HALIFAX, WEDNESDAY, FEBRUARY 26, 2020
COMMITTEE OF THE WHOLE ON SUPPLY
THE CHAIR: Order please. The Committee of the Whole on Supply will come to order.
The honourable Government House Leader.
HON. GEOFF MACLELLAN: Would you please the Estimates of the Department of Health and Wellness.
Resolution E11 - Resolved, that a sum not exceeding $4,822,637,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.
THE CHAIR: I will now invite the Minister of Health and Wellness to make opening comments if he so wishes and introduce his lovely staff to the members of the committee.
The honourable Minister of Health and Wellness.
HON. RANDY DELOREY: I’m certainly pleased to introduce the Estimates for the Department of Health and Wellness for the 2020-21 fiscal year. I really appreciate the opportunity that the Estimates Debate provides to speak about the important work that’s being done by the department and indeed our partners in the health authorities.
With me this evening, and I believe for the next number of days, are two officials from the Department of Health and Wellness who’ll help us in examining and taking a closer look at the specifics of this year’s Department of Health and Wellness budget. To my right is Jeannine Lagasse, the Acting Deputy Minister of Health and Wellness. To my left is Shelley Bonang, the Chief Financial Officer for the department.
Mr. Chair, we have heard loud and clear. The message is not one limited to our tenure in office, indeed, I believe for many years, the importance and priority of health care services for Nova Scotians consistently through all governments is well recognized. That’s why it’s no surprise that the allocated budget for health services and investments expenditure within the province is the single largest, by a significant margin. That is consistent across all jurisdictions in Canada, based on the importance that citizens and thus their governments place on investing and providing the health care services needed by the population.
We certainly recognize that. We know that for my mandate letter since coming in in 2017, it has been very clear where I need to focus the efforts of the department and our partners, in those areas of primary care, mental health and addictions, continuing care, and of course, infrastructure renewal.
Those investments that we’re making are investments. The motion to come into Supply made reference to future generations. These investments that we are making, particularly those around the infrastructure, are investments in the next generation.
Although significant dollar values associated with them, over $2 billion for the anticipated costs for the QEII and Cape Breton redevelopments - that is not an investment that is for a given fiscal year, but an investment that we recognize is to modernize the facilities for the delivery of health care services for the next generation.
We’re focused, as I said, on a number of areas within the primary care space: attaching patients to primary care services; one of the evolutions that we’ve been focused on has been the expansion of collaborative primary care services, responding to those recommendations and interests of health care providers and the desire to work in such environments; focus on improvements around mental health and addiction services; reducing wait times throughout the health care system; and, again, modernizing our health system, our investments and supports around home care and long-term care facilities, Mr. Chair, as well as technology projects that are under way to support the modernization of the technology that supports the work of our front-line health care providers. Those technology initiatives will also support us in ensuring that we have the most accurate and complete data to help inform future decisions and policy investments to be made within the health care system.
We’ve made progress in these areas, Mr. Chair, since coming to form government. We know that we’ve had significant improvements in the wait-list for long-term care placements. We’ve talked about both in the past on the floor of the Chamber, that both the number of people waiting for placement in long-term care and how long they are waiting on the list have decreased between 30 and 50 per cent since we formed government.
As I’ve previously mentioned, the budget for health care is the single largest. It’s over 40 per cent of the provincial expenditures budgeted in this fiscal year. This year we’re increasing the budget for health care services by about just under $185 million. That brings the total expenditure to about $4.8 billion in this budget to meet the health care needs of Nova Scotians. That equates, for those who don’t enjoy math, to approximately a 4 per cent increase in the budget year over year.
The Nova Scotia Health Authority and the IWK, who really are the organizations tasked with the lion’s share of operational delivery of health care service throughout the province - have received more funding as well. They’ve received an increase of I believe about $86.1 million, which means that their combined budgets are over $2 billion to support those front-line health care needs.
When you look at the total $4.8 billion that comes to the Department of Health and Wellness, 44 per cent I believe of that budget - almost 45 per cent of that budget actually gets transferred into our Health Authorities that deliver the front-line operational care - that’s over $2 billion going to our Health Authorities for health care delivery.
I’ve already mentioned the investments in infrastructure. We’ve talked about that a lot. I’m sure that members will likely have questions relating to them. Again, just for a reminder - the QEII Redevelopment Project here in Halifax to replace the aging and challenged infrastructure at the Victoria General, as well as the revitalizing of health care infrastructure in the Cape Breton Regional Municipality. Those facilities, as well as many others, really fell into a state of disrepair over a failure to keep the infrastructure up to date.
With those changes we engage with health care providers to understand what a modern configuration of infrastructure should look like, particularly in those two regions. That’s what has guided the designs, the work, and these projects to date to again look to the future, not to the past, for the infrastructure being delivered in the province.
Again, there’s additional work, but health care is a very large and integrated system in part due to the complexities of those interrelations, Mr. Chair. That is, the organizations, the many different conditions, areas of the health care system, the health care providers, the many different interested parties, all contribute to the complexities and challenges of implementing change and modernization. So, to do so does take time, but the fact is, in order to effect that change, we do have to take action. That’s what we have been doing over our tenure in government.
We know that Nova Scotians expect us to work thoughtfully and in coordination with our partners so that we can ensure that we do make the right changes when they need to be made, but also that we make those changes that will meet their needs as citizens of the province. Those needs can only be met as we meet the needs of those front-line health care providers, as well.
As we continue to focus on a more coordinated and evidence-based health care system, that means we have to take very deliberate and coordinated action. That’s how we’ve been managing the work and the decisions that we’ve been making. Sometimes those decisions have been difficult. We recognize that they have raised concerns by some and those concerns over time, as we’re able to continue to provide additional information, I believe we are able to demonstrate to those affected, again, whether they’re citizens, patients, or health care providers, that, in fact, the plans that we have in place are really guided by clinical advice and recommendations.
Unfortunately, we do not always have a unanimous consensus on those paths. There will always be opportunity to find individuals who are not completely supportive of each individual decision and direction that we take, but I assure you, Mr. Chair, and members of the Legislature, that when we make our decisions, we have done so based upon the guidance and advice and recommendations that have come to our table and with an eye toward those recommendations and advice that we believe are in the best interest of the people of Nova Scotia - meeting their expectations, which, again, fundamentally goes back to ensuring that they get the health care services that they need.
Some of those initiatives that we have been focused on over the last number of years, and which we will be continuing to work on, and what the outcomes of some of those initiatives have resulted in. We know that about 138,000 Nova Scotians have been attached to a primary care provider since November 2016, when the Need a Family Practice Registry was first launched by the Nova Scotia Health Authority. We know from Statistics Canada that Nova Scotia is recognized as being fourth in jurisdictions for attaching and connecting patients with primary care providers.
Based upon the Need a Family Practice Registry, we know about 95 per cent of Nova Scotians have been attached to a primary care provider, and we know that about 20 per cent fewer Nova Scotians are registered on that Need a Family Practice Registry than last year. We know that our partners, the Nova Scotia Health Authority, have also been working in communities to create special clinics for unattached patients to help support them while they are waiting to be attached to a primary care provider.
We’ve also taken steps to recognize that providing the care that Nova Scotians need means that we need to take advantage of the skilled health care providers in the province, and that means providing opportunity for those health care providers to work to their full scope of practice. We’ve seen initiatives that we’ve undertaken as a government - including the modernization of the nurses’ regulatory college and the legislation governing them last year, as well as the more recent agreement with pharmacists, which provides them the opportunity to work to the full scope providing more opportunities for Nova Scotians to receive some basic primary care services, including increased access to prescription refills from their community pharmacists. This work is a very positive step forward to ensuring access to health care services for Nova Scotians. We also know that no health care system is complete without access to physicians. Physicians are
We also know that no health care system is complete without access to physicians. Physicians are an essential and critical part of the delivery of both primary and specialty health care services. We know that these challenges that we have been discussing on the floor of this Legislature for the past number of years, particularly as it relates to doctor recruitment, are ones that are faced by all jurisdictions across the country, indeed, in most of the western world that has a similar health care system design. That means that fundamentally when you pull back the layers, one of the challenges that we face is one of supply and demand.
The supply of physicians is outstripping the demand throughout multiple jurisdictions. That’s why we recognize that one of the only ways to address the fundamental challenges, both for the medium and long term, is to invest in additional training opportunities. I believe we remain the only jurisdiction that has expanded both medical seats and residency training opportunities for physicians in the province.
We believe, and the data shows, that these investments are going to serve the population of Nova Scotia very well for two reasons. It increases the supply of physicians, both family practice physicians as well as specialists, through the medical seats. Sixteen new seats in total will have been added to Dalhousie Medical School and 25 total residency seats - 10 family physician and 15 specialty seats - have been added to the residency training. We know this will be good because we’re adding to the supply, and we know that data shows that about 80 per cent of physician residents stay in the province where they have been trained. When you increase the number of residency seats, you increase the number of physicians who stay and set up practice in the province. These are good investments that will serve the people of Nova Scotia. This expansion, which has been long called for by the medical field, does paint Nova Scotia in a very positive light in terms of our recognition and our listening to front-line health care workers, health care providers, physicians, and residents as to the importance of training.
We have a number of other things, including changes to the clerkship program and the expansion that was launched last year in Cape Breton. It’s expanding into the South Shore region now.
Again, I anticipate we will be speaking quite extensively about access to physicians in the coming days as we debate the Estimates. I want to put on the record up front that there is no single solution to ensuring that we address the need for family physicians. That’s why we take multiple initiatives and make multiple investments and different strategies to help ensure we maximize the opportunities to both attract and retain physicians in the province.
I have already talked extensively about the training and investments that we have been making. We have also been investing in international recruitment initiatives.
We have worked with Doctors Nova Scotia to implement a new contract, the Master Agreement, which governs compensation for physicians in the province. We have listened to physicians. Over 90 per cent of those physicians voted in favour of this agreement. That certainly sends a very strong signal about the negotiations and the increased compensation that will see many of the highest-demand physicians - including family physicians, emergency doctors, psychiatrists and others - actually become the highest-paid in Atlantic Canada, bringing them into a very competitive compensation framework with counterparts in other jurisdictions.
We achieved that negotiated contract by listening to physicians and their bargaining agent, Doctors Nova Scotia. We see that, based upon their input, as being a very significant step forward in both the recruitment and retention of physicians in the province.
We also know the importance of community in the recruitment process. Physicians, like other employees or workers, as individuals they can’t last in a community if they don’t establish roots.
One of the challenges in any field that relies on professionals who are in high demand and fairly mobile, is attachment to community. We recognize that attachment to community, establishment of roots really supports, in particular, the retention of health care providers. That’s why we have been investing with our partners in communities, to support them in their efforts to participate and really exemplify and highlight the characteristics of their communities that they believe are most relevant to supporting both the recruitment and retention of health care providers to their communities and their regions.
There are many other initiatives. I’ve mentioned the immigration stream - first in the country to establish a dedicated immigration stream for physicians. I’ve had over 50 physicians come through that stream already. I’ve talked about the increase in compensation for physicians, through the Master Agreement, but we also increased incentive compensation as well, the incentives for starting up practices. We’ve increased funding for locum programs, which are designed to fill short-term vacancies in hard-to-recruit areas.
We continue to invest in collaborative care teams. Again, that’s a model of practice that is a fairly significant shift from the model that was really longstanding since the dawn of Medicare services. Having multi-faceted teams of health care providers coming together to serve the patients of the clinic. That has been an area we hear from health care providers - physicians, nurses and others - that is how they’ve been trained, in many cases, and they believe it is the future of health care delivery, so we’ve been investing to expand. I believe we’re currently strengthening and expanding about 85 teams now within the province and we’re really trying to focus further expansions that may be made to communities in areas that are in greatest need.
Modernization of our health care delivery includes the infrastructure investments, but also we’re making investments in dialysis seats. We’ll see those dialysis renovations and expansions come onstream, many of them this year while others will continue. We look forward to increasing the access to dialysis for those patients. As I’ve said previously, once we get these additional dialysis chairs online we’ll be in a position to begin re-evaluating the distribution of dialysis patients throughout the province, and the needs to help inform any future decisions about any future expansions from those that are currently under way.
Continuing care has been a priority. We continue now to invest in the Nova Scotians who require these care services to the tune of about $900 million. We continue to invest, as has been our priority since forming government back in 2013, to listen to those Nova Scotians who indicate that they want to stay in their homes and in the communities as long as possible. That’s why we’ve invested so heavily in the home care services but also expanded the Caregiver Benefit that really benefits people who take care of loved ones and provide supports in their homes.
Long-term care, we’ve again continued the work that we started last year, based upon recommendations from the expert panel in long-term care. The real focus there is on improving the quality of services in the long-term care. We continue to invest this year. We know that the strategies and these investments do work. We’ve seen positive improvements in wound care, based upon those investments in training, equipment and standardized processes being brought onstream.
We recognize the staffing challenges, as was highlighted, particularly for continuing care assistants. That’s why we’ve established campaigns to promote CCAs. It’s a very positive and important career opportunity for Nova Scotians. We supported a bursary program for CCAs, which would cover their tuition costs, but also brought in a new immigration stream. I’ve heard from long-term care facilities that recognize the value of having new, qualified individuals coming forward and entering the continuing care space to deliver care. We made some governance and regulatory changes that streamlined the process for retired nurses to be able to leverage their nursing training and be recognized as qualified to provide the continuing care services, as well.
With respect to long-term care beds, we’ve already announced, I believe, over 160 new beds in areas including, as a part of the Cape Breton redevelopment project, the investment in Meteghan, as well as 30 beds in long-term care being converted from residential care facilities in the Halifax area. We’re focusing on areas with the highest demand, while at the same time looking to support our long-term care facilities with their renovation and maintenance needs.
We have over $315 million being invested throughout government towards mental health and addictions. This is in the range of about a 7 per cent increase in the investments towards mental health and addictions. We’re seeing positive results being reported from both the Nova Scotia Health Authority and the IWK, as it relates to the wait-lists for access to their mental health care services. The efforts they’ve been making within their facilities have been focused first on mental health, like physical health, being triaged. They focused on emergency care where people need immediate access to care. They follow that by urgent care, and they have a clinical timeline to be seen, I believe. In the Nova Scotia Health Authority we’ve seen an improvement of 98 per cent of adults being seen within that clinical target in 2019. That’s an improvement from only 85 per cent the year before.
So we’re not all the way there, I’ve never said that. In fact, as I started my remarks with highlighting the importance of health care to all Nova Scotians, it is also a continuously moving target, one that will always be focused on continuous improvement; one where the members of the Opposition, regardless of their political stripes, will always have the opportunity to say, you could do more. That is always going to be the case, that citizens will be looking for more. We’ve been investing. We’ve been doing more. We’ve been seeing positive outcomes, but we also recognize that there is still more to be done and we will continue our efforts to invest both financially and operationally to improve our health services to Nova Scotians for both physical and mental health.
Finally, in the addictions side of mental health and addictions, we have earlier this year moved forward. We announced in December a ban on flavoured vaping juices, which will be in effect on April 1st, the first in Canada. We’ve also committed to bringing forward additional legislative changes to restrict access to vaping products. That legislation we can expect to see on the Order Paper within this sitting and I look forward to bringing that to the attention of Nova Scotians, the members here, to discuss on the floor of the Legislature. I look forward to everybody’s support in advancing that particular piece of legislation.
I have confidence that the steps that we will be taking will have positive impacts. Why, Mr. Chair? Because many of the steps that we are taking are being informed by staff and others, just like our opioid framework, one of the first initiatives that I had the privilege to publicly announce in my role as Minister of Health and Wellness back in 2017. We’ve seen the tremendous positive effect that that framework has had in Nova Scotia, saving lives. We’ve seen a reduction by over 90 per cent on the wait-list for opioid treatment since 2017 when we launched that framework. We’ve seen more than 12,000 naloxone kits that have been distributed across the province through our partners in pharmacies across the province. So, again, we entered into a new agreement.
I talked earlier about the opportunities the pharmacists can provide in helping support physicians and other health care providers in providing care to Nova Scotians because ultimately that is what everybody who participates in the health care system in Nova Scotia ultimately is striving to do. That is to ensure that their patients, our citizens, our brothers, our sisters, our parents, our children, our neighbours all receive the health care services that they need. It will take everybody in the health care system working together to ensure that we do provide the best possible care to all our citizens in the province.
With that, I recognize that it is the responsibility of the department to ensure that we spend the taxpayer monies that we are investing in health care wisely, in ways to improve the health care system that Nova Scotians rely on each and every day, and we are focused on our results. As I’ve briefly outlined here, we are seeing a positive result, so there is much to be optimistic about. Members opposite, in the response to the budget, I think that was a term that was used about optimism. This we do share, I believe, because Nova Scotians share optimism about the future of this province and I believe that optimism extends to the future and the progress being made in our health care system.
Before I conclude my opening remarks, I just want to take a moment to recognize and thank the many dedicated health care providers who are providing care and services in communities across the province, those providing care in our hospitals, whether they are here in the city, in our acute care facilities, in our regional or community hospitals, out on the front lines in community settings, or their own offices. Whether they are physicians, nurses, social workers, psychologists, psychiatrists, pharmacists, or any other allied health professionals, again, all of us working together is how we will provide the best possible health care to the people of Nova Scotia. So, again, I want to thank them with all sincerity for the work that they do each and every day in delivering that care, but also for those who have stepped up to provide advice and recommendations to us as we continue to plan and execute the modernization of our health care services in the province.
Supporting those front-line health care workers and those of us in government, I want to also recognize the many volunteers, whether they are with auxiliaries or foundations, supporting our hospitals throughout the province, or volunteers with non-governmental or non-profit organizations providing much valued support services and services that meet the needs of their community members. Again, they too are an integral and critical part of the delivery of health care services in the province. So I want to make sure that they are recognized, as well, as we have our discussions around health care investments continue over, I believe, the next several hours, indeed, perhaps the next several days.
With that, Mr. Chair, I believe I’ll conclude my remarks and I look forward to responding to the questions of the Opposition as we proceed with Eestimates for the Department of Health and Wellness.
THE CHAIR: Before we jump into it, I just want to remind everyone that the Rules of the House apply during this. The Speaker had addressed earlier in the session that we’re going to keep it cordial and respectful. This isn’t a three-strike-out rule, it’s a one-and-done, so no heckling. Let’s be respectful to each other and let’s get some good questions and answers. So, who’s up first?
The honourable member for Pictou West.
KARLA MACFARLANE: Thank you very much, Mr. Chair. I want to thank the minister and his department. It’s always a great opportunity in Estimates to thank all allied health care professionals working in Nova Scotia, right from Yarmouth to Cape North, for all the work that they do. We know that there are challenges right now in health care.
I think though, when we are faced with any emergency or going to the hospital, the care is great. So, it definitely is an opportunity to thank them, and of course all the volunteers that work on all the different foundations with these hospitals in our province. There’s a lot of time and effort that goes into fundraising and drawing the community together, so I want to thank them as well.
Moving right to the budget, looking here we see that the overall investment in the health care sector has grown to $4.8 billion. What I’d like to ask the minister is this includes $86.1 million in response to increased demands for services but it’s not outlined exactly what those services are, so I’m hoping that the minister can give us a more detailed answer of what those services are that make up the $86.1 million.
RANDY DELOREY: It varies throughout. So specifically, just for clarity, that amount that is being referred to, I believe she’s referring to the amount of increase to the Nova Scotia Health Authorities? I believe just over $70 million to the Nova Scotia Health Authority and just about almost $8.5 million to the IWK.
Those increased services are increased patient volumes. In some cases, increased acuity of those patients in some areas. In addition, particularly for the Nova Scotia Health Authority, our increased operational costs for the new dialysis seats that will be coming online in Glace Bay, Digby, Kentville, as well as the new chemotherapy prep lab that was being set up here in Halifax, with some of the infrastructure investments, come new operational costs as well. So again, there will be increased dialysis being provided in those communities as those investments in expanded capacity come online this year.
KARLA MACFARLANE: I thank the minister for this answer. So, in the speech it indicated that work continues to recruit doctors and that we are seeing success by supporting community groups with their recruitment. We are encouraged that Statistics Canada shows that Nova Scotia ranks fourth nationally for patient attachment to a primary health care provider. So, my question is, and I spoke of it just an hour ago or so when I stood in my place. I’m wondering if the minister can explain what is happening? Because I indicated that a month ago, I received a call asking, have you received a doctor yet for you and your children? If not, we’re calling to inquire. Then I receive that you have a nurse practitioner; then I get this email this week asking, do you have a doctor or nurse practitioner. So, it used to be all about signing up for a doctor but now we’ve included nurse practitioners.
I’m wondering when that shift took place because it doesn’t align well and make sense with the fact that we had the registry call me a month ago and said that I could still stay on, even though I had a nurse practitioner. The voice on the other end of the phone indicated that I could stay on because I was still to be getting a doctor.
I am using myself as an example because I could table the document for proof. I am sure it is happening to so many others and we’re hearing it. We need some clarification here. If you are on the registry and you get a nurse practitioner, that is now in place of getting a doctor. We need to confirm that with Nova Scotians. It is best that we have clarity on that, so if the minister could answer, please.
RANDY DELOREY: I think, Mr. Chair, when we evaluate the work of the Nova Scotia Health Authority’s Need a Family Practice Registry, that’s what it is recognizing - Nova Scotians who need access to primary care services for the delivery of health care. That includes the focus and priority of attaching Nova Scotians who have no care, so that is where the efforts are primarily targeted. When there are people taking names off the registry I guess the question is, when someone is being provided with primary care access, as nurse practitioners are able to provide, really a wide range of those primary care services, or you have a citizen who has no access to any primary care services, that really the work on the registry is trying to prioritize getting Nova Scotians access to the primary care they need.
They are working with a variety of health care providers, including physicians and other health care providers in collaborative practices, where I believe there’s over about 85 now operating in the province. In addition, Mr. Chair, recognizing that we still have, in some parts of the province, more challenges in making a positive dent in the number of people who are registered. In those communities the Health Authority also established some clinics which are really reserved for people who are on the wait-list, so that they have access to I guess kind of a clinic access without being attached. So those clinics are being reserved for the delivery of primary care services to those still waiting to be attached to an independent or separate primary care provider facility.
Again, specific to the question around getting attached to physicians, every effort is still being made to attach Nova Scotians to physicians but, again, recognizing that in some instances nurse practitioners are available in communities and they are being attached to nurse practitioners, and the priority of the people who are on the list again remains to provide them with primary care access through either a physician or a nurse practitioner. I believe efforts will continue to recruit the physicians to meet the needs of all Nova Scotians throughout the province.
But again, as I said earlier in my remarks, there is a supply challenge. We’re investing heavily to address that. We’re expanding the training opportunities, both through medical seats as well as the residency seats and our recruitment efforts that are continuing.
We are in no way reducing our efforts to recruit and train and retain physicians in Nova Scotia and to attach Nova Scotians to primary care physicians, but indeed we also recognize the important valuable role in the delivery of primary care that nurse practitioners can provide as well.
KARLA MACFARLANE: I want to thank the minister for putting a good effort in trying to clarify this but let me be clear here - there is major confusion in this province right now. I received a call two months ago saying I would be kept on the list for a doctor even though I had a nurse practitioner. Someone is not getting the correct information to the employees but, more importantly, we’re not getting that message out to Nova Scotians.
What we’re saying right now is that if you have a nurse practitioner, you are no longer on the list to receive a doctor. That’s the message we have to get out. I’m wondering, is there anything in this budget, any financial amount that’s being dedicated to making sure Nova Scotians know now that if you have a nurse practitioner you’re not getting a doctor?
RANDY DELOREY: I thought I’d indicated in my previous response that our efforts will continue with our partners to ensure that we have the appropriate supply of physicians to provide the care for Nova Scotians. We will continue those recruitment and training efforts to meet that.
I wouldn’t say that the last comment of the member would be consistent with our efforts. To the investments, I’ve listed some of them - again, recruitment and training opportunities, the Master Agreement is a significant investment over the term of the contract with Doctors Nova Scotia for compensation.
I do acknowledge the language that the member has brought to the floor. I have not heard of the confusion of the script or comments that were made through the phone calls versus that of the written submission. I will follow up with the Health Authority in terms of the script that they’re using through phone calls, and the information they’re passing on there. I do acknowledge, based upon the information the member has brought to the floor here today, that’s the first I’ve heard of this apparent contradiction between the language being used in a phone call to people on the list and a written letter being sent out.
I will cross reference those two pieces. I believe the member already tabled the written letter. I will grab a copy of that and bring that back to the Health Authority. I’ve noted the description of the phone call that the member received which appears to be a contradiction. I believe it was about two months apart between the phone call and the written correspondence. Again, I recognize the confusion that would arise from the phone call as described and that written correspondence. I will reach out to get that clarity and ensure that the Health Authority and those who are communicating and making calls and preparing written correspondence, ensure that there is consistency in that to avoid any further confusion.
KARLA MACFARLANE: I thank the minister for his answers. I just believe that there’s a lot of confusion. My colleagues to the right of me here say it’s happening right now in their offices. There’s confusion with NSHA saying that you will be taken off the list but then we have the registry calling us saying no, you can still stay on the list. That’s why you signed up at the beginning, whether it was two years ago or a year ago, you signed up to get a doctor.
Here’s the complex part of this: fine if you decide you are no longer able to get a doctor because now you have a nurse practitioner. Okay. But we all recognize that there are different levels of education - they’re both valued allied health care professionals, we need both in our society. There’s no argument to that. But now what we’re hearing - and I’m sure everyone else has had to hear this as well - people are coming into my office saying that they can’t get their insurance to cover with a nurse practitioner. They need a doctor to sign off.
I’m just wondering, how is the Department of Health and Wellness combatting that and what advice would the minister have for any of us? What’s happening is: I’m trying to track down a doctor to see so-and-so just one time to sign off on something so that their insurance will pay for a certain service that is covered, but the insurance company will not cover it with a signature of the nurse practitioner.
This is a serious issue that’s happening. I’m just wondering if the minister can give some advice or some input on that.
RANDY DELOREY: That’s not an area I recall receiving any correspondence on - not to say that none has come to the department, but I don’t recall having conversations or receiving correspondence from anyone raising that particular issue or concern.
The insured services that are provided by the province is a key focal point of the care that we are responsible for and delivering. That’s kind of a core focus of what we do. For uninsured services, which I assume is what the member’s referring to, that a private insurance company is requiring a different level of care, I think that becomes a bit of a challenge with those insurance companies and those private providers and what level of clinical sign-off they require.
Perhaps if the member could provide some specific examples of the type, rather than just generically insurance, it might be easier to delve into whether that is something that is rectifiable through the College regulatory or legislative restrictions, or if they are really restrictions or challenges relating to the commercial entity providing the insurance and really a policy on their end. Without the specific examples, it’s hard to delve down a potential path forward for addressing those concerns.
KARLA MACFARLANE: Just once again, I’ll table that email that I received. I think perhaps the minister did receive it, but here’s another copy.
Going back to the budget for a moment here. I’m looking at operating costs and the estimate 2019-20 and then the forecast, of course, for 2019-20. There was quite an increase. It’s estimated this year that there’s a decrease. I’m wondering if we can have an explanation for that decrease.
RANDY DELOREY: I’m just looking for a little bit of clarity - which page and line item is the member referring to?
KARLA MACFARLANE: My apologies. It’s Page 13.3, under Departmental Expenses by Object. It’s under Salary and Employee Benefits. I’m speaking with regard to Operating Costs.
RANDY DELOREY: At the high level, just to explain the three columns that do show up. The first column is what was tabled in the budget for 2019-20 which for that line item under Departmental Operating Costs $292.4 million to the forecast of $309.5 million. That’s what we’re expected to close the year out at, which means we’ve spent over budget. That’s part of the additional investments that we’ve talked about.
When you actually look at the estimate, third column of 2020-21, that’s what we’re tabling for a budget. Budget to budget it’s an increase, we’re anticipating a budgeted increase in the spending.
Some of the significant items that we see in there include over an $8 million increase in Seniors’ Pharmacare, which is based upon the beneficiaries in the program and the utilization of those beneficiaries that are in the program; about $650,000 in health strategic initiatives; about $3.5 million related to an increase in IT spending with initiatives like OPOR, which are rather large IT projects; just under $1 million relating to amortization expenses; a bit under $2.5 million for the EHS provincial programs, and medical oversights has increased - they’re the physicians and staff - medical oversights that support the paramedics through the EHS system. Those are a number of the changes in that particular line item.
KARLA MACFARLANE: I would like to go back to recruiting doctors for a moment here. With regard to removing the incentive fund of $150 for each patient that we would have a doctor take on, can the minister give what a total cost of that was, when that actually will end, and will there be any other new initiatives coming forward for doctors to replace this one that is being taken away?
RANDY DELOREY: Right now, we are anticipating or forecasting that we will spend $10 million on that particular program. The wrap-up, for clarity, the program was always designed as a temporary measure as we moved into negotiations with Doctors Nova Scotia in 2018. We recognized, listening to physicians on the front line, the important role that remuneration played. We recognized that was going to be important, one of the important steps we would be taking to improve access to care for Nova Scotians.
The member may recall we made an almost $40 million investment in various programs that we announced around March 2018. This is where that program was established. What we did for that was recognize that what we were launching, were launched to bridge us at the tail end of the contract that was in place at that time to provide an investment, recognizing the importance to physicians while we continued our negotiations.
When the new Master Agreement came online, as the member mentioned other investments or incentives or what have you, that is the total package as outlined in the Master Agreement with Doctors Nova Scotia. That brings in the totality and this particular program and incentive was not part of that. I believe even the president of Doctors Nova Scotia noted that if you looked at the collective of the many things we’ve been doing, this one is running its course.
As far as the timing of it, the new patients that are seen by the end of this month, I believe, are eligible to be submitted. As per the overall billing terms, physicians have 90 days to submit a bill. So, while the eligibility is for patients that are brought into practices by the end of the month, the bill can be submitted by physicians - they have 90 days to submit to the program - we may still have expenses in this program for up to 90 days after March 1st. If that was clear for the member Mr. Chair?
KARLA MACFARLANE: I thank the minister for his answer. There has been a bit of a shuffle here in recruitment and retainment, and Communities, Culture and Heritage has taken on a role. I’m wondering if the minister can point me in the direction of where that is in this budget. Are we cost-sharing on that, or is that completely out of Communities, Culture and Heritage? Perhaps just elaborate a little bit more on why the passing off of this responsibility to Communities, Culture and Heritage?
RANDY DELOREY: Again, I think we might choose different language to classify the relationship between the Department of Health and Wellness and my colleague in the Department of Communities, Culture and Heritage. We believe that as a government, we’ve been working really hard to take down the silos between departments, such that we don’t necessarily look at things as being passed off to or on to another department, but rather, we look at this as really recognizing that in the delivery of services to citizens government needs to act as a total organization.
The rationale I guess is what I think the member is really trying to delve into: Why would government have chosen to use the Department of Communities, Culture and Heritage as the delivery mechanism for this particular program? The rationale really is, in part, the member may recall several years ago early in our mandate where we did some significant restructuring throughout government, it really resulted in the vast majority of government grants and programs being amalgamated within the Communities, Culture and Heritage Department.
The rationale is that for community organizations, often many only consist of a handful of people who are doing a lot of very good work on the ground in their communities that they know best. In the past, prior to that restructuring and the strengthening of Communities, Culture and Heritage, organizations would have to go to many different departments to try to find the funding to provide their services to the people of Nova Scotia. We just felt that consolidating community-based programs and supports under the Department of Communities, Culture and Heritage would allow kind of a single point of entry and contact into government.
In the case of this particular program, it really is a program that’s not targeted at health and health delivery, but rather targeted at community, community promotion, recognizing the strengths of community and so on. Although, the intent is to leverage that promotion in the recruitment and retention of physicians and health care providers, the actual programs that are being developed and designed are really heavily focused on community. Which again, is the area that Communities, Culture and Heritage has strength and capacity.
So, for two main reasons, one is the strength and capacity of Communities, Culture and Heritage in that area of community development, community promotion, as well as their grant delivery mechanism and administration that they have. That allows us in the Department of Health and Wellness to continue to focus on the more health policy, health clinical type of work that we are focused on.
Again, I think it is a great example of departments taking down silos, not being focused on that aspect but rather being focused on the people of Nova Scotia and how we can all work together inside and outside of government to achieve the optimal outcomes that Nova Scotians expect us to do.
KARLA MACFARLANE: I agree with the minister in breaking down those silos. I feel that collectively through the departments, we need to work together. We know that the Minister of Immigration has done a wonderful job in recruiting and retaining, through different immigration programs.
I’m just wondering if the minister can tell me though how often he and the Minister of Immigration and the Minister of Communities, Culture and Heritage meet to discuss recruitment and retainment since all departments are involved.
RANDY DELOREY: Mr. Chair, again as the member noted, transitioning into the role of immigration and for both physicians and other health care providers - I mentioned in my opening remarks - the positive success we’ve had with recruiting continuing care assistants as well over the past year, is in part through support being provided by the Department of Immigration.
I can’t think off the top of my head how frequently we meet. Well, we meet frequently throughout the course of the year and when we do meet as colleagues, as we do with our other colleagues, we consistently talk about the topics of joint interest or oversight or overlap. In addition to our engagement and conversations that we have, Mr. Chair, it’s also our department staff officials who continue to meet, from the deputies’ meetings, other staff, on particular projects or areas.
For example, staff within the Department of Health and Wellness who work with an eye towards health human resources would provide input into the Department of Immigration if we see areas where we think we may need to rely on more international support. They would work with the Department of Immigration who know how to best deliver immigration strategies, programs and promotion to support those needs that we may have from a health human resource demand and supply requirement.
KARLA MACFARLANE: I’m wondering if the minister can tell us when the last recruitment conference was and how many representatives went for Nova Scotia. As well, if he can point me in the direction in the budget where I would look for our officers who do recruit and retain. I’m not sure where in the budget I would find the costs for their services.
RANDY DELOREY: The specific operational task of recruitment falls to the Nova Scotia Health Authority. So, the Nova Scotia Health Authority is where, for example, I think the member would know in her community, in the Pictou area, who the recruiter is. That individual would be an employee of the Nova Scotia Health Authority, so it is the Nova Scotia Health Authority’s budget that covers the cost.
I think the first part of the question, Mr. Chair, related to recruitment conferences, either nationally or internationally. To attend the national types of recruitment conferences would be led by the Nova Scotia Health Authority recruitment department, so that’s not something that I am advised on each time they go. Certainly, for international immigration-type of recruitment initiatives, the Department of Immigration is often very involved with the Nova Scotia Health Authority as they go on those recruitment endeavours, missions. Often, if not always, I believe the Department of Immigration does put out a news release when they are going on those international ones.
If the member is specifically asking about international recruitment conferences and initiatives, I don’t have the specific details off the top but I’m sure if the member went to the government’s website to look up the news releases for the Department of Immigration, I know for a fact there have been several over the past year.
KARLA MACFARLANE: I’m going to move on to virtual health care. Just in the last year, I’m wondering how much money has been spent on virtual health care in total, and perhaps what is forecasted for this year coming?
RANDY DELOREY: I guess one of the challenges in responding to that question is how one defines or goes about defining virtual care and how IT investments and initiatives get recorded and documented. If we’re talking about virtual care in the context of video conferencing, for simplicity, like Skype-based video conferencing between patients and providers; if you’re talking in a more broad context which would include messaging, text-based messaging, like Facebook Messenger, type of interventions, where within the technology then you factor in that there are the costs of the technology and the costs of the service providers. So, the physicians, in the case of virtual care being provided, in the case of physicians and health care providers providing the care, some of the costs would be captured through either insured services or salary lines and not be necessarily rolled up as virtual care.
So, really what I’m getting at is I don’t think I have the specific dollar amount that the member would be requesting in an all-in.
THE CHAIR: Order. Order. There’s a lot of chatter in the Chamber, it’s hard to hear the minister. I ask that everybody lower it and allow the minister and the member to have a dialogue that they can hear.
RANDY DELOREY: So, depending on which aspects the member’s referring to, if we’re really focused or talking about the technology platforms, if we are talking about the MyHealthNS system, I think that’s somewhere around $3.5 million towards the delivery of those services for the 2019-20 fiscal year.
In addition, you’ve got costs that also get delivered in other IT services. Like in the Public Health space there’s a system called Panorama that is used for vaccination monitoring as well as for other public health outbreak situations. So, it’s digitizing those types of health services and information.
As I’ve mentioned, in addition to those costs, there’s sometimes the costs associated with the actual care providers and they get wrapped up in other Nova Scotia Health Authority budgets. That would be mostly when you have a clinic providing a specialist in Halifax, for example, providing virtual telehealth services to another part of the province. So, you can have a specialist in Halifax using video conferencing to another hospital or clinic. Those costs would be rolled up in the operational costs of the Nova Scotia Health Authority and the IWK.
So, to pull it all together throughout the system, as I said in my opening remarks, the complexity because of the wider range of services being delivered by various partners, it gets sliced and diced different ways. It makes perfect sense in the operational way that it be organized, but it might not roll up in quite the way that members on the floor of the Legislature would be hoping to see the dollars and cents because there are different providers at different spots within the system.
KARLA MACFARLANE: So, with regard to the discontinuation of MyHealthNS, is there going to be anything to replace it? What conversations have been taking place for something to replace it?
We know that many doctors spoke on this and indicated that they were having about a 20 per cent efficiency in using this service; we know that it served over 38,000 Nova Scotians; we know that over 300 doctors used it and they want something to replace it. So, I am wondering if the minister can update us on that.
RANDY DELOREY: As it relates to MyHealthNS, as I think members are aware, it certainly has been reported publicly, the vendor in the last fiscal year indicated that they did not intend to renew their contract with Nova Scotia. More recently, the vendor has indicated that they will be winding up their operations across the country, in Canada. That notification, I believe, went out to patients within the last week or two. We were, as a province, I believe back in 2016 when MyHealthNS first launched in the Fall, we were the first provincial jurisdiction in the country to roll out a provincial patient platform.
There are two key pieces of functionality that were provided by that service. At this point in time, that includes the first phase which was the delivery of lab and imaging test results through a web-based portal. Then, about a year ago, the system added an additional module which enabled text, essentially messaging functionality that would be similar to logging in to Facebook and using Facebook Messenger, it would be a secure platform between the health care service provider, the physician, and the patient. So, those are the two main pieces of functionality that were in the platform.
As far as go-forward technology replacements, we’ve been evaluating other products. There have been a lot of advancements in relation to technology in the area of, well, in all areas of health care. I believe it is one of the fastest growing areas within the IT space - technology for health care services - and that includes both in physician offices for physicians, as well as for that emerging area that we were on the leading edge, which is patient access to health information.
So, for the options that are out there, we didn’t find anyone. Staff are doing their evaluations that would, in the current environment, meet our expectations. We also recognized that other aspects and technology platforms within our health care system have also evolved in Nova Scotia since 2016.
For example, over the last 18 to 24 months in Nova Scotia we have worked with health care providers in the primary care settings to upgrade what are called electronic medical records or EMRs. That software is the software that is used in doctors’ offices. When you go into your primary care provider, the software that they would be recording your visit in, that’s called EMR software.
We worked with physicians and saw them transition and upgrade to new software right across the province. I think almost all have been upgraded in the last 18 to 24 months. They are now running on essentially two main product lines, only two different products that are being used by physicians in Nova Scotia.
The functionality in this upgraded software includes the potential for the use of a module for e-messaging. In 2016, even a year ago, that functionality was not even an option for physicians in the EMR platform that they were using. With these upgrades, that’s now an option. Not just is it an option, but for one of the vendors, some evaluation determined that about 60 per cent of physicians on one of the EMR platforms were already using that e-messaging module, even though we were running a provincial system, MyHealthNS, that provided that functionality.
Once we had that information and realization as we were considering options, we said, you know what, we need to step back and have a deeper engagement with our health care providers to understand why they went with their EMR when there was, at that time, a different provincial platform available to them. We need to better understand that, before we make a decision on how we move forward on what platform criteria we may have for the delivery of patient-centric portal access to health information.
In the broad sense, to the member’s line of questioning, are we committed to continuing to invest in modernizing the health IT systems; to modernize the delivery of health care and support to those health care providers, and their patients, that are looking for alternate ways to provide care and enhance their efficiency and productivity? We continue to be committed to that, but we’re also committed to doing it right.
KARLA MACFARLANE: I’d like to ask the minister, what has been the total cost invested in One Person One Record to date?
RANDY DELOREY: I’ll just take a brief moment so that the members do understand what OPOR is. That is a project called OPOR, One Person One Record.
In my previous response, I was talking about a health information system called EMR. I apologize for taking the time for clarity, but I don’t think everybody fully understands what each of these systems are and how they’re similar, but different.
The EMR, Electronic Medical Record, would be the software in a physician’s office; OPOR, One Person One Record, is the hospital clinical information system. That would be the software system that would, for the first time, when this project is complete and rolled out across the province, have all of our hospitals connected to the same medical records.
If you are a patient and you go to your local emergency department, for the member in Pictou, or myself in Antigonish, that would result in our records being stored. Currently they would be stored and only available in our local hospital. When OPOR is complete, if we were in another part of the province and had to go to an emergency department say, in Yarmouth County, that information would be available to our hospital back in Antigonish.
I’ll just use an example of the challenges of the current system. The member often uses examples from her personal life, I’ll use a personal one. A few years ago, my son had a particular condition, in Antigonish; it required a referral to go up to the emergency department at the IWK. Not so urgent that we required ambulance services, so we drove, my wife drove my son up to the IWK. It was a referral that came from the emergency department at St. Martha’s Regional and she was provided with his medical records to take to the IWK with him, with the patient.
We dad that happen this summer when we were camping in the Valley. We had to go into Annapolis Community Health Centre, had a referral then to Valley Regional. Again, as a parent, I was provided the medical records from the Annapolis County to take with me to the regional hospital. That’s the challenge. They have a system on site, but it’s not integrated with the receiving facility.
With OPOR, the intention is that you would have the data entered once and it would be available at any of the other facilities that you might be referred to. So that’s just the context of what OPOR is, so that people can appreciate that.
Now the specific question was the cost of OPOR. This project started back in 2014-15, so total expenditure to date is estimated to be - sorry, just one second here.
Mr. Chair, the number I was about to articulate would be the total amount spent and projected to be spent. I believe the question was: How much has been spent? The amount spent between 2014-15 and forecasted to the end of fiscal 2019-20 is about $4.7 million to date. That would be for all of the preparatory work, as well as the RFP process to date.
KARLA MACFARLANE: I thank the minister for his answer. So, for clarification for Nova Scotians - One Person One Record - it’s a great project if it can eventually be implemented, but to date basically the money that we have invested so far is just in preparation for it, which started back in 2015 or so.
Is this project through the minister’s department or through NSHA? How many people are actually employed working on it and out of that number he gave me, I’m just wondering how much of that went into actual employees.
RANDY DELOREY: As per my earlier remarks about the question on virtual care, about the challenge of getting the exact numbers that play out, in the area of OPOR it is a project that we have at the Department of Health and Wellness, but obviously requires close collaboration with our partners at ISD which provides internal services that provide IT services for government, but also the IWK and the Nova Scotia Health Authority. Because this will be a single provincial system, it will span both the Nova Scotia Health Authority and the IWK.
Much of the work and analysis, we’ve certainly had some consultants with the expertise to help inform and guide us through the readiness and the procurement, but also, what makes it difficult to say the number of employees within the Department of Health and Wellness and the health authorities is because they vary.
There would be a number of clinicians who have come into the system to provide support as we’re doing the analysis. For example, if you look at the maternity ward or the emergency department, there would have been representatives that have provided the early analysis to say what the types of services and features are that you would need in an emergency department or in the maternity ward, or in the ICU or whatever area of the hospital, that would help to inform at the early stages what the criteria would be for the RFP for this project. So, the people were not dedicated necessarily to the project, but they would have been providing support and work with it.
I don’t have a number of specific FTEs because, again, at this stage a lot of it is business analysis work at the front end, and then you have the project team, or the procurement team, doing the work. The staff that are dedicated span the Department of Health and Wellness, Internal Services - both for their IT services and procurement - both the Nova Scotia Health Authority and IWK, as well as some consulting support.
It spans a number of different areas, so our department doesn’t have, in our Estimates Books, the specific number on that project.
KARLA MACFARLANE: I’d like to ask the minister, would it be fair to say that that amount, $4-whatever million, there’s nothing tangible. It basically has been money that has just been put towards employees and in 2020, five years later, we still don’t have anything that’s implemented.
I’d just like to confirm if that figure is basically representing individuals that are working on this and that there are actually no tangible pieces of equipment. When can Nova Scotians expect this to be implemented?
RANDY DELOREY: I thank the member for the question. I disagree. How is it that the Chair puts it, disagreement of facts.
I believe there is a tangible. This would be the case for any large IT project. It does start with what some people may consider intangibles. But that’s not to say that an intangible is not critically important. That business analysis that gets done at the front end of a project, it is very well known, very well researched, documented as to the criticality of doing good upfront business analysis and planning as to what the system needs are. That ensures that when you enter into the procurement process you have the appropriate requirements, so you don’t tangibly have a system at that point in time, but you do have the information.
I think when you look at some of the most valuable organizations in the world these days, they’re organizations that are built upon a foundation of information and data. Information and data are very tangible and so that work that we’ve done has value, significant value.
The status of the OPOR project at this point in time, we are still in the RFP stage, but we are in the very latter stages of the RFP. Submissions have been made, discussions are ongoing, and we look forward to providing an update when completed and a vendor is selected. That will resolve at that point in time in a public notification.
At this stage where the discussions are ongoing with the vendors who have submitted to the RFP, there’s really not a lot of details that I can provide on that progress other than saying it is nearing the latter stages of the RFP process. When a decision is made, obviously as with other procurements throughout government, public notification is made.
KARLA MACFARLANE: We know that One Person One Record didn’t do so well in B.C. There are a lot of concerns and I’m sure the minister is aware of those concerns. I agree, you’re always collecting data. But, five years later and we still can’t access this.
I’m wondering at times, well, let’s implement it. You’re right, we’re constantly evolving, we’re constantly living in a modern world where we have to keep adding things. Why wouldn’t we implement it and just improve as we go along? I think what Nova Scotians really want to know though is at the end of the day we still don’t have a system that they can access, and they want to know, what is going to be the cost of this? Can the minister provide a figure, a dollar amount, today, what he believes this will cost taxpayers of Nova Scotia?
RANDY DELOREY: As I’ve indicated, we are nearing the ending stages of the RFP. Those discussions around the specific costs, the early work that was done in the first couple of years was focused on requirements, gathering, and analysis.
Because we did a very good job of doing that work, we know what the systems are going to need to meet the needs of our front-line health care workers. We know the value that those health care workers put on those services; that is guiding our negotiations with prospective vendors in the RFP process.
I wouldn’t articulate that while we’re still having those discussions with the vendors to ensure that we do get the best deal possible. I think if we were to flag to the vendors what we think we might be willing to pay, something tells me that the final figure that those prospective vendors provide will come in somewhere nearly exactly at that dollar amount. My hope is that we can come in somewhere below that amount.
KARLA MACFARLANE: I just want to thank the minister for those answers. It seems like a project that has been taking a lot longer than it should. Five years, we’re millions of dollars in, there’s no doubt at the end of the day and whether it’s speculation or not, but it has been reported to media, we’re looking into the hundreds of millions of dollars for a system that Nova Scotians at this point don’t have a lot of faith in.
So, I’m wondering what his department is doing to communicate that to Nova Scotians, to remain positive that this is going to be implemented. Is there any way to communicate that to Nova Scotians?
RANDY DELOREY: These conversations are certainly means of delivering that information. I think there was a meeting before, the Auditor General made reference to it, there was some media coverage and conversations there . . .
THE CHAIR: The time has elapsed for the Progressive Conservative caucus. We’ll now go on to the NDP caucus.
The honourable Leader of the New Democratic Party.
GARY BURRILL: Thank you Mr. Chair. I think that shortly, we should ask the minister to model the kind of good health practices that he ought to be standing for before the province; take five minutes for him and those who work for him and just move around a little and then we’ll come back to this. Wouldn’t that be a good idea?
THE CHAIR: What would you like me to do Mr. Burrill?
GARY BURRILL: Grant a five-minute recess.
THE CHAIR: Absolutely. We are going to take a five-minute break starting now.
[5:42 p.m. The committee recessed.]
[5:46 p.m. The committee reconvened.]
THE CHAIR: Order. The Committee of the Whole on Supply will come to order.
The honourable Leader of the New Democratic Party.
GARY BURRILL: Thank you to the minister for the hour and a half or so worth of material that he has already provided. I would like, as far as introducing my part of this discussion this evening, I’m thinking about the NSHA itself, and some of the discussions around its structure and how that structure has been adapted some recently. I’d like to ask the minister about his thinking about some of that.
I’m going back to what was, I think for lots of people, a pretty surprising moment a few months ago, when the interim CEO made a statement indicating that the organization of the upper echelons of the NSHA was not working in a satisfactory way, and introduced some changes. I’m sure the statement would be familiar to the minister.
I’ll just read it. She said, the organization is “overly complex and bureaucratic, confusing and does not allow us to easily address challenges that may be unique to individual zones, teams or hospitals.” Just to keep it in order Madam Chair, I’ll table a copy of that. I’m sure the minister is very familiar with it.
I would just like to begin by asking the minister: Does this seem to him a fair reading and analysis of the life of the NSHA, from the time of its formation, until the time of that reorganization under the then interim CEO?
RANDY DELOREY: I thank the Leader of the NDP for acknowledging the opportunity for a break for particularly those here in the Chamber and those supporting us.
To the question, when I came in to serve as the Minister of Health and Wellness in 2017, one of the first things I did was organize a tour around the province so that I could hear from front-line health care workers. One of the questions I asked, if information wasn’t volunteered at these opportunities, was what they thought about the Nova Scotia Health Authority.
So, the Health Authority was just over two years old at that point in time. By and large what I heard in terms of the concerns or constructive feedback that was being brought forward, would align with what you would have read in the newspaper at that point in time: concerns about communication, which would be through the restructuring, the changes in reporting structures and so on and how that impacted or disrupted the work of people on the ground in various parts of the province.
When I asked the next question though, it was essentially unanimous in recognizing that the amalgamation was still the right thing. That, particularly with a clinical lens, having a single health authority that ensures the standardization and common approach to best practice delivery of health care services throughout the province is actually a very positive clinical outcome. What they were articulating were the frustrations around what would occur with any multi-billion-dollar organizational restructuring.
This was not just the merger of two organizations but in fact, merging nine former health authorities into one. So that’s nine organizations into one multi-billion-dollar operation. What transpired in those organizations, as would happen in any organization that goes through this, and which is the clinical purpose of the amalgamation, is the identification and realization of the variances that existed throughout the province.
Such that the health care being delivered in Cape Breton was very different than health care being delivered in Yarmouth, which evolved based upon the priorities of the district health authority of the day in each of those regions, over time. In some areas a particular authority would have prioritized certain approaches and in another community, they might have been focused in another area.
The goal of having the single authority remains, establishing the best practices out of those operations and then rolling out and standardizing so that if you received care in Cape Breton or you received it in Halifax, Antigonish, Yarmouth or anywhere else in the province, you’re receiving the same care. I think that’s what Nova Scotians expect of our health care system; that’s why the authority was developed as a single entity for the delivery of those services.
As it relates to their operational structure, particularly at the executive level, I think in those early days the design intentions - I wasn’t the Health Minister at the time - but the design intention to have the administration structured with VPs who were responsible for each of the four zones was to ensure that there was a representative with regional expectations and responsibilities sitting at the executive table.
What I think at the five years of age the Nova Scotia Health Authority has now reached, or will be reaching shortly, what was becoming apparent was with the maturity comes the time that you have an understanding of what’s happening throughout the organization now that things have stabilized, at the executive table. Bringing in, as the announcement, to ensure that they have the appropriate executive responsibility dedicated in those zones, and not just one of the responsibilities, will help to further strengthen the communication to the front lines within the Health Authority.
As the interim CEO had mentioned also, I believe this is part of the maturing of the organization through the amalgamation, it’s part of the learning. I think this is the appropriate model to continue moving forward and into the future with this organization.
GARY BURRILL: I want to thank the minister for his thoughts about that. The particular thing that I’m wanting to focus on, I think we could agree that what the interim CEO was in significant part saying was, by her observation, there is not enough regional autonomy in the decision-making structure.
What I want to ask is, in the minister’s view, was she right as she described the period from 2015 up to November 2019, when she made that analysis, as interim CEO?
RANDY DELOREY: I think what was noted was some of the confusion in the decision-making autonomy that, as I said earlier, when you have nine different organizations, nine different organizational cultures - a multi-billion-dollar organization - which gives some idea of the scope of the number of people throughout who are impacted and affected, that some confusion would manifest itself. That played out publicly. It was certainly acknowledged; efforts were made to improve the communications throughout.
As one of the things that’s necessary though in those types of restructurings, is to really understand what’s going on throughout in the amalgamation, to have some centralization in the early days, to ensure that all of the different views and information from throughout the organization can be understood and collected and feed in and inform the new culture that reflects and represents the new organization.
As that matures and grows then so, too, does the ability, kind of like a pendulum swinging, that it would naturally swing back. I think we’ve talked about that before, certainly a former deputy minister of the department often used the pendulum analogy, that it starts as a more centralized approach at the consolidation but then as the organization matures, it swings back to that equilibrium point.
That here, as we’re nearing the five-year mark of the organization, I think is a natural progression of the organization to set the stage for, we’ll say, kind of the adolescence of the organization, moving from five years for the next five to get to the 10-year point.
GARY BURRILL: The minister and I probably wouldn’t, of course, read the old DHAs in the same way. I think one thing we would agree about them is they had some regional autonomy in decision making. I think we could also agree that the outcome of the interim CEO’s restructuring was to move some more regional autonomy in decision making into the zones.
I want to ask the minister, under the new system which has been inaugurated since the CEO’s changes and the effort to re-establish regional decision making autonomy, have we not moved significantly back to the decision making regional autonomy structure that in fact we had before the NSHA was established?
RANDY DELOREY: I don’t think so. I think the structure that we always envisioned and established as government, was a single health authority with four regional zones. I think I can recall when my colleague, the current Minister of Communities, Culture and Heritage, who was then the Minister of Health and Wellness after the 2013 election, went around the province. Certainly when he met in my community with the representatives of the then district health authority, GASHA, the conversations we had were very clear: that the design and the structure was to have a single health authority to establish the common delivery of services throughout the province; to also ensure that through the zonal representation we continue to maintain the regional interests in the delivery of core services and representation and that included decision making. I think that was always the design objective.
As I’ve already articulated, where some of the challenges in the early stages of such a large restructuring and amalgamation that make it very difficult - these types of things are not like light switches where you just turn them on and off - organizational, cultural and operational changes really are more like a lifespan and it does take time to transition and evolve. Again, I think this is the natural evolution.
It’s not the same as the previous district health authorities. There were 10 of those previous authorities in communities across the province. We continue to have two: the IWK with a focus on child and maternal services and women’s health services, and the Nova Scotia Health Authority for the broader swath of health care delivery across the province, with four zones of regional operations.
What the restructured changes allow is a bit more fiscal autonomy within those organizations while still maintaining an objective around some of the clinical and operational consistencies, which, again, was part of the objective - a really critical part of the objective - of amalgamation in the first place. By and large, in any information that was fed back to me when I asked front-line health care workers, there’s generally still consensus that that standardization of best practice operation delivery is good.
One of the challenges, though, is that while people have agreement in that principle, unfortunately what that best practice is doesn’t always have agreement. As the Health Authority establishes a particular practice, we may hear people criticizing and expressing frustration with a change to a practice that they may disagree with. They frame that up as frustrations around autonomy and decision making and so on, when earlier they may have equally expressed their desire to have a standardized approach.
I think the unfortunate reality is that sometimes when people say they want a standardized approach, what they might mean is that they want their approach to be standardized. That’s why, when we make these decisions, we often, as with any change, do end up receiving some level of criticism from some people within the health care system. We make every effort - as the Department of Health and Wellness, and our partners in the two health authorities, when they evaluate the information - to make the best decisions. Truly.
Everyone throughout our health care system, from the executives to the front-line workers, wants to see and provide the best care and service to Nova Scotians. We don’t always get consensus. This is a multi-billion-dollar organization with thousands of health care workers providing care. To get unanimous consensus would be extremely difficult. We have difficulty getting unanimous consensus with 51 members here in the Legislature.
GARY BURRILL: One of the main arguments that has been brought forward all along for the establishment of the NSHA was to work toward a situation of uniformity in the provision of services across the province, and yet as we get towards the five-year mark, we do find that there are significant geographic variations in health outcomes. I’d like to address some questions about this troubling area to the minister.
I’d like to table a document that I’m going to organize some of my questions around. The member for Halifax Atlantic asked earlier this afternoon, following some remarks made by my colleague for Dartmouth North, if the source of some of the things that she had been speaking about, trends in social determinants of health and health outcomes over the last five or seven years, could be tabled. So that’s it. That’s a comprehensive data analysis of Nova Scotia health outcomes data prepared for the NDP caucus by Dr. Emily Kirk.
One of the things that has emerged out of that is some startling-to-me data on the question of life expectancy. I learned from this study that life expectancy is three years lower in Nova Scotia in the Eastern Zone than it is in the Central Zone. By and large, what this means is that people live three years less long in Cape Breton than they do in the peninsula of Halifax. Now I am certain that this is an outcome that the minister would not find acceptable. It’s certainly not an outcome that our Party would find acceptable. I want to ask the minister: What in the budget, that he and his department are bringing forward here, may the people of the Eastern Zone look to to address this striking inequality in outcomes on this key measure of life expectancy?
RANDY DELOREY: Thank you, Madam Chair, and I thank the member for tabling the information, the data tables, prepared by Dr. Kirk. I only had a moment to skim the table that the member is referencing. I would have to do a little bit more analysis, I think, on the data presented here to just cross reference and verify the statistical variability, an absolute variable or variance in a static number. With a little more statistical analysis, you determine if there’s actually a statistical variance in that amount, in that particular variable that’s being cited. So again, I think it just needs a little more robustness to determine if the size of the variance is one that would trigger concern, or if it’s one that has some variability in it.
That said, just off the top of my head, I recognize the Eastern Zone runs from my community in Antigonish up to include Guysborough, as well as all of Cape Breton Island. That would be the entire Strait region, as well as the Cape Breton Regional Municipality and the Highlands. I don’t have the exact stats, so I won’t cite them but certainly there’s a recognition and acknowledgement of certain health indicators that, particularly in industrial Cape Breton area, are historically challenging. To the member’s absolute question that comes out of this of what is in this budget that supports some of those variables, as the member noted in his preamble to the question, he talked about some of those variables that were reported on, which were social determinant variables. As the member would know, many social determinants include things such as education, income, housing, and variables such as that.
In this budget, although not directly in the Department of Health and Wellness budget and line items, but as reported by the Minister of Finance and Treasury Board, a significant portion of this year’s budget, particularly new programs and investments, have been targeted towards the very fundamentals of addressing social determinants of health. These are investments like the finalization of the full rollout of the pre-Primary program.
The Minister of Education and Early Childhood Development in Question Period yesterday spoke to this, about the research that identified how significant, positive impact a pre-Primary program has on those who are less fortunate in the province. They are direct impacts to the individual students who are given the opportunity to level the playing field that perhaps for generations in their family they may have had systemic challenges that prevented earlier generations from receiving that early start opportunity. The early starts allow for earlier identification of needs, to allow for other educational and health supports to be provided a year earlier. It provides opportunity for some parents, particularly single parents, to enter the workforce a year earlier, to help support the income generation that they need to stabilize their household. That program alone is a critical social policy and investment to ensure that we address some of those - not just for the Eastern Zone but for those children right across the province.
The increase in the Nova Scotia Child Benefit tax credit, that too ensures that families with young children, particularly low-income families, more of them are able to receive more financial support for those children, ensuring to help improve the income levels, which we know is a trigger in social determinants. I could continue on with the many different investments throughout. Much of Question Period over the last couple of days in this sitting, particularly from the NDP caucus, has been directed towards the Premier or the Minister of Municipal Affairs and Housing about housing.
In this budget, we recognize the significant role that safe and accessible housing plays in ensuring the safety and the health of Nova Scotians. That’s why we continue to invest in a variety of tools and approaches to provide more housing opportunities for citizens. As I mentioned earlier, when the PC caucus questioned about government really trying to take down the silos and respond as a government to the needs of the people of Nova Scotia, and not simply saying health outcomes are the responsibility of the Department of Health and Wellness.
It is, but we recognize that social determinants are contributing factors that will help improve the outcomes of the health of Nova Scotians. Our social departments - Community Services, Education and Early Childhood Development, Health and Wellness, Municipal Affairs through their role with housing - all contribute. We have social deputies and staff meetings to help identify programs that actually complement each other to maximize the value of our investments, to maximize the positive outcomes and minimize the negative outcomes that many Nova Scotians have been experiencing.
I think this budget, to the member’s question of what we are doing, what we have in this budget that can help address, not specifically limited to the Eastern Zone, but for all of the province.
GARY BURRILL: I want to assure the minister I’m not intending to ask a statistically sophisticated question. My question doesn’t require any regression, so I can appreciate that in order to understand this research and its significance you would want to have it looked at in more depth.
My question really is as simple as this: Is the minister aware of significant variances between zones in life expectancy?
RANDY DELOREY: As I mentioned before, and perhaps this is a previous career that has beaten this into me, the term “significant”, especially when talking about data, is a bit of a loaded term. I’ll acknowledge that the data that the member has tabled here this evening does indicate that there is a range of about two years’ difference, 2.4 years difference in absolute terms. Whether that’s a significant variance or not - again, “significant” does have a very specific connotation when talking about data like this.
This data here that he has tabled does show about a 2 or 2.5 year difference from 78.5 to 81.2, I guess, is the longest life expectancy noted. That’s the range noted in this document.
GARY BURRILL: I’ll avoid the use of a statistical word then. What I’m really meaning to ask the minister is, as the minister for the province, is he aware of major, important - big enough to be troubling and cause a focus of the department’s efforts and thinking - difference in life expectancy within the province?
RANDY DELOREY: As I mentioned in my previous response, certainly we recognize that a variety of factors or variables that contribute to the health outcomes within the population get sliced and diced in a number of different ways. We certainly see it sometimes regionally. We see it done - recognizing that when you do analysis and put the lens of social determinants, socio-economic variability, when you turn around and you can look at it from, sometimes, cultural or racial variances that you come out with particular health outcomes.
Certainly, the health system does evaluate and consider the information research that is done by academics, and clinicians throughout the province do focus in these areas. As information comes forward to recommend policy changes and improvements, and one of those areas, again, is the recognition of the social determinants, the importance of us investing to support those most vulnerable Nova Scotians.
As the Minister of Finance and Treasury Board highlighted and stressed yesterday when she introduced this budget, that was really a key driver, not just for the Department of Health and Wellness but for all of government, to try to address those things that are not just health related. I think that has been one of the challenges with actually moving the needle in some of our health outcomes. We’ve always tried to focus on just addressing health outcomes through the Health and Wellness Department or the health system, when the reality is we have other avenues and levers that need to be pulled or invested in. I think what we’re seeing this year is exactly a move to improve. Whether it’s the mortality rate - or life expectancy rate, I should say - or other variables in health outcomes, we want to see the needle move in a positive direction. However you slice it - regionally, socio-economically, culturally - we want to improve the health outcomes for all Nova Scotians.
GARY BURRILL: I’m certain that would never be in question, that everybody who works in this field would want that outcome. The specific dimension I’m wanting to get to in this discussion is the matter of geographic - I think it would be fair to call it - inequality of outcomes. It has been, after all, a very significant component of the argument for our province, focusing a great deal of its energy and expertise in this most recent period on making a centralized health authority, that it would lead us to a place of greater uniformity of outcomes.
As we think about how we might evaluate at the point of coming to a five-year process, regional variances in outcomes are significant things to consider. Thinking along these lines, whenever we read an evaluation of health outcomes in any field or in any setting, one of the things that’s always looked at is infant mortality. I guess the reason for that is that it is one of the most accepted measurable data indicators of health outcomes that there is internationally.
When we look at infant mortality from the point of view of thinking and evaluating where we are about uniformity of regional delivery of health services in Nova Scotia, on the front of infant mortality the numbers that I’ve tabled are troubling. We learn there that infant mortality is, for example, over twice as high in the Northern Zone as it is in the Central Zone, and this is the figure that was being spoken to earlier this afternoon when my friend from Dartmouth North said that a baby is twice as likely to die, based solely on where it is born in the province, as stark as it is for us to consider that. So, that kind of variation, seems to me, is nothing that the minister would wish to dismiss or speak to in a minimizing way at all.
I want to ask the minister: Is he aware of these regional variances in infant mortality in the province, and what is the department doing to address this stark geographical inequity in health outcomes in the province?
RANDY DELOREY: As I’ve noted, broadly speaking, the work that’s done within the Department of Health and Wellness, analyzing and reviewing health outcomes, this type of work is helped and informed in reports that get done at a national level, as well, to evaluate how we do as a province, as well as on a national scale. So, this does help inform where and how we invest in and support our health system.
The member’s two questions put together really highlight, in fact, that picking a single health outcome variable, the two variables he has chosen - infant mortality and life expectancy - show that the two areas that he has noted with the data set that he has provided are actually in two different regions of the province. Yet when you think about, for example, the Eastern Zone - it has consistently had one of the highest attachment rates to primary care providers.
So, when you tie that into the life expectancy, you would think having attachment to a primary care provider and its role in supporting life expectancy - and yet other variables such as genetics, which are out of the direct control of government and the health care system, also play a role and yet there is a significant component for many of the health outcomes that are regionally allocated that do have a genetic component. There are distinct populations with certain health probabilities for increased risk of certain negative health outcomes based in part on genetics.
Unfortunately it is a much more complex area - and I certainly am not brushing off or attempting to diminish or under-emphasize the importance of these areas and looking at a multitude of health outcome variables, but again I think the challenge becomes delving in and peeling back the layers for an outcome-by-outcome basis does get a little bit misleading when we are having a conversation about an overall health care system and, again, making the continuous improvements to move the needle forward.
As I had indicated, areas - without pulling down and looking at the specific data here, there’s really not a lot of detail that would be in the clinical side of things that would delve down in terms of the likely weight of the various factors that may contribute to the variances that the member has denoted in just a static table of data that he’s tabled here.
GARY BURRILL: I want to ask the minister: Did he just say that in his view, regional geographic variation in infant mortality may, with some likelihood, be significantly attributable to genetics?
RANDY DELOREY: I believe what I said was individual health outcomes often do have a variety of contributing factors. Again, as we noted at the start of the conversation, many health outcomes - indeed, I believe even the title of the document the member tabled broke it out as social determinants of health data breakdown, data that’s targeted on the social determinants of health.
As I said, as a government we recognize the importance of investing in improving many of the underlying variables, things such as education and access to early childhood programs, as rolled out through the pre-Primary program, which will ensure this year that every four-year-old in the province has access to that program. Again, as I’ve previously said, the Minister of Education and Early Childhood Development has spoken, I believe yesterday, specifically in Question Period about the research that shows how a single generation’s access to a program like this has positive outcomes not just for themselves but indeed their whole family.
Yes, in my previous I response, I did note that in some cases the health outcomes have a multitude of factors and variables. One may include genetics. Was I applying that statement specifically to infant mortality? No, but there would be instances, I can imagine, that infant mortality in some cases is genetic if you have a genetic condition that would lead to challenges with the pregnancy and a delivery of a child. Now whether that applies specifically, that’s not the way I was referring to that. I was talking more broadly to try to illustrate the challenge with picking single data points within a broad health care system.
Having the conversation again, I think you could spend entire reports on any one of these individual variables with fairly dense research and analysis and how that goes into the contributing factor. So, my comment previously where I made a passing reference to the genetic components was meant broadly, not specifically. I did say that I wasn’t trying to understate the role or the importance of improving our health outcomes, including those here that we’ve spoken to so far - life expectancy and infant mortality. Of course, we would like to have both of those data points and variables improve again in all parts of the province. We’d like to see those better in our health care system.
GARY BURRILL: Then could I ask the minister: In the current life of the department, and in the current budget, is there any funding being specifically allocated to address the regional inequity in the infant mortality we have in Nova Scotia at the moment?
RANDY DELOREY: If what the member’s looking for or trying to nail down is whether there is a line item or a specific program with a line that says infant mortality: this amount? There is not. In my responses I’ve been trying to explain that, as important as it is, it’s a variable that is one of many that get accessed in terms of how the health care system evaluates overall health care system performance. The programs and the responses get developed. This year, broadly, as a province, a significant focus has been on social determinants though a multitude of departmental investments from Education and Early Childhood Development, Community Services, Municipal Affairs and Housing, to really get to some of those root social determinants.
I recognize that the members opposite clearly also recognize, at least in the New Democratic Party, the important role that social determinants of health play in not just health outcomes but indeed in life outcomes for our citizens. I think that is demonstrated by the data set that they had prepared by Dr. Kirk and tabled here this evening. I think they would also recognize that these investments that our government has been making in this budget, to expand and improve investments in many of those core, fundamental, foundational pieces to support the social determinants of health, to support those Nova Scotians most in need, Mr. Chair, is a good thing, that we are taking steps, we are continuing to invest to improve the situations for those Nova Scotians in greatest need.
Mr. Chair, I hope that means the members will acknowledge that as the Budget Debate continues and certainly when it comes time to vote on it.
GARY BURRILL: Thank you to the Minister for those explanations. There’s another part, another line of concern that emerges out of that data which has to do with people in Nova Scotia, their own self-analysis, their own self-understanding of their health, going back over the recent number of years. One of the things that the comprehensive statistical analysis has pointed to is that the number of people who perceive themselves to be in not as good health as they had been, is increasing and the number of people who perceive themselves to be in good health or improving health has, in recent years, been going down.
I want to ask the minister if he is aware of trends of this nature and what would be his explanation about these outcomes.
RANDY DELOREY: Again, I am just looking at the document that is tabled. I believe I’m looking at the correct table. It shows the indicators of perceived health, very good or excellent; perceived health, fair or poor. I believe in the member’s statement it was that there was a trend over the last number of years, I believe is what was stated. But if you actually look at the data, Mr. Chair, it goes back to what my very first comment was, about looking at this data set.
The data shows in fact perceived health as being very good or excellent, actually increased from 2016 to 2017 and decreased in 2018, while perceived health being poor, again, decreased and increased. Again, it shows variability, not so much a trend when you have only three years as data points, and not every year has been consistent. It has gone up and gone down.
Again, I think we just don’t have the full data set to draw the conclusions that the member has made, suggesting that this shows a trend. It does show data and data is important and over time you get sufficient data to actually be able to establish those particular trends.
GARY BURRILL: This is surely a very important way of evaluating how we’re doing as a province in health and wellness - is it the minister’s view that self-perception of healthiness amongst the people of Nova Scotia in recent years has been improving?
RANDY DELOREY: What I’ve articulated is the data set, which I assume - I’m not sure what the source of the survey was, so again I’m just basing it on the data that the member has tabled and was the foundation for his questions.
What I am saying is the perception is variable. In one year it has gone up and in one year it has gone down. That is about as far as I can draw an actual conclusion from the data set that has been provided here. Again, that’s without having any further details about this particular set of data.
GARY BURRILL: Thinking along the lines of similar, parallel areas in health care that speak to general population health, thinking about the area of diabetes. In the minister’s view, in recent years, are we doing better on the diabetes front in Nova Scotia than we had been, or are we losing ground?
RANDY DELOREY: According to the data that the member has tabled, in fact we’re doing better in 2018 than we did in either 2016 or 2017.
GARY BURRILL: I’m asking just in the life of the Department of Health and Wellness. I’m trying to think about these key areas - life expectancy, infant mortality - one key area, surely, is diabetes. When the minister evaluates the government’s work, and, surely, this must be a metric that is before the department and before the minister. In the minister’s own view, are we in a better place today on diabetes prevalence in Nova Scotia than we were, say, seven years ago?
RANDY DELOREY: I’m not sure what the status was seven years ago, but, again, what I can say from the data that’s here before me that was tabled by the member opposite, we are certainly in a better space than we were three years ago.
GARY BURRILL: Am I to take from that that the minister does not have a sense of the department’s own, and his own, whether in the current period we are gaining or not gaining on the diabetes front?
RANDY DELOREY: What I don’t have, again, here for Estimates Debate is the data that would provide that information. As I’ve indicated, much of the conversation has been based on the foundation of the document and the data that was tabled by the member. Diabetes was one of the variables that was assessed by Dr. Kirk on behalf of the New Democratic Party, and that data was assessed for the years 2016 to 2018.
To the member’s question, over that three-year period, the data that I have on hand does clearly show that 2018, at the prevalence rate, is lower than either the years 2016 or 2017. Broadly, on diabetes as a specific disease, it is an area that I’ve had briefings and conversations about during my two and a half years tenure as Minister of Health and Wellness. I had that conversation recently enough to delve into more detail. As to our absolute longer-term data, no. Most of my recent preparation and focus has been on the budget details for the Department of Health and Wellness.
If the member wants to delve into more information as to the longer-term progress of diabetes as a specific disease or health outcome, that’s something that, certainly, we could delve into and pull some of the data that we do have and make that available to him or his caucus. It’s just not information that I have specifically here at my fingertips.
GARY BURRILL: Thank you for all these considerations about these important indicators of provincial population health, and particularly about regional variation in that. With the short time that we have left to think about these things, I’d like to just switch gears a little bit and ask the minister a question or two about the funding formula for health care and our relationship with the federal government.
The minister is aware of the long-standing discussion in our relationship with the federal government about the need for a funding formula that does more than recognize per capita foundation. A funding formula that can take account of our dispersed population, the greater costs of serving a dispersed population and, of course, the greater costs of serving an older population, not to speak of the greater costs of serving a population that in comparison to the national average has lower income.
This is a familiar and long-standing conversation in Nova Scotia, and I want to ask the minister for his own view. Is his view that, in order to have comparable health services here to the rest of Canada, we need to have a funding formula that recognizes more than the present per capita basis for these calculations?
RANDY DELOREY: As the member has noted, we do have a funding formula in place with the federal government. I should say the federal government has a funding formula, the Canada Health Transfer. That base funding is established, a 10-year agreement. I think we’re in year four? Year three or four on that funding agreement. The foundational component on that health transfer is the traditional funding line that they have.
In our negotiations, we did secure bilateral funding with the federal government that recognizes two very key priority areas that are shared between the government of Nova Scotia and the federal government. Those areas are mental health and addictions, and continuing care and community-based delivery. These areas, and the additional funding targeted to these two areas, I believe, was something we were able to leverage to recognize the needs of our population.
The funding allows us to expand our investment in these two priority areas in ways that recognize the needs of our population. Certainly, when the opportunity presents itself, I continue to make the case, as do my Atlantic colleagues. We believe that having a national health funding formula that more broadly recognizes the health needs and health outcomes within the population is perhaps a better formula and approach than population based. But at the present time the funding being provided by the feds is base funding with defined increments over the 10-year period, as well as the target funding in the areas of mental health and addictions, and continuing community care.
GARY BURRILL: I’m interested in the minister’s thinking about this at a basic level. In the minister’s view, are there negative implications for the present budget which come from our operating on a system of per capita based transfers?
RANDY DELOREY: I believe what we have in place is a health care system which we have invested a record amount into, which means that between our economic growth as a province, as well as the investments provided by the federal government through federal programs like the Canada Health Transfer, we are in a position as a province to expand our health care funding, target priority areas with new and innovative programs, stabilize and expand existing programs and services, as well as invest in other very important social programs and services with funding that does not rest in the Department of Health and Wellness, through Departments of Education and Early Childhood Development, Justice, Community Services, as well as the Department of Municipal Affairs and Housing, and others.
This budget, as the Minister of Finance and Treasury Board introduced just yesterday, during her speech stressed many of those positive investments, as our discussion over the past hour now has focused on, they are very important. I do sincerely thank the Leader of the NDP for bringing to the floor of the Legislature, a significant, focused discussion on the social determinants of health and the important role that that plays in health outcomes for Nova Scotians, for drawing the attention there.
Again, it provides the opportunity for us to say on the floor of the Legislature that we can agree. We agree that social determinants are an important factor. That’s why as a government we are investing in areas to address them. One of the things, though, about investments in those foundational areas is that you don’t necessarily always see the immediate results in investments in social determinants.
The pre-Primary program, this is a generational investment. Those positive outcomes that the Minister of Education and Early Childhood Development spoke about that I referred to, those come over the lifetime of that child, who will have a higher probability of really changing the trajectory of his or her family and the next generation. This is what the funding and the investments from Canada Health Transfer has helped the province . . .
THE CHAIR: Order. The time for the NDP caucus has expired. Now to the PCs.
The honourable member for Pictou West.
KARLA MACFARLANE: Thank you very much, Mr. Chair. I just want to offer the minister and his colleagues an opportunity for a break or for yourselves before we begin again? Do you need five minutes or anything?
THE CHAIR: Everyone good? Everyone on this side good? Yes. Let’s do it.
The honourable member for Pictou West.
KARLA MACFARLANE: Thank you very much. Continuing on with doctors, I know that recruitment efforts from 2016, the province has seen 440 new doctors. Can the minister tell me how many doctors actually retired? How many doctors departed for other reasons?
RANDY DELOREY: We’re just endeavouring to track that down. I don’t have it at my fingertips but what I can indicate is, I believe, the most recent national data from CIHI or Statistics Canada - I can’t remember the source, but we’ll be looking that up - does show that continued net improvement for Nova Scotia. I believe of particular interest to the member’s colleague - I have too many papers.
I know the member’s colleague, the member for Inverness, has frequently asked that same question but very localized to Antigonish. For the last two fiscal years, it does show the net increase. Physicians actual starts - this does not include the number of physicians that are slated to start - and actual physician departures: over the last two fiscal years, up to Monday, there were net one new specialist in Antigonish and net two new family physicians.
So again, that supports that general notion that the recruitment efforts of the province are making improvements. Antigonish is just one example because I know that specifically the member for Inverness, during the last sitting, had made explicit reference to that and the concern about the number of physicians coming in versus coming out. I figured I would be proactive, since he asked on at least two occasions to table that document, that does show net three new physicians - one specialist, two family physicians - over the last two fiscal years in the area of Antigonish.
KARLA MACFARLANE: To be clear, is there a document that perhaps the minister can table later in Estimates for the whole province, showing doctors that have been recruited again? We know there has been 440 since 2016, but is there actually a way that his department gauges those that depart?
While I’m asking that question, can the minister tell me, as well, why are we not having mandatory exit interviews?
RANDY DELOREY: As I noted before, we’re looking to see if we have the data in the broader sense on the provincial level to share with the members, so if I get it during Estimates I will certainly table it, as well.
I guess one of the challenges that I think has been noted with some departures, and again the absolute numbers is the way people measure. When physicians operate as independent practitioners there are two ways that we generally measure their participation. One is through billing. We know they’re an active physician if they’re billing the province for their services. The other variable is whether they’re carrying a licence with the College of Physicians and Surgeons.
I know the variability of the number of licensed physicians is publicly available on the College of Physicians and Surgeons’ website. That is readily available to tell all Nova Scotians the number of licensed physicians in the province.
Again, when you get into service delivery of physicians, that’s where billing information more accurately reflects, because they can be licensed and not practising. We delve into that space, as well. Someone may reduce or retire their services but maintain their licence, so that doesn’t immediately trigger an awareness of their retirement. So there is work.
The other question the member asked was not just about getting the data, the information, but (Interruption) Oh, the exit interviews. Again, Mr. Chair, that becomes one of the challenges with exit interviews. The Nova Scotia Health Authority has certainly been directed, when they become aware, to reach out and offer to have the exit interview with the health care providers, particularly physicians.
Ultimately, physicians, as I just mentioned with the licensing and the billing piece, are not employees in most instances, so there is no direct means or mechanism for the Health Authority to mandate the physician to have an exit interview.
The offer is made. The hope would be that physicians who have input would take that time. I think an exit interview is a very good practice to have. An exit interview, one shouldn’t automatically assume reflects negativity. In some cases, people exit their field just because of general retirement, it’s just that point in their life when they’re just winding down their practice or their work, which happens in every industry. In some instances, it’s people who want to pursue different opportunities. In some cases, they may choose to pursue an administrative type role as opposed to a clinical practising role. They may choose to pursue an academic role, or they may just choose to pursue an opportunity elsewhere.
Having a better understanding of what draws a physician out of active care delivery in the province, whether they stay, they retire, they just shift their career within the province or they choose to pursue opportunities outside. That is always helpful for us to know and I certainly hope that physicians would take the Nova Scotia Health Authority up on offers to complete exit interviews when they identify that they will be wrapping up their services in the province.
KARLA MACFARLANE: I think it would be worthy to make exit interviews mandatory because I think that the opportunity is there for the employee to express their years of service - whether they’re long term or short term, good, bad - it gives us an opportunity to collect that data, see what we don’t have to improve on but also gives us an opportunity to improve on those things that may be pushing allied health care professionals away, out of the province and into other provinces. Sometimes even out of the country.
I want to focus now on nurses. In the budget speech I recall the Minister of Finance indicating that we need more nurses. I wonder if the minister can identify why? Is it because of retirement reasons or some other reason why we need more nurses? I have actually been contacted by a few nurses that have recently graduated, that can’t find work in this province. Sadly, they’re heading to the U.S. and it’s just frustrating and hurtful when we see them have to leave the province that they don’t want to leave.
RANDY DELOREY: As I expressed in my response, I think the member and I are in agreement as to the valuable opportunity that exit interviews provide for both the Health Authority and the province broadly but also that opportunity for the health care provider, the physician, to share both positive and if they have constructive feedback. I think that is a good opportunity for both and I would certainly continue to encourage the Health Authority to continue making the offers to conduct exit interviews and I certainly encourage health care providers to take the Health Authority up on those offers.
The question around - I’m not sure what the specific was - on the nurses. The member mentioned she recently became aware that was something that recently came to my attention. It’s a topic that I’ve discussed with both the president of the Nova Scotia Nurses’ Union, as well as the CEO of the Nova Scotia Health Authority. In fact, we had a joint discussion and that was one of the topics that came up just within the last week or so.
Certainly, key players representing both nurses, as well as the Health Authority, to delve in to understand where the disconnect came from there. I want to let nurses that are graduating know that there are jobs in the Province of Nova Scotia. There are jobs with the employers within the Nova Scotia Health Authority. Recently I’ve heard that three of the graduating nurses, I believe, are going to Canso. A year ago, Canso was unable to recruit registered nurses to the Canso community, a beautiful community that it is. I understand that in this year’s graduating class there are a number of them going down to Canso. I’ve heard anecdotally, I don’t have direct confirmation, but I have heard from community members that they’ve heard three nurses will be going to that community, so it does show there are job opportunities.
Also, to let nurses know that the job opportunities are not limited to just the Nova Scotia Health Authority. Long-term care centres throughout the province look to have registered nurses within their facilities, as well as the VON. So there are other employers besides just the Nova Scotia Health Authority where our registered nurses within the province can find employment.
KARLA MACFARLANE: Are there any current incentives or bonuses for nurses to remain in Nova Scotia after they graduate?
RANDY DELOREY: The Nova Scotia Health Authority, I’m not sure the full extent where they have them, but I do know that in hard to recruit areas, there are at least some incentives. I made reference to Canso and the challenges recruiting to Canso. There was a signing - I don’t know if it’s what they formally call it, but essentially a signing bonus - that the Nova Scotia Health Authority was providing to attempt to attract nurses to that region. I believe last year when they reached a critical level of nursing shortage within that community, the municipality also stepped up to provide some compensation. That was a decision made by the municipal unit, not one that they were asked; there’s no expectation of municipal units. In that case there were two sources of incentives for nurses to go to an area in high need and having difficulty recruiting. What is the full range of communities that have active incentives? I don’t have that information on hand.
KARLA MACFARLANE: I’m wondering if the minister can refresh and update me on having nurse practitioners in our ER departments. I think it was about a year ago, perhaps, there was a pilot project that was starting to ensure that every ER in the province, eventually, would have a nurse practitioner. I’m wondering how many currently have a nurse practitioner and if there are plans to ensure that all ERs across our province have a nurse practitioner to make it consistent and fair?
RANDY DELOREY: I thank the member for raising the question related specifically to nurse practitioners. They provide a very valuable role in our province. We’ve seen an expansion in the opportunities for nurse practitioners, as per our earlier conversation, in primary care, and now, as the member is noting, in emergency departments.
One of the pieces with nurse practitioners is on a relative scale. The opportunities were not as prevalent as they are today, so you run into a supply and demand challenge. We have to manage our expansion along with the availability of supply of nurse practitioners to provide the care. We do have some opportunities - I think Digby is one of those communities that started with a nurse practitioner in the emergency department, providing lower acuity for the responses that were within their scope of practice - to help support. Again, one of the constraints on our ability to more rapidly expand opportunities for nurse practitioners is the actual supply of nurse practitioners.
We continue to support nurse practitioner training through the Dalhousie program. We expanded the number of seats the other year. We also put in an incentive program where an existing registered nurse would continue to get some funding while they completed their nurse practitioner upgrades. I don’t know if it’s clinically referred to as a master’s, but it would be similar to completing a master level of study on top of their registered nurse degree. We provide that compensation, but that comes with the return of service to an underserved area. In that case, we’re predominantly focused on rolling out in underserved areas for primary care.
We’ve been having challenges with both physicians and other health care providers through this training program and incentive, which had great uptake. It’s been able to support those other physicians and communities and provide additional support in the primary care space. Specifically to the emergency department, I made reference to a recent meeting with the president of the Nova Scotia Nurses’ Union and this was a topic that has come up, as well. I just really think supply and demand is the bigger challenge there. The opportunity and the potential role is recognized and acknowledged, but we wouldn’t want to see a situation where we expanded opportunities without the supply to fill the positions, only to see nurse practitioners who had been providing primary care move into emergency departments, and then were not having a net benefit to the system if a nurse prefers a different work environment. So, it is a challenge to strike the right balance with the available supply to maximize the roles that they play, to maximize the health outcomes for our province.
KARLA MACFARLANE: Just a thought that came to my mind is that perhaps if we had enough doctors for every Nova Scotian, then we could take the nurse practitioners that we all have and put them in the ER and be consistent across this province because I know that was originally the plan, to make sure that we had a nurse practitioner in every ER, and they are valuable. I know there’s a lot of great comments on nurse practitioners and where they are servicing Nova Scotians in ERs.
I would like to ask, with regard to the Aberdeen Hospital in Pictou County, a regional hospital, have there been any recent discussions with regard to getting a nurse practitioner full-time in that ER?
RANDY DELOREY: I haven’t had specific discussions about Aberdeen Hospital, but as I remind the member, the operational work at each individual hospital does fall within the purview of the Nova Scotia Health Authority. So, while I haven’t necessarily had direct conversations, the Nova Scotia Health Authority operationally would evaluate the needs of their various communities and the hospitals within those communities and, of course, have to make the decisions to prioritize the resources they put in place. That’s not a conversation that I’ve had but that doesn’t mean that the organization either has or has not had, it just means that I personally was not part of any conversations about specifically nurse practitioners at Aberdeen ER.
KARLA MACFARLANE: I thank the minister for his answer. Going to 811 services, I am just wondering if the minister can tell me how many patients were actually served by the 811 service last year and perhaps, as well, what the total cost of 811 was?
RANDY DELOREY: Just for clarity I want to make sure we are referring to the 811 telehealth program as opposed to the 211 Need a Family Practice Registry. Okay, just give me one second to doublecheck the data.
Just to maximize the time for the member, we’re still looking, and I don’t see it readily in the index of the books or data we brought with us. So, if the member wants to move on, I’ll make note and see if I can track it down and maybe pick it up because I am going to go with the assumption we’re going to be back here tomorrow having this conversation.
KARLA MACFARLANE: So, I believe the cost is close to $6 million. What I really would like to know is, is there going to be an additional financial increase in that number, and out of that number I’m wondering how many are actually employed?
RANDY DELOREY: I guess the challenge that we’re having here is the way that the data - particularly the financial end data - gets rolled up for Estimates. The 811 program is rolled up in a line item that’s referred to as, I think, Provider Services. It’s one of the challenges within the health care system and the way that we connect to health care providers. That’s why we have a broad number, but it’s not pulled out specifically to the 811 system. When the member was asking about employees, was she referring to the number of nurses and employees employed by 811 to deliver the service? The 811 cost - the member mentioned $6 million; I think it’s closer to $5.5 million.
KARLA MACFARLANE: Thank you. So, when we call that number, I just want to confirm, is it only registered nurses or are there any allied health care professionals that are also hired to work under this service? Is there any data that you’re gauging to see - when those calls are ended, how many of those patients on the line are told to go to their doctor or to the ER? Do we have a number of how many are actually told that?
RANDY DELOREY: In fact, we did complete a fairly comprehensive report last year on the 811 system. That report was made public, as posted on the website. I don’t recall what the absolute number was, but I do recall it was an interesting report, building on the previous questions by the Leader of the New Democratic Party and the data set that he provided.
Some of the surveys showed that - the survey questions being perception - and in the report it did show that some of the questions were about the perception of health care providers and the 811 services being delivered. But it also did have more absolute data, such as when a patient was recommended to go to an emergency department. Did they go or did they not go? In some instances, they called and they thought they were going to go to a doctor in an emergency department.
Basically, the question the member asked, as I understand it is: Do we have data that shows whether patients who call in follow the advice of 811? Again, there was that comprehensive report that was completed last year that does show that it has had a positive impact, that people do generally follow the direction. The individuals who call 811 first and are referred to an emergency department tend to have more acute health care needs when they show up at the emergency department than the average population and they generally do follow the advice of the 811 provider. Not in all instances, of course, there’s some variability there. There are people who intended to go to the ER when they called, and they were recommended not to go. Some, but not all, follow the advice to wait until the next day, go to walk-in clinic or their primary care provider. Others called with no intention to go to a health care provider and they heed the recommendation of the referral.
Again, I guess for the sake of value for anyone who has never used the 811 system or is not super-familiar, we had a health situation in my family a few years ago. We didn’t know how to respond to it. We called 811. My initial thought and assumption would have been to go to the emergency department, based upon the symptoms. They provided a lot of valuable information that helped us get through that particular situation. It didn’t require an emergency visit, but it was the right clinical recommendation. We were able to proceed through the next day and follow up with a health provider. It was right, there was nothing clinically that could be done to address that particular situation - it was just a natural thing that time would process.
The point is that just reaching out, the advice they give is clinically accurate advice. It does, I think even as a new parent where it was often - again a personal experience - used particularly for that simple thing of when is that temperature so high that you should go in with a newborn or a young child. Data that you should know, but with the time between fevers you sometimes forget.
Again, I do believe that the service, both from my personal experiences but also the data from the report that was conducted last year, does show that it does play a valuable role and the people who use it, like myself, do value the services provided.
To an earlier question, I think the member wanted to know, Mr. Chair, how many people were serviced. For the last year we have, fiscal 2018-19, we know that just under 91,000 patients were serviced through that system.
KARLA MACFARLANE: I believe the minister is indicating that this is a worthy investment. I’m wondering if he can confirm, are there are any discussions around adding to this service other allied health care professionals? Right now, we have registered nurses who are on another line - are we thinking about adding a dietitian or a physiotherapist? Are there any other allied health care professionals that you are discussing right now in your department that you may add to the 811 service?
RANDY DELOREY: Certainly, we do leverage the services of the 811 system to support other areas. For example, we have a smoking cessation program that we run through the 811 program - I believe gambling support as well runs through the 811 system. Mr. Chair, these are examples where we do leverage the system to deliver programs.
To the member, I am not aware of, again, I guess a dietitian-type of program; I don’t recall that stream. My response, Mr. Chair, I guess is we do recognize the opportunities to deliver programs other than its original intention, which is for kind of immediate clinical care, but to run other types of programs through that service offering and we leveraged them.
The member’s question around dietitians is just an example. I don’t ever recall anyone mentioning or suggesting that, but I think it might be worth actually endeavouring to inquire if anyone has thought about that because just off the top of my head I can think of some potential value there.
Again, just to answer some of the specific questions quickly - I think the first question the member asked was: How many employees or nurses at 811? There are approximately 45, those are both full-time and part-time nurses supporting the system. There are three types of staff who are there - associates at the front line, the counsellors, and of course the nurses themselves. There are counsellors as part of the 811 system, again gambling support and smoking cessation. Dietitians are not one that ever came up but certainly something as future program expansion I’d certainly raise the question. But, again, it has to be prioritized amongst all the other programs and services being delivered within the program.
KARLA MACFARLANE: We’re living in a modern world, things are changing quickly, and virtual health is becoming something we all want to happen too. Can the minister clarify - we’ve had residents who had to go outside of the province for medical care which the Province of Nova Scotia paid for because they couldn’t receive that care in this province. We allowed them to go - most recently I had a resident go to Boston to get an eye operation and it was covered. It was a good process of us working in order to get that to happen for her and I’m grateful that the system allowed that to happen.
My frustration comes from those that don’t have a doctor or any primary care. Why wouldn’t we consider a system something like Maple - and I’m sure the minister is very familiar with that system. I do have residents who use that system but they have to pay for it themselves. I think that’s wrong; I think we should be covering that. Can the minister just maybe give me his opinion on why we’re not covering the cost for a Nova Scotian to receive virtual care from, for example Maple, but we allow others to go out of province and receive care and we pay for it?
RANDY DELOREY: A little bit to unpack there because they’re not exactly the same, I don’t think. In one instance the notion of receiving out-of-province care, if you’re trying to do the comparison to Maple perhaps, you know we’re talking a primary care setting or services certainly Nova Scotians are able to get out of province if they happen to be in another province. Nationally we do have reciprocal billing arrangements with our sister jurisdictions that the MSI coverage does cover Nova Scotians in other parts of the country for care.
To that end, if you’re talking specifically just to primary care in other health services if you’re out of province, that care is provided and you don’t pay out of pocket - it’s reciprocally billed through the provinces; we deal with each other. Just like people from other jurisdictions will receive care in Nova Scotia, we just work out the net balances at financially between the jurisdictions. So, it’s seamless for citizens.
I think the example though that the member described, without knowing the specifics, of going to Boston for a particular eye surgery or treatment, that is likely a clinical service of a specialized nature that’s not provided here that was clinically necessary, that met the clinical requirements for care that we couldn’t provide here in the province. There is a process, but it wouldn’t be the family physicians that provide that referral, it would be a specialty service that goes through and would require the specialists to make the clinical recommendation for a patient. They do that through MSI.
Again, roughly, it should be seamless for the patient if the specialist is making the referral that meets the clinical criteria - it gets evaluated and they just have to make sure they submit that prior to actually following through. Again, just an example of a service that’s not provided here is lung transplants. That’s a particular service that is only provided at a limited number of places across the country. There wouldn’t be enough of them conducted in the province to be done safely, so it is clinically more prudent for us. I believe we generally have patients go to Toronto to receive that particular service.
Moving away from the notion of out-of-province health care services, into the notion which we talked about in our last conversation an hour and a half ago, is the notion of virtual care. What the members raised when mentioning Maple is private third-party service providers for the health care delivery. It’s certainly something we’re aware of, something we’re evaluating.
As was asked in the discussion before, what are the virtual care options for Nova Scotia? Between 2016 and now, a lot has changed. That would be an example of services that have advanced. We also have challenges with internet connectivity, so if we’re going to roll out services that are delivered and require broadband internet services, we need to make sure that residents have access to that to ensure that it’s available to our citizens.
It’s great that the Province, through the Department of Business and led by Develop Nova Scotia, has set aside almost $200 million to help expand rural broadband internet access to ensure that citizens will have the infrastructure in their communities to participate in advancements and technology, whether it’s for their work, for their play, or even for their health care.
These are relatively new services. We need to make sure that as we are evaluating them, when we pull that lever we make sure we do it properly to avoid any potential unintended consequences of pursuing a particular path. This would be a significant disruptor within the current health care environment and it requires a lot of consultation and engagement to ensure what model would be best suited, whether it’s going to a private third party or engaging with our existing physician population and providing them the tools to deliver virtual care within the province.
KARLA MACFARLANE: I want to move on to the construction of the dialysis unit that is going ahead at the Halifax Infirmary. I’d like to know, or have an explanation, of how we got to the expansion of being six chairs - what kind of meetings were held, consultations, and perhaps even stakeholders, to determine that it was six chairs that the expansion would include?
RANDY DELOREY: As the member knows, we’ve done reviews on the needs for dialysis. Most of that attention has been on more rural settings and creating or expanding the number of seats. That work was done before my time in the Department of Health and Wellness. As part of the QEII redevelopment and the refreshment of infrastructure here on the peninsula, and the expansion out to Bayers Lake as well as in the Dartmouth General, the Nova Scotia Health Authority, engaging with clinicians and health care providers and evaluating the existing infrastructure, came up with a need for a dozen seats in the HRM area.
Six seats in Dartmouth General and six seats here on the peninsula was the clinical recommendation, to have a dozen new seats in the Central Zone/HRM region. Based upon the space, availability, and configuration and demands, that’s how we landed on six in Dartmouth and six over here on the peninsula.
KARLA MACFARLANE: I’m curious about the expansions in Kentville, Digby, Bridgewater, Glace Bay, and Dartmouth. If you could let us know how many chairs they are receiving and, perhaps you can’t provide the information today but we’d also like to know what the cost per location of those areas I just mentioned, what the costs will be. Perhaps you would have the number of chairs that each of them is receiving.
RANDY DELOREY: Again, the decisions around the bulk of the dialysis expansions were made before I came into the role of Minister of Health and Wellness, based upon a report and work that was done analyzing where the best locations for either new sites or expansions, based upon the system. Those seats, many of them are coming online, we expect, in the 2021 fiscal year.
The total number of additional dialysis stations that have been announced as being added is 42. They are: Digby, six stations; Kentville, 12 stations, including the replacement of six in Berwick, so it was deemed to be more appropriate to have Kentville with 12 than the six in the Berwick site; Glace Bay with six new stations; Dartmouth with an expansion of six stations; Halifax with the expansion of six stations; Bridgewater with 12 stations that is currently in the design phase.
The cost estimates: the total projected cost for the Dartmouth General dialysis is about $7.75 million, so $7.75 million is the budgeted cost or expected cost for the Dartmouth General Hospital; for Glace Bay it is about the same, $7.7 million; Digby General, yeah, so they are about $7.7 million each for the projects.
The Halifax Infirmary, we are at the early stages, just moving into the design at this point, is about $300,000 but again, that is almost completed so we’ll have an additional investment for the actual construction once it gets to that stage.
KARLA MACFARLANE: So, it sounds like the past Minister of Health and Wellness, now the current Minister of Communities, Culture and Heritage, it was under his direction for these areas to receive chairs.
My concern is that Pictou County has over 46,000 people and we have four chairs. My colleague from Pictou Centre and my colleague from Pictou East and I, all three of us, for the last seven years have been standing in our place, requesting to be at least reviewed, to be considered. We have people travelling to Halifax and other locations to receive this life-saving service; I have a man who is 87 years old. It’s not right, it’s not fair. Sadly, we actually even have the space in the Pictou hospital to have at least another six chairs, maybe even more.
I’d like to hear from the minister what the plans are to increase the dialysis chairs from four to whatever number, at the Pictou hospital.
RANDY DELOREY: I believe the process that was undertaken included a report and some recommendations from the clinicians to identify and prioritize the recommended locations.
Yes, under the leadership of the previous Minister of Health and Wellness, that proposal was brought forward for funding but the origination of the proposal would not have been at the ministerial level.
These are business plans and recommendations that come from clinicians. I know that certainly the member for Argyle-Barrington, both the previous and current, have asked about the dialysis in their communities on a regular basis, much like the members from Pictou County have, as well.
My response remains the same. These projects that are currently under way, as I’ve said in the past, we need to get those implemented, establish the change that that has to the care and the travel patterns - the necessary travel patterns for those in the surrounding communities - to help inform the next phase of review for dialysis. There was a review that was done a few years back; that review informed a proposal for new and expanded dialysis sites. Those were the sites that were assessed and approved projects moving forward. We need to get these chairs up and running. That has been the focus and the priority that we’ve had.
When we are done, this is the year we expect to see the earlier projects come on stream, which I think means we are nearing that point where we will move to the next phase of consideration for dialysis stages but we’re just not quite at that point in time yet. This is a significant amount of funding, not just for the capital investments, but also the ongoing operational investments that are made, so, we need to make sure that we are doing so. Making these investment decisions are very important - as the member rightly noted - very important life-saving investments in dialysis.
It is also worth noting that some of that includes home dialysis treatment options and evaluating what, if any, changes are necessary in our nephrology program to help facilitate and support Nova Scotians who may find that home dialysis is actually right for them - both clinically and otherwise. There are many positive benefits for being able to have home dialysis units established; we don’t need them in large hospitals and so on. In many cases, you can actually have the dialysis run while you are sleeping, so it really gives a dialysis patient their life back.
Unfortunately, it doesn’t serve all patients, but for those who may be eligible, it’s an area where I would like to see some further work and opportunities pursued because of how significant the positive outcomes can be for those who are eligible. Just looking at us on a national basis, we lag behind most of the country for the adoption rate of home dialysis.
So, again, chairs in hospitals aren’t always the only solution. Some of them are actually supporting people in their homes, as well. That’s where I think the next review is likely to focus, is a combination of not just the provincial lens in terms of provincial sites, but also opportunities for home hemodialysis, as well.
KARLA MACFARLANE: So, with regard to the Sutherland Harris Memorial Hospital located in Pictou, there are a number of changes that will be happening with our new clinic that is being built. It is going to provide an opportunity to expand perhaps blood collections, or the veterans’ unit, or our Restorative Care unit or, again, maybe our dialysis unit. So, with this extra free space that we are going to have located at this hospital, I am wondering if the minister has any plans himself for this area, this free space that we are going to now have?
RANDY DELOREY: Just looking for clarity. Which site is the member referring to?
KARLA MACFARLANE: The Sutherland Harris Memorial Hospital, and again we’re moving our clinic out of the hospital; we’re having a new one built. It’s delayed, but my understanding is that it will definitely be ready by September. This is going to free up a whole lot of space in this hospital and I’m wondering what discussions have been taking place to ensure that we can still use that space?
RANDY DELOREY: I thank the member for the question. That again, as I’ve noted in the past, is operational work with the Nova Scotia Health Authority to establish that clinic as well as the work that they would have with their hospital space at Sutherland Memorial. I’m not aware of any plans proposed by the Nova Scotia Health Authority at this point for that space.
That doesn’t mean that they’re not prepared with their own operational plans but as far as when they would time that to bring forward for budget consideration, I think their focus is likely on getting the new project completed so that they make the changes. Then they would know what and how they would want to make use of any excess space that they would have within the Sutherland Harris site. But at this point, there’s nothing that I’m aware of that would suggest new programs within that particular site.
KARLA MACFARLANE: I know the minister has seen me stand in my place and ask often about the veterans’ unit that is located as well in the Sutherland Harris Memorial Hospital. We’re all aware that there’s a federal component to our veterans’ units.
We’re all aware as well that policy on a federal level states that these units are not to serve anyone beyond the Korean War, which is something that I have been advocating to change since 2013. My understanding is that it’s being reviewed and perhaps these changes will come.
Currently, at the Sutherland Harris Memorial Hospital where the veterans’ unit is located, there are 20 beds; right now, we only have 11 veterans. Often, I complain about having these empty beds that are not being utilized and, of course, we could be utilizing them. I’m wondering if there have been any recent conversations with the minister’s federal colleagues on changing policy and ensuring that we are using those beds for not just our veterans, but perhaps opening them up as community beds as well.
RANDY DELOREY: Indeed, the member has correctly noted how the veterans’ beds, particularly in the long-term care space, are configured. That would be a similar situation in many communities across the province. The federal policy on how they define veterans for eligibility for the beds - for which they pay the Nova Scotia Health Authority to provide or reserve those beds - is the purview of the federal Veterans Affairs Department.
I haven’t had a recent conversation but certainly at the staff level it is something that we think is timely. It is part of our broader work in evaluating opportunities, to ensure availability of long-term care beds in communities where they’re needed. We are evaluating many different options; some are building and expanding.
For example, in Meteghan, with the announcement to replace that particular facility, we took a broader look at what the anticipated demand for the region was and we added additional beds. So that it’s not just a replacement, it’s a replacement plus some additional beds.
It’s the same sort of thing in Cape Breton. When we did the redevelopment, we were doing the analysis of what the long-term care requirements would be and we built in the additional beds. That’s on the kind of more traditional building new beds approach. We also have been working to identify other opportunities, as I said, around things like Veterans Affairs beds.
We certainly don’t want to prevent veterans, and that’s where, you know, these conversations get challenging. We want to make sure that they continue to have access to the care that they need, when they need it, So, again, we want to enter those conversations carefully because we don’t want to have unintended consequences. But, as I said, the work of the department and our continuing care team I think has shown some ingenuity.
A prime example is the announcement we made in the Fall respecting the conversion of vacant residential care facility beds here in Halifax - 30 of them - into long-term care beds. These were beds that were essentially chronically vacant at the RCF, a lower level of acuity care, were going vacant. It was significantly cheaper and faster to have that particular facility renovated and transitioned to be licensed as a long-term care.
In that particular instance, that facility was relatively new and was, by and large, built to the long-term care standards. So, it’s not something that all RCFs that have vacancies would be able to do easily, but when we saw the opportunity and had a willing partner, we pursued it. That means we will have 30 additional long-term care beds coming on stream in Halifax, I believe as early as the end of this fiscal, that is the end of March 2020.
KARLA MACFARLANE: I’d like to continue on with some questions around the veterans’ unit because it is a big concern of mine. It’s a great service that’s there and I know that the minister is not going to have time to answer my next question so I think I will just possibly take my seat and we will move on. I will continue on when we start again.
THE CHAIR: The time for the Progressive Conservatives has expired. Now on to the NDP for 23 minutes.
The honourable Leader of the New Democratic Party.
GARY BURRILL: Thank you, Mr. Chair. Same story. A couple of minutes break? No?
RANDY DELOREY: Thank you, Mr. Chair. I appreciate, and I think my colleagues here appreciate, the offer of the Leader of the NDP, but unfortunately, they don’t seem to enjoy these seats in this Chamber as much as we do. They want to just keep going and wrap up this evening as soon as possible.
GARY BURRILL: Well, there are certain kinds of jobs where if you just put your head down and go, it works out a little easier; it might be one of them.
Well, with some of the time that we have left to conclude your marathon here this afternoon and this evening, I’d like to go back to where we left off thinking about the impact on the province of the federal-provincial funding formula. I had been asking about the minister’s assessment of whether, in fact, we need something other than the present formula and the minister had reflected some on that.
I’d like to ask in a more focused way about this particular Health Budget. Would the minister say that the impact of his government’s having accepted a per capita-based funding transfer formula, has had a positive or a negative impact on the budget for health in Nova Scotia in the coming year.
RANDY DELOREY: Mr. Chair, the agreement for the current Canada Health Transfer, as well as the bilateral funding targeted towards mental health and addictions and community continuing care services, has had positive impacts. We’ve been able to leverage that funding support to expand programs and initiatives in priority areas, like mental health and continuing care, two of the three primary mandated items for this government.
For me, in my 10 years as Health and Wellness Minister, my mandate letter is to be focused on improvements. We’ve been able to roll out programs and supports more quickly than we would have otherwise been able to provide if we didn’t have that targeted funding available to us.
That said, we certainly will continue to have our conversations and express our position with the federal government that we do believe that consideration for an alternative model of funding - one that we think would support all Canadians, in fact - when health care funding dollars are funded in a model that is related to the health care needs or challenges, as opposed to a per capita basis. We’ll continue to have those conversations at the national level and hopefully move forward to achieve, but in the meantime, we certainly appreciate the funding program that we do have.
Again, it is more funding than we would have had under the previous federal government because this government agreed to provide us additional targeted funding within our priority areas. These are areas that the health of our population needed; the commitment to target and focus on continuing care that reflects and recognizes one of the primary health care needs of our aging demographic here in Nova Scotia.
GARY BURRILL: Thank you for that answer to the minister. It is certainly not a peripheral thing to be asking about, we have so many areas of concern in health care policy in Nova Scotia. When we pursue the area of concern, we find ourselves back at the question of fiscal adequacy, fiscal competence, fiscal capacity and the root of that, to a great extent, is the federal transfers.
I don’t think there would be anyone who would question the point the minister has made that benefits have accrued from the continuing care and mental health area targeted funding. That’s not what is at issue.
I do think it is a fair question, as we assess together the adequacy of the Health Estimates for the coming year, to ask the minister, is the per capita funding formula with which we are operating presently in our relationship between the province and the federal government, has this resulted in a result which in this year’s budget is beneficial, or a result which is detrimental?
RANDY DELOREY: As I noted previously, the Canada Health Transfer agreement that we entered into, you can’t tease these funding proposals out. In fact, the agreement we entered into is a two-part component: one is the base Canada Health Transfer funding which was, by and large, consistent with what the previous federal Conservative government was going to put in place; in addition to that, we got a new funding commitment from the current federal government in targeted areas that were shared priorities between us provincially and the federal government.
I would say to the member’s specific question about the current Canada Health Transfer program that’s in place, is it better than what we would have had if we didn’t enter the agreement previously? In fact, this is the best agreement we could get with the federal government. It’s better than what the previous federal government was going to provide to a significant degree, particularly in priority areas. Priority areas, one of which very directly relates to some of the demographic health challenges that is our aging population demographic with the support and targeted funding.
The other thing that’s important to note is prior to this agreement there had been a long-standing agreement which did have a higher rate of growth in the transfer. That higher rate of growth didn’t always result in the direct positive health outcomes. One of the challenges with looking at numbers that way and not at the actual areas of care and ensuring that there’s a focused delivery can be that outcomes sometimes don’t get achieved as intended. What we’re seeing with our investments in mental health and addictions, one example: adult urgent care access in the Province of Nova Scotia has gone from 85 per cent - meeting the clinical target time - to 98 per cent of people meeting that targeted time for urgent care mental health services.
That is, in part, achieved by investments that are available to us as a province to share with our health care providers, the Nova Scotia Health Authority. We’re seeing positive outcomes on the basis of that targeted funding that is part of the current Canada Health Transfer. To the member’s specific question, I believe we’ve seen positive outcomes based upon the agreement that we entered into. At the same time, we’ll continue to advocate for a model of health care funding that we believe could be even better than the current model of funding.
GARY BURRILL: Just one other question on the adequacy of the funding formula. Around the time when the minister’s Party was in government the last time, in the 1990s, the portion of our provincial Health Budget that was funded federally was right around 50 per cent; today, it’s right around 25 per cent. I’m wondering, what is the minister’s view of the proportion of the provincial Health Budget that it is appropriate for the federal government to be supporting?
RANDY DELOREY: Numbers are magical things. When you look at the question that the member has referenced, it’s just a proportion of our health care delivery versus the percentage that is directly related to the Canada Health Transfer from the federal government. And looking at it over a period of time, what the member may get lost in just talking about those specific numbers is where we have expanded our health care delivery into areas that are not necessarily explicitly part of the Canada Health Act. One must consider the historical context of our agreements that are in place and the work that we do.
Again, I think what we saw in the current federal government is a recognition that some of the health care needs of the population go beyond simply those defined originally in the Canada Health Act and made available additional targeted funding into new areas, which allows us to expand the services faster than we would have been able to do with provincial funding alone.
Mr. Chair, I think this is reflective of an evolving - which is always important, that we continue to evolve not just how we deliver but the priorities of those areas that we deliver health care services to our population. I’m quite certain that the members of the New Democratic Party agree, for far too long mental health and addictions have not been recognized as a priority area within our health care system - or indeed, within our society - in the same manner as physical health conditions.
I do believe that that has changed. That is a very positive shift. But again, health care is not a system that is so simple as a light switch, that just because you identify the need and the opportunity to do more, you can solve all those problems by just flicking a switch. It does require time. It does require investment. It does require some changes.
That is the path we are on. We are making the investments and we are making investments early - again, back to the first set of questions that the member had been inquiring about, Mr. Chair, that was foundational in the social determinants of health.
Similarly, what you’re talking about is getting back to the root cause, the upstream causes of health conditions. For mental health and addiction, we recognize in the province that most - and particularly more severe - mental health conditions present themselves first in adolescents and young adults. We have heavily targeted our investments towards our youth to provide more opportunities to ensure that we can identify as early as possible and provide the appropriate interventions, as well as the tools and supports that those youth need, so that despite perhaps having mental health challenges, they are given every opportunity to live a healthy and productive life. We know that is possible, provided they have both the necessary diagnosis and support services around them. That’s why we’ve invested heavily in a variety of services, again, particularly targeted towards youth.
It’s done not just in the Department of Health and Wellness, not just with our partners the Nova Scotia Health Authority and the IWK, but with the Education and Early Childhood Development Department and community partner organizations that are supporting us and providing care, like CaperBase in Cape Breton, which actually served as the model for an adolescent outreach that we’ve rolled out in both the Northern and Western Zones.
We’ve seen tens of thousands of visits by those clinicians within those communities. I think over 40 school communities now have visits as part of that adolescent outreach model. I believe we will really see and reap the true benefits of these early interventions and services in the years to come.
That all does tie back to the member’s question about the funding and the supports for the federal government. Again, I do say that we will always, as a Province, champion more opportunities to work with our partners at the federal level to fund the priorities of the Province. Health care is clearly one of them, so we will continue to do that. We will also acknowledge gratefully the support that we do have and the shared priorities and the investments in these areas that we’ve been talking about this evening.
GARY BURRILL: I wonder if maybe I haven’t asked the question with enough focus. What I mean to ask is: Does the minister not think that the proportion of provincial health expenditures that is provided by the federal government to Nova Scotia needs to be significantly greater than it is at present?
RANDY DELOREY: I guess again, numbers become a difficult thing. I could say yes to that and could create an environment where, with no additional money - for example, if there was no provincial contribution, their contribution would be 100 per cent. Simply stating a percentage isn’t always necessarily the best mechanism to establish our funding.
As I said earlier, we appreciate the funding we have, but we also recognize that at every opportunity we will continue the conversation with the federal government to ensure we pursue a funding model. We think that there are opportunities to do more. Would we appreciate additional funding from the federal government? Would we put that funding through the Canada Health Transfer to good use in our health care system? Yes, we certainly would. Will I continue to have those conversations with my federal counterparts? Certainly. I think it has likely been part of the conversation of every Health Minister since the 1960s, when the Canada Health Act and these transfers first were established. Again, I will continue to advocate for more resources to support our health care delivery from our partners at the federal level.
I believe that recently at the Atlantic Premiers meeting, the Atlantic Premiers, including our Premier here in Nova Scotia, did make it publicly known that they would like to see changes in the Canada Health Transfer. Again, as Health Ministers, we continue to advocate for those opportunities, but we are in the situation we are in right now. We as a Province will maximize the funding that we get from the federal government to support the health care needs of the citizens of Nova Scotia. At the same time, we will continue to work with our federal counterparts to make the case for funding that also takes into account the health care needs of our population.
We all recognize that many of the health factors and challenges that we have in the province on a per capita basis are fairly significant. Part of that is due to a multitude of factors, one of which we’ve spoken about already, which is our aging demographic disproportionately impacting the Atlantic region.
Again, of course, we will continue that advocacy, but in the meantime, we’ll continue to make the best use of the funding that we do get currently from the federal government and that which the Province also contributes.
GARY BURRILL: Thanks to the minister for his reflections on that very important question about the adequacy of the funding formula, which impacts so many dimensions of health care, policy, and programming in the province.
I’d like to just shift gears a little for a final question, then. I am thinking about the last Emergency Room Accountability Report that came out at the end of the year and how it indicated that unscheduled ER closures were the greatest single one-year escalation in those closures since this government came to power.
With the pattern of escalating annually unscheduled ER closures, I want to simply ask the minister as we conclude this evening: It had been his view in the past, and I want to check and see if it is still his view now, that the escalating pattern of unscheduled emergency room closures across the province is not symptomatic of a structural health care crisis in the province?
RANDY DELOREY: Again, my view remains that the challenges with maintaining emergency department hours in those communities that are struggling relates directly to the availability of the appropriate health care staff to provide the safe operation of those facilities. That is, when those circumstances arise is when the Nova Scotia Health Authority alerts the community that there will be a closure for the emergency department.
That relates back to one of our very key priority areas, which is the expansion of training opportunities for nurses as well as physicians - the health care providers who are needed in this province to service primary care as well as emergency departments and other care throughout our health care system. We recognize that and, again, we are taking steps to improve the availability of . . .
THE SPEAKER: Order. The time has expired.
Order. The time allotted for the consideration of Supply has elapsed.
The honourable Government House Leader.
HON. GEOFF MACLELLAN: Mr. Chair, I move that the committee do now rise and report process 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 8:10 p.m.]