HALIFAX, MONDAY, MARCH 2, 2020
COMMITTEE OF THE WHOLE ON SUPPLY
THE CHAIR: The honourable Government House Leader.
HON. GEOFF MACLELLAN: Mr. Chair, we will continue with the Estimates for the Minister of Health and Wellness.
THE CHAIR: The honourable Leader of the New Democratic Party, with 44 minutes remaining.
GARY BURRILL: I really hope that the minister and your friends have had a good weekend, you certainly deserved it.
As we continue thinking about the work of the department, I want to go back to where we left off three days ago. We were thinking at that time about wait times for mental health, in particular about the dramatic variation in the province in wait times for mental health. I’d like to ask the minister: Could you address what in the budget is pointed towards ameliorating the geographical disparities from the point of view of wait times that are such a feature of our present provision of mental health services?
HON. RANDY DELOREY: I thank the member for his opening best wishes, I guess, or acknowledgement of having a weekend. I think I can speak for myself: I did. Getting home is always a good opportunity to recharge the batteries and get back at it. I share the same wishes that he and his colleagues managed to make the most of the weekend.
As it relates to mental health and addiction services, I know we’ve had a few conversations not just on mental health and addictions but other health care outcomes and the question about regional disparities. I guess I’ll start at the broadside and work my way in.
At the broadside, when he says where within the budget specifically, so it’s not as easy as saying the specific line item, because really our mental health and addiction services are delivered predominantly through partner organizations and not the Department of Health and Wellness. The funding that we transfer to the Nova Scotia Health Authority and the IWK, those grants provide the operational funding for them to deliver all the health care services throughout the province.
Similarly, as a government, we have funding allocated and targeted towards our youth, through our partners in the education system, with initiatives like the SchoolsPlus programming that would be illustrated through the Department of Education and Early Childhood Development’s budget item.
As it relates to this question of wait times and regional disparities, there are two big things. I think past practices or outcomes in the last couple of years should actually give the members of the Legislature pause to see that there are good things happening. The investments in programming that have come from the recommendations coming up from the system level, we have been and continue to invest in. This year overall investments in mental health treatment and services is the largest budgeted, I believe, in the province’s history. It is building upon significant investments that we’ve been making over the last number of years.
What we’ve seen from those estimates, and to the member’s specific question about regional disparities, one of the things - you don’t see it in a budget line item, but it is happening operationally - is the standardization of protocols and processes for care, particularly in the mental health and addiction space. That is number one. What happened - and this started a couple of years ago - was the amalgamation of mental health and addiction services. This was an initiative that was under way when I came in in 2017, but it was informed by a couple of factors. One is the recognition that within the mental health and addictions sphere individuals often have both conditions. Sometimes an individual has an addiction, develops mental health challenges - depression and what have you - which may arise as a result of the addiction.
The other side of the coin is some instances where you have people with mental health challenges, mental illness, and as part of their coping they end up establishing addictions - self-medication or what have you. You often have co-existence of mental health and addiction issues.
Prior to 2016-17, they were operating as separate arms within the Health Authorities. One of the things was to bring those teams together so that the services in the mental health and addictions sphere could actually then focus on the patient, on the individual, whether they need addiction-related counselling support services or mental health services. They can actually treat the person and treat the two conditions as clinically appropriate and necessary; you need to have one under control to support the other one. That has been a significant positive.
Coming up with the amalgamation of the groups, the standardization of intake protocols and processes throughout the province also helps standardize the responses. What that has also allowed is - and that’s the work that has been happening in the last two years quite significantly on the intake protocols and processes that are conducted within the NSHA environment - that as they standardize that, they are able to then work better across the Health Authority.
For example, one of the areas that the member has highlighted is Cape Breton, which is obviously an area of concern for us as a province. It’s an area that within the first month or so of being appointed Minister of Health and Wellness, I had an external psychiatrist focused on teen and mental health spend some time in Cape Breton to do an assessment and come back with recommendations and advice about his experience and what he garnered there.
While there were challenges, some of those challenges are related to staffing, having a number of vacancies of qualified clinical practitioners. One of the things we’ve done is we’ve adjusted compensation models and support, changes that were made even prior to the master agreement. These were changes in compensation and structure that were informed based upon feedback and advice provided to the Health Authority and the department - indeed, directly to me - from clinicians and psychiatrists directly on the ground in Cape Breton, and we implemented the changes.
We still have vacancies, so one of the outcomes was how to leverage areas of the province that have higher concentrations of the necessary specialties, whether it’s in the area of youth and adolescent mental health and addiction services, which would be centred with the IWK, or even here in the Central Zone for adult and general population mental health and addictions.
One of the things it established was more collaboration and co-operation between those specialists in the Central Zone - and I use Cape Breton as an illustrative example - and also the Northern Zone with challenges to provide those opportunities to support, while the recruitment continues to fill those vacancies. We know that’s a critical, necessary component. That’s where some of the changes in the compensation framework make us hopeful that we’ll be able to fill those vacancies and meet the needs, but in the interim basis, leveraging those resources and supports that we have across the province. As a single Nova Scotia Health Authority, having that collaboration and co-operation in place is one of those things that helps address those where regional challenges exist.
I think to answer the question for outcomes of some of these efforts and initiatives, we’ve seen improvements within the last couple of years. The IWK - for youth and adolescents - the wait-time reductions that have taken place over the last number of times, the percentage - if I recall correctly for adults - in 2018 was 83 per cent or 85 per cent of urgent cases were being seen within the target period of time. I believe this year it’s over 90 per cent; it is either 93 per cent or 95 per cent. I will have to look up the document on that - just one second.
It’s 98 per cent of youth with the IWK are being seen for urgent cases, and urgent care for adults is also 98 per cent. That’s both the IWK and the NSHA. We are, to my knowledge, the only jurisdiction in the country, as a province or territory, that posts our mental health wait-lists across the entire province, the entire jurisdiction. I believe there may be individual health authorities or facilities in other provinces that post this information, but we are the only province that shares that information publicly.
When you go there, I want to make sure people understand what the information is posted in. It’s posted in percentiles. It shows what the wait time is for the 90th percentile. I know on the floor of the Legislature, whether it’s in Question Period - most frequently during Question Period - or in various debates, it’s often cited at over 200 or 300 days of wait time which comes from that website.
I want to remind people what 90th percentile means is that for that time period, 90 per cent of citizens are seen in that time or less. It does not mean that if you were to seek service that you should expect it will take you that long. What it means is that, essentially, there’s a 90 per cent chance you’ll definitely be seen within that time period - not that that’s kind of an average, that the average person waits that long. It’s merely that’s the longest amount of time that people wait.
I think the member’s question was about what we are doing in the budget. It’s not something you point directly to in the line items here, as I’ve explained, because most of the operations are executed by our partners. But I’ve outlined a number of the initiatives that have been under way in mental health and addictions and what those outcomes - positive outcomes - have come from those initiatives.
I hope the member and other members of the Legislature and the general public do recognize and acknowledge that good work. We still acknowledge that there’s more work to be done. We as a Department of Health and Wellness, as a government, and our partners in the Health Authorities - both the NSHA and IWK community partners, the Education and Early Childhood Department, and others - remain committed to making positive strides in this very important area of our health care and, indeed, our society.
GARY BURRILL: I understand the minister’s explanation about the 90th percentile, but it doesn’t change the fact the 90th percentile calculation is being applied to all of the different zones and that within the statistical meaning of that, as the minister has explained it, there remains this dramatic unevenness in the delivery of mental health services.
I understand why a standardized mental health protocol would be helpful in the delivery of mental health services, but I don’t understand - if I’ve understood the minister right - why he thinks that a standardized mental health service delivery protocol would be helpful in addressing this particular problem of the regional unevenness in the delivery of the service.
RANDY DELOREY: I appreciate the inquiry. I believe there are two reasons to drive the response. Number one is the standardized approach is based upon clinical best practice from evidence-based environments that fed input into the design of the programming. Because it’s clinical best practice would be one of the reasons, that sometimes disparity within systems is because they had different approaches, different styles, and some may be more evidence-based than others.
The second reason is that when the system has challenges in one area and relies on others for support, having clinicians and health care workers operating under the same protocols and approaches makes it easier to rely on and transition support from a different jurisdiction into the area that requires the additional help. When everyone is singing from the same song sheet, so to speak, it means that they can sing the same tune - they can provide the same service, they can transition in, whether it is using tele-services or physically visiting a community on a locum or temporary basis.
If the protocols are the same in the jurisdiction in need as they are in an area that has adequate supports, by going down you are not changing or having to learn protocols and processes. You actually have a consistency, so that makes the ability to come in and support your colleagues in that other community. Those are two main reasons: evidence-based and standardization allows for consistency and makes it simpler for secondary support to come in and help.
GARY BURRILL: Is the minister then saying that, in his judgment, the disparity in the delivery of mental health services we have from the point of view of wait times, is to be in a major way attributed to in the previous period, a lack of standardized service delivery protocol?
RANDY DELOREY: That’s not exactly what I said. I think I actually noted that, in particular, staffing remains one of the biggest challenges in some of those areas. Filling vacancies has been a big part of that challenge. What I am saying is in terms of being able to then address that while the recruitment - and I talked in a previous response about efforts that are made around remuneration to help address that.
There were some other changes that were made on the operational sense as per some recommendations and feedback that came from front-line psychiatrists to help during that bridging period, as the recruitment efforts continue. That is a very important critical piece, but in that bridging space what I am saying is the standardization - that clinical approach - does provide better flexibility and better outcomes to get the best possible thing while we can’t fully control whether an individual with the appropriate qualifications is willing to relocate or take on a position in certain communities that have higher needs.
That wasn’t putting, I’ll say, “blame on,” but rather just acknowledging that the challenges which I think do, at this point, remain related to vacancies in some of those communities, you will probably see a bit of a correlation there.
GARY BURRILL: Thinking further about mental health service delivery, one of the things that we hear about more and more is the delivery of e-mental health. I want to ask the minister: What allocation is there for e-mental health programming in the budget?
RANDY DELOREY: I think we are looking at about somewhere between $900,000 and $1 million targeted towards e-mental health and addiction services. These would be services delivered through the internet, and related technologies, to provide support. We already have certain programs that might be considered in a technology delivery. For example, 811 provides smoking cessation services that’s a form of telehealth services - basically anything that’s not face-to-face delivery of services and care.
We also have psychiatric services being provided, as I referenced in my previous response, which has connected particularly clinical psychiatrists, specialists that are in the Central Zone, particularly evident with youth and adolescent where they are really centred in the core, and at the IWK itself being able to then connect and reach out and support other psychiatrists around the province for youth and mental health services.
We also have investments that were announced in 2020 through the Department of Labour and Advanced Education with our universities - Healthy Minds Nova Scotia, which is an e-mental health and addictions platform rolled out in partnership with our universities throughout the province. So DHW and the Nova Scotia Health Authority are involved in that program and initiative as well, although it’s funded through the Labour and Advanced Education university supports.
We also have initiatives around Stepped Care 2.0 leveraging within the Nova Scotia Health Authority that the Nova Scotia Health Authority is working on, so we look forward to seeing some enhanced services come on stream this year around that Stepped Care. For those who are familiar clinically with the notion of Stepped Care in the mental health and addictions space, the 2.0 mostly refers to that being brought online and leveraging e-delivery services for that type of service delivery. That increased investment coming in this year is, in large part, supporting that kind of delivery of services.
Then we have other partner organizations like Strongest Families, the Kids Help Phone, and supports and funding that we’ve continued to support and invest with, as well, on top of that.
GARY BURRILL: Thinking further on this list, the minister mentioned Healthy Minds and programming for university students under the e-mental health heading. Is there any other university student-related e-mental health programming at the moment, in addition to the Healthy Minds program?
RANDY DELOREY: Not that I am aware of. That doesn’t mean that individual universities are not engaged with partners to enhance and provide additional services, and it’s even possible that Labour and Advanced Education may be familiar with those operational investments of individual universities as well, but this particular program is the one and fairly recently launched and designed in part, I believe, some preliminary work in partnership with the universities, as well as our Health Authorities and ourselves. It has been, by all accounts that I’ve heard, well received by all of the parties.
GARY BURRILL: Going back to the characterization of the programming the minister gave a few minutes ago, would it be possible to ask the minister to give some sense of the proportions of the e-mental health budget that are allocated to each of those? What are the major initiatives in terms of costs and how that overall funding is reflected in those different programs?
RANDY DELOREY: Not really. The $915,000 or so that I referenced previously is the increased investment this year for e-mental health innovation, new programs, and investment supports. Many of the other programs are part of the Nova Scotia Health Authority or the IWK’s detailed budget line items. For example, I’ve mentioned a couple of times about the IWK, which I believe the NSHA has as well, but the clinical tele-psychiatry support services, how they connect back into other communities - that’s part of the operational program delivery within those organizations. This $915,000 is what we have in the department to allocate towards e-mental health innovative initiatives like some of the work that the Nova Scotia Health Authority is working on with Stepped Care 2.0 to help get these programs up and running.
Once programs are up and running, they become operational as part of the Health Authority, so I don’t have those detailed line items here with me this evening.
GARY BURRILL: I certainly don’t expect the minister to have this immediately at hand or to mind, but I wonder, could I ask him to provide a breakdown of the programming that is provided by that $915,000?
RANDY DELOREY: That information is not all done. We’re at the beginning of the fiscal year. That’s the amount of money we have allocated to go towards innovation coming through in the coming fiscal year of programming and supports. This is what provides us that ability to respond and execute on programs and opportunities to deliver e-mental health services. We don’t have the program announced, so this is the funding that goes to that specific program.
This is at the front end. We estimate that we would need about $1 million - I think it’s somewhere in the $915,000 range - to go towards that type of programming, support services. There’s no shortage of vendors and opportunities to invest in. What we’ll be doing this year is working with our partners to make sure that we identify and pursue the ones that we believe will provide the greatest value and supports to Nova Scotians with that funding.
GARY BURRILL: Thank you for thinking about that list of questions related to mental health service delivery. I’d like to change gears quite a bit and ask the minister about a different area, the important area of public funding for contraceptives. In particular, a significant need for public funding has been identified for IUDs.
Reports have come to our caucus from health providers at clinics that they have the experience of patients coming multiple times to avail themselves of services for an abortion and identifying that the root of this experience is that they have not had the money to afford an IUD. It’s not difficult - a person doesn’t need to be an expert in reproductive health to see how irrational this is, just from a purely public health administration financing point of view. We know that the cost of an IUD, which is a matter of around five years, is between $300 and $400, while the cost of an abortion is a great deal more than that.
In other words, we have a situation being reported where there are many women in the province who would choose to have IUDs, but they can’t afford to do that, and the result of this, financially, in terms of the budget, is that there’s a significant cost to the province. I want to ask the minister: Would he identify whether the budget includes funding for this needed service of publicly funded contraceptives?
RANDY DELOREY: There is no program funding in the insurance services expansion that I’m aware of. I don’t recall such an initiative coming forward through the planning process to my desk for consideration. That said, I know the member talked about the costs of abortion services.
One thing that I know has been monitored the last little bit with some advances in that area has been the number of abortions provincially, because there were some new medical abortion services that came on stream. What we have actually seen is a reduction over the last couple of years in total number of abortions, even though there have been alternative means and approaches to the delivery of services. We have actually seen provincially a reduction in the number of abortion services in the last couple of years, even though the province has simultaneously provided more opportunities and different approaches.
That’s not to negate the comments and the information the member brought forward, merely that one of the underlying arguments or suggestions was about the costs related to those abortion services. Provincially, those costs have been going down because there have been fewer people availing themselves of that program and those services.
GARY BURRILL: Following up on that, can the minister identify if there is any cost-benefit research or investigation being carried out within the department at the moment regarding public funding of contraceptives?
RANDY DELOREY: As I had indicated off the top in response to this question, I haven’t seen any information that came forward through the budget and planning process. That’s not to say that within the department, people within the public health or insured services space haven’t looked at it. I’m just saying that it is not something that I’m aware of.
I believe that there are some birth control options that are covered through the provincial Pharmacare program, for example, like birth control. We’ve also worked with pharmacists within the province to engage in the ability to prescribe and fill prescriptions for birth control, making the opportunity more available.
I am just being advised here that apparently within the Nova Scotia Pharmacare program there is an IUD that is listed on the Nova Scotia formulary, so for those in the Nova Scotia Pharmacare program, there is a provincial funding coverage for an IUD as part of that.
GARY BURRILL: I’m not thinking necessarily of those who are within the Pharmacare program. I am thinking in a general way about those, many of whom would be outside of the program, who are experiencing the situation as I’ve outlined it.
I want to ask the minister: Can he provide any indication of whether or not this is something that is on the department’s horizon? Is it something that the department is giving any kind of consideration to and that we might be able to look towards possible consideration or possible initiatives over the next couple of years?
RANDY DELOREY: As I had noted, I can appreciate that the member’s inquiry is about people not within the Nova Scotia Pharmacare or Family Pharmacare program, but I want to make it clear that that is a health program that is available to Nova Scotians to register with. It does take into account income levels and ability to pay. That does align with the coverage within the program. For those who do not have other means of medical insurance, I think it is an important consideration for this as a supplementary program.
I would encourage all members of the Legislature, if you have constituents, and whether it’s for this particular program service delivery or others - perhaps MLAs, through their constituency offices, can share information about the Family Pharmacare program to their constituents so they can evaluate. That is something that has an immediate opportunity.
If the member has constituents or other Nova Scotians that they are aware of who feel the need for this or other services, it is worth taking a look at the Nova Scotia Family Pharmacare program. There are a number of services offered and covered by that program, as well, and it does take into account the ability to pay for the program and the availability.
GARY BURRILL: I want to thank the minister for those answers on the important heading of public funding for IUDs.
I want to go back to a place where we were last week. We spent quite a lot of time thinking together about questions in long-term care. There was a thing or two that I had wished to have the minister address that I failed to do, so if we could get back to that, I’d like to ask a couple more questions in the area of long-term care.
One thing that has been a real issue of public concern over the last recent number of years is the adequacy of the budget for diet and food in long-term care facilities in the province. Could the minister please speak to the budget that is currently provided? What is the average food budget today per resident in a Nova Scotia long-term care facility?
RANDY DELOREY: That is not how we break down the budget in this space, so that wouldn’t be information - other than I believe a couple of years ago within the budget we introduced additional funding for both recreation services and for diet. That additional funding is continuing to carry through the system within the continuing care sector, but we don’t have explicitly - we have contract agreements in place with the long-term care service providers for funding.
The funding is, by and large, established and paid at what is known as a per diem rate. That would be the amount of money we pay per bed, with the bed obviously equating to a resident who would be staying in that bed. That is to cover the costs of the services being delivered, which would be their personal care, their dietary needs, and obviously the overarching housing, and then the medical supports and services as well. That is really how we break out the budget for our long-term care facilities.
GARY BURRILL: The minister has drawn attention to that provision - I think it was in last year’s budget, possibly the year before - where there was funding for long-term care facilities in consideration of diet and supplementing what was available to those facilities until then for diet.
I am assuming that the department must have some system by means of which the adequacy of what is being spent on diet is determined. I suggested in my previous question that it might be a metric around how much is spent per resident per day. But if it is another metric, could the minister please explain what that is?
RANDY DELOREY: Within our budgeting document process, we have $4 billion of expenses laid out, so the level of detail that our budget documents break into is really more of the long-term care. We’re going into this program. I don’t have that information broken out here.
What I can say is that we do see, just in the long-term care sphere, an increased investment of something in the vicinity of about $29 million. I’ll double-check those numbers when I sit back down, but just eyeballing the information, we do have an increase of about that targeted towards our long-term care sector.
GARY BURRILL: The question I am asking is not looking for a complex ultra- granular reading of the budget number. I’m really asking simply, what is the mechanism by which the department determines whether or not an investment of the sort that was made a year or two ago improving diet is an investment that is required? How does the department know whether or not more spending on that front is called for - whether or not the amount that’s being allocated is sufficient for what’s required?
RANDY DELOREY: From a policy perspective, that can be answered a little more wholesomely, I suppose. I appreciate the difference.
What it really boils down to is that our long-term care facilities do have dieticians who manage and establish the menus. We rely on the dietitians. Our partners - the service providers, the long-term care facilities - have dietitians available to establish menus that meet the nutritional requirements of the residents. That’s really part of what their obligation is in terms of being licensed and delivering adequate, appropriate care, which includes their meals and their diet.
GARY BURRILL: I want to ask as well, a number of years ago - four or maybe five before the minister was in his present office - I think it would be fair to say there was a commitment to bring forward a five-year strategy on long-term care for the province. We don’t have that five-year plan for long-term care in the province. Can the minister tell us the status of planning to bring forward that strategy or plan?
RANDY DELOREY: As the member would know, and I think everyone here would recognize, one of the things that I shifted efforts within the department last year - about a year and a half ago now, almost - was to the expert panels on long-term care. The really important piece about that was to ensure that we address quality of care in our existing facilities.
At the same time, the work within the department to evaluate and explore long-term care beds throughout the province has also been pursued. We’ve announced a number of new beds - about 162 - over the last year, which are under way. The first 30 should be coming on stream this year in the Halifax area.
THE CHAIR: Order, please. The time has expired for the NDP caucus. We’ll now go on to the Progressive Conservative caucus.
The honourable member for Kings North.
JOHN LOHR: I do want to start with a couple of local questions about the Annapolis Valley. One bit of good news for people who need dialysis in the Annapolis Valley is the fact that Valley Regional Hospital has an expansion on the go at the moment, as the minister knows, providing dialysis for people with kidney failure.
Because of the long distance involved and people driving to Halifax to get dialysis, I do get asked: When will that unit be functional?
RANDY DELOREY: I’m not a contractor or project manager, so as long as the member accepts this information with the appropriate caveat that it is the information provided to me by those working on the project, the expected completion is in early Summer of this year. It should be on stream this year in early Summer. I believe there were some earlier questions denoting some of our increased investments in this area. Part of those increased investments in our overall Health and Wellness budget and transfer to the Nova Scotia Health Authority is for the operational delivery of the dialysis chairs that are coming on stream in Annapolis, Digby, and a couple other sites that we expect to be on stream within the 2020-21 fiscal year. Obviously, these were sites that were announced previously - the design work, the construction - but we expect the construction at a couple of these sites to be completed this year.
JOHN LOHR: I know my constituents will be pleased to hear that.
Another issue we have in the Valley, as the minister knows, is that in some communities up to 20 per cent of the people do not have a family doctor. It seems, when we look at provincial statistics now, the Annapolis Valley really is the area that has the most significant shortage of family doctors. I know a number of people without a family doctor.
I guess the question is: Can the minister outline what is being done to address what is a crisis in health care in the Annapolis Valley?
RANDY DELOREY: It is a question of concern of mine as well - that is, broadly, over the last year or so, there has been a real focus. As we were seeing since 2016, when we implemented the Need a Family Practice Registry, the 811 Need a Family Practice Registry, we were seeing a continued and relatively sustained growth in that registry each month as we reported Nova Scotians looking for a family physician. Our primary focus with our partners has been to tackle that challenge to attach Nova Scotians to primary care.
We don’t have to rehash, unless the members wish to, delve into why that’s such an important part of our focus in the Health and Wellness Department and with our partners in the Nova Scotia Health Authority for that primary care piece. I think we all accept that as important in overall health outcomes and the delivery of care. We’ve been focused on that, and we’ve seen very good results as we’ve been focusing.
We’ve seen, over the past year or 14 months, a reduction in the number of Nova Scotians registered on that list. In fact, for most of the last 14 months, nearly every month saw a reduction in the number of Nova Scotians registered. That’s a total decrease of about 20 per cent of Nova Scotians registered on that list. Within the last year to 14 months, we’ve actually made significant progress.
I acknowledge this for the member and my colleagues who work in the Western Zone, across all parties, that when you look at that information, one of the advantages of us having that list which we did not have and our partners, the Health Authorities, didn’t have, was that it allows us to see geographically where the demand is. We’ve seen that much of the positive progress has been in the Central Zone. We see that the Western and Northern Zones remain significantly challenged. We have been turning our heads and efforts within the department and within the Health Authority on strategies and initiatives that can be targeted more to those areas.
Most of last year was broadly, how do we get more Nova Scotians attached? The programs and services across the province are relatively consistent for incentives and programs. We now recognize that we have to look at what initiatives and programs we have available to those two zones in particular, the Northern and Western Zones. The Western Zone includes the Valley.
We have taken some initiatives. Even just about two weeks ago I was outside of the Valley announcing the clerkship program that provides that opportunity for third-year students to get out to communities to be able to get their third year of training, over 40 weeks of training in the community.
Research has shown that when they get exposed both to primary care environment but also community-based care they are more likely to pursue that as an actual career when they finish their studies.
We also have invested in a capital project in the Valley for supporting the expansion of the residency program there. We know that family physician residents are more likely to stay in communities where they complete their residency training. Providing that capacity, providing a more attractive environment to support those residents as they complete their training, I think all those things are positive. Those are just some of the things that are currently under way as we turn our minds to see what else we can do.
It is top of mind; it is a focus for us in this year. As we have new programs and initiatives to roll out, we’ll continue to do that throughout the year.
JOHN LOHR: Another serious concern of my constituents is that a number of days in the past year we’ve seen significant overcrowding at the Valley Regional Hospital ER. Of course, that ER is serving 40,000, 50,000, 60,000 people. I realize that they have taken steps to reorganize themselves to try to address the issues - and hats off to the Valley ER. I certainly have a great deal of respect for everyone who works there.
The question I would have for the minister is: What, if any - maybe I should frame that up a little bit. What we see is that there are huge demands on the system, and maybe they need more space. The question would be: Are there any plans to add to the infrastructure there - whether physical resources, space, or human resources - to meet the growing demand in the Valley Regional ER?
RANDY DELOREY: As the Minister of Finance and Treasury Board rolled out, the capital plan, along with the budget, does not have allocations for infrastructure work at that site. For that emergency department, however, as I mentioned previously, we do have infrastructure investment to support residents and the residency training program run out of that site, which is important, both training but that training results in recruitment value.
Specifically, as challenging as it is for me to articulate this, in 2017 in the Summer when I did a bit of a tour around the province I remember stopping at the Valley Regional and actually met with a recent, I’ll say, graduate, completion resident who completed their training, one of four who was setting up in the community. They happened to have a family name that was familiar to me and, being in Nova Scotia, inquired if they were connected to a family down my way, in Antigonish. Sure enough, they were from Antigonish. As hard as it was for me to see this young Antigonish physician set up roots in the Valley to deliver care, as a newly-minted Health and Wellness Minister I would have been quite happy to have that newly-minted physician set up roots in Antigonish.
It was an interesting conversation when I asked that question - and I asked it a little bit as an MLA, hoping to consider why someone would choose to set up in a different community - very similar communities, but different. They advised me what came to be a common theme that I get back from staff in the policy shops.
The comment I got from the front line was actually consistent with the information that comes up from the policy staff who analyze this work. What I was told was, they came through as a cohort in the residency program. I believe four out of the five were staying in that community. They by and large studied in medical school together, and they did their residency training together. They felt a supportive network that starting their careers they felt quite comfortable and confident of establishing and setting up their work, because they knew they had each other to support through that early stage in their career. Recognizing the work with those programs should not be understated or ignored, because that is a very important and significant investment for having the appropriate trained staff complement.
As I said, and as the very first question from the member started with, there is a focus on primary care access and attaching patients to primary care when looking at reducing pressure on emergency departments. Really, by volume of visits, I’m not aware of the Valley being dissimilar to other jurisdictions, that many of the visits end up being visits that can be addressed in a primary care setting and environment. As we work to address the primary care challenges in that region, we believe that helps reduce the pressures on the emergency department as well.
One of the steps that was taken was establishing a rapid assessment area to help support the assessment of patients as they come through the emergency department. We know that the Health Authority of the primary care space is working to establish access clinics for people who are attached to or registered on the 811 Need a Family Practice Registry - looking for primary care attachment - to provide them a means other than an emergency department or walk-in clinic to receive the primary care that they need. There are a number of initiatives, many focused in the primary care space, to help reduce those pressures in the emergency department. It’s similar in the Valley as it is across the province.
JOHN LOHR: I want to go to mental health and addictions questions. I notice when I read the Blueprint for Mental Health and Addictions 2019 to 2021 that the number-one action is to increase access to mental health and addictions clinics.
I guess I would like to ask the minister to give an update on that action point, and also to say, just explain to me why the walk-in clinic in the North End here was funded by Communities, Culture and Heritage and not by his department given that this is his department’s number-one action related to the blueprint.
That’s a two-part question: Tell me how you’re doing on mental health and addictions clinics, and why was that one not funded by your department?
RANDY DELOREY: In reverse order, I believe the funding request for the walk-in clinic went into a program that Communities, Culture and Heritage had available for communities - it was one that was reviewed, assessed, and funded through that program. It wasn’t a funding request to my knowledge that had come through the Department of Health and Wellness. As far as how that funding got established through that department, that’s how it manifested itself.
The work within the department certainly appreciates that the North End clinic and Communities, Culture and Heritage supported the work that they’ve done. I look forward to - as does Communities, Culture and Heritage, I think, when they fund these types of community-based programs - a review of the outcomes achieved through the funding that’s been provided so that the Department of Health and Wellness is able to leverage that information to help inform our investments in programs and services like that. As they submit in to government, I look forward to how the program through the grant that was provided by Communities, Culture and Heritage informs the outcomes and the delivery of services. That information can be leveraged, and we can look then at if, or how, such a program model fits within the mental health and addictions care model of services and programs throughout the province. I appreciate the funding that they provided.
Some of that transitioning into how we support that access for patients in need of mental health services throughout the province is through the efficiencies and the work and the system design changes within the Nova Scotia Health Authority and the IWK that they’ve been making over the last couple of years to tackle those wait-lists and to ensure that emergency or urgent mental health care needs are seen in a timely fashion - emergency, really, in essentially real-time, right away - urgent care within a few days’ time. I believe less than a week or about a week is the target time for urgent care.
As I’ve mentioned previously during these Estimates Debates, both the IWK and the Nova Scotia Health Authority have made significant progress there, especially on urgent care, reaching, I believe, 98 per cent. For the NSHA that’s an increase from about 83 or 85 per cent in 2018, to reach 98 per cent in meeting the clinical targets for urgent care.
There is still work to be done in non-urgent mental health care services. That’s where I think programs like mental health walk-in clinics and other community partner program deliveries play a role. We invest, I believe in 2020-21, about $3.25 million towards hiring and supporting clinicians. I believe that works out to about 35 FTEs. I think some of those - that’s an add-on maintaining - so it would be about $500,000 for additional new clinicians. The other funding, obviously, is maintaining clinicians that we added in the last year, but this is important funding.
In some communities it’s a challenge to fill those vacancies, but every effort is being made to ensure that the vacancies that exist are filled because we want to make sure that the care is there.
I also acknowledge the work of the NSHA and the IWK to leverage technology in telehealth services to connect their clinicians from other parts of the province, to support some of those communities that need that specialized care, back to the communities remotely. It reduces the need for travel but also supports while recruitment is ongoing in some of those communities in higher need.
JOHN LOHR: I just want to clarify a point with the minister. For the North End community walk-in mental health clinic funded by the Department of Communities, Culture and Heritage, would his department or the NSHA be providing oversight for that clinic, or would that clinic be managed by Communities, Culture and Heritage? I was just wondering: What is the command and control process there?
RANDY DELOREY: I guess it is multi-faceted perhaps, for the response. The first is that the North End clinic is a mental health clinic that’s established at an existing health clinic environment. As a broad clinic, they do get funding and support, obviously, through the department and the Health Authority within those health services.
For the specific program, referred to as the mental health walk-in clinic, funding for that was provided by the Department of Communities, Culture and Heritage. As they do with any community organization that receives funding - and here I put a little caveat that I am speaking a little bit about another department - but as they provide grants they provide terms and conditions, so to speak, that are expected, including a review or an assessment of how they performed in meeting the objectives that they set out in their application. Communities, Culture and Heritage, to my knowledge, doesn’t provide any clinical oversight of the clinic, if that’s the nature of the question. They merely provide, as I understand it, a funding grant to the organization to help offset the costs of delivering the service.
From a clinical oversight - so that’s just on the financial side - if the question was more framed toward clinical oversight, the clinical side, really as it is through much of the health system, obviously clinical guidelines and obligations do fit with the professional standards of clinicians. Clinicians that provide care and services are part of professional bodies that govern their licence. The clinical oversight and expectations to ensure they deliver based upon those professional standards and obligations really falls to professional colleges.
In that regard, this mental health walk-in clinic was not one that was designed or implemented as part of an overarching Department of Health and Wellness government process, but as they collect and submit information as to the outcomes of that mental health and addictions clinic over the last year or so into government, I certainly look forward to that information leveraging to help review and assess the potential viability of mental health walk-in clinics throughout the province.
JOHN LOHR: I appreciate the answer. My comment on that is we have the Minister of Health and Wellness with a blueprint for mental health and addictions, a plan; on the other hand, there’s Communities, Culture and Heritage, which is simply responding to applications. I believe the minister said it didn’t get funded because they didn’t apply again; they then did subsequently apply.
In fact, if you look at the spending for Communities, Culture and Heritage, there are actually a number of places, a number of significant health and even mental health spending. They’re funding the Canadian Mental Health Association to the tune of $92,000. I could go on. There are a number of different places where Communities, Culture and Heritage is funding different little pieces of the mental health picture in the province. In fact, we could go on and say the Department of Community Services is also doing the same thing, they’re funding, and so is Labour and Advanced Education. We have three other departments with bits and pieces of this.
We have the minister’s plan. I will go on and say that we also have the Milestones on our Journey, which is the Nova Scotia Health Authority’s plan. We have three extra departments, the actual department, the Nova Scotia Health Authority’s plan - that’s sort of five different visions of what’s happening here. I appreciate that we have it, and we do have a suicide plan too. It feels to me like there’s sort of too many plans in the air here, maybe.
I know that when I played hockey, men’s pickup hockey, if we had no plan, we usually lost. If we made the briefest of plans - like you guys play defence; you guys are forwards - we sometimes would win. When I was coaching sports, if we were on two plans it was a recipe for disaster. If I had some of my boys in basketball playing man-to-man and some playing zone, that wasn’t going to work. I see two very significant plans here.
One is the Nova Scotia Health Authority’s plan, which we could break down to - it appears more high level; we have the minister’s plan which feels more concrete. We have three other departments funding pieces of the mental health picture too. I know that we’ve had - in the past, not so much this year - significant investment, yet we feel like we’re treading water.
I guess my question for the minister is, am I looking at this wrong? Are there all these different pieces of the puzzle? Is it to the point where it’s not helping, like it’s making it maybe less organized, not more organized? I wonder if the minister would comment on that and tell me why.
The current situation has evolved to where it fundamentally feels disorganized to me. Could the minister comment on that and tell me if I’m right?
RANDY DELOREY: I know how important this topic is to the member and to everybody in the Legislature. I think nearly everybody raises this as a topic of question, either here or during Question Period at other junctures, and that’s a good thing to have the opportunity to remind Nova Scotians of the importance.
I don’t think that in my response I will agree or note that the member is correct. The reason is the member referenced the plan of the Nova Scotia Health Authority and the blueprint that the department established and posted. What the member doesn’t note in there is that these are actually connected. He mentioned the suicide framework, the prevention framework. That is a part of the work that is ongoing, that fits within the blueprint efforts and works within our mental health and addictions. The blueprint is the overarching, and then there are aspects that require work and progress.
We have different entities that have connections. I think here the member and I can agree that often individuals with mental health and addictions are marginalized populations, so we do have multiple entry points where people with these health challenges have a contact point with government.
In an effort to ensure that we can touch base and connect with people where they are, that is the first point of providing the care and the support. Then help funnel or support the individuals, whether their entry point is through Community Services supports and programming; through Labour and Advanced Education; through the university sector; or through our Department of Education and Early Childhood Development where we have invested heavily, specifically in this area of supports through Youth Health Centres, the adolescent outreach model, and SchoolsPlus programming.
All of these investments, programs, and supports, although they are not necessarily funded directly out of the Department of Health and Wellness budget, the government has seen fit that, for example, SchoolsPlus would be funded through the Department of Education and Early Childhood Development because the delivery point is in the education system. It is in our schools. We see that, but we have a coordinated effort which the member may not see.
We have deputies’ meetings with social deputies on a regular basis to manage and provide the oversight and guidance on where our departments intersect. We’ve recognized, and this was reiterated to us as a government in the Restorative Inquiry - Nova Scotia Home for Colored Children Report where they made it very clear that many of the challenges that were developed, and the timing for corrective action and intervention in part, related to the siloed nature of government, and that would be one department does one thing and one thing only. We are really trying to take those silos down.
We are trying to support the DHW as the central point of entry and the policy development side of things, but every department, particularly those social departments that connect with our most vulnerable citizens, equally recognize that if they are to serve their client base, their citizens that rely on their services effectively, that mental health and addictions often get in the way of - whether that’s in the education system for the Minister of Education and Early Childhood Development and his department, Community Services, or Labour and Advanced Education.
I think it actually is a positive thing that the Department of Communities, Culture and Heritage recognizes, as part of building vibrant communities and establishing community supports to be healthy and vibrant, that they are considering mental health and addictions as a programming worthy of their grants - I think they are responsible for physical health, which is through sports and recreation - while also recognizing the positive roles of having programs and sports and supporting community organizations and delivering programming. They know their communities and regions they service by being citizens there and are really uniquely positioned to identify and deliver and respond with a pilot-type, grassroots-organized service delivery model that can then inform and be brought forward to help complement the research and policy development within the Department of Health and Wellness.
I think the member is correct in assessing the many areas, so to that end I would say I think the member is correct. Where I think we diverge is his conclusion that that reflects a problem within government, whereas I think it reflects a strength within this government and our commitment to advance and improve the areas of mental health and addiction services.
I think as I’ve mentioned previously, seeing the positive progress that we’ve seen in both the NSHA and the IWK in reducing, particularly their emergency and urgent care wait times, and the success of seeing people within the clinical targets for those particularly most acute mental health conditions - for youth, adolescents, and adults - I think suggests there’s more to be done, but we’re moving in the right direction, based on investments and strategies of the last couple of years.
JOHN LOHR: I know the minister gave a very lengthy answer to my question. It appears to me that we have three departments that I mentioned already, other than the Department of Health and Wellness, which are funding programs. The programs appear very piecemeal in terms of who is applying, which you could say are communities reacting to the needs in their community and saying we have a need here, we have to address this, and the minister is saying that’s all great.
My question is, when these other departments are deciding what they are going to do, are they looking at the business plan or the plans? Are they consulting with the Department of Health and Wellness on deciding if this is within the minister’s blueprint? Are they using those kinds of guidelines when they make these decisions on which to fund?
RANDY DELOREY: As I indicated in my, as the member described it, lengthy response - I’ll try to be a little shorter this time around - despite multiple departments having engagement, we do have, as I was talking about the need to take down the silos, established seniors, officials, and deputies particularly, across social departments. If the member looks at those departments that seem to have a role or engagement in this area, they fall within that space. Through those initiatives the Department of Health and Wellness, when we present, makes sure that everyone is aware of where our priority, focus areas, and so on, are.
The member is right; in some instances, community groups see and experience things on the ground, in their community, that don’t always make it up through the system as efficiently as we had hoped. That’s where having a granting agency like Communities, Culture and Heritage responding to those types of community programming suggestions can be done more efficiently - and gather that information through those pilot program initiatives - through those community-granting initiatives that then collects information at a grassroots level that can be fed in and validated or cross-referenced against the policy-based research and efforts that are done more traditionally within the department. I think it is a good opportunity. The example that the member brought to the floor, the North End community after-hours mental health clinic, is a great example of how I think we’re going to see that information, depending on what those results are.
Certainly, the preliminary information they’ve shared publicly suggests that the formal evaluation of the program, when it’s done, may have some very positive things to share with government. I look forward to us receiving that information to help inform what we may be able to do in the future, not just with our partners at the North End but perhaps elsewhere within the province.
JOHN LOHR: We could say there’s probably more than one, but there’s at least another group that’s involved in the delivery of mental health services in the province. I have to admit it was somewhat of a surprise to me, but there’s a rise in private mental health and addictions care. As the minister would know there’s a number of organizations: some of them providing mental health and addictions services are definitely not-for-profits running on shoestring budgets; some of them are for-profit.
One of the areas of concern for me is the lack of access. I know a major concern with mental health and addiction services is getting access. The minister has mentioned wait times a number of times.
Around the province when we look at the private sector, one of the concerns is that very few can get access there and they have to have an employer funded plan. One of the questions I have had from psychologists is they would like to have access to MSI codes, so that if someone wanted to see a psychologist just as you would reach out to your family doctor - if you’re fortunate enough to have one, which not everyone is - but the doctor can access an MSI code, and it’s part of our health care.
Psychologists would like to have the ability to have MSI codes for anyone coming in; it would create more access into the system. There are a number of psychologists in the province who are not in the health care system.
I just wonder if the minister could comment: Is that a plan to provide more access to psychologists through providing MSI codes for them?
RANDY DELOREY: We certainly aren’t in a position to force the individual clinicians in the nature of their practice structure. Notwithstanding that, I can advise the member I believe there are numerous opportunities for both psychologists and psychiatrists within the public system.
We have a number of vacancies, in particular I’m well aware, in Cape Breton. If he’s aware of clinicians, whether they be psychologists or psychiatrists, who believe that they would like to participate in the public system, then I encourage them to connect with the Nova Scotia Health Authority. The opportunities do exist.
I believe, as the member may be aware with the Canada Mental Health Act, the requirements to be in the public system is to be in the public system. If people want to participate and engage in the public system, then they need to be part of the public system.
Opportunities do exist. We have vacancies. We have need. That’s been part of the conversation here. If the member knows of people who are interested and willing to participate in the public system, I’d be very happy to have them join the team in the delivery of services with either the IWK or the Nova Scotia Health Authority.
JOHN LOHR: I believe the minister’s referring to vacancies for psychiatrists. I may be corrected, but I’m not sure that there are the vacancies for psychologists as there are for psychiatrists. They’re two different professions both dealing with the same set of circumstances, of course.
I want to change direction a little bit. Before I do, maybe the minister will comment on that, so I’ll let him comment on that.
RANDY DELOREY: I would have to look up the Health Authority’s site to see exactly the breakdown between the psychologist and psychiatrist. I do know that there are many clinical mental health positions throughout our system that we’re looking to have filled. I believe psychologists would be qualified individuals to fill some of those vacancies. Whether they’re with our Health Authorities or with our clinical partners in various other community organizations that deliver these services as part of publicly funded programming and supports, as I’ve highlighted at this point, I do believe there are vacancies from the Nova Scotia Health Authority. Those can be viewed online to verify the exact locations and position descriptions.
If the member was uncertain, I can certainly advise him and the other members that we are well aware of the clinical difference between the psychologist and psychiatrist; both are very important to the delivery of mental health services in Nova Scotia.
JOHN LOHR: The next subject I would like to ask the minister to address is, as the minister knows, cannabis has been legal in the province for some time, and now we’re on the verge of having edibles. We have excellent researchers in Halifax who have proven and described a link between cannabis and mental health issues in young people under the age of 25.
At some point, we’re going to have edibles on hand, so I’m wondering: What role does the minister see his department have in that, and what is his department doing to address that issue?
RANDY DELOREY: I thank the member for the question; it’s very timely, obviously. Cannabis is a legal recreational product. It’s relatively new in Nova Scotia, indeed, the Canadian context. This is something that has been established: health and youth obviously are of concern for us within the department and across government. That’s why the rollout that we established here in the province was one that maintained consistency with an established model that has a very good control rate, the Nova Scotia Liquor Corporation in their ID programming for people purchasing through the system.
The member mentioned research around cannabis. I believe there were some questions last week during Estimates where someone else was inquiring similarly. In the department, we do not have a research project specifically on the topic, but for research, we provide some funding to Research Nova Scotia which is the standardized, or central, research funding body that we have as a province. As we noted, I believe even the Research Nova Scotia website has some promotion of some research that’s ongoing within the province, that is funded by us as a government.
We certainly review clinical information and research - and academic research as well - to help inform the work that we do. As it relates to youth and edibles, there’s a marketing campaign and really, for all citizens, in terms of the use of cannabis products in whichever form is something that is important and part of the work that we do in the province.
We know that, as I said with the NSLC and the delivery model that we chose to pursue, they have a history of work that they do in a socially responsible manner. We felt that was an appropriate rollout model - other jurisdictions seize that - and they remain the only retailer of cannabis products in the province for that reason.
JOHN LOHR: I think it begs one more question obviously, and that is that there is a concern about cross-contamination or a cannabis-laced product ending up in places where it does not belong. I’m wondering if the minister can outline the strategy to prevent that.
RANDY DELOREY: I might just ask for a little more description in terms of the context of cross-contamination of products, if the member can just elaborate a little bit more of what exactly he means there.
JOHN LOHR: What cross-contamination refers to is a product ending up somewhere that it didn’t intend to be; for example, in a cake at a children’s event which was recently in the news - obviously not intentional.
I wonder if the minister could outline what his department will do to protect young people from these products that could end up in the food supply yet have cannabis in them.
RANDY DELOREY: I thank the member for the clarity. In fact, the rules around and the legislation and regulations governing cannabis I think address that. The Department of Health and Wellness is not mandated to do the enforcement around that, but as I mentioned earlier, the department does have, and government investments in, marketing campaigns to raise the awareness level within the public, the general population.
Obviously, as with any product, it is important for our citizens who partake in these products to do so responsibly. That is why the promotion and education campaigns are there to help inform them; that includes keeping products out of the hands of minors.
As I said, the enforcement of the laws of the province fall to the RCMP as it relates to the general population adhering to the legislation, keeping products out of the hands of minors. For cross-contamination or people bringing cannabis-infused or laced products, in the example that the member referenced, it is not something purchased off the market but something that was produced by someone else.
There are federal rules around packaging of purchase. There are two streams here, I think, because the member mentioned edibles coming on stream, becoming available. There are rules around packaging requirements and so on that are established for those commercially available cannabis-infused products. That has a particular stream of requirements, as I’ve mentioned previously. Having the NSLC as the sole retailer of those products ensures that we have control at that point and with packaging and so on.
The other stream, as was referenced, is if somebody builds or produces their own products. That comes down to doing so responsibly, keeping the products out of the hands of minors, and failure to do so does get enforced by the RCMP. People should be aware of the consequences. Our promotion and marketing campaigns are to help inform and remind people of their responsibilities when they purchase and/or produce these types of infused products in their home environment, and certainly if they were to ever take it to a public space.
JOHN LOHR: I would like to move on to the province’s harm reduction strategy in regard to opiates, which of course is methadone and Suboxone. I want the minister to comment on how that is going, and the numbers of people on methadone and Suboxone, what is the trend with those numbers? Are they going up or down, and what is the number?
RANDY DELOREY: This is an area of our public health policy that will always be near and dear to me. It was the first program that I publicly launched in my role as the Minister of Health and Wellness, in the Summer of 2017. At that time, we launched the framework. I would love to take credit, but I don’t move that quickly, so a lot of that work was done under the leadership of my predecessor and with the staff in the department. It was ready to roll out when I came in.
I don’t believe I have the number of citizens currently on Suboxone or methadone treatment, but what I can advise the members, through our investments, we saw about a 90 per cent reduction in the wait-list for the methadone treatment program for opioid disorder.
In the year before we rolled this out, we did see a bit of an increase in the number of opioid deaths, although we’ve kind of fluttered between 50 and 60 Nova Scotians who die from opioid overdose in the province, in particular in Cape Breton. I believe we had about a third of those deaths in the Cape Breton region, but that’s also the part of the province that had the largest wait-list.
In the year after our investment to really ramp up the treatment services, we saw the wait-list virtually eliminated and the number of deaths cut in half from opioid overdose. To the overarching question the member asked - what is the status and how is it going? - I think it’s going very well. I think we’re saving lives based upon these investments. That’s just in the actual clinical treatment side of things.
We also have the public naloxone program where almost 12,500 naloxone kits have been distributed throughout the province. What we’re aware of, there have been about 138 reversals reported provincially; that’s just kind of public use. EHS paramedics have administered naloxone in an EHS emergency response situation about 190 times in 2019 alone.
We really do believe that these investments are saving lives, and that’s a good thing. Where we have other parts of the country, and much of the western world, seeing increases in opioid deaths and problems, we’ve managed to maintain and, in some communities, reduce the number of deaths. I believe that’s in large part because of our preventive strategies and interventions like the naloxone programs and needle exchanges, the expanded treatment supports that we provided, and virtually eliminating the wait-list. I think those are really critical to our success thus far.
JOHN LOHR: I would like to ask the minister if he could provide a breakdown of where the naloxone kits have been distributed in the province.
I’m also interested in a breakdown by region of the change in the number, so the number year over year for at least the last two years for the harm reduction program. Could the minister - and maybe he doesn’t have it right now - commit to providing us with those numbers?
RANDY DELOREY: I apologize, the member is correct: I don’t have the information broken down the way that he’s referenced.
Here is some of the information that I do have for the member as it relates to methadone for the calendar year January to December 2019. We had 269 prescribers of methadone and just under 550,000 prescriptions. Now, keep in mind, that would perhaps be more than one prescription per patient. That’s not 540 patients but 549,000 prescriptions. Over the same calendar period, buprenorphine/naloxone is another treatment program. For that particular treatment, there were 220 prescribers and just under a quarter of a million prescriptions issued - again, that’s the calendar year - filled for 2019.
For opioid use disorder treatment, we have, as of January or February, about 2,063 active patients in the program. As it relates to that wait-list, when we were launching those increased investments, I believe the wait-list was over 250, so that would be over 10 per cent of the current active patients in our opioid use disorder treatment. We had a wait-list that was over 10 per cent of the currently treated individuals. By virtually eliminating that wait-list, those 250-odd Nova Scotians are getting treatment today that they weren’t prior to those increased investments.
For the additional breakdown, we’ll see if we can track that information down. I think we’ll have some more time in Estimates debate to bring that to the floor.
JOHN LOHR: I started scribbling down numbers but was taken with the first set of numbers and didn’t get the rest of them. I know it’s in the record here, but I would appreciate those numbers. I think what I heard you say was that in the calendar year of 2019, 268 patients accounted - I missed the number then.
RANDY DELOREY: I’ll be very quick. It was 268 prescribers, so that would be physicians who actually issue prescriptions. There are just about 550,000 prescriptions that were filled.
JOHN LOHR: That starts to make more sense. My last question on that subject is - and I suspect this will end my hour - what is the overall cost for the harm reduction program in general? The big number, what’s it costing our province?
RANDY DELOREY: In the early days of this program, as it was rolling out, we did break it out separately as a new program initiative, but as it’s become more operational in nature, it’s been rolled into the budget. We’re just taking a look here, but off the top of our key points, I don’t think we have it broken out at that detail because it’s just become part of our operations. We made the additional investments, all publicly announced, as we came through, and that’s been done over the last couple years.
THE CHAIR: Order. The time for the Progressive Conservative Party has expired. Up next is the New Democratic Party for one hour.
The honourable Leader of the New Democratic Party.
GARY BURRILL: I wonder if the Chair doesn’t think this would be a good time for our three friends to have a five-minute break.
THE CHAIR: We’ll take a five-minute break.
[6:50 p.m. The committee recessed.]
[6:53 p.m. The committee reconvened.]
THE CHAIR: The honourable member for Halifax Chebucto.
GARY BURRILL: An hour ago we were turning back to some questions about long-term care. Where we left off, I had asked the minister about the five-year strategy that the department had spoken about being in the works, and it was something that was going to be brought forward a number of years ago.
As I understood the minister’s answer, which had to do mostly with the expert panel on long-term care, I gathered the intimation that the work of the expert panel had somehow taken the place of the five-year strategy, so I want to see if I’ve understood this correctly.
Is it, in fact, the case that the five-year strategy is no longer something that is in the works and is viewed in the department as something that has been subsumed or superseded in the work of the expert panel?
RANDY DELOREY: I wouldn’t describe it that way. The member is correct that in my response, which I think got interrupted with the wrap of that time period’s discussion - what I was starting with was that certainly for a period of time the focus that we shifted a lot of our attention to was with respect to the expert panel. We took a period of time to turn around and focus on the very important task of setting a strategic path forward to improve the quality of care within our long-term care sector, which I believe represents a very significant and important part of what would be or encompass within a strategy.
We were seeing in the work that had started a number of years ago with the complexity and the number of so very important aspects of the continuing care and long-term care population and environment, that designing that as a five-year all- encompassing strategy we would be making changes to part of our operations that then cause going back to look at that approach again. Variables were changing while trying to establish that five-year focus. By breaking it down, focusing in a little more specifically on the quality aspect, which I think was absolutely critical and essential to prioritize, was an important step and a worthwhile pause on the broader work because I didn’t want to delay. I didn’t want that work to not proceed in the absence of the broader five-year plan.
That said, it is not to replace the strategic, overarching, multi-year, forward-looking strategy, but that work is ongoing. I don’t know that it will come out labelled as a five-year plan necessarily, but it is work establishing the many aspects of the continuing care environment, how our systems integrate and anticipate demands, and how we respond to the delivery of the care and meet the needs of the citizens of Nova Scotia who rely on these very important services at a critical point in their life.
GARY BURRILL: Am I to understand from that, then, that the previous plan for a multi-year long-term care strategy has now been set aside?
RANDY DELOREY: Is the member okay with me just diverting for one quick second to answer a previous question? If the member of the PC caucus wants to jot down these numbers: the opioid action plan was $1.8 million; dependency treatment, which we spent much of our time talking about, $2.67 million; and just over $0.5 million towards the broad strategy. The total works out to a $5 million investment. Sorry for that slight aside; I just wanted to wrap that up.
I wouldn’t say that it supplants or replaces the strategy. The work to set those strategic priority pieces of our continuing care, long-term care vision and priority steps is still under way. I do remain hopeful that we will have more to say on that throughout this fiscal year with information that shows that work has been ongoing.
I did put a bit of a pause so that our teams could focus on the expert panel and get those very tangible, operational front-line initiatives under way, as the recommendations from the expert panel are multi-year focused, a bit more operational and very focused on quality.
We know there’s more to it than that, and we are focused. Having the expert panel work allows us to keep that focus, keep our investments in that area to help improve the long-term care environment. I think the work that’s been done over the past period on the broader multi-year strategy - that would be overarching, a bit broader in scope than the expert panel’s work - is going to be coming out in due course. When it wraps up, we’ll be announcing that publicly. We’ll certainly make sure that the member and his caucus are aware of that, as well.
GARY BURRILL: Could the minister provide some general indication of a time frame in which we could look for a multi-year long-term care strategy to be brought forward by the department?
RANDY DELOREY: I know people like to have them, but I think it’s unfortunate that often you set the dates and for a variety of factors, you miss them, and then you get beaten up for missing the dates. Sometimes it’s easier to just get beaten up for not giving the date in the first place.
I’ll advise the member that I certainly hope to be able to deliver it this year, to roll that out and build upon the work that we’re doing across the sector. Continuing care - long-term care - remains a critical priority within the Department of Health and Wellness and with our partners. We’re certainly focused on trying to wrap that up and bring it forward publicly within this year.
GARY BURRILL: I wanted to bring forward one additional question that I had intended to ask the other day while we were speaking about long-term care and had overlooked. That has to do with the coronavirus situation and long-term care.
I think people in Nova Scotia really paid a lot of attention a week or a week-and-a-half ago when Dr. Strang spoke about how the situation, as it’s coming into view, is one that could potentially place real threats for vulnerable populations. When we think about vulnerable populations and the spread of these kinds of illnesses, it’s long-term care facilities that we think of the most.
Could I ask the minister to speak operationally about what preparations are being looked to in our nursing homes at the moment in light of the quick-changing coronavirus situation?
RANDY DELOREY: I thank the member for this very important question. Obviously, the coronavirus, or COVID-19, situation has evolved significantly since the start of 2020, when it really hit the world stage. What I can assure the member and all members of the Legislature is that public health has taken the lead on the work here.
As the member referenced, Dr. Strang, our Chief Public Health Officer, has really been working to keep the public up-to-date through several interviews with media outlets when they ask. He provides the information requested to be shared with citizens, as well as managing information on our government coronavirus website: novascotia.ca/coronavirus.
I mention that only because in today’s day and age, we actually have so much misinformation out there, particularly through social media. We want to make sure that people know that the sources have the best factual information coming from our health officials.
I got briefed earlier today on the status of the work with the NSHA and the IWK - so our Health Authorities - as well as public health officials, as to the work they’re doing. What they’ve noted is that the overarching planning work is governed and being directed by the pandemic planning and model of care that was designed and enhanced after H1N1, I think in 2009-ish. One of the consistent comments from parties that worked through that period was that we, as a province, and really as a country and a world, are much further ahead with the COVID-19 outbreak than we were with H1N1, because of lessons learned. We know to get the communication working faster, the types of protocols to implement, and I think the media’s awareness, and to share that information with the general public - not in a fear-mongering way but rather in a very factual way and to get that factual information out.
Our discussion today did not specifically delve into long-term care facilities, in part because we still don’t have - and this is an important factor - a case of coronavirus, COVID-19, in Nova Scotia. The planning work continues operationally with their testing protocols for the current status, and that is when potential people meet the screening criteria, have them tested, and send the test results out.
The preparation work continues to be broadly, as a system, preparation work with personal protective equipment, PPE; the evaluation of current stock and stockpiles, including stockpiles to support a pandemic like this - and some that was extra inventory already within the system, making sure they have that; and work to evaluate, should it be needed, the supply chain options to respond. That work is ongoing. Even though we don’t have a case, they’re getting prepared to ensure we have all that information and details ready so that they can inform the response within the system.
Also, in the last week, and moving into this week, is that broader engagement. Up to within the last week, much of the engagement had been within the health system itself: public health officials, the Chief Medical Officer of Health, and the Health Authorities on the operational side of things; preparation and protocols on the clinical side of the response; as well as at the national and international levels, where there are regular updates at the staff level. Even ministers and deputy ministers have regular contact points to stay informed with each other on how things are developing across the country.
What we’ve transitioned to, as the WHO’s assessment of the situation has evolved, based upon reaching other countries, is that we need to move to that next level, which is the engagement with other stakeholder organizations, like education - obviously, a lot of concerns coming up around trips, so we put out information related to that, communicated out to centres for regional education. Dr. Strang provided interviews to media outlets that were inquiring, and communicated that information to concerned parents and students and educators throughout the system. Engaging with the EMO and municipal services, to prepare for - if you get to a worst-case scenario and you need to tap into other infrastructure needs, doing the assessment - we are at that stage.
I didn’t delve specifically into questions on long-term care. I know that was the specific question of the member. I know that is likely triggered by the outbreak, or the expected outbreak, at one of the facilities, I believe, in the United States. That likely led to the question. I didn’t have the detailed conversation on that one but broadly, how it’s all tied together, it’s proceeding based upon the people who went through H1N1. Where we’re at now, they all feel quite confident in the work they’ve done and that they are in a much better place, as COVID-19 progresses, than they were at the same period of time with H1N1.
GARY BURRILL: Thank you for the answers to that series of questions about long-term care. I’d like to ask about something altogether different. I would like to turn to the subject that the government has really identified as important in its agenda: the subject of e-cigarettes and vaping.
I want to ask the minister a few questions about how this commitment of the government’s has been translated into the planning and allocating of the budget. First, could the minister speak to how much of the Health and Wellness budget, in terms of dollars or percentage, is being allocated to this continuing health concern?
RANDY DELOREY: As with some of the other detailed, specific questions, in a $4 billion overarching budget, we don’t always break things down quite to that level of detail, even here at Estimates, for one particular area of program.
What I can say from a treatment perspective, the investments and allocations come through our mental health and addiction services. When we budget and put the allocation, we don’t necessarily always say it’s for this particular treatment, because if someone shows up with an addiction or a mental health issue, they come into the public health system and they get treated for that. We do have smoking/nicotine cessation programs. We have, through our regular health services, our 811 smoking cessation program. With our PANS - Pharmacy Association of Nova Scotia - funding agreement, it includes a pilot program with pharmacists to work around smoking cessation, as well. Then, of course, we have things that don’t necessarily equate directly to dollars within the Department of Health and Wellness.
The regulatory flavour ban coming into effect April 1st, which was announced back in December - that’s not something that’s explicitly costing us money, but from a public health perspective, as we’ve certainly seen with tobacco consumption - has a potential for positive effect, especially with youth not getting started. That’s a big part of that program and it will be a major, positive step forward.
In addition, on the addictions side, a big part of the supports and the focus here is to keep people from ever getting started and to limit the harms when they do. The legislation - not that we’ll delve into it, because I’m not sure if the Rules of the House allow us to talk to it where we have a piece of legislation on the docket, so we’ll probably go into more detail there. Bill No. 233 provides more details on other steps that we are, in the Department of Health and Wellness, focused on in addressing the harms by reducing access for youth to e-cigarettes and also reducing the harm of the e-cigarettes, as can be noted in the details of Bill No. 233.
GARY BURRILL: I think this is a reasonable way to direct the conversation towards mental health and addictions and programming we have related to smoking cessation. I’m wondering, at a time when this is a matter that the government has really identified as a priority, is there anything in the budget that is being directed, on the mental health and addictions front, specifically to addiction treatment relative to e-cigarettes and vaping?
RANDY DELOREY: I know that we are spending over $400,000 specifically around cessation, which relates to vaping. The efforts there cover both traditional tobacco and e-cigarettes, investing in and supporting through Tobacco Free Nova Scotia and the Nova Scotia Health Authority.
We also have investments going towards ad campaigns, which we’ll be kicking off shortly this year, around the harms of vaping, as well. I don’t have the dollar figure for the campaign on hand, but those are areas where we see those investments being made.
GARY BURRILL: Am I to understand, then, that within the $400,000 that is dedicated to cessation and programs related to nicotine-related addiction, that there isn’t any specific e-cigarette vaping component?
RANDY DELOREY: The delivery of these cessation programs is really, as I understand it, essentially the same. What they’re really treating in these programs is a nicotine dependency; that, as I understand it, is the focal point of these cessation programs. Certainly, any Nova Scotian, whether they are consuming traditional tobacco products or e-cigarette vaping products, to get off those products, to break their nicotine dependence and establish a healthier lifestyle, these programs are there to support them.
Through the work in the Pharmacy Association of Nova Scotia, there will be some funding allocated there through that particular program, which is not part of the investment I referenced.
We’ve got the 811 program, as well, and programs through the Nova Scotia Health Authority and Tobacco Free Nova Scotia that we’re investing in. I don’t want to underestimate or understate the significant importance and where a big part of our priority has been, which is on reducing the number of people getting started.
Really, our best health outcomes, when it comes to nicotine dependency, as with many other dependencies, is to have people not start. While we’re investing and making these investments in those treatment services and programs, and that’s important and very good work, we are trying new avenues. Like I said, telehealth programs, working with our pharmacists as possible delivery arms of services - we are evaluating those and supporting the quitting for those who are already dependent. There are initiatives around e-cigarettes, because we’ve seen such an explosive growth in the last three or four years, particularly amongst youth.
We see the research that shows the number of youth - or not just youth but individuals - who have not been traditional tobacco consumers, that once they start with an e-cigarette or a vaping product, a number of them do transition and become dual users.
While I appreciate and respect the many Nova Scotians who have found that e-cigarettes have helped them transition off of traditional tobacco to e-cigarettes without the tar and the other secondary products that they were inhaling - and I appreciate those concerns - I think those Nova Scotians and others need to realize that there’s significant harm happening to the next generation who are consuming these products who actually think - through some of the research suggested - at least in their early stages, that they’re not harmful because they’re not traditional tobacco.
We’ve done such a good job on building a society about traditional tobacco, but once they get that nicotine dependency, then they become more likely to consume traditional tobacco products, so we actually have a greater harm coming through maintaining such ready access to these products. That’s why we have things like the measures announced by the Finance and Treasury Board Minister, through her department, around licensing and taxation of e-cigarette products, and also, the actions that we’ve taken as a Department of Health and Wellness around restricting flavours. I believe we’ll be the first jurisdiction in the country to have a flavour ban implemented in April, and we’ve also highlighted additional actions in Bill No. 233. I won’t go into those details because we will be debating that on the floor in regular House business at an appropriate time.
GARY BURRILL: I think this is a good and sound explanation the minister has offered. When we think about the priority that the government has given to this issue, probably the centre of that priority is, as the minister has said, vaping amongst young people. Can the minister point to anything particular in the budget that’s directed to youth vaping?
RANDY DELOREY: I think, as I articulated previously, the restriction of flavours is a significant piece. I know in some of the conversations the member may have been - as I know many members of the Legislature attended an event hosted by the Cancer Society and Smoke-Free Nova Scotia, the Lung Association was there, as well as a number of students that they brought in to speak to us, as members of this Legislature. These were students from a local high school. I believe at least one of them shared their story about being a vaper, and others shared information about friends of theirs and how the role of information and the accessibility and so on of these products, how they get hooked, and also the impacts. That student who had personal experience, their own health impacts - if I recall correctly, they were an athlete, and they noticed very well the impact it had on their athletic endeavours.
Just this weekend, I was talking to a constituent at home who has a son the same age as my son and is a competitive hockey player. He said his son knows a child on the same hockey team - they’re in a competitive league - who started vaping and he’s seen how this child, who was one of the top performers, doesn’t have the lung capacity and isn’t able to keep up with the players. He knows that in the Fall, he’s likely not going to make the next year’s top-tier team. This constituent who was explaining said, if seeing the effects on another child is what keeps my child from getting involved in that - because he wants to be on that top-tier team, he wants to keep himself healthy - he said that’s a good thing.
The taxation initiative is probably one of the biggest things that is targeted towards youth, along with the flavours. With taxation, the assessment there is to tax on the nicotine basis, like cigarettes, to bring them roughly to the extent you can make it comparable, to keep it out of their hands.
With traditional tobacco, as the rates of taxation went up, we would see youth smoking, in particular, go down. The amount of money that comes from the taxation is not for the public coffers, it’s not an amount that’s driving the move, but one of the reasons we think that e-cigarettes were such an entry point is because they were cheaper and more accessible than traditional tobacco products. I think that is a significant thing.
We know through research that youth become more price-sensitive than adults, especially if they’re not addicted yet, and they’re less likely to get started because it’s just out of their price range to access those products.
I think those are a couple of big pieces. I think the licensing and those other aspects of our Bill No. 233, it’s not explicitly at youth, it does affect all consumers, but I believe that motivation of these actions is really heavily influenced and targeted at youth.
To the member’s specific question, what exactly is targeted at youth, the reality is that it’s not just youth we want to limit and reduce consumption. It certainly is a significant motivator and is what has led to the prioritization of some of these initiatives. It is for everybody. It’s not that you label it as just youth, but youth have been a significant policy motivator for taking these steps.
GARY BURRILL: Further to this, one of the concerns often raised, of course, whenever this is being discussed is the fact that so little is known about the long-term impacts of vaping. I wonder if the minister could speak to whether or not there is, in the department at the moment, any current research, or any research being envisioned, into the long-term impacts of vaping.
RANDY DELOREY: I think this is an area of research of a clinical or academic nature that we are not explicitly conducting, but it is an area of research that I believe is of particular interest, broadly, in the medical and health community, so there is certainly research ongoing.
One of the challenges is that a relatively new product that has reached a certain level, to get the longitudinal data that, with a certain degree of confidence, is actually able to project what the long-term harms will be, requires just that. It requires a long time of consumption to see what those outcomes would be. That’s why, as we’ve said, we’ve seen that explosive growth in the last three years or so, three or four years, in e-cigarette consumption throughout the country and, indeed, much of the western world, as it really hit its stride as a product on the marketplace, despite being around for a few years before that. It really became, I’ll say, mainstream in the last few years.
Based on that, you have a higher population consuming, and you have a higher probability. You are starting to see information that comes out of those effects. That’s what triggered a lot of attention this summer with illnesses being attributed to vaping and e-cigarette consumption, particularly acute in the United States - to a lesser degree here in Canada - but it certainly raises our concern here, as well as others.
That clinical research is taking place. What we do as a province, as a department and within public health, health promotion, and with our clinical partners within the Health Authority and the IWK - they rely on these peer-reviewed research projects that are out there. We subscribe to the journals, and they’re able to access that information and research done in other jurisdictions - to apply and help inform both clinical treatments and progress.
In addition, we provide support funding more localized. For example, with an organization like Smoke-Free Nova Scotia, they conducted a survey last year to assess trends and impacts with youth. That’s where, I believe, data over - and I forget the exact number off the top of my head - those who indicated they would quit if flavours went away. Certainly, the youth are giving indications that they would either not start, or quit vaping, if they didn’t have access to flavours.
Certainly, a big motivator through that information, not specifically on the harms, is on how we can get some of the positive effects of getting people off. I guess those are the two things. I’m not aware of anything specific out of our department, but our department isn’t the entity that actually conducts most research. Our academic institutions throughout the province, as well as our clinicians who provide care - there are many clinical researchers, as well - I can’t speak specifically to what any one of them is doing.
As a province, we fund Research Nova Scotia. The Department of Health and Wellness puts a fair amount of money into that organization, as well, so there will always be health-related research projects coming out of the province. I’m not presently aware of long-term impacts of e-cigarette, specifically, are taking place in the province right now.
There’s certainly a funding agency that’s out there that could look at submissions from clinicians and academics in the province. As a department, we tend to go to those research articles that are already peer reviewed and published, and we leverage that to help inform rather than doing the primary research ourselves.
GARY BURRILL: Thank you for that explanation. I wanted to also ask about specialized training for medical personnel for vaping-related problems, thinking about physicians and nurses and paramedics too.
We know that there’s specialized training that’s required for treating these vaping- related pulmonary infections that have received so much attention. In the context of this overall priority that’s being given to vaping-related problems, is the department allocating in the budget any funding to update training for medical personnel to deal with these distinct vaping-related health issues?
RANDY DELOREY: There are certainly programs and supports for continuous education initiatives and professional development that exist throughout the health system. I believe that’s where there are opportunities to advance and get support for additional training, whether it’s in this area of particular treatment or others.
There isn’t budget specifically allocated, as the member has phrased it, but there are programs, broadly speaking, that do provide opportunities for training and professional development that can be leveraged within the health system. That would be with the employers and their agencies to have those conversations together to help inform, on an individual basis, the training that they might prioritize, based upon the conditions that they would see coming through.
GARY BURRILL: Thank you for those answers to the series of questions about vaping. That’s a discussion that we can look forward to having more of in the coming days in the House. I want to ask the minister a question or two about the QEII redevelopment. I want to ask about the P3 dimension of it. Within the particular health care-related side of that, understanding that there are lots and lots of issues about that where our side of the House and the minister’s side of the House don’t see eye to eye, but they really don’t lie, particularly, within the Health and Wellness Department, but it seems to me that there is one that does.
In the literature that weighs the pros and cons of P3 infrastructure development, one point that’s often made is that the situation with hospitals is not the same as it is with other infrastructure - for example, roads - in that the world of health care infrastructure is changing so rapidly that we can be virtually assured that in the course of this agreement, this contract, there will be modalities of treatment introduced that none of us today would possibly be able to imagine.
One of the concerns about P3 developments, for hospitals in particular, is that those modalities of treatment, which will almost certainly come into being in the life of the contract, will, in every probability, require the refashioning, redesigning, rejigging in various ways of the physical infrastructure of the hospital. We know that changes are going to be needed in that asset, over the course of that contract, because of new processes that will become available in the treatment of health care, which aren’t available today.
The concern - which is outlined in the literature that weighs the pros and cons of P3s, particularly with health care - is that when we’re talking specifically about hospitals, there is a real concern that when, over the life of that contract those changes have to be made, in a situation of private ownership of the facility, the cost to make the transition could become so prohibitively expensive under a private ownership scenario in comparison to a public ownership scenario, that the changes that would need to be made would, in fact, not be able to be afforded by the government.
I want to ask the minister if he is familiar with this line of reasoning, of concern about P3 development with hospitals. Does he think it has any relevance for the present QEII redevelopment, and is there anything within the budget that speaks to protecting us in Nova Scotia against these negative possibilities in the future?
RANDY DELOREY: I appreciate the member’s acknowledgement that, by and large, the policy financing side and the technical infrastructure side of the build is best directed to other departments, that it really comes down more to the clinical service delivery side here.
I would just touch briefly on the member’s own statements in referring to where the challenges or the concerns lie, and I think what I would narrow in on is his reference to ownership of the building.
I believe, as has been publicly announced, that these contracts are DBFM - Design Build Finance Maintain - relationships. That means that the ownership would still rest with the Province, as I understand it, with the aspects of our redevelopments that fall under the P3 financing model. I think that addresses that piece of concern that the member has raised over ownership and the evolution of the buildings over the course of a long-term contract.
In areas where we as a government own infrastructure and buildings, we do have to refresh - to use the member’s terminology - the modality of treatment, the approach, and how infrastructure must be configured to provide that care. That does take place. In fact, as part of our redevelopments in Cape Breton and in Halifax, as well as in communities elsewhere in the province, we are making historic investments to see that these updates and enhancements to our health care infrastructure are made to ensure that we do have the infrastructure that supports the care and treatment options that are needed in our communities and for the province going forward.
Those costs are going to be incurred if we do have to make changes, just like they do in a traditional build. Ownership isn’t a question of concern in the approach and the model that I understand is being taken here.
GARY BURRILL: I understand the distinction the minister has made, and yet in the research around this that I’m aware of, these concerns stand the same for the DBFM model as for other models of P3 development, with the central point being that with a P3 development, the public sector does not have its hands on the steering wheel of potential modifications to that facility in the same way it does with a traditional public procurement.
I want to understand the minister’s thinking about this as clearly as I can. Is it the minister’s view that the medical health care concern I’ve raised about a hospital P3 development is an insignificant or frivolous concern?
RANDY DELOREY: I don’t think I would phrase things quite the same way that he’s brought forward, but rather what I think is consistent is the fact that we can agree, I believe, on the fact that as time progresses, technology advances and treatment options advance. Often treatment requires equipment or infrastructure space to make that treatment available, as well as the training necessary.
That will continue to be a pressure point requiring investment by the public sector to stay on top of. In fact, the situation that we find ourselves in today, requiring the significant, historic health care infrastructure investments, is because many governments in years gone by have deferred those types of modernization investments in our health care infrastructure. That is why we find ourselves in a situation where we have to move forward and invest literally billions of dollars to modernize our infrastructure and, in fact, replace existing buildings that have reached end of life because they were not necessarily invested in, and those were publicly-owned infrastructure buildings to provide the supports.
To properly deliver health care services, to properly make investments in the infrastructure to support the care models needed within the province, that is important and it is expensive, as we can see by the investments that we are making in these redevelopments, but not just in our redevelopments in Cape Breton and here in Halifax, but in investments in other communities, as part of our investments at the IWK and the other hospitals throughout the province, as part of our capital programming.
I think that regardless of the model of financing and building for the hospital infrastructure, I do believe that the concerns the member raised exist. That is the concern that as time changes and progresses and there are needs to modify infrastructure to meet new treatment modalities of care, as the member referred to it - within our health care system, it’s going to cost money. We are going to have to - future governments will have to, at that time, make investments to do that.
What we seem to be disagreeing on is that, I believe, it is a circumstance no matter how the infrastructure is built or financed today, but rather a reality of delivery and the continued evolution of our health care delivery services and technological advances, as well as clinical advances that require that type of infrastructure investment and modernization.
GARY BURRILL: Thank you for that brief exploration of this one dimension of the P3 question. I have a few questions which really are just requests for information. I don’t expect this would all be information that would be available today, but it’s information which would be helpful for our caucus to receive from the Department of Health and Wellness.
The first of these requests is to know how much the department spent last year on employee overtime and how much the department is budgeting this year for this same area.
RANDY DELOREY: I think in this particular question, within the Department of Health and Wellness, we would have negligible overtime costs. It wouldn’t show up as a blip on our budgeting within the work that we perform as a department.
GARY BURRILL: I’m wondering also if the minister could see to having us provided with information about how much, in the last budget year, the department spent on external consultants.
RANDY DELOREY: That’s a significantly more complex question than, I think, the member may have anticipated. The reason is the way that our budgeting and financial reporting gets done. It gets done by cost centres or areas of the department, divisions of the department that align to the services provided and where there would be consulting services provided in multiple areas. Instead of a line item, there’s not a line item that says, “consulting services.” We have line items for our various departments, so it would require going through the budget documents. These details, particularly on year end, get reported more through Public Accounts, which comes out later in the Summer, which is after the books are closed and the Department of Finance and Treasury Board has had the opportunity to roll all of that information forward.
GARY BURRILL: I wonder if it would be reasonable, then, when the books are closed, to ask the department to provide a list of each external consultant contract that had been engaged in over the year and have that list attached with that information about the amount paid out and the type of services provided.
RANDY DELOREY: First of all, the Public Accounts reporting, structure, and format is really governed by the Department of Finance and Treasury Board. We provide the information, and the nature and the format of that information is to adhere to public sector accounting rules, Auditor General requirements, and so forth. That has informed the structure of those reports. I believe there are several appendices or supplementary documents that do provide, in detail, the funding that’s invested. Perhaps what I would do is direct the member to take a look at those supplementary - I forget which volume, explicitly, it’s in. I think there are only three or four volumes within Public Accounts, but the information from the past year would be available online.
If the member or his caucus were to take a look in those supplementary materials, I think he would find where the information is outlined. Not every contract would be there. Some of the very small contracts wouldn’t be reported on, but I think contracts over a certain dollar amount - Public Service contracts or contract funding that go to pretty much any organization or entity - are outlined in their total.
If the member would take a look, I think he would probably find the information he is looking for - maybe not exactly the way he wants but it is broken out, if I recall correctly from my time at Finance and Treasury Board, his department, as well as the lists - so you can see the totals in there.
GARY BURRILL: I wanted to ask a question, too, about compensation structures within the department. Could the minister see to having the information supplied to us about what is the percentage increase in the most recent year for the compensation of senior management in the department?
RANDY DELOREY: I think any Nova Scotian can do that analysis. I believe the Public Accounts documents - again, I forget which volume of the supplementary material in Public Accounts - have those details, if one was so inclined, because it does provide salary information in the supplementary materials, by department.
The member and his caucus could perform that analysis, based upon publicly available information.
GARY BURRILL: I wanted to ask, as well, would the minister be able to provide information about the compensation level, the salary level for the lowest-paid person within the responsibility of the department?
RANDY DELOREY: I believe, it’s in the Public Accounts documentation supplementary material. One could peruse that information. The past year’s Public Accounts are already there, so the member and his caucus could establish the baseline and, again in 2020, when we get to that point that Finance and Treasury Board releases the Public Accounts, they would get the most recent information there, as well.
As far as the information goes, it would have the list of employees and the information for salary compensation that’s provided. I understand there are only about 15 seconds in this line, so I hope the member doesn’t mind that I’ll just wrap up the 15 seconds. I don’t think there’s time for another question before transferring to the PC caucus.
THE CHAIR: Time has expired for the New Democratic Party. We’ll now move to the Progressive Conservative Party.
The honourable member for Kings North.
JOHN LOHR: Mr. Chair, I guess I should ask the minister, does the minister and his team want to have a short break? All right, thank you, we’ll continue.
When I was last up, an hour ago, I was asking about the harm reduction model, and I still had a couple of questions about that. One was, as the minister would know, a significant part of that harm reduction model would be counselling. I am just wondering if the minister can let us know if the increase in the users of that model - has the department managed to keep up in the counselling of those? Is he satisfied that that part of the model is being followed too?
RANDY DELOREY: I’ll get to that point, but if the member has his pen available, I have some details on the financial side of a question he asked in the last hour about the opioid response plan. I’ve gotten the additional details.
The opioid action plan efforts of funding is budgeted at about $1.8 million this year. For the opioid dependency treatment it’s budgeted at about $2.67 million, and work around the opioid strategy is just over $500,000. That does work out to about a $5 million investment within this sphere of services. I know the member asked that question earlier.
As the member is inquiring about the clinical treatment processes and how counselling comes in, the delivery of the services are by our health care professionals and partners who provide the clinical oversight. What I can say is that the work and the recommendations that have come forward through the priorities and the investment in programs and services have been informed in part by the recommendations and advice from the clinicians who work in this area on the front line.
One of the programs or initiatives that has been undertaken, that perhaps doesn’t get as much attention or awareness is about building the capacity within our primary health care system, to engage. One of the challenges, as we started this conversation earlier this evening, is how individuals with dependency or addictions and mental health issues are often marginalized citizens. Unfortunately, in the current system, of those marginalized, often they’re people with opioid dependencies, and as I understand it, for those with addiction dependencies, those with opioid addiction dependencies, they have a particular degree of marginalization, even within the broader health system. That is why it was so important for us to build the framework and make these investments to ensure that the care and the treatment options are available - and dealing with that wait-list - so that we can show Nova Scotians who do have a dependency that their government, their society truly values them.
Many people who have these dependencies don’t feel like they’re valued within society. One of those areas is working to support primary care providers, to help with community-based care and support of those with dependencies. One of those is - I forget the formal name of the program, but it’s been described as a hub-and-spoke concept. There are a number of providers in primary care who have been active, take a very keen interest, and work to support people with dependencies. Obviously, they couldn’t keep up with the demand, and that’s why we need other treatment options.
They recognize that one of the limitations they’ve heard from primary care providers is either a discomfort with the patients or discomfort with the actual treatment, not having up-to-date information. They’ve done a peer-networking support type of program so that someone who might have a patient in their practice in need of treatment for opioid dependency, they can actually connect and consult with a colleague who has more experience in that area. They can help navigate and work them through. One of the common things that I’ve heard - and I will say it’s anecdotal but I’ve heard it first-hand from clinicians on the front line when I’ve been at events in this area, either announcing funding or touring and meeting with people who work in the space - that one of the challenges is getting the treatments the first time.
Eventually, when providers are able to see the transformation that appropriate treatments can have on their patient’s life, then it’s actually transformative; the patient you see in the midst of dependency and crisis, and many of those behaviours that are a result of that dependency - I’ll call them anti-social behaviours - those things that lead to the marginalization in our society because they are not the acceptable behaviours, but yet they are driven by the dependency on the opioid, once they receive treatment, they are transformative. The individual, while experiencing the dependency, is not who they are. As society and health care workers see that transformation, they become more engaged and more likely to deliver the service. This is part of that strategy.
We don’t have, to the member’s specific question, a specific line item around counselling for this particular dependency, because the counselling is in line with the counselling services within mental health and addictions, which often relates to counselling for underlying - and as we spoke earlier this evening, often there are co-dependencies, co-issues where sometimes the dependency leads to mental health issues, depression, and so forth. Sometimes it’s the mental health condition that leads to the dependency, and so by connecting the treatment of the individual, it puts the individual at the centre, and they treat both their mental health and their addiction conditions through that counselling.
We do have what I’d mentioned was the Atlantic Mentorship Network. I think that’s what I referred to as that hub-and-spoke program to help support first-time prescribers and prescriber practices. That’s on top of the methadone treatment wait-list, which we spoke about more in the last hour.
JOHN LOHR: Mr. Chair, I guess we heard in Supply the member for Cumberland North mention that for detox there was no longer the same detox services that there had been, particularly for alcohol addictions; there’s an in-patient versus day detox. I guess I would like to hear the minister tell us what the plan is for detox.
We know what has been continued to be curtailed around the province in terms of what the hospitals are offering. Is it enough? Obviously, the harm reduction model is for opioids, but for alcohol addictions, in particular, are we doing enough to offer detox services for people who want that?
I guess what we are hearing is that there are questions about that in the community, that they feel detox has been curtailed. Can the minister comment on that?
RANDY DELOREY: This is an area within mental health and addictions that I heard about earlier in my tenure as Minister of Health and Wellness. When I did my early tours around the province, visiting hospital sites, I did explicitly request of any of the sites we were at to actually include visits with the mental health and addictions teams, if there were services present at the sites. The reason was the mental health and addictions amalgamation was under way at that point in time, and it was important for me to get out and have the opportunity to hear first-hand from people within the mental health and addictions divisions of the authorities to see how that transition was going, what they thought about that amalgamation.
I’ve spoken to the rationale, and people by and large advised me that that was a positive thing. Any time you do change, it’s disruptive and challenging, but the principle behind it, they said, was sound.
It was in those conversations with front-line clinicians that people were talking about and providing information to me about evidence-based practices and the evolution of clinical service delivery in the area of addictions in particular, and the role of in-patient versus outpatient community-based treatment services. They indicated that the research and the clinical evolution is towards more community-based delivery.
As I recall - and this is more of a lay explanation than a clinical explanation, but it’s my recollection of how the clinical rationale was defined - what they were finding and what the research was illustrating, in simplistic terms only, was citizens who would go through a detox program, an in-patient type of service. They would get that service. They would be detoxed. They would have whatever particular drug or alcohol they had detoxed from their body, and then they would return to the community, the community that had the same stressors, triggers, and challenges that led to the situation that resulted in their need for detox in the first place. The research was showing quite heavily that there was greater long-term success in the health outcomes by providing more of the community-based and real-time services and supports than the historical in-patient model.
That said, that does not necessarily mean that those treatments and the services that were provided required the clinic bed to provide those services. At the same time, it’s recognized that there are times when the health symptoms, or the health implications, of an individual at a particular point in the withdrawal, may require in-patient services. That would be a clinical assessment and decision being made at the facility at that time if clinical in-patient management of that was, and is, necessary.
By and large, changes that have been made in the Health Authority with respect to in-patient versus community-based on the addictions side of things has been driven by the clinical evidence and research. What I did when it was first brought to my attention - there was some data and statistics based upon a facility that was operating in this way. They assured me they still maintained beds and availability for in-patient services for those that they deemed needed it. They indicated there’s a significant reduction in that need, based upon the transition in their care model. They provided some details as to what the recurrence and the success rate of the traditional old model versus the new model was, and it was actually quite substantive. I don’t recall the numbers right now, but I remember it being substantive.
Still, being a layperson coming in at that time, I asked for some research to back up their assessment, and they provided me with about two or three peer-reviewed clinical assessments that supported the model that they were working under at that time. Interestingly, the data that they were providing on their regional - the results that they were experiencing in their community - actually roughly aligned with, certainly in principle, the changes that were predicted in the clinical research that was published.
With that, and as I’ve often said here, relying on the clinical recommendations and guidance for best practices and the delivery of care and treatment, I will continue to defer to their expertise and judgment on the delivery of care. That’s where that model sits today.
JOHN LOHR: I know there are other questions that could be asked about that subject. I would ask the minister if he could table the research that he was referring to there, for our benefit. I do want to move on to another subject.
I’m pleased to see that the minister and his department have come up with a framework for preventing and reducing the risk of suicide for Nova Scotia. I notice when I look at Appendix B of that framework - the minister’s own report - that we have gone from being significantly below the national average in 2007, to virtually a straight-line trend in 2017, to being significantly above the national average.
I guess part of the answer for that would be that, as we see, economic reasons are certainly a factor. We know that we’re the only province that saw an increase in child poverty in the last year.
We’ve not maintained our place in the Canadian model of provincial income. We have the lowest median family income of any province, so those are all factors. I wonder if the minister could comment. I know the minister has, without prompting, mentioned improvements in wait times and I just want to mention Waiting Your Turn: Wait Times for Health Care in Canada, 2019 Report, a psychiatry waiting list survey from January 9, 2019 to April 26, 2019. In this report, for the province, the wait times from GP to specialist - I guess this includes children and adults - was third highest in Canada at 160 per cent higher than the Canadian average; wait time from specialist to treatment was the highest in Canada at 265 per cent higher than the Canadian average. The total wait time of those two combined was the highest in Canada at 219 per cent higher than the Canadian average, 53.6 weeks. For urgent wait time, urgent basis, Nova Scotia at 4.5 weeks was second highest in Canada at 204 per cent higher than the Canadian average. For elective basis, third highest in Canada at 160 per cent higher than the Canadian average.
I guess my comment is that these wait times, which are 2019 wait times - the first quarter of 2019, effectively - would the minister say that those wait times are a factor in that we are significantly above the national average in the suicide data?
RANDY DELOREY: I’m just wondering, if the member is done with that particular document, if he could table it or if I could get a copy of it just to take a peek at it while we’re here, so I can make sure we’re talking and I can refer to the information in the document.
While waiting for that, maybe if the member wants to move to a separate question, we can pick that one up when I get a chance to take a closer look at the information he was citing.
JOHN LOHR: I will go to a totally different subject. Early Intensive Behavioural Intervention for autism spectrum disorder, I notice there really hasn’t been a lot of new material on the website about EIBI. When I look at what material is on your website, from 2017, the statement: “Based on current numbers, many 4- and 5-year-olds will require EIBI within the next year, putting undue strain on the system in order to catch up with demand. Current resources cannot address the immediate or long-term needs of all these families.”
The question is, how are we doing maintaining EIBI for autism spectrum disorder?
RANDY DELOREY: We continue to invest in the EIBI program but also to expand other services. Last year we launched a new program, I believe it was the QuickStart program. I’ll double-check and make sure that’s the correct label for it. We recognized one of the challenges we were having with our EIBI program is that the EIBI model is to have children complete the program before they start the school program and curriculum. What that means is that there is a time period that, by 6 years old, they should be completed the EIBI program to transition into the education system where other supports are provided.
What we recognized was that earlier intervention and supports are important, as well, but because of the wait-list built up over many years, the focus is on getting the oldest children - those who are nearing 6 years old - the treatment into the EIBI program because someone who is 3 years old could wait longer than someone who is 5 years old to get the treatment, and we wanted to get the treatment to as many youth as possible who are in need.
This QuickStart program, we partnered with Autism Nova Scotia to help inform and deliver the program. It’s a program that is actually great because you don’t have to have an autism diagnosis to access the program supports. We piloted it to allow that, and it is targeted at a much younger age. When it’s suspected - it may be autism, or it may be another condition that has similar symptoms or behaviours as autism, which can also benefit from the similar types of interventions.
I’m very proud of that particular program and the work. In the early stages, the original pilot phase before we announced it, both the parents and Autism Nova Scotia that worked with the child - really, it was a transformative impact.
We also recognize, in addition to our continued investments in delivering the EIBI care and program - I don’t have the number of individuals; I believe there were about 120 active service deliveries for EIBI. This would have been back as of September 30th of last year that we were providing this. I think this earlier program will help people with that.
Also, our investments and supports for autism in a community-based setting would be the other program we launched last year, which is the BIOS - the Brief Intensive Outreach Service - that we also rolled out last year. That is not restricted to youth but is actually to help with the potential for crisis intervention in a community-based setting.
Those are two new programs to also support and work with individuals living with autism.
JOHN LOHR: I know that for the families with children who have autism it’s an extraordinarily difficult set of circumstances, and I think they would like to hear the minister reiterate his commitment to EIBI and these other programs. I think I heard the minister say that. These are extraordinarily important programs.
Another important program which we would like to see - and this is, of course, one of the continuing narratives about a lot of things in our province, that services are available in the city but not in other parts of the province. The Mental Health Mobile Crisis Team is available here in the city but not in other jurisdictions in the province. It does very good work; we hear good things about it.
Is there a plan to expand the Mental Health Mobile Crisis Team service and offer it in other jurisdictions in the province?
RANDY DELOREY: I think first of all I will state definitively as the member correctly summarized: yes, we remain committed to EIBI and other supports and programs, which is why I didn’t restrict my previous response to just EIBI. I wanted to illustrate for my colleagues that we recognize the importance of providing the care.
Like many health interventions, earlier is better than later, so we’ve provided interventions like the QuickStart program. We also recognize points in life, not just for youth, and that’s why the BIOS intensive intervention program that I referenced is also important. Just to show that we do value those Nova Scotians living with autism that they and their family and loved ones deserve supports, we’ve been investing in them.
To the question of the regional aspect that the member’s question was referring to, I’ll start with the EIBI reference and, in fact, this was highlighted in the QuickStart announcement when we made that last year - I think there are nine or eleven community sites to support and provide autism-related supports in communities throughout the province. While there’s a core competency and focus here in the urban area, we have these other community sites in partnership with Autism Nova Scotia and some other community- based partners. That information is detailed, available on the website.
As far as the Mental Health Mobile Crisis Team goes, as I understand it that team is, as the member mentioned, predominantly here in Halifax, but the crisis line does serve the entire province. They do have services that are available by phone, and they work in the moment in assessing and connecting with response teams in the community - not the specialized crisis response team that’s in the urban setting, but the crisis line does exist to help with an immediate crisis assessment and to respond appropriately for the individuals, wherever they live in the province, to connect them, if necessary, with emergency response and care for their mental health needs at that point in time.
JOHN LOHR: I believe the minister has the document in hand that I was quoting a few minutes ago when I asked about the fact that Nova Scotia is well above the national average now compared to 2007. I believe the national average is maybe 11.4 suicides per 100,000, and our average is 14.2, which is considerably higher. I referenced that’s possibly due to the fact that we’re the only province to see an increase in child poverty in that time frame, or maybe it’s the fact that we have the lowest median family income.
I quoted from Waiting Your Turn: Wait Times for Health Care in Canada, 2019 Report, the Fraser Institute psychiatry waiting list survey, which showed by province that for psychiatric treatment, which I presume would include adults and children, we were third highest, first highest, second highest, third highest, and second highest in terms of waiting times from GP to specialist, specialist to treatment, total waiting time, and on an urgent basis, the same thing from GP to specialist and specialist to treatment.
I know the minister has said our waiting times are better and, in fact, that may well be true, but they’re still very high compared to the Canadian average. Could the minister comment on that?
RANDY DELOREY: I thank the member for the question on this important topic. There’s a lot in there to unpack and touch on. I think we agree on the first point. We have more work to do to continue to improve the mental health and addiction services in the province of Nova Scotia. That’s an important acknowledgement and recognition but, at the same time, I think it is equally important to recognize the hard work of the health care providers that we’ve been investing in, to help support them in delivering that care and the work that is being done there.
The member referenced the social determinants of health, perhaps not explicitly with that language but when referencing or referring to child poverty rates, income rates, and so forth. Those are essentially the areas that he was touching on, as a measurement or predictor around health outcomes.
I would agree with the member - the importance of investing in those upstream factors, perhaps traditionally not viewed as health. That is, these are not areas that the Nova Scotia Health Authority or the IWK would be responding to. They respond to the clinical health needs of patients, not the broader, societal aspects that can play a significant role in the actual health outcomes of the individual citizen. That’s why in this budget, as a government, we recognize those very components. It builds upon work that has been under way within the government - once we’ve established a sustainable financial position - to be able to focus on social program investment delivery. That would be like our pre-Primary program.
The Minister of Education and Early Childhood Development has previously cited on the floor of this Legislature some of the research illustrating positive outcomes, not just for the child who is provided that opportunity to get an equal footing in an early, play-based program, which is what our pre-Primary program is designed to do, but also how those benefits flow to the broader family unit, as well, providing opportunities in some cases to reduce child care costs, so you are reducing the expenses. You provide the opportunity in some cases for parents to return to the workforce earlier, so you are both reducing the expenses and providing more opportunity for employment, which I think in the current economic circumstances, with our record unemployment, it would be unheard of even six years ago to think that Nova Scotia would be entering a period of economic sustainability. That availability of workforce was going to be one of the greater challenges and limitations that we faced as a province, yet that is where we find ourselves.
This type of program, investment in the pre-Primary program, helped address some of those very aspects that the member referenced. The investments being made within the housing space, through Municipal Affairs and Housing Nova Scotia, to help support both those who need housing, in particular with some strategy and work for those who are homeless, to help provide that foundational piece.
We know in the mental health and addictions sphere that stable housing can have a profoundly positive impact on the mental health of citizens. It is a very important social determinant factor but not one that the health system provides, so it does get delivered through another arm of government.
I can go on with the investments being made by the Department of Community Services, the increase in the child tax benefit, the Standard Household Rate and these initiatives to increase income for those lower-income Nova Scotians. These are investments and opportunities that we believe address those underlying social determinants that the member referenced.
Is there more work to be done? Certainly. As with the health system, our social systems will continue to strive for continuous improvement, will continue to improve the lives of every Nova Scotian, especially those who are most in need.
The member also made reference to the challenge with suicides, suicide attempts within the province. We recognize that. We’ve had recommendations - the blueprint that the member referenced previously. I also acknowledge that we’ve been making significant progress with a suicide prevention framework. I look forward to releasing more details, but that work that’s been under way has been focused on work from many different clinicians and researchers to help inform the path forward.
Like many initiatives, when you bring a broad group together to consult and provide input, there are a variety of ideas as to what the best path forward is. We as a department have done our best to properly reflect and incorporate the best advice that we’ve received collectively, to meet and reflect that input from the variety of stakeholders, from clinicians to community-based organizations, academics, and others. Underlining most of what we were doing with that, it was really a starting point with the WHO suicide structure framework to help inform the work that we do.
While we recognize the challenge and the issues, we’ll continue to work to collaborate. We’ll leverage the learnings and the framework that will guide the actions that we will be taking going forward to help do our best to ensure that those citizens in Nova Scotia who feel there is no other path forward - again, much like when we talked about addictions, to recognize that we value them, that they are important, that we want to be there for them, respond in a way that shows there are other avenues, and we want to be there to support those other paths forward and to re-establish their mental, physical, and other foundations in their lives.
I think my response notes that that’s not just the responsibility of our Health Authorities and the Department of Health and Wellness, but it is the responsibility throughout government, particularly our social departments. It is an area of concern, and we work collectively. As earlier questions were denoted by the member opposite about the investments around mental health services and supports being invested in multiple departments, that’s because multiple departments recognize the importance and the priority as a government that we place on those who are in need.
I hope that answers the member’s question, that we do recognize that we need to do better. We are investing to do better. We are planning and strategizing, particularly as it relates to suicides, to set the path forward and hopefully turn those numbers around.
JOHN LOHR: I’m sure that we could go on discussing this data, but I would like at this time to turn it over to my colleague.
THE CHAIR: The honourable member for Argyle-Barrington.
COLTON LEBLANC: I want to thank my colleague, the member for Kings North for his thoughtful and very important questions to the minister regarding mental health and addictions in our province.
I’ll take a little different spin this evening in talking about preventive care. The health care crisis in Nova Scotia - and I’ve heard it described as an overflowing kitchen sink, with chronic conditions, illnesses, and injuries spewing out of a tap without any stop in sight, and that water of chronic illnesses and conditions is unable to drain due to various obstacles and challenges that are clogging that drain.
Whether it be access to family physicians, access to an open emergency room, access to an ambulance in due time, access to mental health and addiction services, access to surgeries, access to services to manage chronic conditions and access to services that are at capacity and access to services that are not offered in certain parts of the province - addressing these concerns of our health care crisis, we need to look at modernizing and taking a preventive approach to deliver proactive and effective management of these conditions.
When we look at the statistics of avoidable deaths from preventable causes, Nova Scotia compared to Canada - Canada was 130 cases per 100,000 and Nova Scotia, 151 cases per 100,000 - it makes me wonder what we could do differently in Nova Scotia.
I’d like to start off by discussing with the minister something I’ve brought to the floor of the Legislature before, about dialysis services, particularly about dialysis services in my part of the province, in Argyle-Barrington. As the minister is well aware, constituents of mine have been advocating since 2014 for improved services and thus asking for expansion of the satellite dialysis services.
One of my constituents, Artie Smith, who I spoke about before on the floor of the Legislature, travels 60 kilometres one way, three to four times a week, so he travels 1,400 kilometres a week. His wife, in a Facebook post that she asked me to read, said, why do we read about the announcements for expansions and/or opening new dialysis clinics in Digby, Kentville, Cape Breton, Dartmouth General, and Halifax when five years later the patients in the Municipality of Barrington are still being ignored?
THE CHAIR: Order, the honourable member for Argyle-Barrington must table the document, with a name attached to it. Thank you.
COLTON LEBLANC: Mr. Chair, I’ll proudly do that, as she has requested. There are two authors to this one.
She goes on in December, explaining that at 4:30 a.m. she is cleaning her husband’s vehicle so he can make that long voyage to the hospital. As I said, the minister spoke about expansions in other parts of the province, but those expansions don’t help my constituents in Argyle-Barrington.
I’m just wondering, does the Department of Health and Wellness examine the overall cost savings to not only my constituents but for the overall health care system for the expansion of this service?
RANDY DELOREY: I apologize out of the gate that I don’t have the answer explicitly that the member and his constituents would hope to receive from me on the floor of the Chamber this evening.
I guess in looking at the dialysis expansions, as I explained to the member - I don’t remember if it was in Estimates last year or on the floor during Question Period, where this has come up previously. Actually, it wasn’t in Estimates last year, as this is the member’s first Estimates, so I guess it would have been in Question Period. I believe the member has raised this question previously.
First of all, work was done that looks at the important value of dialysis and the dialysis treatment close to home, so I think we’re on the same page. Before I was appointed to this department, work was done that identified a number of expansions. That work was done; those commitments were made.
What I think the member’s constituent is referring to about announcements is keeping the public up-to-date as to the progress on these various projects that are under way. It does take a fair bit of time to get the appropriate design, get the RFPs out for the design, get the design completed, and get the work under way. These are multi-year projects, which is why the member’s constituents may have heard - because at each milestone, as the public expects, the Province provides those updates that the project is progressing, and sometimes it’s here on the floor of the Legislature.
Earlier today the member’s colleague was inquiring about the Valley-Kentville dialysis and when it would be coming on stream. He’s asked that question on the floor of this Legislature multiple times as the project was getting under way. It takes some time, and that’s why we needed to focus as a department and a health system to get these projects done.
Although I’ve been in this role for almost three years now and the announcements came just prior to me coming into this role, it did take about three years to get many of these projects completed from start to finish. We do expect them to come on stream this year.
As I’ve said the last couple of years, including to the member’s predecessor, specifically about the Argyle-Barrington situation, we needed to focus on getting these projects that had already been announced, based upon recommendations of a review of services at that time, get these established, get them operational, see how that changes the patient flow in these new allocations throughout the province, and leverage the information to inform the next phase and rollout of dialysis expansions throughout the province.
I guess I can assure the member, as I said off the top - unfortunately it’s not the response that I know he and his constituents would be hoping for, but it’s a consistent response. I know the member for Pictou West had raised questions earlier for her community, as well, but it is consistent that we recognize the importance. I’ve spoken previously about dialysis, for those members who aren’t familiar.
The member for Argyle-Barrington made reference to his constituent of four times a week. What he didn’t reference was how many hours each day. You are looking at four, maybe up to six hours of treatment on each of those four days. Imagine the impact that that has on your life, and that’s just the treatment that is four to six hours; add to that the travel time on top of it.
I just want to make sure that the members of this Legislature truly understand the importance and the significance of these challenges that are being brought to the floor of the Legislature. I want to make sure that they understand and appreciate that I do understand and appreciate. Unfortunately, I am not able to build these expansions simultaneously in every community of the province, but we are making good progress. We are expecting several to come on stream this year, which I think means that we can then start moving to that next phase of looking at future expansions.
Lastly, I want to highlight and encourage any constituents who have patients on dialysis to also raise the question with their nephrologist or their health care providers as to whether a home hemodialysis might be right for them because that is an opportunity which, on a national level, Nova Scotia ranks quite low, which suggests that we have the opportunity to expand the home hemodialysis, which means that the equipment can be installed in your home.
You can receive the care and, in some cases, even have the treatment overnight while you’re sleeping. Imagine how transformative that can be to your lifestyle if not only do you not have to travel 60 kilometres each way, you don’t have to travel at all, and you don’t have to give up four to six hours of your day for treatment. You can have that treatment while you’re sleeping overnight. You actually get your life back in that scenario.
It’s not applicable or possible for all patients who need the service, but I want to make sure that as MLAs, if we know people who are receiving or in need, we might want to encourage them to have that conversation with their health care provider to see if it’s right for them, and we can see about getting them set up and address some of those underlying issues, as well.
COLTON LEBLANC: I appreciate that the minister has a good understanding of the issues that are facing my constituents. However, to address the home dialysis services, that’s not an option for many due to very complex medical histories with various co-morbidities. It’s understandable that the travel aspect is a huge financial burden on my constituents. I guess this is a two-part question for the minister: (1) is the minister and his department looking at other supports that could be provided to my constituents who are obligated to travel 1,400 kilometres a month to access these life-saving services; and (2) when can my constituents and Nova Scotians, from one end of the province to the other, expect another review of the dialysis services for expansion in our province?
RANDY DELOREY: At this point, our investments in expanding services, which is in the tens of millions of dollars to expand an additional - I believe the total number of seats at all the sites that have been referenced is about 42 additional dialysis stations or chairs. I think we talked about this previously: on average they are roughly $7 million per site for expansions, and there are five sites of expansion. I’m basing that off the math, not the exact numbers that are being looked up right now. That’s just for the capital investment. Then the operational investment that we’re making to expand these services - and when that analysis was done, they looked at the prevalence of the disease and the conditions to need the dialysis treatment, as well as the proximity to treatment. Obviously, the goal is to reduce the travel time. I believe under an hour was the goal at that particular point in time. That’s where many of these investments have been focused and targeted towards.
We are making significant investments to the specific programs and supports that the member has referenced. We don’t have anything in the works at the present time, because the folks have been on these expansions to reduce the travel time, so we can get these done, get those additional treatments, reduce the travel time for those Nova Scotians, and get that further assessment.
To the question of when is that further assessment, hopefully we’ll get that work under way once we get these new and expanded sites on stream and deliver the dialysis to Nova Scotians.
COLTON LEBLANC: Maybe the minister and his department could initiate the review and my Party could implement it when we are in government next time.
I want to speak a little bit to the effects of diabetes in our province. There are currently 113,000 Nova Scotians with type 1 and type 2 that are diagnosed, and that’s going to increase to 137,000 in 2029. I’m not going to get into all the statistics, but we’re going to see an increase in diagnosed diabetes of 21 per cent in the next 10 years.
Currently, the direct cost to our health care system for diabetes is $107 million, and that’s going to increase to $126 million by 2029. There are huge out-of-pocket expenses for the management of diabetes; it’s anywhere from $1,100 to $6,200 for various insulin pumps or insulin injections.
I could go on about the effects of diabetes to an individual’s life, an increased chance of mortality because of various co-morbidities.
I’d like to speak specifically about the Nova Scotia Insulin Pump Program and where that falls under the expenditures of pharmaceutical services and extended benefits. If I am looking at that correctly, Page 13.9, why is the age 26 years or under? There are probably thousands of Nova Scotians who could benefit from expanding that program, improving their quality of life. An insulin pump is not for everybody, but there are thousands of Nova Scotians who could have an improved quality of life, based on the availability and the expansion of this program.
I guess to start, talking about nickels and dimes, where would that fall under the budgetary line on Page 13.9, if I’m correct?
RANDY DELOREY: I’ll start with where the member started, which was back on the dialysis question and his suggestion that he would prefer to have us start it so he could implement it when he’s in government.
I’d like to submit for the record, I don’t think his constituents would want to wait that long. That is because it will be another couple of elections. (Laughter) I’m just not that funny. I’ve once been described as a robot but less interesting.
To the insured benefits for the Insulin Pump Program, it does fall under the Insured and Extended Benefits Program, and although that covers many other items, it is about just under $24 million estimated in the budget. That’s an increase of over $1 million, about $1.5 million, from last year’s budget. For the Insulin Pump Program, I think we’re estimating just under $1 million - a little over $800,000 - for that program.
COLTON LEBLANC: To the point of the set age of less than 26 years old, people who require insulin because of their diabetes, they don’t choose to become diabetics and neither do they choose to cease becoming diabetic. They could be a diabetic after 26 years old.
Looking at the potential positive impacts on the management of their condition, on their quality of life, on the long-term effects in the delivery of health care and managing any potential chronic condition that may follow - whether it be cardiovascular, renal, or eye problems, for example - if we can treat somebody’s diabetes better and avoid having them end up on dialysis, I think that would be a positive step.
Can the minister speak of the advantages and whether they’ve looked at possibly expanding the Nova Scotia Insulin Pump Program for more Nova Scotians to benefit from it?
RANDY DELOREY: Mr. Chair, I believe we already took steps to increase the age for the Insulin Pump Program. I believe it was originally a program established for up to 18 years of age. Then we did take steps, recognizing, just as the member had referenced - expanding that age, so we did take steps already to do that.
As with all aspects of our budget, we have to value our many different priorities to invest in, and at this point there’s not an expansion.
THE CHAIR: Order. Time has expired for the Progressive Conservative Party. We will now go to the New Democratic Party for 13 minutes.
The honourable Leader of the New Democratic Party.
GARY BURRILL: Thank you. In this closing section of the discussions for this evening, I’d like to direct a couple questions first to the minister about the growing health-related problem of obesity in the province.
In every category, kids and adolescents and adults, we have seen in recent years quite significant increases in the percentages of our population in the province that are obese. The health-related consequences of this are well-known and beyond anybody’s dispute.
I recognize that this is not something unique to Nova Scotia, and yet it’s something very important to Nova Scotians. I want to ask the minister first: Where in the budget might we look to see initiatives to improve the incidence of obesity in the province?
RANDY DELOREY: The concerns and the impacts of obesity on our health system and society at large are well documented. We’ve seen investments in programs, for example, with our orthopaedic surgery program. One of the important fundamental aspects of the initiative, as designed by clinicians and invested in by government that accepted the recommendations, included prehabilitation services, which ensured that people would get supports to get themselves into a condition - a physical state - to maximize the success of the surgical procedure.
What’s interesting - again anecdotally, as I haven’t received necessarily a specific report on this, but in conversations both with constituents who I know have gone through the program after these changes and with clinicians who have made comments - is that the prehabilitation, which resulted in many cases with weight loss, diet, and exercise, that in some instances they’ve actually resolved much of the pain and the challenges resulting in the referral for orthopaedic services in the first place.
That’s just one example of how the system is having impacts in our population but also how we are investing, not as a line item, specifically, on obesity but rather recognizing that these investments, even on the front end of the delivery of a particular service, can have positive impacts.
We have clinicians and supports like the Heartland Tour, which is targeted at heart health, but ultimately that heart health is predicated in overall physical health, and they do it through a bike tour across the province. As they tour, they talk about that important role within those with heart disease, cardiovascular disease - two very similar types of services and supports.
I’ve certainly heard from a number of health areas, and I see that common thread on that clinical - even on the treatment and the pre-treatment side of things. Looking at and seeing how we establish and define our policy and some investments in that space, that make sure that our investments in that kind of prehabilitation clinic type of supports maximize the health outcomes of the population.
On the other end of the spectrum, as the member rightly noted, we are having those challenges with our youth, as well. Of course, if our youth have unhealthy habits, that will carry forward with them for a lifetime, and it’s harder to break those habits. We talked about this with respect to vaping, so better to target.
That’s where work within our education system around ensuring healthy opportunities, including investments that we make in our healthy eating programs - just having my own children go through the education system in the schools, bringing healthy snacks to the fore. I remember in early elementary classes and the teachers would bring fruit and vegetables as part of a program. It all disappeared, despite people often suggesting that children prefer junk food. If, in fact, they are presented with healthy food options they will actually happily consume that healthy food.
That then brings up what I am going to anticipate the member is going to possibly ask, because he and his colleagues have asked it on the floor of this Legislature before: the cost of healthy eating and supports that are necessary there. That’s why we roll out programs and support an expansion of the school healthy eating program within our schools to provide those opportunities for our youth. That’s why the standard household rate provided increased investments to Nova Scotians with lower incomes. It’s why the Nova Scotia child benefit increases this year: to provide more money in the pockets of Nova Scotians with children so they can help offset costs to ensure they provide healthy food and nutritious options to youth.
It’s why the Minister of Agriculture and Fisheries and Aquaculture works with his stakeholders throughout the agriculture and fisheries industries to bring more local Nova Scotia products to bear in our environment, for the sustainable food security side of things, with an eye towards healthy products being produced here in Nova Scotia, whether they be our wild blueberries or other products being harvested here in the province.
As it relates to where the investment is, much like many of the other very important areas that the member has highlighted, it’s not necessarily a specific line item but rather an area that gets reflected in a variety of departments and a variety of areas within the health system.
GARY BURRILL: In addition to what the minister has said about the healthy eating programs and school programs, are there other things provided for in the budget that address obesity, particularly in children?
RANDY DELOREY: This is a very important topic, and I do sincerely thank the member because often it’s a topic that gets overlooked by society. The challenges with obesity are sometimes societal and the circumstances that one happens to be born into - we talked about the social determinants of health. It’s difficult to advance a healthy lifestyle, healthy eating, if they don’t have access. As I’ve mentioned, that’s why there are investments, from the Department of Community Services in particular, for those lowest-income Nova Scotians to access. It’s why there are investments in the Department of Education and Early Childhood Development, as I mentioned the School Healthy Eating Program. It’s why there are supports within the Department of Communities, Culture and Heritage, and under that, Sport Nova Scotia programming - so that they provide for recreational sport opportunities for Nova Scotians.
There’s an innovative program - I’ll put a little plug in for my own hometown - called Multisport, which was designed in Antigonish, with Sport Nova Scotia and St. F.X. taking leadership and then supported by our municipal governments, as well as the Province, to make it available and accessible to citizens and provide youth with access to a wide range of sports to participate in. Then they can have those opportunities that they might not otherwise have.
There are sports that youth - they’re not necessarily the most mainstream sports - get exposure to. It’s mostly about just getting out and getting active and being engaged, to help build that lifestyle that will carry forward if you have that active lifestyle as part of these investments in the sports programming.
Within the Department of Health and Wellness, certainly through promotion and throughout our health care system, our health care front-line clinical staff are certainly well aware of the importance. We have nutritionists and dieticians throughout the system to provide advice and support. I believe earlier in Estimates, the member for Pictou West, in discussions about the 811 system that I duly noted, was making broad assessments, but the one that really caught my ear was the notion of, possibly, dieticians through that kind of telehealth system to help support. It’s not something in this budget, but it’s one of the great things, I think, about Estimates debate, and debate in Supply, is that we can get these ideas to come forward.
A little late for this year’s budget, but certainly something we can be thinking about and looking forward to, because the challenge and the issue of obesity is very real. It is very real here in Nova Scotia and, indeed, across the Western world. What we can do is lead by example. Certainly, for those of us who are parents, to lead by example with our children, and perhaps sometimes that means not just exercising our thumbs on our cellphones or video games, but actually getting out - if they want to play EA Sports, how about you go and toss that softball?
THE CHAIR: Order. Time has expired for the Minister of Health and Wellness.
The time allotted for consideration of Supply has ended for today.
The honourable Government House Leader.
HON. GEOFF MACLELLAN: I move that the committee do now rise and that you report progress and beg leave to sit again.
THE CHAIR: Is it agreed?
It is agreed.
Would all those in favour of the motion please say Aye. Contrary minded, Nay.
The motion is carried.
[The committee adjourned at 9:08 p.m.]