it’s with the folks who are here today, but there have been ongoing discussions about it, and if there is comprehensive primary care being provided at a clinic then that code is to be paid. Yes, I will say that, and that there is absolutely ongoing discussion about being able to make sure that we all have the information that we need to be able to do that.

 

SUSAN LEBLANC: It certainly seems like if we have a crisis of primary care in the province, and there are folks providing primary care, that we should probably just pay them to do primary care work, and then we can at least have a slight bit of that crisis alleviated. Certainly I go to my primary care provider for a pap smear every three years, I guess it is now, and other reproductive care, so it seems to me that if someone is going to the clinic for a pap smear that they should be paid as a primary care provider.

 

The fee for service billing structure also prevents challenges for community health centres. I know that our health centre in Chester has gone into deficit, as Ms. Burch mentioned, to staff nurse practitioners. Also we understand that that was repaid back to the clinic as an emergency grant, I guess. I’m wondering: Could Ms. Burch talk about how the changes to the fee-for-service model for nurse practitioners and social workers actually in community health centres could provide the care without this going into deficit and then having it be repaid by the government?

 

LORRAINE BURCH: To speak to our Well Woman Clinics that we run, we hire a nurse practitioner to do that, and we pay them out-of-pocket because there’s no billing and there’s no way to bill MSI for that.

 

Your other question was about the fee for service doctors for the walk-in clinic - medical walk-in?

 

SUSAN LEBLANC: Essentially if there could be a change in the fee-for-service structure, how would it benefit what you’re doing? If nurse practitioners were able to bill for primary care without a physician there, what would that mean for you?

 

LORRAINE BURCH: We’ve asked various bureaucrats and politicians about this but have been told that it’s a federal issue, that the Canada Health Act does not allow nurse practitioners to bill the public health system. I think it’s beyond the province, from my understanding.

 

What it would mean for us, for our medical walk-ins, is that we have nurse practitioners willing to work for us, but we have to pay them. Back to your point, we want to have our walk-in clinic open regularly because it isn’t your typical family-focused walk-in clinic, where it’s an in and out. Our doctors act as family doctors because of so many unattached patients. Out of the 12,000 visits that we’ve had to the walk-in clinic, half of those are by people without a family doctor. They rely on the doctors at our walk-in clinic to be their family doctor, and they are paid at a lower rate than a regular family doctor. That’s another billing issue that is established here. It would help a great deal.

 

 

SUSAN LEBLANC: The Nova Scotia Association of Community Health Centres has a years-long ask for stable operational funding. The funding crisis has passed a breaking point. In 2016, the Rawdon Hills Community Health Centre was forced to cease operations after years of unsuccessful appeals to the Province for operational funding. It is a fate that other community health centres throughout Nova Scotia may face if the government does not commit to operational funding.

 

I’m wondering - I’m going to ask the deputy minister this: Why have community health centres not been given operational funding to this point? I understand that you’re looking at it and it may change, but do you have a sense of why that happened, or why it is happening?

 

JEANNINE LAGASSÉ: I don’t have the way-back history on this, for sure, and certainly even 2016, when Rawdon Hills would have closed, was before my time at the department. I’m sorry, I can’t speak to that piece of it.

 

I would say that part of the answer is in the looking-forward answer. We haven’t looked at the system before as a system. We’ve looked at it as various pieces of primary care. We’ve looked at collaborative care centres as one thing. We’ve looked at independent fee-for-service physicians’ offices as one thing. We’ve looked at community health centres as one thing. We haven’t ever looked at it across the entire continuum to see how all of these interact and provide the best service into community.

 

I think that’s really what’s different, I would say, and probably part of the reason why we may not have looked at the community health centres in the same way as we are hoping to as we move into the future.

 

SUSAN LEBLANC: We know that an average cost to go to the emergency room is $304 and has been rising over the last number of years. We also know that lots and lots of patients are visiting the ER because they don’t have access to primary care. That’s certainly true in Dartmouth. In comparison, a nurse practitioner makes around $53 an hour and can ostensibly see multiple patients in an hour.

 

I guess my question is for Ms. LeBlanc: Can you talk more about the cost effectiveness of a team-based model of care - in two minutes?

 

MARIE-FRANCE LEBLANC: I don’t think that I can do it justice in two minutes. What I would say is that for us, the deviation to the emergency rooms is huge. You come into our clinic and you can see a doctor, a nurse practitioner, a nurse. We take blood. We do addictions counselling. We do social work.

 

We can only take who we can take. We’re way oversubscribed in terms of - we don’t turn anyone away who has a need, but as a result, our caseload is probably double what it should be. We not only deviate to the visits but also the stays in hospital because we also do outreach. We go to the shelters. We go to the couches where people are sleeping. We go to the encampments. For us, we’re really taking an approach that takes people away from the emergency rooms.

 

We also meet with the emergency room nurse - one of the emergency nurses - once a month to talk about the patients in order to provide support for them when the patients go there, in order to not burn out the emergency rooms, both in Dartmouth and in Halifax. The North End Community Health Centre is not just Halifax. It’s not the North End. It’s HRM-wide.

 

We are a solution to a problem, as I keep saying. Nurse practitioners are a big piece.

 

THE CHAIR: Order. Time for the NDP questioning has elapsed. We will now move on to the PC caucus, and we will begin with Mr. Palmer.

 

CHRIS PALMER: It’s been a great conversation so far. We’ve had some discussion already about the recently released action plan for health, and we’ve had a bit of discussion on how there’s been collaboration and some different things with community health centres.

 

I’d like to ask the deputy minister, Ms. Lagassé, if you could maybe elaborate a little bit more on any specific work and collaboration that the plan for health outlines with community health centres to expand services - if you could do that for me.

 

JEANNINE LAGASSÉ: As you’ve said, we’ve discussed a few of the things already where we see discussion, engagement with the community health centres and other community organizations as well to be really important as we move forward. One of those aspects is the development of the community wellness framework so that we can ensure that communities are receiving the services that they need in a particular community.

 

We’re also looking at the primary health care models that we’ve already discussed, and I think the other thing is building on and making strategic investments in diverse communities and ensuring that we are working with community organizations to design culturally safe and appropriate care. I think those are definitely some of the areas where we see collaboration going forward.

 

CHRIS PALMER: This question could be for the deputy minister or maybe Ms. Burch or Ms. LeBlanc: The plan that was just released had a commitment to establish a $2-million fund for recruitment and retention for local communities. Could any one of you discuss how community-based health organizations are often best suited to address the health care issues like recruitment and retention?

 

THE CHAIR: Ms. Burch.

 

 

LORRAINE BURCH: I’m happy to speak to that. There has been improvement in the system around recruiting and retaining doctors. When we established ourselves in 2016, that was when the transition happened to the Nova Scotia Health Authority and communities weren’t involved at all. We are now part of the recruitment team for the Western Zone area, so that is helpful. We know our community best. We know where the resources are if doctors need day care, if they’re looking for housing or whatever. We need to stay at those tables for sure, and I see that going forward.

 

CHRIS PALMER: Just one more question about the plan. The government is committed to establishing a community wellness framework to guide long-term funding for community organizations working to improve community wellness. We’ve had that discussion a little bit already and how that would be important, but I’d like to ask: What difference would stable funding and government support make in helping the community-based health model succeed even more? Could you really elaborate on that - if you would, please?

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: You would allow for planning. You would also allow for appropriate resources being allocated. One of the things that happens right now is that we never know - I’ve had the same funding now for three years, and unless I develop a business plan and go argue it and look into the future, I don’t - and actually, my contract says that the NSHA reserves the right to take away the funding. It’s not guaranteed from year to year. I get to do no planning.

 

Also, the way the funding is designated, it’s done per FTE. There is a small bucket for administrative costs, but certainly not sufficient to cover what we’re doing and, in fact, it’s not designated. So we actually tend to use that to supplement the FTEs that we have in order to put it back into client care, because there’s so much need for that. Like I said, our increase in physicians hasn’t increased in 50 years, and now we support all of HRM.

 

We need to have stable funding that is very specific to what it is. For instance, when I get a bucket of money like that, try telling your staff, no, you can’t have an extra day of nursing care, even though our lineup is out the door, because I need to pay for me to work an extra day, or I need to give this person - our receptionists don’t make a living wage right now. There are a lot of things we could do if we had the funding.

 

The other thing is we could add some services to supplement what we’re doing but at this point it’s always a business case that goes to one person that then needs to go to another person. The last business case took two years to get through the system. By then it was obsolete. We got the money - it was right before COVID-19 - but it was obsolete by then because so much had changed.

 

CHRIS PALMER: I’ll now pass it on to my colleague, MLA Barkhouse.

 

[10:00 a.m.]

 

DANIELLE BARKHOUSE: Ms. Burch, we are so fortunate to have the OHC in our constituency in Chester-St. Margaret's. Our Health Centre is represented here today by the Executive Director. I’ve been very pleased to see continued collaboration between the centre, the Department of Health and Wellness and Nova Scotia Health, as well as with other community organizations.

 

To follow up on your opening statement, can you give us some more detail about how Our Health Centre partners with the community? I want everyone listening to understand how intertwined you are and how much it brings everything together.

 

LORRAINE BURCH: Right now we’re involved with Dalhousie University in a project around research to define social network mapping for our community. That’s defined where everybody is doing wonderful things that connect us all.

 

We are involved with the South Shore Housing Action Coalition. We have worked with South Shore Sexual Health and brought them into our clinic. They help us when we host our Well Woman Clinics. We are involved with the Nova Scotia Food Security Network. We are involved with Chester interagency, which is all the school programs, and on and on. We’re always looking to connect the network because that’s the only way we can serve our communities. We do an annual survey. We just finished that, so we have a lot of data we’re looking at. People are telling us what they need and what’s missing.

 

Could I make another point that’s a little bit off-topic? Part of the confusion is that within this province there are other clinics called community health centres. I think there are about eight or 10 that are actually medical clinics run by Nova Scotia Health, so when people hear the words “community health centre,” they don’t actually understand what a true community health centre is. We are the wraparound care. We are not just a medical clinic. As I said, we’re looking out for everybody and their needs around the social determinants of health.

 

DANIELLE BARKHOUSE: Yes, you are one of six, I think, which is fantastic.

 

Recently we provided the centre with a one-time grant of $35,000, in addition to existing funding arrangements. How is this grant used to support the centre from that and the community and, dare I say, beyond, because I know the health centre takes in everybody who comes to the door, no matter what constituency they live in?

 

LORRAINE BURCH: Yes, that’s correct. As I said, our catchment area is 10,000 but if you look at our data from our walk-in clinic, they are coming from HRM, the Valley and down the South Shore.

 

 

 

The $35,000 was gratefully received. What it did was it wiped out our deficit from our walk-in clinic. We don’t get other operational funding. Nova Scotia Health pays for the footprint that they use in our building, 63 per cent of the building for their staff. We don’t oversee that staff so we don’t deal with their salaries or their operational day-to-day things. It is rent for space used, so that is the difference.

 

As Marie-France has said, what we’re looking for is to be at the table when decisions are made so we can help plan and improve the system.

 

DANIELLE BARKHOUSE: Deputy Minister Lagassé, community health centres are often required to respond to operating pressures that might come from the loss of revenue to cover overhead costs when a physician leaves or a sudden increase in the cost of expenses. How has the department worked to assist community health organizations in meeting challenges like these when they occur to ensure their financial stability and thus their ability to continue their operations?

 

JEANNINE LAGASSÉ: I think that Ms. Burch has already explained the assistance that we gave to Our Health Centre just this past year. We also gave a one-time grant to the Dr. Kingston Memorial Community Health Centre to assist them with some rent for this past year, so those are two examples just within this past year of additional funding that we would have given. I can’t speak to the past, but I know that Ms. Penney has been working on a couple of different things, and as we move forward, we are more than willing to engage in discussions with the organizations and to receive applications and have discussions with them about emergency funding that they may need, but we’re also very interested in the discussion about longer-term sustainable funding.

 

THE CHAIR: You have nine minutes left, Ms. Barkhouse.

 

DANIELLE BARKHOUSE: I will pass it on to MLA MacDonald.

 

JOHN A. MACDONALD: You folks are doing great work. This is to the deputy minister or Ms. Penney. The groups have said that they have room for expansion, but recruitment is a problem. How is the new Office of Healthcare Professionals Recruitment and the community groups working - are they working together to fix that? What’s the relationship?

 

JEANNINE LAGASSÉ: I don’t want really want to speak on behalf of Deputy Minister Orrell here, but I can tell you that his office is working with a number of community organizations. I think Ms. Burch has spoken about the relationship that they now have with NSHA recruitment, and I think the new Office of Healthcare Professionals Recruitment will also be engaging with communities. They’re just very interested because we know that the communities know best, where their gaps are, where their challenges are, and what opportunities there are.

 

 

 

As Ms. Burch said earlier as well, we know that they’re the ones who know their community best, not just from the medical or the health centre perspective, but how to connect health care professionals into the community.

 

JOHN A. MACDONALD: This is to the deputy minister. During the Speak Up for Health Care tour that you participated with, there were a bunch of community groups that were involved, one being the Nova Scotia Association of Community Health Centres, that were consulted and engaged. Can you discuss the communication that took place between the government and the community-based organizations through the tour, and what you’ve learned from and about them?

 

JEANNINE LAGASSÉ: As the members would know, the majority of the consultation through the Speak Up for Health Care tour was with frontline health care professionals. Actually, I met with a number of the members here at various locations where we met with those individuals. After the week-long tour itself in September, Minister Thompson did undertake, I think it was, between 20 and 30 individual virtual meetings with community-based organizations and other health care organizations and stakeholders so that she could hear from more than just the people we were able to see in that one week that we were actually out on the road.

 

What we’ve learned from the community organizations and other stakeholders is really, we hear about what’s going on on the ground, what the challenges are in a particular community, and things that might not normally come to our attention in our day-to-day work, a very important piece of the work going forward. We’ve established our equity and engagement division within the Department of Health and Wellness so that they can be out more in communities engaging with folks. In addition to talking about their issues and solutions that they’re bringing forward, it’s just really the work that they do in community to reflect their community.

 

I know I’ve said that a few times already, but it’s very important that each community be able to articulate and advocate for what they need in their particular part of the province or for their particular group of individuals.

 

JOHN A. MACDONALD: I’ll defer the rest of my time to MLA Ritcey.

 

THE CHAIR: Mr. Ritcey.

 

DAVE RITCEY: This question is directed to the deputy minister. In Truro, my hometown, the Nova Scotia Health Authority and Lawtons Drugs have partnered to bring Lawtons Drugs Pharmacists Walk-in Clinic+ to our local community. I was pleased to visit the clinic just last week. The clinic allows for pharmacists and a nurse practitioner to provide primary care to improve access to care for local residents. Can you discuss these ways in which we are exploring and advancing innovative models in primary care delivery at the community level and their successes?

 

 

 

JEANNINE LAGASSÉ: I think Ms. Penney is going to take this question, if that’s

okay.

 

TANYA PENNEY: Certainly looking at fairly extensive changes of models of care from the primary care perspective. Traditionally looking from a doctor’s office and then from a nurse practitioner’s perspective, really the walk-in plus piece they’re talking about in Truro is exceptionally exciting. So paramedics’ expanded scope, pharmacies’ expanded scope, nurse prescribing, RN prescribing pilots that are happening around the province, I think it’s all leading to a strategy to ensure that Nova Scotians have access to primary care in a variety of different ways, in a multi-pronged strategy approach. It’s very exciting.

 

DAVE RITCEY: This next question is for Ms. Burch. The government has recently taken action to expand virtual care to everyone who is on the wait-list for family practice. Virtual health services are also being expanded and made more accessible with innovative pilot programs such as the one in Truro and the local library in Pictou.

 

As many community health centres provide virtual care or offer consults with specialists, how do you see the investment in virtual care as positively impacting the community health centres that offer it in health care in Nova Scotia in general?

 

LORRAINE BURCH: We were pleased when the pandemic started when the government allowed walk-in clinics to use virtual care codes. That made a huge difference because we also, like the North End Community Health Centre, stayed open. We never closed our doors and virtual care was the only way at the beginning of the pandemic. We use it at our walk-in clinic, and we see it as a model for sure, going forward.

 

Could I just go back to the issue around the naming of community health centres? Just to be clear, the Nova Scotia Association of Community Health Centres, there are six of us right now, we are community-owned and governed. The Municipality of Barrington has just passed a ruling that they are going to open a community health centre and there’s a Pictou County working group also.

 

It’s wonderful to think that communities are still looking to that model and they’ll be looking for support going forward. The issue with the public around branding is that the Cobequid Community Health Centre is in here, the Annapolis Community Health Centre, and those are provincial medical clinics called community health centres.

 

We struggle with getting the message out about the value of a true community health centre. I just want to stress that.

 

THE CHAIR: Mr. Ritcey, two minutes.

 

DAVID RITCEY: I’ll pass my time.

 

 

 

THE CHAIR: Over to Mr. Young. You have two minutes.

 

NOLAN YOUNG: With two minutes, I guess just briefly I’ll start with one of the mental health and addictions questions to Deputy Minister Jeannine Lagassé. Across the country opioid poisoning has become a major challenge. In 2021, 45 Nova Scotians died as a result of this. If you remember my maiden speech here, I talked about losing several close friends with opioid poisoning.

 

My question is: How are we responding to this challenge - are community-based partners part of the solution?

 

[10:15 a.m.]

 

JEANNINE LAGASSÉ: Yes, in the mental health and addictions space in general, community partners are extremely important and a big part of delivery. One of the areas in particular related to opioid is the overdose prevention sites that have been funded. One of them is with the Mi'kmaw Native Friendship Centre’s Direction 180, and the other one is the Ally Centre of Cape Breton - those are both funded for overdose prevention sites.

 

We also have partners that do needle distribution and harm prevention services for us - Mainline Needle Exchange, the Ally Centre of Cape Breton again, and Northern Healthy Connections Society. Those are some of the main partners that we have in this.

 

NOLAN YOUNG: With 15 seconds left I’d just like to say thank you and I’ll pass it back to the floor here.

 

THE CHAIR: Now we’ll move into our second round of questioning. Each one of the caucuses will have eight minutes, beginning with Mr. Maguire.

 

BRENDAN MAGUIRE: I think how we should be reacting to the pharmaceutical company is suing their pants off for the damage they’ve done and the opiate crisis they’ve caused, and the lack of responsibility they’ve taken in all of this. We’ve seen this in other jurisdictions, where the courts have had to get involved and other jurisdictions have taken them to court. So that’s my rant on the pharmaceutical company.

 

My question is to Mx. Heide. I’m just blown away by the shoestring budget that you’re running things on. First and foremost, to you and your staff, a heartfelt thank you.

 

Forgive me if I’m wrong for saying this, but I’d like to have your opinion on this. We’ve heard that the 2SLGBTQIA+ community in particular is very vulnerable, especially when it comes to health care needs. I’m sure you’re taking every dollar and trying to stretch it into a thousand, but what happens when people aren’t getting the timely access they need? What happens to that community when they aren’t getting the resources? How vulnerable are they, especially with the decisions that they have to make?

 

LEIGH HEIDE: That’s a really important question. There are so many ways I could answer this, I think. I was thinking of an example that might help paint the picture of what can happen. I want to talk about our Pictou County Sexual Health Centre for a minute. I did include them, of course, in our list of six centres. However, they’ve been closed for just about a year because of a lack of funding. They’re the first one of our centres to have to pull the plug and close. They went into debt and couldn’t pay their staff member and had to give up their physical space that they’d had for over 20 years.

 

There were a number of folks who were being served there around gender-affirming care specifically, who have reached out to Sexual Health Nova Scotia since Pictou had to close to say, I was getting support here, with help navigating the health care system as well. Without a clinic as part of the Pictou centre, what they were able to provide was health care navigation and support, which is actually a huge piece, especially when it comes to gender-affirming care, because - and I can say this also as an individual trans person - understanding how to get gender-affirming care in this province is impossible.

 

PrideHealth’s website and HSHC’s website are kind of the only two places where you can get somewhat of a breakdown of how to access hormone therapy, or gender-affirming surgery, or any other elements that you might need. But even then, they’re kind of doing their best to put together pieces of a patchwork system.

 

These folks I was hearing from in Pictou were now left without someone to help them navigate that, and the support around that. It’s not easy, especially if you’re coming from families, communities, social circles, or schools where your gender identity isn’t accepted at all. You have no one maybe to talk to about what your needs are, and then for the first time, you’re saying to someone, “I’m trans and I think this is what I need.” That’s what they were able to get at that Pictou centre from our one staff member who worked three days a week because that’s all they could afford. Now they don’t exist at all and we haven’t been able to get them back up on their feet.

 

For those folks, I’m hearing from people in absolute desperation not knowing how to get what they need, not knowing how to access it. Then they’re being left with - which they probably would have had to do anyway - having to go to HSHC for the actual medical part of transition, perhaps, and on their own dime for travel and all that stuff. There are trans people of all ages in our province, but the ones I’m hearing from right now are young people. They don’t have access to transport. They don’t have anyone to ask. They don’t have the funds for that.

 

You can imagine - I don’t think I have to say that that’s lifesaving support and care that those people don’t have. If it’s lifesaving care and they don’t have anywhere to turn to, I don’t have to say what happens. And we don’t always know. I just stop hearing from people.

 

BRENDAN MAGUIRE: Thank you for that. I feel like that’s something that needed to be said, and I hope that by shining a light on that centre being closed - in the Premier’s backyard - that funding comes out of this from the Public Accounts meeting and from the deputy minister.

 

I’ll go back to the deputy minister. We’re hearing it here today. We don’t need more plans and reports and documentation. What we’re hearing today from Mx. Heide is that these services, and forgive me for being blunt on this, but these services aren’t provided. People are potentially losing their lives. They’re disappearing. We’re not hearing from them.

 

I don’t know what else can be said to the Department of Health and Wellness and to the government, what could be said more passionately than that. I understand that you want to have all your ducks in a row, but sometimes you’ve just got to do it. Sometimes that means spending the money, giving the money. I say this for all parties that have been involved in this, I honestly don’t know how non-profits do it, I really don’t. Whether it’s health care, community services, anyone, the struggle is unbelievable. I don’t know how they sleep at night.

 

What I would ask is that we’ve had enough of the we’re going to look into it, we’re going to talk. We had all that through the Speak Up for Healthcare Tour and I would bet that some of these witnesses here weren’t even invited to that. We’re seeing heads being shaken. Why was the trans community, the LGBTQI community, why weren’t those organizations invited into the Speak Up for Healthcare Tour, the ones that are running budgets, providing lifesaving care on next to nothing.

 

We’ve had the talk; we’ve had the plans. I think that’s where the general public gets frustrated with politicians and with premiers and ministers. It’s always the same: we need another report, we need to talk, we need to do this. Nothing - very little - comes out of it. Very little change comes out of it.

 

Again, I will say that this was a quote-unquote historic health care budget and everything else was put to the wayside. It really was. When I and my colleagues from the NDP asked them about housing, we asked them about community services, we asked them about roads, we asked them about all these other things, what we kept hearing from the Minister of Finance and Treasury Board and the Minister of Health and Wellness and the Premier himself was: we can’t do everything, we’re concentrating on health, we’re going to fix the health care system.

 

 

 

Again, I think it takes a lot of courage for these organizations to come here and air their grievances in front of the person who holds the key. What I would ask is that you take that historic money that’s being spent and filter it down.

 

THE CHAIR: Order. The time for the Liberal questioning has elapsed. We’ll now move to the NDP. Ms. Chender.

 

CLAUDIA CHENDER: I want to start by saying thank you to Mx. Heide. I think what we’ve just heard deserves a little space around it because it’s really important and I would say that it’s also true in lots of other constituencies across the province, that lack of access to appropriate primary care is costing lives. We know that. Whether it’s the surgical wait-list, whether it’s the people that Mobile Outreach Street Health can’t find, we know that we do have a genuine health care crisis.

 

I guess I want to start by asking - in the numbers that we get from Nova Scotia Health we know that, for instance, it’s 92,000 people who don’t have primary care, but in New Glasgow it’s 25 per cent, based on the 2016 population numbers, so that’s one in four. In Middleton it’s 25 per cent; that’s one in four people who don’t have any access to primary care. In Liverpool it’s 22.9 per cent - 25 per cent - one in four. We see that it’s not even across the province.

 

We have VirtualCareNS, which we talked about, but that’s not primary care. Those people aren’t attached to a physician who can check their test results and refer them for surgery or whatever it is that they need.

 

I came in on the heels of a failed promise for a doctor for every Nova Scotian. We didn’t hear that in this last campaign. But we didn’t hear an alternative, so what we hear is we’re talking about a policy, we are working on a framework, but in fact, we have these clinics, these care centres, however we want to define them - this is so clearly the answer. We are never going to have a doctor for every Nova Scotian and yet what we see is the Premier picking up the phone and calling doctors. Great, recruitment is super important, retention is as important. The most important thing is that we actually change the model, because the model we have doesn’t work and it’s not going to.

 

I guess my question is: Is there still the sense that we’ll have a doctor for every Nova Scotian, and without a sense of, we gave a clinic $35,000, or we’re working on a framework? What’s the plan for primary care? I guess that’s to the deputy minister.

 

JEANNINE LAGASSÉ: I think that Ms. Penney spoke to some of these things already that we have done so I don’t think I need to go through all of them again, but I think to your point, we’re looking at the communities where - New Glasgow - you raised that, that’s where one of the new nurse practitioner pharmacy clinics is - we’re trying to pay attention to where the issues are. Recruitment is going extra hard in those areas.

 

 

 

I think that Virtual Care Nova Scotia offering that to people who are on the Need a Family Practice registry isn’t going to solve the entire problem, but there are things that we’re doing while we are trying to get to the longer-term solutions. We’ve been talking about this in the department: How do we leverage the entire system in relation to primary care?

 

To your point, if we need a new model - I think you said that we need a new model

 

-   well, that takes some planning and work across the system. I know people want it fast, and trust me, we are working as fast as we can on these issues and trying in the meantime to put some things in place.

 

We know that we need a new model. We know that the health centres and other community-based organizations are a very large part of that, but we need to make sure that we’re doing it across the system and not just doing something now that could have implications in the future that won’t be good for the entire province.

 

CLAUDIA CHENDER: Just to respond to that, I would say, with respect, that giving core operational funding to the Sexual Health Clinic and their centres and to the community health centres across the province yesterday would not have an unintended consequence that would be negative. I can’t imagine. What it would do is it would help with retention, it would ensure that the patients currently covered continue to be covered, and it would recognize that whatever the plan is, this is the model, this is the beginning of the model. The details need to be worked out, but we know that we need wraparound care and we need a different kind of care.

 

We talked a little bit earlier about the cost of emergency care. The physicians I talk to say that the ERs, at least in the HRM, are the worst they have ever been, ever. These are physicians who have 10, 20, 30, 40 years of experience. People waiting upwards of 12 hours, people just not getting addressed at all.

 

We also are smarter than to not think that what we actually just need to do is fix the emergency room, we need to keep people out. We heard Ms. LeBlanc say that they keep people out of the emergency room, these folks keep people out of the emergency room. I guess what I’m looking for is a timeline. Yes, a new model takes time, but we have a government of solutionists who are not afraid to make quick and bold decisions about things that are important. This is the most important, this is as upstream as we can get in a collective way in this room.

 

My question is: When will we start to see, at the baseline, core funding for these health centres that exist now to ensure that at the very least we are taking care in the best way we can of the patients who are currently attached and not risking a worsening of the situation.

 

 

 

JEANNINE LAGASSÉ: I think I already alluded to it earlier, that the department does have a meeting next week with Sexual Health Nova Scotia in relation to funding, so I can commit to you that there is a discussion as early as next week.

 

I’ve also committed to speaking with everyone who is here today. You can ask anyone we have said that to. I have taken calls and emails from a lot of different people and I will talk to anyone who contacts me about what their issues are with their organization or within the system. I absolutely commit to have the discussions with the health centres about what we may be able to do for sustainable funding.

 

THE CHAIR: Ms. Chender, you have 45 seconds.

 

[10:30 a.m.]

 

CLAUDIA CHENDER: I wish I could have had time to ask you all questions and engage more. I appreciate that answer.

 

Talk is cheap. Money works. I really hope that it is forthcoming for these folks who are doing such amazing work on the front lines of this health care crisis.

 

Thank you to all the witnesses today.

 

THE CHAIR: Over to the PCs now for eight minutes. Mr. Young.

 

NOLAN YOUNG: My question is to Deputy Minister Lagassé. Recently the Province announced $700,000 in funding for mental wellness programs at youth centres across the province, including Supportive Housing Youth Focus Team, or SHYFT, which is in my constituency.

 

In general, what role do community-based health organizations play in terms of how we provide funding and support for mental health and addictions? How is supporting community-based organizations specifically an effective way to improve mental health outcomes in our province?

 

JEANNINE LAGASSÉ: As I mentioned earlier, community-based organizations are a very important part of delivery of our addiction and mental health services. In fact, the Office of Addictions and Mental Health have an MOU with the Mental Health Foundation of Nova Scotia to distribute grants to organizations throughout the province. These grants are for various things to various organizations, but really are an effort to, in community, promote positive mental health and to reduce harm for vulnerable populations. We’re looking at improving access to services and supports in communities across the province, and a lot of the community-based organizations are best placed to be able to do that. It’s very important.

 

 

 

 

Just in March - I think it was the end of March - we have our regular granting that we do through the Mental Health Foundation of Nova Scotia. And then an additional $3 million was also given out just recently to community-based organizations, including both

 

-    $2 million of that went to Tajikeimɨk to the creation of the Mi’kmaw mental health strategy.

 

NOLAN YOUNG: My question is again to Deputy Minister Lagassé, and as well, Marie-France LeBlanc.

 

The North End Community Health Centre currently offers a mental health drop-in program where community members can access counselling on a first-come, first-served basis. Can you please share more details about this program and its success?

 

MARIE-FRANCE LEBLANC: Our Pause: Mental Health Walk In Clinic is one that was started just prior to COVID-19, actually, through a grant from Building Vibrant Communities, which was through the Department of Communities, Culture, Tourism and Heritage, which was a bit of a strange way for us to go about it.

 

It proved very successful very quickly. Two afternoons a week - actually evenings,

4:00 to 9:00 - it was first-come, first-served. It’s meant to be a service that is a one-off,

where people come in if they have anxiety, if they have a particular issue, and we try to

refer them on with a trained counsellor.

 

We’ve now expanded to three days a week, and in fact we’re finding that we’re having repeat customers on a weekly basis, which is not the purpose of this program. We’re now looking to provide some counselling services to add to that. But it goes to show you what’s happening in the communities. There’s no access to mental health services in our community in particular. When I say “our community,” we’re in Dartmouth, we’re in Halifax, and we were in Spryfield. We’ve lost our location in Spryfield. We’re looking for a new location there.

 

Again, not a lot of funding to pay for a location, so we’re sort of doing this on a shoestring. We could have triple the number of counsellors working this. We could be there in the afternoons five days a week.

 

We do have support from the Department of Mental Health and Wellness for a grant for our Pause: Mental Health Walk In Clinic now. Annually, we ask for it and hopefully we get it. I don’t think there’s any intention for us not to get it, so we plan accordingly. But we don’t plan for expansion. We don’t plan - I guess what we don’t get to do is plan for what the need is. We get to plan for what we have. For us, asking to be part of the conversation is so that the need can be transmitted and talked to, as opposed to just doing what we have with what we’ve got.

 

 

 

 

NOLAN YOUNG: Question to Deputy Minister Lagassé: Can you share any data or analysis on the success of the Managed Alcohol Program, MAP, at the North End Community Health Clinic? Does the Province intend to continue to fund that temporary program and is the Province exploring the idea of expanding MAP to other parts of the province?

 

JEANNINE LAGASSÉ: I would like to turn this one over to Ms. LeBlanc, but I would just like to - they have been an incredible partner in this, and it started in a very difficult time for all of us, so I just wanted to thank them for that. I think it’s their program and their success, so I think I should let her speak to it.

 

MARIE-FRANCE LEBLANC: We do have an evaluation framework on this, and I’m happy to send you the numbers. I’m a terrible numbers person, so I’m not even going to attempt them, but what I can tell you is that the program has been a huge success. It’s been adopted in Newfoundland and Labrador now as a result of our success. We were the first in Canada to do a scattered site approach.

 

It is an overwhelming program in terms of trying to do it the way we’re doing it. We probably need to add some additional staff. We are looking to also offer Managed Alcohol at our new Overlook location. It will not be a scattered site. That will be on-site. We also offer support to Shelter Nova Scotia - one of their buildings which mainly acts as a full site there on top of going elsewhere.

 

What this has managed to do, in particular in the time of COVID-19, is allow people to not go into a health crisis as a result of not having access to alcohol. The alcohol is prescribed by a physician. It’s a nurse-led program, so a nurse has eyes on everybody on a regular basis. It is our staff who go and deliver our peer support people, people with lived experience who can relate to the people and support the people who are going through this crisis. It’s a dignified way to help people. In some cases, many of these people are at the end stages of their lives, so it’s a dignified way to support them, keeps them out of the emergency room, and keeps them out of the hospital.

 

It’s been a huge success, and it’s one that is being emulated across the country in a lot of different areas, so we’re very proud of it.

 

NOLAN YOUNG: That was very informative. What am I looking at for time here?

 

THE CHAIR: You have a minute and a half.

 

NOLAN YOUNG: A minute and a half. Let’s see if I can get one more question in.

 

Deputy Minister Lagassé, we’ve heard of some challenges faced by community health organizations and recognize that we did not get here overnight, and there’s still much work to work being done now improve the capacity and resources of community health organizations to serve the needs of communities?

 

JEANNINE LAGASSÉ: I think this is a bit of a summary of what we’ve spoken about today, which is that there is incredibly valuable work that’s going on in communities from both a health perspective, but as Ms. Burch said, from a wraparound support perspective. I think that that’s really where we need to take this conversation. There’s a health component, but there are also our other partners across government. There’s a community services component, there’s a housing component, and that’s where we’re looking through Action for Health, how we’re working together within government and with community organizations to say you need a place to enter, but once you enter there’s a whole bunch of us who have to come together to help and work forward.

 

That’s what I’m hoping to see in what the work will bring, that we’re more coordinated in supporting community and everything that they need, which will then bring everybody’s health status up, because all of these other things are as important when you’re looking at housing and other DCS kinds of supports that we need to make sure that that will help everyone be healthier.

 

THE CHAIR: Order. Perfect timing. Now if any of our witnesses today would like to make a closing statement, they can do that now, beginning with Deputy Lagassé.

 

JEANNINE LAGASSÉ: I think that actually I just probably gave my summary, but it was a very good discussion today. I really appreciate the questions from the members and for all of the organizations who came with us here today to share the information that they have. Thank you.

 

THE CHAIR: Ms. LeBlanc, just before you start, I would just like to say as the former minister of DCS how much I appreciated the collaboration with your clinic during COVID-19 on that particular program, because it saved lives.

 

MARIE-FRANCE LEBLANC: Thank you for that. Community health centres have already proven that we’re a solution. We’ve been doing it for a long. long time, and we’ve been doing it on a shoestring. We’re exhausted, we’re underfunded, and we’re not - I apologize for the word - we’re not “appreciated” in the way that we should be appreciated. By that I mean we’re judged from a medical lens, all of us. Just ask what the metrics are that we’re asked to report back on. They don’t actually reflect anything that we do. They reflect how many patient visits we have, they reflect how many blood draws we’ve had. Whatever it is, it’s not based on what we do.

 

What we would ask is - and to the deputy minister’s point, we need an entry point but our entry point cannot be the Nova Scotia Health Authority. They are great at what they do, they are not great for community health centres. We do so much more than medical clinics.

 

 

 

Our ask here today would be for more support, more support for the people that we support, but also the appreciation of what we all do and that we be appropriately classified in our entry points, so that it better reflects - and that the people who work with us understand what we’re doing and are able to support what we’re doing, not just support the little sliver of what we’re doing within the confines of what they are doing.

 

LORRAINE BURCH: I just want to echo Marie-France’s response that the solutions are in the community, they aren’t in the city. No disrespect to Halifax Sexual Health Centre; their solutions are in their city. But the solutions broadly are in the communities, and they’re in people - and their heroes are in the communities and ready to work.

 

Our Health Centre’s vision, mission, and guiding principles align perfectly with what Premier Houston is saying on page 28 of his action plan, and that is reflecting working with communities, establishing a framework, and mapping the work that is being done.

 

LEIGH HEIDE: I can also definitely second what was said. I could just probably have said ditto to that. I’ll just add a little bit and also add one other quick example. We talked about ERs and keeping people out of ERs. I want to just mention Cumberland County for a second. For a long period of time now - and I don’t know if there’s any change on this at this exact moment - there have been no walk-in clinics in Cumberland County.

 

I get calls and the Sexual Health Centre for Cumberland County gets calls from people asking how to get an STI test in Cumberland County. If they don’t have a family doctor and they aren’t able to travel to Truro, at the closest, they are going to the ER for a chlamydia test. It doesn’t make any sense and it’s costing way more money than it should. I just want to give that example. I don’t think I should ever be telling someone to go to the ER for a pretty average STI test.

 

Also, I’ll say about our funding that in 2020 we did have an opportunity for multi-year funding through our annual grant. We had no heads-up on that, so we had two weeks to apply for multi-year funding. We couldn’t plan that quickly; we just could not do it.

 

The next year it was gone and we were actually explicitly told in 2021 to not ask for any more funding because of COVID-19, that everything was going there - that’s in the email - so we didn’t.

 

I don’t know what this year looks like, but I do know that we’ve asked for quite a big increase and I think that’s part of why we’re meeting, to talk about what that would look like.

 

We have submitted many letters of support to that end. I don’t know that we need to say too much more about why we really need an increase to our funding that in over 20 years we’ve barely had. I think we’ve shown the evidence, is what I’m saying, and we want to see the next part come along. I’ll pass it on to Abbey.

 

ABBEY FERGUSON: I’d like to speak a little bit about our funding structure and exactly how precarious that is. We rely so heavily on that 35 per cent overhead fee, which is 10 per cent over the average of a family physician for their overhead fees from their fee for service, and just how unreliable that is. Right now, we are in a little bit of a boon spot with providers, which is excellent but also unprecedented in the time that I’ve been with the centre.

 

We budget for I think it’s approximately 78 per cent clinics being filled. With that number we plan for a deficit every single year. In the past two years, luckily, we’ve been not in that experience, but it is what we have to plan for, and just how unacceptable that is. We are relying on the generosity of our providers to do the services that they do. It is a double-whammy of a hit for them. Not only are they paying this high overhead, but they are also being paid 23 per cent less than if they just worked their Tuesday afternoon at their own clinic. It’s a gift, it’s generosity, and that is unacceptable to ask of any provider, especially in this primary care crisis that we’re in.

 

It also means that all of those providers could retire, could move, could decide that the generosity on their part was no longer acceptable to them, and without any sort of notice, they could leave. We have a full clinical schedule right now, but the next day, all it would take is a handful of providers to say, “I am actually not interested in working here anymore,” and that totally swings us the other way.

 

I really appreciated what the North End Community Health Centre was saying about our inability to plan. Without the core funding being addressed, things like admin costs and rent - basics, basics, basics - we have no way to predict the future. We have to plan as if the worst-case scenario is happening at every single moment.

 

THE CHAIR: I want to thank all of our witnesses for coming in today. We’re going to move on to committee business, and because we have such a large number of witnesses, I think we’ll just take a quick, two-minute break. The committee will now recess.

 

[10:46 a.m. The committee recessed.]

 

[10:48 a.m. The committee reconvened.]

 

THE CHAIR: Order. We’ll now call the meeting back to order. We have a number of items, some of which were on our agenda last week that we did not get to deal with, so the first thing is the Atlantic Lottery Corporation follow-up report. A motion was passed confirming the witnesses as suggested by the Auditor General, but we didn’t decide whether a meeting would be scheduled in relation to this report. Apparently, we have to do that as well.

 

 

 

 

Any discussion on this particular matter? Mr. MacDonald.

 

JOHN A. MACDONALD: I’m confused. Yes, I’d like to have the meeting, since we agreed to the witnesses. I didn’t realize we had to say yes to both of them. I would expect that will be scheduled by the staff.

 

THE CHAIR: Yes. If you would like to make a motion?

 

JOHN A. MACDONALD: I’ll move that we do actually have the meeting with the witnesses.

 

THE CHAIR: Any discussion? All those in favour? Contrary minded? Thank you.

 

The motion is carried.

 

Witness clarification re: grant programs. A motion was passed on May 4th approving the Department of Communities, Culture, Tourism and Heritage, the Department of Finance and Treasury Board, the Department of Natural Resources and Renewables, and the Department of Agriculture as witnesses in relation to the 2018 Auditor General’s report relating to grant programs. However, the Department of Agriculture was actually not noted as having outstanding recommendations, so the Clerk is seeking clarification as to whether we really need Agriculture to come back.

 

Ms. Chender.

 

CLAUDIA CHENDER: We do not.

 

THE CHAIR: Ms. Chender, would you like to make a motion?

 

CLAUDIA CHENDER: I’d like to make a motion to remove Agriculture from that list of witnesses.

 

THE CHAIR: Is there any discussion?

 

All those in favour? Contrary minded? Thank you.

 

The motion is defeated.

 

So Agriculture is out.

 

Summer additional meetings, the item was on the May 4th agenda, but we weren’t able to deal with it as time ran out. It had been agreed to have further discussion as to whether additional meetings were required to be scheduled to deal with the witnesses from the follow-up reports. Is there any discussion on that?

 

BRENDAN MAGUIRE: What I would say is I understand that people want to hit the road in the Summer and it may be difficult to get some witnesses. I would argue that the majority of government officials and bureaucrats are working through the Summer.

 

We are in the middle of a housing crisis, a health care crisis, we’re seeing inflation go through the roof, and we’re hearing from economic experts from around the world that we’re potentially heading into a recession. I think it’s important that we discuss these topics.

 

Last week we had one of the biggest offenders, when it comes to the cost of living, here in front of us. The reason for not bringing them back is that we had no time, all our time was scheduled, people didn’t want to move witnesses, so again I would say that I’m willing to come and I would hope that especially - what we could do is we could do specific topics around housing. We know that people’s electricity is going to be cut off during the Summer, that’s when this happens. So while it may be inconvenient for some people on this committee, what’s more inconvenient is the impact of these crises and the impact of these issues on Nova Scotians.

 

I would be supportive, even running a few more. If the members don’t want to do all Summer, I understand, that’s fine, but even doing a couple more to late June or July, that way we can have these witnesses back in front of us.

 

JOHN A. MACDONALD: As I spoke on that before in camera, I reiterate, that is also when staff - and reports are not done overnight, it takes a lot. As the Chair is a previous minister, she knows better than me. In my view, any discussion on this would be after Summer because it would be totally unfair to the people presenting the reports, that people are booking their vacations - their vacations, not the MLAs’ vacations - that’s my concern.

 

If that discussion was to happen at a later point, I’m fine with it. I’m not, in the opinion of wanting to tell people who have worked to get all this going, COVID-19 (Inaudible), that by the way you can’t have your vacation because the PAC decided they are going to meet. Those are my comments.

 

NOLAN YOUNG: I would like to add as well that our PAC meets more than any other PAC in the country. We moved from a monthly meeting back to weekly again. In an organization meeting that was on the 10th of November we agreed as a committee that we would not meet over the Summer.

 

Summer is an important time for us to be around our constituencies, working at our constituencies. Therefore, I will not be supporting adding Summer meetings.

 

 

 

BRENDAN MAGUIRE: Clearly the motion is not going to pass, but just to counter what was said here, there are hundreds of thousands of employees so it’s not that we won’t be able to find someone - the entire departments are not going on vacation in the Summer.

 

I’m not advocating for every week, I’m advocating for some of these topics that need follow-up that are important to Nova Scotians, i.e., having their power cut off and this is the power cut-off season; housing. I would argue that it would be nice to have these conversations in the Summer while it is still warm, instead of waiting for the Fall and Winter when people will be outside in the cold.

 

Secondly, while I appreciate wanting to go back to your constituency, this impacts your constituents. I will support it, and I would hope that even if we have the ability to call one or two, I think the option should be there. If the members don’t want to come back every week during the Summer, that’s fine, but we should have the ability to call. We should set some dates aside and then we can have a discussion around that.

 

THE CHAIR: Is there any further discussion around this? I don’t believe any motion has been tabled on this particular thing. Not hearing consensus, I think we’ll move on.

 

Just for the members’ information, the annual CCPAC and CCOLA conference dates have been announced. This is a joint conference that’s held annually for members of Public Accounts Committees and Auditors General across the country. The conference will be held in Ottawa from August 28th to the 30th. More information will be available to members as it becomes available. Just to share that.

 

Our next meeting date is May 18th. It’s regarding the Report of the Auditor General

-    oversight and management of individuals serving community-based sentences. The witness is the Office of the Auditor General. It is an in-camera meeting, just to let members know.

 

BRENDAN MAGUIRE: I’m going to try this again. I’m going to put a motion on the floor. Nova Scotia Power will appear before the NSUARB in September. Again, last week, they would not allow us to get any answers. I’m going to continue to try this until we get the government voting on the side of Nova Scotians.

 

I would ask that the very first meeting in September of Public Accounts, that Nova Scotia Power appear so that they can present the evidence that they present at the NSUARB and answer the questions that they refused to answer last week.

 

My motion is that at the first meeting in September, Nova Scotia Power appear.

 

THE CHAIR: Any further discussion? Mr. Young.

 

 

 

NOLAN YOUNG: I think we spoke of this at the last meeting. It’s very important for topics to come through the subcommittee on agenda-setting. I know Mr. Maguire was part of this committee since 2013, and he knows how the topic selection process takes place. I think it would be better for a topic - could you repeat the motion again, Madam Chair?

 

THE CHAIR: I believe it was for Nova Scotia Power to appear before the committee at the first meeting in September, following their appearance before the NSUARB.

 

JOHN A. MACDONALD: I’m not being picky, but if a motion has already failed, can it be brought back? Or is it different - I would just ask for clarification. I thought we already had the motion before. I could be wrong. It was voted before . . .

 

THE CHAIR: It can be brought back, but it does have to be different. What “different” means is in the eye of the beholder. There is some difference in this particular motion.

 

Any further discussion? Mr. Young.

 

NOLAN YOUNG: I’m just curious how this differs from the last motion that we had last week - how substantially different it is. I would ask that we be able to retrieve what the motion is from the last meeting, just so I could see whatever the differences may be with Mr. Maguire’s motion.

 

THE CHAIR: We do want to make sure that it is substantially different. My understanding is that the one last week had dates involved with it? Did it?

 

THE CLERK: I have “that these same witnesses return the moment the presentations are given to the NSUARB . . . and that they return for the next actual meeting of the Public Accounts Committee.”

 

THE CHAIR: I think we have a date here that is involved with this particular one.

I’m calling the question.

 

All those in favour? Contrary minded? Thank you.

 

BRENDAN MAGUIRE: Recorded vote.

 

THE CHAIR: Recorded vote. We will ask the clerk to read the names.

 

THE CLERK: Ms. Chender . . .

 

THE CHAIR: Order. The time for the meeting has elapsed.

 

 

 

GORDON HEBB: The vote is started. You can complete the vote.

 

THE CHAIR: I’m hearing that if a vote has been started, we’re actually to complete the vote, so we will do that.

 

My apologies to the committee members. We will ask the clerk to read the names.

 

[The Clerk calls the roll.]

 

[11:00 a.m.]

 

YEAS NAYS

 

Claudia Chender Nolan Young

Susan Leblanc Dave Ritcey

Hon. Brendan Maguire John A. MacDonald

Hon. Kelly Regan Danielle Barkhouse

Chris Palmer

 

THE CLERK: For, 4. Against, 5.

 

THE CHAIR: The motion is defeated.

 

The meeting is now adjourned.

 

[The meeting adjourned at 11:01 a.m.]