HALIFAX, FRIDAY, FEBRUARY 28, 2020

COMMITTEE OF THE WHOLE ON SUPPLY

11:26 A.M.

CHAIR

Brendan Maguire

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

The honourable Government House Leader.

HON. GEOFF MACLELLAN: Mr. Chair, we will continue with the estimates for the Department of Health and Wellness.

THE CHAIR: We have 41 minutes left for the NDP.

The honourable member for Halifax Needham.

LISA ROBERTS: Thank you, and thanks to the minister and his staff for this opportunity to ask a few questions of local concern.

To start, in the budget there is money allocated for a certain number of residential care beds that are going to become long-term care beds.

I’m just wondering what that means - can the minister describe what a long-term care bed looks like for the department, in terms of space or equipment, that distinguishes it from a residential care bed?

HON. RANDY DELOREY: In the continuing care sphere of services, we have from a facility-based care environment, two main levels of care. There is the RCF - residential care facility – which would be mostly a care environment providing care of a non-medical nature. A higher level of care for needs that may require more medical care, moves up to a long-term care facility. So, it’s really a different level of acuity and thus the actual requirements for the facility are a little bit different.

I don’t have the explicit list of details differentiating between the RCF and the long-term care with me at the moment, but in the general sense the RCFs are less acute and, again, the space and infrastructure space requirements are different between the two.

In the site, specifically to those 30 beds, what we have is a facility that has had long-term vacancies in the RCF, so it’s a single facility that had a mix of residential care facility beds and long-term care beds in the same building. They had, for an extended period of time, vacancies, not adequate demand to fill the RCF beds. So with some investment to update the infrastructure, Mr. Chair, they were able to bring them up to long-term care standard requirements. We were able to license those additional 30 beds once those renovations are complete and then where we know we have demand in the metro region, we’re quite confident we’ll now be able to make use of those 30 beds as a long-term care space. So, it’s adding higher acute residential needs without impacting, that is because there are already vacancies in those RCF beds.

LISA ROBERTS: I am asking about that because as I’ve written to the minister in December, I’m aware that Northwood in my constituency has currently long-term care beds that were built 40 years ago - facilities that were built 40 years ago which have double and, in some cases, even triple occupancy. Whatever that standard might be that you don’t have available to speak to in detail today, certainly given the acuity of long-term care patients, the board of Northwood has determined that they are not meeting the standard required, just even in terms of infection control in rooms that have double and triple occupancy in long-term care.

[11:30 a.m.]

I know that they have submitted a proposal for capital investment through the regular call for proposals. I understand that it was submitted to the Department of Health and Wellness on April 18, 2017. Then, subsequently, in both 2018 and 2019 the initial proposal was for $13 million and would permit Northwood to maintain the same level of long-term care beds, but in single occupancy rooms that would meet the standard that we now require, again, given the increased medical needs and acuity of long-term care patients.

I’m wondering if that proposal will be considered and, I guess, why it hasn’t been considered and why they haven’t had any response to it over the last number of years.

RANDY DELOREY: Mr. Chair, I guess a number of things to tease apart there. Certainly, each and every year the department receives proposals from facilities throughout the province. As was discussed last night in a detailed review of the Continuing Care budget, we actually spent more in 2019-20, allocating about $15 million more than the previous year in capital investments for our long-term care facilities in the province. That investment is something that addresses some long-standing needs within these facilities.

What the member is actually referring to is a scenario of not just the investment in capital upgrades but, as she mentioned, a complete replacement. We as a province continue to look at all of our infrastructure - the replacement of facilities and building of new facilities, and the timing of those investments. We know we’ve already announced I believe something in the vicinity of 162 new beds being added to the system. Most of those are new infrastructure builds.

There are 10 additional ones in Meteghan, which is the replacement and expansion of an existing facility; expansion by adding 10 additional beds in Cape Breton as part as the Cape Breton redevelopment of health care infrastructure - and we’re adding a number of beds in that region as well; and then we have these 30 beds that are able to be converted with minimal capital investment.

I think the suggestion or the terminology that the submission was not responded to, in fact I know staff continue their discussions with the facility provider as to opportunities. It would be inaccurate to suggest that the submission was not considered. They continue to have discussions with the provider about their proposal.

LISA ROBERTS: I appreciate that, and I appreciate that there are always decisions being made. At the same time, as a non-profit provider with a board of directors, the members of the board are expressing grave concern about the standard of care they are able to provide in double- and triple-occupancy rooms that were built in the 1960s. At the level of that non-profit organization, which I don’t have to say a lot about its reputation, but you know it’s a really great organization. It has led the way in being very responsive to challenges around pressure sores. They’ve worked within the constraints of the government and of funding to really try to provide good care to people.

What I know from speaking with the management is that the board is putting pressure on the management to say, we can’t continue to provide long-term care in these sorts of rooms. It is not an adequate standard of care to have two and three long-term care patients sharing a room, sharing a bathroom, without enough space for the kind of medical equipment that patients require today because we are not talking about the same sort of long-term care patients that we had when this was built in the 1960s.

So, at the level of that non-profit organization they are looking at making this change themselves. That would result in the loss of between 30 and 45 affordable, below-market apartments, independent living apartments, on floors below the long-term care beds because the proposal was to build up. They did the structural engineering work to analyze whether they could add beds at floors on top of the current building. The answer was yes, they could, but it would cost $13 million. I am sure that today it would cost more because that work was done four years ago.

If there isn’t support forthcoming from the Province, then they will look at expanding those long-term care beds down instead and remove affordable housing apartments. Obviously, I think we’re well aware of how valuable every non-profit social housing unit is right now, and I would hate to see fewer places for seniors to live in my constituency.

I’ll just share with the minister before I turn over my time to my colleague. I’ll leave, again, the letter I wrote in response to this and I hope that the department will consider it again.

RANDY DELOREY: I guess much of the conversation talks to, and the member referenced, standards within the facilities. There is no provincial standard, to be clear - the detailed standards, I don’t have, but I can advise the member - there is not a standard that requires single-patient, single-resident rooms. It’s not a standard requirement within the licensing of facilities.

While there are certainly aspects of preference, it is not currently a standard that exists. It would not be accurate to state that having long-term care facilities that do have rooms other than single rooms within their facilities are not meeting a standard. In fact, they do, they continue to be licensed and the requirements are not defined in such a way.

We certainly do recognize that with our evolving society, we do have, for a variety of reasons, preferences in many cases for single rooms. I think that’s why you see, Mr. Chair, new builds having far more single-room availabilities within them. To contemplate the redevelopment and the investment in redevelopment of existing infrastructure to accommodate single rooms, as the member herself highlighted, would result in a reduction of total bed capacity.

We would be spending that money not to add beds to the system but, certainly, you may increase some levels of satisfaction and what have you, but not actually add to the net capacity for the same investment. That’s why what we’ve been doing, as we saw in Meteghan, we see in Cape Breton, when we’re looking at those opportunities for redevelopment, we’re assessing and saying, so how much new development do we need to do to add capacity while we’re doing a rebuild to meet the needs within those communities?

So that’s one of the reasons why these conversations do take some time, not just for the infrastructure - building up, building out, building down - what opportunities they have from an engineering, technical perspective but also in terms of what the system demands and needs. I’ll reiterate that discussions continue and are ongoing, I believe, in conversations with representatives from Northwood.

I’ll share the member’s gratitude and acknowledgement of the great care that they provide within their facility. In fact, when we were developing our provincial wound care strategy, we leaned heavily and leveraged much of the fantastic work that was done by the Northwood organization to help inform what eventually became the provincial approach, which was rolled out to others.

I would also like to note that it’s my understanding that representatives from Northwood on this case - the conversation is continuing, but broadly, and I’ll leave it to the member to dispute this point - that they also recognize that the investments and the attention that this government over the last number of years has been paying - in particular, attention to the continuing care and the long-term care sector - is far greater than they have seen in a positive way for many, many years. I think that is included in operational structures, the investments that stem from the recommendations of the expert panel, the fact that we established that expert panel to help form and guide our direction forward and our investments both operationally and with infrastructure and equipment. It is part of a system that has a lot of work to be done but that should not overshadow the great work that we have been doing and are committed to continue doing with our partners at Northwood and other long-term facilities, as well.

LISA ROBERTS: I do appreciate that making such changes across the province could result in a net loss of long-term care beds. I guess my concern is that it looks likely because of the particular nature of this 40-year-old facility that we are looking, quite possibly, at a net loss of housing for seniors, even if we are just replacing one-for-one long-term care beds. That’s my reason that I’d really urge the Department of Health and Wellness to look one more time at that request and maybe visit the facilities and see exactly what the challenges are. I haven’t heard it expressed in terms of resident preference. I’ve heard it in terms of the challenges of providing care and infection control. Thank you, and I’ll turn it over to my colleague.

RANDY DELOREY: Just briefly, in fact, as I indicated the discussions with the proposal, staff have visited - I’ve been to a local Northwood facility - the staff have been to the facilities. The last one I recall, although it’s not necessarily the only visit, was in December with staff to evaluate and assess as part of those ongoing discussions. As the member suggested, those visits have already taken place. As it related to housing, I’m sure my colleague, the Minister of Municipal Affairs and Housing Nova Scotia will speak to it more in depth. During Question Period, we’ve already had many discussions highlighting the investments that are being made in that part of the provincial budget focused on housing supports.

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

GARY BURRILL: The minister will probably remember last night we were speaking about a number of things about long-term care and pretty near had come to the conclusion of things I wanted to ask the minister to speak to. There’s just one or two more. I’m thinking first about the question of elder abuse within institutions. We hear it said by advocates for those in long-term care facilities that only a minority of instances of elder abuse reported in our facilities are actually investigated. I’m wondering if there is any provision in the budget allocated to the whole matter of reporting, investigating and attending to complaints brought forward about abuse of residents in homes?

[11:45 a.m.]

RANDY DELOREY: Thank you, Mr. Chair, and I sincerely thank the member for raising this question. Of course, within our long-term care facilities, which are the homes of some of our most vulnerable population, our aged and frail population, it is incumbent upon us as a society to support, care for, and provide the appropriate services to meet their needs. Absolutely, there would be consensus across the province, not just on this floor, that abusive situations are inappropriate and should not be tolerated.

That’s why we have legislation governing the protection of persons in care. This Act applies to our residential facilities but also other facility-based accommodations. The Act does require that facilities and individuals that are aware of abuse need to report it so that it can be looked into. In fact, every time there is a reported allegation under this piece of legislation, it is looked into.

I think where the member has indicated that some are not - I think the language he used was “investigated” - the work done in a preliminary investigation is very similar to an investigative approach within our criminal justice system, where the initial work is done in a preliminary way to first determine whether a more robust detailed investigation is necessary or appropriate. Again, that preliminary work for every case is done.

As far as the investments go, we have in the area of adult protection - because the member is interested in the financial investments - we are seeing an increased investment of about $84,000 to the team within adult protection services. About a $84,000 increase in our budget this year to that team of support work.

GARY BURRILL: Thank you for that explanation. The only other question about people in long-term care I wanted to ask the minister and the staff is a numbers question. I’m wondering about the number of people waiting for admission today, on formal waiting lists for long-term care facilities, in each of the four zones. I understand that may not be available right in front of you, and we could receive it later, but if it were available in front of you, it would be good to have.

RANDY DELOREY: The member is correct. I don’t have the data on the wait-list broken down by zone but we’ll endeavour to see if we can pull it out accordingly. We do have, as of February 19, 2020, 1,267 clients on the wait-list for initial long-term care placement in either a long-term care or residential care facility.

GARY BURRILL: Thanks to the minister for that answer. Those were the things I wanted to ask about long-term care.

Mr. Chair, would it be acceptable for my friend, the MLA for Dartmouth North, to ask a couple of questions?

THE CHAIR: The honourable member for Dartmouth North.

SUSAN LEBLANC: Thank you, Mr. Chair. I think it will be one question but there might be a B part. Last year in Estimates I asked a question of the minister around collaborative care centres. Last year there was, I believe, $10 million of new money allocated to collaborative care centres throughout the province and I am pretty sure that at the time when I asked about this he indicated that that money would be determined or allocated based on a number of processes.

Throughout the year I had a meeting with senior level staff at the NSHA who indicated that that money had been allocated to different collaborative care centres. I guess my question is: What money is there in this budget of 2020-21, new money specifically for new collaborative care centres - either bricks and mortar centres or collaborative care models in existing buildings - and of that money, how is it being allocated? What are the aspects of the decision-making process going into how that money will be allocated?

RANDY DELOREY: So, this year, I believe, about $27.5 million in total is targeted towards the comprehensive primary care funding for collaborative centres. That includes the increased investments we’ve been making over the last number of years. I think the increased investment for this fiscal year is about $750,000 in growth over the investments we’ve made over previous years.

So, again, in 2020-21 we are going to be investing a total increase in that area of $27 million, based upon investments we’ve made the last few years in growing our collaborative care practices. We certainly focus on two things: some are establishing new collaborative care practices and others are based upon expansion of existing practices.

Early stage was about ensuring that we get practices up. The care needs were quite evident throughout the province. Now we’ve seen the positive progress of the investments we’ve been making in the last number of years, particularly and perhaps in a good way for the central region. The rate of improvements in attaching and providing care to residents has increased, as measured by the number of residents registered on our 811 Need a Family Practice list.

A couple of years ago, the Central Zone was relatively on par with the rest of the province on a per capita basis. That is representing 50 per cent of the population. They also represent about 50 per cent of those residents registered on the 811 Need a Family Practice list. That has shrunk significantly, based in part in the growth of investments and incentives that have been well received in this area. In fact, our attention is shifting to those zones that have not seen the same degree of improvement, such as the western and the northern zones.

While we continue our investments for attachment and primary care and continue to support those investments that have been made in other parts of the province and will continue to expand and fill vacancies and meet the attachments within those communities, we do have to put - which is ongoing - a new focused lens, seeing the disproportionate needs in our Western and Northern Zones, as it comes to primary care attachment. In this year that’s becoming a particular lens that we will be applying or expecting to be applied by the Health Authority.

SUSAN LEBLANC: Thanks for that answer. It makes me feel very worried about some communities in Central Zone. As we know, zones are big and so within those zones, the four zones we have, even within one zone there are a number of disparities.

Of course, I represent the community of Dartmouth North, where there is higher than average social deprivation. We have a number of folks who have serious accessibility issues due to physical disability but also accessibility in terms of an inability to leave the community, or leaving the community makes it very, very difficult for folks in parts of my community.

I wanted to ask the minister if, when deciding where collaborative care centres are placed or expanded in the province, attachment to the 811 list or to a primary care provider is the only metric the department is using? Are there other factors that are being considered?

RANDY DELOREY: In the Dartmouth area, alone, I know that there are several collaborative practices with a number of physicians and health care providers. Some of those include the Albro Lake Medical Clinic, Cole Harbour Family Medicine Centre, Dartmouth Medical Centre, Forest Hills Medical Clinic, Pleasant Street Medical Group, that have been supported here and, of course, the fantastic Woodlawn Medical Clinic. We know there are a number of these facilities within the Dartmouth region.

Yes, it’s true, the Central Zone is fairly large but if we narrow in specifically on the Dartmouth area, that’s about six collaborative centres, I believe. That’s almost 10 per cent of the collaborative centres that we have. We have about 85 now operating in the province, so six of those 85 are right within the Dartmouth area.

No, the attachment is not the sole criterion. Obviously, there are a number of variables that have to come into play. What we are focused on, throughout the system, is improving the care and the outcomes. One of those areas just happens to be one of the large areas that we focus on, patient attachment, because we know how important that is to so many aspects of the primary health care needs for citizens. The primary care providers are the entry point to much of the health care system and we recognize that.

Many of the concerns that have been brought to the floor of this Legislature on behalf of constituents, who are in the unfortunate situation of not having a primary care provider, have been that kind of entry point. Getting people attached is a critical and important one because we know that attaching patients will address many of those other underlying health concerns.

[12:00 noon]

The member did reference other variables that go beyond just primary care attachment that also have impacts on health outcomes. Some of the values of our collaborative practices tie into social workers and other allied health professionals as part of the collaborative care teams. That includes what much of our conversation in Estimates has been so far with the New Democratic Party rightly focused on social determinants of health, those broader variables that impact one’s health and wellness. That’s why it’s not just the Department of Health and Wellness investing in those upstream supports. In fact, we see investments in this budget in the Department of Education and Early Childhood Education, in Community Services, in Housing Nova Scotia, to help address some of those other issues to also support.

Those concerns that the member was suggesting as to what we consider or should be considering. Again, as a government we recognize those, and as a government we are investing in those areas, and we will continue to do so. As it relates specifically to collaborative care centres, it is not the only thing. There obviously has to be physician interest and health care provider interest, there has to be physical space available. There are a number of other variables, from a population perspective. It is one of the high priorities that we do have but not the only one.

SUSAN LEBLANC: I thank the minister for those answers. Yes, I’m glad to hear him mention the social determinants of health. I do think that the collaborative care model works very well, especially, in my opinion, the NSHA’s turnkey model of a health home. It’s one where a community like Dartmouth North would thrive with such a health home, given the severe impacts of poverty, high levels of chronic disease, issues with accessibility, and mental health and addiction issues.

I think that those things need to weigh strongly when these types of decisions are being made and I hope that the minister will see how beneficial a health home in Dartmouth North - and I would say thank you for listing all the great collaborative care centres in Dartmouth - but Dartmouth North is a specific community unto itself, between the bridges, with very specific and different needs. I’ll end there and pass the microphone back over to the member for Halifax Chebucto after the minister speaks.

RANDY DELOREY: I thank the member for the questions. I appreciate it, duly noted. I recognize the importance for each of us in the Legislature advocating on behalf of our specific communities. Again, I assure the member that the characteristics and profile of the community of Dartmouth North, but again indeed, each community and each member here will stand up and express their communities’ interest and needs equally as passionately and to advocate as the member did. But again, community profiles, as well as the physician availability, do tie in. We want to make sure that the services and certainly the profiles tie into the services that are offered when a collaborative practice is established. I do thank the member for the questions and advocacy. Again, duly noted as requested.

Before the next member gets up, I actually have the answer to the Leader of the NDP’s previous question. If he has a pen and paper handy. The wait-times for long-term care - this was maybe a week or so ago - February 19^th the same date I had previously. In Western Zone it was 243, Northern Zone is 176, Eastern Zone is 349 and Central Zone is 499. If my math is correct that should be a total wait-list for initial placement of 1,267, as I responded in my previous answer.

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

GARY BURRILL: I’d like to direct some questions to the minister on the general world of physicians and physician recruitment and retention. There’s no area that figures more prominently for people, when you talk about health care and you ask them about their satisfaction of their health care. The issue comes up over and over: I have or I haven’t got a doctor, or I got a doctor at this point and I lost a doctor at that point, and so on. This is at the top of the list. We see the matter addressed in the budget with this $75.3 million figure for improvement and retention of medical professionals, including physicians.

I’d like to ask the minister if he could provide a breakdown of what, more precisely, this includes.

RANDY DELOREY: I believe that figure relates most significantly to the fulfilment and compensation for the Master Agreement. The full details of how that is expected to play out would be detailed in that agreement with physicians but it does include an overall increase of about 2 per cent in physician compensation, as well as additional adjustments to ensure that family and emergency physicians, and anesthetists within the province will be the highest paid in Atlantic Canada.

These increased remuneration compensation opportunities outlined in the agreement are what we heard from physicians and Doctors Nova Scotia would be appropriate and the best means in that particular area for helping with recruitment and retention of physicians in the province. Thus far, feedback has been very positive by physicians as, I think, is reflected in over 90 per cent of them voting in favour of this Master Agreement, so we’re quite confident that this commitment, this agreement and these financial resources will facilitate that progress.

It does also include money, about $9 million, to create new specialist positions across the province. Having these additional support positions to provide care and services in the province helps maintain that work/life balance that we’ve talked about for some of the other health care professionals. It’s also a concern for physicians and specialists, so we need to make sure that we have the appropriate supply and allocation in our hospitals across the province. That’s additional investment that is being committed to, as well.

GARY BURRILL: Am I understanding correctly that minus the $9 million for the new specialist positions, the entirety of the $75.3 million is to be accounted for by the Master Agreement?

RANDY DELOREY: Not the entirety. I think about $69 million in the coming fiscal year is targeted towards Master Agreement commitments, but those commitments are - some are directed to just wages on the bottom line but some are new programs within the physician community that are designed in partnership with physicians to better deliver care. For example, the CHIP program . . .

THE CHAIR: Time has expired for the NDP caucus. It is now time for the PC Party.

The honourable Leader of the Official Opposition.

TIM HOUSTON: I’d like to talk about the One Person One Record system. The Province has allocated billions of dollars, really, to infrastructure. There has been very little transparency around most of that. Indeed, some of the first things that have had light shined on them are around this parkade situation, and we know what happened there. The One Person One Record is certainly a project that I’m very concerned with.

I understand the RFP was issued many years ago, somewhere in the range of 10 years ago, and there have been quite a few million dollars invested in the procurement process. I wonder if the minister can provide some clarity on when the RFP was issued and how much has been invested in the procurement process to date?

RANDY DELOREY: I believe the official procurement went out in 2018-19. That procurement is nearing the end stages. As I think the member can appreciate, as the negotiations are ongoing with vendors, it is important for those details that support our negotiating position to be managed at the negotiating table with vendors. Once an agreement is reached, as is the case with procurements, that information on the procurement details would be made available at that time.

TIM HOUSTON: How many vendors is the Province negotiating with at this time?

RANDY DELOREY: I believe it has already been publicly reported. The process that was undertaken for this particular project was a process that was also recently undertaken with the twinning of Highway No. 104. That is, a pre-screening stage took place first. That’s called a request for qualified bidders.

I believe there were four or five submissions. Two of the submissions were deemed eligible for the actual RFP phase. Both of those qualified bidders submitted bids and at this stage of the RFP process they are in the latter stages of work with both of those bidders. I guess at the early stage we know they meet the technical requirements of the Province. We are working to ensure we get the best value out of those providers and will determine the one that has the best value for the Province will be the one we would consider proceeding with.

TIM HOUSTON: In the minister’s view, is this a custom build from scratch or is this technology being used in other jurisdictions, where a lot of that can be imported here with some process changes? How would the minister describe this? Is this a full-on custom build, or what has been done in other areas that might provide some value and benefit to us?

RANDY DELOREY: I’ll put, I guess, an asterisk or a caveat at the front end. I think I can answer this question at a high enough level that I hope meets the member’s inquiry, but I put the caveat that, given the sensitive nature and, as the member rightly indicated, the importance of this particular procurement, there’s a certain level of detail that I am not going to be prepared to go into while the discussions and negotiations are still going on. For the specific question that was asked, this is by and large an off-the-shelf. The two submissions are both off-the-shelf providers, not a custom system developed.

That said, any time a system is implemented there is often configuration adjustments to ensure that the needs of the system respond to the specific operational configuration. So, you get a system that’s installed and then you get around to configuring - in a very simplistic way, it’s like you get a cellphone and you can go through and tweak your configurations so that your cellphone doesn’t necessarily look quite the same as the person sitting next to you.

TIM HOUSTON: I thank the minister for that response. I do want to talk about MSI. So, MSI must approve all practitioners and give them a billing number. I just wonder if the minister can give us some numbers on how many family physicians were recruited last year and how many of those got a billing number. I’m just trying to see if those are in sync. When the government reports on recruited family physicians, does that mean that family physician also got a billing number or is it possible that there is some time lag in between those two things?

RANDY DELOREY: That’s not information that I’ve brought with me here or have off the top of my head, in terms of aligning those two figures. I know from a physician recruitment perspective, since April of last year we have recruited over 100 physicians to the province through various streams and those would be physicians, I believe, that have already started. If they have started practising, they do have a billing number.

[12:15 p.m.]

In some instances, there are recruited physicians and there’s often a lag time or a lead time from when someone commits to starting a practice to actually coming here. That would be particularly for those who are coming from another jurisdiction, as I’m sure the member would appreciate - giving notice in such an important role as a health care provider. If they’re coming from another jurisdiction, they would give adequate notice, sometimes a month and sometimes it could be up to six months’ notice. That gives us lots of time to complete the appropriate licensing, as well as ensure they get the billing numbers to provide the care in the province.

TIM HOUSTON: In terms of general practitioners, is there a cap on the amount they’re allowed to bill?

RANDY DELOREY: In a general perspective, over the suite of services, I would say no, I’m not aware of any caps on the amount that a physician - general practitioners in this case - primary care providers can bill the province.

I want to put a couple of clarifications in there. Obviously, physicians are expected to provide care that meets their professional expectations. In just the very nature of human capacity to provide safe, adequate care, their clinical and professional obligations to provide that care would put some upper limits. Theoretically one couldn’t even achieve infinite but there’s no cap per se. That would be particularly noticed in a fee-for-service model.

I also put a caveat only because I’m not certain. In a fee-for-service environment within the Master Agreement there are many different fee codes so my statement that globally there’s not a cap does not necessarily mean - and I don’t say that there is - but I don’t want the member to take this as a statement that there is not a cap on a particular fee code.

There may be a specific instance where a particular service or procedure may have a negotiated maximum billable amount and that’s in the fee-for-service environment. To the other side of the equation, where about 10 per cent of our family physicians are in a contract or salary-based environment, known as APP, in those instances they have a defined salary that they work towards. Again, it’s not really a cap but it is the salary that was agreed to for the services provided.

TIM HOUSTON: I’m hearing from physicians that there is a cap on allowable billings of $275,000 and that if they submit more billings than that MSI will claw back 50 per cent of it. Maybe I’ll just leave that with the minister to confirm and respond to us. So that would be a cap on allowable billing of $275,000 and that MSI would claw back 50 per cent of any excess amount over that. I’ll leave that with the minister to maybe investigate and respond back to us.

I just want to read something. Obviously, we’re all hearing these types of stories but this is from a lady that said: I have severe arthritis in my foot. I was referred to a surgeon at the Halifax Infirmary. I need to have surgery. I was told there was an 18-month wait for my first consult. I called to see if a date was now available, as I’ve been waiting 15 of the 18 months but I was told the wait-list is now extended to 24 months.
 

They’re on a cancellation list but no one cancels because . . .

THE CHAIR: Order. The member for Pictou East has to table that document with a name on the document. Thank you. Sorry for the interruption.

TIM HOUSTON: Well, I’m just speaking hypothetically. I want to ask about wait-times.

THE CHAIR: Order. Order. No, the member for Pictou East read an actual email word for word. That has to be tabled with a name attached to that email. We’ve gone over this several times.

TIM HOUSTON: It’s actually not an email, it’s just some notes I have. I’m happy to table it or I can just disregard that, and I’ll ask the minister a very direct question. We have people in this province who were told the wait time for certain surgeries was 18 months. Now a year later they’re finding out the wait times are increasing. The minister has been the minister for quite some period of time now, I think four years, maybe five? This government has been there for almost seven years, invested maybe $35 billion in health care and wait times are continuing to go up. I’d like to ask the minister, what does the minister say to those people who, today, are waiting for surgeries and hearing that wait times continue to increase?

THE CHAIR: One second please. Just to be clear to the member, you quoted from a document. You quoted from an outside source. That needs to be tabled. Please let me finish. This is something that we’ve gone over a few times here. If in the future you are going to quote from a document, you need to table it, and it must identify the author. We’ve gone over this several times.

The honourable Minister of Health and Wellness.

RANDY DELOREY: Thank you, Mr. Chair. I guess I will get to the answer to this one. But, to follow up, the member had asked a question that was related to the billing code information. In 2018-19, we had 130 physicians and they all received billing codes. So far, from 2019 we have 108 physicians all with billing codes. Again, running it on fiscal year, so we’re not quite done this fiscal year, and we’re at 108.

To the other question where I wrapped up, providing a little additional detail, I’ll take a look again. That scenario doesn’t ring a bell to me, but I’ll look into that notion of the 50 per cent scenario to see if there is a scenario where that happens. I would assure the member that anything that gets us established - if such a scenario did exist - it would be in accordance with the Master Agreement that was negotiated and accepted by over 90 per cent of physicians. It’s important to recognize that if it is a scenario that is inconsistent with the Master Agreement, I would certainly be moving to rectify that. We expect our systems to adhere to our contracts.

To the question in the specific round about surgeries, particularly those in the orthopaedic space, the member’s right. There are challenges with the wait-list. That’s why in 2017 or 2018, in the Fall, I established a new program under the leadership of clinicians within the Health Authority to focus on our orthopaedic surgeries. We’ve invested by hiring more surgeons and anesthetists. We established clinics and additional support people to help them do the work.

In fact, we’ve been completing more surgeries, as well. Just on a calendar year, the year ended December 2018, we had about 3,100 orthopaedic surgeries. In the current year, as of December 2019, we had 3,400. So, we are increasing the number of surgeries that are being provided but, again, demand also is going up in many cases.

We’re making every effort. We’re making the investments. We’re streamlining our processes and protocols to provide the care. The other thing I would highlight for people on the wait-list is they can go to our website for looking up surgeries and the wait-list. The wait-lists are allocated by regions, but also by surgeons. It is possible that there may be another surgeon within the province who may be able to complete that surgery more timely. In that case, the individual could request to be referred to a different location where the wait times may be shorter. There are a number of options where, again, one of the advantages of having a single Health Authority and one of the streamlinings we did with orthopaedic surgeries was to allow people from different areas to get put on the wait-lists in other parts of the province.

To the member, if they know, hypothetically or actually, of an individual, I would encourage them to take a look, have that conversation and they might be able to be referred to a site with a shorter wait time and get that surgery as soon as possible.

THE CHAIR: Before we continue, I would like to clarify one last thing - and this is for the entire House - the member for Inverness and the member for Pictou East had asked to remove something from the official Hansard record. We don’t have the ability to quote something and then - one second, please let me finish - to just say we’ll just remove it from the record. We don’t have the ability to do that.

To be clear, if something is going to be quoted, the source must be tabled. The members don’t have the ability to just say that we’ll just remove it from the record.

ALLAN MACMASTER: Mr. Chair, I certainly respect your position. In fact, I had just come over to you, I didn’t disagree with you. I was just trying to explain that it was referenced as an email, it was not in an email format on the paper, so that was the purpose of my conversation. I would never suggest that something be struck.

THE CHAIR: I appreciate that, but the comments that were made from this side was just to remove it from the record, from both yourself and the member for Pictou East. I heard that.

What I’m saying is you don’t have the ability to do that. I would say the same thing to you that I would say to any side of the House, so I appreciate it and we’ll move on to - who is up? I am actually not putting words in your mouth. The conversation is over, thank you.

The honourable member for Argyle-Barrington.

COLTON LEBLANC: Thank you very much, Mr. Chair. Participating in Estimates yesterday in the Red Chamber, it’s a little different etiquette over there.

In my first time taking part in our provincial budgetary process and the Estimates process, it is my honour and pleasure to be able to ask questions that are near and dear to my heart. Today I am speaking as our caucus’s critic for pre-hospital and preventive care and having had first-hand knowledge and experience in our provincial ambulance system -

greater than four years - I have continued my consultations with some of the stakeholders, including colleagues, to hear their first-hand experiences. I want to be on the record stating that things have changed significantly in my career as a paramedic and the minister spoke about changes, in referring to himself and another member, in emergency care, from funeral homes which initiated diesel therapy - the drive to the hospital - to the high-quality care that paramedics deliver in our province today.

I’d like to begin by asking the minister, looking at the first line of the provincial budget for ambulance services, $128,993 million, I’m just wondering if the minister could explain what that line, in fact, entails.

[12:30 p.m.]

RANDY DELOREY: That was the ambulance services or the ground ambulance services line item, Mr. Chair? Could you just double-check which line item that was again?

COLTON LEBLANC: The Ambulance Services line, the first line in the budget.

RANDY DELOREY: That line relates to the services provided through our EHS-EMC services that provide our emergency ambulance services in the province, so that essentially would be predominantly the contract with EMCI.

COLTON LEBLANC: I guess I’m trying to differentiate between the ambulance services and the ground ambulance operations. Is operations more of the management of the operations? Maybe there’s fleet maintenance, repairs for example, equipment and supplies, medications, all of that nature. I’m just trying to have a better appreciation of that. There’s medical quality control, sort of an idea there, and provincial programs that we’ll get into probably later on.

RANDY DELOREY: Yes, the member is correct, the ground ambulance operations line does refer to services outside of the EMCI contract, things such as patient care equipment that is not in the budget, research or new programs, emergency equipment, disaster preparedness things. There are a number of things like that, so they are there to support and they are things that fall outside of the EMCI contract but we think are important for the care and the service provided by our paramedics.

COLTON LEBLANC: We won’t disagree on the fact that paramedics deliver high-quality, exceptional care but I guess we will disagree that we’re in a health care crisis. The government is presenting this budget with a statement of “better together” but I believe the sentiment felt across most of the paramedic community is “do more with less.”

There are announcements of capital project investments regarding the infrastructure in this province; however, there exists huge staffing challenges across various professions, including the paramedic profession.

Paramedics for years now have been feeling the pinch. They have been picking up the slack of different aspects of the health care system. I’m concerned to see the budget for EHS - despite the increased call volume, despite increased transfer volume, despite all the challenges that paramedics face day in and day out - the budget being slashed $1.2 million. Can the minister try to address that, please?

RANDY DELOREY: I assure the member and all the paramedics, in fact, that line item reflects the amount we pay into EMCI. We absolutely are committed to ensuring that the ground ambulance and our ambulance operations are funded to meet the needs within the province.

In addition, as the member started in the question background by making reference to investments and infrastructure, as the member would know, we’ve announced investments in important infrastructure upgrades for our paramedics, including those power lifts, to get almost 50 per cent of the fleet outfitted this year with those power lifts. So, we certainly haven’t forgotten our paramedics.

In addition, some of the investments we’re making are to help support some of the most critical concerns raised by paramedics that I’ve heard, certainly, about off-load times. I think we have about $4 million being invested, not necessarily in the EMC/EHS budget but rather in our budget with patient flow support, so that should feed back to help with those patient transfers and off-loads at hospitals, which we know is one of those critical areas.

Again, the investments are being made to help actually improve the front-line work. I absolutely want to assure the member that in the operational budget there are no cutbacks or concerns with funding the operations. This adjustment relates to our contract work with the service provider.

COLTON LEBLANC: For correction of the record, I misspoke. Rather than a $1 million cut to the budget, it’s $6.3 million cut to the budget.

For paramedics and for the general population of Nova Scotia and my constituents, I’ve heard it before. It doesn’t matter which way you try to spin it, a cut to a budget is a cut to the budget. With the increased burden on the system, there’s some grave concern about that. My question for the minister is: What information does his department use to make budgetary decisions for the EHS system?

RANDY DELOREY: What we have is a service provider that provides the work on behalf of the province for emergency ambulance services. That contract stipulates the criteria. For example, there are criteria about the number of calls that come in that inform the rate by which we pay. They’re recognized as bands. Off the top of my head 1,200, I think, 1,250 or thereabouts is equivalent to one band and we have a rate that we pay.

In previous years, information comes in and informs future years’ obligations under the contract. Essentially, as we see demand going up in the province for the care based upon call volumes, that is a significant contributor to the drive of the costs within our contract.

COLTON LEBLANC: We’ll get into the increased demands later on but, for the record, I’ve mentioned it before and my colleague for Pictou West has mentioned it before, that Nova Scotians from Yarmouth to Sydney in the paramedic community were very eager to hear that a systemic review of the ambulance service was conducted and after numerous delays finally completed. The minister stated after the FOIPOP process that it would be made public in a certain format. Nova Scotians paid $145,000 toward this report.

With the Fitch report in hand, I’m curious to know how much did the minister and his department consult the Fitch report for this year’s budget?

RANDY DELOREY: The Fitch report is really informing the negotiations that we have with the service provider to update the contract. We’re using that for improvements throughout the system. As I’ve previously mentioned, we aren’t waiting. We didn’t wait just for a budget year to make investments to power structures. When we identified an opportunity for funding, through the bilateral program with funding from the federal government, we were able to invest and take advantage of that and direct those funds to our paramedics. We didn’t wait for a budget cycle to help inform and influence the patient off-load direction to the Health Authority and EHS to work together to improve the situation.

We’ve seen improvements, I think, here in the Central Zone, where the challenges were the worst. The average time has decreased from something in the vicinity of 90 minutes to less than 60 now. Still not good enough but it is certainly progress that was made based upon those. As I previously mentioned, we’ve looked at that and the concerns from paramedics to inform the budget, recognizing the patient flow challenges impact their ability to efficiently transfer patients into a hospital setting so they can get back out to the community to do their work.

This is really just because I know the member has a practice here. I want to really use this to illustrate that I’ve heard it’s not just about how much time they spend there during their shift, but a real frustration is also when they miss the end of their shift, or they finish their shift and they have to get back to their community because they came from outside of the urban centre to do the transfer and the transfer takes too long. That’s why we’ve prioritized funding into patient flow services and support to continue that work, to try to continue to see these improvements.

The great thing about these investments, and as we recognize - in the same way that these challenges developed over time because of an integrated health system - that challenges in one area have an impact in other areas, this patient flow investment should help, not just for the paramedics and the transfer off-load, but other parts of the health care system in the hospital, as well.

COLTON LEBLANC: Quickly on the topic of power stretchers: noting the bilateral funding opportunity, it’s a request that has been long coming from the paramedic community, but I think the question that remains is: When can the paramedic community expect the remaining fleet to be equipped with the power load systems and the power load stretchers?

RANDY DELOREY: We don’t have a defined period of time, but we know that, with the investment, right now almost half the ambulance fleet is being retrofitted with the equipment and retrofitted to have the capacity to work with the power stretchers. That is the first step that’s ongoing throughout this year.

We don’t have defined for future years where the investments would be, but as we discussed last night, operationally, we think potentially three to five years. If we find opportunity to advance more quickly than that, we will do that but, again, that’s not a commitment that it would happen. Operationally, we think that staff have suggested that they think they might be able to do it in roughly that time period.

COLTON LEBLANC: I thank the minister for that response. I want to say that I appreciate the minister’s knowledge of all the issues, or a lot of the issues, that paramedics face day and night, but I’m not sure if the picture is being properly painted in his department.

Paramedics in Nova Scotia have one of the leading scopes of practice in North America but with the increased demand such as call volume, transfer volume, and the off-load delays, all of that is causing the system to be over-burdened - a system that was created 20 years ago, a system that hasn’t really significantly had any increased numbers to reflect the call volume that has exponentially increased. We’ve seen a significant decrease in ambulance availability across this province.

I’ve brought it before the floor of the Legislature regarding code critical. I know it’s not a term that the department uses but it is to sound the alarm regarding ambulance availability. When you hear of an ambulance parked in Yarmouth and one in Blockhouse and the next one in the HRM, that’s very frightening to me.

I know that the system is very complex and it’s not an easy fix, but this is a matter of public safety. Lives depend on these decisions being made, and appropriately made in a timely fashion. Bases are not being covered due to the ambulances being spread thin and not being staffed because of staffing issues. Paramedics end up spending hours on end parked on the side of a highway with no access to washrooms.

My question for the minister at this time - you know, I have three paramedic stations in my community: Pubnico, Woods Harbour and Barrington, and a big portion of my constituency is covered by Yarmouth. What does the minister have to say to my constituents who have a paramedic based in their community but do not have ready access to an ambulance and have exponential wait times for that ambulance to arrive on their doorsteps?

RANDY DELOREY: I think, first and foremost, as the member is familiar, and I explained not just the complexity in the system but some of that complexity in the system is based upon the design and the dynamic nature of redeploying, as I am sure the member is aware, and those ambulance resources that are in communities throughout the province get redeployed, so they’re stationed at locations based upon anticipated areas of higher call demand so that it does ensure the fastest response time possible. It’s important for residents to be aware of that, that just because an individual doesn’t see an ambulance, doesn’t mean one is not dispatched to the community or to the emergency in a timely fashion.

[12:45 p.m.]

In fact, with that dynamic nature, it’s also worth noting investments that we’ve made in the last couple of years, not just for ground ambulance but also our investments in air ambulance support services for those regions of the province further away or, particularly with emergency, highly acute needs that need to bring them into the Halifax region at the QEII. We now have two helicopters available as part of the upgraded contract from a couple of years ago. The fixed wing that’s available, as well, for the LifeFlight services. We’re investing in emergency services. We recognize the importance of rapid response and we’ve been investing to support those services.

COLTON LEBLANC: I thank the minister for that response. I have a hard time justifying to my constituents - often Pubnico doesn’t have an ambulance parked in that station, neither does Woods Harbour. Two of the four stations - and I’m just talking about my constituency - quite often don’t have an ambulance parked in that station. This is all due to increased demand on the system. I appreciate the justification of best deployment with what we have, but it’s hard to agree that this is the greatest we can do with what we have. In all this - the overburnt system, the decreased ambulance availability, the increased off-load times - wouldn’t that be indicative that the system needs to change and that we need more resources, such as more ambulances, more staff and more shifts?

RANDY DELOREY: In the list cited there the member indicated increased off-load times. In fact, with the efforts we’ve been making, we’ve been decreasing the off-load transfer times into hospitals. Seeing increases was certainly indicative of cause to look at, evaluate and work with the system. That’s why I provided the direction I did last Spring to both the Health Authority and EHS. It seemed to me that for too long the parties were operating their respective systems and not enough attention was being paid to where those systems intersected and the responsibilities overlappped.

The essence of my direction at that time was to mandate those two parties to work together, recognizing the challenges of both parties to see improvements. They didn’t necessarily require the improvements of more ambulances, but we have seen the reduction in time, which means that time that they haven’t been waiting this year, from those reductions it means that they were back out. We’ve actually increased the availability because we’ve reduced those wait times.

Before expanding the hiring and establishment of more infrastructure and systems, we need to make sure that we have an efficient operating system throughout the entire health system. We believe that there’s more opportunity there to make more improvements. That’s why we invested in the patient flow program this year, to see if we can get some further advances with an increased budget, to see those benefits flow back through the system, including to front-line paramedics. That, I think, is an important part of it.

As far as recognizing that, after 20 to 25 years from the last major redevelopment in our ambulance paramedic emergency services, in fact, that’s why we established the Fitch report. The Auditor General had made a suggestion, I believe, to perform such a review. We conducted the review and recognize that some of those changes that are recommended affect the contracted service delivery with our service provider. So we will take that under advisement to help inform our negotiating strategy as we update our contract with our paramedic ambulance emergency service provider. I think that is indicative of a joint recognition of the need to make changes, and we’re committed to doing so.

COLTON LEBLANC: I just want to note that the last time a Fitch report was done was in the early 2000s and that report is, in fact, available online and unredacted.

I have to respectfully disagree with the minister that off-load guidelines, from what I’ve been told, are working. I’ve heard that the off-load times have since risen, so my question is: What data does the minister have? What is the most recent data that he can provide?

RANDY DELOREY: As I mentioned earlier, I think the most recent - compared to December 2018, the average time in Central Zone was 90 minutes and now it’s at about 58 or 59 minutes, so that would be the date. I don’t have the exact date of when that 58, 59 minutes came into the department but that’s the data I have.

COLTON LEBLANC: If memory serves me correctly, those off-load guidelines were implemented in a certain number of - five, maybe - hospitals across the province. Is the minister and his department considering expanding those guidelines right across the province?

RANDY DELOREY: Our focus is on those six facilities, which we recognize take up about 82 per cent of the provincial off-load time. Really, our intensive focus is on those sites because that’s where we’re going to get the most value within the system. They are both the most frequent and the longest durations, so to make sure that we make the greatest value with our investments.

It’s important to recognize, particularly since most of these facilities are in the central region and part of the QEII system, it’s important to recognize that it’s not just an investment that supports paramedics who service the central region, because many paramedics from outside of Halifax, providing transfers from communities across the province, are actually transferring and driving and being caught up in those Central Zone off-load delays, so these investments in the Central Zone, in those other sites, do have a positive impact on paramedics, who do work at other regions, as well.

Again, this is recognizing that we’re trying to invest to support all our paramedics.

COLTON LEBLANC: Let’s talk about the increased demand on the system. In part, it’s increased call volume. I’ve done some research over the last few days, looked online. The last published EHS annual report, which goes over the whole system, I think it’s from 2012, so nothing published online - I guess we could try to FOIPOP that.

I’ve heard from the older generation medics that back in the day if you did 200 calls a day, that was a busy shift, a busy day. But now we’re seeing days with 500, 600, probably eventually creeping up on 700 calls a day. That’s quite significant. My question for the minister is: Why has this increased?

RANDY DELOREY: I’m not sure about the earlier numbers but, certainly, those peak call volumes in that 500-plus range is consistent with the information that I would have, as well. That is the challenging part.

As far as reasons go, obviously the reasons would be variable in various communities but at the end of the day it boils down to citizens who are calling to receive emergency services and the system has to be there to support them.

Looking at it, what we’ve recognized is that perhaps there are other ways that we can be more efficient in managing calls, where we can do a better job in supporting people at home so that we can provide care in an alternative setting, so that that care doesn’t necessarily require transport. If you look at programs like the Special Patient Program - I have to double check if that’s the official title for it - where patients can register and receive care within their home and don’t necessarily need the transport.

If you look at what we rolled out last year in the Cape Breton region as part of the redevelopment in Cape Breton for the community paramedicine program, if you look at how that Special Patient Program supports the palliative care patients who may otherwise require transport to a hospital for their management, instead we can have dedicated paramedic experts, health care providers, go into the home and provide care and support with oversight through dispatch or phone calls back to medical oversight from a physician.

These are some innovative programs. In recognizing those programs, I should note to the member’s earlier statement that the system hasn’t evolved. In fact, we continue to be pretty innovative here in Nova Scotia and evolve our system. Again, we just haven’t recognized all of that. We’ve done them in certain parts of communities. Part of our going forward is identifying those ones that have the biggest value, do the most to improve the system and the health of our citizens. We’re still committed, as shown with our community paramedicine program to leverage the skill sets of our paramedics to help in the delivery of care and reduce the number of transports necessary.

COLTON LEBLANC: Talking about Nova Scotians that don’t necessarily require transports - has the idea circulated around the minister’s department about deviating people that don’t necessarily need 911 and paramedics, and that those types of calls could be deviated through another path, such as an improved, efficient and effective 811 system or another allied agency?

RANDY DELOREY: Indeed, we have a number of initiatives and suggestions that have percolated. Certainly the opportunity - again, this isn’t just about our EHS system - to leverage virtual care opportunities for our citizenship, we hear that from physicians, as well, which would be similar to leveraging telemedicine care provisions, which is a form of virtual care that is non face-to-face.

We do have work ongoing to plot that course in what is a relatively new area within the health care system. We do have work ongoing to establish the plan and chart a path forward, not just within the emergency health services space but in the broader health services space, as well.

COLTON LEBLANC: Part of the increased demand on the system and the increased call volume is reflected in the increased number of transfers, notably in the facility, return to residences, medical appointments, dialysis. Has there been any consideration or discussion within the minister’s department to potentially separate the emergency from the non-emergency systems and have a separate transfer service so the transfer service can deal with the transfers and the emergency services can deal with the 911 emergency calls?

RANDY DELOREY: As I’ve indicated, we have a large number of initiatives that have been flagged throughout the last year or so. Those details are informing the work that we will be doing.

[1:00 p.m.]

What I can assure the member is that for all those recommendations and the actions we’ll be taking, we will be informed and guided by a desire and an objective to ensure we have the most efficient and effective care delivery provided to our patients. That’s a principle that has guided us through all aspects of our health care system, the primary and acute care system as well as our emergency system.

Without getting into all of the details, I’ll assure the member that we’re taking a look at many opportunities to improve. Many of those require negotiations with our service provider and that would be ongoing so I won’t be going into details as to what we may have specifically on the table with them at this time.

COLTON LEBLANC: To make the hypothetical argument that such evidence may be being withheld in the Fitch report, I guess that will be a conversation for another day.

Let’s talk about the paramedic morale across this province. Not only are the circumstances of the job above and beyond, but the current state of the system is having a negative impact on the overall mental health and well-being of our first responders. The minister alluded that they are missing the end of their shift; it’s hard to make plans when you are a paramedic - you miss birthday parties, hockey, and sporting games for your children and whatnot.

The average paramedic career is around 20 years. New and the older paramedics are unsure if they will even make it to that 20-year mark. As we know there is a huge staffing challenge in Nova Scotia for various health care professions, including paramedics. Has the minister considered the impact on the system if the number of current paramedics were to leave the profession?

RANDY DELOREY: I do appreciate the member for raising awareness here on the floor of the Legislature about the challenges, particularly the member alluded to some of the mental health and stressors, that affect our front-line paramedics and other health care professionals and emergency responders. I don’t think we can raise that topic and awareness too often.

In fact, without using the individual’s name, perhaps the member may be a little too young to be aware of a particular paramedic - he is from my constituency - who actually through his challenges with mental health on the front line actually established a PTSD conference which is hosted in my community annually. He’s a fairly well-known individual, especially within the paramedic community, so he may be aware. Again, I just want to give a nod to those paramedics who are suffering and in particular to those who have made it through their challenges and for the mentorship that they provide to others in the system.

So, the challenges are real, Mr. Chair, we recognize that. We continue to focus when it comes to the morale; I know in my conversations there is a lot more work to be done. We’re committed to continuing the work that we’ve commenced. I want the member and all paramedics out there to recognize that they are recognized, their concerns are being heard, and we are taking efforts to address them.

As with many of the challenges within our health care system, there’s no single solution, there’s no immediate solution, but we are taking those steps. In my conversations with people on the front line - and this is not to diminish the frustrations and the challenges that are out there - they are recognizing the good work and the investments that we’ve been making, and our focus.

To the specific question that the member raised about workforce planning, in fact we do have a team within the Department of Health and Wellness that is focused on health human resource planning. That’s what their roles and responsibilities are, is to do the planning and forecasting of anticipated needs within the system; they do that for all of our health professions, which would include paramedicine.

COLTON LEBLANC: I thank the minister for his response. I’m concerned for the well-being of paramedics. It’s not just because they’re regular Nova Scotians, it’s because many of them are my friends, close friends and former colleagues.

What I understand from the paramedic population is that they’re not being heard and that their calls for help for mental health and their overall well-being are not necessarily being supported at the best that they can be. We’ve talked about mental health on the floor before. We’ve noted the insignificant increase in mental health services in the budget of $550,000. I think it seriously has to be considered how government can take a proactive approach of addressing their concerns of well-being, and that’s reflective on taking significant and immediate steps to address the system. The system is taking a toll on their day-to-day life. They’re on the go all day, they’re in a truck all day, dealing with all kinds of things; now we’ve heard increased instances of verbal and physical assaults and abuse, and that should not be tolerated.

Maybe to wrap up my questioning, the minister could comment on what approaches government should be taking to recognize that paramedics are facing verbal and physical assaults, and that should not be tolerated. I know if you assault a police officer, you’re going to get charged differently than if you assault a general citizen. Maybe he can address that.

RANDY DELOREY: I thank the member, again, for raising these important questions. I think the actions we’ve already taken shows our commitments.

In being heard consistently, the off-loads is the number one; I’ve heard this directly from union representatives, if you can do one thing, make some improvements in the off-loads. That’s the number one stressor, it’s not the only, but at that moment in time last year, it was the biggest. We need to see that change. As the member said, the system needs to change. Well that’s exactly what we’re doing with the patient flow. That’s exactly what we’re doing to address what was flagged for me. If that’s not true, if that’s not the number one issue and the number one concern, then certainly I’m happy to receive others. That had been a consistent from front-line paramedics I spoke to, as well as their union representatives, and that’s why I made that direction, because I did hear them, I did take action. I brought those people together, and I continue to invest in doing that.

As it relates to hearing from them, we also hear the pressures that come from the injuries, the workplace injuries, and the impact that paramedics being injured has on the availability of workflow. That’s why we’re investing in the power stretchers. So, we’re hearing and we’re taking action and investing. It’s a start, not the finish.

THE CHAIR: Thank you. The time has elapsed for the Progressive Conservative caucus. I’ll ask the minister and members if they would like a five-minute health break?

The committee will recess for five minutes.

[1:09 p.m. The committee recessed.]

[1:14 p.m. The committee reconvened.]

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

GARY BURRILL: It could be in the course of Budget Estimates that a person simply just standing up seems quite dramatic.

I’d like to go back to where we were an hour ago when we were thinking about questions about physicians. Where we left this, the minister had given me an explanation about the $75.3 million and I was asking what of that could be attributed to things other than the Master Agreement allocated for recruitment and retention.

The minister had explained to me about the $69 million from the Master Agreement and had spoken about, as I understood it, $9 million allocated for new specialist positions, but it would be easy to see where I am getting lost in the arithmetic of that - that $69 million and $9 million comes to $78 million, not $75 million - so I think I’ve misunderstood.

My question is really simple, I’m just trying to understand the part, in addition to the Master Agreement, what that $75 million would include and how it is allocated to this purpose.

RANDY DELOREY: Yes, I think I may have misinterpreted or misspoke in my previous response because the commitment on specialty seats is actually reflected in the Master Agreement as well.

So, for the arithmetic, what I was referring to, I think, was items within the investment that aren’t necessarily just directly to remuneration wage increase aspects, because those are service and program delivery things that would be different.

Collectively, in the Master Agreement the number stands that we’ve estimated and budgeted at $69.3 million for this fiscal year. So just outside of that, additional funding for an Enhanced Locum Incentive Program of about $2.8 million.

Sorry, I was just reading the sheet incorrectly. Items that would fall outside of the Master Agreement would be the residency seats that would be coming on stream, so $1.9 million for 15 specialist residents, and $1.3 million for the 10 new family medicine residents, starting in July. That would be what is outside of the Master Agreement.

GARY BURRILL: Thinking back to the report that Doctors Nova Scotia then brought forward about satisfaction within the profession in the province; this is going back to May 2017. I am sure the minister is aware that the report from Doctors Nova Scotia spoke about the struggles with workload that are very common in the profession and the very high levels of exhaustion and cynicism and also a general sense of, as I think the survey had put it, of inefficacy, which I take to mean a sense that one is not making much headway in general.

Also, that report talked about physicians experiencing a lack of respect. These are the words of the report, that only 40 per cent agreed it was possible to provide high-quality care to all my patients. I am sure that the minister is aware, too, that the report did speak about one of the most potentially fruitful ways to address all of this, identified by physicians there, was to improve the relationship with the NSHA.

I want to speak to that concern and ask first, what specifically is being done to address physician burnouts at the moment?

RANDY DELOREY: I think at the highest level, and we can tease in perhaps a little bit more if desired, but I think a lot of the work of teasing out and identifying what investments and steps could be taken for Doctors Nova Scotia on behalf of physicians would have manifested itself at the negotiating table, leading to the Master Agreement.

I can’t speak for Doctors Nova Scotia but as they represent the interests of their membership and had authored a report based upon a survey of their membership, I would have expected that the items they bring forward to be negotiated would also be informed by that same material.

We do have some changes within the Master Agreement, some with remuneration, some actually relate to new programs for the delivery of services that meet both the needs of government and the Health Authority to ensure continuity of care, for example, in-patient services at some community hospitals, a new program was developed to support that through the negotiations; that has been well received by physicians.

So, I think the Master Agreement does a significant part of contributing to that and, of course, recruitment and retention. As we build the supply, as we’ve seen over the last year or so and as the member noted, that report he was referencing was from back in the Fall of 2017, here we are in the Spring of 2020 about, you know, a couple of years later - we actually have had a lot of change. We’ve had success with our recruitment, new program and initiatives, and as I just mentioned in my last response, we have new residents who will be available to come on stream in just a couple of years which will, I think, give some hope and support to the work.

One of the other contributing factors I think that was flagged by physicians was administrative burden; that one of the underlying concerns about being able, as the member referenced, to provide the care, having adequate time to provide adequate care, what have you, to their patients. Part of their frustrations stem back to spending too much time on paperwork and administrative burdens. That is why it is part of the Master Agreement as well, we recognized that as government.

We have an Office of Regulatory Affairs and Service Effectiveness that was already established in government. They obviously have shown major strides when it comes to engaging and efficiencies within the private sector. So, we are engaging them to lead work and help guide us through the reduction of those administrative burdens while at the same time ensuring all of the necessary oversights and administration that is necessary - but only that administration that’s necessary - to inform the appropriate care and administration of our health care system. So, we should see reduced administration which would further help reduce burnout, based upon the information that has come to us.

GARY BURRILL: Thank you, and I appreciate that explanation. So, when we look to the budget for government initiatives and spending that address the physician burnout question, are there lines elsewhere beyond the Master Agreement that we ought to be looking to?

RANDY DELOREY: Again, the Master Agreement really is that overarching agreement that governs our compensation and relationship with physicians and their bargaining agent, Doctors Nova Scotia. While we have a number of initiatives in there, that is probably the most significant area of investment. As I’ve said, we do have the regulatory efficiency piece or the administrative efficiency piece that we are bringing in, as well. Conversations, I believe, have already started. I think, again, what were flagged as the top areas of priority that have come forward to us from physicians, really does help.

Another area of investment is the investments we’ve been making in support of collaborative practices, collaborative teams within our health care system. That is something we’ve heard from physicians, about being able to provide a more sustainable environment; we do have additional funding supporting collaborative teams this year. I think, based upon the last number of years of investments, upwards of sustained investment of something in the vicinity of $27 million to support our expanded collaborative care practices throughout the province, these are some of those things.

Again, they show up in different ways and different forms and different areas, but in a broad context, I think the Master Agreement will be the biggest that you would point to for the member’s interest.

GARY BURRILL: I’m sure the minister recognizes what a major area of research and concern this whole question of vocational exhaustion has become, and that in the world of health care, and that in our world in Nova Scotia health care, the matter of vocational exhaustion and burnout of health care providers is a very major consideration.

Is the government undertaking - specifically thinking about this whole matter of physician burnout - is the government undertaking, the department undertaking, any research at this time on the subject of professional exhaustion and burnout within Nova Scotia health care, particularly with reference to physicians?

RANDY DELOREY: I know that there’s work with partners; I know this because I have a local physician who is part of it, kind of a mentorship type of program within physicians - physicians helping physicians. This is a part of the work that gets undertaken within the physician community, that takes place at the work.

As well, broadly speaking, we invest in mental health programs and supports. Yes, we take those concerns very seriously. One of the areas, again, is trying to tackle root causes, and that’s what the earlier questions focused on but there is also the need, as the member referenced, to have supports available and in place. We do work to ensure appropriate programming within the system for mental health services as necessary - EAP programs or what have you - throughout our employment places.

We also look at the feedback. It’s such a diverse way of recognizing where the challenges are. If it’s the stress of being asked by many people in your community, because there’s a high demand or a high number of people looking for a primary care provider, so that’s the feedback we get in some parts of the province with some providers. I get many calls a week where I’m being asked, or I bump into people at the grocery store; well, how do we address that root cause? The only way we can address that is by attaching more Nova Scotians to primary care so our recruitment/retention initiatives, our training programs, those are how we’re addressing that root cause.

How do we address those managing the burden of work that they have before them within their practice? As I’ve mentioned earlier, reducing the administrative paperwork burden gives them more time to give them the space to do work. How else can we support that? It’s through the collaborative practices, bringing other health care providers; no longer viewing our primary health care system as individual physicians or physicians working alone in our health care system, but rather recognizing that our health care system has many health providers with a diverse range of skill sets. The best outcomes for all, both the providers and the patients, is through that collaborative work. Again, that continued efforts in that space, I think all of those things help contribute to address the concerns that the member has raised.

GARY BURRILL: Am I right, then, in understanding that the Department of Health and Wellness doesn’t have, at this point, any ongoing research in provider burnout, particularly physician burnout?

RANDY DELOREY: I guess, looking at research, and I apologize, when I think of research I do think of it in a true, pure, academic or clinical sense that we fund. This came up, I think, yesterday with a member on a different theme about the notion of research projects or programs that get funded by the department, we provide funding into Research Nova Scotia and Research Nova Scotia administers funding for research projects for a variety of disciplines including the health field. As far as specific research programs, I’m not aware of one specifically. That doesn’t mean there aren’t researchers within the province undertaking this work to provide the feedback.

[1:30 p.m.]

What we have done though, if he means research in a less specific or formal sense, of course, I guess research in so much as we review information that comes into us, that we’re aware of, that we engage with participants and receive information and assess that information to help inform the actions that we take. So, if it’s in that more generic sense of the term research, that’s the nature of the work that we do each and every day; not just in the area of burnout but in all areas and concerns being raised by our health care providers, physicians and others.

GARY BURRILL: I think the minister just said that research in the more generic form is actually called life. I guess that’s right.

Going back to the Doctors Nova Scotia physician satisfaction research and that key point identified there of unhappy relationships identified by physicians with the Health Authority, and how prevalent that was out of that research and how underlying it came forward from that. Can the minister speak to what the department is doing with an eye specifically to uplifting and improving that relationship which has surely not been at a satisfactory level to anyone?

RANDY DELOREY: I believe that within the Health Authority, that is an organization governed by a board that does report back to me through the department, the work and the changes being taken within the Nova Scotia Health Authority have been well noted. I believe that where the concerns - we talked about these in our earlier discussions here during Estimates - that many of the concerns and frustrations stemming from communication challenges and flows and decision-making processes, that process is well under way for significant changes within the Health Authority; they were announced back in the Fall to respond to those concerns.

I think, again, work is being done within the Health Authority. We continue to monitor the proposals that they bring forward to address those concerns. I think we have a new chair within the Nova Scotia Health Authority. I would maybe note some of the changes - keeping in mind this is a report from 2017 - things that have happened subsequently: we’ve appointed for the first time a physician to the board of the Nova Scotia Health Authority; the Nova Scotia Health Authority has hired a CEO who happens to be a physician. A deputy minister has been appointed, although has not yet started - actually we did have a former physician as the deputy minister for six months on an interim basis, and the successful candidate for the position as deputy minister in the Department of Health and Wellness is a physician who is winding up their practice. An active physician will be transitioning into an administrative role. So, you’ll have then a physician deputy minister and CEO of both of our health authorities.

I think that certainly ensures that those concerns and communications and relationships have the opportunity to ensure that the lens of physicians is brought to bear. At the same time, it’s important to recognize that we have many other health care providers within the health system, and we need to hear their voices as well. That is why there are former nurses appointed to the board of the Nova Scotia Health Authority as well - those with that expertise - and we have that opportunity for those lenses to be presented in the senior ranks of both the health authorities.

I think that if we go back to that report that the member is referencing, that was a significant piece; they didn’t feel the doctors’ voices. Now the doctors’ voices are literally at the tops of these organizations. That is in the early stages of rollout. The CEO just started in the middle of December 2019, and the deputy minister is only slated to start in a couple of months. I think that will go a long way.

On top of all the other initiatives we’ve been talking about, I’m not going to rehash those changes and responses we’ve made in the Master Agreement but again, that Master Agreement itself and the relationship with Doctors Nova Scotia I think is reflective of significant shifts; feedback that I’ve been hearing has been quite positive.

All issues for all individuals are not necessarily addressed and resolved, I’m not suggesting that. I am saying that broadly, people are seeing, on the front lines, the changes that are being made and they believe those changes are good.

GARY BURRILL: Thanks for that answer. I’d like to then just go back to where we started a few minutes ago, thinking about the amount of the money that is in the budget allocated for physician recruitment and retention.

Could the minister characterize the trajectory of budget spending over the last five years? Are we seeing a parallel amount being spent on retention and physician recruitment or are we seeing an increase? A small increase? A large increase? Could the minister speak to, let’s say, the trajectory of the last five years.

RANDY DELOREY: The breakout again, I think as we’ve had several discussions back and forth about what is or what isn’t recruitment and retention, I think our budget line items don’t line up exactly with that category. So, to do an historical approach would take some time to answer that more broadly because as I said, investments in Dalhousie Medical School’s residency and medical training seats, we believe is a very significant investment that supports recruitment and retention of physicians. That doesn’t tie into a line item that says recruitment and retention, it actually is a line item about an investment for physician education and training. For that reason, it becomes very difficult but as I said, we’ve invested millions of dollars to just the training seats, residency and medical seats, at Dalhousie University.

We’ve invested in this most recent Master Agreement what I believe amounts to a $135 million increase in financial supports and programs to support physicians. Now that would be on the go-forward side of things but that does show a significant increase for physicians in that area. They flagged, if we go back to the report and the information that was floating around in 2017-18 about the concerns and issues raised by physicians, remuneration was a significant one. That’s why we didn’t wait until we had a new Master Agreement in 2019, but rather, took steps in March 2018, to actually do an interim top-up to physician compensation.

Has it increased? Well if you factor in those increases in compensation in 2018, the Master Agreement which does even more, I think that very clearly shows a trajectory and a trend in, again root causes, root supports for recruitment and retention.

If we narrow in and go to what would be traditionally considered recruitment and retention, the actual recruitment team that is on the ground doing active recruitment activities, those are activities and actions taken by the Nova Scotia Health Authority and the IWK within their respective organizations. The line items there would show up in their budgets.

GARY BURRILL: Just one thing further about this same question, then. Is the Province of Nova Scotia spending significantly more in the upcoming budget year for physician retention and recruitment than it has over the previous five years?

RANDY DELOREY: I think, as we noted, that’s about an $80 million - $78 million or $79 million - investment that goes towards a number of things including items detailed within the Master Agreement contract with physicians, the expansion of residency, and medical seats at Dalhousie Medical School.

I would say pretty definitively that that would be significant new monies that have been invested this year, that were not part of compensation and investments five years ago. That would be a pretty definitive yes in the broad sense of supporting those things that support recruitment and retention.

GARY BURRILL: Thanks for that explanation. Continuing to think about this whole area of professional satisfaction and professional morale in the whole health care world in the province, I’d like to turn and think some about nursing.

We know that this is a multi-faceted concern but that in the world of nursing, a great deal of the concern that has been expressed has to do with nurse safety. I’m referring to that 2019 Nurses’ Safety Survey review that was presented to the Minister of Health and Wellness when it was done last year.

We note that 93 per cent of the nurses surveyed said that they felt that their patients were being put at risk because they, as nurses, were working short; 92 per cent said that in the last five years for them, their workload had increased; and only 12 per cent of them said that they feel safe at work. This was a pretty dramatic revelation, I think, for a lot of people when the survey was distributed.

At the time, according to the NSGEU president, Jason MacLean, he said, “The results of this survey clearly show that nurses are struggling to provide safe patient care, given the consistent staffing shortages they are facing on the front lines. Something must be done, now, to address the very serious concerns our members are bringing forward.

I’m sure the minister will remember that at the time, when the survey was released by the union, there was a call to him to establish a working group in order to identify solutions to improve morale in the nursing profession and, in particular, to address the specific concerns related to safety in the nursing profession in the province.

I want to ask first: Has such a comprehensive team to address these concerns been put together?

RANDY DELOREY: Yes, steps were taken within the Nova Scotia Health Authority to evaluate security and security provisions and so forth. In fact, just recently I had a joint meeting with the CEO and a representative of the Nova Scotia Nurses’ Union to talk, in part, about this very thing. I believe there have been some additional meetings set up and established between the union

[1:45 p.m.]

I think where perhaps some of that work may have been challenged was the engagement with the unions; I don’t think unions were necessarily kept up to date as to the work that the employer was performing. The reality is that a lot of work has been done and the new CEO is certainly committed to trying to bridge those lines of communication, to make sure that the nurses’ representatives are also aware of the work that’s ongoing and next up. It is an area that was taken seriously, and work has started and will continue.

GARY BURRILL: Could the minister, following along this line then, identify how much funding in the current budget is being allocated to respond to these particular nurse safety concerns and to move toward possible solutions.

RANDY DELOREY: We don’t have a specific line item targeted to that specific report, broadly, because that particular response is a focused responsibility of our health authorities who would be the employers of the nurses.

We know that there’s a significant increase in our funding to the Health Authority to deliver their operational services and delivery of care; part of that care, of course, is supporting those health care providers within their system to deliver that care.

With respect to the importance of health and safety within our workplace, I know we’ve spoken about this and we have been investing in programs in other areas as well, for equipment. There is a broader initiative around workplace safety within the health care sector. Much of the focus has been with partners like AWARE-NS and our unions really coming together to provide input, along with the employers within the sectors, to ensure that we have recognized our shared responsibility and the importance of health and safety - and it is all of our responsibilities. That’s why, as we talked about yesterday in the long-term sector, the continuing care sector, the investments we’ve been making there.

Again, as it relates to the action and the workplace safety concerns being raised in the report that was cited, I think these are less, kind of, the workplace safety in the traditional sense and more violence related workplace safety incidents and concerns, which picks up on the remarks that the last member of the PC caucus, who had been inquiring as it related to paramedics. It is certainly a growing concern for government that our front-line health care workers are being subjected to verbal and sometimes physical incidents that no one going into their workplace should be subjected to. We recognize that, and that’s why we support this work that’s ongoing with the employers.

GARY BURRILL: Then further to that, is there then within the department any specific evaluation work or research work being conducted around this issue nurses have identified as paramount for them, the question of their safety?

RANDY DELOREY: I think as far as research, within the department we rely often on other research that’s conducted to help inform strategies for solutions for moving forward. But also, when we look at our nursing strategy in the partnership that exists, all stakeholders that represent nurses come together at a table to share information, insights, and a path forward. I think that’s an area where a lot of that sharing of information and solutions - and there is a financial contribution to that strategy that allows us to prioritize some investments, targeted at improving circumstances for our nursing workforce. That includes some support in investing in non-violence crisis intervention training and programs like that.

GARY BURRILL: Then thinking about nursing, I’d like to just ask some more empirical and specific questions. I don’t expect that the minister or his staff would have the answer at hand here today but would it be possible to supply for us the number of emergency room nurse vacancies there are in each of the emergency rooms in the province? Is that a figure the department would have and could be made available?

RANDY DELOREY: Given that the emergency departments are the purview of the Nova Scotia Health Authority, and the IWK for their emergency department, the member is correct, we don’t have that information here today; we would have to reach out to the health authorities to obtain it.

GARY BURRILL: But the minister is saying it would be possible to do that for us and we could take that as an undertaking to do that.

Then also thinking about nursing vacancies in general, on the same list it would be useful to know how many nurse vacancies there are at each hospital in the province. Is that a figure that the minister could see we could be supplied with?

RANDY DELOREY: Again, we’ll connect to the Nova Scotia Health Authority to see what vacancies are established. In the interim, as perhaps a bit of a proxy, the member can certainly look at the job postings within the Nova Scotia Health Authority; those job postings would be publicly available and certainly would reflect vacancies. Those would, predominantly, be permanent vacancies; you also have some short-term ones. We’ll make some inquiries to see what kind of vacancy data we have for nurses that can be made available. Again, in the interim, for a short-term proxy, the member can look at job postings as well.

GARY BURRILL: On that same list of information about nurse vacancies, would it be possible for us to be supplied with how long the longest nurse vacancy in the province, at the moment, has remained unfilled?

RANDY DELOREY: We’ll take a look. Again, I can’t state definitively that the Health Authority has that exact data, but we’ll certainly connect with them and see what data is available.

GARY BURRILL: Thinking about this problem which comes up not that infrequently, about the provision of nursing, the situations in the province where we have shortages of nurses in regional hospitals but we don’t have shortages of nurses in community hospitals, in particular with collaborative emergency centres, I want to ask the minister, is it a common practice that in the province we are, in effect, pulling nursing staff from CECs to cover regional ERs where we have nursing shortages?

RANDY DELOREY: I can’t say definitively that, as the member phrased it, it is a common practice or not, but it is something that I believe occurs. Of course, number one priority is ensuring that our acute care facilities and regional hospitals have the fully functioning staff available that serve an entire region. But again, as far as the specific circumstances that the member has described, I can’t articulate at this point whether that could be classified or characterized as a common practice.

GARY BURRILL: Could I also ask the minister to see if he could make available for us figures about where there are any wards in the province’s hospitals in the last year that have had to close by reason of nursing shortages? Is that a metric that the department would be able to get its hands on?

RANDY DELOREY: Again, I think I can say that there have been instances of closures due to the unavailability of nursing staff, just as there have been closures due to the unavailability of physicians. I think that information is often provided when the NSHA posts the closure notices for facilities. I believe they usually indicate the reason for that closure, whether it’s unavailability of physicians or nursing staff.

GARY BURRILL: Thank you for those answers and making that information available about nursing positions and vacancies and staff vacancies in general. I’d like to shift gears then and think some with the minister, if we could for the time remaining, or some of it at least, about the whole world of mental health. We do know that in our province the number of people who report a prevalence of the presence of mental health disorders over their lifetime is a lot higher than the Canadian average. This is a very significant part of the landscape of health care in our province.

One of the things about it that is particularly difficult is that unlike most parts of our health care system, in the world of mental health the care that is available in the province varies according to a person’s financial means. What I am referring to here is the fact that we have a growing sector in the province of private clinical, psychological, and counselling services.

Normally the rate that people pay is between $100 and $200 an hour but one of the features of all of these facilities, at least as I have experienced them, is that they are available on very short notice and a person can be seen quite quickly. This is not, of course, the case throughout our province in terms of wait times for mental health in the public system.

So, when we try to think about what the cause of the problem is here, one of the things that is often identified by people who talk about this area, and study this area, is the percentage of the global health budget that is devoted to mental health. Here in our province we know it’s between 4 and 5 per cent. We know there are other provinces where it is much higher than that and in some, close to double. We know that the World Health Organization speaks about the need to provide adequate provision for mental health requiring a 10 per cent allocation of the global health budget.

I would like to ask the minister first, in general, what is his sense about what would be the right percentage of the global health budget? What ought we be moving towards in Nova Scotia that would allow us to get on a footing where we could provide the mental health services that we would want to?

RANDY DELOREY: I think, and I’ll put an economist’s hat on now based on some previous experiences I’ve had with some economists in a previous role. The notion of defining a hard percentage to a service like this is sometimes problematic, the reason being that over time the needs of investment may change. Once you establish what may be an artificial target comparator, perhaps at times it should be higher than that, and at times it can afford to be lower because of the whole system.

[2:00 p.m.]

Broadly speaking, I think my response to the member’s question is that we need to continue to focus on advancing improvements, as we’ve done in each of our years over the last several years, and continue to increase our investments in mental health services and supports.

This year we have the largest amount of money ever committed in the province to go toward mental health services. We know there’s still more work to be done, but we will continue these investments. I think it’s also important to note the effects that these investments and the attention of the government and the health authorities - both the NSHA and the IWK - as well as our partners in the education system and in other parts of government - by paying attention and investing in these areas, we’ve seen improvements.

For example, in the last four years the IWK has seen a 75 per cent improvement in wait times based upon investments and new ways of delivering mental health services. They have 98 per cent patient satisfaction with their first appointment. That’s a 24 per cent improvement since 2016. They’re actually being simultaneously more efficient and more effective in the delivery of their mental health care services.

Within the Nova Scotia Health Authority we see emergency mental health services that are true emergencies being seen right away throughout our system. For urgent care within the clinical time - I believe it’s 98 per cent of those at the IWK are being seen within the targeted time period and 95 per cent for youth being seen in the Nova Scotia Health Authority. Of urgent care mental health referrals, 98 per cent are being seen within the target in 2019. That’s up from 85 per cent, meeting the clinical threshold the year before.

Is there more work to do? Yes, there is. Are we making significant improvements? Yes, we are. Are we going to continue to work to meet the mental health care needs of the citizens of Nova Scotia collectively through our investments, not just through our partners in the health authorities but also through education and other avenues of government? We most certainly are. That includes investments in some of those social determinant areas - helping with housing security through the investments in Municipal Affairs and Housing Nova Scotia, investments in pre-Primary programs to support those children across the province. So yes, as a government we collectively continue to invest.

I won’t put a definitive number as a percentage as the member has inquired, but I will reaffirm our commitment, my commitment, to continue to make mental health investments and improvements a priority for health care in this province.

GARY BURRILL: Certainly it was not the presence of that commitment and the minister that I was meaning to question. I also don’t question that there are areas of significant improvement. I think there’s lots of evidence about that. But I think we also cannot fail to accept - we have to face the fact - that over the last seven years the numbers of people in our province with perceived fair or poor mental health have increased. I presented the minister with data about this yesterday.

In light of this, I want to ask the minister if he will outline the specific programming costs that are related to mental health spending in this budget and what there is with new initiatives, addressing this sharp problem.

RANDY DELOREY: First off, I think it’s important to note that one of the most significant things we’re doing for mental health and addiction services in the province is continuing the very good work and continuing those investments that we’ve been making over the last number of years into new program areas and program services.

In fact, those continued investments will continue to provide improvements. Some of those examples, Mr. Chair, include programs like the adolescent outreach model that has been expanded to the Northern and Western Zones, modelled off the CaperBase model in Cape Breton. I believe that is now in about 100 schools across the province where youth have access to these services. If those youth are having mental health issues, they are then able to be identified earlier.

We know that early identification does result in the greatest positive health outcomes over the course of one’s life. We also know that for those who experience mental health challenges, particularly chronic ones, they often first manifest in youth, in adolescence. By focusing those investments, as well as the youth health centre program that was recommended by Dr. Stan Kutcher, the evaluation of those investments is ongoing to help inform the best practices to be rolled out in other community schools and health centres.

We continue to invest and work with e-health innovation in the mental health space, as well as in other areas of our health care system when it comes to technology to support the delivery of care.

We continue to recruit professionals. We know that within the Master Agreement the compensation for psychiatry would have increased as well to help with that support. I think that builds on some changes we made a couple of years ago, particularly in regions that have high demand or high vacancies for psychiatrists, to help support the recruitment.

We’re also seeing things that don’t cost money, but again, that is the advantage of having a single Health Authority.

There have been efforts within the Nova Scotia Health Authority to really rally the clinical expertise that may be in areas of the province like the Central Zone to support those in other communities that may not have higher-level medical professionals available to provide those supports. So through that rallying - it’s not necessarily a need for more investment, but it is a change in the way that people perform their practices and leverage technology like telemedicine to provide those consults remotely from areas that do have the expertise into communities that may not have them. This type of work is ongoing as well.

GARY BURRILL: Then following on that, could the minister please outline what mental health programming is newly being supported by increases in mental health funding for the coming year in this budget?

RANDY DELOREY: Some examples include community-based mental health services expansions and hiring additional clinicians in the community through our partner organizations. I believe we have about $3.2 million there. New is $2.7 million, another half a million, to continue the work of some clinicians who were recently hired. Expanding access to urgent services, an investment of $1.5 million. Another $900,000 investment towards virtual care services options.

That’s an example of some of the larger dollar amount contributions, most significantly going towards additional clinicians to support, but they’re in community spaces. So it’s not necessarily new programs specifically, but rather continuing our investments in those programs we have to ensure that we expand the care and support options that are available.

GARY BURRILL: In the couple of minutes that are left that we might think together about this, I would like to ask the minister to speak to the question of wait times to be seen for mental health and the regional variation in them. I’m sure that the minister is well acquainted with the numbers, how really stark and unacceptable the range is. In some parts of the province a person can be seen within a couple of weeks, but there are very significant parts of the province where it’s measured in months and some parts of the province where it’s measured in a lot of months before you can be seen.

Can the minister provide his sense of why there is such dramatic inequality in mental health wait times in the province?

RANDY DELOREY: I think there are a myriad of factors at play, as there would be with many regional variances in any number of areas one wishes to assess - not just in health but in other aspects, whether economic or otherwise.

One contributing factor would relate to demand. When you look at demand, what are the underlying factors that result in an increased demand or need for mental health services within regions? We have talked about some of those socio-economic conditions. For very acute mental health conditions, there are genuinely genetic factors at play. There are variables like that that feed on the demand side.

When it relates to the supply-of-services side, part of that relates to historical variances in where and how our health authorities would invest in providing services. This is part of the work that has been undertaken at the Nova Scotia Health Authority over the last number of years to standardize the care path and delivery of mental health services throughout the province. It did take some time to complete the formal structuring of the Nova Scotia Health Authority and then to gather up the information about the myriad of practices that were taking place.

[2:15 p.m.]

THE CHAIR: Time has expired for the New Democratic Party. We are now going on to the Progressive Conservative Party for one hour.

We’ll start with the member for Argyle-Barrington.

COLTON LEBLANC: During my last line of questioning I expressed my appreciation to the minister for his knowledge of the various issues that are facing paramedics across our province. Although I’m not an artist I want to try to paint a picture of the current situation.

Ambulance drivers back in the day worked in funeral homes, delivered a ride to the hospital, delivering “diesel therapy,” like I’ve heard it referred to multiple times. But that has since changed to one of the leading scopes of practice in North America. Gone are the days of ambulance drivers. Paramedics are not technicians, they’re clinicians, who are highly skilled individuals that are feeling the pinch of our health care crisis in our province. I understand and appreciate that our health care system is complex and it takes time to implement changes and it takes time to see those changes reflected in, hopefully, positive effects.

The increased call volume, which I have referred to previously, has doubled at least in the last 10 years with a very slight increase in resources. The minister could provide any evidence contrary to that, but we’ve seen an increased number of emergency call volume, increased number of transfer call volume and that leads to my point for the department to examine a separation between emergency services and transfer services. All this increased demand on the system has caused the minister to react and implement these off-load guidelines, which I’ll speak to a little bit after.

The increased demand results in decreased ambulance availability, which causes increased response times. Ambulances are spread thin throughout the province. Paramedics are thus missing breaks, missing lunches, being tied up in hallways, and they didn’t go to school to do hallway medicine. They went to school to be in the ditches and homes, delivering the care that they are granted through their scope of practice, which is anything from advanced airway management to seizure control to advanced cardiac life support, from trauma to obstetrics.

With all that overburdened system impacting their mental health and well-being and then on top of that being faced with more occurrences of physical and verbal assaults and abuse, this is a matter of not only public safety but also a matter of safety for our front-line workers.

Going to the availability of ambulances, which I’ve heard that ambulances have been spread out - one in Yarmouth, one in Blockhouse and one in HRM - what confidence does the minister have in the system that the ambulance system could properly respond to a mass casualty incident?

RANDY DELOREY: As the member mentioned here, and I think it was the last part of our previous conversation inquiring about the notion of workplace verbal and other assaults or actions taken. I just want to go on the record and be very clear, as I did with the member from the NDP caucus raising questions in a similar vein as it related to other health professionals like nurses. I want to be absolutely clear for the member that no one working in the province should be subjected to abusive situations, least of all those who are working in a capacity to help support individuals.

I know some of these instances are not necessarily by the patient, they could be others around the patient in a very highly stressful situation, so we appreciate that but do not in any way condone that environment.

We know that there are programs throughout the EHS system to provide peer support networks to help each other and support those challenges within EHS. There is also a program called R2MR - the Road to Mental Readiness. That’s the same program used by the Department of National Defence that has been rolled out to support our emergency responders, again, back to the mental health challenges of being in emergency situations.

To the specific question brought up in this last question about a mass casualty, the system is designed to respond to the emergency situation. The system will respond to the situation that is presented to it. If there is a mass casualty, how the system responds in that instance would be with the resources within the system to respond.

In order to prepare for such a situation, we do have annual mass casualty exercises. We know that mass casualty scenarios are not something that’s just restricted to our emergency responders in the EHS to respond to but, in fact, is a pressure drawn upon our entire health system. Mass casualty exercises actually do draw a collaborative, integrated exercise to test the protocols and systems that are in place.

Again, I would have confidence that we have the systems and the protocols to respond in a mass casualty situation.

COLTON LEBLANC: The minister stated that the system will respond, is designed to respond, and it will respond, but if it responds as it currently stands at present, as it exists with the system demands, I am very afraid that lives are going to be lost. There will be patient safety - Nova Scotians’ safety - at risk. I just want the minister and his department to be cognizant of that.

Going back to the assault aspect I alluded to in my last line of comments, does the minister believe that the assaults - the verbal, physical assaults and abuse that paramedics are facing - should there be any legislation to handle these occurrences, similar to law enforcement?

RANDY DELOREY: I’m not familiar with legislation respecting law enforcement officers, so I’m not really able to comment on something comparable or not. Do I believe that paramedics and others should be free from that kind of scenario? I would agree with that.

COLTON LEBLANC: What I’m referring to is that if you assault a police officer, it’s a different charge than if you assault just a public citizen.

I guess we’ll change paths a little bit and we’ll refocus. Our caucus has been strong advocates, including myself, about public access to AEDs in our communities, thus we’ve introduced legislation to have them in our schools - mandatory in our schools - and myself having introduced legislation to amend the Building Code Act to make them mandatory in particular buildings.

Can the minister provide a response to the House regarding current initiatives for AED placement in our communities? I am very well aware and well-versed with the AED registry because I sat on that committee previously. Is his department looking to either (a) adopt one of our pieces of legislation; or (b) introduce one of their own to make public access of AEDs more readily available and legislated in Nova Scotia?

RANDY DELOREY: On a slight technicality, the Department of Health and Wellness would have no role in approving a piece of legislation on the floor of this Legislature. I would defer, as to the passage or debate of any pieces of legislation, to the 51 members here as opposed to the department. As far as programs and initiatives go, as the member mentioned, I’m very aware of the work with EHS to map and make available and integrate, so that work is considered ongoing. That helps promote not just the good value of having the map available to direct people but also is a good value because through that initiative they’ve actually promoted AEDs as a general concept. I believe there are also programs in place to support some community locations with refurbished AEDs, as well, that are made available to some facilities, including fire halls, that are already in place through the EHS system. There are some initiatives already out there to help expand the availability of AEDs but also, most importantly, is supporting the tracking and notifications of where AEDs are already available.

COLTON LEBLANC: Going back to preparedness in mass casualty incidents, I had a question that I wanted to ask regarding coronavirus and our province’s preparation throughout the health care system. I guess this question could be widespread throughout all professions. How is the Province preparing for - I know the Minister of Health and Wellness has indicated in the House previously that the Province is looking at measures of preparation for the coronavirus arriving on our doorsteps. However, what preparations for front-line staff are being taken? Such as, if we are hit with coronavirus and we have 20 per cent of front-line health care workers that are unable to go to work because they’re not quarantined, how’s the Province going to mitigate that solution when it presents itself?

RANDY DELOREY: In fact, the protocols and the approach led by our Public Health Office are following those standards and protocols that have been designed and enhanced over time from past situations, like with H1N1 and SARS, and informed by what they know about the current virus, COVID-19, that is expanding around the globe.

I think it’s important to remind people that although the risk remains low - we haven’t had any cases here in Nova Scotia and only a handful for testing. The reality that we have seen - actually the Chief Public Health Officer put out a notice earlier today. I’m not sure if the member saw it, but it is reflective of the evolving situation on a global scale, just advising that we are approaching that point where containment, as we’re seeing, from the origin country is now expanded to other countries.

As it expands further, public health officials internationally are monitoring to see if it reaches pandemic levels, simply meaning that it is spreading across the world. It doesn’t change the acuity of the virus infection but just the scope and the spread of it. We are recognizing that as it continues to spread across the globe, the probability of seeing a case in Nova Scotia does also go up. Those protocols for our front-line health care workers that are currently in place were triggered by Public Health planning. As it relates to quarantines within our health environments that have protocols in place for people who have the acute symptoms of the condition to be managed, those are clinical aspects.

[2:30 p.m.]

As it relates to what the member has described, a worst-case scenario occurring, the work within the public health system to prepare for such a scenario, as unlikely as it may be, is part of their planning process. How do we execute the steps that we prepare for that? We move through the steps of the preparedness as information evolves and becomes more relevant. We’re not at that stage of preparation yet, but we are at the stage of looking at, evaluating, making sure our contingency is in place for equipment requirements and needs, having discussions about if high-volume instances require dedicated space outside of hospital environments, or what have you. Those discussions are ongoing. Planning and preparing for worst-case scenarios really pick up on the member’s previous line of question about mass casualty. You always prepare for the worst and hope for the best. At this stage, we are working our way through those levels of preparation.

COLTON LEBLANC: I want to go back to off-load guidelines. I believe it was in March 2019 that five hospitals announced taking part in these new off-load guidelines, being the Halifax Infirmary, Dartmouth General, Sydney, Truro and Kentville hospitals. Can the minister confirm that all five of those hospitals are still taking part in the off-load guideline process?

RANDY DELOREY: Although initially it might have been five, as work proceeded, the Health Authority committed six - I believe Valley Regional, Cape Breton Regional, Colchester Regional, Cobequid, Dartmouth General, and the Halifax Infirmary. They did more work. The intention here was to focus on those sites that have the greatest impact of delays in the transfer of patients into the hospital. That is the off-load time that we’re referring to. As they continue to be outside of the norm or expectation for off-loads, they would continue to work to improve the situation at those sites. As I previously mentioned, we did see a reduction in off-load time, improvement here in the central zone, which I think represents three of those six sites, from 90 minutes down to 59 minutes.

COLTON LEBLANC: If memory serves me correctly from my last line of questioning, that data supporting the improvements in off-load times was reflected from September 2019. Here we are at the end of February. I’m just wondering if the Minister of Health and Wellness could provide at a later date the most recent data on all the hospitals that are still taking part in the off-load guidelines.

RANDY DELOREY: I believe the data was from December to December - December 2018 to December 2019.

COLTON LEBLANC: Again, I have heard from front-line workers that there is some deviation from the data that the minister has at his disposal. I’m just wondering what the cause might be for that deviation, that’s possibly not reflective of the accuracy.

On the same topic of off-load guidelines, guidelines are guidelines. They can be bent and broken. What are the repercussions for not respecting those guidelines? Who is responsible at the hospital if we’re not meeting these targets?

RANDY DELOREY: To the first part of the question about what might explain variances, I don’t have the variances that the member is referring to, so it would be hard to speak to them.

With respect to the work, we know the system was not operating efficiently when we came into office, that even in talking to front-line paramedics and their union representatives that this was a challenge that was 15 years in the making, that it was just continuously growing as a challenge. So recognizing that, again this question of reaching the guideline right now, particularly in those sites most acutely impacted, the measurement and focus is on improvement, on driving the off-load time improvements at those sites so we get the results that we’re looking for.

Again, it’s not something that’s immediate. This has been less than a year in effort of work and, again, I think we’ve seen some improvements but, at the same time, recognize there’s still a lot of work and improvements that can be made further. That’s why we invested that $4 million in the patient flow space, Mr. Chair.

COLTON LEBLANC: Since the conception of the EHS system, which I praised – it doesn’t matter if you’re in my constituency in the southern part of the province or if you’re in Meat Cove, you call an ambulance and whenever it shows up you will be getting the same level of care.

The problems that are present today, the solution exists much more than just off-load guidelines. I just want to be very clear on that point. It’s nice to wait and see that the off-load guidelines see their effect but we’re at a point where we need to be implementing more changes.

I’d like to speak briefly about some of the programs that are currently offered through the EHS system, such as the Extended Care Paramedic Program, the Community-Based Paramedic Program in Cape Breton. We can focus on that one a bit and then we can move on.

RANDY DELOREY: I’m not sure if there’s a specific question about the programs so I’ll just speak broadly about it for our members here. The Community-Based Paramedic Program is something that was born out of the Cape Breton redevelopment project work that identified the opportunity to leverage, as the member has rightly highlighted, the scope and the skill set of our paramedics. Very different, far more evolved as health care professionals than 20 or 30 years ago. I know that 20 or 30 years ago probably predates the member opposite but the reality is that this program is designed to help with the discharge of patients from the hospital so they can be supported in their home earlier, so earlier discharge but they may require a little bit of support that falls within the scope of the paramedics to do that. They would be on shift to respond to those community-based calls, do the follow-up.

Some aspects would be like the Extended Care Paramedic Program, where they could evaluate the home environment for, in some cases, frequent users of the system that in those cases may be a bit older, may have trips and falls resulting in frequent or multiple calls. They can evaluate the home environment for hazards that might be easily addressed. They can take a quick look to support what the medication situation looks like, and so on, to then engage with the health system, to try to address if there are root issues that other health providers would be aware of. The paramedics are the health care providers who show up in the home and see that environment. The physician may not necessarily have the information the paramedic is able to provide and bring back.

Again it does go to show how really the future of our health care system, which we’ve started already here in Nova Scotia, is about integration; it is about respecting the scope of practice and the capacity of our health care workers; and it is about them coming together collaboratively and recognizing it’s not about turf wars - about whose responsibility a patient is - all health care providers and partners have a responsibility for the care of Nova Scotians. It is about coming together and providing that care.

COLTON LEBLANC: So looking at the current model that is implemented in Cape Breton for the community paramedicine, has the department looked at any costs that would be required or the amount of money that would be required to expand this program to other regions in the province?

RANDY DELOREY: Not in this year’s budget but certainly, because the program really only launched about a year ago or so, we wanted to run the program, monitor the effectiveness of it, identify and tweak where we see some challenges; an important part of the program, it really works and requires some cultural change within the hospital environment as well.

The paramedics are there, ready, eager to provide the services but we do need the nurses and the doctors within the hospital to participate and refer into the program. So, we continue to engage in work there, but the education and sharing the information to allow them to note that this a new pathway for them within the system - we want to make sure we figure how it is and optimize the program before we start expanding it out - because if we roll it out before all the kinks are ironed out, then we roll out an inefficient program. We want to get the best program possible and then roll it out and expand for others.

COLTON LEBLANC: Regarding the Extended Care Paramedic Program, I’ve never worked in the central region but my understanding is that the program permits a paramedic who travels solo and frequents nursing homes, where there are potential patients who require transportation to a hospital, they’ll coordinate at a better time that is more convenient for the system.

Has that program itself been investigated or examined to be implemented in other parts of the province?

RANDY DELOREY: Yes, that’s roughly where the extended care program as it relates to our long-term care facilities would see a paramedic attend to a patient within, or a resident who would become a patient in a long-term care facility, to do an assessment. They have clinical oversight that they can call back in to help with the assessments to see whether they need immediate transport or not.

That is the approach, I think, as we do our work, both within patient flow but also in our continuing care space. We continue to look at and evaluate the best programs and processes. Again, in this budget we don’t have explicit expansions but as part of the overarching work in our Continuing Care Branch, as well as patient flow, we see opportunity for programs and initiatives exactly like this to help address some of those pressure points in critical areas, both in the acute system - the emergency system - and in our continuing care, long-term care segment.

COLTON LEBLANC: A quick question regarding general revenue for the department, pertaining to the EHS. In 2019-20 it was estimated that there would be a general revenue of $1.9 million and the forecast amount for this fiscal year is $2.2 million, so $200,000 more, and then the estimate for the upcoming fiscal year is the same as the forecast for this year. What’s indicative of that figure?

[2:45 p.m.]

RANDY DELOREY: Just for expediency, can you refer to the page if you have it there so I can cross-reference?

That would be recovery, I believe, for LifeFlight services predominantly, that other jurisdictions leverage our services for within the region.

COLTON LEBLANC: A question for the minister and his department: Where would the fee recovery for the ambulance - so the $146 for Nova Scotians and the other fees through Workers’ Compensation and NPCs and out of province and out of country - where would that fall into the revenue, please?

RANDY DELOREY: Yes, I believe that fee, along with some other fees and charges, show up in the first line item, Other Fees and Charges.

COLTON LEBLANC: On the topic of fees, with the current revenue and the current expenses of the department pertaining to EHS, do the minister and his department foresee any changes to the current fee structure for EHS?

RANDY DELOREY: At this point of budgeting for fiscal year 2020-21, we are basing our estimate for 2020-21 upon past performance of the system. Again, the amounts do vary. They vary based upon a number of variables such as the volume. We see it change based upon recoveries. We do each year, when Public Accounts comes to be in the Summer, have adjustments to write off.

Again, there are programs for those who can’t afford that fee. It’s waived. We follow a protocol that seems to have been working well within our province for the last number of years. There are no forecasted changes to the actual fee program, but again, the dollar amounts may vary from budget to estimate at the end of the year.

COLTON LEBLANC: This is going to go back to one of my interview questions when I was hired by the operating company as a paramedic. It has to do with response time. In our province, if you live in an urban area, the response time is nine minutes and 59 seconds or less. If you’re in a rural area, it’s 19 minutes and 59 seconds or less. If you’re super rural, which happens around Nova Scotia, it’s 29 minutes and 59 seconds or less. That’s 90 per cent of the time.

I’d like to know if the minister has data that indicates if we’re making the mark for that. How often are we deviating from those response times when responding to calls for Nova Scotians?

RANDY DELOREY: I don’t have that information at that level of detail here with us, but the last time his predecessor inquired, I did retrieve the reports and reported back that we were broadly meeting those standards within the system. Again, I just don’t have the reports and that detailed report with me.

COLTON LEBLANC: I was just wondering if at a later date he could provide such information and possibly also include the most recent annual report for EHS.

RANDY DELOREY: We’ll endeavour to track the information down.

COLTON LEBLANC: I’ve mentioned staffing challenges in our province and we’ve talked at length about doctor recruitment and retention, and the thousands of Nova Scotians still without a family practitioner and the uncertainty, how it’s not clear if Nova Scotians have a family physician or if they have a nurse practitioner when they come off the 811 list. I want to speak specifically about the staffing challenges facing paramedics and the recruitment initiatives by this government. It has been said on the floor of this Legislature that there’s incentive programs for other professions. So I am just wondering if the minister could speak regarding the current need for primary care paramedics, advanced care paramedics, and how the government is supporting their recruitment.

RANDY DELOREY: At this point the employer would perform the hiring of paramedics. I’m not familiar with what hiring incentives they may have within their system. They’re a contracted service provider that would manage those programs a little differently than a government-created service provider that is a consolidated government entity like the Nova Scotia Health Authority is, where we have significantly more insight and support. Physicians, for example. Some of those incentives actually do rest with the department and we roll them out in partnership with the Nova Scotia Health Authority that’s responsible with the delivery of the recruitment and retention. That’s something managed and administered more with the service provider, EMCI.

COLTON LEBLANC: It has been brought to my attention a couple of times about the Cobequid Community Health Centre and how it closes at night and then the transfer volume exiting that hospital is sent to a hospital in Halifax. Is the department looking at how efficient that current structure is working for the system and how that could be improved? Sometimes by the time a patient exits that hospital and makes it to the QEII, they wait hours on end in a hallway before actually ending up back at Cobequid.

RANDY DELOREY: That scenario is something that I can recall having come up in some broad discussions about whether or not restructuring - and it was broad discussions, as it would be within the scope of the Nova Scotia Health Authority and the work they do around patient flow and responding to off-load times. At this point I haven’t heard anything definitive about any forthcoming changes, but I can confirm the notion of the concept has been floated and discussed. That’s not to say that it will or will not be pursued. There are a lot of initiatives in this space to try to improve the performance of our hospital systems, to support our ambulance off-loads. As was noted earlier, I don’t think Cobequid was on the original list of direction, but through the work of the groups focused on improving off-load times, they did recognize that Cobequid was an important participant in the system. I think that’s where some of those discussions were, but I’ve not seen or received anything formal about such changes coming forward at this time.

COLTON LEBLANC: Constituents and a neighbouring MLA for Queens- Shelburne know too well the effects of ER closures - I know we had the Roseway Hospital in Shelburne and of course there are numerous ones across the province - some are so frequent that they’re part of the weather report on various radio stations.

Are the minister and his staff keeping a close eye on the impacts that these extended ER closures and prolonged ER closures, are having directly on the EHS system?

RANDY DELOREY: The work throughout the Health Authority to manage their hospital infrastructure to provide the care to residents throughout the province, we work with them to minimize those impacts. As we’ve talked extensively about - I won’t go into all the details again - we’ve spoken extensively about our investments and supports for recruitment and retention of the health care professionals which are ultimately at that root cause challenge for keeping facilities - particularly emergency departments - open in some of our communities.

With respect to the integration, the connection between facilities and the EHS system, that interface between the EHS and the Nova Scotia Health Authority - our partners there and at the IWK - obviously is part of their operational ongoing work that they do. That’s the type of relationship that allowed a focused effort on making changes within the hospital system to help improve the transfer of patients from paramedics into the hospital system around off-load times.

Broadly speaking within the system, these are two partners providing critical services to the care and the emergency services for patients; they would continue to work together to address any of the concerns or challenges that come up. I would expect both parties to maintain open dialogue; should one see challenges from the other, that they might be able to collaborate and work with the other. If they ever have challenges or issues, we’re here as a department to help facilitate if necessary.

I do see the success within the first year of the off-load changes. It shows they do have the capacity to have effective engagement to first recognize and then improve the situation for our paramedics.

COLTON LEBLANC: I thank the minister for his response. It’s a scary reality for paramedics across this province and particularly in rural Nova Scotia that not only are they spread thin through the areas but then have to keep in consideration when hospitals are closed.

I just wanted to make sure that the minister and his staff are cognizant of that impact for paramedics in the care they’re delivering to Nova Scotians. Paramedics are highly skilled with an advanced skill set. Their interventions are limited and obviously they want to transport to definitive care and the increase in transfer time or transport time to that definitive care can unfortunately have a negative impact on Nova Scotians.

The department has three options when investigating or examining the future of EHS. It’s either, the status quo and we cannot afford this. We have increased demand which I’ve gone over a couple of times this afternoon, the challenges with an aging population and ER closures for example. You also have option B, which is to expand the system. As I have mentioned before, more trucks, more staff, more shifts. It’s easy to get a company to build ambulances but it’s difficult to recruit the staff. The third option is a reduction in services, and I know that’s certainly not something the minister wants to implement, or at least I hope not. That’s not what my constituents want or deserve and neither do the paramedics. So, I don’t think we should be moving backwards.

[3:00 p.m.]

With that being said, I just want to ask a couple of questions about the budgetary lines for this year. We’ve seen a $7.54 million reduction in ambulance services, very slight increases of $79,000 for ground ambulance operations, an increase of $283,000 for medical quality control, and an increase of $851 million for provincial programs.

Noting that we were slightly over budget for the ambulance services by a couple hundred thousand dollars, under budget for ground ambulance operations, on par with the medical quality control budget, and over budget on provincial programs, I guess maybe, line by line, we can start exploring.

So, on par with ground ambulance operations - why the significant decrease of $7.549 million for that budgetary line?

RANDY DELOREY: I thank the member for the question. I think we talked about this line previously, that this relates to the contracted services. That amount is reflective of the operational services provided by our paramedics on the front line, and I can assure the member that that fund will continue to respond 100 per cent to them.

There are other aspects within the contract that included some funds for strategic initiatives and others. I believe there continues to be a bit of a balance in that account that allows us to continue to do some innovative work without needing to put the additional funds in this fiscal year while we continue our negotiations with the service provider.

COLTON LEBLANC: That $7.549 million cut that the minister is saying is operational services, is nearly 9.5 per cent of that budget line. I fear that that is going to have a reduction in service, in impact for front-line workers and, most importantly, a negative impact for Nova Scotians.

I would like to ask the minister: Can he provide some clarification to that line, that reduction?

RANDY DELOREY: I want to be very clear, in fact, what I said was there is not a reduction in the operational services. Within that same line item, it included a fund that rests for essentially unanticipated responses. That fund that was contributed to annually had a balance within it. So, those unanticipated investments hadn’t been drawn down upon so there was not the need to put funding into it this year while it still has the capacity to respond. So, again, I want to reiterate very clearly, particularly for those paramedics on the front line, this in no way reflects a reduction in the operational investments to support their core operations of services.

COLTON LEBLANC: I appreciate the minister’s clarification. You know, with the system that we’ve explored this afternoon fairly in-depth, I’m pretty sure we can agree, or at least I’ll agree, that it is in dire straits,

I’m just curious why the department would opt to even consider slashing the budget by that much money, and if it’s not required, if it was just a fund for unanticipated responses, couldn’t that money be invested for the remaining fleet of power stretchers and power load systems? Couldn’t that provide extra staff, couldn’t that provide increased infrastructures, such as more ambulances, on our streets?

RANDY DELOREY: As we’ve discussed at various points throughout Estimates thus far, we recognize - and I believe here I’m not just agreeing with myself - but health care is an integrated system with many players and skill sets that contribute to the care environment.

We also, I think, even just in this hour of questioning with the member for Argyle-Barrington, recognize and reflect that one of the most challenging areas for paramedics is the inefficiencies particularly around the transfer of patients into hospitals, otherwise referred to as the off-load time. That creates a situation that to address some of those most pressing needs, the investment wasn’t necessarily directed toward the paramedics, but rather in the patient flow space. So by taking this opportunity without jeopardizing the operations and the investments and the availability to respond within the EHS budget space, we’re able to support the work and the investments within the Nova Scotia Health Authority and our partners broadly around patient flow to support those needs.

Again, I want to reiterate this is perhaps one of those challenges or problems of integrated systems where the problems may rest, and how we may address some of those root challenges might be up or downstream from where a particular service provider is present. I think that’s really what is transpiring here in this year’s budget. So, again, we felt in doing our analysis and due diligence with the budget this year that this could help support other investments that will have, should have, a positive impact on those paramedics and the delivery of services while there remains a balance that can be drawn down if necessary.

COLTON LEBLANC: I’ll agree with myself on certain things, the minister will agree with himself on certain other things, but we will both agree that health care delivery is a complex and integrated system.

The second line - Ground Ambulance Operations sees a slight increase of $79,000. Seeing as it was under budget last year by nearly a couple of hundred thousand, or $190,000 - I’m bad at math right now, on the spot - but what’s the reason for the increase this year?

RANDY DELOREY: We’re talking about the increase in the Medical Quality Control line item. No? He’s looking at the Ground Ambulance.

We have a forecast, so we want to know why the increase from the forecast? We use the best information that we have available for our systems. These are for investments that are outside of the provincial ambulance system and supports. In this year, we’ve transferred some of that money down to the increase in the Medical Quality Control, so it’s really just a shift between those two line items and that was to the provincial programs within EHS, so supporting some of the LifeFlight operations this year, so that came out of Provincial Programs instead of the Ground Ambulance Operations.

Total investments toward emergency response is still there, but to cover some new night vision goggles for our relatively new helicopter fleet, we moved some of that funding in to provide that equipment for that cohort in this coming fiscal year - if that makes sense?

COLTON LEBLANC: It does make a little bit of sense. So, the increase of $283,000 for Medical Quality Control - forecast for this year’s matching up, but what’s the reasoning behind a $283,000 increase?

RANDY DELOREY: That’s part of the medical oversight team that supports our emergency services. As the member would know, we entered into a new Master Agreement with physicians who saw a significant increase in compensation. This is reflective of changes within that space, to be consistent with other health changes in the system.

COLTON LEBLANC: The time is ticking, I’m just shy of five minutes. I just want to see what insight the minister can provide to not only the members of this House, but to Nova Scotians, regarding the accessibility of the Fitch report. Again, I’ve stood in my place in this Legislature - that is a taxpayer-funded report - and there are some concerns, positive and negative, about that report, but mostly there are very good and positive outcomes that could be hidden in that report right now.

The minister said that after the FOIPOP process it would be made public, under a certain format, whether redacted or not, then he said in December after negotiations were completed with the operator it would be made public.

Can the minister provide insight to the House if the report will be made public? If yes, when will it be made public?

RANDY DELOREY: I appreciate the member’s interest and I want to assure the member that my public comments on this stand, I think, if I recall correctly, the way that proceeded was I was asked if this report would be made public. I indicated, as I always do when asked about documents within the government’s domain, that it would be subjected to a review under the FOIPOP provisions.

It is really important, Mr. Chair, to remind the members of the Legislature that FOIPOP has two components to it - there is the freedom of information and making documents within the ownership and control of the government available to the people - that’s the freedom of information part.

The second part is the protection of privacy and those provisions that would create scenarios that may delay or prevent the disclosure of information. That’s why I have a tendency to - and when I look at information disclosure I tend to err on the side of having to go under the lens because if we proceed with releasing the information in advance of getting an adequate lens on it, you can’t put the toothpaste back in the tube. If privacy is violated, if that information is violated, you can’t put it back.

There’s always the opportunity to complete the release and exposure. That’s why generally, and it’s not unique to this report, I often respond when asked that question, to put it under review.

What did happen in this particular report is recognizing the public interest, I had it go through that lens without an actual FOIPOP application, so I did trigger the staff review of the report to provide then the recommendations as to the disclosure, a publication process.

What came out of that process was a recognition by staff who were working on preparations for negotiations of the contract with our service provider. They felt that the information and some of the recommendations within the report would help frame those negotiation strategies and recommended maintaining that information so that it can be used as strategically as possible at the negotiating table to

ensure that we obtain the best possible negotiating position with our service provider. That was the reason to retain it until those negotiations were completed.

[3:15 p.m.]

What I can assure the member and others within the Legislature, and what I’ve also indicated, was that we recognize the important need to continue to invest and make changes within the emergency services space. That is why we didn’t wait for the Fitch report to be completed and make recommendations around off-load times. We saw it, we brought parties together, and we invested in it.

Again, I know this is a question of suggesting to the member opposite to trust me on this. The report will be made public after the negotiations are complete. I’m not withholding good action that doesn’t need to go forward . . .

THE SPEAKER: Order. The time has expired for the Progressive Conservative Party. There are 16 minutes left for the New Democratic Party.

The honourable member for Dartmouth South.

CLAUDIA CHENDER: Thank you, Mr. Chair. I am pleased to let the minister know and less pleased to alert his staff that we won’t hear the resolution today, as he so greatly desires. We will be here on Monday, but I want to take these last few minutes and ask some questions.

I know my colleague already did, but to go back to the COVID-19 issue, we know that COVID-19 is here in Canada and we know that we are getting closer to pandemic phase. There was an article yesterday in the Chronicle Herald entitled, “COVID-19 could hit Nova Scotia’s aging population hard”, where the Chief Medical Officer of Health talked about how, as we all know, we have a very high percentage of seniors as a portion of our population and that they are at greater risk, that our hospital systems and emergency departments are already stretched with things like the flu, and so we could be facing some big challenges here.

My question for the minister is: Given this, what is the department doing specifically to prepare for the arrival of COVID-19 as it relates to seniors in the province?

RANDY DELOREY: I thank the member for the question. With outbreaks such as COVID-19, when a new virus makes its way into the human population, the Public Health sphere has many protocols in place. You can look back to January when we first started becoming publicly aware, that the first response is containment. If you can contain, you limit the spread, and so on. If you follow the news stories of Public Health officials, you see those updates and see how that works.

As the member referenced, more recently - including a news release that the Chief Medical Officer of Health here in Nova Scotia put out today - he does acknowledge that area in an effort to keep Nova Scotians accurately informed. As it expands more globally, the probability of a case showing up here does increase.

I just want to be abundantly clear: no cases have been documented in Nova Scotia to date. I just want to be clear so that people don’t get too fearful - when we are having conversations about preparation for worst case scenarios, that is not reflective of what is happening today or expected to happen, specifically, tomorrow. I just want to put that, I guess, viewer discretion out there before responding.

The work within Public Health for preparation around COVID-19 and the potential eventual appearance in Nova Scotia is really focused on the general population; it’s how the system responds.

I haven’t been presented with something specifically that says this is the response for seniors yet, but as the news article indicated, which was an interview with our Chief Medical Officer, we already know that, like the flu, this virus would have a disproportionate impact on our elder population, our aged population. That’s because they have weaker immune systems. Any of our population that would have weaker immunities would be more subjected or more likely to contract and have, perhaps, more acute symptoms as a result of it.

Without getting into, specifically, seniors or other populations, I think the system’s preparation already acknowledges and takes into account - like with the flu season - the number of people with the traditional flu. It’s disproportionate . . .

THE CHAIR: Order. There’s about 10 minutes left in the day and there’s a lot of chatter. We’re having a hard time hearing the Minister of Health and Wellness. I ask that everybody hold back their chatter for the next 10 minutes. Thank you.

RANDY DELOREY: Again, what I was just saying is that I’m not aware of something specific targeted to seniors because the general response to these types of situations already takes into account and recognizes how the population responds to the particular infection. I hope that clarifies things for the member.

CLAUDIA CHENDER: Thanks. You mentioned a couple of times about preparation. Your caveat is understood, that it hasn’t arrived in the province. We’re not trying to raise any alarms, but as you said, in public health scenarios we prepare for the worst. You’ve mentioned that a couple of times and so I’m going to get two questions in here because I know you like to take your time answering, so maybe I’ll get an answer, too.

If I look at the budget line on Page 13.11, I see that the budget for Public Health has, in fact, been adjusted downward relatively significantly this year. My question is: Is this the budget line where that preparation for the worst would be happening? What is it and why has it gone down?

RANDY DELOREY: The response to two things. The first is that the emergence of COVID-19, internationally and here locally, really happened very late in the budget preparation process. As reported and reflected in the risk assessment the Department of Finance and Treasury Board prepared as they submitted, it does acknowledge that any increased costs in responding to COVID-19 are not part of the budget.

That is really just a factor of timing for the analysis and preparation of the materials - because it only came in in January - which were well progressed in work. There’s no certainty. When budgeting, we have to have a certain degree of certainty for being able to respond. As the Minister of Finance and Treasury Board responded in Question Period one day, we do have provisions for unaccounted or unanticipated expenses within the province and that’s where funding would be drawn down upon.

As far as within the provincial Public Health department, where would the funding show up? It wouldn’t necessarily - the response wouldn’t be within our Public Health department. The response and the bulk of any cost increases for responding to a health situation like COVID-19 showing up in Nova Scotia would be seen in our health care system that is run by the Nova Scotia Health Authority and the IWK.

The line item in the departmental budgets would see an increase in our grants that we provide out to our health authorities, which would likely be reflected - forecasting with a whole bunch of hypotheticals that increase the material amount, and so on - that demand would show increased utilization within the health authorities’ response to services. Then if there are any other specific items, they might be broken out. It would depend on what those needs are at that time. It could be equipment, but again, that equipment is often procured through the health authorities and we would just be passing the funding through to them.

CLAUDIA CHENDER: Maybe I’ll just come back and ask you: Why the reduction in the budget line for Public Health this year?

RANDY DELOREY: I’m being advised that was an error in last year’s budget that was updated and reflected in the forecast update in 2019-20 versus the estimate. It was an amount that apparently had been duplicated in the funding, so it was updated in the forecast and reflected in the estimate for this coming fiscal year.

CLAUDIA CHENDER: That’s a helpful answer about the grants and that increased utilization is where those costs would show up and perhaps unanticipated for funding in the budget. That being said, presumably there are added burdens to the public health system specifically.

My question is around - this isn’t going to be the only pandemic we’ll see, so presumably there’s preparation, there’s communication. There are things like vaccinations, potentially. Does any of that show up in the Public Health budget and have they requested increased funding to deal with these issues?

RANDY DELOREY: First, the member’s comment that this won’t be the only pandemic. I certainly hope that pandemics don’t happen frequently - certainly not new, unanticipated ones. I certainly hope that we don’t go through this - the efforts and challenges they present.

Knowing that these types of scenarios are not common occurrences is the first thing to acknowledge and recognize as it relates to - as I said previously - the actual costing and estimating. We’re still too early in this in terms of needing to execute or trigger. There have been no triggers with the budgeting during the budgeting cycle and the preparation here. This was not something that could have been forecast or anticipated.

As far as the planning and preparation goes, we already had protocols and plans in place that were built upon. Once we stabilize with the COVID-19 situation, internationally and in the province, we will do a look at our planning preparations - how they held up in this situation - and we will adjust accordingly for the next scenario, just like we did after H1N1 and SARS. That helps us inform and improve so we’ll be more well-prepared - my English teacher would crucify me for that statement - for the next time this occurs in the future.

You rightly mentioned vaccination as it relates to, hopefully, receiving vaccinations that we’ll be able to proceed. If there were to be changes, that would show up under Communicable Disease and Prevention line item. That would be on Page 13.11. Yes, there would be areas, but as we said at the beginning, this budget does not reflect those to respond to COVID-19 because at the time of the preparation, we weren’t aware. We certainly don’t have the information. We don’t have a vaccine developed yet in the world that I am aware of, to respond to this particular virus, although I’m aware that researchers are actively pursuing that. Hopefully, we will have a vaccine to respond, going forward.

[3:30 p.m.]

CLAUDIA CHENDER: I’ll just wrap up. I don’t think there’s possibly enough time for the minister to answer a question. I’ll thank the minister and his staff for those answers and just say that when we come back I hope to ask about issues that might be engaged regarding staffing so if we do see a worse-case scenario, which you say you are planning for, that would probably require the need for increased staffing. We know we already have challenges in that area, so I’d love to hear a little bit more.

You did mention a potential quarantine, if we’re looking at containment. What do those preparations look like? I understand you’ve done a post-mortem after H1N1 and SARS and there’s a protocol. It would be great to understand a little bit more about what that is and about what kind of preparation and planning is being done.

With that I’ll just thank you for your time. I’m not quite as adept at getting right to zero as the minister is, I’ll just let you do it for me.

RANDY DELOREY: What I’ll say in the last dozen seconds or so, Mr. Chair, is I appreciate the heads-up on that piece. I’ll endeavour to dig in over the weekend and I will be back at this on Monday and try to have some of the additional, more granular details available at that time.

THE CHAIR: Time is up. The time allotted for the consideration of Supply today has elapsed.

The honourable Government House Leader

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

THE CHAIR: The motion is carried.

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

[The committee adjourned at 3:32 p.m.]