HALIFAX, TUESDAY, APRIL 2, 2019

COMMITTEE OF THE WHOLE ON SUPPLY

4:05 P.M.

CHAIRMAN

Suzanne Lohnes-Croft

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

The honourable Government House Leader.

HON. GEOFF MACLELLAN: Madam Chair, we will now continue with the Estimates for the Department of Health and Wellness.

THE CHAIR: The honourable member for Dartmouth South with 33 minutes.

CLAUDIA CHENDER: I have just a couple of minutes actually to finish up my line of questioning from yesterday and then I will yield the time to my colleague.

Before we move on to mental health, which we were just starting to talk about yesterday, I wanted to clarify one more time - I believe the minister said yesterday that where facilities have capacity we need to look at our health care system province-wide and not as kind of individual facilities, and I want to clarify that where facilities don’t have capacity, particularly where they are, in fact, over capacity, that the first - I don’t know exactly how to phrase this, but I guess a specific facility’s capacity will be first determined by the people moving through that one facility.

What I am talking about here is that where we know there are severe overcrowding issues in the Dartmouth General Hospital emergency room where we have people being admitted to lounges and hallways, that were more beds to open up in the Dartmouth General to handle emergent care, that first those people would come out of the lounges and hallways before other people would be transferred from other facilities, such as the QEII or the Cobequid.

HON. RANDY DELOREY: I don’t mean disrespect, but I think the way the question is phrased is perhaps more simplified than the way the health care system works in terms of within a hospital context, that really you are looking at capacity of course but you are also looking at criticality and the triaging of patients for care. It just gets a little bit challenging to answer that type of question when you are talking in a bit of hypotheticals. Let me phrase it in a more positive or constructive way - when you have a specific context of the type of beds or how beds are allocated for what condition or purpose, as opposed to framing it as just generally there’s this pool of beds so anyone from this region would be moving into those beds, what is the actual purpose of the beds, from a clinical perspective, if the utilization or the clinical purpose and objective of the beds to meet the health care needs of Nova Scotians, what does that mean?

As I said, I believe, in my response yesterday, Madam Chair, certainly nothing has been brought to my attention that I recall, any proposal or discussion about beds coming online. It might be going on two months now when I was at the Dartmouth General and again, the work is under way but we’re still quite a way from actually having those beds that are to be opened up for use.

Again, the work on operating room theatres in the hospital facility and the purposes within the hospital system, what I can assure the member, Madam Chair, is that our health care system, and really it has been this way for as long as I can remember and as long as I am aware, is very much predicated on a triaging-based system for much of our health care system, where the objective and the goal is to make sure that our most sick, our most in-need patients in the province are delivered care.

Where the conversation went yesterday, I was merely saying that as a single Health Authority, at times - and I used the orthopaedic surgery and I believe digital imaging is another area where you get some changes, when there’s capacity you can move people around, but that doesn’t necessarily mean, for example, if there’s a surgery, say, at the Aberdeen Hospital in New Glasgow and someone from Halifax says it’s a shorter wait-list at the Aberdeen than here in Halifax, I’m willing to travel and have that surgery down there - can you put me on that wait-list and get referred to have the surgery at that location?

I guess I’m painting the opposite picture of what the member is asking about here, that the member would be saying that person should get bumped by anyone from the Pictou area, that’s the way the description has come across to me in the other side of services being offered in the Dartmouth space. If we have a resource in our hospital at the Dartmouth General, that priority will be given to Dartmouth residents or residents within the traditional catchment area of that hospital facility, as first priority. I guess what I’m saying is generally that’s the way the system works because the people in the hospital are generally those from the region, the catchment area.

However, just to use the orthopaedic as an example, there are times and services where resources can be shifted and people from another part of the province should be able to access the resource in another part of the province. Once they enter that, they shouldn’t, I don’t believe, be getting bumped out of their queue just because of the region. I think it’s based predominantly on the criticality as opposed to the geography in many circumstances.

I think we could probably go back and forth on this a little bit, but we’re talking in hypotheticals at this point so I’m using examples that don’t apply to the Dartmouth General. The ortho piece, for example, in New Glasgow only because as I said the whole scenario is quite hypothetical. If the beds were going to be utilized for a purpose other than the original intended, what are they going to be allocated as. What level or classification of beds would they be and then how does that fit within the clinical protocols and work being provided by those health care professionals. That’s kind of where I land on that one.

CLAUDIA CHENDER: Madam Chair, I agree with the member that we could probably go back and forth forever. This is our second go-round on this, at the end I’ll remind the member of the context which is emergency care and the admission for people in critical condition from the emergency department into a hospital bed.

So, my question was not about orthopaedics; it’s not about elective surgeries; it’s not about any of that. It’s about if we end up opening up capacity for those folks in critical condition - and I know that’s a term of art so let’s just say coming from emergency, and I know there are levels of triage within that - people who need emergent care and are being admitted to hospitals. I’ll ask my next question and if the member wants to comment on that, that’s fine. It is somewhat hypothetical because those beds don’t exist. My concern, obviously, is that we alleviate the real and severe pressures that the emergency department at the Dartmouth General is facing before we try and move other patients needing emergency care into that facility, which I know some are concerned may happen.

Moving on to my last question, I would love for the minister to give an update on what’s happening with patients who present at the emergency room at the Dartmouth General in mental distress. My understanding is that is has been for the last few years, and still is the case, that there is no actual medical resource available to those patients at the Dartmouth General. So, they are medically cleared, which is awkward because they’re normally presenting in mental distress, so they’re physically medically cleared - often that would include being tranquilized or something of that nature - and then they wait until they can be transferred to the QEII in Halifax. That may take up to two or three days, and then once they get there, they enter the queue in a slightly different way from patients who are triaged who present in Halifax.

I know that the member has been looking at solutions to that problem. I know the hospital has been working on solutions to that problem, so I’d love an update so that we know that the residents of Dartmouth have access to mental health care in the emergency room.

RANDY DELOREY: Madam Chair, I’m not sure that I have much more on the original bed situation; even if it is an emergency it would be the same thing. I guess my hesitation is in making an absolute statement before final decisions are made because sometimes there are needs to have exceptions to rules. It goes back to that notion of capacity – the general use to alleviate, perhaps, the fears.

[4:15 p.m.]

I don’t think it is anyone’s expectation that a system would be looking to take people in need of health care resources and put them in places that aren’t the appropriate places for them. Really, it is often the clinicians doing the assessments and making the recommendations of the patients being transferred.

To the extent that that alleviates the member’s concerns, probably not fully but at this point, that is the best I can get to on this one.

With respect to mental health services, particularly through the emergency department and through Dartmouth General, I believe we did have some questions a few weeks ago. I don’t remember which member asked about it but I think it came up in Question Period that there have been some new nurses being hired at Dartmouth General with the skill set as mental health liaison nurses.

I believe there was some work and discussion to ensure the appropriate staffing model to have the nurses in place. I believe all those hurdles have been overcome and the position has been posted to fill.

The efforts are ongoing to fill the position and ensure that they are enhancing and strengthening the health professionals within the emergency department to facilitate the care of patients.

When you have someone who has a more focused or specific training, there is cross-training. As you get exposed, as in many professions, to the skill sets that colleagues have, you begin to acquire and some of that rubs off in the work environment. There is that element of strengthening the awareness and supports of educational awareness on the front line and particularly in an emergency department.

As far as the more acute mental health services, they still predominantly are resourced and staffed based upon a historical structure where the clinicians reside. I think there are upwards of over 80 psychiatrists serving the Central Zone area, predominantly out of Halifax on the peninsula side. That is still the case at this point, but we recognize and wish to improve. I think these mental health liaison nurses show that genuine commitment to improve the services while still leveraging the resources that are in place for the more acute mental health system.

CLAUDIA CHENDER: I thank the minister for that answer. I would like to ask the minister: When does he expect those nurses to be in place?

RANDY DELOREY: As I’d indicated, I believe the positions have been posted and the last update I received is an expectation that they should be operational within a couple of months. Again, you can’t force that.

I believe there was conversation with one of the members of the Official Opposition yesterday about a very specific position that had been posted two or three times to get appropriate staff to fill the position. Every effort is being made to get it filled as soon as possible. The last update was that the process should take probably a couple of months.

CLAUDIA CHENDER: I thank the minister for those answers and I will yield the remainder of my time to the member for Cape Breton Centre.

THE CHAIR: The honourable member for Cape Breton Centre.

TAMMY MARTIN: I’d like to go back where we left off yesterday about the One Person One Record. From what I understand, it is a significant investment into One Person One Record and physicians I’ve talked to are very worried about that.

First of all, they are worried that the Privacy Commissioner believes that she needs to be in consultation with this to ensure, of course, an individual’s privacy. Physicians have expressed their concern to me that if the wrong person sees the information - and I’m being told that we’re all human and, if you have the ability, you could look at somebody’s record. There are times when physicians tell me that they record information that is quite devastating about a condition or a diagnosis for you or your loved one that you wouldn’t want anybody to see. Physicians tell me that they’re included and told more private information than even psychiatrists and counsellors.

So, having said that, what protection is the government taking to ensure that there is never a privacy breach with this program, because when I’m talking to physicians they’re telling me they want to go back to pen and paper because the personal records of the patients are the physician’s, the responsibility of the physician and, if that information gets out there, they are very concerned. So, what protection is government taking and what is the dollar amount that it’s going to cost Nova Scotians?

RANDY DELOREY: I thank the member for the interest and the questions. I know the member referenced feedback that she’d received from some physicians. I can advise, Madam Chair, and my colleagues here that I don’t think it was two weeks ago I had my last meeting with the Doctors Nova Scotia president and executive director and, indeed, the main point of discussion was actually digitization and technological progress within our health care system, and obviously OPOR, One Person One Record, was a significant part of that discussion.

I can advise the member that the president expressed in no uncertain terms his belief that moving forward, this is the right direction, and with this updated and enhanced technology that this is the way physicians are being trained, digital systems. The member made reference to going back to pen and paper. I suggest that perhaps if you talk to current students and residents and physician on the future of our health care system, they likely have never seen paper records for the most part and that happens.

A parallel analogy, when I was in school, we talked in a business program about ledgers and so on, journal entries and how to do them, but we did them electronically but that was early stages, very early stages. I was the treasurer of a union for a period of time - yes, believe it or not. I thought I would surprise the member for Cape Breton Centre with that little tidbit - and imagine my surprise when, as I was transitioning, my colleague advised well actually don’t worry about it. You know, you’re working to manage the ledger at the end of the month, the journal entries and so on. There was not a lot. It wasn’t a large entity and I said, oh great, what software are you using. He said no, no, no. It’s a ledger; it’s a book. I’d heard about these in school, but I had never seen one until I started that job and I was doing it on paper, but I’d never actually done it on paper like that before.

My point is I think that would be a similar experience for the next generation of physicians. So, it’s important for the members of the Legislature to understand that this investment is about the investment in the future of health care systems in Nova Scotia. We already have a lot of digital systems in the province already providing these services. OPOR is - and one of the features is about having a single record across the system but, rest assured, there are already systems tracking and collecting this information. It’s already being documented. EMR, electronic medical records, is the system being used by primary care providers, family physicians, and nurse practitioners on the front line in their practices in the community. That’s already happening. Those systems are in place. The OPOR system largely is predominantly in the hospital system.

We currently have because of the history, the historical nine health authorities, nine different systems essentially, not talking to each other. So, we’re talking about a hospital system so that if you’re transferring from Cape Breton Regional Hospital for a particular specialty up in Halifax that those Halifax physicians cannot see the medical information cleanly from Cape Breton, or if you go from Antigonish to Cape Breton, both in the Eastern Zone, because they weren’t necessarily integrated. The vision and the objective of OPOR is to have the single same system so all that data is available to those health care providers and specialists. It’s about clinical access to information.

As far as the privacy side of things, I want to advise members that, in fact, we have started bi-monthly meetings with team members, including representatives from the Privacy Office, Madam Chair. These meetings are starting up. It’s important to realize the point in time we are with this project. The RFP process is still under way, Madam Chair. The technical side of the project hasn’t been initiated. There is still a lot of work to go with this project. Those technical privacy questions are still part of the equation.

What I can advise the member is that more often than not, privacy breaches that do occur in these types of systems are often the result of human factors rather than technical ones. This is one of the challenges we have to strike a balance with. The clinical benefits of our clinicians having access to the clinical information on patients when they need it and having that flow of clinical information to support that, versus locking it down and keeping it too restricted. The more restricted you keep it, the longer it takes to pass that information from one health care provider to another, potentially having a negative impact on the delivery of care.

As the member would know, particularly in emergency situations, seconds matter. That’s where these digitized systems improve. The more you constrain and restrict from the security perspective and the technical solution to limit access, the less you are achieving the clinical objectives of the system where that flow of information can ensure the right health care provider has the right information on a patient at the right time.

Now that means, though, those health care providers have to have the ability to potentially access a citizen’s record at any point in time, just like in the old systems when it was paper based, Madam Chair. For example, a nurse or a health care provider in a hospital could access those charts within the hospital environment but they should only be accessing it at that time for the charts of their specific patients they are taking care of. It is the same expectation in an electronic or digital system.

The big improvement around privacy, Madam Chair, and I took from the member’s suggestion of switching back to pen and paper, that that somehow solves privacy issues and concerns. In fact, the issue with pen and paper is the capacity to actually audit and know if there has been a violation of privacy becomes almost non-existent. One of the advantages of having these digital systems is the auditing and the logging that takes place, so you know if somebody is violating and accessing records when they are not supposed to. If it was back in paper based, you could have health care providers flipping through those charts that are onsite that they have access to and nobody would be the wiser. With our digital systems we are able to do scheduled and unscheduled audits and have triggers for what would look like inappropriate behaviour.

There’s a lot of technical features to help ensure, because I assure you, Madam Chair, there’s lots of research out there that highlights for individual citizens when evaluating the type of privacy interest, it is their personal identifiable information and indeed is health and financial information that is most concerning. I think upwards of 87 per cent, 90 per cent, that’s their top concern in the health care space. Rest assured we are aware of that, I am aware of that, and it’s a big part of what we’re doing with the OPOR project.

As far as costs, the RFP hasn’t been completed yet, so those figures and cost values aren’t going to be deemed public again. We want to ensure we get the best value from our negotiations. If we announced the dollar figure publicly before we start those negotiations, I suspect it will be somewhere, as the bids come in, somewhere just slightly under what we put out there, so we want to negotiate and try to get the best price possible so the public will know how much the system costs, as our estimates and the RFP process proceeds.

TAMMY MARTIN: I’ll tell the minister that the number I’m hearing is about a $0.5 billion dollars, so that’s a significant amount of money to put into something that still has some questions out there.

[4:30 p.m.]

While I appreciate the auditing factor, I also remember back several years ago when Meditech came online. This was supposed to be the be all and end all for medical care from Sydney to Yarmouth and that didn’t happen.

Regardless, just to clarify then, or to finalize, we understand that patient records are legally the property of the physician. I would like to ask the minister what arrangement will be made to ensure this continues and/or what legislation will have to take place in order so that it doesn’t.

RANDY DELOREY: Just a minor modification to one of my statements before. I think I had mentioned that there might have been multiple systems; I think I might have used the term, nine, when I was referencing the nine health authorities. I believe some of those health authorities did have an integrated system as part of the Meditech update; I think there may be three or four implementations, not nine. Again, I didn’t want to leave people with the impression that there were nine.

There was some work to begin the amalgamation, even while they were separate, but to the member’s point that she just raised, it was supposed to be the whole system across the province. That was one of the complexities of having multiple health authorities. Everyone had to have their budgets aligned and timing and so on.

As a single health authority - a single project - to bring these integrations and finally and truly get to that point where we have a single system for our provincial system. Perhaps, to some degree to put the member’s mind at ease, we are taking this project very seriously.

It is very large and complex. Indeed, we know that it is the front-line health care providers who use this system and will be using this system day in and day out. It may be a period of time that we are trying to make the policy decisions, but we want to make the ones that support the operation, the delivery of care - I believe there have been about 50 physicians who have been a part of the team that has identified the business requirements needed. There have been - that’s 49 in the evaluation process - I believe there are over 300 clinicians across the system that have been involved in some way or another providing input, feedback, suggestions, even to this point in identifying the requirements and moving forward to evaluation of the RFP.

Rest assured there are many, many - as I said, around 300 - clinicians having some form of engagement and participation in this work to date. We are at the early stages of identification. There is still a whole, large project once the vendor is identified and the particular product; then you get into the detailed project work and there will be still more consultation engagement before we can start implementing and rolling that out.

As far as legislation, there are multiple steps in there. The other question was around privacy and ownership of data; the custodian of health records and what legislation may need updating or modification through the process.

I guess, first and foremost, is looking at the notion, by and large the physicians who create and manage or any health care provider, they are defined as their custodian. The predominant or main piece of privacy legislation would be PHIA, the Personal Health Information Act, that governs these aspects and defines the notion of a custodian as the owner and having responsibility.

As far as record management and maintaining records, there’s the regulatory requirements around the College of Physicians & Surgeons, they have certain requirements for how long records are maintained and so on within their systems that they are responsible for.

So again, there are intersections as we delve in and build an environment with technology providing access. These systems also provide the opportunity for patients to have more access, although historically and traditionally we see it as, again, physicians creating the record and being the custodian.

At the end of the day, I think, most Nova Scotians would believe that those health records are actually their property, that they own them and that’s why, again, the language is custodian. The health professionals are the custodians of that health information, but the health information ultimately does belong to the individual Nova Scotian that the health information is about. It’s your health; it’s your information.

The language though, in our privacy Act, doesn’t talk about ownership of data; it does talk about the custodian role that health care providers play in maintaining. We’re aware of the privacy legislation and privacy impacts, but again, we’re not quite at that stage through the project. There’s still quite a bit of runway left. We’re really focused at this stage on the RFP to make sure we get a vendor and a product that will meet the needs, based upon the information we received from clinicians to date.

TAMMY MARTIN: Something just twigged while the minister was speaking. The minister said that they’re the patients’ records. If that was the case, and I agree that it should be the case, but so many times when doctors leave, their health records go somewhere else - many times in Ontario. My office has had to try to track down patients’ records and health files in order to get them so they can bring their new doctor or health professional up to speed. I’m not aware that that happens currently; and secondly, I’m just wondering if there is a timeline on the One Person One Record.

I would like to hear from the minister on the health records being the property of the patient, because that’s not what we experience.

RANDY DELOREY: I think what I said was that I believe Nova Scotians would believe that the records belong to them as it is health information pertaining to them. I referenced that the legislation really only makes reference to custodianship of records, not ownership. I don’t think ownership is actually defined anywhere through our privacy legislation but rather, the custodianship definition that our health care workers have.

It also mentions the professional body that regulates physicians - the College of Physicians & Surgeons - does have professional standards and requirements around the retention of records for which a physician has been the custodian. So, the circumstances that I believe the member is referring to generally relate to physicians who most often retire and have a series of records, and often paper records in many cases, based upon historical practices. So, they have large boxes that they have to store; there is a requirement for them to maintain those physical records for an extended period of time.

It’s a very similar requirement for professional engineers for the projects that they’ve signed off on and stamped off to approve. They have to maintain them in case something happens down the road. I think the same is true for physicians. The College defines those retention requirements.

When you see those circumstances of physicians who retire, they need some place to store. Not everyone has - and particularly if you’re getting to that point in your life, often you’re looking to downsize your home environment and so on, needing less space – so they outsource the physical storage to third parties and costs associated with that are what are passed on.

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

The honourable member for Cumberland North.

ELIZABETH SMITH-MCCROSSIN: I have a few questions and they’re going to be pertaining to my constituency of Cumberland North. The first one is the North Cumberland health care facility was announced by the Premier in April 2017. I’m pleased to see that it remains in the Capital Plan.

I’m wondering if the minister is able to provide the amount budgeted for the Capital Plan for this facility and to provide a timeline for the construction of the facility.

RANDY DELOREY: As with many of our projects, we break out and focus on the specific costs as we move through the procurement process - not to weaken our position as we move through that. What we have is, the design is nearing completion with the site. The next stage would be the final completion of that design and moving then to a procurement to have the construction of the site implemented.

The work is ongoing and a lot of progress has been made on the design side. We will make sure that the member and the community are well aware when it moves into the next phase.

ELIZABETH SMITH-MCCROSSIN: I don’t know if it’s possible or not, but it would be nice to have some sort of an announcement or update the public could have just to give them a little bit of hope because, of course, they worry that it’s another announcement that doesn’t get fulfilled. I have assured them that the Premier has said that it is going to happen but any kind of timeline or update that could be made publicly, I know would be appreciated by the community.

On another topic, I know I’ve brought up in the Legislature previously about my concern about the empty long-term care beds in Cumberland, especially with the long wait of people in our acute care beds waiting for long-term care beds and I don’t know if this is an issue province-wide or not but, as of the end of last week, there still were 15 empty long-term care beds and I first brought up the concern about six weeks ago. The chair of NSHA did set up a meeting with me with the Continuing Care director, which was a great meeting. We discussed the reasons behind the delays and moving people from acute care beds to the long-term care beds, but nothing has changed, and we will have the, of course, overcrowding in the emergency departments. So, I guess it just makes me question what we can do to try to facilitate faster movement. The director had shared with me that it is, on average, 10 to 12 days to move somebody from an acute care bed to a long-term care bed. The expectation is six days. As a nurse, I would have thought it would be more like 24 or 48 hours.

I’m wondering what can be done. It’s definitely a problem in Cumberland County. I don’t know if it is province-wide. So, I’m wondering if it is possible to look into how many empty long-term care beds there are province-wide. I know how many there are in Cumberland but is this a bigger issue and, if we could solve the problem there it would help alleviate some of the pressures in the hospital.

RANDY DELOREY: I’ll start with the announcement thing as I’d mentioned earlier. Once we formally complete and sign off on the design and are ready to move forward to the next phase, we’ll certainly be having that information made available publicly. I think it’s important again for the public to be aware as we move through the process keeping in mind also that the process, particularly the RFP process and so on, are also public processes and we’ll make sure that the information is announced and put out there so people do know.

As far as the long-term care beds and the efficiency of moving through the system, we’ve talked a few times about emergency departments and patient flow within the hospital system. We didn’t carry that conversation to this point but it’s all really part of, to some degree, the same conversation. It highlights the integration of our health care system and the various parts and how it is, as the expression goes, a well-oiled machine. I believe as part of the Health Authority’s renewed focus and concentrated focus on improving the flow and efficiency of our emergency departments, we’ve talked a lot about the ambulance transfers into the hospital system to help on the EHS side and get those ambulances back out on the road. I’ve also stated multiple times that that work is not limited or restricted to just that piece of the system.

I believe recently the Nova Scotia Health Authority has begun engagement with our long-term-care providers in the Continuing Care space to look at improving those efficiencies between those two organizations, so that the system can become a well-oiled machine where inefficiencies exist. I really do appreciate the member raising the question, but I want to assure her that this and opportunities like that are exactly what’s on the radar of the Health Authority to improve the system because we know that that’s going to be good for residents. I guess, to introduce the caveat piece there, when the member mentions 24 hours to move through, I guess there’s a balance between being a perfectly efficient system and being a compassionate system that, to some degree, these are life-altering decisions so there is time for people to make the decision that they are actually going to be moving and so on. We do want to move people through, but we want to be compassionate.

[4:45 p.m.]

These are major life points for some of our most vulnerable citizens, so the system is trying to strike those balances between the clinical efficiency and effectiveness, while at the same time being a compassionate system, as I know we are as a province.

ELIZABETH SMITH-MCCROSSIN: Absolutely, I agree with your comments. I think the patients I am referring to are people who have made the decision and the family are aware that they are waiting for a long-term care bed. They are ready, waiting in an acute care bed, for that long-term care bed and yet the long-term care beds are empty.

Paperwork was the number one reason that Continuing Care gave me for the delays. One of the pieces of paperwork that they gave was that the family doesn’t always have the financial paperwork done. I know if I had to fill out financial paperwork for my father, it would take me a long time to find income tax information and that. They did share with me that 90 per cent of patients going into long-term care are paid by the province anyway.

I guess my suggestion would be if 90 per cent of the people are being paid by the province, let’s not hold up people being moved because of paperwork not being quite filled out.

The reason this was brought to my attention is the physicians who are working in ER; it’s a small community, so they all know that there are all these empty beds in long-term care. They believe it is needless jamming in the hospital, where there are these empty beds.

Recently, one of the facilities - and I have brought this to the attention of the minister – one of the reasons that they are not accepting patients from the hospital is due to a staffing crisis, which leads me to another question to the minister.

Because of the staffing crisis that the nursing home is having – not able to staff adequately – is that something that the minister could discuss with our Minister of Labour and Advanced Education and maybe add seats for the CCA program? I’m just looking at the critical importance of ensuring we have safe conditions for our vulnerable in long-term care.

RANDY DELOREY: I thank the member for raising these points. Again, the notion of paperwork and the role that plays, as I said, that is exactly the type of thing we are trying to focus on with the NSHA and our partners in the long-term care continuing care sector; to improve those efficiencies.

I think we do have, as a government, writ large on reducing administrative burdens. I think, as we’ve seen, we established an office in government to do just that and we’ve had a very good track record thus far leading many parts of the country in this regard.

I think we’ve been building our capacity to do this across the board and look forward to having the skills and our efficiency improvements, especially where they are administrative as opposed to a clinical burden. That’s exactly the type of path that we’re on to try to make improvements there.

With respect to workforce within the Continuing Care, long-term care sector, of course, that is something we’re aware of, as well. It is something that is through Labour and Advanced Education and working on multiple fronts.

In fact, the expert panel on the long-term care quality in the long-term care sector, many of their recommendations are very specifically related to workforce; both in terms of the complement, but also specifically related to CCAs workforce. For workforce planning, the program curriculum requirements would be in collaboration with Labour and Advanced Education - and also references to how we improve and increase the number of CCAs available in our province to fill vacancies and provide care. A very challenging, but very rewarding and very important career in our province. Part of that that was highlighted by the extra panel was actually to remind people about how rewarding a career as a CCA can be so people do look at it when they’re considering what programs they may be taking. With Labour and Advanced Education, as I understand it, there are some locations where the seats aren’t all filled and there’s a wait-list in other sites. Again, we’re looking to optimize and get those improvements.

There’s a recommendation around bursary programs, so we’ve introduced about $200,000 to begin providing some bursaries and target so we can fill what may be hard to fill positions within the program, so we’re willing to support you financially if you’ll fill those vacancies that are kind of are long-standing in certain communities or certain facilities. We’ve had a lot of success partnering with my colleague, the Minister of Immigration, on a number of fronts, from physicians to early childhood educators. There are discussions of working with the Department of Immigration as well in the short term to see if there is an opportunity there to help strengthen our workforce at this point in time.

We have a number of items, I guess is what I’m trying to articulate to the member. We’re aware of the challenge that some providers are facing, not just in long-term care facilities, in some of our home care partners, as well. The work that we do here, based upon the long-term care panel reviews, will be helping build home care and long-term care facilities.

ELIZABETH SMITH-MCCROSSIN: I’m trying to think of how to pose this next question without sounding harsh. We pay long-term care facilities whether there is someone in the bed or not and I am wondering if it’s something that the minister thinks we should be looking at. I was trying to figure out in the budget where nursing homes are paid, I think it’s from Continuing Care, which is under the Department of Health and Wellness, I think.

I’m just wondering if the payment model is something that the minister and his department has looked at. Should we be looking at, if nursing homes are not filling their beds, should we be looking at only paying if the beds are filled as an incentive for them to work harder to take the patients that are in the acute care beds?

On that same vein of payment, I’m also concerned about the number of empty residential care facility beds. In Cumberland alone, there’s well over 20, and for a few years this has been an ongoing issue. The owners of the residential care facilities are paid whether the bed is empty or full. From a business model standpoint, I’m just wondering if this is something that the department should be looking at. It’s a problem in Cumberland County and I don’t know if it’s a problem province-wide. If I’m a business owner, and if I’m going to be paid for a service and I don’t actually have to provide it, and don’t have to provide the staffing, there is opportunity there for businesses maybe not to be motivated to be making sure their beds are filled. I’m wondering if payment is something that the department has discussed and looked at.

RANDY DELOREY: Madam Chair, I think in the budget around long-term care facilities, I think that was the first part of the question; the total Continuing Care space for 2019-20 is just under $870 million for this year’s budget. That includes adult protection and home-support services, so if I just look at long-term care itself, we’re looking at about $582 million of the just under $870 million is in the long-term care space.

As far as the payment process, again, the agreements and so forth that are in place with many of our facilities have a long history to them. We have a mix of providers that are out there, many of them non-profits, a long history, some of them historically are municipal based, community. The history and understanding the history of where they evolved from, they actually were communities’ response to needs long before government actually recognized and became involved in providing care for citizens.

Based upon those historical contexts, it does mean we don’t necessarily have the certain aspects of efficiency in there, but we do recognize where we have them and we’re working with our providers and our partners to improve systems. For example, the concerns raised in this particular line of questioning, if we address the question that was asked previously, which is the efficiency and have fewer of those vacancies and again, recognize that sometimes they’re system problems.

I think just one example the member used previously, Madam Chair, that it wasn’t necessarily the provider restricting access, it was because of paperwork and the paperwork requirements needing to be in place. In a situation like that, should the provider be penalized for that? What we are really getting at is how do we become more efficient in the operation and delivery of our system?

We are working to identify where the inefficiencies are, who is responsible for those inefficiencies, and driving that accountability to that part of the system. I think, Madam Chair, believe it or not, as many people in the Legislature may be surprised, I think we’re thinking along the same theme. Whether we would hit on the exact way we would implement or not, maybe we would have some differences of opinion there, but I think we’re certainly rowing in the same direction on this one.

ELIZABETH SMITH-MCCROSSIN: On another topic that is an issue in Cumberland County, specifically at our regional health care centre, but also in more rural areas, is our support for our IMG physicians.

This has been an ongoing issue and I continue to hear from our local physicians about their concern for their colleagues who are faced with having to write the Royal College of Physicians and Surgeons of Canada exams. What if they don’t pass? What if they leave before writing them? How are we going to replace them? Especially our specialists like anesthesiologists. It causes a real stress, Madam Chair, for both the physicians, and the IMG physicians that are faced with that requirement. Also their colleagues knowing that if they leave, it’s like a house of cards, how that impacts everyone else.

I’m wondering if the department has any plans for providing academic support to our IMGs, so they can be successful and stay here in this province?

RANDY DELOREY: Madam Chair, I do thank the member for raising this concern for international medical graduates. I’ll touch on a few different points here and a few different programs, services, and things that exist in the international medical graduate space that I think address not just the specific, but also more broadly, the concern being raised by the member.

First is, again, the context of the concerns being raised. This was a change that was brought into effect in 2017 by the College of Physicians and Surgeons. This issue and this challenge, I want to stress to the members, was not initiated or precipitated by anything the government has done other than the fact that we allow physicians to self-regulate and they have a regulatory body that adopted some standards and provisions that required changes to an historic program to find licences but requires, within a set period of time, that physicians that would be internationally trained to obtain the national standards, the Royal College exams successfully. So that’s just the context so people, our colleagues, understand what we’re talking about here is the challenge point that historically these defined licence contracts were continued and maintained without an obligation to write the Royal College and then, in 2017, that changed, and it’s how we manage that change.

[5:00 p.m.]

So, I’ll address how we manage it on a long term and how government stepped up and worked and brought our partners together to move forward with this so we can address the go forward and then we’ll delve in - I’ll talk a bit more about the specific question and concerns the member raised which is how do we catch and support those people caught in between. On the go-forward program and supports that we’ve developed is a replacement program, so engaging with the college and saying, you know, international medical graduates, physicians with training and certifications from outside of reciprocal jurisdictions have historically provided valuable support in communities across the province, obviously, the college’s concerns being what their primary mandate is around public safety and so on, and they had deemed what they thought would meet the public safety requirements.

We wanted to say okay, but how can we provide more opportunities and supports, and that’s a Practice Ready Assessment program that we’ve worked with our partners - and those partners are not just the college. It’s the college, it’s the Health Authorities as well as Dalhousie Medical School and, again, physicians on the front line. None of this can be successful without front-line physicians who are willing to step up and work as preceptors or supervisors as physicians go through to get their clinical assessments and certification that is acceptable to the college to ensure they get their full licensure.

So, we have the Practice Ready Assessment; the website is online. If anybody is aware of individuals who may be interested in coming to Nova Scotia but they don’t have a recognized licence, maybe with the Practice Ready Assessment program you want to encourage them to go through. Again, those are for already licensed in another jurisdiction. That is a difference from international medical graduates looking for a residency program. So, there is a distinction between the two, but for those fully licensed in other jurisdictions who essentially can come in and get that training support.

So, we’ve worked to build that program; the website is online. You can do a quick search. You can find it and people can get the information and apply and they’re reviewing applications now, and we expect through the Spring or summer the first cohort being trained and we’ll start to see that stream of physicians that was previously under a defined licence coming through the Practice Ready Assessment. So, we start to build up another stream which in the last couple of years has been missing - that’s kind of the go-forward to say we’ve recognized.

Things that we also have in that space are for those international medical graduates - I’ve talked briefly about this before - who haven’t been licensed yet. They need their residency, Madam Chair, and in our residency system we do have, I believe, three maybe four residency seats in the first round of the CaRMS matching that are reserved for international medical graduates to be filled, and in the second round, any unfilled residency matches you have equal standing as an international medical graduate as with a Canadian medical graduate. So, the first round preference is given to Canadian medical students and the second round is open to everybody, but we do have some reserved international seats in the first round.

The other piece then about those physicians that have historically been working on the defined licence and the college is requiring them to complete their exam, again, I mentioned earlier that I recently met with Doctors Nova Scotia and one of the topics was in this space and it was a very positive conversation. They spoke about the work and the collaborative work that’s ongoing between the stakeholders, the medical school, the college, the employer, Doctors Nova Scotia, and the department, to do just that.

They’d indicated that they’ve spoken to many and they’re focused on a cohort that is in the process of needing to write the exam - the ones that they think might be of most benefit from the supports - so I would encourage, if you have a particular constituent, maybe they could reach out and see if they are one of the ones involved in those discussions - kind of that focused effort to try to support them to get through and, if not, they can reach out and perhaps provide more details for how it might be available to support their specific circumstances.

ELIZABETH SMITH-MCCROSSIN: Thank you for the answer. Certainly, in rural Nova Scotia the specialists, in particular, have a really hard time because they are often on call rotations of one in two, so I am pleased to hear that there is some work being done.

I might have misunderstood. I was thinking the Practice Ready Assessment program was an assessment program. So, it’s more assessing – making sure the IMGs that we accept meet our requirements? I didn’t think there were any academic supports to help them actually pass the exam.

What I’m hearing from our IMGs who are here is that they really need academic support, and when they’ve gone to Dalhousie, at least the ones whom I’ve spoken to in Cumberland, Dalhousie Medical School has said no, unfortunately, to providing them with supports, but we can certainly talk more about that.

I do only have a couple more minutes left before my colleague is going to take over, so I will use my last couple of minutes to ask about psychiatry.

I think we’ve all heard here in the Legislature about the concerns with mental health around the whole province. I can certainly say that in Cumberland we are in dire need of psychiatrists.

Everyone in health care is valuable and important, but in mental health we need psychiatrists to actually make the diagnosis, and when you don’t have a diagnosis, there are often treatments being given that sometimes aren’t in alignment with what the actual diagnosis is.

I would love to see a real emphasis placed on recruitment of psychiatrists. Definitely in Cumberland, at our regional health care centre, we are in dire need, and I think it is province-wide.

I’ve been speaking with our local staff, and my question to the minister: Is there an actual clinical plan for psychiatry which would outline the number of psychiatrists that we need in the province based on population and where people live? If yes, would it be possible to make that available? I offered to help do some recruitment of psychiatrists for Cumberland.

There is a big conference in Quebec and some of us from our area are going to go up to try and recruit, but I was warned to make sure that we actually would be approved if, in fact, we were able to recruit some psychiatrists to Cumberland, that they would be approved to come.

I am wondering, is there an active plan to recruit psychiatrists to Cumberland and throughout the province?

RANDY DELOREY: I thank the member for the question. As I’ve indicated to other colleagues, every time the question is raised around mental health, I do genuinely appreciate it.

I believe all advocates who have either experienced or know someone who has been touched by someone with a mental illness or mental health challenges appreciate it because every time we stand up in this Legislature to talk about mental health concerns and issues and opportunities and what we are doing to improve them, I hope that in some small way we are also breaking down the stigma which is one of the challenges and we become more accepting and more willing to engage.

I just wanted to put that on the record so that people understand why this is so important to us and why, even though we are having the discussion here, I hope others see this, appropriately, as a good thing, that this is a priority for all of us in this Legislature.

Specifically, to the questions and there are, I think, a couple in there around psychiatry. We do have the vacancy across the province, so I’ll provide that to the member, in the four zones. In the Northern Zone, where the member resides, in Cumberland, it’s eight psychiatrists; in Eastern I believe, it is 11; Western is two; and Central is seven. So, we recognize it as a challenge across the country. We have these vacancies and we have vacancies in part because of supply and demand.

I guess, as a society, in the province and across the country and across much of the world, over the last even 10 or 15 years, the progress we have made at breaking down the stigma and recognizing mental health challenges, I believe through that there has been a positive effect and that is we are seeing people perhaps more willing as we break down the stigma to step forward and ask for help. It’s not perfect, there is more work to be done in breaking the stigma and providing that safe environment, creating an environment and a society where people feel safe and comfortable coming forward, but I think, Madam Chair, we have made strides, significant strides as a society writ large to do that.

One of the impacts of that though is you increase the demands. You know, as we’ve been working so hard as a society to break down the stigma and be more welcoming and so on, we didn’t necessarily build the capacity in our system to respond to the increased demand that was going to materialize within our health system, providing mental health services. That’s, I think, one of those pressure points that we found because our health system and the planning to develop and train the psychiatrists, was based upon an old model where not everyone in society was willing to engage but they were serving those in our society who did reach out, but that was only a fraction of the people impacted and affected, I believe. So, that’s one of the challenges we’re having and all of us as a society, across the country, are facing that and I think that is a contributing factor.

So, what are we doing about it? That is what I think is really important. What we’re doing is we’ve reviewed compensation based upon feedback. We know that even if you look at the numbers, the Eastern Zone, Cape Breton, is one of the areas most acutely in need of psychiatrists. So, I’ve spent a lot of time in my first year in this role engaged in conversations, learning from those psychiatrists on the front line, not just to understand the challenges but what are some possible solutions.

Some of those suggestions that have come forward, we’ve actioned. One was a concern about whether the compensation rate in the last master agreement didn’t properly consider the way that some psychiatrists in the Central Zone are compensated relative to those working in other parts of the province. We made adjustments to that because when we looked at it, we recognized the legitimacy of those concerns and made some adjustments there, including some consideration for the Northern and Eastern Zones that had the most acute vacancies.

When you look at not just the absolute numbers, but where those absolute vacancies left the demand, so the percentage of vacancy, I guess - although the Central number is only slightly less than Northern, they also have somewhere in the vicinity of 85 psychiatrists, so that is less acute of a challenge because there are many more hands in the Central Zone to share the work, versus the Northern Zone, those eight vacancies are quite impactful because there are so few additional ones.

We recognized that; we’ve made those changes. We’ve also made a change, again, a very specific recommendation from a psychiatrist in Cape Breton is acknowledging and recognizing the recruitment challenges because of the availability of psychiatrists to do the work, providing additional support for the psychiatrist we do have in place. Particularly in communities with more challenges with the psychiatrists, and there was a recommendation for a new program called a clinical assistant, who can provide support. So, we’ve launched that. Again, it’s something that took some time to work with the college and the Health Authority and the school to develop this program, to get the college to recognize the licence and what the standards would be. That took some time, but we listened, and we heard. We worked with our partners and said we support this. There are two in Cape Breton. I believe their training started or starts this month. I believe it’s a three-month training initiative, so we expect them to be in the community soon, and there’s another two that have been approved to begin their training maybe a month or two from now, and they’re targeted towards Northern Zone service.

[5:15 p.m.]

We have listened. We have done these things. On top of all of that, again recognizing how you address the vacancies, if you have a system-wide challenge of availability you increase the number of training opportunities. Those 15 specialist positions, we have identified positions. At least three of them, off the top of my head - I don’t have the number here in front of me - I believe we have at least one in youth and adolescents, one in adult, and one in geriatric psychiatry. The residencies will be beginning in July of this year.

That’s just a sampling of what we’re doing to say that we’re aware, we have been listening, we have taken that feedback, and we have executed a number of the recommendations, but it took time to get them developed and implemented in some cases. We look forward to seeing the positive result that these efforts by multiple partners in the health system are going to have on our mental health services.

THE CHAIR: The honourable member for Cole Harbour-Eastern Passage.

BARBARA ADAMS: I’m happy to have another opportunity to speak with the Minister of Health and Wellness - and I would like to another gold star today if it’s at all possible.

Yesterday, we were talking mostly about continuing care, home care, and long-term care. Today I want to ask specific questions that my constituents have at the top of their minds. I will go to the reference that you made about continuing to listen and work and invest with respect to psychiatric services. In my constituency, although we don’t have a family doctor, we also don’t have any other services. The only government offices that are paid for in my constituency are the unemployment office and the Liquor Corporation. We don’t have anything else there with respect to any type of government services or health care services.

On the weekend, I had a constituent who called me at home. She has an adult son who, when he was still in high school, was able to get access to psychiatric services and supports, but he has graduated out of that, as he’s now an adult. He was becoming increasingly violent, and she managed to get him into a car and go to Dartmouth General and they said, we don’t have any psychiatric services here, take him to Halifax. She got all the way over to Halifax, and they wouldn’t come out and help her get him in. She’s little, and he’s big. They were told to call the police department. When the police department came, they said we can’t transport him into the hospital unless we arrest him for assault.

She’s absolutely distraught, asking me: “Is my only choice to get my son in to see a specialist is to have him arrested?” I just want to make the minister aware of that, and I’m asking you: What do we tell her? I have to call her back today, and I would like you to help me figure out what it is we tell her.

RANDY DELOREY: Indeed, the member’s constituent has struck to the heart of one of the most challenging circumstances in our mental health system. In short, that is having a family member or loved one you see suffering through mental illness. One of the characteristics, unfortunately, like illness and addiction, is individuals don’t always notice or aren’t necessarily self-aware when they are suffering and in need of help. Yet our loved ones can sometimes see first. Being the compassionate society and people that we are, we want our loved ones to get the help that they need.

The unfortunate challenge, as it exists in legislation and so on, is for mental health services and having the involuntary admission, I believe, and I’m paraphrasing and it’s not exact but, essentially, unless individuals represent kind of harm for themselves or somebody else, if they don’t want to seek help or be provided help, we can’t force that on them.

The process we do have in place is the involuntary psychiatric admission program, I believe, and there are very set rules. There is an arm’s-length body that would review those requests to be admitted, again involuntarily. I believe that one of the thresholds is about harm. Unfortunately, observing the behaviours and the outcomes of certain behaviours that we know are influenced by, again, whether it is mental health or addictions, often the two going hand in hand when there are challenging behaviours that go along with it, it is that threshold of that imminent threat to themselves or someone else.

I would have to go back to the history books to show exactly how we evolved to that point, as a society. It’s relatively consistent, as I understand it, in other jurisdictions. Again, this wouldn’t be 100 per cent factually accurate but in a simplistic way to describe it, I believe society previously erred on the other side of the equation, in which case we had individuals being admitted involuntarily for services. Again, there is abuse in that model and process and people were not necessarily in need. So as a society and through various means - again I’d have to look it up to see the details - we have evolved to this point in time and this stage as the threshold.

I’ve seen people, long before I got into politics, struggling with that very same challenge. If we can come up with a solution to that balance, this is the best that people have come up with to date, to strike that balance. Again, it is the heart of one of the biggest challenges we have and one of the most stressful, challenging things for loved ones, people struggling with their mental health.

BARBARA ADAMS: I thank the minister for that answer. I think that right at the moment she is left with the only option of having him arrested in order to get him into the building. I’m wondering if we can’t work with HRM police and the RCMP to see if there isn’t another alternative to having to arrest one’s child to get them in.

Another question I have from one of the constituents is: How many of the new medical grads have signed on for the recruitment incentive for family doctors this past year?

RANDY DELOREY: Just back to the previous question, too - another scenario or option, again there is the crisis intervention team to engage. They would have the training and the process, so clinically speaking they would know and provide the best direction and course of action for the specific circumstances in place.

To the current question, Madam Chair, I don’t have it broken out specifically to first-year graduates that came in, but in terms of the various return-of-service programs we have, the IMG residency program that I talked about where in the first round there are three or four residency seats that are reserved for IMGs. If an IMG takes one of those seats, they are obliged to a return of service with the province. That’s the quid pro quo, I suppose, of us reserving seats for international medical grads is to tie them to a return of service.

Tuition relief, which is probably the largest dollar value piece, family medicine bursary for those pursuing family medicine, IMG clerkship, debt assistance program, and then re-entry for existing physicians who want to take some time to tweak or get another specialty. Those are the different programs and again, I don’t have this broken out because these are multi-year commitments, but we have 163 active physicians who are part of our return-of-service program right now. The member asked specifically about first-year graduates, unfortunately, I didn’t have that I just have the total number across the system.

BARBARA ADAMS: Thank you, Madam Chair. When we’re looking at the budget books for the Department of Health and Wellness on Page 13.2, it shows that the forecast for 2018-19 for physician services was $860 million and for this upcoming year it’ll be around $871 million. What I’m wondering about is, and correct me if I’m wrong, but the fee-for-service physicians got their raise last year. I believe it was 5.6 per cent.

My question to the minister is: How many of the physicians, especially those who are in the underserviced rural areas who are on the APP, will actually be getting the raise from last year, if they meet their 80 per cent threshold, so they will end up actually getting a similar raise that the fee-for-service physicians were already getting? My understanding is that this raise, even when they do get it, is going to be spread out over the next year. It’s like they’re earning it for almost two years before they’re actually recouping it. I’m looking for how many of those are actually going to be getting their raise that are on the APP.

RANDY DELOREY: Just for clarity for the members here, and even for myself, the member’s question about the raises relates to the increase for comprehensive primary care services we entered into about a year ago. It’s outside of the master agreement, but an amendment for primary care to help encourage physicians and is recognized as part of our recruitment and retention. The member’s right. When we implemented, and that program went live, the vast majority of physicians who are fee for service in our primary care system would be receiving the compensation based upon the completion of office visits that meet the criteria defined for comprehensive primary care and the attachment that they have for patients.

For the alternative payment plans, the nature and the approach of how they deliver their care is more salary-based and the criteria is to ensure they bill at an adequate rate as per the criteria that was established in conjunction with Doctors Nova Scotia. The member’s right, it is at the year-end, so it’s a year in arrears, but part of that is because this was not just an automatic increase, it was an increase that was tied to delivery of outcomes. In the fee-for-service model, you see those outcomes being delivered on a day-to-day basis. In the APP model, they do something called shadow billing, which is done kind of more retroactively than the billing program within our fee-for-service model. That’s why the programs are a little bit different, but the models of compensation writ large, again, we have the money allocated to provide the compensation that we’ve agreed to provide. We thank those physicians for doing so, who have participated in it.

[5:30 p.m.]

BARBARA ADAMS: Madam Chair, I thank the minister for his answer. I’m not sure if there is an actual percentage. If he knows that percentage yet, that would be good to know.

One of the other things that I’ve run into over the last few years is when I speak with MSI about billing codes and practices and procedures that are possibly cheaper to perform now than they were in the past. Eye surgery is one of those surgeries where in the past it might have taken you one, two, or three hours, so surgeons were paid accordingly, but now they’re in and out.

I personally have been in and out in 10 minutes - I think I saw the surgeon for less than five - but they’re still being paid at a rate that was considerably higher. Not that I’m looking at discouraging any surgeons, but I’m wondering if that particular dynamic has been looked at in terms of a reasonable amount of time versus a reasonable amount of compensation?

RANDY DELOREY: Sorry, to the previous question again that the member asked about percentage, I believe it is about 5.6 per cent that it works out to on the APP contracts. (Interruption) Again, I don’t have the data on the members who have earned that percentage, but that was the percentage of compensation. I don’t have the list of the number of members who have achieved that threshold requirement at this point.

To the current question on compensation, as the member would know, the compensation framework is negotiated with the bargaining agent for physicians, Doctors Nova Scotia. We negotiate that agreement. It establishes the fee schedule and the compensation rates and how those rates are distributed across the physician population. That’s the way this works. I am always willing to consider how we can be more efficient in our distribution of funds for ensuring the efficiency and the effectiveness of our compensation structure and framework with physicians, but we also have to ensure that we have physicians willing and able to provide the care that we need in the province.

That’s what negotiations are all about, and that’s what’s taking place. We are actively at the table, so I’m not going to go into too much detail about the specifics of what’s happening at the table other than to say that we are at the table with Doctors Nova Scotia negotiating the next master agreement compensation structure.

I certainly appreciate the member’s interest and suggestion around how we could perhaps be more efficient in that.

BARBARA ADAMS: Madam Chair, I thank the minister for that answer. I was hoping for another gold star. I’ll keep working at it.

One of the things I’m aware of is that sometimes there’s a change in procedures because we’ve evolved and we do things better. One of those procedures, which is the old way of looking after varicose veins, is stripping. Currently, if you get a referral to a specialist, you can get vein stripping in the hospital. It’s an outpatient procedure, but you then have to take four weeks off work. You have to go on unemployment.

There is laser surgery that the same surgeons can do that doesn’t require you to take four weeks off. It only requires you to take four days off work.

For somebody who is a single mother or father who has small children at home, taking four weeks off work is not optimal. I know of constituents who have advocated to MSI to change the billing codes, and they’ve said, well, if a surgeon comes and presents a sufficient case, we’ll look at it. I’m wondering about how many opportunities there are to save money for the system as well as stress on family members.

I am wondering if the minister is familiar with this particular surgical procedure, and where there is an opportunity to save money, could we take a closer look at it?

RANDY DELOREY: Again, as I had mentioned earlier today, I think to the member’s colleague for Cumberland North, while we may not always agree on the specific implementation or action, I think we’re perhaps rowing in the same direction on some of these questions.

The member may not realize, but in 2015, I was the Minister of Finance and Treasury Board, and one of the first things I did in that role was present information . . .

THE CHAIR: Order. Just a minute. Can the chatter in the Chamber please lower? The Minister of Health and Wellness has the floor.

RANDY DELOREY: Thank you, Madam Chair. What I was saying was that one of the first proposals, knowing we were going into the 2015 round of negotiations with unions and bargaining agents like Doctors Nova Scotia, was a bit of a framework. It was predicated on our fiscal capacity and ability to deliver. We laid that out very clearly - I laid it out as Minister of Finance and Treasury Board, that that was going to be our guiding principle.

One of the things I also recognized is that we believe there are efficiencies within the system. Being the minister of a department - so for example, the Minister of Health and Wellness may not know where all of the best efficiencies within the system reside. We had proposed, through that process, a means of essentially shared benefit that if their members, as we negotiated with bargaining units - you know, if we entered into a compensation rate that met our fiscal amount, that we could also negotiate shared gains - a prospect where if we were bringing something new to the table, they were willing to work with us on an implementation that was going to bring efficiencies and cost savings into the system.

That would be new fiscal capacity that we would have as a province, that we could then reinvest partly back into compensation for those individuals and the compensation they have. So we did make an effort. I’m not aware of any bargaining agents that took us up on that proposal to pursue those efficiencies.

I assure the member that we thought, hearing from front-line professionals and providing a financial incentive through the negotiations, the opportunity to do that - to implement and capitalize. But perhaps in some of those cases where those efficiencies exist, those efficiencies are coming at the expense of somebody, and again, I’m talking in my time when we were talking about all of the systems.

I’m not talking specifically about health care, just to show that as government, we certainly were thinking that line. We were looking for those opportunities. We continue to look for those opportunities and are certainly willing and open to work to find those efficiencies and make sure that our system is efficient and as effective as possible.

On the specific clinical treatment that the member has raised, I’m not intimately familiar with the specifics. Certainly the member raises some compelling considerations that I’ll look into with staff and our partners within the system to see if there is any compelling clinical rationale for the current, if inefficient, treatment versus alternative modern approaches, and whether that is something that’s at the table or appropriate to bring to the table, or if it is something that has to go to the table at all, as part of negotiations.

Again, we are looking for efficiencies, because we want to deliver the best care possible.

THE CHAIR: Order. Time has elapsed for the Progressive Conservative caucus.

The honourable member for Cape Breton Centre.

TAMMY MARTIN: Thank you, Madam Chair. I’d like to move on now to home care and talk to the minister and ask some questions about home care.

We learned last year through a FOIPOP request that reconciliation of care received and approved is not currently done.

We’d like to ask the minister: Why is there no reconciliation of services done? Will that be done in the future? What is the process now, if that is not being done?

RANDY DELOREY: If I may, if I could ask for a little bit more clarification on - just to make sure we are talking apples and apples here - what the member means in terms of the reconciliation portion - reconciliation of which portion of the system to the other. If we could just take a second to get that clarity.

TAMMY MARTIN: I think I forgot that. It’s what’s requested and what’s actually done - the services that are provided versus what’s requested by the family or health care.

RANDY DELOREY: A couple of points to the member’s question about care requested and provided - really, the home care services should predominantly be needs based. We do have care coordinators who do assessments, and that helps determine the needs of the care being provided. There may at times be gaps between what individual clients request or want versus what they have been clinically assessed in terms of needing. That might be part of the reconciliation. We would be starting with what someone is assessed with, and what we then request the home care providers to provide based upon that assessment.

Just a slight piece on the language: there might be some gaps using the language of what someone as an individual or a loved one has requested versus what they have been assessed for. That’s step one where there could be some variance. Where we’re focused is on once they’re assessed, and the service providers are providing those services that they have been hired to provide.

Some of the things that we have ongoing here is the development - this is work that was started by my predecessor, the Minister of Communities, Culture and Heritage, when he was in my position - of key performance indicators. I think we talked a little bit about this yesterday, so I won’t rehash it. These are performance indicators to assess things like missed care and delving into that space. It’s a fairly new process, and we’re working to identify the best performance indicators.

We started with things like whether they’re getting a visit when they’re supposed to have a visit. Then once we get that improved in the system, we’re delving in to say, are they getting the specific care that they need? We’re working our way through the system to find where there are challenges, and if the challenges are related to particular providers, working with them to say, why are there challenges in achieving these expected outcomes in the delivery of care for your clients?

That’s the approach we’re taking. It’s through the key performance indicators, but I don’t have data on the specific reconciliation, because that can get kind of complex in terms of the many different types of care plan. They do become very individualized for individual Nova Scotia clients.

TAMMY MARTIN: Following up on that, I would like to ask the minister, how do home care assessments work? What is the least and the most amount of home care that any individual may receive?

RANDY DELOREY: Notwithstanding any potential exceptions, generally the vast majority - I’m not aware of a minimum amount. That’s not something I’m cognizant of. I’m not sure - again, for that minimum, though, as I said in my previous response, there are clinical assessments that are done that there’s a certain need requirement, but that’s not necessarily based just on hours for the individuals but the nature of the needs.

[5:45 p.m.]

For example, there may be services that perhaps an individual only needs, but it’s a critical need - to have help getting in and out of bed. It may not take a lot of hours to complete that one task, and perhaps the individual, once they are, for example, in their wheelchair and the equipment, they are actually able to care for themselves throughout the rest of the day, but there’s a critical need. It’s not about the hours of need but rather the criticality and the nature of the need that they have.

Now, some individuals may interpret that as, if they don’t have a really critical thing that they are in need of, then they may not meet those clinical thresholds for the requirements. It may be interpreted by some as, well, I don’t think I need a lot of hours, so why am I not allowed? It’s really because the nature of the care you would need for those few hours. Again, it’s back to the criticality or the need - needs based as opposed to strictly just time based.

From a time perspective of those cares and supports, I believe it’s on the upper end, somewhere in the 150 hours range. Again, once you start getting into full-time care provisions, you start to look and say, if your needs are that great, is home the best place? Obviously that’s not 150 hours a day, that’s 150 hours a month for care. When you start getting up, then you start to say okay, is there a long-term care setting, perhaps a better setting for the care needs of the individual?

TAMMY MARTIN: Last year when we talked about this during Budget Estimates, the minister clarified that those 150 hours wouldn’t affect any hours that were provided by the VON. Can the minister confirm that the number of hours still doesn’t affect the lack of - in a situation where if somebody was receiving the max 150 hours, Madam Chair, some believed or understood that VON hours would be subtracted from that. I’m just looking for reconfirmation.

RANDY DELOREY: The process or the parameters haven’t changed from last year. I don’t specifically recall the question from last year’s Estimates. It’s amazing, I know, Madam Chair, when I put in about 20 hours of Estimates, I don’t remember every question and response from a year ago, but I do my best.

On this particular one, I don’t remember the specific one coming up, but I can assure the member that we haven’t made any changes. So if that was the information provided at this time last year, that information should be the same. I’ll endeavour to verify that again with staff, that the recollection from last year was correct.

TAMMY MARTIN: I wonder if the minister could tell us how many appointments are cancelled per year. Is the department tracking the reasons why they are cancelled, and are the home care providers still paid, even though their visit has been cancelled?

RANDY DELOREY: I don’t have the specific datapoint. We have some staff looking that up. For the sake of not holding up to get the information, as I’ve done before, we’ll work to come back.

There is a little bit of data that I do have, just so the member knows that I’m not without data here in preparation. Perhaps, Madam Chair, if the member submitted the questions before we came to Estimates, I might have the exact data on hand.

As a point of interest for the member, a home-support hours breakdown in terms of the type of care being provided in our home care: about 42 per cent of the care time being provided is for personal care, 23 per cent around meal preparation, 21 per cent respite, 13 housekeeping, and a smaller remainder in other categories. I thought, given the interest in the nature of home care, the members might be interested in that information.

To the specific question about missed visits, no, I don’t believe home care providers are paid for the missed visits. For the ratio of missed visits, I’m just waiting to get that information. I’ll provide it to the member.

TAMMY MARTIN: Thank you, Madam Chair. So just to be clear then, if I’m working full-time as a home care provider in a unionized environment that guarantees me 40 hours per week, and for some reason John Doe cancels his visit, would I just not be reassigned and paid for the full 40 hours? Or has that standard come to reality where home care workers are being paid by the minute?

RANDY DELOREY: I think, Madam Chair, it gets a bit more complex. For example, if there’s a client cancellation, then through scheduling, there are efforts to fill that missed visit for the care provider to be able to ensure they get their visits in.

Obviously, there are different bargaining units and collective agreements with different home care providers, so the specific nature of how the compensation to the care provider would be addressed may vary. It’s hard to say. When I was referring to the compensations, talking really from the provincial perspective to service providers, I was not interpreting that question as a question of whether or not employees were being paid for the services.

It does get complex, because efforts are made to ensure that a visit is made and care is provided. If there is an inability to build that into the schedule because of the cancellation - and the other side of the equation is sometimes the care provider cancels, if there’s something that came up that prevents the care provider from getting to a client. Cancellations or missed visits can occur on either side of the equation.

I do have the data to the member’s question. I figured if I talked long enough, I could pull it out of my head. I believe it’s about 2 per cent of the visits that are missed or cancelled.

TAMMY MARTIN: Thank you, Madam Chair. I’m wondering if the minister could tell us, of the home care budget, how much is paid to private for-profit providers versus non-profit providers? And are the profit margins of home care operators disclosed?

RANDY DELOREY: Madam Chair, I apologize for the delay. We had some figures here and we just wanted to cross reference and verify that it is correct. I’m going to wear this - someone talked about getting a gold star. I’m going to get a gold star for mental math that I’ve learned in school, because I’m going toe-to-toe with a calculator here. It is about 16 per cent, the contracted home support from the 2018-19 budget that we had established. That’s about $20 million on about $124 million.

Sorry, Madam Chair, just to clarify, when I said $20 million on about $124 million, I want to clarify that it’s about $124 million for non-profit and about $20 million for for-profit, the total amount being $143 million in that case.

For this upcoming budget year, it’s again about $122 million for non-profits and $20 million estimated for the for-profits. That’s what the budget is expected to be for this fiscal.

TAMMY MARTIN: Do we know what the wages are in comparison between profit and non-profit?

RANDY DELOREY: We’re not the employer for the service providers. We contract the services out. So in terms of the budgeting we do and prepare, that’s not information that I would have available.

As was mentioned, even when you delve into the conversation with multiple employers in both the profit and non-profit sectors, these are all service providers outside of the Department of Health and Wellness providing the care, whether they are for-profit or not-for-profit, and there are different bargaining units out there and different contracts in place. So to actually articulate or specify what the rates of pay are, they would vary from service provider to service provider right across the province. That’s not something we have, and it would be more challenging to delve into with the member, I think.

TAMMY MARTIN: I understand that some home care providers are no longer providing travel allowance to their home care workers. Are these companies within their rights to do that? Is there an agreement or something made with the province to protect these workers from not being paid travel?

RANDY DELOREY: As I indicated, there are many different employment agreements in place with the employers who provide the home care service to the province, and they are with different bargaining agents in some cases, as well. But again, each individual employer - there’s a wide range of different contractual agreements in place.

Again, I am not aware of specific examples, and I couldn’t talk about it in generality, again because I’ve not heard of an allegation to that point, and secondly, the specifics as to whether it’s applicable or appropriate or not.

Again, in many instances it really boils down to the collective agreement that’s in place at many of these providers.

[6:00 p.m.]

TAMMY MARTIN: As the minister knows, we’ve discussed the Cobequid Community Health Centre in Question Period before, so I’m wondering if the minister can tell us how many times people have to stay at the Cobequid overnight and what they’re being fed when they’re there?

RANDY DELOREY: I think the last data set I had was from the end of February and I’m doing this by recollection, I don’t have the notes here, so I will put an asterisk beside this comment, it might not be 100 per cent accurate. I believe for the month of February it was somewhere around 18 days that they ran extended hours in the month of February. We just completed March, so that information and work would be collated.

The question of food, again, on any given day what the specific dietary availability would be, I can’t speak to. What I can advise the member is that food services are provided by a central NSHA food program. So, while they don’t have food preparation services on site, food is brought to the facility from the NSHA system. So it would be similar food produced, I forget exactly which location prepares and brings it forward, but it is food that would be produced and would be of the same menu structure that other facilities would have. Again, it is NSHA food preparation and they just transport it and bring it in to the Cobequid Centre.

TAMMY MARTIN: I, like the minister, just received some clarification. So, if I could go back, I’m actually looking for if there is a provincial contract with home care providers that the province details what some of the minimum requirements may be - paid travel, for example.

RANDY DELOREY: As we previously discussed in this space, the nature of the agreement and the work that we’re doing, and the evolution, again I won’t rehash this for the sake of time, Madam Chair, but I believe a previous day when we talked about this, the evolution and the history of home care services and the efforts that are ongoing for us to be respectful of the long-standing nature of many of these organizations, most non-profits in the province, to work with them, to continue to move them forward on a quality delivery of care program.

The nature of our agreements with these home care providers really is at a much higher level about the fact that the expectation of care is being provided, that you know, Madam Chair, if there is an appointment booked that it’s fulfilled, that the care that has been identified for the client, that care plan is being followed and provided and those types of things, it is of that nature, our contracts.

Again, because the employment relationship and what compensation structure that employers have with their employees, again, gets negotiated and worked out by the employer, which is the home care provider, not the province.

TAMMY MARTIN: I’m wondering if the minister could tell us: How many visits does the Cobequid Community Health Centre receive every year?

RANDY DELOREY: The data we have on this particular question around emergency departments broken out is more financial than visits at this point. I think that is data we can reach out and connect with the NSHA, which would be tracking visits. Again, it’s not a level of detail that I have at this point. We’ll make note of that, so Cobequid, number of visits.

I would like perhaps to get a clarification on that, if the member means visits because the Cobequid Centre provides clinic services at the site as well as the emergency department. I’m just curious, when the member raised the question, if it’s the entire site, how many people have clinical appointments at the site, or just emergency department.

TAMMY MARTIN: If the minister was able to provide both emergency and scheduled appointments - we’re trying to understand the volume that goes through that centre.

I understand that the land around the Cobequid Centre is owned by the provincial government. Instead of using that property, $16 million is set for a developer in Bayers Lake. I wonder if the minister could explain if there has been any analysis done why the Cobequid Centre is not being expanded into a full-blown hospital and why it’s not, and why this money is being spent in Bayers Lake rather than expanding the Cobequid Centre.

RANDY DELOREY: As the member would know, in the province, one of the health care initiatives that we recognized and are responding to is some of the infrastructure challenges that we have. In this context, what the nature of this question delves into is the QEII, the Victoria General, and Centennial buildings and the need to replace those aging facilities. We made it very clear that as a government our policy direction on this for the path forward, based upon advice and information that we have received, is that the opportunity to move forward here is not just to say, we had a building that looked like this with this many beds and these services and just rebuild it over here somewhere else.

The advice and feedback said this is an opportunity, because of the size and the scope of this infrastructure project, to really evaluate what the care needs and care delivery models look like not just today but what we anticipate going forward. There’s extensive work done in functional planning and planning delivery. That’s why we have seen projects as far away as Hants that had an operating room refurbished and a second operating room that had been used 30 years ago, basically a brand new one, put back in. We returned an operating room to one of our rural hospitals that had previously been taken out of service.

Dartmouth General we talked a bit about with the member’s colleague because it’s in their riding. A lot of investment is going into Dartmouth General to expand their operating room capacity and some patient services and changing the structure and the flow in parts of the hospital there. Bayers Lake as a clinic to provide care, why that part of the region? Part is the growing nature and the intersection points of travel patterns. This provides an opportunity for some of those services to be provided to Nova Scotians - not just those on the peninsula but those from outside and surrounding areas who would be coming in, so that they don’t have to go all the way downtown necessarily, reducing some of the pressure off the QEII site as it develops, providing care, and again, two important and growing communities in the Bayers Lake area and the Cobequid site.

As far as explicit expansions, again, we had the teams do assessments on the overall and we said what needs to be done, the path forward. They came forward with a plan. A lot of clinicians had the opportunity to provide input and insight and we were very clear, as government, as I think was demonstrated by the work at the Dartmouth General Hospital and at Hants and Bayers Lake that this was not to be restricted to simply the peninsula services, but how can we improve the overall flow and system and these were some of the recommendations.

That is what has been announced to date and the work that is being done there. Certainly, what we’re seeing take place now at the Cobequid raises questions and some people are now having some conversations saying, what does this mean - is this a short-term, temporary? With the QEII redevelopment there are going to be some expanded beds and expanded services, a new building going up - is that sufficient to address what we’re seeing as challenges today? Do we need permanent infrastructure at Cobequid or not?

Again, at this point, from long-term planning, part of the QEII redevelopment wasn’t identified and determined to be part of that. But in terms of the current situation and having the extended hours, again the clinicians, Madam Chair, are making those assessments based upon where the pressure points are on a given day to make sure that the patients are in the best place for them at a given time, to ensure they are getting the care they need.

TAMMY MARTIN: I’m wondering, would the minister say it’s fair then to think that we’re spending $16 million when we already own the land around the Cobequid Centre and now we’re looking at expanding it? Was there a full-blown analysis done as to what it would take or cost to turn the Cobequid Centre into a hospital, or at least take that $16 million and invest it in the Cobequid Centre rather than land and start from scratch?

RANDY DELOREY: Again, as I mentioned, the clinical considerations, it’s a health centre - the reality again is the nature of the care. We’re not building a hospital in Bayers Lake, Mr. Chair, that’s not the development. I think the nature of the inquiry about building hospital infrastructure, adding on to the Cobequid building, why aren’t we doing that when we’re building a centre out in Bayers Lake?

We are not building what the member has just asked. Why aren’t we building this? Because we’re not building that; we’re building hospital infrastructure on the QEII on the peninsula. That’s a clinic space being built out in Bayers Lake, which would be similar to the Cobequid Centre and the services, to bring that capacity, a new capacity.

Again, having two of those types of centres, that’s population density and demand in the area, plus the flow of traffic and the ability because people being referred to clinics, Mr. Chair, that would be provided at sites like this, being able to come right off the highway for those who are coming from a distance to receive that care, that new capacity in the system, it makes it easier for those Nova Scotians, too.

Again, the Province of Nova Scotia owns, I think, about 30 per cent of the land in the province, Mr. Chair. If we only made decisions to put our infrastructure on land we already owned, it wouldn’t necessarily be in the best locations to meet the needs of Nova Scotians.

TAMMY MARTIN: Is the minister at all concerned about the closure of the walk-in clinic in Sackville?

RANDY DELOREY: Indeed, it’s important to recognize that walk-in clinics are services that are provided by physicians predominantly in the health care sector that they establish as independent businesses and providers of health care services they choose, if that’s a model of care that they wish to provide, they do provide an important service to many Nova Scotians.

[6:15 p.m.]

The convenience of operating hours outside of regular business hours makes it – which aren’t necessarily available so not all primary care providers and practices provide an after-hours opportunity to receive care. Walk-in clinics do provide a valuable service.

Any time we see a reduction in primary care services in the province, of course it’s a concern for us but, unfortunately, we have to also respect and recognize the decisions that are being made by an individual or group of individual physicians that they make for the care and how they plan to practise and provide care.

I’d also like to highlight and, I guess, remind my colleagues that we do recognize the importance of primary care and the services being offered; that’s why we’ve been investing heavily in collaborative practice teams.

I know it’s like a broken record - the investments that we are making there, providing opportunities for nurse practitioners and family practice nurses and other health care and, indeed, even social workers to come and join our delivery team in the health care system to ensure we are treating the whole person and making the best use of the skills of our health care providers to ensure we get the best primary care services we can delivered to citizens and, again, certainly it’s concerning any time we have a reduction, whether it’s in a practice or walk-in clinic environment.

TAMMY MARTIN: Mr. Chair, to finish up regarding the Cobequid Centre, I am wondering if the minister can tell us how much of the budget for Cobequid is spent on mental health and how many people use the mental health services there per year?

RANDY DELOREY: I can’t do that. We don’t have the breakdown of the budget. Again, the level of detail that the member is requesting is quite specific.

We work at our investments in mental health with physician costs, pharmaceutical costs, clinical/clinician costs, and community-based - I think we have a few different ways we have it broken down, but not at a specific site level breakdown.

TAMMY MARTIN: I’m going to pass this along to my colleague for the remainder. Thank you.

THE CHAIR: The honourable member for Dartmouth North.

SUSAN LEBLANC: Thank you, Mr. Chair, and thank you, minister, for answering some of my questions. I’m thanking you in advance.

My first question is about collaborative care centres. In the budget there appears to be $10 million of new money for collaborative care centres, and I believe that in your opening comments at the beginning of the Estimates session, you did name some communities where something was happening. You made a list and Dartmouth was in there.

I would like to ask the minister if he could break down the number, that $10 million number, and talk about what the plan is for collaborative care centres for this year - how many centres are scheduled, and in what communities?

RANDY DELOREY: Yes, indeed, we have added another $10 million to continue building and expanding our collaborative care practices.

I believe the member’s interest is specifically in the Dartmouth context, so I’ll mention some of those practices that are already in place and providing care: Albro Lake Medical Clinic; Cole Harbour Family Medicine; Forest Hills; Pleasant Street; Woodlawn; and in North Preston and East Preston, the Community Health and Wellness Centre. Those are six teams in the Dartmouth area providing care to people in that region.

As far as the teams that will be established or expanded in the current fiscal year, we’ll have the budget approved and the NSHA will continue working with the clinicians that have expressed interest. It was in January 2018 when they had a request for expressions of interest by health care providers in collaborative teams. At that time, they had identified over 100 teams, interested potential teams, made up of over 400 physicians if I recall that data correctly, that had an interest in this.

So, this is their ability to tap into it. They have a wait-list of teams that are interested, and health care providers interested, so they’re going to be working their way through that once we get this budget passed so we can move the funds forward and they can get going on their work for this fiscal year, but I don’t have a list of those specific sites for the upcoming fiscal year.

SUSAN LEBLANC: So, I know that there is a group - I know it because I go to the meetings - there is a group in Dartmouth called the Dartmouth North Community Health Centre Planning Team that has been working with the NSHA for over a year. The members of the NSHA staff are at our meetings and in December it was my understanding that there was to be an RFI put out and there was some site selection being looked at and that kind of thing.

It concerns me, your answer to that first question, because this would be a brand new home, there are no clinicians attached to it as far as we know, because this is a community-driven project, but the NSHA has been working with us. So, I’m concerned, because as I said, we don’t have clinicians attached, does that mean this project for Dartmouth North would be going to the bottom of the pile because there are no clinicians attached - how does our project in Dartmouth North fit in with those new centres?

RANDY DELOREY: Part of that work is a combination of ensuring that there are teams that have, or organizations having an interest in building or existing teams that would be looking to expand their services to meet the needs. Obviously there’s an element of, or multiple variables, that need to be considered as they go through that work, things like is there an interest? So, that’s step one. Is there a location or a potential location? Is the potential or the capacity to actually staff and fill it in? Do you have the clinicians? So, it’s sometimes making decisions on matching. Another important variable, Mr. Chair, is the need - what is the need in the communities for expanded care options?

As far as the individual sites that the NSHA is working on, we’re really relying on them and their work in health system planning and focusing on the communities and the needs to make sure they provide the care, so I wouldn’t say I made reference to the RFI, the expression of interest request from 2018, it closed in 2018, Mr. Chair, mostly to assure members that there’s no shortage of interest and opportunity to expand as far as other opportunities, and if representatives from the Health Authority have already been engaged and have been working with a group in a community where we know that there’s demand and need, I would expect that they are doing so in good faith based upon their anticipated capacity to expand and grow.

Again, I don’t have the specific list that they’ve made decisions on any of the sites, but certainly we know that this is a model that we’ve been seeing success with. We know that we support it from a policy perspective and we support it from a financial perspective, but we do rely on the Nova Scotia Health Authority to identify, work with the teams themselves, whether they are starting from the ground up from a community base or from a clinician base to get them implemented, get them staffed, and get that primary care rolled out to those communities. So, again, I note the member’s concern, but I wouldn’t read necessarily too much into it. If the member has been meeting on the specific one, I would fully expect the NSHA to be working in good faith with the meetings that they have. If they’re continuing those meetings, then I would expect that the work that they’re doing is part of their planning work.

Until it’s a done deal, though, and the i’s are dotted, and the t’s are crossed, nothing’s absolutely for certain, but I’m not directing them in one way or the other, other than saying we need to get it in communities that need it with people who are willing to provide the care.

SUSAN LEBLANC: Thanks. I recently attended a focus group that was led by the NSHA around doctor recruitment and at the meeting there was a lot of discussion from the people around the table about their experiences in doctor recruitment. There were a couple of people who worked at clinics, who were in charge of the recruitment for their private clinics.

I have to say that some of the information that I learned at that meeting was concerning around the rules when a doctor comes to visit a clinic, they’re on a tour or whatever, that there’s not a lot of information that’s allowed to be exchanged. For instance, my understanding from this meeting is that a clinic would not be allowed to give their business card to the doctor, the potential physician, to do a follow-up and vice versa. When the clinic received the resumés from the potential physicians, there was really no information except for their qualifications and experience. It had no information about whether they had children or if they like to play soccer or whatever.

That was information I learned. I also know that there is a focus from the NSHA but also clearly from the government because of this $200,000 that’s in the Cultural Innovation Fund, which I think is a great idea, to have community members focusing on doctor recruitment. I’ve had conversations with colleagues and community members and creative ideas have been floating around about what we could do to bring doctors to Dartmouth North, but it seems to me those two ideas are clashing. In order to be creative about attracting doctors, we need to have some information about who they are. For instance, if we know that they love very good restaurants, we could say that Dartmouth is the perfect place because we have these amazing, award-winning chefs who are working downtown.

Can you explain a little bit about how that process is working and how those two things can co-exist? Thanks.

RANDY DELOREY: Mr. Chair, nice plug to the member for their constituency. I know we all like to take the opportunity. Actually, talking about that, I think the member for Guysborough-Eastern Shore-Tracadie highlighted one of the teachers at the school that my kids go to being on MasterChef Canada and doing quite well there. I guess we have some great chefs coming out of Antigonish and Guysborough areas, as well.

Mr. Chair, the concern being raised by the member, it’s not one other than I think a week or so ago it might have come up in Question Period. One of the members from Dartmouth, I believe, raised a question about this notion of information flow. I think it was actually slightly different. The question was when the community group was meeting with the prospective physician, they felt rushed. There wasn’t really an opportunity to delve in and I think it seemed in line, whether it’s the exact same scenario or if the information came from the same community group, I can’t say. I don’t know if the details had been passed along or not.

The benefit of Estimates, more details being provided here. I’m not aware of that circumstance taking place in any part of the province. I’m not aware of it. If it’s from a policy perspective, it’s certainly not one that we’ve engaged in. So, not being familiar with it, I can’t articulate the rationale for it. I’m going to put a big asterisk on this and I probably shouldn’t do it, but the only thought of a rationale that I can think of is the NSHA might be concerned with competing community groups on the recruitment and the notion of trying to recruit from each other. The NSHA wants to get people in and attached to the community and they want to leverage the community groups but they don’t want necessarily - and this was something I heard when I toured the province in 2017 as the new Nova Scotia Health Authority, it was relatively new at that time, trying to establish and get their feet under them for how we are going to recruit provincially.

[6:30 p.m.]

There was a lot of talk and discussion that has continued since then. We continue to evolve and mature our recruitment mechanism. Mr. Chair, the member noted the $200,000 being made available for community groups and efforts to support their ability in communities to put their best foot forward as the Health Authority continues to recruit physicians and support those initiatives and communities.

One of the things I heard when I was going around, again these are from front line, that as we acknowledge nobody can sell their community or present - I shouldn’t say “sell,” perhaps present their community better than those who live in the community. They know where the best chefs are, they know what the recreation opportunities are, where the theatres are, where there are recreation or sports activities and things for children or partners, and job opportunities. It is the local voice, and I heard that. But when it came to the point of provincial recruiting and where the driver should be - in the Health Authority centralized system or should it be in the community and whether that should be the lead point.

Some of the people had stressed one of the challenges in the past, we had communities that were negotiating between communities over the same physician and actually negotiating to the bottom, kind of a race. Everyone was incentivizing, an individual had decided to come to the province and then communities were investing a whole lot more, making it much more expensive in the delivery of that care. I think that might come from some past experiences and that space might be what the Health Authority is trying to avoid.

Again, I’m not specifically familiar, I can’t say with absolute certainty but I did want to provide a scenario on some information that I had received, not from administrators in the Health Authority but rather some people I met with as I went around the province, and a couple of different communities that did reflect on a general consensus of yes, there’s an important role for communities to play in recruiting but a differing of opinion as to whether or not communities should be the starting point or merely a supporting actor in the recruitment process, because of that competing interest and negotiating up, so to that end again I can’t say for sure, in terms of the sharing of the information.

The member is right, though, the role that the communities play, I’m hopeful that the investments we make this year in working with communities, as the member said, what could or should we do to help if you are limited in the information you have, how do we make that work? I think one of the advantages of the investment and the program that we’re investing in the $200,000 is that it allows us to, again, connect with these community groups, hear from them some of their thoughts and then figure out not just the financial but, again, operational way to build the relationships stronger and ensure that all of the players, both the Health Authority and the community representatives of the community groups and of course the prospective physicians, all have the information they need to be as efficient and as effective as we can be at recruiting physicians, but at the same time minimize the internal competition, that we’re not again just moving physicians around the province.

We want to focus on the physicians we’re bringing to the province because we know there are needs in all of our communities and we want to fill all those needs, Mr. Chair.

SUSAN LEBLANC: I’m going to change directions for a minute in a way, not staying with Dartmouth North. Despite the emphasis we place on health care in Canada and Nova Scotia, across the country we know it’s the top concern of most people in the country. Health care actually isn’t the biggest factor in determining health itself. The social determinants of health - income, education, social supports, housing, nutrition, environment, and more are what make the greatest difference when it comes to health outcomes, as I’m sure you know.

In Dartmouth North which is a community half of which has a great need, there are numerous examples of the social determinants of health negatively affecting the health outcomes of the population. There’s a lot of poverty, there’s a huge housing crisis, and lack of services. I could go on and on. I could tell you lots of heart-breaking stories.

I am wondering if you consider the social determinants of health a priority for your department, and what leadership are you providing to the rest of the government on this issue?

RANDY DELOREY: Just if I can, a little bit of an aside - I believe the member for Cape Breton Centre had asked about Cobequid ED visits for fiscal 2017-18. It was about 45,000 visits and for the first three-quarters of 2018-19. We only just finished the fourth quarter, so we don’t have that date included - it was 35,000 visits to that site.

Sorry, Mr. Chair, for answering an earlier question.

In terms of the social determinants of health, this is a growing area of recognition in our health care system. It aligns with the principle of the health care system that I think has been long recognized as the role of taking preventive action. Following that principle, you delve into and say, so what are those root causes that lead to better or worse health outcomes. As the member noted, things like income, housing security, food security/nutritional aspects do contribute, obviously, to one’s health.

As a government, I’ll talk first a little bit in the department. One of the things when we talk about our collaborative teams that we’ve put in place, in some of these teams we are establishing social workers as part of that team, I think a very clear indication to Nova Scotians that we do clearly recognize the fact that not all health care needs are treatable root causes by traditional health symptoms.

To illustrate that point, one of the physicians in Cape Breton who was working on a collaborative team passed along the story that they had added a social worker to their team. First time they admitted that they didn’t really understand how or why they would use it, but then they passed on a story where they had a patient who had a recurring respiratory illness. They come in, they get treated, cleared up, and three, six, however much time they’d be back in with the same sort of respiratory illness and that had been ongoing for a bit.

With the social worker, the social worker was able to meet and connect and learn a little bit more about this individual and found out that they actually had some housing challenges – some leaks and moisture in their home. The root cause of the respiratory symptoms was actually moisture and mould in the home.

The social worker who has that training and the time in their collaborative practice was able to work with and connect that patient with the housing supports through DCS and Housing Nova Scotia to get some programs and support them to put some renovations and improvements in their home. That’s just an example of how directly it is integrating with programs and services we already have in place through Community Services and Housing and other organizations.

Other examples, you know, our collaboration with schools, particularly when we are looking at youth and how we ensure that our youth get the best start. Our four-year-old program recognizes that education is one of those variables that has a lasting impact through the life of an individual. Getting the best start and equalizing the educational playing field, so to speak, by getting that four-year-old program in place and rolled out across the province is an example of our commitment socially to seeing these things.

Food programs, rolling the breakfast program out to all schools in the province is another example.

THE CHAIR: The time for the NDP caucus has expired.

For the Progressive Conservative caucus, the honourable member for Dartmouth East.

TIM HALMAN: Thank you, Mr. Chair. Minister, do you need a break?

You’re good? That’s wonderful.

Just a few questions from my community of Dartmouth East. These questions will encompass the topics of mental health, home care, the working conditions of our front-line physicians, and some of the things I’m hearing about our paramedics.

I’d like to start of with mental health, Mr. Chair, to the minister. I certainly know that it’s something that you are very passionate about. I know that, and I want to thank you for the work you are doing. Certainly, as a former teacher, some of the things I witnessed as a public school teacher are quite alarming as to the wait times that exist for Nova Scotians.

So, my question is this: I’m curious as to whether or not there are plans for a new provincial suicide prevention strategy in order to keep people safe until they can take care of themselves - could the minister elaborate on that?

RANDY DELOREY: Mr. Chair, again, I won’t belabour the point but as each member raises questions, as I’ve said before, I do appreciate it. It gives us an opportunity and I hope showing that, regardless of political affiliation, our concern and interest in moving the benchmark and the needle, so to speak, in mental health services in the province is a non-partisan issue and it’s a concern we all share and a desire for us all to proceed on.

To the member’s specific question, in fact we did receive a recommendation from Dr., now Senator, Stan Kutcher pretty much right away actually, I think, literally the first action that I took when I was appointed in June of 2017 there was a situation unfolding in part of our province where there were multiple suicides in a short period of time and that was very concerning to me especially as a new Minister of Health and Wellness, and Dr. Kutcher agreed to go down and do an assessment and provide some recommendations back. Again, as a brand-new Health and Wellness Minister, I really didn’t know where to turn, but I knew Dr. Kutcher has a very strong reputation particularly for youth and adolescent mental health. He came back with a number of recommendations.

One of those recommendations, to the member’s question, was to review and update - and really I think, in discussion with him, create a new suicide-prevention framework for the province to set the stage for the work that needed to be done and, again, specifically I believe the criteria around that in the recommendation was to be very much evidence-based, and clinically led to drive the structure being built, and that work is well under way in the department along with others.

Our starting point was to do some jurisdictional review to help build the parameters by which we would approach the question of how to best pursue a suicide-prevention framework. That included jurisdictional and some literature reviews, but also some information. We realized that the World Health Organization has a model that can be reviewed. We looked at our own data in the province and then, once we kind of identified the skeleton of the approach we wanted to take what we thought would lead to a positive, we then reached out.

I wrote letters to a number of experts that staff, and some clinicians, had identified, and Dr. Kutcher provided some recommended clinicians and experts in the area of suicide prevention and mental health. It’s important for us to look both at adult and adolescent or youth because the parameters and the responses might be different, and we invited a number of experts to see if they would be willing to work on an advisory committee.

So, staff are continuing to work with them. They’ve made a lot of progress and I think we’re nearing the point where we’ll have kind of the structure of the framework and, then, moving from there based upon them, is taking us to the actions then that will stem out of that framework. So, we’re nearing the completion of the structure of the framework and then looking at what that means in terms of the actions to actually help reduce both suicide attempts and, of course, obviously, to save lives in this province.

TIM HALMAN: Mr. Chairman, I’d like to thank the minister for his remarks. I’m curious as to whether or not the department has attached timelines to a new provincial suicide prevention strategy in terms of when the residents of Nova Scotia can expect this to be unveiled, and I’m curious also as to what jurisdictions has the department examined as best practices - what have they looked at as sort of a template as this might be a good model for us to adopt here in Nova Scotia?

[6:45 p.m.]

RANDY DELOREY: Mr. Chair, the process of the work that they looked at in some jurisdictions and then through the engagement with the expert staff in the department have certainly policy lens and experience there. They would look to see what jurisdictions have something and how recent those plans are that jurisdictions across the country might have. Again, the World Health Organization (WHO) has a bit of an approach and a framework that they’ve identified. So, we use that as an informing piece of work.

That was kind of the starting point, and then engaging with those experts that responded to the invitation to help provide some guidance, Mr. Chair, some guidance and feedback as experts in the field, to make sure that as we assess we did want to ensure that we have a Nova Scotia solution, but one that’s informed by evidence.

As far as the timeline question, like I said, I say nearing completion. I think the last update I had, the goal was to have the broad focus of the framework done at the end of fiscal, so Friday. I’ve been busy in Estimates here to get the exact update, but when I say near completion, it is very, very near. So, then that framework approach structure will guide and provide guiding principles for us as a framework, for where and how we approach our investments and work being done around suicide prevention within our health system.

TIM HALMAN: Minister, as you are aware, for the residents of Dartmouth if they are experiencing a mental health crisis, they have to go to Halifax. Certainly while Dartmouth is very much excited about the renovations, there’s no doubt about that, you know I have to be completely up front. I mean, there is certainly the concern that there won’t be sort of front-line psychiatric care at the Dartmouth General.

That being said, Mr. Chair, the minister knows the concerns of that; I’ve expressed that to the minister. So, because often the ER at the Dartmouth General is confronted with patients that are experiencing a mental health crisis, I’m curious as to what assessment tools are used in the ERs to assess risk in our mental health patients. Could the minister walk me through sort of, what are those assessment tools, what are the steps that are taken?

RANDY DELOREY: I guess, at the front end, the more acute upper end of mental health psychiatry services that are being offered in Halifax on the peninsula at the VG and QEII sites are continuing and that’s where the core has traditionally been and continues to exist and that is in play.

I want to assure the member, Mr. Chair, that we do recognize, and efforts are under way to recruit a nurse with mental health expertise to join the team at Dartmouth General. I believe the position has been posted. We expect it to be in place within the next couple of months once that recruitment process is completed. So, we do recognize that there’s opportunity and the Nova Scotia Health Authority recognized the opportunity to enhance and strengthen, particularly at the emergency department when people are presenting through the assessments. One of the approaches and actions that’s already under way is the recruitment of their mental health nurse liaisons, so they have some additional training and expertise to support and be there in the emergency department. So, that is investment being made directly to the Dartmouth community.

The other thing is, again, there are community-based supports as well. I believe some of the funding supports that we have include an additional support with the IWK and some supports that they provide in Dartmouth. So, that’s one of five clinical positions that were added in 2018-19, was at the IWK; Halifax and Sackville have some additional supports as well, and then the Health Authority had additional supports added in Truro and industrial Cape Breton, but I know the member’s questions were specific to Dartmouth, so community-based IWK one last fiscal.

We do recognize, we are investing, we’re adding resources across the province, including in Dartmouth. As far as the clinical tool for mental health risk assessments, I don’t have the very specific clinical details. That’s work that I do leave to the clinical teams that do the work. That’s not my area of expertise as to the specific, but I do assure the member the question of how mental health patients are triaged and move through our health system - I had a very extensive conversation with a whole host of representatives from our Health Authorities as well as the Department of Health and Wellness to better understand that flow.

Again, while I’m not intimately familiar with this specific, that risk of profile assessment as I’ve been advised is clinically driven, best practice type of tool and training and supports for that throughout our emergency departments to help improve our response to people when they do show up at an emergency departments needing mental health supports.

TIM HALMAN: The next question is related to our mental health services. I’d heard over the years when I was a teacher and now as an MLA those who are experiencing a mental health crisis, when they present themselves at an ER, oftentimes they have a peer support person with them. I’ve heard some stories where that person who is in a mental health crisis and had that peer support person with them, they were not permitted to join them in the assessment. If you could clarify, what is the Health Authority’s policy on a peer support person? Are they permitted to be a part of that process or are there circumstances that’s written out in policy where it says that person is denied access to the patient?

RANDY DELOREY: Madam Chair, I’m not aware of a specific policy in that regard. I think part of if the individuals are receiving any health care service whether or not the physicians would have a third party in there other than a parent or a guardian with a minor, I don’t know that they usually have a third party in for any of the clinical piece. I don’t know the policy specifically in that regard, but often people do show up at emergency departments for non-mental health types of conditions, physical health conditions and I will check on that policy.

I think I understand where the member is going with that. If someone feels the need for the support and I think it would be a balancing act between the individual’s privacy option - you know, really the question of the patient – do they want the support person to be present? What I don’t know is if there’s a clinical driver that would say having a third party there may influence or impact the assessment that’s being conducted, so there may be a clinical driver as to why, for a mental health assessment, they would want to have that one- on-one with the clinician and the patient.

Again, I’m not sure on the policy but I can envision some clinical rationales or logic that might be driving that type of scenario, but I don’t recall it ever being brought to my attention before.

TIM HALMAN: Thank you, minister. I’d like to talk a little bit about the wait times within our mental health system. I’m curious as to whether or not we have clear wait time standards when it comes to our mental health system and is there an action plan to improve the wait times which often - I know when I was a high school teacher a young person would be in a state of crisis and required assistance and sometimes you would discover that they couldn’t get the assistance for up to three months - is there a wait time standard and is there an action plan to improve those wait times?

RANDY DELOREY: In fact, work being done for wait times on mental health is active within the Health Authorities, both the IWK and the Nova Scotia Health Authority. One of the things to note is that we are the only provincial jurisdiction that publicly posts our mental health wait times, that we did go through a process to review and update the data because historically they had been reporting a little bit differently across different regions of the province, and in the Fall we announced and rolled out the updated wait times for mental health systems, so it is standardized as being collected and is more comparable. The details are available for the general public on our wait times website. You can drill down by zones and possibly even facilities.

On the site it does make reference to some of those parameters that they are being measured against, or what would be the kind of target parameters for each of the different assessments. I believe there are two or three acuity levels that are considered - I believe emergency, urgent, and other kind of care. Just on the acuity level, there are a couple of different categories that the wait times are broken out to - it shows how in each situation the response time is being achieved or the work that is left to be done.

Have they identified some standards or targets? Yes. Are we publicly reporting that, so people have an understanding and appreciation? Yes. Is it publicly available? Yes. Are they working? Of course, that’s why we’re making the investments we’re making throughout our mental health systems; we want to make improvements.

Some earlier questions from the member - actually two members. I think Cumberland North actually brought it up, about some of the vacancies for our acute care psychiatry services earlier this evening. We have vacancies in each of our zones for psychiatrists. Unless the member wants, I won’t delve into the details again for the sake of time, but we know there’s recruitment, we’re making investments, additional residency seats in the specialty space, and working to try to enhance the availability of those acute clinicians to meet the needs of all Nova Scotians, on top of the community-based investments we’ve been making, particularly targeted at our youth.

TIM HALMAN: With respect to the $11.7 million that is being invested in health care, I’m curious as to what systems of accountability will be built into these new investments to ensure, by way of example, minister, that wait times are reduced. I’m curious as to the extent to which that money will be invested to see a reduction in the wait times for Nova Scotians to access our mental health services.

RANDY DELOREY: Madam Chair, a number of steps are being taken as we make the investments - in some cases, it’s a matter for new programs and services. The department holds the funding until they get rolled out. We don’t want to just pass the money over and say okay, let’s see at the end of the year how you’ve done. We’ll hold the money until the program gets rolled out and then we’ll release the funds to meet the program that they’ve developed. That’s an example for new types of program investments.

In some cases, the investments relate to utilization and support. Again, we’ve made investments that aren’t necessarily directly to the Nova Scotia Health Authority to help with this, like the residency program, the 15 specialty residents. The 15 specialty resident seats, Madam Chair, at least three of them are for psychiatry positions. This is off the top of my head, so I will verify if I’m incorrect. I believe one is for a youth/adolescent, one is for adult, and one is geriatric, and there may be two in one of those categories.

[7:00 p.m.]

We’re ensuring that there are going to be more psychiatrists in a residency program in Nova Scotia, because we recognize the need to have more trained - not just in Nova Scotia, but across the country. We also know that where physicians complete their residency training, there’s a higher probability of them staying to work there.

We’re showing our interest and our commitment to physicians by expanding, and I think that’s a positive sign. We have listened and worked and established new programs to support our existing psychiatrists in some of our more acute demand areas like Cape Breton and established a clinical assistant program to support the psychiatrists up there, while we continue to recruit and fill the vacancies that have materialized over many years. I believe there are an additional two clinical assistants established in the psychiatry space for the Northern Zone as well, which is another more critical-need area within the province. These are where some of these investments are being made. Again, as you add those people, we should see the care improve.

Much of the dollar amount in investments, though, is targeted in particular at youth services and programs in partnership with other organizations like our school system - the SchoolsPlus expansion, the work on youth mental health centres, the expansion of the adolescent outreach model for mental health care, which we rolled out in the province.

The CaperBase model in Cape Breton is in adolescent. It’s taking that CaperBase model - obviously “CaperBase” as a label or name doesn’t quite apply in the other parts of the province; the technical descriptor would be “adolescent outreach model” - and then each of the zones are working to label it for their own community base. That has expanded services and availability of supports in 41 or 42 additional schools across the province.

There’s a lot of work going on, the investments being made - I’ll run through some if the member wants to know exactly. It’s things like Kids Help Phone, an expansion in our investment for 2019-20 of about $300,000; the youth health centres in schools, about $1 million. That, again, is building out of some mental health recommendations that we had. The adolescent outreach model, the CaperBase expansion, is about $1.25 million. There are some programs supporting new clinicians in First Nations communities. That’s just about $1 million, recognizing the disproportionate need in some of our First Nations communities for many health services, but in particular mental health. There’s almost $1 million being spent there.

Capacity building around e-technology solutions is about $1.5 million, leveraging technology to provide support and to help connect clinicians who may exist in Halifax in the Central Zone without necessarily having to travel - they can leverage technology to provide support - and then other support providers.

I mentioned the Kids Help Phone, the online chat services. When I met with the Kids Help Phone, they had indicated to me last year that I think out of all jurisdictions on a per capita basis, Nova Scotia is an outlier in how much volume we have through the chat service, disproportionately relative to the traditional telephone base. Digitally is the way that Nova Scotia youth seem to be predominantly interacting with their services. For that reason, we do believe that in Nova Scotia in particular, the opportunity for some technology-based interventions and supports is important both at the clinician level and in that public space for initial points of contact.

Mental health crisis expansion is a little over $1.5 million. There’s about $6 million being invested in SchoolsPlus mental health clinicians through that program. This is just some of the areas that we’re investing in. I think all of these often have programs or supports that are recognized and have a positive track record.

Then as far as accountability, I have regular engagement with the Chair. When we think we’re slipping on something, we make sure we let him know that we need to definitely get going. Of course, at the staff level, there are those conversations on an ongoing basis, not just on mental health but other parts of our health care system as well.

TIM HALMAN: Thank you, Madam Chair. I appreciate the response from the minister. That was, in point of fact, my follow-up question in terms of how Nova Scotians find out when and where they can find response services.

Switching gears, I’d like to take a moment to chat home care for a few minutes, and then I’ll hand it over to my colleague from Par-en-Bas, for Argyle-Barrington.

When it comes to home care, I’m certainly hearing stories of a shortage of staff, struggling to meet the mandate sometimes. I’m curious as to what measures have been implemented to get more resources for home care.

RANDY DELOREY: Madam Chair, I thank the member for the question and the interest in our home care services. To tie our continuing care space in broadly, the member would know about the expert panel review.

Much of the role and the work that is provided to our aging population through home care services and in our long-term care facilities, much of that care - personal care in particular, as opposed to other medical care - is provided by CCAs, or continuing care assistants, in both our residential long-term care facilities and in home care.

In the expert panel, they did highlight the need for some initiatives to improve both the training and recruitment and retention of continuing care assistants in our long-term care facilities. Those efforts will help support in the home care side as well. We’re looking at workforce planning of CCAs, and although the recommendation came specifically out of a long-term care panel review, the reality is that we recognize that it supports the overarching continuing care system for both home and long-term care.

Some of the things that are under way are re-establishing a bursary to provide supports. That was one of the recommendations that was made, but to target towards areas of higher need, and hard to fill, historically - similar to some of the programs we have in other parts of our health care system to provide support for return of service agreement.

We’re working with Immigration. They had very successful programs launched in physician recruitment, through our immigration partnership. Through the Department of Education and Early Childhood Development for early childhood educators, immigration has played a role. We see opportunity in working with the department to come up and see if we can develop a program that helps there, as an interim. We’re working with the Department of Labour and Advanced Education to establish where there would be program requirement changes, if appropriate, in the training programs provided in our community college and how to best ensure and let people know about the opportunities.

It is a very rewarding career to provide care for some of our aging population. These are the people whose shoulders we all stand on because they have lived here and really created the province that we inherited. It is a very rewarding experience for CCAs to have the opportunity to work closely and build relationships with their clients. So those are just a couple of examples of things we’re going to be doing to improve the recruitment and retention of CCAs in our continuing care system.

TIM HALMAN: Thank you, minister, for that response. My colleague has allowed me to ask one more question - a very local constituent question that came to me the other day. One of my constituents, her child was in the IWK, and I guess there’s a cost for walking casts. I’m curious as to why that is not covered for children at the IWK. Has there ever been funding proposed to cover those types of things under MSI?

RANDY DELOREY: First time that question has come up - it’s not one I’ve ever seen as an MLA or as Minister of Health and Wellness. I think certainly there are sometimes various types of equipment options, or the walking cast versus a traditional cast - options for implementation and a formulary is established what’s available on it. I’ll take the member at his constituent’s experience, but it’s not one I’ve seen. That specific item hasn’t come up before. It’s not one I’ve looked at.

TIM HALMAN: Maybe it’s something we could both look into together and find out what the situation is.

I want to thank the minister for his time, and I pass this over to the member for Argyle-Barrington.

THE CHAIR: The honourable member for Argyle-Barrington.

HON. CHRISTOPHER D’ENTREMONT: Mr. Minister, staff, a pleasure to see you. This is the latest I have ever asked questions of the Minister of Health and Wellness in my whole career.

I want to start in a little bit over the next half hour or so - a little less than a half hour - when it revolves around the Health Authority’s spending. I’m looking at Page 13.12 of the budget documents, the Estimates and Supplementary Detail. I just want you to dig out a little bit where the provincial dialysis program and maybe the Yarmouth cancer therapy - cancer therapy for the province - where does that fit within that matrix that I see has about $100 million more in there? There’s an expenditure of $1.9 billion for our Health Authority.

RANDY DELOREY: I’ll start with the dialysis piece, where from a capital perspective, the capital expansion work, that would be on Page 13.14, the Programs and Services, the Capital Envelopes investment. That really covers all of the capital, so it’s not broken out specifically at dialysis. It’s a capital grant to cover the cost of the capital work being done.

In terms of cancer care services, I don’t know if this is broken out explicitly in our budget document piece, but it would show up under Ambulatory Care on Page 13.12. When you look at Programs and Services, Ambulatory Care would be where oncology cancer services would be one of those areas in the ambulatory space.

CHRISTOPHER D’ENTREMONT: We’ll go down the dialysis road first. The minister knows why I’m asking that question when it revolves around the expansion in the province. I’ve been a proponent for the expansion of at least a satellite in the Barrington Passage area, but I know there are other projects ongoing. One of them, of course, the Lunenburg-Bridgewater - and there’s sort of that discussion around that, and of course the Digby and the Kentville hospitals.

[7:15 p.m.]

Maybe you can give a quick rundown of how those construction projects are going, how that expansion is going, and when I might be able to go back and ask you about the Barrington Passage project again, once those are complete?

RANDY DELOREY: I’m interpreting the interest of the questions that the member had, I believe, were predominantly for those in the same zone area. I’ll answer with those, and if he wants more, I will let him know.

Kentville dialysis, their construction is well under way, and we expect that to be finished this year, in 2019. The dialysis at Digby, work is under way. We still expect construction to make progress this fiscal year, though, and if all things go as we hope, we would hope to see it completed this year as well. Glace Bay, we recently announced that this work was moving to complete the design and nearing completion, and then the funding for construction as well. Those are the ones in that area, I believe - the main ones, the Kentville dialysis.

We’ll take a little pause and dig in on some of the other information on the sheet. Let me just take another look at some of these items. Just give me one second, Madam Chair.

The work being done as well, I think - Bridgewater, South Shore Regional, is part of a broader project, so I didn’t see it jumping out there. Then others would be working through and I think at various stages of design. These are items that I flagged there, I think, from a construction perspective and the work going on there.

CHRISTOPHER D’ENTREMONT: You know, as we continue to talk about the availability of it, making sure that we have the right number of beds, Yarmouth at this point is almost fully subscribed. It is running, I believe, two shifts at this point. Of course, we want to maintain and make sure that that service is as strong as it is, but the community that I represent is sort of saying, well, if you’re going to start adding seats to Yarmouth, maybe there is a consideration for a satellite unit somewhere else.

Has this been a discussion with the provincial dialysis program, to try to get these units closer to people so they don’t have to travel as far? The challenge that my constituents have had over the last number of years is driving an hour in one direction, driving back another hour, and that’s only when the weather is good. So of course when the weather is bad, it makes it that much more dangerous for those patients.

RANDY DELOREY: Again, I thank the member for his continued advocacy on behalf of his constituents for the service. In fact, as we do the assessments, the notion of travel time is an important variable that is considered. That’s why there was that broad expansion and the work, the capital projects that are now under way to get additional seats throughout the province.

We haven’t delved far enough into discussions that we’d be at the point that the member has asked about - whether there’s looking at expansion in Yarmouth or would other sites be open to consideration. But what we do in addition to these initiatives - again, not that it lines up for everyone, but the value proposition, the value for those Nova Scotians for whom home dialysis can work, we are working to try to encourage and work with the Health Authority and the clinicians who would be required to support home dialysis to expand that. In that situation, I think, we really eliminate the travel requirements for the dialysis, and in many cases, that home dialysis is actually able to be run overnight while people are sleeping.

So not only are we getting into addressing the travel time, but actually the treatment time, what this does, and the time that it frees up for patients on dialysis. Amazing opportunity, and we really want to try and encourage and provide and find those opportunities where we can expand the home dialysis. Then that’s not necessarily always tied to a specific community, but rather available to Nova Scotians throughout the province, and again, hopefully reduce those travel times and increase quality of life dramatically, because they get three or four hours a day of their treatments back. That’s multiple days during a week, so you’re potentially getting dozens of hours back per week. I see home dialysis as being a very important part of our solution and path forward.

CHRISTOPHER D’ENTREMONT: I thank the minister for that answer, even though home dialysis is not for everyone, because of the complexity of it and the health care considerations. If it’s home dialysis versus peritoneal dialysis, the location of the ports - there are a whole bunch of issues that people are concerned about.

We talk about home dialysis, and I was just wondering what the uptake of home dialysis is - maybe in its two basic forms of home dialysis, regular versus peritoneal. I know there’s a bit of a difference in those two.

RANDY DELOREY: Thank you, Madam Chairman. I don’t have the breakdown percentages, but the data I do have, and why I feel somewhat confident that there is more opportunity for our province - what I have been advised is that as a per-capita basis, we are the lowest uptake of home dialysis in the country. I would expect that if other jurisdictions have patients who meet the needs, then we should have some opportunity to expand and successfully provide this improved service to patients in Nova Scotia as well.

I do think there is upside opportunity. I don’t have it fully quantified. But again, if we’re at the bottom of the pack in the country, so to speak, there is room for improvement. I thank the member for giving me the opportunity to re-inform members of the Legislature of that option.

CHRISTOPHER D’ENTREMONT: Well, Madam Chairman, hopefully the minister might be able to provide us with some information later on, as it comes, and maybe not only what the uptake is but what the distribution of it is around the province. Is it more people in urban Halifax, maybe since they’re closer to the hospital system versus someone in a rural area who might be a lot further away, and having to depend on the possibility of an ambulance? There are a couple considerations there, so if the minister could provide us with that.

I’ll move on to cancer care in the province and I’m going to bet it shows up a little bit in the IWK as well. We’re talking $280 million there for ambulatory. I’m just wondering what the cut is on cancer services in Nova Scotia right now?

RANDY DELOREY: Again, this is just the way that certain costs get broken down and broken out. For example, drugs show up in our pharmaceutical. What we log as Nova Scotia Health Authority Oncology and Cancer Care, it is for fiscal year 2019-20, we’ve budgeted just under $84 million, I think that’s $83.8 million budgeted in this fiscal year. That’s up from about $78 million last fiscal year.

CHRISTOPHER D’ENTREMONT: I’m going to guess that in that $84 million we’re going to start talking about the enhancements for Yarmouth. The services Dr. Bethune has underlined, or the committee has underlined, for, well, instead of having radiation oncology in Yarmouth. Again, I’m frustrated on one side because I believe that we had a great case for that but, of course, we didn’t.

In the meantime, we have to come up with some solutions for transportation and accommodations because that’s the one I hear of the most and appreciation for coordination of appointments so, having to come back and forth on a number of different occasions for maybe minor appointments. They may not seem like minor appointments as they’re for cancer services and cancer treatment, but when you’re coming up for an MRI or you’re coming up for a CT, it does add up to lots of travel for the patient.

I’m just wondering, I asked you a question about this the other day, but maybe it will give you a little bit more time to answer: How are these things going to be put in place and what kind of timeline are we to expect to see them in place and serving the patients from Yarmouth?

RANDY DELOREY: Madam Chair, I thank the member again for the question. Off the top, not just the member for Argyle-Barrington, indeed, I want to thank the member for Yarmouth, I want to thank really all the community members, Derek Lesser, Sandy Dennis, who unfortunately passed away, who participated first in encouraging government to take another look at the request and to respond appropriately. Of course, Dr. Bethune and the entire cancer care team that took place and engaged and worked here.

Honestly, Madam Chair, although Dr. Bethune was given the opportunity to take the lead and run this review, and he structured it and did all the work, and then came back and provided a report and recommendations, I had the privilege, it truly was a distinct privilege, to go and make the report. I apologize, I am using the member’s time here, but I just want to let the member know this truly was one of those experiences, this review, in particular being in Yarmouth to present the report to the various stakeholders, clinicians, the municipal representatives, and community representatives. Again, one of the most powerful moments was when I had the opportunity to meet with Sandy in her home. What a privilege to hear from her about her pride in having had the opportunity to be - in her words - a small part, and in my words, a large part - from Dr. Bethune. All those people who were part of that review and the decision and the recommendations made, I thank them for that.

[7:30 p.m.]

As far as the request and the rolling out, in fact, some of the work has been under way even when it was rolled out, because some of the work is work being done out of Halifax, things like the improvements around scheduling. Although the impetus to review and say, hey, is there a better way, the people of Yarmouth should take pride, because they triggered it. I hope they are okay with the fact that some of those improvements that come out of this system will be benefiting many Nova Scotians and not just those in Yarmouth.

Again, I think that is one of the things that made this review such an experience. They were so gracious in their recommendations that they knew, this doesn’t just help us, it does help others, and that’s why we think this model is better.

Some of those works around scheduling are already under way. The committee is in place. Dr. Bethune is taking the full lead. I’ve been pretty hands-off, actually, to be perfectly honest. Dr. Bethune and his team did such a great job with the actual review. I trust the work they are doing there. When they come through with their final decisions, much of it is operational and can be done within the Nova Scotia Health Authority without necessarily coming back. Then the work that we’re doing around the travel accommodations within the department, again, the committee is being struck and meetings are taking place to build the framework.

Work is under way, and I assure the member, Madam Chair, and all members here, that I want to get it done as soon as we can to get these changes rolled out. The community has been very patient, very accommodating, and very engaged on this file.

CHRISTOPHER D’ENTREMONT: I know the minister understands this, and I know Dr. Bethune understands it as well. Urgency is important here. Urgency is of the utmost, because cancer waits for no one. While we continue to talk about it, more people are being diagnosed with cancer. They are having to face the issue of coming here for service and looking at it with - I don’t know how they look at it. It’s such a big, daunting issue. You not only have this terrible diagnosis but you now have to figure out, “Okay, I’ve got to get to the city, I’ve got to see my oncologist.” It’s just a lot for people, which is why I like the idea of the psychological support for patients, because it’s a lot for them to take in.

As well, I want to thank Derek Lesser for his work and his working hard putting that together and being part of the decision-making process. My heart goes out to Sandy’s husband, Ken, and of course their family. Sandy was most definitely a driving force in this issue. Sometimes experience - she lived it, and she fought it right to the end. If we can do anything to put aside some disagreements that we have in this House and just say we’re going to do it for Sandy, I think it puts all this into perspective.

Thanks to the minister for the hard work. By the way, the next time he comes down for an announcement like that, a call to the local MLA next door wouldn’t be too bad. I would have loved to have been with you during that presentation. I didn’t get a call. I just want to say that.

Let’s switch quickly, because I have only a few more minutes. I’ve got about five minutes to go. I do want to go to Page 13.8 when it talks about Programs and Services for Physician Services. I don’t know if this question was already asked, and I am sure it was. When it comes to Fee for Service, we see a short or a loss here of about $30 million.

How many services are we not doing? Or is this a direct issue of not enough physicians in the province providing primary service? Why such a large drop in Fee for Service when it comes to Physician Services?

RANDY DELOREY: I apologize. It sounds like not the member for Argyle-Barrington, but rather my colleague the member for Preston-Dartmouth, about my sometimes focus on the task at hand and not always colleagues that are in the vicinity of where I go to have the communications and engagements. That’s not a partisan shot there because my own colleagues remind me of that point from time to time as well.

I want to remind people, too, the role Yarmouth plays not just in this review, but the Take-Home Cancer Drug Fund that we launched the other year, Derek Lesser from Yarmouth was very much an instrumental part in drawing the awareness of my predecessor, the current Minister of Communities, Culture and Heritage, myself when I was Minister of Finance and Treasury Board, and so it was a real pleasure and I’m proud to move that advocacy forward.

To the member’s specific question, what he’s asking is on Page 13.8, there’s a reduction of about $30 million in Fee for Service. But you do see an increase in Alternative Payment Plans, which I’ve talked about before. The fourth item down in that same category increased to $78 million. This is about the change in how the physicians coming into the system are choosing to pursue their compensation model for how they work. We’re generally seeing a shift from our experienced physicians who are traditionally on fee-for-service programs and to younger, newer physicians pursuing alternative payment plans, the APPs, which is more of a traditional salary-based question. I will let the member go forward with another question.

CHRISTOPHER D’ENTREMONT: We get to flip to something else quickly on the next page, 13.9. Not necessarily anything that’s on there but maybe it should be or maybe it shouldn’t. We’ve been talking a lot about a National Pharmacare program again. I remember talking about it years ago when I was minister and we had a program all designed and ready to go and Ontario dropped out and the federal government didn’t want to do it anyway. That’s a whole other issue. I’m wondering if a National Pharmacare program does fit in, how would you be able to adjust your pharmaceutical services extended benefits?

RANDY DELOREY: A timely question. The federal government’s budget just came down recently. As the members would know the federal government did conduct a review. In fact, one of our former colleagues here, the Honourable Diana Whalen - nice to be able to use her name and get it in Hansard - was actually one of the three panelists the federal government tapped to work with Dr. Eric Hoskins in the review. Their budget made some commitments to work at a national stage. I look forward to when I next connect. We have our next meeting with our federal, provincial, and territorial counterparts so we can delve in to further discuss the federal plans.

There’s not enough kind of meat in terms of what the provincial role and expectations here would be for that, so it’s not something we’re able to budget at this point in time. The recommendations the federal government made, and their budget, were really about them establishing some starting points and work on their end I think to help work with provincial and territorial jurisdictions to pursue that objective.

THE CHAIR: Order. Time has elapsed, and we will turn it over to the NDP.

The honourable member for Dartmouth North.

SUSAN LEBLANC: I’m going to continue with some questions about the social determinants of health.

When we last spoke, you were saying that you understand the importance of the social determinants of health. As I’m sure you know, I am particularly concerned by the shockingly low income assistance rates we have in Nova Scotia. I’ve already mentioned many times before that in Dartmouth North we have many people who are living under the poverty line. I believe the most people living on income assistance in the province live in Dartmouth North. I am struck by the impacts these rates have on the health of my constituents.

I’d like to ask the minister if, in his view, the social assistance rates set by the Department of Community Services are supporting the health of Nova Scotians.

RANDY DELOREY: The Department of Community Services, over the last number of years, has embarked upon a fairly extensive review. It’s not necessarily incumbent on me to delve into a lot of detail of the review and the work that they’ve done to transform - I believe they talked about it in that terminology of transformation - within the Department of Community Services and the rollout.

I know how extensive the consultation and engagement were. I say that because as MLA, I know that there were staff from the department who were in Antigonish in my constituency to meet with both front-line staff and clients. They had meetings with clients who are making use of the programs like ESIA, hearing directly from the front line about what types of changes would be appropriate and felt to have the best impact on them. Extensive work was done over a period of time.

What we’re seeing now, more recently, is starting to implement those changes. I know it took a fairly extensive amount of time in the Department of Community Services, but I want to acknowledge the work of both the current Minister of Community Services and her predecessor to do this work. We’re now starting to see those changes implemented. We’re starting to see expansion in the amount of earned money that can be retained by members on income assistance programs. The amount when they start work - it may only be part-time work or casual work, they may still require income assistance, but the amount of earned money that they’re able to keep, they made that change to increase that.

My colleague the Minister of Community Services already announced the plans to establish and move forward with the new income household rate program to improve the program and also put more money back into pockets to support those people in need of this program. It’s not just through our income assistance program but through other programs and supports that the Department of Community Services provides.

I’ll speak from an experience in my own community. A little more than two years ago, a community group, the Antigonish Affordable Housing Society, came to my office as a constituent group expressing the work that they had been working on for about 25 years, I believe, to establish some affordable housing units in Antigonish. The last time there was something in the space of affordable housing would have been through the co-op units that would have been built in certain parts of the community.

This affordable housing group really reached out, and like any other MLA, you get them in touch with Housing Nova Scotia and the programs. Through that work, after 25 years, they managed to work out and establish a program - with existing programs, with Housing Nova Scotia - and they built a four-unit complex. Two are barrier free, and two traditional units in one complex.

At the time of that announcement, they then announced, you know what? We managed to get four, so let’s shoot for another 10. I anticipated that we might see this in maybe five or 10 years, but 18 months later I was at the opening of a 10-unit affordable housing unit based upon Housing Nova Scotia programs and the work of this group. They didn’t even come back to my office as MLA to engage in this. These are just the nature of the programs and supports that are available to these organizations. Again, they had been working for 20 to 25 years to establish this. They knew the need. They had the drive and the desire. They have spoken about how the programs and the changes that we have made have been able to support them, including the fact the investment expanded between their four-unit complex and their 10-unit complex. The program actually provides even more money now based upon some of those additional investments.

[7:45 p.m.]

On top of that, there are rent supplements that are available. Like many of us in this Legislature, we do support some of our most vulnerable, and housing is one of those areas. Sometimes it is that rent supplement that actually allows us to connect the constituent in an insecure housing situation to housing. Antigonish is a university town. The affordability of housing is skewed when you think of it as a rural area, but because of the university demand of students in the population, the cost otherwise is disproportionately high because of those additional demands in the community for a community of this size. Those rent supplements are sometimes the difference between finding an affordable location and being able to cover the cost. A lot of work has been done to expand the accessibility of those programs so that we can use existing stock that’s already in our community. There are a number of things here both around income and the housing side of things.

I’m speaking quite extensively about investments from a colleague’s department. But the questions are tying on social determinants, and I believe, Madam Chair, the question was around whether I think the government and our department are doing enough.

I think we’re doing a lot of great things here, even back to when I was Finance and Treasury Board Minister and had the opportunity to work and stabilize our investments, Madam Chair, and our fiscal foundation, so that as a government we could introduce a tax cut that was targeted. Normally tax cuts, when they get put in our income tax system, apply across the board. As our tax system is progressive, a tax cut traditionally would also be progressive but in reverse. We took effort, because we wanted to target the lower-income population of the province when we had the opportunity to make that tax cut, and that’s exactly what we did. We ensured that, in fact, it didn’t make a reverse progressive tax cut but a targeted tax cut through the enhancement of the basic-personal exemption. We put parameters on that that limited access to people, and then we progressively rolled it off as income went up. We made sure that the most value was targeted to those who needed it the most.

SUSAN LEBLANC: I appreciate all those answers. I really do recognize the housing programs in Antigonish, in particular, are working very well. I recognize that the standard household rate that’s going to come in will make things easier for people. But the bottom line is, it’s not enough money.

I just bought groceries today. I used to pride myself on not spending much money on groceries, even though I bought mostly healthy food. I was shocked the other day when I went out, and I bought groceries for the week for my family of four. It was $176, and the only unhealthy thing in that cart was two bags of chips for $3. They were two for $3, so I got two. (Interruption) Barbecue and regular, thank you very much. My point is this: I try to eat as healthy as possible, and I try to feed my family as healthy as possible, but the fact is that it’s super expensive. The other part of this is that I got home after spending that money, and I was like, we don’t have this, this, this, and this, and I went out and spent another $100 the next day.

The amount people have to live on is not enough money to buy healthy food. That’s the bottom line for people with the lowest incomes in the province. We can argue about this forever.

I’m going to change tack a little bit. Yesterday, I heard some very disturbing information about people who are in remand at Burnside jail. There is a revolving door issue with many people on remand. This is what I heard. There are many women, in particular, who go to jail for a variety of reasons, mostly related to poverty - shoplifting and drug addiction. Those are the two big ones, actually. When they get to jail, their income assistance is cut off, boom, off, not put on pause but cut off. Then, their prescriptions are taken away from them. They are given some medications in jail, but their Pharmacare gets cut off because they’re off income assistance. Also, their housing, if they can’t pay their rent then, if they’re in for more than a month or two, very often they lose their housing, which is in very short supply in Dartmouth North. So, they’re on remand. They have not been convicted of a crime. They lose their Pharmacare, they lose their income assistance, and they lose their housing. They’re in jail, they get tried, whatever, they come out three or four months later, they’re given a bus ticket, and they are told, you know, have a nice life. They don’t get their income assistance back for several weeks. Sometimes, if they change locations, they have to start their files over again.

We then have these people who, had they been able to keep their income assistance, or at very least had that been just paused, acknowledging that they’re getting their food and their bed in the jail, so they “don’t need that money”. Had their Pharmacare been continuous then they would be much healthier when they leave the jail or they would be at their regular standard of health and not have their health, including most mental health care, go out the window with their lack of prescriptions or, in some cases getting different medications and in often cases when they get out of jail having no medication for months until everything can get back and the system working.

I feel like this is an obvious place where simple policy changes could make significant changes in people’s lives. My question is to you, minister: Would you commit to showing leadership with your colleagues from the Department of Justice and your colleagues from the Department of Community Services to work together, the three ministers and the deputy ministers, to address these situations, so people who get out of jail, reminding the House that they haven’t even been convicted of a crime in many cases, but they get out of remand and they can continue with their lives without this massive disruption, which throws people into mental health tailspins and other kinds of health care tailspins?

RANDY DELOREY: Thank you, Madam Chairman, and the member highlights just that exact point on the integration and how department interactions overlap. Certainly, the specific circumstances I was able to talk a bit about Community Services there because of the work and certainly the advocacy and the work of the Minister of Community Services in that regard and hearing a lot about it.

I will admit I’m perhaps less familiar about the judicial system and process and some of those decisions and the history and the context for why those parts of the system are established the way they are. For example, the remand process and so on is not something I’m as intimately familiar with, so it’s difficult for me to articulate in a health context what and if the process, as it relates there, is appropriate or not.

One of the things that just for contextual purposes is important to know is that, again, health services aren’t cut off. The Nova Scotia Health Authority is responsible for providing health care in our correctional institutions that they do provide as part of those services, which includes providing the drug coverage that they have on their formulary in those institutions for people. Again, the health system that has been established recognizes that even when in a correctional institution, correctional facility, Nova Scotians still require health care services. Those services are provided by the Nova Scotia Health Authority, including the drug coverage that they provide.

I believe the Heath Authority is looking and has been looking at what their health services in the correctional institutions entail. I think they’ve heard from a number of people. I don’t have the full details of what that work is but certainly there’s consideration as to a number of programs people have been advocating on looking towards, opportunity to enhance health services in correctional institutions. It’s my understanding that the Health Authority has been taking that under advisement and looking to make some improvements.

To the specific question the member left off with, would I connect with my colleagues in the Department of Justice and Department of Community Services. In fact, we do connect on a fairly regular basis and to further look at the question that has been raised, as part of our overall continued work to bring down silos and find ways we can provide the supports we have, recognizing we have a lot of competing priorities and interests. A limited budget, as we know, we do have a fixed budget amount as a government to invest in. Every year when we go through the budgeting process there’s no shortage of important areas to invest in. We do target areas, as my first response highlighted, a lot of those areas are targeted towards the social side of the equation, although we don’t necessarily always hear about them, we don’t always talk or focus on them on this side because we’re so focused on that next area.

I can certainly advise the member, I’ve heard her concern. It’s the first time I’ve heard that, that I recall hearing that particular circumstance or scenario being raised. As we always do, we’ll work with our colleagues to try to understand where and when opportunities align to make improvements within our systems rather than just, for example, specifically the health care system.

SUSAN LEBLANC: Thank you for that answer. I appreciate there are budget concerns and there are many demands on the budget and the expenditures for the province. I think we’ll probably never agree on the fact that this government prefers to post balanced budgets than to invest in some serious social programs and other programs we need currently. The fact is that - I don’t want to go into all the financial part of it, but my point is it’s a choice to balance a budget and it’s a choice to not invest in certain programs.

I also think if the government is concerned with balancing budgets and finding efficiencies that the social determinants of health are one of the best places to go to find those efficiencies. The amount of money it costs to jail somebody and put somebody in remand because their Pharmacare got cut off and they couldn’t get access to their mental health medications must be extraordinary. I don’t have the numbers obviously in front of me, but I would love to look into those numbers. Maybe one day I’ll bring them to you minister.

In a similar vein, I want to ask another question. Last week we saw the Wortley report on the hugely disproportionate use of street checks by Halifax Regional Police and the RCMP on Black citizens. This is a huge cause for alarm when it comes to the social determinants to health and protective factors against mental illness, especially in our Black population. I wonder if the minister can tell me in his view if the position taken by the Minister of Justice to not impose an immediate moratorium on the use of street checks is a good decision for our population health in our Black communities?

RANDY DELOREY: To the first front end of the member’s remarks, I guess the assertion as to a point where - as the member for Cape Breton Centre refers to it - agreeing to disagree, in terms of certain points of either fact or, I think in this case, policy. With respect, I do take a little bit of an exception though both as a former Minister of Finance and Treasury Board and still a member of government on this side of the Legislature with kind of the tone or approach in terms of the assertion that our priority is somehow misguided where we do have a commitment to fiscal management and ensuring that we have financial sustainability as part of our guiding principles here.

[8:00 p.m.]

The member talks about the need to invest in social programs and services to meet the needs of our population. Here it is in health, but obviously it’s broadening out through the angle or the lens of social determinants of health. Let me just explain through this thread that the member raised about balanced budgets and how and what kind of impact - if governments that came before us had such a commitment to the population, what kind of impact and effect we can have today because of the decisions that were made by those who came before us that tie our hands.

The fact of the matter is that we have debt-servicing costs in the range of $850 million per year. Those debt-servicing costs come off the top of our budget. Those debt-servicing costs are from two different sources of debt.

One is from capital investments that are made into infrastructure that provide value to the citizens over time, so the payment - both the capital and the cost of borrowing - is aligned with the timing of the utilization of those assets like roads and hospitals and things that we are continuing to invest in and borrow money to meet those needs.

But 65 per cent of our debt comes from deficit financing. That means 65 per cent of those debt-servicing costs. Of the $850 million, that’s $550 million that we would not be paying out of our budget each and every year off the top. Imagine what kind of social programs and services we could provide to the people of Nova Scotia if we had another $550 million to invest, but no. The policy and fiscal decisions of past governments, of those who came before us, have tied our hands to the tune of $550 million each and every year.

So yes, I do take a bit of exception and concern to have our government’s commitment to fiscal sustainability on behalf of this province - because as a former Minister of Finance and Treasury Board and a proud member of this government, I will not tie the hands of my children and the next generation by burdening them with extended deficit financing to consume programs and services today.

We do have a difference of opinion, and we likely will not come to a consensus on that, but for every time the member stands up and criticizes us for not having enough money to invest in a good program or service or idea that is out there, let me remind her of the $550 million that those who came before us have spent that we cannot spend today because of those decisions.

I don’t have the choice. I don’t have the flexibility. But boy, can I assure the member - and I think under the leadership of our Premier, the commitment to invest in social programs like the largest tax cut that we’ve had. Can the member remember the last time a government made a significant income tax cut in this province? Not only that, but that tax cut was targeted to those at the low end of our income system.

It was a creative solution to come in with a tax cut. I was at the Department of Finance and Treasury Board when we were doing that. We did a lot of work. We challenged the staff who didn’t think it was possible to structure a tax reduction that could be targeted the way we did. We were adamant that we could not afford to give that tax cut to the richest Nova Scotians. Under the leadership of the Premier, we wanted to make sure that it was the lowest-income Nova Scotians who got the benefit.

We want to provide a social investment to education through our four-year-old program to balance the playing field. That is an investment under the leadership of the Premier. I remember at our first AGM, after being elected in 2013, the Premier stood up amongst Liberals at that table to say that he wanted to get back to balance so he could invest in a program like that. I’m so proud to be a member of his government that made that happen because of our fiscal restraint.

THE CHAIR: Order, time has elapsed. Order. Order. Order. Time allotted for the consideration of Supply today has elapsed.

The honourable Government House Leader.

HON. GEOFF MACLELLAN: Thank you, Madam Chair. I had no idea we had Red Bull in the kitchen back there.

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 8:05 p.m.]