HALIFAX, THURSDAY, FEBRUARY 27, 2020

COMMITTEE OF THE WHOLE ON SUPPLY

3:20 P.M.

CHAIR

Brendan Maguire

THE CHAIR: Order, please. I call the Committee of the Whole on Supply to order.

The honourable Government House Leader.

HON. GEOFF MACLELLAN: Mr. Chair, would you please call the Estimates for the Department of Health and Wellness.

THE CHAIR: We will resume the Estimates for the Minister of Health and Wellness. There are 37 minutes left for the New Democratic Party, and then we’ll jump back over to the Progressive Conservative Party.

The honourable Leader of the New Democratic Party.

GARY BURRILL: Mr. Chair, I again want to thank the staff and the minister for thinking together with me last night about important questions of the funding formula and of the structure and the functioning of the Health Authority.

I thought that maybe a good place for us to start this afternoon would be to turn our attention to the question of emergency rooms. I’m sure the minister recognizes how broadly this is a subject of concern across the province and how widespread its implications and ramifications are throughout the whole system.

When the most recent report came out in December, the annual accountability report on emergency departments, I’m sure those numbers were an object of some concern for the minister, showing that emergency departments were closed for almost 49,000 hours. I think maybe the part that was most concerning there is that it was 18,000 hours more than the year before.

I think the thing about those numbers that seemed particularly gripping for me, and which I would say is worthy of the government’s focus and attention, is that last year was the single greatest increase in the aggregate number of unscheduled hours of emergency room closures in the period since the government came to office.

I want to ask the minister: Would he speak about what changes and improvements are anticipated in the work of the department, perhaps as reflected in this budget, to see that in the next report we get, or the one following that, that we don’t see this situation repeated, which is so concerning?

HON. RANDY DELOREY: I thank the member for raising this important topic. As he duly noted in his remarks, the work that we are doing around health care broadly, in primary care extends to the emergency department situation.

I think first and foremost it’s important for the members here to realize that in our larger hospitals’ emergency departments, in our regional facilities, they are never closed. Those are a top priority and continue to remain open.

What the member is referring to is some communities across the province with community-based hospitals and collaborative emergency centres that have historically - and others that have - established challenges generally with recruitment and retention of the necessary health care providers to meet the requirements to safely provide the operations at those locations. It’s then and only then that those doors would be closed.

What steps are taken to address that? As the member would know, we’ve invested heavily in building and expanding our primary care supports in communities across the province - efforts to attach patients to primary care providers. The reason is because often in our emergency departments the demand is by volume - the lower acuity visits, visits that could otherwise actually be cared for in a primary care setting. By strengthening our primary care environment, it reduces and removes some of the pressures in our otherwise busy emergency departments across the province.

As it relates to those that are having challenges with recruitment, there are two critical health care professionals in the operations and others who support them, but the two that we find most frequently result in the closure of emergency departments are physicians and/or nurses, depending on the community.

What are we doing? The fact is we recognize that in order to have a greater availability, we need to recruit more. Part of that recruitment means training more. We are taking multiple approaches. We’ve started new recruitment programs, including a partnership with the Immigration Department, to recruit health care providers, creating new streams of entry for physicians, which is helping us increase the supply of doctors throughout the province. That is something we can leverage to support the demands and the vacancies in emergency departments, as well.

We also recognize that educating more doctors is an important and valuable tool within the province to increase the supply. That is why we’ve invested in expanding the number of physician positions in our residency program, as well as adding additional seats to the Dalhousie Medical School. We started that in September 2019, and there will be a further expansion in September 2020, this fiscal year, to bring the total number of new medical resident seats to an additional 16.

Those are steps that we’re taking, but in addition, we recognize steps we’ve already taken. A nice compensation in some instances is part of the challenge with recruitment and retention. As we entered into a new master agreement, that agreement includes recognition. We’ll see the compensation for family physicians, emergency department physicians, and others who will become the highest paid in Atlantic Canada, making them competitive, not just regionally but nationally, in terms of their compensation. We’ve increased incentives through that agreement to support and assist facilities that need to fill vacant shifts. These are just some of the examples of the steps we’re taking to help ensure that we have the appropriate staff in place at those emergency departments.

Another example is the work that we’ve started in Digby, where there were long-standing challenges, and we were able to bring in a nurse practitioner to support the continued operation of the emergency services in that community. There is no single solution to solve the challenges in health care, but rather a multi-pronged approach. I’ve just provided a few examples of steps that we are taking.

GARY BURRILL: As I look at the accountability reports on emergency departments, unlike some government reports, they are not desperately thick and complex. They are pretty accessible to understand what it is they are having to say. It seems to me that I would read them, as many people might for whom emergency closures around their communities are major concerns - and I speak from my own background. I formerly represented the constituency of Colchester-Musquodoboit Valley, where closures were perhaps the most pivotal community concerns in the Musquodoboit Valley.

[3:30 p.m.]

As I look at those, the reading I take of the trajectory over the last five years of unscheduled emergency department closures, is a trajectory that goes without any break like this, and upward it’s steadily increasing over the past five years - the volume of unscheduled closures in the emergency departments of the province. Is this, in fact, a correct description of the trend of the last five years?

RANDY DELOREY: The fact is that the challenges with maintaining continuous 24/7 emergency department services in some communities across the province - and indeed, Nova Scotia, as I’ve said numerous times, is not the only jurisdiction with these challenges. Just recently members would be aware of the challenges faced in New Brunswick with the exact same situation - other jurisdictions as well, in both urban and rural areas - based fundamentally upon the challenge around having adequate supply of appropriate health care providers to provide those services needed. That is the underlying root issue that is contributing to those challenges in these communities.

One example that made the news about this time last year was the availability of nurses in Canso. That was a challenge where the community was unsuccessful in recruiting nurses for a period of time. Eventually those existing nurses get to a point in their career where it’s time to retire and move on to the next phase of their life.

In that scenario, despite incentives and other investments, individual nurses had not pursued the employment opportunity presented in that great community. However, more recently, we’ve seen through efforts over the past year that some new nurses, as I understand it, have expressed interest. I’m not sure if they’ve signed contracts yet, but there’s certainly a degree of interest in nursing staff now to fill those vacancies.

We’re quite optimistic that with the multitude of steps we’ve been taking to increase our recruitment, as well as our education of both nurses and physicians, that with more available, qualified professionals to fill those shifts, we will be able to address the underlying challenge of those closures in those community hospitals and the CEC emergency departments.

GARY BURRILL: Going back to the question I had asked originally, I want to ask the minister, in his understanding, am I describing the trajectory of what has happened in the last five, six years with unscheduled emergency department closures? Is it correct to say that the trajectory has been one of steady, unremitting increase, with the increase in the last year the worst of all of them in the last five years? Is that, in fact, so?

RANDY DELOREY: Mr. Chair, I don’t have the reports with me, but they are posted annually online. They provide the comparator year over year, so that information, as the member noted, would be readily available for all Nova Scotians.

I don’t have it with me to say exactly whether the specific statement is accurate, but I believe the member would have the report with him and we’ll take his work for it, if that’s what the data in front of him says.

GARY BURRILL: With respect, the question I’m asking is not very complex. It’s just that it appears to me that in every year since the minister has been the minister, there has been a deterioration in this situation, that we have not seen improvement.

As a beginning point, I want to establish whether or not, in fact, that is also the perception that he has.

RANDY DELOREY: Actually, it’s not the same perception or experience that I would have. In fact, when you look at the report you do see improvements. There are improvements, and that’s what makes this situation so challenging. As you recruit and bring in more staffing and are able to attract professionals to one particular community that may have been challenged in a previous year, others may be retiring or moving on and pursuing new opportunities.

I would not agree with the member’s statement in terms of not seeing any improvement. In fact, the challenge is broad, and it is in a variety of communities. Our partners in the Health Authority continue to support those communities, to do what they can to ensure that vacancies are filled, that the appropriate health care professionals are available. It is very important to remember that our regional facilities are always open and available.

We have our 911 system that responds to health emergencies, as well, to ensure that people get taken to the appropriate site for further health care, depending on those emergency health needs. As I’ve said, in terms of overall total hours, I take the member’s word for it, not having the reports over the past five years in front of me.

I think the characterization that there are no improvements would be a misreading of the reports, because we do see improvements in years at some facilities. Unfortunately, we see challenges at other ones during those same years, so it is a challenge to stay ahead of that curve, but it is a challenge that is not unique to Nova Scotia. I think Nova Scotians are very familiar with the challenges being presented and with the proposed solutions brought forward in our neighbouring province recently.

GARY BURRILL: I think I understand where our views about that differ, but what I am trying to understand is how the department’s work over the recent period is viewed within the department and is viewed by the minister. Maybe I could put it this way. When we look at the trajectory of unscheduled emergency closures in Nova Scotia in the last five years, would the minister say that this provides evidence of something that has been successful? Is this an area where he feels that the department’s work has been in accord with his own goals?

RANDY DELOREY: I am quite proud of the work of the staff, both within the Department of Health and Wellness and with our partners at the Nova Scotia Health Authority. Staff continue to engage with our partners to identify challenges and propose policy and/or program changes to help address those issues and challenges that are faced within the health care system. Specifically, right now we are talking about that challenge within the area of emergency departments.

As I’ve said earlier, the fact is that these challenges with emergency department closures did not start in 2013. They are not isolated or restricted to the geographic boundaries of the province of Nova Scotia. These challenges have been long-standing, building over time. The fundamental root challenge in there is attracting appropriately qualified health care professionals to those communities that are seeing retirements. That is the fundamental root challenge that we are trying to address.

The steps that we’re taking - obviously, if we have a higher supply of those required health care professionals, then the probability of attracting some of that larger pool or supply of health care professionals to these communities that have had long-standing challenges of recruitment will improve. That is why I am pleased with the work of the department and the Health Authority, as well as through engagement with our partners within the health system, like Doctors Nova Scotia, to negotiate a master agreement, a contract, that when we went to the table, we identified challenges that we have within the health care system. Many of those challenges are recognized by physicians as challenges within the system that they wanted to help address as well.

At the negotiating table, they provided work to design a contract, a master agreement that is believed to help with that recruitment and retention. That includes a targeted focus on primary care and emergency physician compensation.

We know that with this agreement Nova Scotia physicians in those areas will be the highest compensated in Atlantic Canada, making them very competitive regionally and nationally. That work is something we believe will help improve the situation. We believe that that work with nurses and nurse practitioners, expanding the opportunities for training, will increase the supply, as well as the increased sites that I’ve mentioned previously for residents and medical seats at Dalhousie Medical School.

To the member’s specific question: Do I believe that department staff and our partners at the Health Authority have been doing good work? Yes, they have. Not every program or initiative that we’ve undertaken will see immediate, short-term impacts. I believe if that the member would look at other areas of investment and priority efforts, areas like the attachment of Nova Scotians to primary care providers, we’ve seen an approximately 20 per cent reduction over a time period of slightly more than a year in Nova Scotians who are registered and looking to be attached to a primary care provider.

We had questions to that end on the floor of this Legislature: What are you doing to provide a physician and primary care to Nova Scotians in need? We continue to respond with the programs, initiatives, and investments that we’ve been making, with a recognition that they would have an impact. A multi-pronged approach, no single solution - and the same is true for emergency departments in our community hospital environments - will take some time. The work is well under way, and we believe that we’ll continue to see some improvements in that regard.

GARY BURRILL: Thank you for that explanation. I also want to ask about emergency services relative to the hospital redevelopment plan in the CBRM. I recognize that the minister’s side of the equation and my side of the equation don’t look at this question in the same way, and we don’t need to rehearse all those arguments this afternoon.

I would like to think particularly about the question of emergency services. In my experience in the North Sydney-Sydney Mines area and in the New Waterford area, public concern about the government’s redevelopment plans, public criticism about it, has as one of its sharpest and most deeply-held points concerns about the unavailability in the new picture of emergency services in their communities. This is not something that has been spoken to only by Opposition Parties; this has been spoken to throughout civil society in industrial Cape Breton.

I am sure the minister has been present to hear the arguments made from New Waterford and the Northside about the concerns, the dangers, and the very real worries about accessibility for numbers of people who don’t have private transportation in an area that does not yet have the same public transportation as does the HRM. There are many concerns that, when all is said and done and the redevelopment is finished, one of the things which will be different - not improved, but different - is that there will no longer be an emergency department in New Waterford and there will no longer be an emergency department in the Northside.

[3:45 p.m.]

I want to ask the minister, in this period of over a year in which he has been present in, it must be, hundreds of these conversations, is there nothing about the points that have been made about how those communities need emergency services that has commended itself to him?

RANDY DELOREY: I want to reassure the member and residents of the Cape Breton region that these changes are part of the Cape Breton redevelopment, the single largest health care infrastructure investment, to my knowledge, ever made in that region of the province. We’re looking at well over a $0.5 billion investment in new, modern health care infrastructure to support the health care needs. That means that if we’re going to invest in infrastructure for the future, the starting point is looking at what the needs of the community are, not a starting point of what infrastructure is in place.

We did look at the infrastructure that would be available. This has been publicly noted, which is what resulted in the decision to move forward with replacing infrastructure in North Sydney and New Waterford with new community health centres. Indeed, that model has also expanded to see, in addition to those community health centre facilities, the addition of long-term care beds and, in the New Waterford instance, a new school facility. It’s a first of its kind community hub model, linking an educational and health care facility together. These are both the vision and the belief in the positive outcomes that are afforded by this redevelopment project.

The member specifically asked about, or in regard to, emergency department services. We’re watching and evaluating the information that’s available and advice from health care providers. I think in our conversations yesterday I made note that one of the single greatest challenges in being responsible for the health system in the province is that given the diverse complexity of needs and perspectives of providers it is nearly impossible to obtain 100 per cent consensus on any change within the health care system. Therefore, I think the member would appreciate that we can probably agree that the status quo was not an option. The status quo situation and services being provided to the Cape Breton region was not the best path forward for the delivery of health care, including emergency care services to those communities.

If we can at least come to that agreement on the floor of the Legislature, then we can move to the next part of the conversation to say, if the status quo is not the appropriate path forward, then let’s look at the path forward that we have chosen to pursue. It is a path that has been informed and influenced by front-line health care providers. We as government have agreed to invest hundreds of millions of dollars to bring these changes to reality, to ensure that this modern health care infrastructure is available. That includes availability of brand-new health care infrastructure in the communities of Northside and New Waterford, as well as an expansion.

When specifically talking about emergency department care, by doubling the size of Cape Breton’s regional emergency department, newly modernizing through that development, the capacity and ability of our health care providers who are working in emergency health care are able to have the appropriate tools, the appropriate space to provide the care, and not just for those citizens in New Waterford and North Sydney but over the entire region. That, I think, is a testament to show that these changes will enhance not hinder, as the member has suggested, the emergency care provided to those citizens. That is informed by information, advice, and recommendations that we’ve received from our partners at the Health Authority and front-line health care providers.

GARY BURRILL: Not intending any disrespect, is it really the minister’s view that the provision of emergency services in New Waterford and on the Northside will be improved by a situation in which there is no emergency department in either community?

RANDY DELOREY: If the member is to review the path forward for the work being provided in this Cape Breton redevelopment, he will realize, for example, in the New Waterford situation, the new collaborative environment centre being built, connected to a school and long-term care facility - the first of its kind - community hub, education, and health care facility being built, to my knowledge, in the country, but certainly in the province. I think it is important to recognize that in the current situation, I would ask the member opposite: Does he think status quo is a better alternative than the redevelopment of enhanced programs and services, including the expansion of the Cape Breton Regional Hospital?

I thought that perhaps we’d come to an agreement that the status quo was not the best option or path forward, but in addressing the member’s earlier questions about emergency department availability, New Waterford is one of those communities that is challenged to appropriately staff the emergency department, having closures. I believe that having, within not too much of a geographic or time distance apart, a much larger and robust emergency department at the Cape Breton Regional will actually enhance the emergency department services and health outcomes for the community when factored in with the overall complete picture of health care, enhancing and improving the primary care environment and services available to the community.

In isolation of emergency services, when you look at the data within our emergency departments, many of the visits by volume are of a lower clinical acuity, which could have been addressed in a primary care setting. By strengthening the opportunities within the collaborative health centre environment within that community, having brand-new infrastructure available to help attract and retain health care providers to provide that care, the objective there is to reduce the lower acuity emergency visits by residents in those communities and, in addition, they would still receive that care in their community.

For the emergency departments it’s important for members to realize that when it is a high acuity emergency, calling 911 is where that service should begin. That means the ambulance paramedics begin providing that care right away and provide that care from the site of the interaction with the patient and continue that care while in transit to the emergency department.

I believe that through the advice that informs the decisions we’ve made that the redevelopment in Cape Breton is designed to ensure that we maximize the positive health outcomes for these communities throughout Cape Breton.

I don’t believe the member was in New Waterford when we announced this, but it was extremely well received by the residents in New Waterford. The Premier, the member for Glace Bay, the member for Sydney-Whitney Pier, and I were there. The members can attest and confirm that the feedback was very well received by those community members at that public announcement, and there were many of them. In fact, as the announcement was done outside, it’s hard to quantify the exact number, because it wasn’t based on seats.

Mr. Chair, I believe there are many people in the community, as well as in the health care system, who agree with the decision of the government in these redevelopments, that for the future of health care in that region this is the right path.

As I’ve said earlier, yesterday as well as earlier this afternoon, the fact of the matter is it’s not necessarily a consensus, there are a lot of perspectives. As the member started his comments and his questions with, we probably are not going to end up on the same side of this particular equation. To answer his question: Yes, I believe that we are pursuing a path forward that, based on the information we have, this is the best path forward to ensure that not just emergency but all health care for residents of the Cape Breton region is met, and not just based upon their current immediate needs but those needs for the future as well. That’s what we were designing this redevelopment for: not just the current generation but the next generation as well.

GARY BURRILL: What I am trying to understand with as much clarity as possible is the minister’s own thinking and the department’s thinking on this particular area of emergency services. In all our lifetimes, emergency services have been provided in New Waterford and on the Northside. This was never done as something frivolous or extraneous. It was always done because those emergency services were needed.

I want to understand: What, in the minister’s judgment, has changed in the year 2020 to make that no longer the case?

RANDY DELOREY: I don’t mean this flippantly, but our lifetimes span different decades of time. I think the member, perhaps, has seen significant changes in many areas of society and the delivery of care, specifically emergency health care. In that period of our lifetimes that do overlap, in emergency care specifically, look at the evolution, because during my lifetime and memory, emergency services that started with ambulances were run by funeral parlours. I’m sure the honourable member recalls that period of time.

If you were to look at the services provided at that time and those provided now, they are nowhere near the same.

THE CHAIR: The time for the NDP caucus has elapsed. The next hour will be for the Progressive Conservative Party.

The honourable member for Cole Harbour-Eastern Passage.

BARBARA ADAMS: Mr. Chair, I appreciate the opportunity to speak with the Minister of Health and Wellness about topics important to Nova Scotians.

I would like to start with a couple of topics that are important to my constituents, and the minister probably knows where I am going to start. There are approximately 85 collaborative health centres in Nova Scotia. There are 51 current constituencies in Nova Scotia, so if you do the math, that’s about 1.5 collaborative health centres per constituency. That means some of them have two or more.

I’d like to ask the Minister of Health and Wellness, after three years of me asking: Why are the constituents of Cole Harbour-Eastern Passage not being given the funding for a collaborative health centre?

[4:00 p.m.]

RANDY DELOREY: Sorry, I was just looking for specific data that I know I have on paper. As those who know me well, I don’t manage paper nearly as well as electronic documents.

To respond to the member’s question, in the member’s community there is less than 0.1 per cent of residents registered looking for primary care access. The primary health care needs in the community are very well served. In fact, as illustrated through the attachment data that we have, the member would also be aware that through work, we’ve established a nurse practitioner within her constituency. She’s using the boundaries based upon constituency lines. The work that’s done within the Health Authority, and the health care system, doesn’t always line up with those same boundary lines.

The fact is what we look at is the care needs. We know that there are about 400 residents registered that would fall within, roughly, the boundaries that the member serves. If you look at the total population of that area, you’re looking at about 15,000 voters registered, and that would only be legal voters. The population for the community would be significantly larger than that when you factor in the children and perhaps non-residents that wouldn’t be eligible to vote. You’d factor in the 400 people that are registered looking for a primary care provider. You’re looking at a fraction of a percentage relative to other communities and the demand, particularly in our Western and Northern Zones.

I think the member can certainly appreciate that while I value her advocacy, as I’m sure her constituents do, there are many communities within the province where the primary health care needs are significantly greater in the demands to fulfill them.

We’ve taken steps, we have responded to some of the community needs, and provided a nurse practitioner that is working. It’s also worth noting that nurse practitioner is working as part of a collaborative practice that just happens to be located in Dartmouth. That nurse practitioner is part of a collaborative practice within her community. The whole notion of collaborative care is not necessarily a physical space; that is something we heard from health care providers.

It’s about having a collaboration between health care providers. They are not always necessarily co-located. That is how we responded to her community, by providing a nurse practitioner as part of an existing collaborative practice, which happens to be located nearby, and that just happens to be outside of the electoral boundaries of the member’s riding.

If you were to compare the actual primary care needs that the member’s community has - there are about 400 people registered on the need-a-practice list - I think she can appreciate why our primary focus, after the recruitment and filling of that nurse practitioner seat, has been in other parts of the province.

BARBARA ADAMS: For those who may just be tuning in for the first time, I’m going to refresh everybody’s memory. When I took over as the MLA - after this government had been in power for four years - I don’t know the exact number, but I think it’s around 20 per cent to 23 per cent of my constituents did not have a family doctor, and nobody was getting called.

I pushed and pushed to find out if my constituents were getting called off of the Need a Family Practice Registry, and they were not. For months I pushed to get those postal codes added, because we still don’t have a family doctor in my constituency. Because we didn’t have a family doctor, every time a new doctor was hired in Dartmouth, or the other side of Cole Harbour, or anywhere else, my constituents were not getting called. I found that out.

I brought it to the attention of the Department of Health and Wellness and the Health Authority. I got them to add those postal codes, and they started getting calls. That’s why those people have a family doctor.

I asked the Minister of Health and Wellness in this Legislature for a clinical nurse practitioner until such time as you could find us a family doctor. You were so gracious in giving that, I’ll never forget that day. It took 18 months of you and me working with the Health Authority to get that clinical nurse practitioner there.

We went through episode after episode of the Health Authority, the Department of Health and Wellness, not being willing to come out and look at sites. We found a site; it took them months to come out and talk. It took months to come up with a contract. It took more months to actually find somebody there, because it turned out they weren’t even advertising for my area. It took 18 months from the time that you said we could have one.

I am very proud that 0.1 per cent of my constituents now have a family doctor, if that’s the case. But I know why that happened, and I don’t want anybody misrepresenting how that happened for my constituents.

Having said that, you don’t just put collaborative health centres in places where there is no doctor. Everywhere else in this province there are doctors with collaborative health centres that provide people to collaborate with: social workers, physiotherapists, psychologists. The suggestion that my constituents have a clinical nurse practitioner who is attached to elsewhere has just actually highlighted the point that her attention is separate from my constituency 100 per cent. She is now being shared with another constituency or two; in fact, I am hearing that we have less than a full-time clinical nurse practitioner.

My question for the Minister of Health and Wellness is: Why are my constituents not important enough to have a collaborative health centre in their constituency, exactly as was promised by the previous MLA in my constituency?

RANDY DELOREY: I’m not exactly sure what the member was going on about to suggest there’s a misrepresentation of anything. What I was stating were the facts, based upon the question that was brought to the floor here. The member asked a question about why this wasn’t a priority, and the fact is that I’ve explained that. In serving the people of Nova Scotia across all constituencies, all regional boundaries, county boundaries, however you want to slice and dice the geographic region, one of the major priorities we have as a government - that has been the case since I was appointed to this role in 2017 - has been to focus on primary care services, to attach Nova Scotia residents to primary care providers. We’ve taken many steps to do that. That includes the establishment and expansion of collaborative care practices.

I’m glad to hear that the member supports this work and these investments that we’ve been making as an important contributing factor to improving primary care access and health outcomes to the people of Nova Scotia. I believe that’s what I’m hearing the member say in her advocacy and desire to have one in her community.

I believe we’ve seen around 85 collaborative practices in communities throughout the province providing care. The member noted the work that the province and the Health Authority have been undertaking to make better use of the data that was collected, which began in 2016, to help inform the decisions about heath care - particularly in the primary care space, recruitment, programs, and investments. We were being informed in part by the 811 Need a Family Practice Registry, that the approach that would be taken to best utilize that information, to attach patients throughout the province, not just in the area of Cole Harbour-Eastern Passage, but making the necessary changes to become more efficient and effective at attaching patients to primary care.

That’s why I am pleased that the member notes - what did she say? - that 18 months ago it was about over 2,000 residents not attached, and now it’s down to about 400. I am glad that the member appreciates the positive progress that we’ve been making in serving her constituents - because she’s referencing her specific constituents there, that there were about 2,500 and now its down to about 400. I hope that those constituents appreciate the work and the efforts to attach those patients to primary care services.

In the Cole Harbour region, just since April of last year, there has been a new physician hired that started practice last summer; there’s another one who is slated to start in June, to provide even more care. To those 400 residents in the member’s constituency, in the broader Cole Harbour area, a new physician is slated to start in June which should provide even more opportunity to attach those patients to primary care services in that region.

Why is establishing a specific collaborative practice directly in the constituency of Cole Harbour-Eastern Passage not at the top of the list of the many things that we have to focus on?

I recognize that when you look at the successes that we’ve had provincially, seeing a reduction of about 20 per cent in the number of Nova Scotians who have registered to find primary care access over the last year to 14 months or so, seeing that progress is fantastic, and provincially we’re very proud of that work. I’m sure those Nova Scotians who have found those family physicians, in part because of the Need a Family Practice Registry, appreciate those efforts as well.

Unfortunately, one of the things that we also realize is that the successes have not been equally distributed across the province. In fact, our Western and Northern Zones are the areas that we need to really start to buckle down and continue to focus on to address wait-lists in those areas. The Eastern and Central Zones both still have people unattached; we are going to continue to work to fill vacancies in those communities to ensure that they get primary care access. As a proportion of the population, it is significantly higher in the Northern and Western Zones, so that is where we are turning our attention to focus.

About a year or 18 months ago, the Central Zone which represents about 50 per cent of the population of the province of Nova Scotia, also represented about 50 per cent of the people registered looking for a primary care provider. That’s no longer the case.

On a per capita basis the Central Zone is significantly lower, particularly than those residents in the Western and Northern Zones. I hope the member opposite can really appreciate the fact that in managing the health care investments, particularly for primary care access and services, that we’re making those investments and re-evaluating how we can better support those people in the highest need communities: the communities that have had the most difficulty over time with recruitment and/or retention of primary care providers.

That’s why we’ve done other initiatives with our partners at the Nova Scotia Health Authority. We’ve done innovative programs like establishing access clinics in some of those really higher need communities. Those access clinics are actually reserved for people who are registered in needing a primary care provider, and as long as they are not attached to a dedicated primary care provider, they have access to these clinics. As they get attached to a primary provider they are moved out of the clinic for services, because then they have their primary care provider.

[4:15 p.m.]

There are a number of initiatives. I’ve spoken about our investments to expand both the training opportunities for nurse practitioners and physicians - those nurse practitioners and physicians who have not yet entered the workforce - based upon investments that we started making a year and a half to two years ago. I look forward to seeing continued positive progress in this particular area that the member has asked about, which is primary care access.

It’s that very same success that her constituents have seen in getting attached to primary care providers over the last 18 months to two years, that we want to bring to all parts of the province. That’s what we’re committed to doing.

That’s what our investments and our strategies, along with our partners, are focused on doing. We’re committed to continuing that work so that all Nova Scotians, not just the residents and the constituents of Cole Harbour-Eastern Passage, have the opportunity to get attached to primary care providers, to receive the health care that they need and deserve.

BARBARA ADAMS: Given that I have an hour right now to ask questions, I guess if the minister is going to take almost 15 minutes to answer one question, I better get to the most important ones.

Just a clarification for the record, I didn’t say 2,500. I said approximately 23 per cent of my constituents were without a family doctor, just to clarify the numbers, I’m not exactly sure what it is. The point is I just heard the minister say that my constituency was not a priority for a collaborative health centre, but yet, when it was election time and it was a Liberal running in my constituency, it was a priority then. It’s just not now, so I get it.

I want to move on to the next question. The minister mentioned about how urgent it is to get family doctors to the Western Zone. Right now, in the Western Zone, there are 21,044 people without a family doctor. In metro, there’s only 7,955. We’ve got the rural doctors moving into metro, and I get that.

We’ve often wondered, is there any direct impact on a zone being that short of family doctors? I want to ask about one of the results on CIHI, which is the Canadian Institute for Health Information, and I can table the document if the minister needs it. It shows the results for Canada and gives the statistical average, then it gives the results for Nova Scotia, and then it breaks it down by zone.

These are the results for all regions within the province of Nova Scotia for hospital deaths following major surgery, by percentage, between 2018-19. In Canada, the percentage was 1.5 per cent of deaths following major surgery; in Nova Scotia, it’s 1.8 per cent. In the Central Zone, if that’s where you live, it’s 1.5 per cent, but in the Western Zone, which is the worst, it’s 2.5 per cent. That’s nearly double the number of people dying from major surgery, because they happen to live in the Western Zone. I’m wondering if the Minister of Health and Wellness can tell me, why is that?

THE CHAIR: I will remind everyone that the minister has as long as he feels to answer the question as the questioner also has as long as she feels to put the question. There’s no questioning procedure here.

We’ll table that document, please. Thank you.

RANDY DELOREY: I think this highlights one of the important reasons for the work that continues within the Nova Scotia Health Authority: to focus on improvements and standardization in the care and the services and implementation of best practices of care throughout the province. I believe that’s part of the effort that’s ongoing.

One of the areas includes a recognition of patient safety as an important factor to improve patient outcomes. In this year’s budget, we have dedicated additional funds to hire additional staff to focus on the data analysis to tease apart this data, like this from CIHI, to understand where we have variances - why those variances may exist - so that it can help inform the investments and/or changes in practice that may be necessary to improve those outcomes. That is part of the commitment to continuous improvement and a pursuit of best health care practices that informs the work of our partners at the Nova Scotia Health Authority and the IWK Health Centre.

Specifically to the member’s question about this specific data set, I think the other thing to note for the member is we kind of had a discussion like this last night with the member from the NDP presenting data and looking at a single specific measurement of a particular health outcome and tying it to a geographic region.

I just want to remind the member that while in some instances a particular region may have one health outcome that is better or worse than another, when you factor it out, another health outcome may be different in a different jurisdiction. For example, in this case the specific measurement is hospital deaths following major surgery flagged as the Western Zone needing the most improvement.

Last night the member from the NDP caucus was questioning about a variable on infant mortality, and the Northern Zone was the area that required the most improvement; on life expectancy it was the Eastern Zone that required the most improvement. My point is that we bring questions on one single parameter or variable that’s being measured or assessed and tie it to a geographic region. It’s not how we can necessarily operate the health care system because we have to look at all of the health outcomes, all of the health variables. But the one thing that is standard in the response is a focus on continuous improvement, health care best practices informed by the clinicians who really do bring forward the recommendations to prioritize the investments, policy, and procedure changes.

As I said, we recognize, not based on the specific data point, but broadly speaking, that there is opportunity for us to do better with patient safety. That’s why we have budgeted to hire additional staff to help dig in to data like this throughout the province to identify what we can do collectively with our partners in the Nova Scotia Health Authority and the IWK to improve the results across the province.

BARBARA ADAMS: As a published researcher in health, I respect that statistics don’t always indicate causation, but CIHI has endless statistics for us to look at, so something leading to death is certainly an important one to consider and keep top of mind.

One of the members previously asked about the difference between being attached to a physician versus being attached to a clinical nurse practitioner. There are still a lot of people in this province who don’t realize that if you get attached to a clinical nurse practitioner, that ends your hopes of being attached to a physician.

I’d like to ask the Minister of Health and Wellness: How many people in the province are considered attached to a clinical nurse practitioner?

RANDY DELOREY: I don’t have the data. That would be housed with the 811 registry. To break that up, I believe the specific question was how many nurse practitioner- attached patients would be recognized as being attached? I don’t have that data with me.

BARBARA ADAMS: Can I ask then: How many people in Nova Scotia are attached to a physician?

RANDY DELOREY: That’s not a question we’re able to directly answer. The best data that we have available to us is information that identifies those Nova Scotians who have advised us that they’re in need of being attached to a primary care provider.

Physicians in the province, primary care providers, did not have an obligation to tell the province, and this is an historic practice. There’s never been a tracking of the information of the rosters that physicians have, to identify the number of patients that they individually necessarily have.

We recognize that a couple of years ago, not having information about not just the number of people looking, but where those people are looking to require primary access, was challenging in optimizing the recruitment efforts to ensure we maximize the attachment of patients to primary care providers. That’s why the Need a Family Practice Registry was started back, I believe, in the Fall of 2016. That has provided us a lot of information. That information has informed the province on how to best target initiatives.

I think it’s one of the reasons we’ve seen the progress we have in the central region. It also is why we identify the challenges in the Northern and Western Zones. There’s where attention on identifying opportunities and approaches to service those communities and address the stubborn, continued growth in those regions, to further support the attachment of those residents to primary care providers.

Not being able to say how many are directly attached, I believe it is about 5 per cent of the population. I think about 46,000 or 47,000 people are registered on the 811 Need a Family Practice Registry. It should be about 5 per cent of the population that has identified that they are not attached to a primary care provider. If I was to flip that number around, it would say about 95 per cent of the population is attached. As the member noted, as a researcher she would know that couldn’t be said with absolute certainty, so I’ll stick with the reverse of her question and just go with the 5 per cent that we know are unattached.

BARBARA ADAMS: According to the statistics we have for January, there were 46,991 without a family practitioner; it went up in February to 47,695. What I’d like to know from the minister is, in the Summer the Department of Health and Wellness gave a one-time incentive to all physicians to roster their patients: $7.50 per patient was given to the family doctor to put them on a roster.

Can the minister tell me how much we paid in rostering fees? We can take that number and divide it by 7.5 and find out how many people are attached to a family doctor.

[4:30 p.m.]

RANDY DELOREY: We spent about $6.6 million on that program, but as I said before, we did that to collect as much data as we could. Unfortunately, only about just over 60 per cent of physicians contributed or participated in that incentive program, so it is not reflective of the total rosters at that time across the province because we had only about 60 per cent of the physicians participating. For those who did participate, the total cost was $6.6 million, which would be about 44,000 patients for the 60 per cent of physicians.

BARBARA ADAMS: I’m confused. This is the one-time opportunity for the government to find out exactly how many people are attached to a family doctor, and yet there was only 60 per cent participation by family doctors? Why would this have not been a requirement of every doctor to tell the government how many patients they had?

RANDY DELOREY: Sorry, I did a wrong calculation there. Numbers are magical, but they work better when you put in the right numbers. The calculation of $6.6 million at 750 per rostered patient is 880,000 patients for the 60 per cent of physicians.

This was an incentive program that we negotiated with Doctors Nova Scotia. We would prefer 100 per cent participation. That wasn’t achieved to mandate the physicians to participate in that program. I think it may have required a different approach.

I think this information, although not 100 per cent complete, is very helpful to the government. I think as the member noted, having done research herself in a former career, she would recognize that you really don’t need to have surveyed 100 per cent of the population to obtain valuable data. What you need is a random sample that is reflective of the population to help inform the decisions that you are making.

Given that we have participation by about 60 per cent of the total population, I think in all probability it suggests that the information garnered is very helpful to us in the work that we’re doing to attach Nova Scotians to primary care providers and respond to the needs of both patients and the health care providers.

BARBARA ADAMS: I’m just wondering, where we all have an MSI card, are the MSI cards attached to a physician or is that something we could very simply do? If your MSI card is attached to a physician, then we could actually count exactly how many people in the province have a family doctor.

RANDY DELOREY: As the member would know, just as in the last question, she recognized that physicians are autonomous, independent providers of services, so our ability to mandate that they participate in an incentive program is not within our purview to be able to do that.

Similarly, for patients, we’re not able to force or ensure that they are restricted to seeing only one provider. That notion of a health card number being able to flag or identify their attachment to a primary care provider - for example, when a citizen goes to a walk-in clinic, they provide their MSI number so that the physician at the clinic can provide billing. If we were to do an extraction, that patient, who may already be attached to a primary care provider, would show up under two providers. How would we know which of those providers the patient is attached to?

Alternatively, an unattached patient could show up at a walk-in clinic, provide their MSI number, and if we looked at the billing data, we would interpret that data then to say that that patient was attached when they really are not attached. I appreciate the suggestion from the member, and if she has more positive suggestions, I’d be happy to hear them. But I think the data that we do have through those 60 per cent of physicians who participated in the rostering program, plus the data that patients and citizens provide through the 811 registry, tells us who says they are unattached and are looking to be attached. The physicians tell us who they’re already attached to and that helps us a great deal in the steps that we take to attach more patients to primary care providers.

BARBARA ADAMS: One of the things that occurred to me, as the minister was mentioning, is that every time we go to register at a hospital or an outpatient clinic through the public health system, we are asked: Who is your family doctor? There is already that data being collected, so that may be another opportunity.

I want to move on to physicians in long-term care facilities. I’d mentioned earlier in a speech that I gave that Ocean View Continuing Care Centre in Eastern Passage had its two physicians indicate they were leaving back in June 2019. They were convinced to stay, and they did so for a short period of time because they didn’t want to abandon their patients. There are actually three doing part-time work at the facility, but I’ve been advised by their CEO that come March they’re all gone. What’s the plan for Ocean View Continuing Care Centre if all three physicians leave?

RANDY DELOREY: With respect to providing primary care access in our long-term care sectors, the member noted in her Supply Motion - she referenced a scenario earlier this year where long-term care providers, particularly in Truro, had challenges where a physician was no longer providing the primary care services needed to meet the requirements of the residents of the facility. That resulted in efforts being undertaken within the department to identify - recognizing the challenge that presents if a physician chooses to withdraw services or, as is the case, retire from providing services.

Number one, of course, is recruitment by the Nova Scotia Health Authority to fill physician vacancies, as they do for providing primary care to all citizens, including those in long-term care facilities, is ongoing. The compensation agreement to the master agreement that we entered into in the Fall, I believe, is a positive means to support the recruitment and retention efforts within the province.

On top of that, recognizing the primary care needs, the Nova Scotia Health Authority also posted and hired a couple of additional nurse practitioners. They have also been working to provide care in long-term care facilities that have been in need with not having adequate physician coverage. I think the work of the Nova Scotia Health Authority to ensure that appropriate and adequate primary care services continue at Ocean View is ongoing.

In the event that the physicians retire before a replacement is available, I would expect that the Nova Scotia Health Authority would, as they did in Truro, ensure that nurse practitioners that they have on staff are made available to meet the primary care needs within that facility.

BARBARA ADAMS: Just to clarify, I am not aware that there is a clinical nurse practitioner at Ocean View Continuing Care Centre. I think one was there casually for a very short period of time. But the question remains, if all three of these physicians who are there part time leave in March - I have a cousin who lives in that facility - they want to know, I want to know on a personal note, will they then be shutting down admissions? Will they be shifting these people to other facilities where there is access to a physician? According to the legislation, there is a physician required to oversee that facility.

What’s the strategy if, in less than a week, all three of them are actually gone?

RANDY DELOREY: I appreciate the member’s personal connection to the question. As I said in my previous response, the Nova Scotia Health Authority recognized earlier this year a similar circumstance where physicians had wrapped up the services being provided - the primary care services - at a couple of locations. One of the actions taken by the Nova Scotia Health Authority was to redirect nurse practitioner services, employees of the Nova Scotia Health Authority, to provide care at those sites while the recruitment of primary care physician services continued.

I would expect that the Nova Scotia Health Authority would be continuing their recruitment efforts.

As the member noted, there are three physicians, but those three physicians share the workload. A single nurse practitioner with more time dedicated may actually meet the immediate needs. That would be the expectation of a likely step, but efforts for recruitment of finding physicians to provide the care directly is ongoing.

BARBARA ADAMS: I appreciate the minister’s efforts on this because I know he appreciates how serious this issue is.

I have a couple of questions from the Nova Scotia Health Authority’s By the Numbers annual report. There is one number that doesn’t get repeated past 2016 and 2017, and it’s the patients seen from out of province. In 2015-16 it was 62,000-and-change - people from out of province who were seen here - and then in 2016-17 it was 34,807. But then in the next two years of reporting, that line isn’t included.

Does the minister have an idea of how many people from out of province are coming here and using the health care resources that we are paying for?

RANDY DELOREY: The scenario of citizens or individuals who use services within the province from out of province, non-residents, would vary from year to year. They may come from a number of sources. They may be visiting and require care services, or they may actually be referred here, where we have regional health care services serving the Maritimes, in some cases the Atlantic region, here in Halifax, so it is difficult to flag exactly.

I think the thing that’s important to note that when we’re serving other Canadian citizens within our health care system, that is part of a national agreement, reciprocal with jurisdictions across the country, where the billing gets covered from province to province. This happens, and I think it happens because of the agreement that when Nova Scotians go to another jurisdiction, another province, with their Nova Scotia health card, they will also receive care without being billed for it, provided it’s covered by the Nova Scotia health system.

I don’t have the specific numbers for the current year with us here this evening, but as I said, the scenarios by which people would be coming in to receive the care, could be referred here for higher acuity care at the IWK or the QEII, or you could have more primary care services or emergency services being acquired by other Nova Scotians or others who are visiting.

[4:45 p.m.]

On Ocean View, just to provide us with a little additional information, one of the physicians that’s providing care there - I think there are still some discussions; I don’t think it’s necessarily a retirement - there are some ongoing discussions. I won’t get into the details of those negotiations, but there are some discussions with at least one of them who may be in a position to continue service.

BARBARA ADAMS: It’s kind of ironic. I appreciate the answer. We do know that there is a physician who has been doing a little bit of coverage. If we had gotten the Communities, Culture and Heritage grant, we might have had the ability to actually woo that physician in a little more of an aggressive way. I am a little puzzled, though, that the statistics for patients seen from out of province were able to be collected in 2015-16-17 but not 2017-18-19. I’m going to encourage the government to consider putting that back on the Nova Scotia Health Authority’s By the Numbers. Similarly, they used to report how many lab tests were done in the province. In 2015-16, it was over 18.5 million; the next year it was 16.8 million, which suggests that there were fewer tests. I’m not saying that’s bad or good, because we’re trying to encourage physicians not to order tests for too many things, but it’s also not reported for the last two years.

One of the things that is reported, and I’m struggling to understand what it means, is under Care Delivery, for the number of hospital beds - I’m assuming this is hospital beds. In 2015-16, it says there were 3,198 beds. In 2016-17, it went up to 3,503 beds. Then, in 2017-18, there’s 3,554. Last year, it went down over 404 beds to 3,150. I’m wondering, were those beds decommissioned? Were they closed due to lack of staffing? Why do we have almost 10 per cent of our beds not in service in the last year?

RANDY DELOREY: As the member’s citing from a document with information from the Nova Scotia Health Authority report that they prepared and made public, I don’t have that with me. It’s not a document that I reviewed in preparation, so I don’t have the answer to the member’s specific questions.

BARBARA ADAMS: Then we’ll switch over to mental health and addictions. We only have reporting for two years, the last two years. The number of patients that were seen in 2017-18 was 44,300. The number last year was 42,998. We’ve talked a lot in this Legislature about increasing investments, and yet that is 1,200 people fewer who got mental health services last year compared to the year before. How do we pair that up with increasing investments when, in fact, fewer people got mental health services.

RANDY DELOREY: In this case, the member’s referring to the services from the NSHA’s By the Numbers, which would be reflective of the services that the NSHA was directly providing for mental health services.

As the member referenced in the question, for the past number of years I’ve stood here to talk about the increased investment in mental health and the question is: How can you spend more money and serve fewer residents?

The fact is that the reduction in the number of patients going to receive mental health services at the Nova Scotia Health Authority can be potentially attributed to the investments that we’ve been making through other partners providing mental health services, the investments that we’ve made in partnership with the Department of Education and Early Childhood Development to expand SchoolsPlus and the health care providers in community. I think a very significant contribution was the expansion of the - when we first launched it, we called it the CaperBase model because we were mirroring or modelling an adolescent outreach model, so clinically it would be referred to as an adolescent outreach model.

CaperBase was a model of adolescent outreach that was already in place in Cape Breton that we identified. That program, I believe, is in almost 100 schools across the province that are touched by the adolescent outreach model of care. They’ve seen more than 25,000 visits of young people since October 2018.

I think the number, perhaps, is reflective of the actual positive outcomes, which we anticipated seeing in providing care closer to younger people, to help. We recognize there’s still more work to be done here, but I think that may be a possible explanation to the member’s question.

BARBARA ADAMS: I appreciate that response because I think that the increase in the services through SchoolsPlus has been a real positive change.

One thing, though, when we were in the Health Committee talking about youth mental health, we were told that in industrial Cape Breton the wait time is up to nearly 300 days. One of the members who was speaking said that the wait time, on average, for non-urgent cases had increased from 62 days to over 120 days, so there are people who are waiting longer, and that’s always a concern.

With the little bit of time I have left for now, I want to just go to home care because we have some serious problems in home care, especially with the number of people whose services get cancelled quite regularly, so I want to touch base on the actual statistics. The hours of home support - and I am referencing the Nova Scotia Health Authority’s By the Numbers, those numbers have been reported for the last four years. Last year, the year before, the number was 3,098,828. Last year it went down to 3,063,279, so 2,012 more people - sorry, those are hours of care. There were 2,012 fewer hours of home care last year than the year before.

When you look at the hours of care per home care client, three years ago they got an average of 106 hours of care per person. Two years ago, they got 104 hours of care per person. Last year they got 97 hours of care per person. When we say we’re investing in home care, that doesn’t match with what an investment in home care means if the number of hours of care per person have gone down in total and they’ve significantly dropped per person. Can the minister explain to me why the number of hours that seniors are getting in this province in home care is dropping each year?

RANDY DELOREY: I believe the member has previously spoken about her previous career, which I believe included some support services in the continuing care sector. I believe she may already know this, but for the benefit of other members here, the decisions about the home care support hours are based upon a review of the needs of the individual citizens who are registered to receive care. That would be expected to change from year to year, based upon the citizens that are registered to receive home care and the actual needs that they have.

The investments that we’ve made stem back from 2013 - heavy investments. In expanding the investments we’ve seen dramatic - if you go back to the starting place where those increased investments started from, to address the wait-list and the care needs in the home care environment, they have been realized. What we see here is a recognition - which we’ve talked about since I’ve come into office - that we’re starting to see the home care investments plateauing in and around the time that I came into this role, which is why we’ve shifted.

We continue those investments, we continue the supports of the home care space, and we continue to see increased investments. The absolute number of home care visits that were made between 2013 and 2018 was about 2.155 million. The number in 2019-20 is forecasted to be over 202,000. The number of visits that are being made in the home care system have been increasing, and the hours and the nature of the care and the services being provided to those residents would be based upon a review and an assessment, which follows an assessment protocol that is in place to ensure that they get the care they need. With home care services, that is care delivered in their home.

BARBARA ADAMS: I thank the minister for that, but just to clarify for those who might be watching, the number of home nursing visits is actually a nurse who is going into the home, so an increase in the number of home nursing hours is an indication of increased frailty in the elderly because the number of people waiting for long-term care is going up.

Just to highlight, the actual number of hours of care that people get who are getting home care is 97 hours of care per year. That is four days of care for those home care clients. It is nowhere near enough home care for these clients.

The last question I’d like to ask the minister is with respect to long-term care. CUPE has called on the minister to give an increase in staffing hours from the 3.45 hours of care per resident per day to 4.1. The minister called on the long-term care expert panel to give an opinion, but they didn’t. Can the Minister of Health and Wellness tell me what he thinks about CUPE’s recommendation for 4.1 hours of care per resident per day in long-term care?

RANDY DELOREY: As we’ve noted, as the member referenced, in the Fall of 2018, I appointed an expert panel to review the quality of care services within our long-term care sector. I want to thank those panel members and all the people who came out to engage with the panel, which resulted in recommendations that came forward just over a year ago. What we’ve done is focus on those recommendations, which were broken up in short-, medium-, and long-term objectives. What was made very clear from that panel was that we needed to make sure that we invested in and identified the quality investments in the care that’s being provided rather than just expanding. They made reference to that with respect to the number of beds.

For the care being provided, they wanted to complete analysis work that continues and is ongoing in partnership with the Nova Scotia Centre on Aging at Mount Saint Vincent University so that they can know what’s the best collaboration or package of care services being provided.

THE CHAIR: The time has elapsed for the Progressive Conservative caucus. Unless the minister needs a health break, we’ll carry on.

The honourable Leader of the New Democratic Party.

GARY BURRILL: Mr. Chair, I wonder if we might want to appeal that decision. Surely to goodness five minutes wouldn’t hurt the staff of the minister to stand up and stretch for a minute. (Interruption) It’s not you that I’m worried about so much. Would that seem reasonable?

THE CHAIR: Is the member requesting a five-minute break? So granted.

[5:00 p.m. The committee recessed.]

[5:03 p.m. The committee reconvened.]

THE CHAIR: The honourable Leader of the New Democratic Party.

GARY BURRILL: I’d like to think some now with the minister about the whole issue of the work of paramedics. We know that it has been an ongoing issue and challenge. The amount of paramedics’ time that is being dedicated to the accompanying of patients while they are waiting in emergency services, for patients to be in that particularly inelegant phrase in the EHS world, “offloaded.”

I’m wondering about this problem, which really has been recurring and long-standing. Could the minister say anything about possible research being undertaken in the department about ways we’re going to improve this and get down significantly more than where we are, the number of our paramedics’ hours that are spent in this comparatively unproductive situation?

RANDY DELOREY: This was an area that, particularly at this time last year, was of utmost urgency and concern. It was the most common or frequent concern brought forward by the paramedics that I would speak to, including their union representatives. In response to that, I recognized the importance of that and provided direction to the Nova Scotia Health Authority to work with EHS to find ways to improve the situation.

I’m pleased to recognize that we have seen improvements. I believe we’ve seen improvements in Central Zone, where I think the challenge has been most acute. Compared to December 2018, we were seeing offload times on average of about 90 minutes. That has been reduced to under 60 minutes. That does show that the work by those in EHS and the Nova Scotia Health Authority is, number one, to recognize the importance of improving that offload time, and also that the recommendations and the investments being made and changes to process within the facilities have been making improvement.

That said, those are not the times that we are satisfied with. We recognize there’s still more work to be done. That’s why in this budget we’ve targeted a position to be dedicated to, in part, focus on patient access and flow within and an investment, I believe, of about $4 million - not for that individual position but to go towards recommendations that come out of the work being done to improve the offload times.

We also recognize that in order to have the system flow - access in the system and the flow throughout the hospital system to keep the whole system working efficiently - we have invested about $4 million and dedicated people focused on this exact problem of access and flow, which is a critical part of improving the offload times for our paramedics, to get them back out into the communities, and some of the concerns that I’ve heard to get them back home at the end of their shifts so they can spend the time that they need to maintain their work/life balance with their loved ones.

GARY BURRILL: Thanks for that explanation. I certainly recognize that the last year has been a year when there really have been initiatives on this subject and yet it isn’t rare, when you speak to paramedics and ask them what the top challenges are at this moment, this subject always comes up. A person certainly acquires a sense of this subject, the offload times, as a very key area that paramedics identify, relative to work dissatisfaction and relative to pinpointing inefficiencies in their work.

The position that the minister explained, it’s clear to see how that speaks to this, but in the continuing effort to address this problem and to improve it, as we look at the budget in front of us this year, are there other areas of investment, in addition to the one that the minister has just explained, that people who have concern about this issue might be able to identify as investments that are being made to improve our position on the offload problem?

RANDY DELOREY: That investment is specifically focused at patient access and flow, which is what has been identified as really the underlying root challenge that results in increased offload times. That’s why this is the initiative for this year. The work that was done last year was focused on what could be done with existing resources in changing the processes within the way the Nova Scotia Health Authority worked with EHS. The objective there was to improve that collaboration, to identify not just the pain points that could be addressed - I guess, the low-hanging fruit that was targeted. This financial investment is to target investments that would be needed to continue that positive work.

As I’ve stated before, we have seen about a 30 per cent improvement here in Central Zone. There’s still more work to be done, but if that was what could be done with the low-hanging fruit, we expect to see continued improvement with this targeted investment and not specifically related to offloads.

I want to remind the member that the attention and the support to paramedics, that we recognized the importance earlier this year - actually, I forget the date, if it was in the Fall or earlier in January - where we announced the expansion of power stretchers to be made available in our ambulances across the province.

That is another investment, not specifically to offload times, but to help with the health and safety of paramedics so that we can reduce their injuries and keep them working in the jobs that they love, and also to keep them safe in the work that they do so that they can have a healthy, productive work environment, as well as a healthy, productive personal life.

GARY BURRILL: I was speaking about things that paramedics identify as challenges and the areas where they see problems in the work. But I want to say that when you ask paramedics, just anecdotally, about things where they see improvement, one of the things people speak about is the installation of, in the last recent period, those power stretchers and load systems. Injuries related to lifting are always a big concern for everyone in this field.

Everyone speaks about this as a real material improvement in their work circumstances. My understanding is that it’s somewhat less than half of the trucks in the province that have been equipped with this. It sounds as though the logic for the ones that have been equipped for them to have this, having been equipped, is all foolproof and very sound. What do we see in the budget in the way of investments to extend this power stretcher load system to the ambulances that we have at the moment that still don’t have it?

RANDY DELOREY: The announcement that we made and the investment that was made later in 2019-20 fiscal year, the actual outfitting and retrofitting of those ambulances and the procurement of the power stretchers for their implementation, it was over $2.5 million announced to do that work. That work is ongoing.

Although the investment was made in 2019-20, the rollout is coming this calendar fiscal year. There are only so many vehicles that can be retrofitted at a time. The work is under way, and we are trying to minimize the time an ambulance would be out of service to get the necessary retrofitting to work. We did buy, I believe, about 54 complete systems, but the work for installation is still under way.

[5:15 p.m.]

GARY BURRILL: Am I to understand that the retrofitting that’s taking place at the moment would have been provided for in the previous year’s budget? Is there in the current budget provision for working towards a more complete complement of our present fleet having the power lift provision?

RANDY DELOREY: At this point our focus is on the investment that was announced in 2019-20. That investment is ongoing to ensure that we get those ambulances retrofitted, the systems to support the power stretchers and the power stretchers themselves rolled out to those ambulances. We’ll get those out. That will allow us then to see whether every ambulance in the province requires the power stretchers. We want to get these rolled out.

We’ve had a pilot for a little bit, saw the positive improvements, so we’re going to get them out, get them in the most active ambulances where paramedics would be doing the lifting most frequently. We have to see how long it’s going to take to get those ambulances retrofitted this year.

Our $2.6 million investment, I think, makes it very clear that we recognize the value of these stretchers. We don’t have a separate investment line item for this fiscal year for that, but don’t take that to mean that we don’t believe there will be future expansion. We have to get these ones rolled out first, see how it affects the system, and then we’d make future investment decisions at that time.

GARY BURRILL: Thinking about the future investments, could the minister speak to what kind of general timeline the department might be thinking of? Just in the most general terms, are we talking about a 10-year conversion of the fleet or a three-, four-, or five-year conversion of the fleet?

I guess we would have some sense - I think it’s 60-some ambulances that are being converted now - of the timeline there, and what the investment would require. I’m really trying to get a sense of the overall timeline we would need to look at a completely made-over fleet.

RANDY DELOREY: As the member noted earlier, with the investment that we’re making and the conversions that are ongoing, I think we’re looking at just about half of the fleet being converted and having these power stretchers within this year. The conversions can happen relatively quickly. When we have the investment available, we’ll get these in the system this year and see about what comes onstream the next year.

I can’t forecast what next year’s budget will look like, but I look forward to getting half of the fleet, or thereabouts, rolled out this year so that we can get the benefits of those ambulances and anticipate the positive results in that half of the fleet will continue. Then we’ll see if the analysis indicates that every vehicle in the fleet needs to be retrofitted or if there are scenarios where sometimes they may not. That’s the data we need to collect and verify to determine if we need 100 per cent of the fleet or if it’s some other number, but we know we needed this investment. That’s why we made it and are moving forward with it.

The member mentioned 10 years. I wouldn’t think it would take that long. If the final analysis determines that we’re going to be doing the full fleet, I think it would certainly be expected to be done in less time than that.

GARY BURRILL: I think there will be a lot of people very glad to hear that. I just want to think with as much precision as possible about this. Is it fair to say at this stage that there is not yet within the department, or not at this point, a timeline for conversion of the entire fleet, or is it fair to say that the minister is trying to say that thinking about a timeline at this point is premature?

RANDY DELOREY: I think that those of you who know me, I’m not apt to make absolute statements in advance, so any kind of future projection would be dependant upon future budgets that come to the floor of the Legislature.

If we were to set that aside and just think practically, I think operationally speaking it’s been suggested that somewhere in the three- to five-year range for conversions might be reasonable. But that would be subject to budgets and seeing the final recommendation, whether it’s 100 per cent of the fleet or some variable less than that.

GARY BURRILL: I was really just wondering about a general framework that people might be able to look forward to.

Thinking more about paramedics and the issues about the health care system that they bring forward - of course, you can’t talk about this with somebody without talking at some point about remuneration. This is a subject that paramedics raise routinely as an object of dissatisfaction and frustration, comparing paramedic remuneration in our province to elsewhere in the country. Many people speak, reasonably it seems to me, about how this is a serious issue for us from the point of view of recruiting and retaining paramedics here in Nova Scotia. An improvement of remuneration for paramedics is something that we need to have in order to do the best that we can on the retention and recruitment front.

I want to ask the minister: Is there a part of the budget that is dedicated to improving retention and recruitment, particularly of paramedics, and I am wondering within that, particularly on the front of remuneration?

RANDY DELOREY: I can appreciate the challenges and frustrations for paramedics, but I believe that the parties negotiated many aspects of their collective agreement over the past period of time. It is an agreement that last expired, I believe, in 2015, so there have been extensive negotiations and time. Many aspects were negotiated and concluded by the parties at the negotiating table, but the final aspects of that agreement went to an arbitrator. I believe just recently a decision was issued by that arbitrator.

What I think you see here is the wage base and the benefits for that bargaining unit. It works out to about $77 million. I think if you note that the agreement expired in 2015, the compensation of this particular agreement runs from that date until October 31, 2023. The increases that are received, they will be receiving as this contract gets implemented as per the negotiated and final-stages arbitrated decision, so there will be increases to their compensation. I believe that likely has already been communicated to them from their union. I don’t want to get into the specifics here in case that hasn’t been done, because the ruling just happened about 10 days ago.

GARY BURRILL: Thanks for those explanations about the work of paramedics. I appreciate them, and I wonder if we could change gears a little to think some together about long-term care. The minister was speaking earlier in response to questions from the Progressive Conservative Party about that landmark expert panel and its recommendations and all of the conversations that took place around that.

Core to the discourse and work of the expert panel was the question of the adequacy of the staffing complement on the floors of the facilities of the province, RNs and LPNs, but particularly the discussion has centred on the work of continuing care assistants. One of the things that came to the fore in the course of the discussion around the report of the expert panel was the fact that the government provides financial support to long-term care facilities to support now a staffing minimum of 2.45 hours of direct care per resident per day.

I’m sure the minister is familiar with the volume of research that talks about the change in recent years in the world of the population of nursing homes. Not just from the point of view of increased age of the population in nursing homes, although surely that’s a big factor and also in increased frailty and in increased acuity, it seems there’s a pretty general understanding now amongst everyone who speaks to this subject, that one of the consequences of an expanded home care regime is that when the day comes that people are no longer in a situation where home care is going to be able to provide them with what they need, and they need to look towards moving into a long-term care facility, that very often they are in a situation where they need an awful lot more support than was the case just a few years ago.

When we were talking a little earlier, the minister was referring to the fact that I’m a bit older than him. That’s true, so I have experienced this change very much within my memory. When I first was a caller in nursing homes, which I’ve done for many years as a minister of the United Church - if one might go at suppertime, it was very common that the visitor could pull up a chair with the people that you were visiting and they would be having their supper at the table and you might even be served one yourself.

This is almost unthinkable in the world of long-term care facilities, as I’ve experienced it in the last few years, that the volume of people who need support in order to have their meal is so much greater, support in every aspect of their lives. We know that one of the unions that represents probably more CCAs than any other in Nova Scotia - CUPE - on the basis of their research, called on the government, on the basis of these facts, to increase funding for CCAs from the 2.45-hour provision at present to the provision of 4.1 hours per resident per day.

[5:30 p.m.]

I want to ask the minister: Would he speak to whether or not the budget addresses an increase in CCA hours per resident, as we have heard it called for and amplified by so many voices, including the authors of the expert panel?

RANDY DELOREY: I don’t think I mentioned or used the term that the member was older than I am. I think we just mentioned that we existed over a different continuum of time. Semantics, I suppose.

On this particular one, I don’t believe the expert panel explicitly recommended, as he mentioned at the tail end of his question, to increase the hours. As it related to the services that were needed, the panel’s recommendation was an acknowledgement that ensuring that the quality of the care and how care is delivered and provided to residents in long-term care settings needed to be, perhaps, modified. In the short period of time that the panel had to dig in and research in this space, they did not feel they had adequate time to come up with a detailed recommendation, but rather they recommended that we pursue more research to identify the recommendations.

Some of what the recommendation was, just to the member’s point, was the recognition that the care needs do vary. They vary from facility to facility or community to community, but also within a community or facility, the care needs of the population of the residents may change over time, becoming more or less acute, depending on the population of residents at any given time. They had recommended more work. That work is ongoing with the Nova Scotia Centre on Aging, which is located at Mount Saint Vincent University. We look forward to the continued advice and recommendation.

We know one of the challenges with providing care is also with staffing, as with other parts of the health care system, even within the existing care parameters, ensuring that we have the staff to fill, to manage overtime and other requirements which, for the nursing staff, is predicated or supported by expanded investments in nursing student seats and for CCAs. The work that we’ve done to promote, as recommended by the panel - the industry is a very rewarding, albeit challenging, career to pursue. We supported, as we did with the bursary, those potential CCAs, those CCA students, to complete the training they need to provide this care.

There is more work that falls in the medium- and longer-term space. I understand and appreciate the advocacy of the bargaining agent, the union, on behalf of members, for that specific request. We are investing in a multitude of initiatives. We’re having conversations with the experts in the area to help inform what the best staffing model and approaches are for the future of our long-term care facilities. We’re being informed by evidence and the information and guided by the principles provided to us in the expert panel’s report.

GARY BURRILL: The expert panel, however, did say that it had real concerns about the adequacy of the care that’s being provided in long-term care. Although, of course, I’m not quoting directly, I think it’s a fair construction of the general sense of the report to say that the authors of the report identify that inadequacy of care that they are concerned about as being very closely tied to the inadequacy of the numbers of people on the floors.

I want to ask the minister in a more precise way: Does the budget in front of us provide for addressing this question by making financial provision for there to be more hours of CCA care per resident in long-term care facilities?

RANDY DELOREY: I don’t believe the conclusion that the member drew in his remarks - let me back up. The member is correct in terms of the references, that the long-term care panel’s report acknowledges the need to strengthen the care provisions to residents, that in part they did reference relating to acuity and care needs. The member is correct in that regard. We acknowledge that.

I think where the member perhaps drew a different conclusion than what I understand the recommendations to have been, though - they did not explicitly conclude that it was about hours. In fact, when they released the report, they made it clear that the front end wasn’t where the primary focus needed to be. The focus is on ensuring that those providing care are providing the appropriate care, providing it to the full scope of their practice, doing increased capacity with those providing care and the potential value-add of different providers - allied health care providers - the potential for expanded recreational opportunities that can have other benefits that can reduce the acuity needs and demands on the existing staff complement.

It’s coming to that better understanding that those other programs and services that may not currently be in our long-term care setting environment might actually provide better outcomes within the long-term care sector that the panel was directing us towards. That is why they recommended more work around that to provide those further recommendations, as opposed to simply taking the investment money and putting it toward additional hours under the same model of care.

As far as investment to support the continued implementation of the panel, I believe there’s about $5.1 million in the budget that we have targeted towards continued investment in recommendations identified in the long-term panel’s report. I think that’s an important and valued investment in a priority area that I believe all members on the floor - certainly the member and his colleagues and my colleagues on this side of the floor - share as a priority. That’s why we put that money toward continued investment to achieve the outcomes flagged by the expert panel.

GARY BURRILL: It seems to me that there is no question more central in the long-term care world than the question of the adequacy of staffing. I am sure the minister must hear this from many angles. I can’t imagine how anyone could be near the work of nursing homes and not continually have discussions about staffing adequacy.

I think about one highly-respected nursing home administrator in a highly-regarded facility in the province. I spoke to him about this one time not long ago, and when I was talking about this, he said to me, if we only had one more CCA per wing we could change everybody’s lives. We could change the whole picture.

When a person speaks to CCAs about their work and how they find it, I am struck - I’ll bet the minister is too - by the quality of the motivation of CCAs. People go into CCA work in nursing homes and almost uniformly when you ask, how did you go into this, they say they love working with old people.

When you talk to people about their work, I find very commonly in the last couple of years, people speak about how they went into the work out of that altruistic motivation, but they’re not enjoying their work like they did when they started. They are finding it hard going. When you ask why that is, they say it used to be from time to time they would have to work short, everyone does that in their job, but they work short all the time. As a result, they’re getting hurt more than they used to.

Besides that - and so many people said this - the big thing is they don’t feel like they’re doing their job at the level that they would be able to do it. I don’t think there’s any more pressing matter before a long-term care provision in the department then seeing that we have an improved number of CCAs on the floors.

I want to ask the minister to speak to this in a little more detail if he will: Where in the current budget is the matter of the adequacy of the CCA complement on the floors of the nursing homes of the province addressed?

RANDY DELOREY: Mr. Chair, to specifically answer the question with the budget details, the Budget Estimates and Supplementary Detail document, on Page 13.10, provides the investments towards continuing care. The details aren’t broken down in every aspect of detail, but certainly at the level of detail the member is looking for. As I mentioned previously, about $5.1 million is what we’ve allocated towards the continued implementation of work on the expert panel recommendations. This is where we are focused on addressing those recommendations.

I think to those two scenarios about the ultimately unacceptable rate of injuries of health care professionals, in this case in the continuing care/long-term care segment, we recognize that. That’s why we’ve done investment in new equipment - not just in long- term care facilities but for home care providers as well, with equipment to help reduce the risk of injuries through lifts and moving the slip sheets that go on beds to help move. This is something we do value and think is important, so we’ve made investments in that area for the appropriate equipment over the last couple of years as well in both long-term care and the home care environments.

The notion of working short - unfortunately, that notion is not necessarily directly or completely associated with the hours of care that the member is referring to. In fact, the challenge there is like the challenge in many parts of the health care system: it’s about having the appropriate adequate supply of professionals to provide that care. When examining the expert panel report, recommendations came out very clear that in fact having an increased supply of staff, particularly CCAs, to provide the valuable and rewarding work that they do available in our long-term care facilities would address that piece. We have to first address meeting the necessary staffing complements so that the existing staff don’t have to work the extra time if they don’t want to work out of necessity.

[5:45 p.m.]

That’s why we’ve invested in things like the bursary program in the training program, changing the policies around to recognize the training and expertise of nurses who may have retired and left the profession, and to recognize that they can work as CCAs, without having to do additional training, a certification process, doing work with colleagues in the Office of Immigration, to help support the recruitment. I believe there have been several hundred, or certainly over a hundred, CCAs who have come in in the last number of months, in part because of better collaboration and partnership with the Office of Immigration.

Like in other areas, when it comes to the health human resource requirements, to deliver the care that the citizens of Nova Scotia require, it has been a collaborative effort, multiple streams of initiatives, and that’s step one.

As that work is ongoing, as I’ve said previously, the expert panel, the Centre on Aging, is continuing its research to help inform any other staffing changes that might be recommended for long-term care space. Once we have that information and finalize the path forward, we would obviously come forward and advocate for the funding. At this point we don’t have that, but we do have a number of other initiatives that are targeted, recognized to increase the recruitment and training of qualified CCAs to provide the care and help offset those challenges that the member has highlighted.

GARY BURRILL: About the $5.1 million then, the budget explains that $2.3 million of this is an increase to be attributed to the budget itself. Could the minister, with his staff, be able to provide an explanation of what the $2.3 million is actually covering?

RANDY DELOREY: That increase is attributed to - I think last year’s fiscal budget had about $3.7 million and it has increased to $5.1 million, so some of the investments are being made into the various recommendations from the long-term care panel.

There is work that will continue with some of these recommendations. Some of them include the CCA bursary. There’s a significant investment for the training, as I’ve said. Other items that are within the recommendations are continued work to support the research that is ongoing for the longer-term items. Meetings are ongoing within the sector, including one as recently as yesterday, to focus on exactly which priority items. We have the money, but not all of it has been directly allocated. As I said, there was a meeting as recently as yesterday with the sector to discuss and see where they want to prioritize some of those investments, knowing the funding is available.

We’re guided by the framework of recommendations provided by the long-term care panel. We’ve obtained the investment through this budget - or we will through this budget - provided my colleagues vote in favour of it when the time comes. That lines us up well to continue to work with our long-term care sector to really ensure we’re all on the same page as to the sequence of the prioritizations of those investments. It’s not all laid out at this point, but it’s being guided by the expert panel recommendations and the ongoing discussions with the sector.

GARY BURRILL: Does that mean then that it’s premature at this point to have a breakdown of what that $2.3 million is for, the fact that the department is not really in a position to speak to that in other than a global way?

RANDY DELOREY: That’s correct. The global broad sense is that our investments are being guided by the recommendations from the expert panel. We have a number of items that have been completed, others that are in progress, some that require a bit more research, and some funding for the actual implementation. We are focused on having those continued conversations with the sector to ensure that as we prioritize the many items and recommendations from the expert panel that we get their feedback, to ensure that what we prioritize and the sequencing of the investments align with what they think would have the greatest value and positive impact to the residents.

The member is correct that it would be premature to break out exactly how the $5.1 million is being distributed on the various items. Suffice it to say that the investment will be made towards the expert panel recommendations to achieve the outcomes that have been flagged for us there. But the sequencing prioritization of that is being done in part in consultation with the sector. As recently as yesterday there was a meeting with staff and the sector to have those discussions on how to proceed forward.

GARY BURRILL: The minister, I’m sure, can understand that this is a matter of pretty big interest in the sector. I’m just trying to get some sense of the $5.1 million. Is this too specific a question: Is any of this directed towards long-term care facilities?

RANDY DELOREY: For clarity on the question, when the member refers to “long-term care facilities,” does he mean physical infrastructure within the facilities or achieving the expert panel recommendations?

GARY BURRILL: I’m not talking about capital spending. I’m talking about operational spending and the context is, thinking over the history of cuts that have been made to operational spending in the last six years to nursing homes, the question of what this $5.1 million might represent for the lives of those who live in nursing homes is significant.

It’s from that point of view that I’m wondering, of this $5.1 million, is there some component or no component that the minister could identify as being allocated to the operational budgets of long-term care facilities themselves?

RANDY DELOREY: If I understand the question about the operational side of investment and if it ties back into the theme of the questions that we started with here about dedicated operational funding and the per diem rates being provided, that’s not the area that - and if the member refers back to the expert panel for that report, he would note that that’s not the nature of the recommendations.

That said, the value of the investments is targeted broadly towards the sector. The value is targeted towards, in some cases, research that will help inform future policy investment decisions. Some of it is invested in equipment, there may be some equipment purchased to support the sector in some areas. Much of the challenge that was identified, a significant number of the recommendations were about the training, recruitment, and retention of workers for the continuing care sector.

That’s really more on the training preparation side of the equation that they’ve been focused on in the recommendations, as well as some other areas of unique and new types of care and support. I guess it’s to the question: Is there kind of a blanket investment that goes directly to the bottom line or an increase to per diems based on this targeted investment? No, but the contracts and the agreements that are in place with continuing care for their per diems are established.

This investment that we’ve been talking about is to support the implementation of the expert panel’s recommendations. That’s what the $5.1 million is targeted at.

GARY BURRILL: The explanation about the $5.1 million, I think I understand. I’m still not understanding, particularly, what is newly being offered and funded with the $2.3 million. Did I understand the minister to say that the $2.3 million is covering the CCA bursary? If that is so, it would be good to have a sense of how much that is.

RANDY DELOREY: If I said that, I may have misspoken. I was talking in the broad sense of all of the $5.1 million, so the increase of the $2.3 million.

I do want to go back to the previous question, though, where the member asked - again, here we’re talking about that $5.1 million, which is totally targeted in these initiatives, recommended by the expert panel. I don’t want the member to leave this evening thinking that there’s no increased investment in the operations of long-term care. In fact, I believe there is about a 5 per cent increase to the operations budget in the long-term care sector. This $5.1 million targeted towards the expert panel is in addition to the operational increase of 5 per cent.

GARY BURRILL: Could the minister give an indication of roughly how much of the $5.1 million is taken up with the CCA bursary component?

RANDY DELOREY: Based on last year, we had about 102 bursaries with a budget of about just over $400,000. Those bursaries were, I believe, $4,000 each. There were just over 100 bursaries at $4,000 apiece, so about $400,000, based on last year’s investment.

[6:00 p.m.]

GARY BURRILL: Outside of that $400,000, in the $5.1 million, are there any other particular envisioned expenditures for CCAs?

RANDY DELOREY: It’s going through the recommendations of the work, a significant number in section one within the expert panel recommendations. There were five under the category of Human Resource Capacity and Staffing Mix. Many of the short-term investments - for example, long-term care assistance, a new role that was brought in to help support those facilities and the staff where there are chronic shortages of CCA staff - to be brought in while these investments in the training and bursary program help strengthen the actual pool of CCAs available to fill these longer-term or chronic vacancies.

That relates to a number of other investments to help promote the area and work with the training facilities on the curriculum that they deliver. Attracting and growing the facility - that is through education and that’s where the bursary program is recognized. We continue to work on a broader, or longer-term, more sustainable strategy for recruitment and retention. That work is to design and implement. We don’t have all the answers, but we took the recommendations, like the bursary program, from the panel and pursued that because it was a little bit more of the low-hanging fruit.

Work is continuing in those other areas, specifically for continuing care. The investments that we’ve already made with respect to the equipment that will be used within the facilities with a focus on, particularly, the health and safety of both the resident and the continuing care assistants providing the care - lifts and slip sheets and so on. Most of the injuries occur when moving the residents around within the facility.

Other work ongoing and engaged with the sector is to see what’s exactly the best use of the funding to help with the theme of recruiting and retaining the CCAs within the workforce so that they can continue to provide the care that’s needed by the residents within those facilities.

THE CHAIR: Time for the NDP has elapsed. If we do not need a break, we’ll carry on with the PC caucus.

The honourable member for Pictou West.

KARLA MACFARLANE: I’m going to go just quickly for a little bit to cannabis. I’m just wondering if there’s anything in this budget for research regarding the health risks associated with using cannabis.

RANDY DELOREY: The research-focused priorities in investments that get made, including health research, is made through Research Nova Scotia and the funds that they have. That entity then works to identify and prioritize the research projects that come forward.

I’m not aware that there’s a specific research project that’s currently identified and funded, but they receive their budget and put out their calls for research proposals and/or in some cases researchers, including health researchers, would submit proposals to the research funding agency to be considered.

Off the top of my head, I’m not aware of a specific research project that’s under way directly other than with researchers in the province. We do have some collaboration with our federal partners looking at research to better understand the harms and potential medical benefits and establish some data standards within the area of cannabis. But again, as far as specific research or research projects, I am not aware of any under way at this point in time.

Funding exists for research programs, broadly. If there’s a researcher in Nova Scotia pursuing that, Research Nova Scotia is where that research grant money would be.

KARLA MACFARLANE: What is the financial investment out of your budget? Is there anything in this budget that goes to those researchers?

While I am asking the question, perhaps I will frame it around what kind of investment, or if there’s anything in this budget that’s going towards applying researchers to investigate further into vaping and e-cigs as well.

RANDY DELOREY: I think the contribution that we are making - I don’t have the number right here with me, but I guess off the top of our heads it’s somewhere in the $4 million range from the department’s budget to Research Nova Scotia.

The nature of the research for e-cigarettes - much like the cannabis question, researchers who have the interest in that space would approach Research Nova Scotia for funding grant opportunities as well as other federal granting agencies and programs.

KARLA MACFARLANE: Out of that figure that was given, is that the same fund where there would be money given to Dalhousie for research, or is that separate?

RANDY DELOREY: That’s the funding that would go to Research Nova Scotia. Dalhousie as a research institution, or the researchers who work at Dalhousie, may have multiple sources of funding.

I guess it was last April that Research Nova Scotia came into being. It’s not directly a purview here, but there were several different granting agencies in the past. We amalgamated to simplify for researchers to have a single entry point for research grant submissions within provincial funding investments. That is predominantly governed by the Department of Labour and Advanced Education, although recognizing the importance of health operations and research, we do provide funding into the granting agency to ensure that there are still important health research projects undertaken.

We don’t necessarily direct what those projects are. We put the investment into Research Nova Scotia. We don’t necessarily direct the actual research project itself.

KARLA MACFARLANE: I’d like to ask the minister, has he had any recent meetings with regard to researchers who are identifying and looking at the effects that cannabis has on brain tissue and behaviour? I’m wondering as well, has he had any meetings with his colleagues with regard to cannabis, perhaps the Minister of Justice?

RANDY DELOREY: I’m only aware of one researcher who I’ve been in contact with. In fact, it was a clinician who recommended connecting with a particular researcher - I believe it was Dr. Mary Lynch. I believe that’s her name. She’s a pain researcher and a clinician who had an interest in having some research suggested connecting with her. I did meet with her about a potential research project, advised the various avenues to look at pursuing funding. I’ve not heard if that funding application had been submitted or not, but they also haven’t followed up to express any concern.

I don’t know if they chose to pursue further research, but it was a very good engagement. I learned about not just a potential research project that was being considered but also the state of much of the research with a focus on cannabis in the area of pain and pain management.

KARLA MACFARLANE: I think it’s extremely important that those conversations are happening. I’m wondering if there’s anything in this budget that’s aimed at preventive measures and awareness for our youth with using cannabis as well as vaping.

RANDY DELOREY: In terms of research, on Nova Scotia Research’s website there is indication about a Nova Scotia researcher connecting cannabis and mental health. Clearly there is work being undertaken, in part funded by Research Nova Scotia, so researchers are aware of that as a funding source, and obviously that’s an example of a connection being made.

As it relates to efforts to reduce youth consumption, earlier today I tabled a piece of legislation that is targeted exactly at reducing youth consumption of e-cigarette vaping products. That builds upon the earlier regulatory changes that were announced in December that are set to go into effect April 1^st, eliminating flavours and putting a ban on flavours for e-juices.

We continue to make strides to promote and support a tobacco- and nicotine-free province, and we take these steps very seriously. I think we will have deeper discussion on the floor with that particular piece of legislation, but that’s separate from estimates.

KARLA MACFARLANE: Since the minister has brought up that piece of legislation, I would like to ask: What consultations took place in order to arrive at that piece of legislation?

RANDY DELOREY: Work that was undertaken within the department - they would have engaged with a number of stakeholders. Smoke-Free Nova Scotia, the Lung Association, and the Canadian Cancer Society have made very clear recommendations, some provincially and some nationally, and then within our staff, doing an assessment and some recommendations for us to do some work.

[6:15 p.m.]

We take all of that information. There is a significant amount of correspondence that has also come in from people across the province. It was no secret that we were pursuing additional legislation coming forward, based upon my public comments in the Fall, that we would be making the flavour ban through regulations and further legislative changes, so there was a lot of correspondence that came in to the department, as well, making recommendations.

Where I see a lot of consensus - one of the biggest things is moving on restricting the nicotine content. That certainly showed a lot of consistency, both with advocates who supported vaping in general, making recommendations to reduce or restrict the nicotine content, to put a maximum cap on nicotine content. Even those who were perhaps otherwise supportive of the vaping industry, that submitted correspondence to me as minister, were noting that if we’re going to do something, that’s something we should be doing. That also lined up with recommendations from those other stakeholders who, broadly, were not supportive of the vaping industry or vaping products.

KARLA MACFARLANE: I believe the minister may have just answered my next question. I wanted to ask if he specifically met with those who own and operate vaping stores within the province and if he actually held a separate meeting for them to be able to speak on this piece of legislation as well.

RANDY DELOREY: I did not meet separately with any representatives of the tobacco or vaping industries. That was something we announced in the Fall. I believe the Premier made statements in the Fall, perhaps during the last sitting of the Legislature the topic came up, and made it clear that we would not.

That said, certainly, unsolicited correspondence did come in to me at my ministerial account that I read the information, take that information in, but I did not have a meeting. I do believe that their positions were articulated through that correspondence.

KARLA MACFARLANE: Moving along here to coronavirus, there’s a lot of global media attention about coronavirus. It has caused a lot of worry and anxiety among many Nova Scotians, particularly since the World Health Organization has designated the virus as a public health emergency of international concern. The virus may currently be considered low risk in Nova Scotia, but because the virus is contagious when it’s actually in its incubation stage, our ability to act to prevent and react will determine if Nova Scotians’ lives are really at risk for this virus.

I’m wondering if the minister can provide information on our ability to handle a potentially significant strain on the lives of Nova Scotians. Also, can our health care system actually survive such a virus?

RANDY DELOREY: I think a very timely inquiry, given the developments over the last two months or so - this is a situation, as the member rightly noted, of international concern. I believe it’s getting the attention that such a concern warrants.

Public health officials within the province, led by our Chief Medical Officer of Health, meet on a very frequent basis with counterparts. There would be teleconferencing, of course, with colleagues across the country. They have access to international information, as well. The World Health Organization, obviously, is coordinating and disseminating information and recommendations out to international jurisdictions. That filters down at a national level for what steps we need to take.

The member is correct, by and large the risk identified for Nova Scotia as being quite low, particularly when, internationally, the outbreak was largely contained to China and regions within China. More recently, in the last number of days or week or so, as noted by the World Health Organization, we’ve seen the spread to other parts of the world. They’re starting to say that nearing the point of containment becomes more difficult, that it may expand more broadly across the globe. The efforts that have been taken to date by all countries has been to minimize the spread within the originating areas and globally. In a Nova Scotian context, we have had no cases identified. There have been about a half-dozen individuals that have been identified as worthy of being tested, based upon their circumstances, and all were deemed negative.

This, however, does not stop the planning and the work of public health officials and our health system. The work and the approach that’s taken, the elevation of actions being taken, is informed by an ever-changing environment. The spread of the virus across jurisdictions is not heavily present in the North American context at present, but health officials do continue their planning, even for a scenario where it does become present and begins spreading.

That said, the prevention and preventive measures are really just proper health recommendations for citizens at any point in time: proper hand-washing, perhaps washing your hands more frequently with warm water and soap, anti-bacterials, and so on, to prevent the spreading; and minimizing - and I am a victim of this, as well, especially when sitting and listening in this Chamber, of having my hand near my mouth. If you get the virus transmitted through saliva, or what have you, onto your hands, which may transfer from other surfaces, then by putting your hands near your mouth, is how you would transmit or come into contact with the virus. Keeping your hands away from your mouth and face area and frequently washing and sanitizing your hands are the recommended approaches for individual citizens to minimize the risk of being affected. Not just with COVID-19, that’s good advice for the common cold, and flu conditions as well.

KARLA MACFARLANE: I would like the minister to inform us what labs in the province actually have the capability of testing for the coronavirus. Is it just one particular lab in the HRM area?

RANDY DELOREY: I believe at present, particularly for confirmation of COVID-19, we still send results to Winnipeg to be confirmed. I’m just double-checking to see if the preliminary testing availability is here. I believe the final confirmation - that’s where you’d see a presumptive case. You might have a preliminary test, but to get the final testing is done out of Winnipeg at a national lab.

The other thing that’s worth noting is that we have researchers here in Nova Scotia. I believe Sona Nanotech has been highlighted in the news as taking an active role in establishing a lower cost, quicker, and readily accessible initial test program.

I believe the CEO of that company - a Nova Scotia-based company, founded in Nova Scotia - was working in the U.K. previously and has had some success in its previous work with developing rapid tests for other conditions. He has seen the potential for his company’s technology to potentially reduce the cost of those preliminary screening tests and also get the test results in a shorter period of time. As it stands now, within our health system, we screen individuals, but the lab tests go to Winnipeg for confirmation. The actual testing is done in Winnipeg at a national lab.

KARLA MACFARLANE: I appreciate the minister discussing this with us, because I believe probably all MLAs are getting a lot of calls about this. We are trying not to put fear into anyone, because I think that we can have control over it and make sure that we’re all consistent with our messaging. That’s why I’m asking these questions.

I would like to know if there is a plan being prepared for containment once the virus has possibly affected someone in Nova Scotia.

RANDY DELOREY: I really do appreciate the approach being taken, to ask factual questions. I think she shares the concern of ensuring that people have the appropriate and factual information.

I’ll just take a moment to let the member know, and for all the colleagues here, that if you have constituents who are calling or inquiring about COVID-19, they can go to our provincial website: https://novascotia.ca/coronavirus/. That provides the latest updated information from Nova Scotia, as well as providing links back to other reputable sources of information about this particular virus.

I think if we can get any information out to Nova Scotians to help manage their anxiety and concerns, it would be that. We know that in today’s day and age with social media, posts get made, and sometimes in our busy lives people don’t take the time to validate the accuracy of the information being presented. I’m not sure if you’re aware, but our education system does have a particular part to the program curriculum that does help educate our youth in Grade 9, through one of the courses there, on identifying and validating information. We can give kudos to the Minister of Education and Early Childhood Development for the great work that they are doing there.

The specific question the member asked was about containment in Nova Scotia. At this point I would think that, given the origin and the status of the virus spreading to Nova Scotia, if it was to arrive with a single individual, you could manage to contain through self-isolation and so on, which is the recommended protocol.

[6:30 p.m.]

We do have in place a protocol with our health care providers in our emergency departments to respond and provide the appropriate health care to the potentially affected individual. That protocol rolled out several weeks ago, as it did following similar approaches in other jurisdictions in Canada. If what the member is referring to is a broader prevalence - reminding people there is no instance of COVID-19 in Nova Scotia - to a “what if” scenario, that if globally it becomes a pandemic and begins establishing itself in Nova Scotia in a broader sense, I think at that point, from public health officials’ perspective, it’s no longer about containment. At that stage you wouldn’t be able to contain it. It’s about managing the spread of the virus and managing and minimizing the impacts.

At this point, prevention still remains the number-one recommendation, proper hygiene, and that’s to prevent yourself from becoming sick. The other is also proper etiquette for preventing yourself from spreading disease to others; coughing and sneezing into your elbow and so on, are the public health recommendations there.

As far as a broader response if necessary, we developed protocols in public health with our partners, following H1N1 and SARS, and they get refined each time we have a situation like this occur. We’re executing in our public health offices with our partners in the Health Authorities based on that, and as the information and the status of COVID-19 globally and nationally and locally evolves, the various stages of that planning get executed.

The planning is there, more detailed planning, because we’re seeing the spread go out. That means we’re moving up the scale in the execution of the work that we’re doing in our public health offices here in Nova Scotia and across the country as well.

KARLA MACFARLANE: I thank the minister for that. Just one more question on this subject. I believe that Nova Scotians have a right to raise their concerns and ask us questions and that we have a plan prepared. Let’s hope we will not have to use that plan and let’s take a reasonable approach to this. One of the things that has been brought to my attention is that the Ontario Government has committed to providing updates on this virus. One of the ways they are doing it, besides using social media - because believe it or not, I think a lot of times putting something out in the mail is actually more effective than social media. You’re getting the correct information out, especially if it’s coming from the Department of Health and Wellness or NSHA, there’s perhaps more credibility than reading something on social media.

I’m just wondering: Is this something the minister would consider as a plan moving forward, if necessary?

RANDY DELOREY: I thank the member for the suggestion, I guess, as much as a question. I would have to double-check with the Chief Medical Officer of Health as to what specifically goes in terms of what stage a mass mailing communication may be triggered. It is possible that’s in their detailed pandemic planning, at a particular stage of an outbreak. I don’t have that level of detail with me to know if that’s in there or not. I can certainly bring forward the suggestion that it be contemplated or considered as a possibility. I’d certainly advise it in the meantime.

The member started this line of questioning, acknowledging that constituents are calling or expressing concerns, either through our offices or in our community when we’re out and about, what is an interim measure? What I’ll commit to the member is that I’ll go back and engage with public health officials and pull together a fact sheet that we’ll distribute to the three caucus offices and the Independent members so that each of us, as MLAs, have it in our offices, as well, and we can use it in our communication, which may be newsletters or others, as well as our own social media or other online communication channels. If nothing else, at least our assistants in our offices in our communities will have the information to support Nova Scotians as well.

KARLA MACFARLANE: I want to thank the minister for that, because I think it is important that we are consistent and that we all have the same messaging. I appreciate that offer, and we will look for that information.

I’m going to move on to oral health care. This is very important to me. I think I mentioned once here in the House that we have wine snobs. I’m a dental floss snob, and I totally believe that we underestimate the value of proper oral health care and starting at a really young age.

I don’t think we’re putting enough investments into oral health care, particularly around preventive care. Can the minister, his department, or perhaps the committee that I understand is working on a dental strategy, update me on that Oral Health Advisory Group, which I believe was formed in 2015? I’m just looking for an update on that committee.

RANDY DELOREY: I believe last year, about a year ago, we entered into a new agreement with the Nova Scotia Dental Association, which did expand youth dental health preventive services at that time. We did take steps to provide more molar sealants and some other services that were recommended as part of that agreement.

In addition, Dr. Franklin has been hired as a dental consultant to provide guidance and assistance in establishing the next phase of our dental strategy at work in the province. She was hired just under a year ago.

KARLA MACFARLANE: What is the budget for the consultant that was hired a year ago? Is this actually a full-time position?

RANDY DELOREY: It’s not a full-time position; it’s a part-time position. I don’t have the specific individual amount here with us. The data in our Budget Estimates are usually rolled up a bit more detailed than the individual providers.

KARLA MACFARLANE: Going back, this consultant was hired - at the time, I know I had introduced a bill for a chief dental officer, and one of the reasons the Liberal Government didn’t believe in that piece of legislation was because they were hiring this consultant. But I understand that this consultant is only working one day a week. Is this consultant’s mandate actually to create an oral health care strategy for our province?

RANDY DELOREY: I think I said Franklin earlier; it’s actually Kraglund, not Franklin. I apologize to her, as well as to the members for that mistake. She is a dental consultant who is providing the advice, recommendations, and guidance to the department staff as they perform this work. I’m trying to recall the exact environment I was in when somebody had commented how lucky we are in Nova Scotia to have someone with Dr. Kraglund’s expertise with dental health within Nova Scotia, because she has some training around dental health and public health space. She has the exact expertise that we need for performing this type of engagement and provides the advice we need to complete that dental strategy work that the staff is working on.

KARLA MACFARLANE: Just to confirm, is her mandate to create an oral health care strategy for our province?

RANDY DELOREY: It’s as a consultant, it’s around all things dental for us as a province. She is a consultant that we can connect with on any range of oral dental health support that we may need that can help inform the direction that we may need to do for prioritizing various investments in this area. In addition to that she is there to support our staff that are working on the next phase of the big-picture objectives and direction for our oral health file.

KARLA MACFARLANE: Has there been any discussion within the Department of Health and Wellness, perhaps even with the Minister of Education and with regard to providing access to dental care within our school system, pre-Primary and Primary?

RANDY DELOREY: I’ve not had discussions with my colleague about expanding and providing dental health services at that stage. I believe there are some fluoride provisions still provided in the school system, fluoride treatments being provided in our schools.

KARLA MACFARLANE: I’m not aware of those schools. Can the minister confirm that he sees this as a preventive measure and that we should be consistent across this province, ensuring that all pre-Primary or Primary are receiving the same type of access to oral health care, whether that is ensuring that they all have fluoride treatment once a year? I’m looking for the minister to endorse that he believes that is a preventive measure that this province, this government, should be taking.

RANDY DELOREY: The fluoride rinse program that I’d referenced is one that is targeted predominately to rural areas, those not on municipal water supplies. Obviously, as many municipalities have a fluoride treatment in their water supplies, this is for those that may be more likely on a well. That might be why the member wasn’t necessarily aware of the schools.

I happen to live in a rural part of the province, and it is in the schools in my community. I think it’s just that we’re rural and there is no municipal water supply with fluoride in it. As a treatment for the fluoride, that’s delivered through the public health offices, as I’m sure the Minister of Education and early Childhood Development would be able to note as well. As I understand it, the early screening that goes on for a variety of health conditions - eyes, oral, and others - are taking place through the Department of Education and Early Childhood Development and the Regional Centres for Education. That will help inform what other types of services may be necessary.

To the member’s point about consistency in preventive care, that’s why we have a youth dental health program that provides dental health services that are targeted at prevention, available up to the age of under 14 years old, I believe. That is something that’s important and can be shared with your citizens, that they can have their dental care taken care of for those youth under 14 years.

[6:45 p.m.]

KARLA MACFARLANE: There is a long waiting list - actually, 500 - waiting at the IWK for some form of dental surgery. Of course, a lot of these children are living in pain. They are not having proper nutrition. Can the minister explain to us what his department’s plan is to decrease this waiting list?

RANDY DELOREY: I think we recently renewed our investment contract, updated contract, with the pediatric dentists who provide that care. I think that’s an important, positive step for the care being provided.

The member, in an earlier question, made reference to prevention, and in this most recent question, she made note as to one of the contributing factors about diet, and so on. I think when we look more broadly at our budget that my colleague the Minister of Finance and Treasury Board tabled just a couple of days ago, it shows significant investments being made with the child benefit, for example, to help provide more money to families with children so they can afford to provide and meet the necessities of the children within the household. That was just one example of investment being made, which could help in a preventive way to support those youth, and not just with their dental but their overall health as well.

KARLA MACFARLANE: I’m going to ask one more question with regard to dental care and then I will pass it over to my colleague, the member for Sackville- Cobequid. We know that children who have their first visit before they are two years old are definitely more likely to have a good future with oral health care for life.

Children who see a dentist before they’re two years old have a better outcome in ensuring that they will have good oral health care for life. What is the minister’s plan for encouraging families to get their children to the dentist before they are two years old?

RANDY DELOREY: The program is available and has been available for families and providing dental care to youth under 14 years of age. It has been in place for several years.

Recently, in the last year or so, we expanded that program to provide enhanced preventive care as part of the agreement we entered into with the Nova Scotia Dental Association. The services are made available to Nova Scotians, but how do we encourage more Nova Scotians with young children to take advantage of those services that are being offered?

I think each of us here in the Legislature, through our various means of communicating to our constituents, one of the important jobs that we do have in our constituencies is to advise our constituents of programs and services that are offered and made available. I encourage and hope that my colleagues across the province will take the opportunity.

I thank the member for raising these important questions. It’s a great opportunity perhaps for some of our newer colleagues, who may not have been aware that these programs existed, to be aware of them. If they have questions or need more information for their constituency offices, they can reach out to me or my executive assistant. We can pull together some additional information, point them to the appropriate spots on our websites to have the information that they need to provide to their constituents, as well, to encourage this, if you want to use it in your mailers or other communications that you have.

THE CHAIR: The honourable member for Sackville-Cobequid, with just over 14 minutes left in this hour.

STEVE CRAIG: It’s the first time I’ve been in the House to do something like this, and I must say I am impressed with your decorum and the way you’re answering the questions, so thank you for that.

Right off the top, coming from Sackville-Cobequid, we have the Cobequid Community Health Centre, which was previously called the Cobequid Multi-Service Centre. It’s part of the organization that set that up initially. It’s been a long history of growth and providing incremental services throughout not only Sackville but the broader HRM community. In fact, we have a cancer care centre there where people come from the Maritimes.

My question is: Are there any plans to expand the services of the Cobequid Community Health Centre in Lower Sackville?

RANDY DELOREY: I welcome the member to his first Estimates debate on Supply. As far as the specific question goes, I know his predecessor also inquired about that site. Off the top of my head, I’m not aware of any substantive changes to that particular site, but it is operated by the Nova Scotia Health Authority as part of their operational work. As they would with all of their sites, they evaluate, and as there are changing needs within communities and so forth, they look to the resources they have, which includes their infrastructure resources, to align that to optimize the care for patients within the community and surrounding catchment areas.

Unfortunately, off the top of my head, I’m not aware of anything. That doesn’t mean the Health Authority doesn’t have some plans they’re working on that they can actually execute within their budget that doesn’t require notification directly back to me.

STEVE CRAIG: I’m going to focus on Page 13.10, which is continuing care, for the remainder of my time. Continuing care provides funding for eligible Nova Scotians who need care outside of the hospital, their home, and their community. It looks at Adult Protection Services; it also looks at Home Care and Long-term Care. The proposed 2020- 21 estimates are $3 million for Adult Protection Services, $283 million for Home Care, and $612 million for Long-term Care. The FTE is constant at 25. Just briefly - and please do not go into the math, just broad strokes - is there five, five, and ten in those particular areas of Adult, Home Care, and Long-term Care FTEs? Roughly, where are they?

RANDY DELOREY: I don’t have the exact numbers of the breakdown but by simply numbers, Adult Protection is the area that most of those staff are in. These funded FTEs are departmental FTEs. These are the individuals providing the care. Adult Protection would be ones actually providing operational care and services. But within the Home Care, nursing services, and so on, this is funding that we pay out to other service providers.

There’s significantly more than 25 people providing these home and long-term care services throughout the province. The majority are in Adult Protection. Within the department, the remaining staff would be more on the policy and administrative side of things that we provide. Services would be spread out, and they would provide support in each of those areas. Just the way that long-term care and our continuing care team is structured, the NSHA and our other partners administer long-term care providers and VON and those organizations.

STEVE CRAIG: I notice in one of the lines here, it’s Long-term Care Capital Infrastructure. You’re overspent forecasted by about $17 million over the estimate of 2019-20, and then you’re back down. What is Capital Infrastructure? It’s my first budget. I know what my history is and how my understanding is of that; however, it was unplanned, and it is significant. Would you comment on that, please?

RANDY DELOREY: Each year we receive submissions from our long-term care providers with recommended or requested capital projects. We were in a position this year - by this, I mean the 2019-20 fiscal year - to provide more funding, support more projects. Often the budget that is available in that roughly $9 million range is what we’ve historically had available.

It was not meeting the needs. We had available funds, knowing deferred maintenance and capital requirements within these facilities, so we had the opportunity in 2019-20 to advance more projects than we would have otherwise because fiscally, as a province, we were able to do so. We approved far more projects, and as part of the broader budgeting, we couldn’t guarantee that the funding would be available.

For our plan this year, we go down again but, year over year budgeted, it is still almost a $1 million increase, or about a 10 per cent increase. We recognize the need to have long-term sustainability, but this one-time increased investment in 2019-20 was a bit of a catch-up with deferred maintenance and other capital projects within these facilities.

STEVE CRAIG: Thank you for that response. It helps me understand that it’s capital infrastructure of somebody else’s facility, not ours, and hence it’s operating from - so that makes sense now.

We would have the facility-based care, which would be part of a contractual agreement, with a number of facilities throughout. We don’t, as you mention, own any of those, so these are companies like Shannex, Rosecrest, and those types of agencies that we do have programs, and they provide that service to us.

The $589 million that we’re looking at for this year represents a $27 million increase. I think that earlier I heard you tell the Leader of the NDP - correct me if I’m wrong, please - that $5 million or so was for additional CCAs. I’m just curious to know what the other $22 million is for. Is it a normal increase? I don’t believe we’ve had an increase in the number of long-term care beds or facilities, so that seems to be a significant increase where you’re taking out $5 million and you’re putting that into new people.

My question is: Is there in the contracts, assuming that we have contracts with all these facilities, an automatic increase in each of the contracts?

RANDY DELOREY: I might have misheard the comment about reflecting on the earlier conversations with the Leader of the NDP. It wasn’t that the $5 million was going to the CCAs but that $5.1 million was targeted towards the implementation of the expert panel recommendations and the ongoing work we do there. Much of that was targeted towards some of the training programs and promotion and things around CCAs.

As far as the increase in annual, some of it is related to wage increases, workers’ compensation costs. As we know, the member was listening to the conversation with the Leader of the NDP when he was inquiring about the investments, so wage increases. He also at one point talked about injuries, so we do recognize this. This is reflected in WCB rates within the health care sector and, in particular, the continuing care sector, are some of the highest as far as an industry goes. There are growing cost pressures there.

[7:00 p.m.]

In addition to that, we have about $1.3 million going towards the operations of 30 new nursing home beds here in Halifax. That is the previously announced conversion of 30 RCF beds to nursing home status at Melville Gardens in the HRM area. There are a few other things, but over $20 million is for wage increases within the sector.

STEVE CRAIG: In those facilities, the contracts seem, by your remarks, that we would automatically include wage increases and other staffing costs. I’m assuming that’s written into the contracts with those organizations. My question is: How many of those organizations have unionized staff?

RANDY DELOREY: If memory serves, I think we have over 130-odd facilities across the province. Those facilities have a wide-ranging scope. I don’t know off the top of my head, it’s not the way I’ve sliced the data to have with me, about what the unionized status may be of the staff provided within those facilities. I’m sure if we looked through each of them, we’d be able to track that down.

Suffice to say that the evolution of the long-term care sector - in many instances they’ve grown and were established before government played a role in providing this type of care; sometimes they were community organizations. In my own community, the Sisters of St. Martha’s role was to work with the municipalities to establish a long-term care sector, and then when the province got involved, they transitioned, and we started funding those existing operations.

Subsequently, as there have been expansions, there have been other contracts established, as the member had referenced, some of the for-profit organizations that provide these services. It’s been around so long; it has a long history. The circumstances of the facilities are very different throughout the province, and I believe almost all of the facilities do have unionized staff.

STEVE CRAIG: I don’t have any more questions at this time. I just want to leave you with a comment that there’s a very good chance that I am older than the Leader of the NDP in this room, and I find that you don’t have to be old to do a good job.

THE CHAIR: The honourable Minister of Health and Wellness - you have 44 seconds.

RANDY DELOREY: Mr. Chair, I’m not sure if that’s adequate time, but I have some practice in Question Period, although I might be a little bit rusty; I haven’t had quite as many questions this session thus far.

Limiting myself to 45 seconds, as you know, is challenging, but to the member, I do appreciate the time he’s taken to ask some very thoughtful questions, both for his own constituency, but also, he’s obviously taken time to understand this sector of the continuing care segment. He asked some very poignant and directed questions about the budget. I hope I adequately responded to those questions for him.

THE CHAIR: Time has expired for the Progressive Conservative Party. We now are back to the NDP.

The honourable Leader of the New Democratic Party.

GARY BURRILL: I’ll be waiting for a parallel soliloquy of appreciation at the end of our period. I don’t expect the minister to remember exactly where we left off, but we were exploring the ramifications of the budget for long-term care in nursing homes and, in particular, for CCAs.

One of the things that the minister was speaking about in a number of his answers, about what is the focus of that $5.1 million and the $2.3 million, were the considerations relative to the retention and recruitment of CCAs. I want to go back to this for a moment because it seems to me that retention and recruitment of CCAs is a different kettle of fish in some ways than it is with other health care providers. Particularly in that, CCAs are so, at least in my view, dramatically underpaid with wages that extend somewhere around $17, $19, or $21 per hour.

I want to ask the minister: Does it not seem to him that this problem identified by the expert panel of the recruitment of people to the continuing care vocation, that the way to address this is to invest in something near reasonable salaries for people who take up this important vocation? This is the line of reasoning that I have been pursuing and asking about the $5.1 million since it does seem to me that this is so critical in speaking to the crisis in long-term care.

I want to ask the minister: Where in the fiscal planning of the department does this question fit, of making some serious improvements in remuneration for CCAs as we look at the retention and recruitment question?

RANDY DELOREY: As per the previous line of questioning from the PC caucus, it was noted that the service providers who are the employers of the continuing care assistants in the long-term care sector, they are the employers who negotiate the compensation with their CCAs and other staff within their facilities. They do that negotiation.

We have contracts that establish the rate that we pay for per diems that cover the services provided. I believe the Leader of the NDP in previous questions made reference, or noted, the fact that it has both protected and operationally unprotected - protected with the medical and health services and operationally unprotected - envelopes. It is a formula and analysis that’s done with our service providers. We provide funding to them, and they negotiate and establish the distribution of wages throughout.

I believe we have an over $20 million investment increase in the long-term care service provisions and $20-some million - $22 million, I believe - towards specifically wage increases, which is about a 2 per cent wage increase for the 2020-21 fiscal year. As I said, there is an investment of over $20 million, about 2 per cent, for wage increases specifically within the long-term care sector.

GARY BURRILL: In addition, then, to the monies allocated for the bursary and the monies allocated for the 2 per cent, are there any monies in the budget allocated to improve the retention and recruitment of CCAs?

RANDY DELOREY: I think it goes back to our previous conversation. The investments targeted around the recommendations from the expert panel on long-term care flag initiatives, program areas, or research that they believe will help improve the overall environment of care within the long-term care setting.

Some of those investments are things like promotion. We launched a campaign last year to promote the field of continuing care assistant. That was designed to encourage qualified people to look at employment opportunities, but it was also to encourage others to pursue the educational opportunities to become qualified within the CCA field.

In addition, as the member said, some of the challenges with retention are not necessarily the same as in other parts of the health care system. As I’ve mentioned in one of the previous responses, the fact is that the continuing care sector is one of the highest-risk industries for injury in the workplace. That is concerning to us. It’s reflected in the growing costs of WCB - workers’ compensation insurance and costs for employers funded by the government. But more than those dollars being spent on workers’ compensation insurance, and the fact that that money could be redirected elsewhere to care if we bring the prevalence of injuries down, it’s concerning that when an injury occurs, that individual employee is unable to perform the work that they are so passionate about.

For anyone who’s been in a long-term care facility or has met a CCA, nurse, or administrator in a continuing care facility or a long-term care facility, it is a labour of love: love of the work, love of the residents that they serve. When an injury occurs that takes a person out of their workplace, that then increases the pressure on the remaining workforce while they recover. That is something we want to avoid. That’s why we’ve had other investments and strategies targeted toward improving the safety in our continuing care, both in the long-term care and home care sectors. We believe that will help ensure that the CCAs who are working are able to continue working and not become injured, both in the short term and the longer term of their careers.

GARY BURRILL: I’m sure the minister would want, as I want, for the record of our exchange on this to show that when we are talking about CCAs, we don’t in any way mean to leave out the contribution of all those who work in departments like environment, laundry, and dietary.

What I said earlier about the striking altruistic motivation and commitment of people that I’ve experienced working in nursing homes is not just a matter of the people doing patient care. It’s a matter of people who work across the board. I’m sure the minister shares this view.

Thinking about the particular difficulty that we face with retention and recruitment of CCAs and these problems that we have been speaking about - injury proneness, the relative inadequacy of CCAs’ pay, and I think it’s fair to say, the intensification of work in terms of working short - I want to ask the minister: Is the government, in addition to the expert panel and the department, undertaking any or envisioning undertaking any research into the well-being and preventing the burnout of CCAs? Are there any initiatives along this line that the minister can speak to us about?

[7:15 p.m.]

RANDY DELOREY: It’s great at Estimates that we have the opportunity to come to points of agreement, as to the member’s comments about recognizing all of the employees throughout the continuing care sector in our long-term care facilities as well as other areas, anyone who is involved. They are providing care to some of our most vulnerable citizens, our loved ones, our family members, and community members, and we appreciate the work they do, as we do for the work of all of our health care professionals throughout the province. That does extend to those who support those health care professionals in all of the support roles, as the member mentioned.

As it relates to investments that go beyond, we have programs and investments, not under the expert panel but separately, around injuries in the workplace. That set of recommendations actually came out probably about two years ago. We’ve been investing and following through on those recommendations as well. I truly believe it helps with burnout when you have those issues with injuries.

The investment in equipment, so that the care providers have the right equipment to know they can perform their service to the residents and can do so safely, not just for themselves because, as the member mentioned, many of the care providers are altruistic. Part of the reason I believe, it’s been suggested, that leads to some of the injuries is because they’re so altruistic that they sometimes perform tasks that should be done with two people and they’re doing it themselves. That’s why there are investments in additional lifts, the slip sheets, and the equipment necessary for them to provide the care: so they know they can provide the care safely for the resident and for themselves.

I think these are different initiatives, but the expert panel’s recommendation and investments there and those investments around safety equally help support the workforce there as well. I think those, along with the recruitment and retention, if there’s a larger supply of the workforce, we can fill the vacancies. With those vacancies filled we reduce those missed shifts or those additional shifts that people have to fill in. I believe those various initiatives will all help, as the member mentioned, reduce the burnout. That is the goal of these investments and the initiatives that we’re undertaking.

Much like the rest of the health care system, no single solution will solve these challenges. Step one is recognizing them, which I believe we have. Step two is identifying the plan of action to hit the root causes, which I believe in many respects we have. Then we have to prioritize and invest in those initiatives, which we have been in the process of doing over the past couple of years, and we’ve committed to continuing that into the future.

GARY BURRILL: Continuing to think about long-term care, one area where I know the minister and I haven’t seen eye to eye in the past is on the importance of the construction of new facilities. I don’t want to necessarily now rehash that whole debate.

For the purposes of clarity, I would like for the minister, with the help of his staff, to speak to the exact number of new beds and replacement beds that we have provided for the province by means of the present budget.

RANDY DELOREY: The commitments that we’ve made and announced for new beds in the province is 162. Those beds are distributed as follows: 122 new beds in Cape Breton, 10 beds being added to the Meteghan area, and 30 that are residential care facility beds being converted to nursing home beds here in the metro region.

The member’s specific question was: How many beds have funding specifically in this budget? Out of all those beds, 132 of the 162 are actually new capital buildings. These are projects that are in the works, at various stages of design and then moving into construction. The costs that would come up in our budget come up as part of the operating costs, when those facilities come online.

The beds out of the 162 are the 30 beds in Halifax that are expected to come online next month, in March, so by the end of this fiscal year.

Late-breaking. I guess there have been some delays in the work on the construction. The intended “come onstream” was by the end of fiscal. It looks like the renovation work is taking a little bit longer but certainly within the first quarter. We’re still expecting the 30 conversion beds in Halifax to come onstream, and we have the operational budget set aside to fund the operation of those 30 additional beds here in the Halifax region.

GARY BURRILL: Am I right, the 30 that the minister is speaking of, is the conversion from the residential care facility in Purcell’s Cove, Armdale? Yes.

The 122 number for Cape Breton, can the minister speak to how much net new capacity that represents?

RANDY DELOREY: That is the net new, 122. In North Sydney, with the beds being there, there will be 38 new beds. In New Waterford there will be 36 new beds, and in Eskasoni there’s a 48-bed facility being developed. There will be 122 provincial long-term care beds, once those three facilities come online in Cape Breton.

GARY BURRILL: But net new in this sense does not take into account, am I not right, the alternate level of care beds at the moment in the Northside General and the New Waterford hospital?

RANDY DELOREY: With respect to the overall redevelopment, I was referring to net new beds with respect to actual long-term care beds, so these are new long-term care beds being added to the facility.

I’ll cross-reference. With 20 seconds left, I assume we’ll be continuing this conversation tomorrow. I will be sure to more fully and directly bring that answer to the question that the member has raised in the context of the broader hospitals and not just long-term care beds specifically.

THE CHAIR: Order. The time allotted for the consideration of Supply today has elapsed. I want to thank the NDP, the PC Party, and the minister.

The honourable Government House Leader.

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

THE CHAIR: The motion is carried.

[The committee adjourned at 7:25 p.m.]