HALIFAX, MONDAY, APRIL 1, 2019

COMMITTEE OF THE WHOLE ON SUPPLY

4:37 P.M.

CHAIR

Suzanne Lohnes-Croft

THE CHAIR: Order, please. The Committee of the Whole on Supply will come to order.

The honourable Deputy Government House Leader.

KEITH IRVING: Madam Chair, would you please call for the continuation of Estimates for the Minister of Health and Wellness.

THE CHAIR: For the continuation of the Estimates for the Department of Health and Wellness, we will go to the NDP for 32 minutes.

The honourable member for Cape Breton Centre.

TAMMY MARTIN: Thank you, Madam Chair, and welcome back. Here we are again. I’d like to start off talking about the current situation with what we believe is a staffing crisis in the Nova Scotia Health Authority. Currently, as many people may be aware, the interpretation has changed for how overtime is paid to those who would qualify, nurses in the NSGEU and in the NSNU.

For as long as I can remember - the last two rounds of negotiations at least - overtime was paid at a rate of double time for any hours that were earned. Earned hours are classified as worked hours, holiday hours, sick hours, and vacation because they are all pensionable earnings, they are all hours earned. So if you took a week’s vacation and you got called in on a day off to come in and work overtime, you got paid double time.

Now there is a new interpretation to the exact same contract language.

THE CHAIR: Order, it’s a bit noisy in here and it is breaking the concentration. I ask that the anteroom doors be closed and also, to people here in the Chamber, please give the respect to the speaker.

The honourable member for Cape Breton Centre has the floor.

TAMMY MARTIN: Thank you, Madam Chair. Just in this past round of negotiations there has been a new interpretation to the contractual language which says basically exactly the same wording, that overtime shall be paid on hours worked, so there’s a discrepancy between hours worked and hours earned. But because of that, staff are working short. Hospitals are going short, RNs are not coming in to work when they’re not being paid overtime the same as they used to be. If somebody takes a day off today, so they haven’t physically worked their full 75 hours, they are no longer being paid overtime. They’re being paid straight time at overtime rates, which means they get the equivalent of 11.25 hours if that’s the shift they’ve been booked for.

My question for the minister is: Who made that decision, to start?

HON. RANDY DELOREY: I believe the circumstances described by the member for Cape Breton Centre correctly referenced the collective agreement and a particular clause in the agreement.

It is my understanding that the Nova Scotia Health Authority advised the bargaining agents of changes to the interpretation of the language during the negotiation process. Negotiations concluded and there was no alternative language or information tabled on that point. I believe in February the interpretation began being applied.

The decision, as this is an operational and employer-based decision, was made by the Nova Scotia Health Authority.

TAMMY MARTIN: Unfortunately, I would hope the Minister of Health and Wellness could intervene in this situation. Currently, and I can say without any doubt in my mind, nurses are refusing to come to work because they are not being paid accordingly, the way they have for the past 20 years. I can say that verbatim.

I know one nurse who has been called seven times in one day and she didn’t go to work because she was going to get straight time, whereas prior to February, and for the past number of years, she was getting paid double time. Nurses are working short and because of this, patients are receiving less care. The nurses are overworked and not being paid the way they used to be.

Is this something the minister could intervene with because it is about the safety of the patients and the safety of the staff? Nurses go to work and they should be paid accordingly.

This is an interpretation and, in my opinion, an incorrect interpretation, to old contractual language. I would hope that the minister could intervene and revert back.

RANDY DELOREY: The agreement and the relationship between the employer and the employees would be for the parties to work on, consult, and figure out if they have discussions and agreements that should be modified. That’s the work.

It is my understanding, I believe, that conversations have taken place since February between the employer and the union representatives on this very topic. I am not aware that a resolution has been reached, but certainly those conversations have been had and, as far as I know, are ongoing. I haven’t heard that there has been any conclusion to those discussions at this point in time.

To the member’s concerns or specific request, I would say that the Health Authority, as I understand it, is in discussions or has been in discussions with the union representatives on this very topic.

TAMMY MARTIN: While I appreciate the minister’s response, the Department of Health and Wellness is the employer. They fund the NSHA and the NSHA takes direction from the Department of Health and Wellness.

Nurses are working short and I’ll say it again: patients are suffering. Patients are not receiving the care nurses want to provide, and this is because they are not being paid the way that they have been for the last number of years.

They continually get calls and the only time that you will get paid overtime is if you work every one of your scheduled shifts. You are not allowed to take vacation; otherwise, as I said, you’d be paid straight time.

I would think, as the employer, which this government is, the Department of Health and Wellness is the employer, and I would suggest that in order to protect the patients, to protect the staff, and to ensure that everyone in this province is getting the proper care these staff members want to give, I would respectfully request the minister give his direction to revert back to the contractual language that paid nurses accordingly.

[4:45 p.m.]

RANDY DELOREY: I appreciate the member’s perspective and desires but the factual point that needs to be stressed, I suppose, or highlighted is that contrary to the statements made, the department and government is not the employer. The employer and the contractual relationship are with the Nova Scotia Health Authority, which is a separate entity from government, so it is that organization that has a governance structure in place that exists and reporting and decision making and, again, the contractual relationship between the entity and the bargaining units and the employees, who are members of the bargaining units.

Again, I think appropriate steps are being taken, to the best of my knowledge, throughout the negotiations process. As far as I’ve heard, the authority has followed the bargaining process, advised of their intentions around this particular interpretation of the language, and implemented per that process after the collective agreement was negotiated and ratified.

Subsequent to that point in time, it’s my understanding the discussions between the Health Authority and the bargaining units for the nurses have begun and, to the best of my knowledge, are continuing. I haven’t heard that there has been a conclusion to those discussions, so I think the discussions are taking place between the appropriate entities: the employer, the Nova Scotia Health Authority, and the bargaining units. I think that’s the way the labour process dictates should take place to rectify if there are concerns being raised by employees on the front line through their bargaining units, the unions that represent them and then to the employer. The employer has a responsibility to assess the information being brought to them, along with the mandates they have to deliver care to the patients in the health care system and make the appropriate decisions from that point.

Again, as I’ve mentioned to the member, I believe, Madam Chair, those discussions are ongoing. What the conclusion will be, I think that’s something we’ll wait for until the end of those discussions.

TAMMY MARTIN: While I’ll agree to disagree with the minister, I remember several late-night negotiations at four or five o’clock in the morning when funding couldn’t be completed until somebody from government was in the backroom somewhere saying yea or nay to the deal. It may not be the direct employer, but the government is the funder, and the funds don’t flow through unless there is somebody from government in a backroom saying yes or no.

Regardless, I’m wondering if the minister was advised of this change prior to or did the minister have any input?

RANDY DELOREY: I guess just to that one point about funding, that is correct, the government does fund the Health Authorities. That’s their primary source of revenue, as we know, in the budget process you’ll see the vast majority of the Department of Health and Wellness budget is actually a grant to our Health Authorities: the NSHA and the IWK. So, despite the portion that the member for Cape Breton Centre indicated, we agree to disagree, that’s a point we can agree on. It is the factually accurate statement.

I would also clarify or highlight to that member that at the end of the day, when government is funding a program or service, it is the taxpayers of Nova Scotia who are the ultimate funder, not the government, because the primary source of revenue for government to invest in our health care system are the taxpayers, those very same patients who rely on the care. Of course, it is a responsibility mandated to work between those and find the right balance to ensure that we are funding appropriately and adequately to provide the care, but not funding more than the necessary amount. The goal is to fund at the appropriate levels. I think the effort within all the departments of government is to ensure that taxpayers, the ultimate funders of government programs and services, are being expended appropriately.

As far as this particular policy position, again, these are through the negotiations that took place between the employer and the bargaining agent. This was not a level of detail in terms of their policy positions that I had any direct engagement or conversations with during the negotiation process.

TAMMY MARTIN: I would like to move on now and start talking about emergency rooms. I would like to talk to the minister about emergency room visits. How many emergency room visits do we experience across the province? How much do we budget per emergency room visit when somebody is there? Specifically, what does this budget provide for or allow in every emergency room visit across the province?

RANDY DELOREY: We discussed earlier in our Estimates the complexity of our health care system, and when we get into physician compensation, there are multiple different models and things, so things do get fairly complex when you start slicing and dicing. What I have on hand is the amount we spent on physician services within our emergency department, but that’s not the total cost of emergency department costs. We’re still looking through our notes here to determine if we have that specific categorization broken down the way the member has requested. For our emergency departments, we’re budgeting about $67.5 million just for physician services in 2019-20. That’s what our budget is. That’s an increase of just about $3 million from the previous year for physician services in our emergency departments over last year.

TAMMY MARTIN: I guess to be clear then, the minister doesn’t have the information here on what’s supposed to be provided in the budget per person for the emergency room or what is to be provided in that budget to the person when they show up at an emergency room.

RANDY DELOREY: For the level of detail that we break down, the emergency departments would fall under a category that’s tracked under ambulatory care. It is one, albeit a significant piece of the ambulatory care services. I just put the asterisk on this amount that it is not only emergency departments. There are other clinics in the ambulatory care space here. That breaks down, the amount here, the budget for all ambulatory care for 2019-20, is $250 million, just over $250 million. That’s an increase over the 2018 budget by about a $25 million increase, and that’s just for the Nova Scotia Health Authority.

There is another $30 million being invested at the IWK ambulatory program, as well. That’s a total system ambulatory program of about $280.5 million.

The increase over the previous year’s estimate would be just over a $25.5 million increase in investments in our ambulatory care programs.

These costs that fall into ambulatory care, of which emergency departments would be part, exclude the physician costs, which I previously noted, for emergency departments runs at about $67.5 million. If you add that to the $280.5 million plus the $67.5 million, you are well over $300 million in emergency, plus a few other ambulatory program services.

TAMMY MARTIN: I am wondering if the minister is able to break that down for us, the ambulatory care budget, and what categories? I realize that many clinics are run out of ambulatory care, as well as emergency, but if you could break it down and be more specific and what categories it would cover.

RANDY DELOREY: Again, this is the level of detail I have here for the Department of Health and Wellness budgeting purposes. I know the member is interested in this level of detail, which aligns with the Nova Scotia Health Authority’s level of detail in budgeting as they break down their operations.

The ambulatory is the category that we break down in the department for the data. We certainly work with the Health Authorities. They build their budgets and come up with their year-end data points.

When we have the information, we’ll see if we can get it over to the member’s caucus or to the member directly. I don’t know that I’ll have it here as part of estimates, but we will take a look and see what we can do.

TAMMY MARTIN: I appreciate the response from the minister.

Continuing on with emergency rooms, my question to the minister is: Can the minister provide us with the number of patients who have spent more than 24 hours in any emergency room across the province? Are we keeping track of these numbers to try to keep the knowledge and awareness of the workflow and how many patients are actually inpatients in the emergency room?

There were two instances we were informed of the other day where there were 23 admits at the Cape Breton Regional Hospital in the emergency room. They only have 23 emergency room beds and the next day they had 19 admits. Is this something the department tracks and can provide for us?

RANDY DELOREY: The nature of the questions and the details being pursued here really delve into the operational questions of the Health Authorities. As per the first set of questions that came through that were employer/employee-related questioning, that is the Nova Scotia Health Authorities.

Really, when you look at the Act, the role and the responsibility of our Health Authorities, both the Nova Scotia Health Authority and the IWK, is on ensuring, providing, and delivering the operational delivery of health care services. Particularly and probably the large part is in our hospital environment.

I can certainly assure the member that data on hospital visits through our emergency departments, et cetera, are tracked by our Health Authorities, but that is not the level of detail and data that I have brought for Estimates in the budget process. The volume of data required to be prepared to answer operational-level questions on the Health Authority and the copious amounts of data that would be there for me to try to anticipate that and have those data points at my fingertips, it wouldn’t be possible.

[5:00 p.m.]

I have two support teams with two separate, fairly large binders; I think we would fill this entire front row of desks, and then some, with data to try to have that level of operational data on hand for Estimates debate.

What I can assure the member is that data throughout our health care system does get tracked. I can assure the member - I think we had a brief discussion with the line of questioning from the PC caucus last week around our data analytics work - that, as I said, we are growing our capacity there.

The One Person One Record, and other IT system projects that we have in place, are all part of us actually strengthening our capacity for the data; ensuring that we have the right clinical data, at the right time, to the right people, which is both for clinical and policy-based decision making.

We will get more efficient at tracking and reporting, but like I said, I just don’t have the data here with me to answer that level of operational details that the member is asking for.

TAMMY MARTIN: I wonder if this is something that the minister would be able to provide us at a later date. I’m new to this game, so I don’t know, but would it be pertinent to have somebody from the NSHA here with these kinds of statistics just to add to the mix? If not, could the minister provide us with the information later?

RANDY DELOREY: Again, I think that to have the capacity to anticipate - the Estimate debates that we have are across the board. The starting point is around the budget piece, and then obviously our discussion delves into what are the drivers behind some of the budget pieces. But to anticipate the copious amount of data that gets collected to know exactly which pieces of details, I think the process by which we follow now which is a question comes in and if we don’t have the data, we certainly endeavor to track it down and provide it to the members.

When they have a specific inquiry that delves in a bit deeper, so again, we’ll get it back as soon as possible. It really just boils down to the specific request and if the request is in the same format or structure or categorization that is already being tracked; because sometimes you are tracking data in a particular way that doesn’t exactly match the way that the question comes up.

We will endeavour to strike the balance between the specific inquiry and the way the data is tracked so that we can get at least a balanced piece in between. I think it is fine. I’m certainly comfortable if the member is to continue asking the questions.

If I don’t have the data I will certainly advise, and in those instances where I don’t have the data, I will again confirm that we will dig in and I’m taking some notes here. Right now: the specific breakdown of the ED cost estimates, broken out from the higher-level ambulatory care which is what I have, and I will endeavour to pull the ED specific; then, the member’s follow-up question which is the specific ED visits and, I believe, those who have stayed for in-patient, over 24 hours I believe was her definition of the in-patient piece.

We’ll pull off after Estimates and engage with the Nova Scotia Health Authority to cross-reference the data that they do have and will bring that back to the member, either on the floor or on the side.

TAMMY MARTIN: Continuing on with emergency rooms, I would like to ask the minister: How much money was spent last year for travel nurses? How much is budgeted for travel nurses and where could we find that in the budget?

RANDY DELOREY: I appreciate the inquiry and I don’t mean to be flippant with the response, but I guess following the trend - and I think the members who are, as you are listening to this debate, you can see the path that the member is obviously structuring the questions and following a theme here. But along that same theme, they are very much operational at the Health Authority piece and the travel nurses - that specific line item - would be something that you would see more detailed and broken out in the Nova Scotia Health Authority’s budget. When they table their budget, that line item, we can expect to see it in their budget if it’s broken down that far.

Usually in budgets - particularly as large and extensive as the health system, you have generally higher-level categories that are broken down. I don’t know that you’d actually have a line item as visible, but certainly the data would be tracked. We’ll contact the Health Authority and pull that data point for the member from them in their financial system.

TAMMY MARTIN: I would like to ask the minister: Are those numbers available publicly?

RANDY DELOREY: I guess in a broad sense, I can advise the member that information would be public as per our FOIPOP legislation, which does dictate that information does have to be provided through government and public entities like the Health Authorities. At that level, I can assure the member that this information is available to the public.

What is posted are the Health Authority’s business plan, which has a breakdown of their high level of budget that they would have. That specific piece around travel nurses, I don’t know if it’s broken down at that level of detail in the publicly posted information, but the information - I assure the member and other members of the Legislature - would be available to the public, whether or not it’s at that level of detail proactively posted. At the top of my head, I don’t know if that line item is a line item in the publicly posted business plan, which seems to usually be a little higher-level budget information than that.

TAMMY MARTIN: This information is extremely important to staff, as well as the general public; when they know that they’re going to work and getting paid one amount, and travel nurses are coming in and getting significantly more money; when the employer has just taken away their ability to get double-time payment for working overtime shifts, as they were in the past. Staff find this very offensive.

While we need travel nurses - a good friend of my daughter’s is a travel nurse and she’s all over the country, and they’re giving up their personal lives, they’re giving up benefits and the like - we have nurses here at home who are not getting the proper payment for the work that they do. As I said, they’re leaving; their colleagues are working short; patients are not getting the care that the nurses want to give.

For many years, the way overtime was paid, worked. Hours worked are hours earned, and hours earned are hours worked. I would hope that through the government, the NSHA finds the significant error of their ways because it is affecting the lives of so many people in Nova Scotia. People that decide to stay at home and work in our hospitals, rather than do travel nursing and earn more . . .

THE CHAIR: Order. The time has elapsed for the NDP. We will move over to the PC caucus.

The honourable member for Pictou West.

KARLA MACFARLANE: Welcome back to the minister and his colleagues. I’m going to start off with the SchoolsPlus program that connects students and their families with mental health services and other community support services.

I’ve had a lot of people on two sides of this; some say it’s a fabulous program and I’ve heard others, of course, say that it’s not working, it’s not helping. I see that there is a $1 million increase to complete the province-wide SchoolsPlus expansion, bringing the total budget now to a little over $10 million.

My question for the minister is: Could the minister elaborate a little bit on the $1 million and where that is actually going? As well, when it says it’s completing the province-wide, does that mean that every school, province-wide, has it and, if so, what grade levels does that include?

RANDY DELOREY: I guess, to the policy - the philosophy behind SchoolsPlus - I can put it into this context because the SchoolsPlus program is not a program that was developed by our government, but I can advise the member and others, just to put it into context.

I remember the very first school board meeting I ever attended. It was in the Spring leading up to the school entry, so it was the Spring before my first child entered the school system. I remember, during that particular school board meeting, one of the board members from my community - not representing my specific community but from Antigonish - did bring up the topic. I think one of the agenda items did bring in SchoolsPlus and that was the first time I’d heard of SchoolsPlus as a model. That individual school board member did highlight and stress how valuable they felt the program was.

But the big challenge was actually getting it implemented so that it would provide that consistency in implementation. She felt that the inconsistency of schools having it or not having it, so that community members and students and parents would know that these services - and for those who aren’t familiar with SchoolsPlus, it’s just that; it’s attaching more to our schools, more than just education.

It’s bringing, really, the social departments of our government services to bear through our school system. Because access is sometimes a barrier; people knowing about the ability to access, or knowing how to access services, and whether those are health services or social services or, in some cases, justice services, and recognizing that sometimes there are relationships there.

When you engage in health care and you look at the social determinants of health, often there are social programs and services that can help improve or enhance the health outcomes for individuals. Recognizing that there are relationships between these different services in our social programs being delivered, as I understand it, that was the premise developing the SchoolsPlus model. It has rolled out. We, as a government, certainly took an active role and a commitment to invest and roll it out province-wide.

To start answering the specific questions of the member, her statement is correct; not all schools have SchoolsPlus. The current, I believe coming in as of today, plus or minus, I don’t know the exact date when this number came, but 327 schools have access to SchoolsPlus. When it rolls out it will be 371, I believe should be the full complement of our schools within the system.

The way it works is, there are key hub sites within some community districts or school districts that a counsellor may be at, and then they branch out and support the other community of schools, sometimes. There are slightly different models, but they ensure that SchoolsPlus services are available to all of the schools. Where and how they’re actually structured might look a little bit different, but it is designed to ensure the social programs, such as: facilitators and social workers that would be there, mental health clinicians that are available there, as well as community outreach workers that are available to support those relationships and the work.

[5:15 p.m.]

A big part of what they do is also not just the services they provide directly but the navigation of the services when there are more acute or advanced conditions that they would support and address with those services and delivery of services and supports that they can provide, but also it’s that linking back into other programs and services that the departments, whether it’s the Department of Justice, the Department of Community Services, the Department of Education and Early Childhood Development, the Department of Health and Wellness, or what have you may have that they can then connect to supports and programs there.

The $1 million, we frame it and target it as health because it provides health-related supports, which SchoolsPlus does as I noted. Even the social programs and the social workers supports that’s part of addressing social determinants of health and having positive health outcomes. That’s why in the budgeting structure and flow it’s broken out and flagged or identified under the health services, but I believe the $1 million is under the education budget rolling out the SchoolsPlus itself as an overall breakdown. Again, I believe the funds there are going to complete the expansion to ensure that the supports are available to those remaining schools across the province.

KARLA MACFARLANE: I thank the minister for all that information. Just for clarity, because maybe it’s a question that I should be asking the Minister of Health and Wellness. My understanding is that the minister has indicated this program is not in all regions within the province but, yet, what I’m reading here is that the $1 million investment was to complete the province-wide program. It may be easier for me to ask: What schools in our province or regions do not have access to this program?

RANDY DELOREY: As I indicated, I believe the money is to complete the rollout, which means those who don’t currently have access, by the end of this year, everyone will have it. That’s the point of the funding is to complete.

I guess I’ll use the example in this year’s budget under the Department of Education and Early Childhood Development - I apologize to my colleague, the Minister of Education and Early Childhood Development, for getting into his space, but I think it’s a good example, a program that had a multi-year implementation plan getting Reading Recovery rolled out to the whole province in all schools. I believe in this year’s budget we complete that investment, so in September when school starts back up again, all schools eligible for Reading Recovery will have it reinstated. That was a multi-year commitment that we were rolling out. You had to get the staff up and trained again and certified to complete that. You couldn’t just do it all at once; it did have to be phased back in. The rollout and expansion of SchoolsPlus was a similar type of thing.

I believe it’s available kind of generally in all regions. If you think former school boards and so on, I believe it was available in all regions but not all specifically all schools. As this implementation completes this fiscal year, all schools should have access to the SchoolsPlus services throughout the province, again recognizing that there are certain schools that act as hubs and may have some enhanced services that continue to support their sister schools as a community of schools, kind of hub-and-spoke model to make sure that we’re maximizing the availability and use of the clinicians there. All schools will have access to the SchoolsPlus programming this year. That’s the purpose of the $1 million.

KARLA MACFARLANE: I thank the minister for clarifying that. Staying on this same topic though, with regard to HealthyMindsNS with the initiative to supply support in universities and NSCC, I’m wondering, with regard to the online peer support and the professional telephone counselling, I see there’s a $600,000 investment made in this budget, so I’m wondering where the $600,000 is going and as well, who was contracted out to provide the telephone counselling?

RANDY DELOREY: That particular post-secondary program was a program embarked upon through the Department of Labour and Advanced Education with their university post-secondary institution partners. It is a program under that department. Obviously, one providing services that we certainly are interested in, that we support as the Department of Health and Wellness. But it is an operational university program being partnered and funded through Labour and Advanced Education.

You have to make judgment calls and decisions when you’re looking at how you budget and provide funding. On the one hand, it’s mental health related services; on the other hand, it’s targeted towards our post-secondary population. Which budget and which department should those supports be engaged in and run through? Really, the LAE is the department that maintains the relationship with our post-secondary institutions.

It would be the post-secondary institutions that would be operational in delivering and connecting on their campuses, so it makes sense for ease of relationships and the discussions that will be taking place is to keep it within LAE with the post-secondary institutions. That’s where the details of that program would be housed.

KARLA MACFARLANE: I thank the minister for clarifying that last question, as well.

Aberdeen Hospital is located in Pictou Centre, and Pictou County has a population of about 46,000 people. We know a number of people across this province go there for hip and knee surgery. I often hear that there is more opportunity to perform more operations, but what I understand from surgeons there is that they just don’t have the knees or the hips, the equipment, to perform more surgeries. Certainly, there are hours in the surgery room to perform more operations.

I see that there’s a $2.2 million increase to improve access to hip and knee replacement surgeries, for a total of a little over $17 million. I’m wondering, what portion does the Aberdeen Hospital get now for hip and knee replacements? Will they see an increase in their budget out of this new investment that is being made?

RANDY DELOREY: I thank the member for the question and I apologize if the response is a little longer than she would expect. I’m going to try to be concise, but kind of like the SchoolsPlus thing, it ties into some policy things that explain the numbers.

First off, I’ll state I don’t have the breakdown in terms of where it goes on a hospital-by-hospital basis for that specific level of program detail. She’s correct that it’s just over $17 million that we committed to the program around orthopaedic improvements. We committed just over a year ago - I believe it was in October 2017 when I announced, just downstairs, we held the announcement - that we were embarking upon a committed program with the investment. As well as procedural changes to help enhance the delivery of hip and knee surgeries, to move us in the right direction to bring us towards the national benchmark established around hip and knee replacements.

What we’ve seen is an increase in our delivery of hips and knees. Last year, between October and the end of the fiscal year, it was really predicated on structural changes within the ortho program. What I mean by that is it was about evaluating, or establishing, and looking at our ortho program for hips and knees as a provincial program.

This really goes back to the principal of why we established a single health authority; there were certain parts of the province that had very short wait-lists and other parts that had very long wait-lists. To optimize the availability and utilization of resources and maximize the outputs, it was important to standardize how we deliver our ortho services across the province. It was that team that established the recommendations for standardizing the forms and the data being tracked; when patients would be available or recommended for ortho surgeries.

Right now, we still track wait-lists, because people are referred to the specialist. We do track it and the information is available on our wait-list website. Again, there are certain surgeons, or regions that have longer wait times than others. Nova Scotians who may be willing to travel to another part of the province could ask to be referred to a different surgeon or location based upon what they see as the wait-list and can use that.

What you see then is a levelling or balancing of our wait-lists within the province, and part of the anticipated improvement is by stabilizing that way.

We’ve put those steps in place over the last year to allow people to move around the province and get their surgeries. I’ve heard of people from Halifax travelling, for example, to Aberdeen or Cape Breton to receive their surgeries. Coming from the northeastern part of the province, usually all you hear about is people from outside of Halifax travelling to Halifax to receive treatments and services.

This is a very unique transition that we’ve seen in our health system. To see now that people from around the province may be actually moved out, reducing the pressure and the strain on our core centre here while stabilizing, and increasing perhaps, the availability of services being delivered in some of our other regional sites. It’s really maximizing the value proposition and the delivery.

The dollar figures that we’ve invested, that $17 million, really predominately has gone towards investments. We’ve hired, I believe, the additional orthopaedic surgeons, the additional anesthetists; they got hired in the last fiscal year. They will be continuing to provide their services; but also, the pre and post-habilitation services and support, so their support staff that go along with the additional anticipated surgeries.

I know we talked last week, I think more so during Question Period, about some of the data around hips and knees. Still got, I think, somewhere over 4,000 of them done this year, which is pretty good compared to what we’ve been doing.

Our movement on meeting the benchmarks hasn’t been as far this year as we would have liked, but it’s important to realize that this is in an environment where we have a higher percentage per capita demand in our province than in other jurisdictions. The pressures in our province are greater than other jurisdictions and that’s why we have to work harder than other jurisdictions to achieve the outcomes, which we are pursuing.

I’m pleased to see improvements over the last year and half or so, that we’re seeing progress. We’ve seen other benchmarks within our ortho space improve, in part because of the efficiencies and the investments we’ve made through this program. Nova Scotians are getting improved care through here, and a number of people that I’ve bumped into have indicated - you know, I was told I was going to be waiting for at least two years and I got in within nine months or a year - they’ve been speaking very positively. I’m seeing on the ground the impacts of these investments and these program changes to our ortho hip and knee program.

KARLA MACFARLANE: Moving on to veterans. Definitely very dear to my heart. We were brought up in a family in our household where the most important day out of the year, before our birthdays or any other holidays, was Remembrance Day. I’m fortunate enough to have a veterans’ unit in Pictou that is most enjoyable to go out there and spend time with the veterans. Both males and females are there; it’s a 20-bed unit.

[5:30 p.m.]

Since 2013, when I was elected, there was a waiting list. Now that 20-bed unit is down, there are only 13 veterans, so we have seven empty beds. I realize this is federally operated. However, I had written a letter requesting some attention to this unit, and this summer Seamus O’Regan did make a visit to the unit, and I also received a letter from the Honourable Jody Wilson-Raybould with regard to the fact that those beds should be and could be filled if the provincial government wanted to pay for those beds. For example, while we have a long list of individuals waiting for long-term care facilities that are obviously using up beds at the Aberdeen Hospital, which then creates the overcrowding in our emergency department, those individuals could be moved to the veterans’ unit. As well, it is my hope, and I understand that there is potential or they may have decided since this letter, that anyone who served in Afghanistan can also access these beds.

I guess I would just like the minister to perhaps provide what he knows about the availability to expand beyond the Korean War veterans so that all people who serve our country know they will be looked after. As well, why are we not tapping in as a province to use these beds so that we can free up other acute beds in regional hospitals? That would obviously help with decreasing the overcrowding in the emergency departments.

RANDY DELOREY: I thank the member for raising this question. I think Nova Scotia in our collective interest, all Parties, all members of the Legislature, I believe we’re one of the only, and possibly the only provincial jurisdiction that has a Veterans Affairs Committee, which I think is a committee that’s a privilege for members in this Legislature to sit on that committee because it’s important. Nova Scotia as a jurisdiction, I believe, has the highest number of veterans per capita, by a fair margin, in the country. Perhaps that’s one of the reasons, because we have so many veterans in our communities that we’re able to continue to fulfill our November promise to remember. I want to thank the member in all sincerity for bringing the theme and these questions to the fore.

The question of long-term care and the beds within our facilities, I guess as the member noted, there has been some turnover in the federal minister’s office for Veterans Affairs Canada. I can say I had a very good working relationship with Minister O’Regan. We met on several occasions to discuss various health-related themes about the veterans. He was quite receptive to our conversations that we worked on and continue to work with the department. I’m working to build that same relationship with Minister MacAulay, the current minister, from P.E.I. I know how much time it takes to transition into a new department.

I look forward this Spring/Summer to connect with the new minister, to continue these conversations and see what, how, and where our departments intersect and where we can perhaps achieve more working together than working in our separate silos. That was kind of the nature of the conversations with Minister O’Regan on a few files. I look forward to continuing the discussion with our federal partners and seeing where we can do things and not worry as much about the jurisdictions but more about the outcomes.

The specific question around the policy positions of the federal government, as far as the decisions for those veterans’ beds, they are federally funded, federal programs that they establish their parameters for eligibility for the beds for their facilities and the beds they are paying for. I’d have to, the same as the member, follow up with the federal department to verify their current eligibility criteria area.

Really, it’s the NSHA, the Health Authority employees, who are providing the services, are paid by the federal government for those services, but they are really outsourced. The federal government is paying them so the policy position on it is driven strictly by the federal government.

We have seen some changes, though. The policy changed in the Fall to expand availability. For example, Camp Hill up in the city, I believe some Allied veterans were invited and given the opportunity to move into beds. I think that was an expansion of their interpretation of the policy that the federal government agreed to, so I think some progress has been seen there.

As far as the Health Authority making use of beds that belong to the federal government, I believe in some instances around the province that that does take place from time to time. When they have pressure points within the system and they are able to, if they know there’s a vacant bed, connect with, and I think the dialogue and the relationship between the Health Authority and Veterans Affairs is pretty good in that regard. They try to maximize and meet the needs of both parties, to ensure the best use of the resources that are being provided, to care for our veterans and other seniors across the province.

KARLA MACFARLANE: I thank the minister for his comments with regard to that. I hope moving forward that there are things that are, and should be, non-partisan. I believe our veterans and their well-being and the policies and concerns around supporting them should be non-partisan.

I would hope that if there are future discussions, particularly with regard to the veterans’ unit at the Sutherland Harris Memorial Hospital in Pictou, that the minister would consider coming and perhaps setting up a meeting with me in the Spring, to come to the unit and meet the veterans there.

We do have some ideas, some of the individuals who work there, as well as some of the family members of the veterans. We sincerely want to continue making sure we all continue a dialogue that’s going to benefit them. I will be following up with a formal letter of invitation, and I hope the minister will consider coming to visit.

Staying with that, the theme of the Sutherland Harris Memorial Hospital in Pictou, again I mentioned last week that we are excited that we will be getting a new collaborative health care practice, a brand-new one. We’re excited about that and we understand they hope to have it up and running this summer, or definitely by the Fall.

Currently, the doctors and the nurse practitioners and staff are housed in the Sutherland Harris Memorial Hospital and use quite a large area. When they move into their new location, I’m wondering if there have been any discussions held yet with regard to what that space can be used for moving forward.

RANDY DELOREY: I think at this point a lot of the attention and the focus has been on getting the collaborative team up and running in a space that they’ve been excited to pursue. That’s been kind of a focus stabilizing the availability of practitioners for the community and possible opportunities to expand primary care supports and services in that community.

On the same theme, as the member noted, she had some questions before. One was whether there’s one position that wasn’t officially part of, but they were co-located. I have confirmed I believe that individual is moving as well so that they stay as a co-located even though not formally part of - so the design is contemplating or taking into consideration the desire of that individual to be in the same physical location. That was the information I received over the weekend subsequent to that earlier question.

KARLA MACFARLANE: I thank the minister for his answer as well as for the good news with regard to the individual doctor that I asked about last week to ensure they would be part of the new collaborative centre as well.

With regard to no discussions yet being held with what this empty space will be used for, I definitely have some suggestions. One of the other great aspects of the Sutherland Harris Memorial Hospital is our restorative care unit. It is a very well-run operation there with the staff and Dr. Cooper. It’s one that we hear a lot of good things about. A big shout-out to them.

However, we understand, too, there is a bit of a wait-list, as there would be. I’m not sure if the minister is aware, but if he could confirm, we hear at times it is four to eight weeks to get in. Hence my idea of why wouldn’t we expand that restorative care unit with the extra space that will be left over when our new clinic is up and running? I’m wondering if the minister would comment on that idea.

RANDY DELOREY: I thank the member for the suggested options. What I can assure the member is I will certainly bring that suggestion forward to the Health Authority as I do continue the work, as the member would know, throughout the province. The Health Authority continues to look at and evaluate where they can improve their operations and the delivery of health care services. That’s their mandate. We work with them when they come up with the proposals for operational changes or capital investments that may be required to meet their operational ambitions, that we engage in those conversations and discussions.

I can assure the member health care does represent over 40 per cent of our budget as it does in many jurisdictions, the investments are quite extensive. We have a very expansive capital investment in infrastructure campaign and initiative that we’re embarking upon in the province, investments in health care infrastructure that hasn’t been seen in a generation. We clearly have shown our commitment to ensuring we have health care infrastructure that meets the needs of the citizens of Nova Scotia.

Again, as ideas and opportunities come up, they get evaluated, prioritized, and as resources are available to execute, we embark on those initiatives. We’re all striving for the same end game, and that is to improve the access and delivery of care for all Nova Scotians in the health care system.

KARLA MACFARLANE: Sticking to the Sutherland Harris Memorial Hospital in Pictou. Back in the Fall, I was informed that the dishwasher was not working. I thought, okay, that’s fine, things take time. By Christmas it still wasn’t working and by the end of January it still wasn’t working. We’re going on four months now without the veterans and the restorative care unit patients, the employees not having access to a dishwasher. I said, look, let’s just get this done. We went to the Sutherland Harris Memorial Foundation. They actually said, we’ll buy it, let’s just get this done. Great. They’re willing to invest $30,000, believe it or not, into a new dishwasher.

[5:45 p.m.]

But it wasn’t until last week that they were able to finally get the dishwasher approved and install it. It was almost six months from the time the dishwasher broke down to the time that it was installed. It’s just really hard to believe it took that long, even with the community’s effort and ensuring we would purchase it ourselves.

I just want the minister to comment because, believe it or not, a lot of constituents are asking me, really, Karla? Really? Did it take that long to install a dishwasher? I’m like, apparently so. If the minister could please comment on why these processes have to take so long.

RANDY DELOREY: I’m just reflecting on the inquiry. I think the member for Pictou Centre may have brought this up to me in the past. There are many projects and initiatives. I’m not positive; maybe not. But I thought he had brought a case.

I guess maybe I’ll just ask this question to see if it is the one. Was it strictly just the dishwasher, or were there other renovations that may have come forward as part of the proposal? I’m being advised it was just the dishwasher.

Let me put it this way, the reason for the confusion is that there are a lot of individual files or concerns that get brought forward, even those of a capital nature. I don’t recall this specific one.

I do recall one, and maybe it wasn’t the member for Pictou Centre, but I thought it was one out of somewhere in the broader Pictou County area, at one point. Again, it was a similar scenario where someone had offered to do the work or contribute in kind to get the work done in a more expedient way. If I recall that situation, as I sometimes say, there’s more to it, I guess, and we start breaking down that it’s sometimes not just about the specific. Sometimes when you dig in there are more complexities than it appears on the surface.

Again, you say, throw a dishwasher in. Cripes, they could have called me, and I could have put the dishwasher in, if I would be allowed to do it through the appropriate processes, which aren’t necessarily allowed. Technically speaking, the capacity to install a dishwasher is not a super complex process.

I can’t really explain on this specific one, but again, I could look into it and see. I don’t know.

The last time with something similar to this, a similar description, when I did dig in or look at it on behalf of the member, it ended up that there were some technical issues. I think in one case it was some insurance-related things that tied into it. I think in the previous case, it was that the foundation or an organization had offered to install the renovations, and that was part of the problem, that they didn’t have the appropriate insurance things to be able to perform that work on that site. That’s what took the time and things.

Again, I’m not sure if that plays into this particular case. I can inquire about it, and maybe on the side, I’ll let the member know.

KARLA MACFARLANE: I thank the minister for his answer. I realize the complications and the due diligence in moving forward with things like this.

It’s just rather discouraging for those who are living in these units at the Sutherland Harris Memorial Hospital and, of course, for those constituents who donate and fundraise for such projects, only to be like, what’s the delay? What’s the delay? It gets frustrating.

I’m going to move on to incentives for doctors. I know the minister has often spoken about the incentive of the $150 fee to take on new patients. My understanding is that, and perhaps he can clarify it, the $150 fee if you take on a new patient is only given once you actually have that patient for a year.

My question for the minister is: Can the minister confirm that, as well as update how many doctors took on new patients and received this fee last year, and what the total cost of that initiative of $150 amounted to?

RANDY DELOREY: I thank the member for the inquiry. As of January 31^st, I believe it is something in the vicinity of 530 unique physicians across the province, so 530 would predominantly be family physicians or primary care providers.

We have, just to put that into context, I believe between 1,200 and 1,400 family physicians in the province. Almost half of all family physicians have taken advantage of the program, essentially. That’s a little less than a year, it was in January of this year. I believe they’ve submitted claims for just under 25,000, just over 24,000 unique patients; so 530 physicians, 25,000 patients since April 1, 2018. The cost booked for that is about $3.6 million.

Again, the timing of the financial dollar amount of $3.6 million might be a little bit off, based upon the date I have here for January 31^st, for my physician and patient match.

What I can advise the member and the whole House is that we actually have a website that does provide monthly updates on the incentive fund. Anyone can go online and see the stats based upon the number of unique physicians participating in submitting claims and the total number of patients who have been attached since the fund came.

I believe we probably do have more updated numbers on the website, but the work for the book has data as of January 31^st.

It is true that the payment flows at the end of the year. The actual intent of this program and this incentive is to attach patients to a primary care provider. We wanted to ensure that the attachment took place, which means maintaining them on your roster for at least a year. That’s why we have that. It’s a bit of a control mechanism to ensure that. We could make the investment and we knew that relationship, so the decision and the agreement that was put in place when we developed this program was that the payment would be after one year. As a province, we book the expense anticipating to pay it out. Then we pay it out when they’ve been on the roster for the year.

Yes, they only receive payment at the end of the year maintaining the patient for that long, but we anticipate these physicians will maintain the relationship because I believe they enter into these agreements with both the patients and the province in good faith. There may be some instances where someone might move, and that relationship may break up before the year, but again, the goal is about long-term attachment to primary care providers. That’s the way we designed it in partnership with Doctors Nova Scotia. Now we’re honouring our side of that commitment to pay out for those physicians that have met the obligations under that particular program.

KARLA MACFARLANE: Thank you to the minister for his answers. Moving forward to a release here from NSHA from the end of January with regard to drug shortages and back orders - I find this has been becoming more and more of an issue the past year. People are very concerned with regard to the unfortunate drug shortages and back orders that people are experiencing. My understanding is that this is sort of the new norm, so I would like to ask the minister: What would be the new plan for his department to ensure we can guarantee Nova Scotians that they will receive the necessary drugs and services they require to manage the conditions they need drug coverage for?

RANDY DELOREY: I think, depending on the specific items, there was some information in January around, for example, vaccines for the flu. That particular situation occurs. The way that the flu vaccine is produced, you need a fairly long lead time to submit your orders. For example, we submit our orders in the Spring or early summer for the flu vaccines that we’re going to require in the Fall. We really have to try to anticipate not just what strain of flu we’re going to be requiring, anticipating for the upcoming flu season, but also how many people are going to come forward looking for a vaccine.

This current fiscal year, the Public Health Office distributed all their vaccines out to physicians and pharmacies throughout the province to the point where we exhausted our supply to the providers. There were still supplies of the vaccine in the province, but not every provider had a vaccine on-hand and we had exhausted our supply. That’s an example where even though the demand was increasing, and people were consuming perhaps above the rate of what we had anticipated, you can’t order it in season because it takes so long for the flu vaccine product to be produced. If we ordered it when we started to see that the demand was greater, we would end up getting the flu vaccines after the flu season was finished and there’d be no more need or would provide no more clinical benefit. There are times that the shortage, or the impact, is because you have to anticipate and order the drugs in advance of when the demand is.

Two specific drugs that may be in the broader pharmaceutical program and system, a little bit different scenario, obviously demand you can’t necessarily predict or wholly anticipate for every drug, but you try your best and pharmacies order, government departments, the Health Authority or public health, if they have to have pharmaceuticals on hand, would do the orders.

[6:00 p.m.]

My understanding of the circumstance and the situation is on specific drugs, they are usually running into situations where there are manufacturing challenges, so whether that is some operational impact which may be everything from operational issues at the manufacturing site, which may be regulatory in nature so if the regulators, Health Canada, or the FDA go in and U.S. or Canada regulators go in or wherever the manufacturing facility is located, if regulators go in and basically say you’re not actually meeting the protocols required for you to produce a safe product, then sometimes they may require them to stop producing until they fix the problems with their production facilities. Sometimes there is a regulatory challenge that might impact or there could be technical operational things, if there’s a natural disaster, anything that would impact the physical infrastructure and production lines.

Those are manufacturing issues, challenges, with the producer of some products. In some cases manufacturers decide that with limited production capacity they will choose to increase production of certain product lines and decrease the production of other product lines. A lot of these variables are outside of the control of any government entity to drive those pieces within the system.

But what we do have is certainly when it comes to kind of the traditional pharmaceuticals, growing equivalent product lines, where you can have a name brand pharmaceutical being produced and you can have an equivalent generic drug being produced. Sometimes it’s just a particular manufacturer and you can get the equivalent product from a different manufacturer and it just takes the time to negotiate and make sure you’re procuring the drugs through them.

As technologies and the development in the pharmaceutical industry expands, you start to get into more complex areas like biological treatments that are more complex than what we would traditionally think of as a chemical compound pharmaceutical. Even in that space we’re starting to see biosimilar products coming online now as patents and technology expire to allow other products to compete in the market so that you have multiple product lines which could possibly treat the same condition. One of the responses is having more competition, more products available to contemplate, and getting those products into our marketplace as quickly as possible is one possible action to help respond more timely when there are drug shortages.

Again, I want to remind everyone that when these types of issues hit, they do hit nationally, internationally at times, and the pressures and the competition to obtain those pharmaceuticals are nationally and sometimes internationally to obtain them. If the products aren’t being produced, we can’t just make them appear, we have to respond and come up with the best clinical response that we can to provide the best treatment options to patients, if it requires pharmaceuticals, the nearest pharmaceutical supplement or alternative pack.

KARLA MACFARLANE: Dr. Ryan Sommers, with NSHA, had an opportunity I believe around this time last year to go around the province. I know he came to Pictou County to speak to my colleague in Pictou Centre and myself with regard to Lyme disease.

Lyme disease, whether we all want to believe it or not, is a very serious disease and it is increasing in this province. There are those who will still deny that it even exists, but there is absolute proof out there that it does exist, and we have to be more diligent in moving forward and taking proactive measures.

I know that the minister has spoken before on this but has never indicated any type of strategy in moving forward to combat this. I’m wondering if the minister can update us with moving forward, now that it has been out there a lot more in the news - what new strategies are coming forward to help Nova Scotians with Lyme disease?

RANDY DELOREY: I guess a couple of things, and whether they are deemed new or not, I think they are really a continuation and implementation from a high level, programs that are in place. But, of course, these are adaptable and evolve based upon the evolving prevalence of ticks which, as we know, are a key means by which the Lyme disease bacterium are being transmitted in parts of our province.

I guess step one is to allay any concerns of anyone in the Legislature as to whether or not government or health officials within our public health agency believe that Lyme disease exists. There’s no clinical dispute, I don’t think, certainly from our perspective, of the fact that Lyme disease does exist.

The efforts we strive to implement, a couple of things - one is around having a tick-borne disease response plan to ensure that we do monitor and track the prevalence and what specific actions we may be taking in a given year or the approach and the communication material and the education that takes place. There is the tick-borne response plan and that’s reviewed and updated each year, so it would be coming up to that point. It would be rolling out as we move into the Spring, a little bit further, and get ready for the summer season. That includes public information.

Last year we actually put out flyers and pamphlets to hiking areas and things, actually in three languages - English, French, and Gaelic for some parts of the province - to ensure that people who were out and about in the hiking areas they could see - a fairly simple chart that shows how to check yourself for ticks and so on, letting people know if they are at the location, so there’s kind of that preventive piece to it which I think is probably one of the main ways or the best ways, again, like many illnesses, if you can prevent it then you are further ahead. Those steps are very clear and those don’t change. I’m not aware of any real changes in the prevention side - wearing light clothing so you can see the ticks, if you are untucking your pants into your socks or your shoes, again not having exposed skin when you are out hiking in longer grass areas and shrubbery and things like that.

I believe it’s a DEET substance, if you use a DEET insect repellent, I believe that works to help repel the ticks as well. These are key preventive measures and again, we do have a website.

THE CHAIR: Order, time has elapsed for the PC caucus. I’ll turn it over to the NDP caucus for an hour.

The honourable member for Cape Breton Centre.

TAMMY MARTIN: Thank you, Madam Chair. When we left off, we were talking about staffing ERs and we were talking about nurses in particular. Currently, we know that LPNs are being called in to cover rapid assessment units, and brand-new RNs with very little clinical experience are being asked to come in and cover ER shifts. I suggest to you that’s because of the change in the interpretation of that collective agreement language, as well as now we know that vacations are unable to be covered for RNs. We know that a memo came out talking about Guysborough Memorial Hospital and Eastern Shore Memorial Hospital. They were not approving summer vacations for registered nurses.

I would suggest to you that everyone is entitled to their vacation, and with the current state of our health care system and how hard our nurses work, what is going to happen? What is the Department of Health and Wellness doing to ensure that memo is rescinded and that all staff are able to get their vacation when they should or when they request, of course, within a reasonable amount of time? Regardless, everybody is entitled to a summer vacation.

RANDY DELOREY: I thank the member for the question. Indeed, I think every member of the Legislature can appreciate the - I don’t know if it’s apprehension or frustration of a nurse who would receive the notification, having applied or looking for vacation in the summer and getting a notification in March that the employer could not commit to that requested vacation schedule. Indeed, it’s my understanding that the Health Authority will continue to endeavour to meet the vacation requests of staff. As I understand it, I think the notifications were that they do not have at this point the staff schedule complement in place to enable some of those vacations, but efforts are ongoing to ensure that they are able to meet as many or all the vacation shifts that they can.

Some of the things that would be ongoing, and I hope will perhaps give some level of comfort and encouragement to nursing staff in the province, are things like the growth in our graduating class of nurses, of RNs in the province. I believe we’re expecting an increase throughout 2019 versus 2018 by almost 20 per cent of additional graduated RNs coming on stream. I think there are 500-and-some, and I think it’s going to be over 600 anticipated this year, so there are efforts being made.

There are increased graduates coming into the system and I’m quite confident the Health Authority will continue to employ the vacancies and the opportunities do exist for nurses to obtain positions. With that anticipated increase in graduates, I think they’re hoping to bring a number of them on stream, and that should help alleviate some of those concerns. As well, recruitment for ongoing or existing vacancies continues in attracting experienced nurses from other parts of the country, obviously, that would meet our licensing criteria here in the province.

TAMMY MARTIN: Mr. Chair, with all due respect, the upcoming hires are of no help to this staff currently who are looking to take vacation time this year. As well, in this specific instance, in Guysborough and Eastern Shore where it’s much more rural, when there were two employers and two different bargaining units, the nurses would come from other sites and pick up the shifts. Because it was two different employers, they could do that and be paid at straight time. Now that it’s one Health Authority, the nurses can’t go and pick up extra shifts because it would be overtime. In this specific instance, that is one of the problems. Now that it’s one Health Authority they can’t work to pick up extra shifts to help out a buddy down the road, because it’s one employer.

[6:15 p.m.]

To that end, we are also aware that the emergency rooms in Cape Breton, other than Cape Breton Regional, have their schedules up for doctors for the month of May with very few shifts covered. We’re fast approaching the summer when we all know that there will be summer closures, summer rotational closures, bringing the OR down a bit. But right now, we’re unable to staff emergency rooms in Cape Breton, other than the Regional, which is also at its maximum.

I would like if the minister could tell us, how many locums are we requiring or relying on to keep our emergency rooms open? I know we talked about the cost of locums, but if the minister could provide us the line in the budget where we can see the dollar amount associated.

RANDY DELOREY: Mr. Chair, to the first piece, which I know is just a carry-over from the earlier questions. I’m a little bit confused, and it may be a continuation of some of our earlier discussions where when we move on, it’s an agree to disagree. I guess earlier, in the last round of questions, there’s a lot of attention on the notion of changing the interpretation of the agreement and that nurses wouldn’t work for straight time if they were filling an additional shift, so there’s a lot of conversation about the need to change the program back.

In the preamble of the question, if I understood the member correctly, she had indicated that one of the problems with the single Health Authority is some nurses can’t come over and work for straight time to cover an additional shift. But I’m missing that because if the nurses are available and willing to work the extra shift, I believe the Health Authority is willing to take them on. From the start of the conversation previously, the member had indicated nurses aren’t willing to take the shifts; now the member is saying the nurses want to take the shifts. If I understood that correctly, I’m just a little confused on that side of it.

To the specific question on locums, the budget is not broken down at that level of detail. However, the category where it is found is under the Physician Services budget line item. I believe there is a line item, Physician Services - Other Programs. In the budget under the Physician Services category or specific piece is Other Programs. The anticipated forecast for this fiscal year closing is that we spend about $3.5 million dollars on these services and we are budgeting just under $3.8 million for the upcoming year. In 2018-19, we are forecasting spending $3.5 million and we’ve budgeted to increase that - it will rely a little bit more on locums - to just under $3.8 million.

You won’t see that line item specifically, but under Physician Services - Other Programs, about $45 million is the estimate in that line item, and of that $45 million, we anticipate about $3.8 million budgeted for locum services physicians. That’s the locum program in its entirety, not just for emergency departments. That’s across all locum services. Again, we don’t have it at that level of detail. These binders would be much larger if we tried to slice and dice at every possible configuration.

TAMMY MARTIN: Just to clarify, for the nurses it’s two completely different issues. When a nurse works full time in her position and takes a sick day or a vacation day, let’s say, this week, and next week she’s called in for an extra shift, an overtime shift, she will not get paid overtime because she took a benefit in that pay period.

In the smaller hospitals they are choosing, they know their buddy can’t get Friday off to go to their sister’s wedding, so when it was two employers they could go there and work without incurring, because they know the employer is not going to cover pay for Eddie to take a vacation day and cover it at overtime, but they will pay them straight time. It’s two completely different issues.

Now that it’s one employer, they can’t do that. Under the collective agreement, it would have to be overtime.

The other thing that is somewhat disheartening, I think, is that we’ve had to put more money into the budget for locums. How come we can’t get our own doctors? To me, that’s a little disheartening.

To that end, at the Roseway Hospital, the locum doctors are paid less in the country than they are in the city. We talked about incentive programs the other day and how many regional hospitals have them. Could the minister explain how the incentive rates differ from those rural hospitals and metro? Is the minister also able to provide the rates per hospital, how the rates compare between rural and metro?

RANDY DELOREY: To the broad scenario of locum services and support, part of that, of course, is about helping support work/life balance to ensure we provide temporary relief when the local complement of physicians is not meeting the needs in a particular community or a particular program area, it does provide that opportunity.

In addition, there are certain physicians I’ve spoken to in the province who have indicated that they may take some time off, but they may not want to work in their community. Going somewhere else, they find, is almost a learning opportunity for them to work in a different environment with different colleagues and they can learn from those experiences.

Some physicians do like to take a bit of their time throughout the year, take vacation in their community and go do some locum support. It helps balance both work/life where they are actually covering a shift or a set of shifts for a physician to take some time off, and at the same time that they’re doing that, they’re choosing to because it’s something that they’re interested in.

To the specific question around programs and how they were established and the rates, broadly the locum program was developed and negotiated in the master agreement with Doctors Nova Scotia. That’s what lays the foundation of the locum programs and where and how they get established.

We have enhanced some of those locum programs. I think I mentioned it the other day. This is off the top of my head. Some of those enhancements saw the travel budget almost double. It used to be $500, and I think it has increased to $1,000 and has expanded the pay period and accommodations for physicians in some of that enhanced locum compensation opportunities, again, responding to feedback and what we’ve heard, because we need to cover shifts.

We have seen some positive results. We have seen physicians in communities. We have started to see with some enhancements in Cape Breton psychiatry, for example. Following the vacancies that the Health Authority continues to recruit for and fill those vacancies, following that is how we even get temporary staff in to help support the work environment for the existing complement of staff dedicated at the Cape Breton Regional. The existing locum programs and support programs weren’t drawing clinicians from other parts of the province to come into the program.

The work of locums is really targeted at our rural communities, predominantly. Maybe we can do it offline if the member has information. My understanding is that there wasn’t locum eligibility in the greater HRM area because generally there’s a sufficient complement of physicians to cover those shifts, that it really is targeted towards more rural hospital sites. I’m not sure of the information that she started with about some communities getting more than HRM in the central area. If she has the specific sites, I would certainly take a look at that. I didn’t anticipate that that would be the case, that an urban core would be getting compensated for a locum program greater than other rural sites.

TAMMY MARTIN: I appreciate that. I appreciate hearing that from the minister because I think each community is just as important, and doctors should be paid accordingly, regardless of where they go.

However, I’m curious if the minister could talk to us about the rates that locums are paid at these hospitals. Specifically, like I said earlier, we’re looking at Glace Bay, Northside, and New Waterford being closed or with no doctors signing up for any shifts for the month of May, as of yet. We’re specifically concerned about Eastern Shore, Roseway, Digby, Glace Bay, New Waterford, and North Sydney. Have any of these incentives helped bring locums to these areas?

RANDY DELOREY: This data is a little bit dated, but I think as of some point in February or early March, within emergency departments, I believe we had 222 days since we made these changes in August 2018 - so in about a six-month period, we had about 222 days being covered that wouldn’t have been covered before we made some changes in August 2018.

[6:30 p.m.]

TAMMY MARTIN: Mr. Chair, the Premier tells us that having ambulances waiting in off-load bays is not acceptable. I would just like to read something from the paramedics’ union, the IOUE. They say paramedics are tired, they’re hungry, and they’re sick of being treated with such little respect by this government. Talking about the $4.6 million to increase emergency health services in Nova Scotia, paramedics are saying they have no idea how this is going to be used. The problems are long-term, systemic issues. How will they help front-line workers? It’s the second year in a row that EHS has received extra funding due to increased calls, but yet paramedics are still struggling. They want to know where it’s going to go. Will it buy more ambulances? They don’t feel that it will fix the problem. I will table that document.

Recently, in a Health Committee meeting, we had members from the Nova Scotia Paramedics Union. While the Premier says the wait times in off-load bays is unacceptable, when I asked Terry Chapman who is the business manager, I believe, for the IOUE, what is the standard, he said that sometimes you’re waiting 45 minutes. Sometimes in my community of New Waterford an ambulance has to come from Baddeck or Antigonish.

I asked Mr. Chapman what would happen at that time to the patient, should it be a member of my family who suffered a cardiac arrest. His answer was that they will be non-living by the time EHS gets there. Mr. Chair, is this acceptable to the Minister of Health and Wellness?

RANDY DELOREY: As the member noted, in a recent Health Committee meeting, the topic of discussion was focused on improving the transition time or ambulance off-load time. For those members not familiar with it or who may not have been on the committee to get the details, when an ambulance shows up at an emergency department, that’s the length of time for them to transition or transfer the patient they brought in the ambulance to the care and control of the hospital facility to which they are entering - how much time does that take?

We’ve had discussions during Question Period about this topic over the last year or so, and I’ve been very clear when the topic first came up, that this is something that was on my radar. I’ve been engaging with the Health Authority and other partners to better understand the situation and, delving in even further, having the parties come together to assess the situation and come forward with some recommendations.

I believe there was extensive discussion at that committee as to the path forward; the targeted efforts that the Health Authority and the partners were going to be making to improve that transition time from ambulances, from paramedics to the hospital system, to get those ambulances back out on the road.

When I met with the union representatives to discuss, at a high level, the overarching direction that I was giving, and that this was very clearly a priority for me and for the government - that I had articulated this point very clearly to both the Nova Scotia Health Authority and EMC that provides our ambulance services and the Health Authority that provides our emergency department services - that the specific details, the programs, and the efforts being taken does rest with the Health Authorities and EMCI.

They had painted, in some broad strokes, the path and the direction. My indication was within the overall patient flow space, the area I thought needed to be addressed first was to get the transition time - the off-load time - addressed because that will get our ambulances back out into the community.

Having had that conversation, I believe, and recognizing the other pressures that paramedics have articulated, the long shifts, and the frustration at being at some hospital sites for - I’ve heard stories where it could have been upwards of an entire shift at the same hospital, not doing what they were trained to do, to be in the community and ready to respond to an emergency situation.

Ultimately, many of those pressures and frustrations and stress points on individual paramedics can have a large step forward in addressing them and improving them if we address the off-load piece, and that’s why I wanted to focus there. It was my understanding, in my conversations and engagement, that that is the root cause pressure point that had been building for many years, but had gone unaddressed and almost became normalized within our health care system.

I’ve been very direct and clear in my expectations that it be addressed and that we can anticipate seeing improvements. It was to target five or six hospital locations that have been articulated as having the highest pressure points. This is off the top of my head, so forgive me if I have one mixed up: the Infirmary in Halifax, the Dartmouth General, Colchester in Truro, Cape Breton Regional, and the Valley. Those are the five that are going to be prioritized and focused, and we expect to see actions taken and exercised.

For what it’s worth, with this focus, I can say that I had a family member that did have to go in for emergency services in my community on the weekend. It was a child, and their mother actually came back and advised me. I’ll say that this mother is a health care provider as well, who doesn’t work in the emergency department, but did indicate they were pleased with the change that they’ve seen based on this visit, which was that the nurse was able to have the X-ray requisitioned without having to wait for the physician to come. They were able to transition in, get the requisition, and engage with the physician as soon as they were available, have the conversation, and move on. Again, this was a health care provider who engaged through the emergency department, and they’ve articulated that they are seeing changes on the ground resulting in more efficient treatments and care.

My goal as minister to articulate how to clinically respond to these pressures, but rather to provide the direction of the policy perspective that these were pressures that were priorities for the Health Authority and their partners to address in our health care system - that work is ongoing. They talked a bit about it at the Health Committee meeting. Again, I anticipate, and the feedback that I have received from the Paramedics Union was if they see the results, they would anticipate from this focused effort on improving those off-load times, that that will actually not solve, but certainly improve the situation on the ground for our paramedics and provide that opportunity to continue our focus on other parts of our system for other health care workers like our nurses in our emergency departments, to help improve patient flow there as well.

These are directions that I’ve given to the Health Authority that these are priorities. We are hearing, and I am hearing - and I want to see these improvements in our health care system because I think it’s better for the employees, the front-line health care workers, and ultimately better for the patients who go in to receive that care, as well.

TAMMY MARTIN: I agree with the minister. I agree that off-load times are part of the problem; however, I really have a simple question. For example, last week when the Regional Hospital had 23 admits, there’s only 23 beds in the hospital. I know there’s a whole bunch of contributing factors, and I agree that part of the problem is off-load times, but when you have 23 beds and 23 patients and ambulances are coming in, nine times out of 10, they’re already working short-staffed - who are they off-loading those patients to?

The nurses have told me they cannot take another patient, that they’re already seeing 10, 12, or 14 patients. They cannot take these patients from EHS. Maybe I’m missing something, and if I am, I apologize. I’m just looking for what I’m missing there.

RANDY DELOREY: To the member for Cape Breton Centre, I think that’s a very legitimate question to be asking, if you haven’t seen or been communicated the details. I’ve spoken in the Legislature before, for example, about the program that was started last year at Dartmouth General Hospital for the off-loading. What they’ve done is they’ve created what they call, I believe, an off-load zone. The NSHA hired dedicated staff to be there to monitor and provide care for those patients that are being transitioned, so they are being transitioned in that example to a dedicated team.

At the Dartmouth General Hospital, I think it is nursing and paramedic staff, but they’re employed by the Health Authority at the Dartmouth General Hospital. For example, let’s say there were five ambulances that showed up at the hospital in succession. Under the traditional model those five ambulances, two paramedics per patient, would be waiting together with the patient. That would be 10 paramedics tied up with five patients for the duration until they are able to transition. But with a health care team of a paramedic and a nurse, they’re able to transition them from the EHS stretchers to hospital-based stretchers, or rooms dedicated for this space, and provide the care; those five teams of paramedics and those five ambulances can go back out the community from that point, so there’s dedicated staff in that space and in that environment.

Some of the work at HI, I believe, was reclaiming the rapid assessment unit to help improve the assessments and care being delivered there.

Again, it’s really a combination of initiatives at different locations to try to improve the situation; it’s difficult to be too prescriptive when looking at opportunities, because for some things you need the space or infrastructure, and some are about staffing.

We made it very clear that again, an investment in the additional nurse and paramedics, you allow those 10 paramedics back out on the street with their five ambulances, was a good use of our health care resources at Dartmouth General. It’s seeing positive improvements, I think I’ve heard anywhere between 25 and 35 per cent improvement in achieving off-load transition time targets, based upon the investment, and that’s based upon a period of time while there’s an increase in demand at that site.

With that team that they put in place there, they’re seeing very positive improvements. If we can apply that 25 to 35 per cent improvement in efficiency to our other sites that are having pressures, that’s a 25 to 35 per cent improvement in ambulances back out on the street in our communities. That, I think, is going to pay dividends for our front-line health care workers, particularly our paramedics, and communities across the province.

TAMMY MARTIN: Madam Chair, the other day I listened to the minister talk about the EHS budget and the fact that the minister is increasing the bands. That’s where the $4.8-and-some million increased to the EHS budget.

First of all, I wonder if the minister could tell us, where in the budget are those details? Secondly, I wonder, with the increased bands, should I assume then that we will be hiring more EHS paramedics and putting more ambulances on the road?

RANDY DELOREY: Madam Chair, that’s correct, the notion of the bands that we hire. That’s the contract with the EMCI that provides the EHS ambulance services and its utilization based, so we pay for the calls that we receive. The actuals, we don’t pay for the ambulances per se, we don’t dictate the number of ambulances within the system; we pay for the services to ensure that the ambulances are responding to the calls within the province.

With increased demand of our emergency services, we’re contractually obliged to pay for the increased demand. Then, the expectation is on the employer, the service provider, that provides those EHS services to ensure that they have the appropriate complement and system to respond to those calls that come into the system.

TAMMY MARTIN: So, the employer is free to use that money, whether it’s to buy more ambulances or to hire more staff?

RANDY DELOREY: As far as physical capital assets - the ambulances, so the physical ambulances - the province purchases, and that’s part of fleet management and so on, so the physical asset.

[6:45 p.m.]

As far as the staffing and so on, we pay for the calls that come in and they decide how they staff. That would be similar to how the majority of our physicians are paid. We pay them for every office visit. How they conduct or manage their office visit or what kind of support staff they employ within their operation and what costs they incur there is incumbent on each individual physician, by and large. It would be very similar in other parts of our health care system where the service provider has a rate that gets paid for the service that they provide to deliver a particular health care service. With physicians, it’s office visits; for primary care office visits and for EMC in the EHS system, it’s for ambulance calls. We have to pay the rate that’s been negotiated, and they have to provide the service for which that rate of pay is associated.

TAMMY MARTIN: I’d like to talk about vacancies with nurses in emergency rooms and other parts of the hospitals. I’m wondering if the minister could provide us with the actual number of vacancies in hospitals across this province, specifically how many vacancies are in emergency, and what would be the longest vacancy, or continuing vacancy as it’s called, with the NSHA that we have in the province.

RANDY DELOREY: We don’t have the detailed breakdown, certainly not at the department, and the hospital-level vacancies. This is kind of per some of the earlier questions we had, that the employer responsible for the hiring of the recruitment would have those details more readily available. Certainly, we know that we’ve been investing and supporting the growth of nurses within our health care system, and just some general statistics more on the availability in the workforce side of things is what I have available.

We have about just under 15,000 nurses, I think it’s about 14,700 licensed nurses in the province. It has been growing over the last number of years. We continue to invest in programs like $4.7 million in our nursing strategy, $8 million in RN education seats, and $1.6 million for additional investment in the nurse practitioner education seats to help us forward. Over the last number of years, we’ve added funding for RN education seats. I mentioned earlier that about a 20 per cent to 24 per cent increase, I believe, is anticipated in nursing graduates in 2019 versus 2018, and we added those extra nurse practitioner seats in the Fall. We’ll see those graduates and an increased complement of 25 nurse practitioners. That’s an increase over the existing number of seats.

Some interesting things - a lot of people talk about our greying workforce and the pressures within our health care system. I think that’s why initiatives like these nursing strategies put in place are to deal with that. With such a large workforce, obviously, like other professions, you’ll see the retirements coming in, so how do you respond to it? You have to respond by building the front end of that workforce.

We’ve seen a reduction in licensed practical nurses - we have about 4,600 licensed practical nurses. The average age has decreased from 44 years to just under 43 years over the past year, so we are seeing the workforce becoming younger, which does show that you’re seeing a shift from more people at the end of their careers to early in their careers. This bodes well for the future as we continue that we are responding to the aging workforce as people are retiring and moving on.

Nurse practitioners - we see just over 200. They are a little newer in the workforce. They average just over 45 years of age this year. I don’t have the data for what it was four years ago but most of them are employed. About 76 per cent of them are employed full time and others are employed either part time or casually, which are often choices being made. Almost 97 per cent of those licensed practical nurses are employed.

The registered nurses are the largest nursing cohort, there’s just about 10,000 of them. Again, their average age is decreasing as well, down to currently about 44 years old. Ninety-six per cent of them are employed; about 67 per cent are employed full time - not so much from the vacancy side, but the availability and what their work profiles look like. That’s just a little bit of information for the member, in the absence of the data she specifically asked for - some other data that I think might have been of interest to her.

TAMMY MARTIN: I’m surprised to hear that only 67 per cent are employed full time. That shocks me. However, I’m wondering if the minister could please describe the nursing strategy, or the strategies that the minister speaks of.

RANDY DELOREY: Just to the first point, the surprise that the member referenced about the employment rate, keep in mind that’s of all the licensed nurses, so I think that ties into the profile. I’m ad-libbing here a little bit, but I think it may be linked to the profile where at certain points in one’s career they may choose to work part time or casual. I suspect that has much to do about the individual choices of nurses, as opposed to the opportunity. Certainly, the opportunity to work full time, the opportunity exists in the province. It’s the choice being made by individual nurses. I just wanted to clarify in case any of the members thought there were some limiting restrictions, but the opportunities are there, and certainly if any of those other nurses that are out there working casual or part time are interested. It sometimes lines up with specific locations and where the challenges are, the opportunities and the availability of the workforce don’t always line up the same.

To the specific question around the nursing strategy, it’s really a multi-stakeholder program. I believe the nurses’ unions, as well as the college might be on as well, and the Department of Health and Wellness and the Health Authority representatives. It really is a collaborative initiative that says - and again, this is responding to the anticipation of the pressures within the workforce for nurses in the health care system.

They started this a few years ago, I don’t have the exact year that it started but it was in place. I won’t take credit for it because I didn’t create it, but we’re continuing those efforts. With multi stakeholders, the efforts around the nurse practitioners, for example, that was a direction and feedback that came out and recommendations and support out of that nursing strategy to provide that initiative.

I think these are great ideas. People are coming to the table as stakeholders and their objective and mandate is to ensure that they have the right complement of workforce to meet the health care needs of the province. I think everybody goes to that, all the members of the groups come together in good faith. I think that nurse practitioner program is one of those great examples that shows they have good outcomes, as well, with the ideas they generate. It’s great that we have dedicated funding to help deliver on the recommendations coming from those at the table.

TAMMY MARTIN: Thank you for that answer. I wonder if the minister is aware of any circumstances or situations where nurses, RNs specifically, are being pulled from either an emergency room to cover in a collaborative care centre because there may be admitted patients there and it’s closed, so there’s no staff there or vice versa when they’re pulled from collaborative care centres into emergency rooms. Specifically, we know that coming into the summer that there will be rotational closures, and that may be departmental as well. Does the minister provide a guideline or is there a certain amount of acceptable closures, a certain number of beds that are permissible to go down every summer? Or do we have staff from the different areas that may have to close because of lack of staff?

RANDY DELOREY: I guess I don’t have a specific criteria that the member is requesting, but as she would know when it comes to emergency departments, for example, there are some sites that have scheduled closures anticipated. I think it really developed on historic trends or availability of staff and so on. That becomes kind of a recognized response in some of those communities.

To the member’s inquiry, I think what the member is referring to is Collaborative Emergency Centres, just for clarity for the other members in the Legislature, as opposed to collaborative practices or collaborative teams in the system. I just didn’t want members to be confused between the two. It’s really Collaborative Emergency Centres that might be in a community hospital around a regional hospital and whether staff would be moved around.

I think what I can say is certainly the emergency services provided in a regional emergency department setting versus a Collaborative Emergency Centre is very different, much more acute response and services in our regional hospital settings. When the Health Authority is found with pressures for staffing, I believe their first priority is ensuring the emergency services at the regional hospitals are up and running. As frustrating as that may be in some other communities that have a hospital and may see staff moved from a community to support that regional hospital emergency department, I would suspect most Nova Scotians, including the members in the Legislature, would agree if it means the difference between maintaining the emergency department at a regional environment or not, we definitely need to have those regional facilities open and staffed appropriately.

The guideline and the standard are the clinical drivers to make sure they have the appropriate staff complement to have the operations of their emergency departments and to provide the care and response to the emergency care of Nova Scotians when they come to the facility. That’s kind of the expectation. Off the top of my head, I can’t say I’m aware of a specific site where that may occur or may be planned to occur. That’s not something that comes to the minister for approval or what have you. It’s about the operation, and the mandate of the Health Authority is to provide the care, but they need to do so safely. They need to meet the clinical needs of the patients and ensure they’re doing that appropriately.

When they do have an emergency department closure, it’s because generally they were unable to staff the facility with the appropriate staff complement to ensure safe operations. If they had the complement, they would be keeping those emergency departments open. They continue to recruit to fill them. We continue to use incentive programs like the locum program enhancements that we have done to try to facilitate and assist the Health Authority and improve their ability to recruit and retain.

[7:00 p.m.]

As I mentioned in one of the earlier responses, since August 2018 - about a six-month period - we had about 220 days covered where the locum was used. I think the member referenced some communities like Roseway, Yarmouth, and Digby. These sites made use of the incentive program, of locums, so some of those 220 shift days that were covered were covered at those sites that the member had raised questions about previously.

TAMMY MARTIN: I believe I just heard the minister say there’s a commitment to keep all of those emergency rooms open.

RANDY DELOREY: Effort.

TAMMY MARTIN: I think I heard the word “commitment.”

Regardless, moving on from emergency rooms, we appreciate the work that has been going into hips and knees. At the Valley Regional, for example, I understand that the commitment to provide more orthopaedic surgeries may have inadvertently bumped other surgeries from happening because they didn’t have enough recovery beds to put people in after surgery.

I would like to ask the minister: Is there anything in the budget to increase the receiving capacity of hospitals providing these surgeries specifically, other than hiring new anaesthesiologists and surgeons and the pre-op program?

RANDY DELOREY: It’s an investment somewhere in the vicinity of a bit over $17 million to help with the orthopaedic strategy that was announced in October of last year. It has been an effort and work to improve the outcomes.

The investments are across the system in terms of our orthopaedic - again, hiring the orthopaedic surgeons and the anaesthetists, the pre- and post-habilitation services, and the staff required to provide those services. That’s what the target was.

The way resources are distributed and the hips and knees, it’s not just about the individual dollar investments. It’s about how the system was standardizing across the province, recognizing the opportunity and the availability of orthopaedic surgery time and professionals throughout the entire system, and saying, how do we organize and utilize those resources in the most efficient way possible? How do we provide flexibility to patients across the province?

Obviously, giving them flexibility to continue to be referred if there’s a preference for a particular surgeon or location is an option. If the preference is to have the surgery done as soon as possible, that’s an option as well, to look at the wait times that are publicly posted and request, either by location or surgeon, the referral that would have the shortest wait time and would give you the best chance of getting your surgery done as expeditiously as possible. This is where the focus and the efforts have been made.

How the investment and the work that’s being done in the orthopaedic program versus other surgical programs - that, again, is part of the overall operational planning and efforts to evaluate the resources available and distribute and ensure that those resources are invested and made available to provide the care and the services that patients need in the province. If someone needs emergency surgery, there are times, even in our orthopaedic investments, when other surgeries end up bumping an orthopaedic patient in order to get - if that emergency room, operating room, and recovery space are needed. Generally the way our health care system is built is on a triage-based system, so that those who are the most acute or have the most urgent need get their care first, and then the other ones get plugged into the system.

To the member’s question about where other types of surgeries may get bumped or waylaid, I just want to ensure, Madam Chair, that you and others know that the triage system is still in the health care system. If those are urgent, critical-based surgeries and emergency-based surgeries would still move to the front of the line and those surgeries would get done.

For example, in the orthopaedic space, I think I tabled a document recently in some recent CIHI data that showed the recommended guideline in acute emergency response time for fractures in the hips is to have that surgery within 48 hours. We are meeting that somewhere in the vicinity of 96 per cent of the time. That’s an increase from - I think we were only at 88 per cent or so and the national average is only at about 85 per cent.

We are exceeding national averages and seeing improvements in part because we had these resources available, but again, those emergencies end up taking away from the scheduled hip and knee surgeries. There is give and take, and we are responding to emergencies, because that is the way our health care system has been designed - not just for surgical but in our emergency departments as well.

TAMMY MARTIN: I’d like to move on now and talk about One Patient One Record. While the jury is still out on this, in the few minutes we have left, I would like to just ask a simple question right now before we get to continue.

The Privacy Commissioner thinks that the Department of Health and Wellness needs to consult with her office in developing One Patient One Record. Is this happening?

RANDY DELOREY: For the One Patient One Record (OPOR) project - which, as the member rightly acknowledges, is a fairly extensive overhaul of our IT systems within the modernizing of the systems for the province - and the work being done with the Privacy Commissioner, I can assure the member that the department staff meet with representatives from the Privacy Office on a variety of topics.

Where we are in the OPOR project phase - it is still in the procurement stage, so we are still at the front end of this. The actual detailed project and the work on this comes out over time, but we are at the front end of this with procurement. It’s a very large procurement process that is under way. It is quite extensive, and we want to make sure that we get it right and ensure we have the right system.

The implementation and the work that gets done, and the rollout throughout that project stage - there is certainly more work being done with a variety of stakeholders, including clinicians and others who will help guide the successful implementation of this project to improve health care outcomes.

I can advise the member that at my most recent meeting with the president of Doctors Nova Scotia, this was a priority topic that was brought to the table. The current president articulated his commitment and support for modernization of technology, again with the caveat - and I think we all share this caveat - that it’s done right, and this is the critical thing. This is very important. It provides a lot of upside potential - a lot of opportunity to have a single health care system providing the tracking of data for Nova Scotians wherever you reside.

I may be a resident of Antigonish, and historically only GASHA - the old GASHA district - would have my health record, so it would be fine if I ended up at Strait Richmond. But if I ended up in Cape Breton or Yarmouth, they wouldn’t have my hospital record.

THE CHAIR: Order, time has elapsed for the NDP. We will move over to the PC caucus for one hour.

The honourable member for Cole Harbour-Eastern Passage.

BARBARA ADAMS: I am delighted to have an opportunity to speak with the Minister of Health and Wellness and his staff for the next hour.

I would like to start off by asking the Minister of Health and Wellness if he has read the Nova Scotia Health Authority’s Accreditation Report for 2017.

RANDY DELOREY: I’ve certainly reviewed aspects of the accountability report. I have not read the report from cover to cover.

BARBARA ADAMS: I thank you for that answer. I have read the whole 188-page report several times because it’s the most impartial way to review how the Nova Scotia Health Authority is doing. We can get into debates here as to whether we are interpreting things differently than the government might.

I want to draw his attention to a couple of things that are in the Accreditation Report. On Page 30, and this goes under Priority Process: Human Capital, which I maintain is health care, there might be buildings and equipment, but 70 per cent of the cost of health care comes from the people who work there.

The bottom paragraph says, “The team has identified concerns about the span of control and pressure and demand on the front-line managers because of the many changes that have occurred in building the new NSHA, such as the implementation of new policies, procedures, and processes.” And then, this concern was expressed especially around the significantly more time it takes to recruit any vacant position using the SuccessFactors system.

Janet Knox, the CEO, mentioned to us that there were over 23,000 employees. About 2,000 of those change every year, so that’s a 10 per cent change. If there’re problems hiring staff for over 2,000 employees a year, that’s a significant burden and barrier to getting staff where we need them. I’m wonder if the minister can tell me if they are looking at changing the SuccessFactors system of hiring.

RANDY DELOREY: I think just for clarity with SuccessFactors, the software module system that’s used for - and this is for the benefit of other members who may not be familiar with the terminology. The software platform module is what’s used for the recruitment services.

I believe the timing of the accreditation process; the rollout and standardization of SuccessFactors was in the very early stages. To consider pursuing a change, if you did an accreditation after you change it again, you would likely get similar responses. I think as with any system changes you get more familiar with that process, the standardized process, the system, and the availability of the information. I think you see those improvements stabilizing.

It’s about the change management at the front end. The recruitment side of the Health Authority is a very active, very critical focus point. As the member noted, between 70 per cent and 80 per cent is related to personnel costs in the system, so it is an important part of the operation. There are to my knowledge no plans - no one has ever raised the prospect, and I’ve not considered it either. As I said earlier, it was a relatively new system getting rolled out at the time of the accreditation. To just change it shortly thereafter, you’re just basically going to keep yourself in a perpetual - you’re going to get a similar sort of feedback in the early stages of whatever system you shift it to.

You need to let these systems stabilize and get the benefits that come from it. I can assure the member that having a standard, consistent recruitment program system across the province actually does provide help within the system - for planning and knowing what the status is across the province - at a glance in a single system, instead of having those administrators have to use multiple systems and then have to consolidate all that together after the fact.

[7:15 p.m.]

BARBARA ADAMS: I thank the minister for that answer. The bottom line of that page says the significant delays due to this system are impacting the ability to have appropriate staffing in some clinical areas. If you go through the report, quite a number of those clinical areas are having difficulties.

One of the steps I’m aware of is that, although some sectors in this province in terms of employment are going up, the health sector has gone down by 6 per cent in the past year, according to Statistics Canada. We are having a difficult time recruiting staff. I want to bring the member’s attention to, unfortunately, an issue that he and I have talked about numerous times.

THE CHAIR: You should be addressing the Chair.

BARBARA ADAMS: I would like to ask the minister about an issue that we have discussed many times in the Legislature. As the minister’s aware, for those who aren’t, the minister, 16 or 18 months ago in this Legislature, agreed to give my constituency of Cole Harbour-Eastern Passage a clinical nurse practitioner. It took several months to get someone to come out to look for that location. We found the location, it took another six months to get the agreement in place and physicians to supervise the clinical nurse practitioner, and then we’ve been battling to get the job advertised online.

Since the last time we talked, I called the College of Nursing and asked them if I could meet with the 12 clinical nurse practitioner students, only to find out that the majority of them have already found positions. I asked if I could speak with them specifically about the opportunity available in my constituency because I couldn’t find it advertised online. Lo and behold, I found out that several of those students already applied for the position in December and never heard back. They called the Nova Scotia Health Authority. They emailed the Nova Scotia Health Authority and none of the students from the Dalhousie School ever heard back. The minister can imagine how disappointed I was to hear that.

I did speak to the minister and he suggested I call human resources at the Nova Scotia Health Authority, which I did. I spoke to them several times to find out that the position for the clinical nurse practitioner in Eastern Passage, you couldn’t search for it under Eastern Passage. And if you go and search today, which I did as I do every day, you can’t find the position. When human resources found the position, it was advertised as a Dartmouth South/Eastern Passage position. I asked why that was done, when the minister gave the position to me. There are already other positions advertised for Dartmouth, so why was there not a separate position for me? I was told that it was the chief of the Central Zone who said that it had to be advertised that way.

I haven’t been able to post an advertisement since a year and a half ago when the minister gave me that position. He’s probably as frustrated as I am because neither one of us wants to be talking about this anymore. I’d like to ask the minister: Can he explain to me why my position didn’t get advertised consistently the way others did; why was it advertised for Dartmouth South; and why were those nursing students, most of whom have now got jobs outside of this area, not contacted by the Nova Scotia Health Authority human resources?

RANDY DELOREY: I guess first, I would like to clarify for the member, and I do so with respect, but I wouldn’t refer to that or any other position as mine or yours and take ownership. I think it would not be appropriate for any political member of government to frame positions within our health care system as a stake of ownership as individuals. I do so respectfully on that point.

The fact that we did have the conversation, we can go back to Hansard, and I did go back, as the member knows, to the Health Authority to indicate the desire to have a position, as the member’s preamble stated, and I won’t restate all the efforts and work that had been done there.

To the specific questions around potential applicants and what have you, I don’t know the answer to that. It’s not something I was aware of, no candidates, that had been brought to my attention. I don’t know if, in the member’s conversation with HR, they’d asked that question. I’d be curious if she’d heard a response to that inquiry from the Health Authority, if she knew in advance. I think the member would be happy to fill me in as it would save me saying that I’ll go back and ask the Health Authority. If the member wants to share that I am happy to hear it.

BARBARA ADAMS: I appreciate that you’ve been willing to work with me on this. I guess I’m using it as an example. If it’s this difficult to fill one position, you multiply that by 2,000 per year - we have some issues.

The latest conversation I had today with human resources is that they had some applicants in March, and I said I know that these students had applied in December, so there may be others. The other thing I was advised was that there was an applicant from out West who has some experience, which might be a preference over a new grad; however, there are 25 or so clinical nurse practitioner positions. All the other students have already gotten jobs, so they have already been hired. We’re down to a very limited pool.

I’m wondering, given the challenges we’re having with clinical nurse practitioners, why you wouldn’t interview everybody who came through the door. Obviously, if there’s someone who is not qualified, that would be one thing, but I guess I’m wondering if the minister can tell me what he might be able to do to help me solve this issue for the constituency of Cole Harbour-Eastern Passage, as well as globally for the whole hiring process at the human resources department.

RANDY DELOREY: Madam Chair, I guess the first thing I would say is - and I can appreciate the member’s inclination to use a position that she’s intimately familiar with, obviously through the advocacy work and continued attention to the process to fill that position, but I don’t think it’s necessarily reflective of all positions throughout and the process for hiring.

For the benefit of members who may not be as familiar with the position, I think some of the characteristics that reflect it are a little bit different than others. I won’t remember this word for word, but I do recall the essence of the first time this question came up, as the member said, about 18 months ago. It was that there are no physicians in this riding for Eastern Passage, so what can be done, and that’s where we move forward to a nurse practitioner.

It’s a little bit different because this isn’t recruiting to an existing location or facility, or practice or what have you. Starting something from scratch is different than recruiting for a vacancy at an existing practice or space. The member alluded to something, and I can’t say with certainty, but just from the member’s own comments in the discussion, the way I’m interpreting that is when they talked about the preference for someone with more experience, perhaps, I suspect that may relate to the specific nature of the position for which they’re advertising.

Nurse practitioners are very highly trained and skilled health care professionals and they work in a variety of settings. Some are in hospitals, many of the new hires that we’ve been hiring are in collaborative team settings in the primary care space, working alongside other health care professionals. In many instances, and I hear this from other health care providers including physicians, that it’s sometimes daunting to go out absolutely on their own, not co-located but in a facility or a space, literally by themselves without the clinical experience or the benefit of that experience, that it is sometimes challenging.

I suspect that experience, given that it would be kind of a solo location for this nurse practitioner in that geography, that it’s likely a clinical kind of desire that the Health Authority is likely - again, I say this with a huge asterisk of assuming these aspects based upon the information that the member has brought forward.

I would say that I think it’s positive the member noted that there are applicants that are from the most recent, because I believe the position had been posted - I think the last time I checked, two or three times over the past. They have been recruiting; they have posted. Again, as far as the specific applicant pool, when I inquired it had always been indicated that there hadn’t been - I can’t remember the exact terminology - a qualified candidate or that the candidate hadn’t been fulfilled.

I did not delve into the question of what qualifications or what gaps they had in those specific positions for their expectations, but I can certainly keep a little bit closer look on it. Knowing that there is a pool of applicants, I think is what the member had said, hopefully the community will see that hiring process continue in the near term.

BARBARA ADAMS: I thank the minister for his answers. Unfortunately, I did have a chance to talk to the students because the posting was Dartmouth. When I actually explained to them that this position was in Eastern Passage, they were not interested in that particular area, so it makes it harder if we were not advertising where it is because I think we could be doing a better job and hope we’ll work together to do that.

I’d like to move on to continuing care, home care, and long-term care. Last week in the Legislature during Question Period we asked the Minister of Labour and Advanced Education about the continuing care assistant grants that had been in place that resulted in an increase in the number of CCAs that were trained in this province. I’m wondering if the minister is aware of what year that program was cancelled.

RANDY DELOREY: I don’t recall the dates around the CCA bursary program but certainly as I was being briefed on and delving in and digging into our strategy and approach and recommendations coming out of the long-term panel and how we’re going to approach this, one of those recommendations, I think, that triggered the discussions about the CCA bursary program, one that previously existed. I don’t recall the time frames of it but what I do recall, because it stood out to me when reading the panel’s recommendations is that the recommendation was to reinstate or re-establish, which obviously leads to the next questions: What was the old one; what did it look like?

The indication was it was something that was brought into place. It was a two- or three-year program, but it was a program that had a defined start and end to it. It wasn’t something that was part of an operational program; it was a set program that had a beginning and an end period to it. I don’t recall what those times were in the information, but I was advised that it was not a cancellation of a program but rather a program that had been established at the front end for two or three years, if I recall correctly for the duration.

The program came to an end and now we have a recommendation - I think this is the important part - to establish a bursary program. We have the intention in this fiscal year to fund about $200,000 to develop this bursary and have participants be eligible going through in the current fiscal year for this bursary, to help as part of the recommendation from the long-term care panel.

BARBARA ADAMS: I thank the minister for that answer. I have the information in terms of the continuing care strategy in 2006 is when that grant program started. It ceased in 2013, so it was a seven-year program. It expired at the same time, I believe, as this government became the new government. In part it ceased because of the expiration of the provincial labour market agreement with respect to that.

If you look at the May 2013 continuing care assistant report for our province, you’ll see a graph that showed exactly how many new CCAs we were training. It was on average about 450 before the grant program came in. It jumped up to about 1,000 at the peak in 2010 and 2011, dropped down to 789, then 875. It has continued to decline ever since.

I quickly did the math as the minister was speaking, where he said he was going to put $200,000 toward a grant program. I’m delighted about that because it was one of the key recommendations of the long-term care report. But when I did the math, that’s 50 CCA positions. That’s not anywhere near enough. We need at least 10 times that amount if we are going to fill the gap in what we need right now.

[7:30 p.m.]

I’m wondering if the minister would acknowledge for me now, there are approximately 700 people sitting in acute care beds waiting for long-term care. The definition of not being eligible for home care and needing to be in hospital is that home care, continuing care, and community services were insufficient to keep someone home. What I’m wondering is, with the extreme shortage of CCAs, would the minister reconsider expanding the CCA program back to the way it was in the past, where it provided grant funding to all students who wanted to take it, so we could start going back to training about 1,000 CCAs a year, which is what the experts estimate we need in order to provide all of the home care and long-term care staffing we need?

RANDY DELOREY: With respect to the member, there’s a question about the number of CCAs needed and the target. As the member would know, many of the recommendations in the long-term care panel’s report do centre around workforce planning, and much of it is targeted around CCAs. Much of the work in that space includes things like curriculum redesign. Some of the challenges that they identified was not just on the number being trained but rather the number that you’re retaining, when they complete their training, enter the workforce in this industry, and provide care, but then, for whatever reasons, they opt out. The recommendation was to delve in and look closer at that.

Some of the complement could perhaps be addressed with changes in the curriculum and training programs that ensure people are - and I don’t mean this in terms of a technical preparedness, but more broadly prepared for a challenging but very rewarding career in the continuing care sector, in long-term care facilities, or through other services. That’s why we’re working with the Nova Scotia Centre on Aging to do research around staffing models and staffing mix within our long-term care facilities before delving in and stating with absolutely certainty what the numbers are. That’s part of the more medium- and longer-term efforts, to identify what exactly those demand points are. We obviously assess and reassess the decisions that we make.

We recognize the importance and the value of bringing in some incentives to help support the expansion and fill in some areas that are hard to reach, so tying our grant program appropriately to ensure we have people who come in and are eligible and that they fill positions that are the hardest to fill. Then there’s additional work being done around workforce planning, around curriculum program design. We think with the combination of the recommendations that came through the panel and the work that’s ongoing, we will see improvements in the quality of care being delivered in our long-term care facilities across the province.

The grant program was one recommendation, one piece of it, and this is the approach we’re taking in the short term to help have an immediate effect. We’ll adjust and modify our approach as we get more information, and more of that work is being done to fulfill the recommendations from the long-term care panel.

BARBARA ADAMS: One of the things I found interesting about the minister’s comments is, he said they are doing workforce planning, but they can’t say with absolute certainty what the workforce needs are. I’d like to provide the minister with a copy of the CCA Annual Report and he could perhaps give it to the Minister of Labour and Advanced Education, because it falls under his category with the Nova Scotia Community College which did not fill its CCA training programs.

Just for the minister’s knowledge, the attrition rate for CCAs is around 16 to 18 per cent. It hasn’t really waivered over the last decade or two, and I don’t want to speak on behalf of the CCAs, but I don’t think curriculum changes are what they’re looking for. They’re looking for a higher wage than an average of $17.50 and they’re looking for help in the nursing homes because they’re not always filling positions when somebody’s sick and so one person is handling twice as many residents as they should.

One of the questions I have for the minister is when the long-term care report was requisitioned by the minister, one of the requirements was to say what those staffing needs were. The committee that came back with the report did not provide that.

I’m wondering if you want to know with absolute certainty what the actual staffing needs are in long-term care, why are we okay with this report not giving us an answer, and when can we expect the minister to require that answer?

RANDY DELOREY: The work that the panel completed did research around the appropriate staffing complements and needs within our long-term care facilities, with the overarching direction that came with the panel’s report, and that was to focus on improving quality of care in our long-term care facilities.

What I believe the panelists made clear was that the work in determining exactly the structure of the workforce within our facilities - they investigated, they heard concerns and information about the evolving clinical needs and support needs of residents. But what they came back with was an indication that, through the work that they’ve done, there’s a recognition that the right complement may not be in the traditional sense of just looking at CCAs and nurses but bringing in other health care providers.

There’s an element of that work that they felt was necessary to delve in a bit further to better understand and appreciate how, I’ll say in a similar fashion to our primary health care system, bringing collaborative teams together - those who highlight and stress the combined complement of multiple service providers with different skill sets actually provide a broader comprehensive and ensures that the right type of care is being provided to the patients.

I think that’s really an analogy or parallel to the references that were made. So, the discourse around staffing models for long-term care have certainly, leading into this, been focused on the nurse and CCA staff complement appropriate with LPNs, RNs, and CCAs within our long-term care facilities.

The panelists raised the prospect in their research and the work they were doing that if you ramp up and move other levers within the environment, whether it’s with physiotherapists or occupational therapists, and you bring in more of those supports within the system that could, or would, impact and influence what the ratio or the needs within the CCA and nursing complements would be - that’s why it becomes a much more complex question around that type of research and analysis. That’s why we’re continuing that work with the Centre on Aging, to ensure that we do answer that question, so that we’re staffing to ensure we have the right quality program delivery for our long-term care facilities.

BARBARA ADAMS: I thank the minister for that answer. As somebody who worked with seniors and home care for my entire career, I do have overwhelming confidence in Dr. Janice Keefe and the Centre on Aging. We are incredibly lucky to have them here. But I do find it puzzling because this government has been in power for six years and all we’re hearing is about the crisis in health care, home care, and long-term care.

I’m just wondering if an expert panel cannot come up with appropriate staffing levels, then who are we listening to? I would suggest that those who are working in the industry, the residents, and their families could tell you that what is there right now, isn’t anywhere close to enough.

I’m wondering if the minister is aware of some of the things that are happening when we look at continuing care. I just want to mention a few of the challenges. The question will be - with the continuing investment in home care, my understanding is approximately $283 million invested in home care for 29,676 Nova Scotians, give or take, works out to an average of $9,536 per home care recipient.

Several of the things that I saw personally in the 10 years that I did home care, and I continue to hear about, is it’s a different CCA who shows up at the door almost every day, so the family member has to stick around and actually train the new CCA every time. They will often say that they have a lot of people to see so they don’t want to stay for the full hour, that they’d like to leave early. Or they cancel frequently, sometimes without notice, especially on evenings, weekends, holidays, and most certainly in the summertime.

I’ve already mentioned in this House that I’ve had two constituents whose family members had seen the CCA on a Friday, they cancelled Saturday and Sunday by leaving a phone message, and those residents were found on the floor on the Monday morning.

There are all sorts of challenges in the fact that the private home care agencies who have the service contracts will not directly bill private health insurers, and we discussed that last week. That’s a huge issue and that can be addressed by next time those contracts are negotiated, to give contracts to those who are willing to make it easier on our seniors, not harder.

The other thing that I know happens quite regularly is that the care plan that was established isn’t necessarily the care plan that gets done. I’m wondering what the minister can tell me his department has done to improve the continuity of care with the current private health providers sending in a different CCA on a regular basis.

RANDY DELOREY: I thank the member for her continued concern and interest in the continuing care space. As we know, the supports we provide to our aging population are important. That’s why we continue to invest and focus on understanding the challenges better. We make better policy decisions and better investments to ensure the quality of care that we provide, whether it’s in home care or long-term care facilities, meets their needs.

What I can advise the member is we recognized, when we came in, that we were going to be investing in home care, expanding the access, and addressing wait-lists and the care provided. We also needed to establish better accountabilities and so on for the money we were investing in that care - so a couple of things, I guess.

[7:45 p.m.]

First, I’ll just touch on why it’s more challenging perhaps than some people would think. Part of it is that home care being delivered in many parts of the province, the relationships with the home care provider is longstanding; many nonprofits are well established in their communities, with extremely good relationships with the residents, the clients that they serve. There is certainly a lot of effort to work with those care providers in our communities, many non-profit organizations that began providing these services before the province had an interest or a stake in the delivery of home care services.

It’s really the evolution of the home care environment that we have that I believe is a significant contributing factor to sometimes variability across the province in terms of the delivery of that care. The work that my predecessor, the current Minister of Communities, Culture and Heritage, undertook was, in his tenure with the staff, to develop a process to better understand what metrics - we call them KPIs or key performance indicators - we could apply.

Again, this never existed before. There was never any means or mechanism to evaluate and assess, anywhere in our home care system. We were starting from scratch as a government to bring some level of measurement and oversight, and building from there, is building into the accountability. I believe it takes time to develop what is likely to be an appropriate set of KPIs, what are the metrics that should be tracked.

Then, we have to work with our care providers who provide the home care service, keeping in mind that in many instances these are not necessarily large corporations with a ton of resources to build in. These are, in many parts of our province, small non-profit agencies that have been providing the service from long before government ever got involved.

As government changes the expectations within these entities, there is a need to work with them and help bring them along and support them as they begin tracking the new data information and so on. It does take some time.

We have implemented a set of KPIs. We’ve been collecting the data, continuing to work with those service providers. We collected the data, we looked at it, you see some anomalies in that data. Then we have to work to try to understand why there’s an anomaly. Is this an anomaly because of the provider or do we have data collection issues? Are we not appropriately collecting the data from some providers?

You do more training and support. I think we’ve just finished the second year of collecting data, but we continue to work with them. We’re building those KPIs into our expectations, working with them. It does, at the front end, allow us to identify where we need to do some more work with providers and that’s our first step, rather than coming in with a hammer over the top instantly.

Again, we’re recognizing the historical role and relationship that we have with many of these service providers. The goal and certainly the work that we’re doing with these KPIs is to help do just what the member has been talking about: understanding how the performance is, how many cancelled visits or what have you - I don’t have a list of what the KPIs are, but things like that where we’ve had challenges. We’ve heard those concerns too: cancelled visits or completion of visits - I forget exactly how we’re tracking, but things like that are what’s captured in those KPIs.

BARBARA ADAMS: Thank you for that answer. I agree with him 100 per cent, it is about changing expectations and requiring people - and I know quite a number of those companies, because I worked side by side with many of them; they’re all working as hard as they possibly can. There are some who are staying late and coming on weekends and going well above and beyond, so I don’t want anybody to ever think I’m not 100 per cent in support of what they’re doing.

I think those KPIs and the information will give us a lot of information that we can use, because I think the consistent theme is always about the caregiver and the stress that they’re under.

I do want to switch. I just want to throw out a different topic here for a second. I would like to ask the minister: Has he considered covering hepatitis C vaccinations for those who are in our prison system in Nova Scotia?

RANDY DELOREY: Before I answer that question and switching topics, since we are switching topics, I’m going to switch back to a previous topic: the member’s question around the nurse practitioner in the Eastern Passage area.

The latest update, I just got an update from some staff in the department who are watching and trying to help me answer when there are some specific data questions. On this one, staff did reach out and as of Friday, there were actually interviews. I know the member had indicated that there are some applicants; we do understand that there were some interviews that have taken place for the position, but that’s the latest we have.

As far as whether any of those interviews will result in an offer will remain to be seen, but certainly, to the member, applicants are step one; interviews are step two; and offers would be step three.

Sorry, I was just looking at that update a little closer and it looks like there may be some reference checks for some of those applicants, but I’m not sure. Again, it sounds positive and it is progressing.

To the current topic which is that of hepatitis C treatments - again, if the member will indulge me or, Madam Chair, if you will indulge me, and just for the benefit of the other members who may not be familiar with this. Hepatitis C is a condition that has historically been a condition requiring extended treatment care. There has been a lot of progress with treatments that can actually cure one’s hepatitis C status.

I do know that public health has been doing some work to roll out and provide some care. I don’t recall, off the top of my head, though, and I just checked with staff here about the status of the program, but certainly I know from early on in my mandate that there has been some work, I believe, in the prison population.

I don’t recall what the current status of that work has been, but certainly - and just for the benefit of members who may question why the prison population would be a starting point to pilot some of the work and moving to the investment for addressing hepatitis C - if the member is okay, I’d just like to explain that to people who might be wondering why we would target that population.

What it is, number one, is the prevalence of actual infections; the risk factors and the transmission from someone who is infected to someone who is not in an enclosed environment, and some other characteristics of that population, result in a higher percentage of people with the hepatitis C condition.

The other thing that is important to note is that this treatment that can lead to curing, does require strict adherence to the treatment protocol. I believe one of the reasons it was originally brought forward to look at working in this population related to the ability, given the nature of the environment, to be able to monitor and ensure the successful completion of the treatment to have the cure ultimately maximize the possibilities of the cure taking place.

The member may have already known that part of it, but for the benefit of other members, I wanted to make that clarification.

BARBARA ADAMS: I thank the minister for that answer, and I do want to clarify what I meant - the treatment for it, not the vaccination for it - so yes, the treatment for it. Of course, I would maintain that where there’s a treatment for something like this, there are some who would have private health insurance that would cover it; for those who aren’t covered, I would like to see that covered for all of them.

I do have another question about medications. Residents in long-term care facilities are automatically given the high-dose flu vaccine. We have, give or take, 700 Nova Scotians sitting in acute care beds, waiting to get into long-term care. I’m wondering, would it not be possible and practical, where we know they are not going home, to give them the vaccinations so that they are already starting to build up an immunity before they move into the long-term care facilities?

RANDY DELOREY: May I suggest we give the member a gold star for that one. It’s a great question. I don’t believe that was a question discussed with the public health officials when they brought this proposal forward.

What I can advise the member is certainly, when we were looking at last year, and again the last fiscal year, the one that just ended, was the first year we actually did this. We made the decision in the Spring of the year that we would pursue or cover the high-dose flu vaccination, which is relatively new. Again, I want to highlight that this is a relatively new treatment option within the health care system, and we wanted to roll it out.

People have, over the year, asked why we only targeted long-term care facilities. Really, the rationale behind that was because they are at the highest risk.

Part of the risk factor that plays is not just their age, so it’s not just a notion, but some of the frailties - living in long-term care facilities, tend to be higher frailty aspects - and the third variable at play, which is what distinguished long-term care facilities from the general population, is that they essentially live in an institution. They are co-located with a large population, so if one person gets the flu, the communicable nature of that condition would spread through the facility. You don’t have the flexibility of being in only shortly; you are in that environment and that’s where you’re residing. Your entire day is often spent and exposed, so you’re at a greater risk in those settings.

Our commitment was that we would perform that, proceed with it and collect the data and analyze to determine whether the results we see in Nova Scotia, in these facilities, meet the expectations that we’re going in. That would help the public health officials analyze and make recommendations as to whether or not that would be a policy to pursue in the general population for other seniors.

I know there’s a lot of advocacy to do that but the commitment we made was that we make an informed decision on that. I will definitely highlight and thank the member for raising that question.

I will take that back to our public health officials. I think when you look at the characteristics for those in ALC waiting for long-term care placement, I think many of the characteristics - again the age, frailty, and the institutional setting - would be consistent. I will double-check to confirm that they were not included in the round because I’m not positive that they weren’t included, but I’ll double-check that. If they weren’t included, we’ll look to see if we can include those numbers in our order for this upcoming year.

BARBARA ADAMS: I thank the member for that answer and for that assistance. I want to switch now to orthopaedic wait times. I know we talked about it a little bit in the House last week.

The update on the orthopaedic wait times for Nova Scotia compared to across the country had improved here; if you had fallen and broken a hip, the average was 48 hours. A friend of mine whose mother is 98.5 years old, just fell the other day, broke her hip, got in within the 48 hours, and I’m extremely grateful for that.

I just want to draw everyone’s attention to the fact that by the time someone reaches the point of needing a consult for a hip or knee joint replacement, they have already been suffering for years, if not a decade or longer.

[8:00 p.m.]

Currently, in Nova Scotia you can see the wait times on the Nova Scotia Health Authority website which is a phenomenal piece of transparency. The average wait time in Nova Scotia for general hip surgery replacement is 213 days, just for a consult. That means you’ve been living with it for probably five years or more; you have probably sought all sorts of care; you may or may not have a family doctor to facilitate a referral - that’s 213 days, to get a consult.

If the surgeon refers you for an MRI, the average wait time is about 224 days for an MRI in Nova Scotia. The surgeon won’t operate on you until he’s seen that MRI, so then, once you get back in to see him and he says you need surgery, you wait in this province an average of 467 days. So, from the time you actually step through the door - from the time your family doctor says you need to see a surgeon - to the point where your surgery is actually scheduled, is 904 days. That’s an average of three years.

There are an awful lot of interventions that could have been done in the meantime; they could have seen physiotherapists, occupational therapists, or a pharmacist for better management of chronic pain throughout that time. I know there is a greater investment in orthopaedic surgeries, but at the same time, we’re increasing the number of people who need those surgeries.

I would like to ask the minister: Has he calculated, based on the investments they have made this year and are planning next year, how that wait time of 904 days - from the doctor referring you to the specialist, off to the tests, and back in for the surgery is 904 days on average - how much are the current investments expected to reduce that wait time?

RANDY DELOREY: I thank the member for both the interest in this topic area and the question.

The progress that has been made, as the member noted - I think one of the members for the NDP caucus asked a similar question, and as the member for Eastern Passage referenced - the demand in Nova Scotia is great. If you look at where we are situated in terms of wait times historically and you look at the demand factor we have, as well, with that increased demand, it makes the pressure and the challenge of reaching the national benchmark times that much more challenging in our province.

Certainly, since 2013, just as an example to show the improvements and what kind of impact, not necessarily in wait times specifically because volumes are part of it and getting these done, but in 2013, we had about 3,000 cases completed. As of February 2019, we had over 3,800. We had an increase of over 800 cases, and in February, we still had another month of surgeries to be done.

I believe we are estimating that we will have hit or will be very close to 4,000 cases. We’ve basically increased by 30 per cent the number of surgeries. From 3,000 to 4,000 is a 30 per cent increase in the number of surgeries based upon the investments we have done to date.

The driver in these investments, it’s not just the dollars. The dollars are important, but last year we saw an increase of surgeries; a couple hundred additional surgeries from the point when we announced the program that we were implementing in October and the end of fiscal year at the end of March.

Those changes were actually focused on procedural systems, standardization, flexibility, and working as a single unit within our ortho program rather than working as isolated islands. We optimized the delivery of the care. That change, actually, without a substantial investment, some investment but not the most significant investment, did have a positive impact on the number of surgeries completed.

Maintaining those system changes and a more efficient system, in the last fiscal year, 2018-19, we hired the anaesthetists, the surgeons, and the support teams to support that prehabilitation and rehabilitation and all the work they have to do to complete the surgery. Our goal is to get more of those surgeries. As we get more of those surgeries done, obviously we look to see the wait time come down. We can’t directly control the input variable, though, which is the demand on the system for the needs and pressures. Certainly, that’s where some of the demands on our system and some of those surgeries are.

When I talked to Dr. Dunbar, a surgeon who does a lot of research in the space, I remember one of the last times we chatted, he showed the data around not just the number of surgeries, but the secondary surgeries; that is, replacements or fixes to hips and so on. One of the quality-control improvements that was part of the overall design of this plan was bringing the prehabilitation component, the research that influenced the recommendation and the recommendation we accepted and pursued was that you get better outcomes. You have fewer re-surgeries. Not only are we working to get more surgeries, because of the investments and having more staff, but we’re investing so for everyone who does have the surgery, they are prepared to have the best possible outcomes and the highest probability of success from that surgery. That’s what we’ve done.

BARBARA ADAMS: I thank the minister for that answer. For those who aren’t familiar with prehabilitation, it was actually one of my former professors who sort of came up with that when he was talking about Parkinson’s disease. It’s a program where people go into a six-week program prior to their surgery, and the outcomes are so much better. We do need more home care, physiotherapy, and occupational therapy after the surgery, especially if the surgeons are getting to the point - which I hear they are very close - of doing day surgery for hips and knees. We could use a little more support in that area.

My last question is about the Veterans Memorial Building. I understand that there may be some beds vacant over there. I know that in long-term care there is a great emphasis on keeping spouses together. We know that the number of veterans is declining. Every year, we estimate approximately eight to 10 veterans have been separated from their wives but reunited with people who also served in the military. I’m just wondering if the minister could tell us, without me getting into specifics of any individual veteran himself or herself, where there are some beds empty at the Veterans Memorial Building and where it is a Nova Scotia Health Authority asset in partnership with the federal government, if the minister would do what we’ve done for long-term care clients in trying to keep spouses together, if he would help work with us to try to reunite the partners who wish to so they could also stay together in the Veterans Memorial Building.

RANDY DELOREY: This is an important topic. I believe the member’s colleague, the member for Pictou West, raised similar questions related to a federally funded facility in the Pictou community. I’ll start with the premise that the federal government is ultimately the one that has those beds. They’re the federal Veterans Affairs Canada beds. They set the policies as to the use of those beds.

I can advise the member that I believe I built a fairly good relationship with the former Minister of Veterans Affairs Canada, Minister O’Regan. We met on several occasions to talk about a variety of topics that intersected between the Nova Scotia Health Authority and Veterans Affairs. We talked about why it is so important for Nova Scotians, and myself as Minister of Health and Wellness, to engage and have those conversations about the services for veterans and how we can collaborate to enhance and do things differently. Nova Scotia has the highest percentage, per capita, of veterans in our province, and we as Canadians across the country very much value the service that has been provided. I will advise that we did discuss at one point, but there have been changes in the federal Minister of Veterans Affairs, so I have to re-engage and pick up those conversations. I want to make those improvements and I’ll continue those conversations.

THE CHAIR: Order. The time has elapsed for the PC caucus. We’ll move over to the NDP caucus for the remaining time.

The honourable member for Dartmouth South.

CLAUDIA CHENDER: I’m pleased to be able to ask a few questions about the Dartmouth General Hospital - the third largest hospital in the province and one that serves many constituents of many of the MLAs in this Chamber.

We’ve heard a lot about the Dartmouth General lately from the minister, particularly because it has been able to come up with some really innovative solutions. One that has been pointed to a lot is the off-load system, which I know has been discussed today in this Chamber. It has been mirrored in other places so that we can get ambulances back on the road.

What we haven’t talked about is that we’re very efficient at getting patients into the Dartmouth General emergency room. We are less efficient in moving them through that emergency room and on to the next stage of care. It’s my understanding that there is a capacity crunch at the Dartmouth General, particularly around the ER, and I’m wondering if the minister could comment on that.

RANDY DELOREY: Along with conversations that we’ve had in the Legislature during Question Period, where most of those conversations have taken place to date, I think a lot of the attention has been on the off-load and the transition from paramedic stretchers to hospital-based and the care of the hospital, so the paramedics can go back out. That’s correct. That has been a focal point of the conversations.

Simultaneously, I assure the member that the questions of how to improve the patient flow more broadly, through the health care system, through emergency department in-patients, would also be on the agenda and the radar for not just myself, but the health authority; to focus on addressing and improving the situation; bringing in options to come forward with efficiencies to improve that patient flow, not just with the emergency department. We have talked. There is the integration between our health care system, that changes in one area have an impact.

For example, as we build our capacity with our paramedics and we’re able to get paramedics back out and build that capacity back in our community by improving the off-load times, we have the new Community-Based Paramedic Program rolled out in Cape Breton. We’re monitoring that. That program is designed to help improve the discharge so that patients are able to get discharged from the hospital even quicker, while still getting care in their home - with a combination of the paramedics who could be in the home and tele-nurse services - to ensure that in that short term we can get the patients with the care that they need in a safe home environment - freeing up some beds within the acute system.

There’s a number of innovative ideas and solutions being pursued within the health system, and one of the areas getting a lot of the attention is the off-load. But I want to assure you that the Health Authority and our partners continue to look at all of the areas to improve the system flow and the efficiency of our health care delivery, while still maintaining the quality of that care that’s being provided to all Nova Scotians.

CLAUDIA CHENDER: A quick question is whether there is a line item in the budget. I recognize the Dartmouth General is part of the Central Zone, but I am specifically interested in that facility. We know that there is the renovation going on; we know that there is an expansion of the surgical theatre, as we know that there are corresponding beds. But what I want to know is - I’m sure there’s work being done to help with the capacity issue, but my understanding is that there is a very real capacity issue right now. Is there investment being made to that end in that facility?

[8:15 a.m.]

RANDY DELOREY: I do note, and I’m fine with the member focusing on her community. I think it’s one of the privileges of being in the Chamber and Estimates debate, that we can actually engage in a conversation, even on specific community-based areas of concern, not afforded in Question Period. I don’t think the member needs to apologize for that.

The member noted a number of the initiatives taking place as part of the QEII redevelopment project for the Central Zone, which is the surgical theatres and some of the other in-patient work that’s been done, the dialysis chairs that will be added and so on. All of this is part of recognizing - and I hope the member and her community recognize - we see the important role of what some of the people I’ve spoken to from Dartmouth have articulated.

I’m not from the city and I’m not necessarily as acutely aware, being from outside of the city. I guess, in fairness, before I got into politics, I used to just think you go into the city and it was all the city because it’s just a lot of big buildings and houses. What I’ve come to appreciate more acutely is that, particularly Dartmouth, there is culture. When I was there, the pride is tangible in the citizens of Dartmouth. I do hope they appreciate that when we’re looking, we see Dartmouth as an important part of our health care system.

As far as the emergency, there’s not a capital piece to that work in terms of the investments that have been announced to date as part of the QEII New Generation redevelopment, but the work that’s being done and the investments within the overall hospital system are to improve and increase the capacity and the delivery of services out of the hospital in Dartmouth. The work is ongoing and there are, as we talked just with the previous member, the questions around orthopaedics, that much of the work to improve the efficiency was actually structural, and by structural, I mean process structure changes as opposed to physical infrastructure changes. We can actually see improvements in the delivery and the efficiency of delivery of care through those types of changes. That’s the type of work and investment and focus that’s taking place. It’s not always about physical infrastructure, but when it is, those are different conversations within the system.

I interpret the member’s question as infrastructure investment change in that capacity space for the emergency department at Dartmouth General, and that’s not been a project announced or direction thus far.

CLAUDIA CHENDER: To clarify, I don’t think it is necessarily infrastructure; it could be staffing related. I’ll move on to my second question, which I think provides context.

My understanding - and if the minister has these numbers and could table them, it would be great - is that the average length of stay post-admission for ER patients at the Dartmouth General is double what it is at the QEII, so it takes twice as long for a patient to move through the emergency room at the Dartmouth General as it does at the QEII. Patients are being admitted to lounges in hallways, notwithstanding the efforts going on, this was happening last week. There were elective surgeries cancelled.

I leave it to the clinical care experts to understand where the investment needs to be made. I guess my question is: What is being done about that because from the outside, or from just at the outer edge, it feels like there’s a huge capacity issue and one that, although we are a city hospital to the member’s former point, we also serve an enormous catchment, as the member knows, that expands well beyond what anyone thinks of as the city, and as you get further and further out in that catchment you are at the edge of other facilities that are often experiencing emergency room closures. We have maybe a couple hundred thousand people on some days that might rely on the Dartmouth General as their primary care hospital.

That’s the question I’m asking about, that posted mission state, the fact that it’s so much longer than our other main hospital in the Central Zone and what is being done about it?

RANDY DELOREY: That is kind of where I was getting at in terms of the member’s clarification or more context around the question, that it is looking at the ability to build efficiencies in the system. The work I’ve highlighted, I’ve talked about it in the broad sense and not specifically to Dartmouth General.

As we’ve talked and focused more on the off-load, when I was responding to those off-load contexts and targets to improve the paramedics’ return to service and getting those ambulances back out to the community, what I also indicated and highlighted was that that doesn’t preclude the work. That’s just been one area and it’s been a focus because we believe that it can have a very positive impact on the emergency side of our system and getting those paramedics.

As I said, one example of having increased capacity with paramedics and managing the availability and workflow workforce, is something like the community paramedicine program that we rolled out as part of the Cape Breton redevelopment project. It’s a pilot in the early stages, but that program is being designed to help our hospitals.

While it is not in Dartmouth now, it started in Cape Breton, as we learn from this program to have health care providers in our hospital settings recognize that sometimes they have patients who are just waiting for discharge and they are kind of on the line, that if they were comfortable and confident with the supports they might have a little bit of extra monitoring, and that’s the only reason they’re in. They don’t necessarily have a high, acute condition, but they have a condition that might need a little bit more monitoring, that we can have the paramedics provide that in-home in collaboration with nurses who work through Telehealth and are available to support, to bridge that gap. Sometimes the gap is actually just waiting for home care to be available for the patient before they discharge.

Having the community paramedicine helps bridge that. They can respond in real time, address that day or two days to having home care scheduled in. Because of the paramedic system being more of a kind of instant, call-based response time, they can build that in through that program.

That is designed in Cape Breton and we are testing it with a goal to see about having it rolled out at other sites to help improve the discharge time. That is building capacity without physically building infrastructure capacity.

In terms of other efficiencies within the system, the Health Authority evaluates and makes decisions on how they’re going to operate their facilities, as the member noted. Looking at the clinicians and the Health Authority administration to make sure that they are managing and administering our health system to be efficient, while still respecting the quality of the care being delivered by our front-line health care workers is the balance that we expect of the Authorities, both the IWK and the NSHA, to always be pursuing on behalf of Nova Scotians.

CLAUDIA CHENDER: I thank the member for that answer. Just to go back before I move on, that waiting period I mentioned, I wonder: Could the minister share those numbers now going forward?

RANDY DELOREY: Sorry, I apologize that we don’t have the details here with us, but we will dig in, and as I’ve been able to do sometimes, I get the data and I might interject. If I can get it while we’re here, I might interject in between other questions; if not, I will make sure I get the data, I will make every effort to get the data to the member when I do get the information.

CLAUDIA CHENDER: I thank the member and look forward to seeing those numbers, I think.

But I guess, some context is, as has been referenced, we have this big expansion that’s going to happen at the Dartmouth General Hospital where essentially it will close to double in size. I think there are, accurately many in the community, myself included, who are excited about that.

I think as the member was just talking about with my colleague in the Official Opposition, orthopaedic surgery and the wait times for that is a huge issue that all of us are aware of in this Chamber and starting to alleviate some of that is great.

I think, however, there are some concerns that there are these new beds opening but that the clinicians, and particularly the emergency department, aren’t really going to have access to them for the community. Which isn’t to say that there’s anything against the expansion, and that services will be offered to everyone, but there has been some indication that perhaps some of those beds would open earlier than the operating theatres. I wonder if the member could comment on that.

RANDY DELOREY: I don’t have any details to share in that regard at this time. Again, the project team is busy at work getting - in fact, I’m trying to remember if the member was at the announcement when we were up on - which floor is it now, I can’t even remember, where they were just starting the renovations? The fifth floor, I believe - and we were able to observe some of the roughed-in rooms. There’s a lot of work still to be done, so there’s nothing to share or provide at this point in time.

The first priority of the project teams is focused on the completion of the work and doing so in an active hospital is a little bit more complex. As we announced during the Cape Breton announcement, it’s one of the contributing reasons for building in back and, that said, that means there’s time as they look at how they can move forward and address some of the pressure points.

I wouldn’t be surprised if people are looking at and evaluating creative or new ways to create some improvements in the processes and looking at what resources they have is always part of that exercise.

There’s nothing on stream yet. I’m sure people within the system are looking at evaluating and bringing forward their suggestions of how they can optimize the use of the resources they have available, but until they’re on stream, it wouldn’t have an operational decision on what’s being done with them until closer to that point in time.

CLAUDIA CHENDER: To clarify, I think one of the questions some people have is - bear with me, I feel a little bit like a conspiracy theorist, but I’ll just ask this question because this is what I’m hearing. You’ve got 44 beds that are going to open for the new surgical spaces, but at least half of those beds may well be ready before the surgeries. There is some concern that with the massive amount of volume throughout the Central Zone, including at the QEII Health Sciences Centre and the Cobequid Community Health Centre, that some patients will be transferred from other points in the Central Zone to the Dartmouth General Hospital to alleviate those capacity issues.

From where I sit, that’s very troubling because we know that we’re already experiencing situations where elective surgeries are cancelled; where the ERs are backed up; where people are being sent home. I guess I’m looking for an assurance that that’s not being contemplated, not because everyone in the Central Zone doesn’t need and deserve the best care, but because we’re already at something of a breaking point in our community hospital. While I think it’s wonderful that we’re expanding these services, I think we need to ensure that this enormous catchment is taken care of.

RANDY DELOREY: I think, as I’d noted in the first response, there is nothing to report in that space at this time. What I went on to articulate is, I wouldn’t be surprised if people are looking at and considering or contemplating, but certainly nothing that I’ve heard. To that end, I’m responding to the member’s question that clearly there are people contemplating or talking about it, but all of that said, I think the member’s concern is about how patients flow within the system and between facilities.

[8:30 p.m.]

To that end, depending on the specific clinical nature of patients, there are times that maybe patients need to move from one facility to another facility, to meet their care needs, because it’s the appropriate place for the patient to be. I think that will continue. I think it’s one of the design things, like with orthopaedic surgery investments, as I said it’s looking at a provincial health care system, that we are actually able to improve the efficiency of our orthopaedic program, because we shared our resources and stopped thinking about them as, this is mine and so it’s only me. And by mine, I mean in a broader sense as a community or what have you, that it’s only me and the people in this community allowed to have or should have access to the resources.

The health system is evolving to be more efficient and effective in providing care, because the mandate is to provide that care to all Nova Scotians, to ensure we are providing that care to all Nova Scotians as efficiently and effectively as we can. But I certainly can’t make a commitment that patients from one community that may not fall in a traditional catchment for a particular facility will be the only people ever admitted or transferred into that facility.

Just as an example, early in our mandate - I wasn’t even Health Minister at the time - I remember a conversation with one of my colleagues about a patient in a Central Zone hospital who actually wanted to be transferred to a community hospital, which would have been different and outside what would have been traditionally the old Capital District, the Central Zone, transferred to what would have been one of the other districts.

It was early on and the flows weren’t there yet saying this is a system. I recall the conversation we had that, actually, that’s part of the purpose: that patients can or should be able to be seen or treated really anywhere in the system, and if there’s capacity and the ability to accommodate, that may be considered. That situation actually resulted in someone from the urban centre being transferred to one of the rural communities, because it was closer to family that would be able to support and help them in the recovery process.

That’s just an example of one of the reasons we have a health care system that is provincially-based, because we need to look at our provincial assets. In many parts of our province there are assets that are being underutilized, while others are being strained on those same assets. We need to be willing to look at us as a province and share the resources we have, because we’ll go broke trying to ensure everybody has everything everywhere. We really do have to ensure we’re being efficient with our investments.

CLAUDIA CHENDER: I’m well aware of our need to work as an entire province, but I think the key word that the member just said is, if there is capacity. As I said in my last question, I think it’s great we are opening up the Dartmouth General. I think it’s great there are orthopaedic surgeries there. It’s not great that patients are consistently being admitted to lounges and hallways. If there is capacity there and people can be transferred there, I’m all for it.

My question is, when there is no capacity, when it is always at 150 per cent capacity, that’s where I think it’s troubling to think of other even more stressed parts of the system kind of layering over that. I won’t belabour the point, but I wasn’t implying everyone should have their own fiefdom. I’m well aware we can’t run a province that way. I am very concerned because of the acute lack of capacity we have there already.

I guess my last question - and I don’t know if the member will have time to answer - is just around mental health. In terms of people moving across the system, we know that routinely patients are triaged to the Dartmouth General Hospital with acute mental health issues, which happens all the time because they go to the nearest facility, are medically cleared, and then often wait for days until they can be transferred to the QEII to actually receive any mental health care at all.

My understanding is that there was some progress made on this. I wonder if that’s true, and could the minister speak to any plans to improve that situation?

RANDY DELOREY: I do genuinely - as I do when members raise mental health, because it is one that we all share as a priority - so I appreciate the member’s question.

There isn’t much time left. I’m not 100 per cent sure so maybe if we pick this up tomorrow, unless they want me to do the resolution, I can whip it out pretty quickly. If we can pick this one up tomorrow - I’m not exactly sure what the member meant, if there has been some change here. I don’t know the details of what that concerned piece is. We’ll try to tighten that up.

THE CHAIR: Just keep talking.

RANDY DELOREY: I guess the member is not going to afford me the opportunity to read Resolution E11 this evening, so as we continue to make progress on our Estimates debates, perhaps we’ll have that opportunity tomorrow evening to complete that resolution.

Oh look, I have it right here if you guys would like to - no? I have three seconds; I can speak fast.

THE CHAIR: Order. The time allotted for consideration of Supply today has elapsed.

The honourable Government House Leader.

HON. GEOFF MACLELLAN: Madam Chair, I move that the committee do now rise and report progress and beg leave to sit again.

THE CHAIR: The motion is carried.

The committee will now rise and report its business to the House.

[The committee adjourned at 8:37 p.m.]