HALIFAX, TUESDAY, MARCH 3, 2020

COMMITTEE OF THE WHOLE ON SUPPLY

6:18 P.M.

CHAIR

Suzanne Lohnes-Croft

THE CHAIR: Order. The honourable Deputy House Leader.

KEITH IRVING: Thank you, Madam Chair. Would you please call the Estimates for the Minister of Health and Wellness.

THE CHAIR: We will continue with the Estimates of the Minister of Health and Wellness.

The honourable Leader of the New Democratic Party.

GARY BURRILL: Welcome again. I have about three quarters of an hour for us to think together and there’s a range of things that I wanted to touch on. The first of them has to do with the provision of equipment to do with severe allergy treatments - about EpiPens.

We know that this is a lifesaving emergency personal medical device and that it’s not at all without expense. They are around $200 each, and everybody who needs one - who, of course, absolutely needs one - has to have a couple of them a year, and once you have them, they don’t last forever. They come with an expiry date and that is around about a year and obviously therefore for people with severe allergies, particularly who are in lower or lower-middle income situations, this is a significant difficulty and challenge - and we’re not speaking about a small number of people. We know that it’s in the range of 10 per cent of the population who are living with real life-threatening allergies.

I’m wondering if the provision of EpiPens on a public basis is something that is within the department’s consideration at all.

HON. RANDY DELOREY: I’d have to double-check. Specifically, there are a variety of means by which Nova Scotians obtain health services, which in some cases includes medication or equipment. Those include MSI, the medical insured services, that we provide but there are other means as well, including our various Pharmacare Programs, Seniors’ Pharmacare, the program being run by the Department of Community Services for those low-income Nova Scotians, that would be part of their program.

We do, within those medical insurance programs that do take into account people’s ability to pay for that insurance which is over and above our MSI insured services coverage, provide a variety of services and features.

To the member’s specific question, I do know that the EpiPen is included as part of that formulary, so we do, through a provincial insurance program, provide that coverage as well under our Pharmacares.

GARY BURRILL: Thank you for that explanation. I want to ask about something else that is a real continuing concern for people of middle or lower incomes, related to health, and that is hearing aids and hearing aid repairs. We hear repeatedly amongst our constituents what a real weight and life diminishment for a lot of people is their inability to afford hearing aids.

I think about one person in particular who didn’t have a great many financial resources who explained how she had purchased a hearing aid around five years ago and now it needed repairs and the manufacturer didn’t repair them any more, so would have to get a new one and it was going to be over $8,000 - it might just as well have been over $800,000, in terms of accessibility.

Now I know there are excellent programs for young people in hearing aids and that there are some fairly minor subsidies for older people. I think we are all familiar with the charities that provide financial support for hearing aid repairs and for hearing aid acquisition. I want to ask the minister if there’s any thinking within the department that we need to open up the door on this and get serious within our health care funding of Nova Scotia in the provision of hearing aids, so that everyone in Nova Scotia will be able to hear, whether they can afford to do that through the private sector or not.

RANDY DELOREY: Again, I thank the member for the question. The range of hearing and speech programs and services that are provided, in particular through Nova Scotia Hearing and Speech, is the main area and avenue by which we would provide supports. The relationship there from the Nova Scotia Health Authority is that’s an operational delivery of health services avenue. The member is correct, there are only some very limited avenues - I believe some might be related to Workers’ Compensation - for hearing loss, of actual devices being covered.

In this year’s budget we did not have a program or expansion allocated to cover those services, that is, the hearing aid equipment that the member has inquired about.

GARY BURRILL: Does the department have within its planning horizon programming that might extend to repairs?

RANDY DELOREY: At this point, I don’t believe we have anything allocated specifically for a program such as that in this year’s budget. I do take the member’s point on programming in this space, and I appreciate him bringing that forward. As we’ve established our budget going ahead for the various programs of the health system for the year, which relates to the programming and the funding in the budget as tabled by the Minister of Finance and Treasury last week, certainly, in this year it’s unlikely to see progress there but, again, as we note, opportunities to advance.

As we go through the budgeting process, obviously there is an aspect of focusing in on programs whether they be for expansions or new program opportunities. That’s what we do each year through the budgeting exercise and that’s what leads to the budgets that get tabled here. In this budget we don’t have, that I’m aware of, I don’t recall any programs specifically for hearing aid devices or hearing aid device repairs.

GARY BURRILL: From under the minister’s continuing leadership, can he see this area - both the acquisition of devices and funding for repairs for lower-middle and lower-income people - can he see this as an emerging priority for future budgets?

RANDY DELOREY: I would say that certainly each year whatever the forum, whether here on the floor of the Legislature or through interactions that we have as individuals within the department, myself as minister or our colleagues on any side of the Legislature with constituents who identify opportunities to strengthen our health care program and services - that does all come into the department, we take a look at and evaluate and prioritize.

Again, I can’t make any firm commitments as to outcomes but I will certainly commit to the member to go back within the Department of Health and Wellness to ascertain what research and work has been done in the past or to date in terms of evaluating this particular possibility. There are always pressures and challenges to expand the insured services provisions within the programming of the department. It continues to be a fast- rising area of expense, that is health broadly.

Unfortunately we have to make decisions each year that we come forward, but I’ll certainly endeavour to pull the information we currently have to see if there’s adequate information to consider the proposal brought forward going into next year perhaps, or if it’s a situation of further research delving into that as a priority amongst the many other competing health priorities that we have.

So, duly noted and we will take that recommendation, suggestion, forward for a future budget.

[6:30 p.m.]

GARY BURRILL: Could I then just ask the minister: Could he give some explanation about the thinking behind the fact that this has not been enough of a priority for the department for this to be included in this budget?

RANDY DELOREY: As you’d be aware, we have been very clear as to the broad stroke categories of priorities we have. We know the challenges that we have within primary care. We know how those challenges affect other areas within our health care system, including increased pressures within our emergency departments. Those emergency departments where, by volume, many of the visitors are deemed to have lower acuity, less-urgent care needs than is needed to be seen in emergency departments. Phrased another way, what I mean to say is that many of the visits to emergency departments across the province by volume with a lower acuity could be, or could have been, seen in a primary care setting.

As we strengthen our primary care throughout the province, as we see in the most recent updated 811 Need a Family Practice Registry numbers, which were just released earlier today or maybe online tomorrow if they’re not already there, we continue to see a reduction in the number of Nova Scotians registered seeking a primary care provider. Work still continues. We have more work to do - and that has been a major focus and priority of investments that we’re making in this year’s budget.

GARY BURRILL: I’d like to ask a couple of questions about the new organ donation program, the new framework that we’re about to enter into which, in our Party, we’re enthusiastic about supporting. I think everybody I’ve ever heard speak about it speaks about the enormous administrative challenges that it’s going to pose in its implementation in the province, and that there are administrative challenges too that go along with setting up an opting-out program and operating it.

This overall big change that we’re about to be going through with its inevitable, very major increase in the number of people making organ and tissue donations and the number of transplant operations, given that that’s going to be the case, a person would naturally assume that there’s going to be additional training for health care providers, particularly new physicians. As more and more physicians are going to be involved, it would stand to reason with this higher volume of donations that there would also need to be new policy regimes that would need to be developed and implemented.

All these things, surely, will have a financial impact on the budget of the department. So, could I ask the minister first about this: Does the present budget include any comprehensive education plan for current or future health care professionals related to our new organ donation anticipated regime?

RANDY DELOREY: What we have in place for this Human Organ and Tissue Donation Act is, from a budget perspective, an increased investment in this fiscal year. It’s about a $2 million increase, bringing the total investment around organ tissue donation to to $3.2 million. Again, that is an increase this fiscal year of about $2 million.

That increase, where we expect to have this legislation in place and actually proclaimed within and into effect in the Fall of this year, in 2020, obviously some of that increase goes towards the expected increase in organ and tissue donations that would be completed during the latter half of the fiscal year - the other funding goes towards those very costs that the member has referenced. Those costs of that relate to initial set-up of the program.

Two key areas are the administrative function which, by and large, are administered and will be affiliated with our MSI card registration, which is an existing administrative process for where organ donation in our current model of opt-in is administered and managed in relation to our Nova Scotia health cards.

We will continue to rely on the existing infrastructure with some modifications to enable that system that tracks the information to enable that opt-out option. So, it is with some technological adjustments there, we are actually engaging the public now on some input on the exact phrasing of what the updated Nova Scotia health card will look like, exactly how we want to identify one’s donor status on the donor card. If you pull out your MSI card you will see that there is currently a flag identified. There are some discussions and consultations ongoing to determine what Nova Scotians would like to see there. On the administrative side, some of the costs are covering those system updates and changes.

The last part of the member’s question was about education. Obviously, when we brought forward this piece of legislation there was a recognition of the need to hire additional staff - specialists, nephrologists, and transplant surgeons - to manage additional cases that would need to be done. It also recognizes that to successfully achieve the outcomes that we are all striving towards here, which is more lives saved, it does require engagement and education, particularly in our more rural settings in the number of instances where a donor situation may arise. Those are still very sensitive conversations to be had and there is a certain amount of training and education to help support those front-line health care workers who have to lead those conversations.

Earlier this evening the member noted that in his former role, or it might even be his current role as a minister, but I’m sure in his role as a minister he has had to have some of those challenging conversations. So, we have heard from those involved in transplant and organ and tissue donation that providing that support and that education - so again, part of that $2 million increase goes towards that.

I believe they have already hired the leads within the Nova Scotia Health Authority and the IWK lead to go out and support and lead that education in both the Nova Scotia Health Authority and the IWK. There will also be information and investments in the educational regime to promote and market to advise Nova Scotians.

Once the technical configuration system is complete, Nova Scotians who may choose to opt out can register their desire and we will have that up and running before the actual implementation date. We do expect to have that up and running in the not-too-distant future so there is lead time for those Nova Scotians who may choose to opt out, they would be able to do so. In the system we would be tracking that information so when it goes into effect those wishes can be respected right from that moment in time.

GARY BURRILL: That kind of educational programming is just exactly what I had in mind. This is not a kind of box on a form to tick - the conversation has been had, but it requires an extraordinary sensitivity.

Could the minister characterize out of this $2 million of the $3.2 that is the budgetary increase for the new program, what part of that is allocated to education, and is there an educational component in addition to the part we have just spoken about?

RANDY DELOREY: I don’t have the specific breakdown. As I’d noted, what we’ve done is we’ve really taken the lead from the team - Dr. Beed and others are the leads within our organ donation program, and we rely on them to design and deliver those programs within the system. This increase is an increase that transfers over to the Multi-Organ Transplant Program administered by the Nova Scotia Health Authority and then they ensure the funding gets redistributed and allocated.

As far as the educational specifics of the program, I think, again, really those two main streams, how much further those streams might be broken down I don’t have the full details with me. But, again, the two main streams being provider, health care front-line training support, then how to identify and how to have those conversations with families when or if circumstances arise, but also then the education of the general population so they understand their rights within this legislative framework and the legislation governing an opt-out provision.

We do respect all Nova Scotians and their right to choose, and this legislation maintains that right to choose not to be a participant in the donor program. So, it does respect that right. We want to make sure that part of that education that goes out is to ensure Nova Scotians are aware of the changes so that they can exercise that right. Part of that does require an education campaign. Those are the two main streams, the details though are really left to the experts in the field, particularly on the transplant clinical side.

GARY BURRILL: I’m thinking then about the overall $3.2 million and the cost that must surely is going to be required to administer an opt-out system. When a person thinks about it, it’s a pretty major administrative undertaking.

Can the minister characterize the financial implications of setting up an opt-out system and how much of that overall budget is allocated towards it?

RANDY DELOREY: I guess in principle, to some degree, I can appreciate the member’s characterization of the administrative framework, as I believe the language was “complex.” It’s certainly important, but not necessarily complex. I don’t know that I would necessarily describe it as a complex system.

[6:45 p.m.]

Recognizing in the first instance that we already have an administrative system in place which tracks citizens’ organ donation preferences in an opt-in framework, our design approach is not to throw the baby out with the bathwater but rather to leverage the administrative system we have in place, and enhance it so that it does provide that opportunity for opt-out. That does require some technical changes on the back end of the systems that do the tracking which is that MSI system that tracks our our health insurance information - which is where the current opt-in donor preferences are recognized. That is administered by our third party that administers our MSI insurance, including the cards.

Those cards and the back-end computer system will have that information that is part of the system. It will lead to changes on the front of the health cards, as I’ve mentioned in my previous response, which currently identifies an opt-in portion which is the current model. It will be changing the way that that flag is represented.

Within the health system, when a health card is presented or made available and that provision is made aware of to the health care providers in an individual circumstance, they would see that visibly on the card. Also, if they have the MSI number for the individual when they log onto the computer system, they will see it as well.

In addition, part of our efforts with this opt-out provision is to actually enhance and streamline our administrative burden for Nova Scotians themselves, and that includes efforts that are under way to provide online options. The advantage of this is that, ideally, we will be able to leverage that for online MSI card renewals as well. So, there’s work looking at and evaluating how we can leverage technology to reduce the overall administrative burden, even though there are some upfront technical and restructuring costs associated with it.

Again, I wouldn’t classify it as overly complex. It is very important, of course, but we don’t see it as being overly burdensome on the system.

GARY BURRILL: Thinking again about the $3.2 million allocated for the area, are there other budgetary costs associated with the Organ and Tissue Donation Program that are elsewhere in the budget in addition to that $3.2 million, or is that pretty well an exhaustive figure?

RANDY DELOREY: There would be costs - they are not costs that can be easily teased out. As noted, the transplant program and the investments there are really part of the overarching program that manages the entire organ donation. We would have additional costs in the physician services budget for physicians who may not be part of the program, but in a given instance they may be part of the team and be providing health care services.

So, depending on to what level of detail one breaks it down, there would be costs incurred. We see those and they would be captured in a broad, overarching health care delivery. They wouldn’t necessarily be mapped back into the overarching because it would be the specialists that are captured and their services and work there. So, really this is the big thing.

I think there is also, within the NSHA Legacy of Life, some programming and investments, but I believe that’s administratively managed over at the NSHA and the work they do there.

GARY BURRILL: Does the department have projections about the anticipated trajectory of donations over the coming years, and then with that, associated increases in necessary funding?

RANDY DELOREY: We certainly have data with respect to our expectations this year, recognizing that this is expected to come on stream in the latter half of this fiscal year, in the Fall of 2020. The estimated is for an increase of about 10 additional organ donors and about 130 additional tissue donations being made within the system. If we were to forecast that out on a full-year basis, you could probably double that donation to about 20.

Over time the familiarity, the education and the experience of our front-line health care professionals, but also as a society “mature”, I guess would be an appropriate word - we may see further growth beyond that.

In terms of the pressure and so on, we would factor that for the future years, based upon if we see the estimates from this year, how they materialize, that will help inform the budgeting process and the planning for the future years.

We do recognize that the delivery and to achieve these outcomes includes hiring up to 27 people as part of this program and service - that’s people within the Legacy of Life program, the Regional Tissue Bank and the Multi-Organ Transplant Program. So, a number of clinical and administrative support to personnel who were identified as needed to ensure the actual delivery of care and maximizing value to delivery, and the lives that are saved and transformed based upon the availability of increased donations through these programs.

GARY BURRILL: So thinking about the projections the department is working under, looking towards the inevitable increase in donations that there will be, did I understand correctly that the thinking at the moment is to take that first year of operation and to see what kind of a change happens and then build planning from there? Or, are there any other longer term, say, five-year, ten-year pictures, working in the department besides that at the moment?

RANDY DELOREY: Not exactly. From a budgeting perspective, I guess what I was attempting to articulate in my previous response was that we are in the current budget year, we have forecasted, which is a little bit different than a normal year. Any time you’re in the first year of your set-up, because you’re breaking down your costs with the actual set-up and kind of one-time initiatives, and then you have your operational piece, that you’re expected to see some increases. We’ve noted what the expected increase on the operational side would be and that’s based upon, roughly, a half a year, with a Fall implementation - a little bit less than half a year, so you would see something in doubling that as a rough rule of thumb.

I’m almost certain that when we tabled this legislation, we did have some broad estimates as to that longer term - unfortunately, I don’t recall what the numbers were off the top of my head and I don’t want to misspeak - I’m almost certain that if we go back to the announcement of this legislation, about this time last year, we would see exactly what those numbers were. Again, when we’re building the budget with our partners on the operational side, they provide the input each year as to what they’re anticipating and forecasting.

That’s why, when I was trying to be a little more exact, saying that yes, next year as part of the budgeting we will get advice and information from the Nova Scotia Health Authority which would be collecting from their various operational units, which includes the organ and tissue donation and transplant programs to help inform the budget needs that we would anticipate which, of course, is driven in many cases by utilization and demand.

That’s why I was referring to it. It’s not that we’re just kind of twiddling our thumbs and waiting to see what happens, but rather that the projections are just that right now - broad level projections. The percentage, I just don’t recall off the top of my head. We don’t seem to have it here, but I think we did have it. I’m almost certain when we tabled the legislation that we had those discussions last year.

GARY BURRILL: What I was really wondering about was the rough sense of a potential trajectory of increase for budgets, not so much the operational side. Are we looking at, over the next years as we move from our present situation into the new regime, a steady escalation in the budgetary allotment to the program, let us say over the next, for example, five years?

RANDY DELOREY: I believe, if we’re talking on a financial scope - again, these would be preliminary as part of that, as the member would say, forecasting exercise - I think more of projections out, seeing the program’s operational budget and investments potentially growing to about $4.5 million.

This year not quite being comparable because we do have the set-ups and so on. In the early years, we would have, if we assumed the same budget, but money’s not going to those new administrative investments at the front end. That same budget amount next year would actually allow for an account for increased operational services and supports for the same total budget amount. Even though we may see more in next fiscal year, we may not necessarily see a corresponding budget increase, recognizing that this year’s budget is allocated on the basis of some set-up costs.

For future year projections, there has been a broad stroke estimate of possibly a $4.5 million program that it could grow into - until we see how exactly the program plays out, the degree of certainty as to that as the actual outcome. The advantage is that with that number would come several more organ tissue transplant donations, which means transformative, life-saving delivery. I think a very good investment. That’s the ballpark that we’ve been looking at in this and the, kind of, permanent or steady state that we would expect out of this program.

GARY BURRILL: I certainly agree. It’s not only a good investment, it’s a very fine initiative and something that I think the government must surely be proud of. It’s going to do an awful lot of good for an awful lot of people, including those who are having to deal with loss. I thank the minister for attending to some details about how the program is going to be set up.

I’d like to switch gears a little and ask a couple of questions about a subject that has come on our screen publicly in a way that it really hadn’t before, and that’s the subject of vaccinations. We know that the Public Health bottom line about this is beyond debate - there aren’t any dissenting voices amongst major international health organizations about the importance of vaccinations. If we had a grocery cart here full of credible, peer-reviewed studies, they’d all say the same thing.

I wonder if we could begin thinking about this sometimes oddly contentious subject. What part of the budget, what extent of the budget, what is the framework of the budget related to vaccinations?

[7:00 p.m.]

RANDY DELOREY: We’re just continuing to consult with the budget documents here for the bottom line the member is looking for, but two quick comments while we’re pulling that information together: the first is on the previous like of questioning. I just want to acknowledge and thank the member.

I recall when this legislation moved through, I think there was unanimous support within the Legislature on the legislation, I would just like to put on the record. From the government side, the leadership that the Premier has taken, much like the Leader of the NDP, who just commented about how significant this legislation is. Again, with this particular path the Premier took a very keen interest, as did several other government members. When the legislation actually got tabled here, I think all members of the Legislature took a very keen interest in the supportive role with the legislation. I thank the member for bringing it to the floor again here this evening.

As it relates to vaccinations, in this fiscal year we are looking at just over $10 million, I believe, going towards that service that you would see reflected in Communicable Disease and Prevention. So, $10.2 million is what we see for the entire communicable disease and prevention programming. I believe vaccinations are roughly 20 per cent of that. That includes some other treatments, including biologicals, in that line item, I believe. So, vaccines is about just under $2 million.

We do have an increased investment in vaccination that we announced, that took effect in January 2020. That is the introduction of the rotavirus vaccination for youth. Again, the vaccination program, like many health programs, continues to evolve. That evolution of the program, I believe, in the year prior we introduced the high-dose flu vaccination for the first time within Nova Scotia, targeted towards our senior population in long-term care or continuing care settings, institutional living - and that was identified by public health officials as the highest risk areas - where people are living in close proximity.

We do continue to evolve our vaccine and vaccination program, and we’ve done so - again, those are just two examples - in the last couple of years, while continuing to provide the programming of the vaccination schedule as covered in our programming.

GARY BURRILL: In addition to the addition of the rotavirus funding, could the minister then characterize the pattern of increase in vaccination funding over the past few years, let us say the past five years? Are we looking at a steady pattern of increase or, minus rotavirus, more or less the same?

RANDY DELOREY: I want to just clarify; there was a little bit of confusion on the financial numbers in my previous response - so if you will scratch that. The $10.2 million that falls under Communicable Disease and Prevention is all vaccines. There are multiple types of vaccines, though, so that is where some of our confusion came from in reporting the financial numbers. We do have a breakdown here. Again, there are three different CDP program deliveries in tonics and biologicals. Again, that comes out to a just over $10 million budget, so they do all fall under the vaccine space.

By and large, a significant part of the increases are the new vaccines we bring on stream for the delivery of those services and the vaccines. We’ve also seen, particularly this year, an increase in our regular flu vaccine. We invested in that and brought it on stream. We did anticipate higher demand. We don’t have the utilization data back yet, as we’re just hitting the peak - I believe we’re on the start of the downside of the peak flu season. But initial response was very good to the vaccinations there. But the regular kind of vaccination schedule, I think, is roughly consistent with the trends. The corresponding budget would align with that, as well. Again, with increased awareness of flu vaccines we’ll see that. Obviously, the COVID-19 doesn’t have a vaccine yet.

THE CHAIR: Order. Time has elapsed for the NDP. We will turn it over to the PC caucus.

The honourable Leader of the Official Opposition.

TIM HOUSTON: Thank you, Madam Chair. The current plan has the Nova Scotia Cancer Care Program moving to the Infirmary site. Why are we moving these services?

RANDY DELOREY: I thank the member opposite. As the member would know, as we’ve communicated throughout, the work for our redevelopment projects, be it in Halifax or Cape Breton - we’ve made it clear we would consult and engage with front-line health care providers to provide that input and advice to the program and design teams. That recommendation - I believe the Premier spoke to it earlier today in Question Period - had advice from the leads within the Cancer Care Program within the province that was fed into the lead team designing and preparing the work to bring forward to government. We took that advice and it formed part of the proposal and the project that has launched the RFP for the redevelopment here in Halifax.

THE CHAIR: The honourable Minister of Municipal Affairs and Housing on an introduction.

HON. CHUCK PORTER: Thank you very much, Madam Chair, I appreciate it. I just want to introduce our MP for Kings-Hants, Mr. Kody Blois, who was elected last year. Nice to see you in the House, Kody. I’d like to ask the members to give him a warm welcome tonight. (Applause)

TIM HOUSTON: Nice to see Kody in the House today. Maybe he might have missed it this morning when Lenore Zann was referred to as the best Liberal Member of Parliament from Nova Scotia. But I won’t tell you who said that, Kody. Thank you for joining us.

I’d like to ask the minister: Was the move of the Nova Scotia Cancer Care Program to the Infirmary site, was that a recommendation of the Deloitte report?

RANDY DELOREY: As the member would know, the details with the Deloitte assessment to support the planning and the negotiations of the redevelopment project, I believe that the member is referring to, is something that is informing the negotiations taking place through the RFP process and those details would be made available when the process is complete.

TIM HOUSTON: Madam Chair, I guess at issue is that many of the services could be administered equally well at the existing site without a loss of effectiveness. The current site is not outdated and we could save, as a province, millions of dollars by not moving it. I think it’s an important question of why we are moving these services? Because we know that those millions of dollars that could be saved by not moving the services could certainly be used elsewhere in this province.

I would like to ask the minister: If the Cancer Care Program was to remain at its current site, would there be any significant impact on ambulatory patients who are requiring radiation treatment? Would there be any impact on the actual patients for leaving it at the current site?

RANDY DELOREY: The advice and recommendation and request that was made of us by the cancer care team did flag that, in light of the ongoing redevelopment project, the recommendation to move the cancer care services, particularly recognizing the patient impacts, particularly for those most frail patients who would be on an in-patient basis receiving care, the need - because if the site did not move they would be located at the QEII Halifax Infirmary site and would have to be transported and then transported back while in a vulnerable state. That, in a high level, was a significant part of the patient safety outcomes case that was brought forward by the cancer care team to support the advocacy for, ultimately, the design change that has been pursued.

TIM HOUSTON: Yet again, in places like Toronto it’s working just fine, where patients can be moved a very short distance - and we are talking about a very short distance in this situation, but we’re talking about a significant add to the cost of the project. I’m just wondering if the minister can articulate the benefit of moving it to the Infirmary site.

We’ve all been reading the editorials from front-line workers who think this is not necessary and I understand there are a lot more people with a lot more to say on the reasons it is not necessary, as well, but they’re not able to find their voice on this for fear of repercussions.

There are obviously impacts on the cost but certainly moving the cancer care program to the Infirmary site will have another impact, which we know about, and that’s on the parking situation because it will cause the demolition of existing parking spots.

I’d ask the minister one more time if the minister is able to articulate what the actual benefits are of moving it because they are not obvious to most Nova Scotians. He has raised an example of - well, moving some patients might be a problem but it’s not a problem in other areas. For what’s at stake here, I’d just like to ask the minister again: Can he articulate what the actual benefit is to patient care for moving the Cancer Care Program to the Infirmary?

RANDY DELOREY: Madam Chair, I believe I answered that in the previous question. As it was brought to us by those representatives of the Cancer Care Program, as to their belief, as to the patient quality and safety value of making this move. It is not necessarily something they would have advocated for in the absence of the fact that we were developing a plan for infrastructure for the future of the province.

[7:15 p.m.]

Those changes that were identified - this is a once-in-a-generation sized health care infrastructure revitalization initiative. That means that when we are evaluating and making the decisions about these investments we’re making today, the decisions we are making are looking forward to the future for many, many years. The opportunity to address the overarching health care infrastructure challenges within these sites, the overarching consensus around the co-location of all these services at this point of our redevelopment project, is what came forward.

We accepted those recommendations. As mentioned to the member, the cancer care team did bring forward and made the case to flag on those grounds, as far as to how that clinically breaks down on an individual patient impact basis. I defer to those experts within Cancer Care Nova Scotia because that is who we rely on for advice and recommendations. But we do recognize what this investment means for Nova Scotians, this means modern equipment and service delivery. That equipment will ensure that Nova Scotians have access to the most modern cancer treatments available when this redevelopment is completed.

That has patient outcomes. The member may be aware that, with advances in radiation treatment and technology being made available, there are significant improvements. One example provided by Dr. Bethune in conversations was advances in radiation therapy that allow for reduction from, I believe, dozens of radiation treatment requirements.

For example, a patient with breast cancer, having fewer treatments necessary, based upon the ability to target the cancer more effectively and accurately. If I recall correctly, from a couple of dozen treatments down to as few as five.

Having fewer treatments means less impact on the patient. Less exposure to harmful radiation for an otherwise healthy individual, by targeting it, means less residual damage within the healthy tissue and cells of the individual.

There are a wide variety of opportunities, as well, for research opportunities with the modern equipment. That provides opportunity within the modern health system, which ensures that the cancer care services and the enhancements available and afforded by this investment will translate to research, and that includes support for recruitment and retention of the oncology specialists necessary to ensure that the utmost, top-notch quality of care is being provided to cancer patients throughout Nova Scotia by virtue of this change.

I hope that addresses the member’s question about some of the benefits and the clinical patient safety aspects that have supported the advocacy made by Cancer Care Nova Scotia to have this change included as part of the redevelopment project on behalf of Nova Scotians.

TIM HOUSTON: Maybe the minister can clarify. It seems as though the minister is implying that we can only have this new equipment if we build a new building. My understanding is we have a perfectly good building and we’re going to tear down a good building and tear down a good parking lot so we can build another building somewhere. Certainly oncologists have spoken out against this. I know the Premier appeared to be very dismissive of Dr. Bernard Badley. He kind of referred to him as a retired guy. I think there’s a value to people who have worked in the system. I respect their opinions, possibly more than the Premier might.

Is it the minister’s assertion that we can only have this new equipment if we have a new building? Is that what the minister is saying, because I suspect we could probably have more new equipment if we didn’t waste money on tearing down buildings that don’t need to be torn down. Is it the minister’s position that we could only have this new equipment in a new building, it can’t go in the existing building?

RANDY DELOREY: The member makes reference to individuals that are opposed to this part of the redevelopment project. I’m not aware of any concerns being raised. This project was originally announced in several - the details, even, were over a year ago when the details of this project were announced. We are well down the planning and RFP process to raise those concerns. The development and preparation for this project were under way for a period of time prior to that, prior to those details being announced when the new generation project was officially launched. Both at that time and subsequently, the information and the awareness that this cancer program was changing, was part of the program design, was noted as a part of that work.

Off the top of my head, I don’t recall any correspondence or outreach that came to my attention at the time that we made the announcement, or subsequently, that would indicate anybody was opposed to this particular course of action. In fact, all the feedback that I have received to date, short of the member’s concerns being raised here, which I believe are predicated on some public correspondence through the media, that have been broaching some concern with that from an individual.

I want to reiterate the amount of time and energy that this project has taken in the planning stages. The effort and work that was undertaken - the preliminary work to identify what that master plan for the transition of health care services would look like. This effort and work within the QEII redevelopment, we have to recognize, is looking forward. It is a multi-site project, where we see expansions over at the Dartmouth General providing opportunities to expand health care services and health infrastructure at that site, to support the transitioning of services from the existing VG site to over there, while we see investments, as well, in the Hants area - opening up an operating room that hadn’t been operational for decades, while modernizing the other existing room, as well.

Again, the overarching review and feedback was provided by the clinicians who were engaged as part of the planning to identify what services had to move, what services were desired to be moved, what the clinical rationale was for advancing those changes. That work all preceded the announcement as to what the QEII New Generation Project was going to look like. We took that advice, a significant amount if I recall correctly. There were over 300 clinicians throughout the consultation process there to look at how and what services needed to be moved.

I know the member is focused here on, specifically, the cancer services. As I’ve previously stated, we heard from the leads within Cancer Care Nova Scotia that they had particular concerns that for patients who are the most ill, cancer patients within the province who would be receiving care and in-patients within the HI site, that after the redevelopment was completed and the VG site decommissioned, those patients would be located at the new HI site with the upgrades.

The concern that was brought forward is that those most ill cancer patients in the province would be expected to be brought down, transported to receive that treatment, and then transported back. That was a particular concern that was brought forward that this government recognized. We are making a once-in-a-generation investment to modernize, not just our health care infrastructure here, but indeed a significant portion of our tertiary and quaternary health infrastructure in Halifax that services not just the peninsula, it services not just HRM or the Central Zone, it services the entire province and, indeed, much of the Maritimes and, in some instances, people from all of Atlantic Canada.

To the member’s inquiry as to whether or not this particular investment decision to support cancer care enhancements is something that could - how did he phrase - whether equipment could be updated. Equipment can be updated, of course, but with this opportunity, the concerns that were brought forward to us and presented to us as a government, saw additional rationale. They recognized that the movement of the in-patient services from the VG over to the new location at the HI, would create concern, that there would be patient safety concerns about that potential for negative impact to those most ill cancer patients in the province. That is the beginning point of the case being made for the advancement.

I think the member opposite has started with the premise suggesting that new equipment was the starting point. That wasn’t the starting point of the decision here, Madam Chair. The starting point was patients and, indeed, those most ill patients within the province and under the care of the Cancer Care Program. That was the starting point. From that evolves the opportunity, then, to obtain the new equipment as part of this redevelopment.

If new investment in the infrastructure for a Cancer Care Program was to be made, the question - again, if the member wants to frame in hypotheticals - if one was to create the Cancer Care Program with new equipment, would they be creating it at an alternate site or would they be co-locating it? What is the design for standard of care and target objective to maximize the positive health outcomes and minimize the strain on our sickest Nova Scotians in need of that care?

[7:30 p.m.]

This government accepted the recommendation that was brought forward to us as part of the preparatory work on the design of a redevelopment project, the likes of which, from a health care perspective, have never been seen in the province. It is a project on a scale that hasn’t been seen in the health care system but also one that is long overdue. That is why we’ve relied, throughout the system here in Halifax, to hear from those clinicians who are affected by the redevelopment initiative. It is a very similar process that took place in Cape Breton to engage with front-line health care professionals to inform the design for the clinical needs of the redevelopment project. Those needs were the foundation of the planning process at each of those sites. Again, I can’t imagine that the member opposite is suggesting, given how frequently he and his colleagues across the aisle have been on the record demanding, in particular within the health care space, that we need to listen to our health care providers as part of our planning for health care delivery. That is exactly what our redevelopment projects here in Halifax and in Cape Breton have been founded upon.

We will continue to engage as the detailed work within these redevelopment projects continues down that path. As I’ve said, and answered the member’s question, the foundational starting point for the cancer care development here in Halifax being moved as part of the QEII redevelopment was predicated on patient safety. That is the driving force. The member was asking for information. That patient safety then expands, besides just the scenario presented, to the other aspects of that new technology and investments in equipment and new opportunities for modern cancer radiation delivery that the transfer and development of a new cancer centre at the HI site affords Nova Scotians. Again, I doubt that the member is suggesting that Nova Scotians deserve anything less. The starting point - as I’ve reiterated numerous times, but the member asked multiple times so I’m taking the time to ensure that he’s aware - was that the patient safety aspect was the driver here.

The member cited, multiple times, allegations of concerns that this is not something supported by health care professionals. I’ll reiterate that this is not something that has ever been brought to my attention. I’m certainly accessible, Madam Chair. My contact information is available on the department’s website for people to reach out and express those concerns, particularly health care professionals. This evening, the member has made an allegation, which I’ve heard in the past by members opposite, about health care professionals fearing retribution to speak out and provide criticism. Yet we can look at media outlets over the last number of years; there are many health care professionals on the front line who have publicly criticized aspects of the Nova Scotia Health Authority and/or government.

I’m not aware of any retributions that have been brought forward. I don’t know why the member would suggest that was something that took place, or why health care professionals may feel that. Again, I’ve never advocated, or advanced in any case, nor have I heard or seen, to my knowledge, retribution being made for individuals who have publicly criticized the Nova Scotia Health Authority or the government. Again, I submit to the members of this Legislature, you only need to look at the many news articles that have been tabled by the Opposition over the last couple of years, the many references that have been made to statements by health care professionals expressing their concerns over aspects of changes within the health system that they didn’t advocate or support.

With the work that is ongoing here, in the QEII and Cape Breton redevelopment projects, we start by recognizing and acknowledging - I think all members of the Legislature agree - that the VG site needs to be dealt with. If we can start to see where we build consensus, that site needs to be replaced. Governments of the past, for far too long, ignored the need. They never developed the plan or set aside the financial resources to invest in either maintaining or replacing that aged piece of health care infrastructure.

One of the major projects, obviously, that we’ve undertaken is to do the work of the redevelopment. The work started under my predecessor, the current Minister of Communities, Culture and Heritage, the former Minister of Health and Wellness. That began engaging with the teams within the Nova Scotia Health Authority and Transportation and Infrastructure Renewal to pull together and solicit the requirements that a redevelopment project may require. That work continued through the work of representatives within the Department of Transportation and Infrastructure Renewal, our partners with the Health Authority, as well as the Department of Health and Wellness, to ensure that voices, particularly clinical from the front line, have the opportunity to provide input on both the absolute requirements and the desired changes to be made to meet the health care needs.

We are not looking at a redevelopment project that merely mirrors the existing infrastructure within the VG site, but rather - since we have to go through such a significant cost - one that in our redesigning, we don’t just take what is there. We evaluate and say, where are we going with our health care system design and delivery? What will that look like? What we do there is take that clinical advice and feedback that informed the master planning work that framed the overarching requirements that have been advanced through the RFP process to have this development work done.

The significant undertaking recognizes that it was not just an opportunity to build a replacement for the VG and those new services right here on the peninsula, but also a recognition that this was an opportunity to modernize and distribute, and recognize that, as a single Health Authority delivering care to Nova Scotians - be it cancer care, surgical care - that those services can be provided elsewhere. Some of the expanded service delivery and infrastructure investment was most appropriately distributed to other sites, as well, including the extensive expansion and renovations that have been under way at Dartmouth General Hospital, the Hants hospital, the Bayers Lake development as well.

There are many different aspects to this project. I know the member just asked, specifically, on the cancer care side of things. To the member’s point that he has asked multiple times this evening, when brought to our attention, there were other circumstances, driven by clinical patient care needs, that were wrapped up in the proposal, as I’ve flagged previously, that relate to the opportunities that the new technology provides. Recognizing, as well, that much of the technology in the existing site would be coming up for replacement at some point in the not-too-distant future.

We are looking at a 50-year project to build and design. I can predict what he would suggest is: Well, why don’t you leave it now and do the cancer care piece later? You see that in sites like Dartmouth General that had a floor on top of the building that was never utilized. It was designed and built there with the intention of expansion. It took decades before a government came along willing to make the infrastructure investments to leverage that space, to provide the care and show the respect to the people on the Dartmouth side of the harbour, that we recognize the valuable health care contributions they make, again, not just to the citizens in and around Dartmouth but as part of the integrated Nova Scotia health system. That was a starting point for much of the work that’s being done and continues to be done at the Dartmouth General site.

Again, I am happy to continue the discussion with the member opposite but I believe I’ve answered the question he posed about the equipment and whether that equipment needed to be moved or what the rationale is for the move of the cancer centre from its current location to the HI site as part of the QEII redevelopment.

TIM HOUSTON: I appreciate the minister’s response and there will be lots of time to talk about this. I recognize that the minister said he hadn’t heard any issues about this redevelopment. Perhaps he was out of province or out of the country when the parkade issue was happening. For sure, that was certainly something that opened the door and shone the light on what was happening to a lot of Nova Scotians.

Look what happened when the lights went on. There’s going to be a little change, I think, around that. I think that in the fullness of time, we will see that this will also happen because Nova Scotians are concerned.

This government can’t get this wrong and we look at the major capital projects from this government. Maybe somebody can point to one that they got right from the beginning. Can’t get this one wrong. I think when you have oncologists speaking up - the minister said he wasn’t aware of anyone getting retribution for speaking up. I think I informed him, maybe jogged his memory, of at least one and there will be numerous other ones, as well.

The point is that we have questions being raised about this and we have a track record of a government that tends to get things wrong and those are valid concerns of Nova Scotians. With those few words, I will pass the remainder of my time to my colleague, the member for Sydney River-Mira-Louisbourg.

THE CHAIR: The honourable member for Sydney River-Mira-Louisbourg.

BRIAN COMER: I might get one question in. I’m going to switch things a little bit, Madam Chair, and focus on some mental health and addiction issues, specifically in Cape Breton.

I have an article here from 2018. It interviews a local psychiatrist in the area. I think at that time there were about 11 psychiatrists in Eastern Zone and there are about 120 in Halifax and the surrounding area. I wonder if maybe I could ask the minister to clarify that ratio to the present day and what issues are ongoing with recruitment and retention for Eastern Zone, Madam Chair.

THE CHAIR: And you will table that?

BRIAN COMER: Yes, it’s right here.

THE CHAIR: Okay, thank you.

[7:45 p.m.]

RANDY DELOREY: Thank you, Madam Chair. Certainly, I’m just seeing if we can track down the specific current vacancy numbers there that the member has asked for. In the meantime, I think I’ll answer some of the context or the background. First and foremost, I think we’ll come to an agreement and acknowledgement of the fact that we have vacancies, particularly around psychiatry, in the Cape Breton region. That is something I spend a significant amount of time on. In fact, when I first got appointed in 2017 - and it’s one of the reasons I’m not necessarily known as one to set people’s expectations high because if people go back and look at about August of 2017, as I was getting my feet under me and proceeding with a tour around the province, there was an announcement that went out that said there were three psychiatrists that had been identified and had accepted positions in Cape Breton.

Unfortunately, I don’t think a single one of those three, who were publicly announced as committing to joining the team at Cape Breton Regional, ended up, for various reasons, making that move. A number of them were personal decisions, circumstances that did change. Often when physicians are committing, they commit 3 to 6 months in advance and life does happen. In this case, I truly believe people had committed with the best of intentions. Public communication had been made. Expectations were raised at that point in time, both within the community, but equally as concerning, expectations within the clinical community.

Subsequent to that, obviously there were concerns when it became apparent that those individuals were not joining the team. I will acknowledge, Madam Chair, the amazing fortitude of those front-line mental health clinicians, including the psychiatry team at Cape Breton Regional. I’ve met with members of them, some formally, some informally. One individual in particular that I met with on multiple occasions to truly understand and appreciate the challenges being faced, but also to receive recommendations and suggestions of steps that could be taken to try to support the team that’s in place and the work that they were doing while the recruitment efforts to fill the vacancies could be done.

The member just referenced, and even though I don’t have the number, the difference between the number of psychiatrists in Central Zone versus, in particular, the Cape Breton Regional portion of Eastern Zone. One of those requests was, essentially, how do we get more support from those areas like Central Zone that have a higher degree of support to come in and help us, to help those in parts of the province that are more acutely challenged, which would be Eastern Zone and Northern Zone in particular.

We took, essentially, those recommendations and included a compensation change, particularly targeted toward psychiatrists in those zones that had an acute volume of vacancies. It included changes to the engagement in other zones, to have locums and other telehealth services implemented to support those on the front lines. I don’t think I have the specific number, but if the member wants to continue with some questions, if I do get that information tracked down, I’ll interject it in a later response.

BRIAN COMER: I do have some time constraints. I’m going to switch things up, Madam Chair. My next question is going to be in regard to the Cape Breton health care redevelopment, which has been a significant topic of discussion in this House throughout the last number of weeks. A cornerstone belief with the health care redevelopment is if we build it, they will come. There’s much worry in Cape Breton that, as I’m sure you can understand, what if they don’t come? How does this conversation look in the department if there’s a brand-new building with no doctors, no nurses to staff it?

RANDY DELOREY: I think the fact remains that the redevelopment work is a necessary part of infrastructure refreshing within the Cape Breton region, much like it is here in Central Zone, and that work is under way. The underlying premise and motivation of the Cape Breton redevelopment is not as a recruitment strategy or initiative. That would be a very expensive process simply motivated to support recruitment initiatives.

We have certainly made reference to the fact that because of the redevelopment, the acknowledgement of aged infrastructure and program delivery within the region, having the opportunity to refresh, certainly, we do believe that - in combination with the many other initiatives, like the Clerkship program that launched in Cape Breton last year, the expansion of residency seats outside of urban centres to more rural communities - these types of programs and initiatives, including the expansion of nursing seats at Cape Breton University, will help support recruitment and retention opportunities along with the infrastructure.

That has not been the driver for the infrastructure redevelopment, but we do believe that the infrastructure redevelopment will help with those recruitment and retention initiatives. Thinking just specifically about nursing staffing, we recognize that. We announced the additional 60 seats at Cape Breton University that will help ensure the supply of nurses within the region, to fill existing vacancies and any additional demand based upon the service restructuring within the Cape Breton redevelopment. With physician recruitment, we continue that throughout the province and the Cape Breton region is one of those areas where the recruitment continues.

BRIAN COMER: There is much shift in the structure of the Health Authority, I think, over the last number of years, as the minister I’m sure would know, from the centralized model to a decentralized model. In the last number of months, there has been much speculation about what this decentralized model looks like going forward. Will these decentralized models, for example, institute local health community boards back in local areas? Will these decentralized individuals in Eastern Zone have the ability to hire primary care providers on the spot without authorization from Halifax?

RANDY DELOREY: The Nova Scotia Health Authority, as the overarching entity providing care, is not changing. There will be one organization responsible for the operational delivery of the health care services, as per its current mandate. The legislative mandate and obligations of the organization are not changing. What is changing, Madam Chair, which was announced in the Fall, is within the organization itself, that they have adopted or are moving forward with a reorganized administrative structure within the entity itself.

This isn’t the piece that we’ve structured that requires any legislative or structural changes; it’s within the entity itself. The details of that roll-out are taking place within the Nova Scotia Health Authority. I believe some of the preliminary information about how increased focus on the autonomy of the zone VPs that would be in place - that would be four senior-level representatives. There had always been VPs with zone responsibilities, but what was identified was the challenge with them having multiple roles, with a clinical role and a zone/regional role in place. By having that zonal focus, they then can build their team around them that supports that local decision making.

The member, Madam Chair - and perhaps he can clarify if I don’t answer this question because I think I can interpret it two different ways when he made reference to local health boards. Community health boards continue to exist and continue to work in collaboration with the Nova Scotia Health Authority within their local communities, to support efforts at the front-line/grassroots side of health within communities and supporting other non-profit community-based health initiatives within community. They continue to exist and be part of that structure.

If that’s the piece that the member was referring to, whether community health boards will be returned - they never left. But if the member was referring to community health boards as in the community health districts, like the former Cape Breton Regional Health Authority, that would not, as per the start of my response, which is that the Nova Scotia Health Authority as a single entity will continue to exist. The operations and the increased autonomy that’s going out to the zones within the Nova Scotia Health Authority structure is to give them more autonomy within the decision-making.

He asked a very specific question about a hypothetical on the decision-making at the ground level for hiring. I think, at this point, that would be something I would defer to the Nova Scotia Health Authority, as they roll out to the province that administrative and decision-making structure within those zones.

BRIAN COMER: My next question relates to public health. There has been very little mentioned in this budget about public health preventive treatment regarding chronic health conditions such as diabetes, hypertension, congestive heart failure, chronic mental health conditions.

I think that, with budgetary resources, if these were accurately identified they could reduce a significant number of ER visits, thereby resolving the backlog. I do think that there is a significant focus on hospital-based acute care and not too much of a focus on public health treatment and proactive preventive treatment.

I’m just wondering why no one has really mentioned, in the budget that I’ve seen, preventive health care.

RANDY DELOREY: I thank the member for the question. Indeed, within health systems it’s a constant challenge and one that’s recognized in health systems throughout much of the Western world, at least - striking that balance of being responsive to the immediate acute needs of our citizens while at the same time recognizing the value of preventive interventions.

Where and how those preventive opportunities are - we do have funding within the budget, broken out through a variety of areas, including in our mental health and addictions programs, supports and grants within the public health space. We do have a lot of work in those areas. I think our focus in mental health and addictions over the last number of years - in expanding, particularly targeted at youth-based and community-based mental health supports and initiatives - were very much built upon that foundational piece of preventive, of early identification, early intervention, because we know how those clinical benefits play out over the life of the individual.

Mental health conditions that often, for those with chronic mental health challenges, manifest themselves or first present themselves in adolescence and youth, so getting more supports and investing there - those investments which are continuing in this budget are preventive on the mental health side of the equation.

I think the member’s colleague in the motion to go into Supply - and if not in Supply then in a previous day in Estimates - cited some data, if I recall correctly, about fewer people receiving mental health services. Actually, I will have to go back to the tape on that one; I’m now second-guessing whether it was on mental health services or if it was home services that she was referring to, but the point is that these investments in early identification and intervention, particularly for our youth, are designed for exactly the purpose that the member had referenced, to reduce the demand upstream in our acute system so that care can be supported and spread further throughout the health system.

[8:00 p.m.]

To the member’s previous question, there does continue to be 12 psychiatry vacancies in the Eastern Zone, 10 of which are in Cape Breton. Again, I think my comments still stand in recognizing the challenge with those vacancies being outstanding for the long term.

I think we’ve made significant strides - the Nova Scotia Health Authority has made significant strides - both with compensation, we’ve increased by almost 20 per cent by October 2019, psychiatry compensation and I believe another 9 per cent increase in April 2020 - recognizing that compensation as being part of the concern that was brought to us for psychiatrists that we’re really driving to fill those vacancies as quickly as possible.

Again, I think in my previous response I spoke at length about how valued the work is of those psychiatrists and other health care professionals and mental health services in Cape Breton.

BRIAN COMER: I know recently the senior director - I guess the former senior director - for the Cape Breton redevelopment project was hired as a deputy minister. Will there be a replacement for his senior leadership in that project? Can we expect a timeline for that replacement?

RANDY DELOREY: We certainly recognize the critical importance of that role, so we do expect it to be replaced. As I’ve mentioned in a previous, lengthy response about the complexity and the multiple partners involved in this - the NSHA, TIR, ourselves, with the Department of Health and Wellness - that we’ll be engaging to ensure that we go through and identify the right individual to replace the incoming Deputy Minister of Health and Wellness. Again, that start time is still a month or so away.

BRIAN COMER: Has there been any discussion within the department - an idea that makes a lot of sense to myself and other individuals I think in post-secondary institutions - to perhaps have a satellite campus for local residents at the university, such as Saint John, New Brunswick does through Dalhousie University, as I am sure the department is aware, where you could recruit residents from the area who would stay and train in the area, therefore, kind of increasing your numbers for primary care health care providers? I just want to know if that is something that has been talked about. I think probably it would be an excellent idea for local recruitment.

RANDY DELOREY: If the member is referring to medical school programming, not an entire satellite within the Province of Nova Scotia, in part just based upon the size of the program and the costs associated with establishing an entire educational program delivery site.

However, Madam Chair, the principle underlying what the member has proposed, is something we share and the policy and program recommendation that came forward and, in fact, has been pursued, is the establishment of a Clerkship program.

What that is, Madam Chair, for the benefit of the members of the Legislature, I believe the member opposite might be aware because we launched the program in Cape Breton last year, it is a program where the entire third year of medical school is actually, for the participants, conducted within a single community environment. Normally the various modules of clinical education that take place in the third year of studies in the Dalhousie Medical School program would normally take place in multiple locations when you go out to complete your clinical placements for that year of study.

We’ve identified two driving factors; one is by rolling the Clerkship out in Cape Breton, and in this expansion that was announced just a couple of weeks ago in the South Shore region is, as the member mentioned, by having exposure to these communities, medical students are more likely to pursue a residency and set up practice at a future date in those types of communities outside of the urban centre.

The other reason is from the clinical experience, having the opportunity to spend, I believe it’s about 42 to 43 weeks of programming that’s completed; that’s completing almost an entire calendar year of training in the same practice environment. So, for example, when you, in the traditional model, move from community to community, you might have the opportunity to provide care to, and I’ll just use this because it makes sense, providing care to an individual over a period a time to a pregnant mother. Well you would only see them for that two- or three-week period that you’re within the community; in the Clerkship model, you spend almost an entire calendar year within the community and you’re actually able to monitor that patient over that period of time. You get to see all of the developmental and clinical changes that take place. It’s a very different and I believe perhaps more rewarding opportunity and experience.

As far as an actual full-fledged site, the satellite that was referenced in Saint John, New Brunswick, is part of a New Brunswick government initiative where they don’t have any university medical program of their own. They’re leveraging the accreditation and the delivery model administered by Dalhousie University for that. I think Université de Moncton, not sure if they still have, but I think they had a relationship with a French university in Quebec, I believe Sherbrooke at one point as well.

BRIAN COMER: Just one last question in regard to Cape Breton health care redevelopment. Just curious as to the flexibility of the infrastructure plans with that proposed development. For example, if there’s an expansion at the Cape Breton Regional, and it can’t be staffed with physicians, will the planned expansion in Glace Bay still happen?

RANDY DELOREY: I think for that particular project, we’ve already shown a significant amount of flexibility which is predicated and built upon - what we said from the beginning in 2017 when we announced the redevelopment project - that we would be going out to engage the clinicians and the front-line health care workers to help build the functional plans that would then inform the master planning work that would be done for each of the infrastructure re-developments.

THE CHAIR: Order. Time has lapsed for the PC caucus. We will turn it over to the NDP caucus.

The honourable Leader of the New Democratic Party.

GARY BURRILL: In order for our guest to celebrate the act this is the closing shift of their job on this front, maybe they would like to take two minutes to just jump up and down. Let’s take a little second for them to have a minute to move around. How’s that? Fair? Yes. Good to go? Great okay.

THE CHAIR: Thank you for your kindness.

GARY BURRILL: I would like to go back to where we were an hour ago. We were talking about vaccinations and talking about funding for vaccinations and how some of that $10 million is allocated. I wonder if I could get the minister to speak to if there’s any increase in the budget for public education related to vaccinations?

RANDY DELOREY: I think if the member is referring to a specific new program launched or expansion this year, there is not one designed specifically as a new program targeted. Recognizing however, that within our Public Health sphere of mandate and work that they do to continue to promote and educate Nova Scotians about vaccines. In particular, probably the time of year that you see the most aggressive promotion about this is during the flu season, which is the most recurring vaccination that citizens would receive. There’s not a specific new program announcement, but within the existing, ongoing budgets, certainly we have mandates and responsibilities to communicate and promote. I thank the member for bringing it to the floor of the Legislature. It’s a reminder to each of us.

As constituency MLAs, we have our newsletters that many of us send out to our constituents. It’s a great reminder and opportunity, if anyone needs Public Health information to help support communicating to your constituents about the health value of vaccination - and the concern the member mentioned in the last hour about some Nova Scotians, some people in the world, who don’t necessarily believe the clinical evidence that supports vaccination - we can certainly help in communicating and providing links to the resources that make very clear the clinical consensus that is out there on this topic.

GARY BURRILL: Speaking of the flu vaccination, it’s certainly an important subject for us in a province where we’ve got about a fifth of our population receiving the old age pension and where, I think the number is more or less right, that we’ve only got about a third of the population that gets the flu vaccine.

I’m wondering, in light of that, what initiatives are contained in the budget for the public education around improving those flu vaccine update numbers.

RANDY DELOREY: As I noted, not something that’s separate or specifically noted there, we make our efforts each and every year to share information. The final information isn’t in yet on this year’s flu vaccine uptake, but preliminary information suggests that we would anticipate seeing - we prepared with more vaccines that we ordered - I believe this might have been one of the highest doses by volume, the number of doses that we ordered, in several years based upon a bit of a trend anticipating more use. We greatly bolstered our promotion in this current year, well, I guess, the current fiscal year just ending, so in the Fall of 2019.

We work with our partners, including Pharmacy Association of Nova Scotia, Doctors Nova Scotia, Nurses’ Union representatives, to ensure that we try not to duplicate our promotional efforts. If you have multiple organizations doing promotional initiatives, we would not want to duplicate, but rather maximize the investments that each of the organizations are making, so that coordination is done.

We do engage throughout the province and the media do often provide significant coverage of the launch of our flu vaccination programs each and every year. I think that’s because some of the media like to see me poked in the arm with a needle; there was a particular reporter from CBC who couldn’t hide his glee this past Fall when I was poked in the arm just downstairs, and he was taking a photo. We do get media from a PR perspective based upon the launch of the program as well.

I do think that discussion this year and last year about various vaccinations was a very timely topic. Over the Spring and the Summer I think it brought it top of mind for many people. Those are often even more effective than simple promotion activities with traditional advertising. It’s when it becomes organic, when the demand makes it into the public conscience and the discussions take place at the dinner tables, then people start to buy in and recognize.

[8:15 p.m.]

So again, I encourage everyone to continue those conversations, that organic growth in person, at Tim Hortons, at home at the dinner table or on social media, making sure that you encourage people to focus on clinical and evidence-based research; refer them to Public Health information, the World Health Organization, and credible health organizations, rather than, I’ll say, random social media posts for their health information.

We are seeing that, we’ve seen it with vaccinations, and we are seeing it even with the COVID-19 situation right now. As recently as today there was a social media post that drew media attention, suggesting that there was a case in Nova Scotia. So, misinformation on social media is very easy to distribute, very hard to contain and put back into the bottle. There are no cases in Nova Scotia. That was corrected.

I do appreciate the media, recognizing in these very important health situations, for not perpetuating false stories, and taking the time to validate their information. I think that’s true as well when the vaccination discussion came up that the media were doing their part to present the clinical efficacy and evidence that is by and large the consensus of the health care community.

GARY BURRILL: I guess when we think about the public conversation around vaccines it’s not really the flu vaccine that is at the centre of it, it’s probably more measles and mumps. And with measles and mumps, we know this has really been an issue and that where there has been an impact it has been kind of focused in the Central Zone.

Is the department increasing its funding for vaccinations and education around vaccinations related to the measles and mumps program?

RANDY DELOREY: Again, in some of the increase that we spoke about in the previous hour’s conversation, in the vaccine budget it actually relates to anticipated increased utilization specifically for measles and mumps vaccination.

As well, in the previous hour, I just referenced a couple of examples of new initiatives but there is also a cost allocation because we’ve seen increases around that. I’d like to hope that some of the effort that’s done by our Public Health officials and other health care providers out there on the front line, educating and encouraging people to ensure that their children and themselves get their vaccinations, and a reminder for those of us that are adults, that for some of our vaccinations we need to get boosters as well. That means you need to get revaccinated at other points in time; if you’re not sure what your schedule is you might want to check with your personal health care provider.

GARY BURRILL: Continuing to think about measles and mumps, are there other programs in the department, other initiatives, to prevent these kinds of outbreaks? Is there spending related to prevention particularly?

RANDY DELOREY: There is surveillance work within the department. Again, these are things that are often focused on our operations within our Public Health space. We recognize the vaccine has been around for a long time and the vaccination program, so it’s really a part of our ongoing operational delivery of care and services.

I will disclose to the member that I have had and am aware, I guess I haven’t fully had formal discussions, but I’ve been made aware of a particular stakeholder, that would be a non-profit in the province, that has a potential proposal. I look forward to hearing from them more formally. That wouldn’t be something in this year’s budget explicitly; I haven’t heard formally from the organization, but I’ve heard informally about some work that’s being done that they are looking to bring forward to government. It seems to be, at first blush, a pretty innovative proposal that can actually help us with the communication and education around the efficacy and help to counter some of the, as they call it, the anti-vax misinformation that has been spreading over the last number of years. Really in the last year or so, we’ve been really seeing on a public health perspective some of the consequences of that information that went perhaps unchecked for too long.

So again, in this budget, it’s operation as usual, but I am aware of an interesting project. It just wasn’t ready to proceed at this time. I look forward to hearing more about it and seeing if we can incorporate that in some of our program delivery in a future year.

GARY BURRILL: Well as we continue to face this challenge of uptake levels in vaccinations which are not really sufficient to provide the collective immunity we need across the province, I wonder has the department given any thought to potential incentive programs to augment education programs that might be undertaken in order to improve our numbers?

RANDY DELOREY: The notion of, I guess if I interpret the question or suggestion around incentive, I’m assuming financial incentive, and I’m assuming the member is referring to incentives for the citizen or the patient, not for the service provider; that’s not something that has ever been contemplated or considered to my knowledge within our Public Health space. I’m not aware of any programs. I’m not saying that they don’t exist in other jurisdictions, I’m not aware of any in other jurisdictions either. It’s the first I’ve heard of a suggestion like that.

GARY BURRILL: Thanks for that series of answers to questions about vaccinations. I’d like to ask a few questions now about health care provision. In particular, I want to explore some of the minister’s thinking and the department’s thinking about the relationship between health care provided through pharmacists and health care-provided through physicians.

We know we’ve had a number of pretty significant changes on that front by which pharmacists are now prescribing some medications and ordering some tests and that hadn’t been the case before. We’ve got pharmacists now in a position to be able to offer prescriptions on some kinds of bladder infections, shingles, and birth control.

We know there have been these changes about the conditions when pharmacists are able to extend prescriptions in terms of the length of time that they’re able to do that before it requires a visit to a physician. That has been changed from one month to I think half a year. We’re in a pretty significantly changed landscape, as far as the role of pharmacists and the interface of the role of pharmacists and physicians.

Although, I think everyone as we face all the challenges about providing primary care, I think everybody who thinks about this, part of what they think about is how the scope of practice of everybody can be raised to the maximum so that we can serve the needs of the population to the maximum capacity.

Nevertheless, it’s plain from the point of view of just an onlooker from some distance that this is not altogether without some frictions. You hear conversation from health care providers out of those frictions, between the physicians’ scope of practice and the pharmacists’ scope of practice, relating to how the two are connecting to each other in the early days of this expanded role for pharmacists. You hear even said sometimes that there are unintended consequences of the expansion of pharmacists’ role which we would have envisioned to decrease the load on physicians - in terms of the ordering of tests and so on - some people say there even are increases, sometimes, for doctors’ workload.

In light of the fact that this is a new landscape for us with potential, lots of potential, to offer but not entirely without some dissonance, I wonder is there any provision in the department for doing an ongoing cost benefit analysis of how this new world of pharmacist physician relationships is rolling out?

RANDY DELOREY: I thank the member for the question and indeed, for taking a moment to draw attention to this notion of scope of practice and how it can relate to the delivery of health care services in the province, including some recent announcements specifically relating to pharmacists in the Province of Nova Scotia.

In answering the question, there are really two streams that I think members should be cognizant of. When one talks about the scope of practice for our health care providers, that scope of practice is really defined by the college that governs their licensing. That’s not government, generally, that defines the scope of practice for our various clinical professionals in the province. We have in many of those instances self-regulated professions, including the major health professions like pharmacists, physicians and surgeons, nurses; all have those governing oversight bodies with the clinical expertise to know what the training programs look like and so on. Their responsibilities are governed by their legislation and their governance bylaws and so forth.

So, when we talk about what transpired late in 2019, the college expanded the scope of practice for pharmacists within the Province of Nova Scotia. That expansion included engagement and consultation with other health care providers, particularly college representatives like the College of Physicians and Surgeons, to get the input and advice about the appropriateness of that expanded scope in these areas that would traditionally be viewed as physician services. So that work gets done.

In fact, the scope of practice, although there is a lot of attention on this capacity within the scope of practice of pharmacists, in December, as the member rightly noted, the change was to expand the duration by which a prescription can be issued from, I think it was about 30 days to about 180 days, the 6-month time period. That was a change of the college, but they already had a scope of practice to refill prescriptions.

They would still rely on, in these instances, a clinical diagnosis by a primary care provider, by a physician. What it would allow them to do is to assess the patient, this would apply often in chronic illness where there are ongoing renewals of the same prescription - to assess the patient and if their health variables haven’t changed, that they would be in a position to renew the prescription on behalf of the patient based upon their clinical education and their ability to assess the health situation. But the original diagnosis, in most of those instances, would still remain with the primary care provider. Now, that’s what streams mean and again, that pre-existed, their ability to renew prescriptions, pre-existed the college regulatory change in December.

[8:30 p.m.]

That second path, though, is the question of insured services. A pharmacist, prior to December, could do a renewal of a prescription but it would cost out-of-pocket for patients because it was an uninsured service. What we did as a government and announced later in December was that we entered into an agreement with the Pharmacy Association of Nova Scotia, a contract that would see some of these services be recognized within the insured services delivery of care to patients. That means that when a citizen goes in for that renewal now, to a pharmacy, the pharmacist can bill the province for that fee. Again, the contract is what negotiated the fee rates, just like we do with Doctors Nova Scotia in the Master Agreement for physician services.

Again, we will certainly continue to evaluate. As far as I know, Doctors Nova Scotia did have representatives on the steering committee for work. The evaluation of changes is built into the contract with PANS, the Pharmacy Association of Nova Scotia. To date, and it’s very early, really it just started in the new year, there are some additional changes to come on stream in I believe April of this year, but so far, feedback from patients and others has been quite positive. We look forward to seeing the final results of the implementation but again, there is an evaluation which was the essence of the member’s question. I just wanted to make sure that the members of the Legislature were clear that the notion of scope of practice is not divined by us in government, but by the regulatory body.

What we brought in to help with access to care, which was our intent in the negotiations with the Pharmacy Association of Nova Scotia, was to bring some services that were within their scope of care that we felt could reduce some of the pressure at emergency departments, in primary care offices or at least support those Nova Scotians who may not have a primary care provider - so urinary tract infection, birth control, and some prescription renewals - that the member had referenced in his question.

GARY BURRILL: Does that mean then that there would be no upward budgetary pressures from the expansion of the scope of practice for pharmacists? One could think, for example, when we expand the numbers of people that are able to order tests, we are apt to have more tests. Is that, in fact, what the minister is saying, that it’s kind of budget neutral?

RANDY DELOREY: To clarify, we wouldn’t anticipate a change in costs for the government based upon the scope of practice, in and of itself. Because the scope of practice, in and of itself, is governed by the regulatory body. The Pharmacy Association of Nova Scotia predominantly provides uninsured services; they could set up their practice and provide and promote those services that they are allowed to perform under their licence, but it would cost patients, so that would not be a pressure on the government.

Where there would be the increase in costs and would be seen in our budget, is with the agreement we entered into with PANS, the Pharmacy Association of Nova Scotia, because we will see increased growth in the services and the fees submitted. We agreed to pay for UTI, birth control, and some prescription renewals, things that were well within the clinical scope of practice, as defined by the college and things that we believed individuals, particularly women and in some cases seniors or others with chronic illness; again, this is about access. This would anticipate some increased utilization of the health system because the access, and I’ll just use an example of the correspondence I receive sometimes from people complaining and expressing their concerns about long waits in emergency departments, often those very complaints make reference to, all I needed was a prescription renewal, but I don’t have a primary care provider.

I guess on the one hand, one of the reasons they probably had to wait so long is because our emergency department is triage-based. Those with the most acute health care needs, who need to be seen right away - heart attacks, cardiovascular issues and so on - are moved through the emergency department very rapidly because of the expediency needed for their care. For a prescription renewal, a span of hours is inconvenient and it’s a challenge for the individual and frustrating and all of those other things, true, but it is the way the emergency department was designed.

We believed that we provided more access to care by covering the cost of renewals, we would have to pay for the renewal of the prescription in the emergency department or a primary care environment, if the individual had access to a primary care provider. So, the net cost to government providing the service would not go up because the person is going to get their renewal one way or the other.

What we are doing is providing more access, closer to the patient. Again, the intent was targeted towards patients who don’t have primary care providers, so they wouldn’t feel obliged to go to emergency departments, thereby reducing demand in our emergency departments for those types of care that could be provided by others.

Again, where the cost would be seen would be in the Pharmacy Association of Nova Scotia agreement area, so we would forecast that increase based upon anticipated uptake of citizens using the pharmacy services. Some may be cost-neutral, again someone who would have been filling a prescription in an emergency department having it filled by the pharmacy, it actually reduced the demand by one in the emergency department and it just was then seen in a different environment.

I hope that clarifies for the member, Madam Chair, how we see the budget and this playing out and actually complementing, while at the same time providing better care and access to services for Nova Scotians.

GARY BURRILL: Thank you for that explanation. Would it then be the case that there are, in fact, budgetary savings for the department overall, through this new relationship of pharmacists for the health care system?

RANDY DELOREY: I don’t think we viewed this really from a budgetary savings perspective. I think we’ve noted the anticipation, the expectation, of growth in utilization and demand of health care services. That is built upon a trend that we see over the last number of years, a trend that I believe is seen over much of the country in health care needs. Again, it’s hard to tease out then that piece of the rate of increased utilization and demand on the system while we’re introducing another piece.

What I’m really saying is that we’d be seeing that demand in the system one way or the other. We’re trying to respond to those Nova Scotians, to provide convenient access without having to rely on the emergency department, to reduce that pressure on our emergency department; again hopefully reducing the pressure and frustrations for patients and the health care providers working there with some of these particular conditions. It is not a wide scope but again, the relationship and the dependency, as a pharmacist, as part of your health care delivery team, I think is an integral part.

As I’ve mentioned, many of those prescription renewals do depend upon a physician’s actual diagnosis of the condition that results in the prescription in the first place. So, the renewal is predicated on not having changing health conditions that allow the renewal to take place by the pharmacist, so you still need that dialogue and engagement with the physician community as well.

GARY BURRILL: That’s a good clear explanation, I’m glad to have it. Just one last piece of clarification on this, then does that mean that there are not, in fact, any additional expenses to the province related to training for pharmacists in the context of their new expanded role?

RANDY DELOREY: No, provincially we don’t pay. I’m just trying to think, I don’t recall that there’s any provision for professional development or increased training. I’ll say that there’s no new training or expanded professional development training related to the expanded scope of practice that is part of the Pharmacy Association of Nova Scotia contract.

What I was thinking about at the beginning was that I can’t recall if there was already a provision that’s just being maintained or rolled forward in the new updated contract. There might be provisions in the contract, but this contract did not see a substantive or material change in that investment as a result of these changes.

What would be expected there is that newer pharmacists would be coming out of their education program already having the training to meet the college criteria. That’s in part one of the variables that the colleges look at when assessing what an acceptable scope of practice would be, they are looking at what the educational component is - we are talking about pharmacists here, but it would be a similar process with nurses or other professionals. What is the education system? What are they being trained and certified to be able to perform? The newer ones, the education system has already been updated to provide this information.

Now for pharmacists who may have graduated several years ago or perhaps even a decade or two ago, that might have had a slightly different training curriculum, or even if they had an acceptable curriculum at the time, because they didn’t have the opportunity to practice to their full scope because of those regulatory restrictions, they would have to perhaps go through a re-education or an upgrade process. Those are, again, from a scope of practice perspective, part of the self-regulation of the profession and they would have to adhere to the College of Pharmacists guidelines and responsibilities to ensure that they are capable and properly educated to perform those various tasks.

What that means, although all pharmacists have the potential to be able to provide these services, some may choose not to. They may have the education and just choose not to expand their services, because there are some requirements including having to change their environment to have an examination room, space that’s not currently part of a design in many pharmacies. If you don’t have it, you might not want to incur the costs of building on an exam room to provide some of these enhanced services which are required as part of their scope of practice. So, they may have the training and education requirements, but not want to make the capital investment to expand their services. Others may be later in their career and just choose not to go with the educational requirements.

I know some that I’ve bumped into after these announcements who are very excited and have described this as transformational and shows a lot of respect for the profession. They are not going to squander the opportunity to really show all Nova Scotians that they are valued partners within the health system, and they will respect the confidence that has been placed in them to fulfill their delivery of health care to that expanded scope that they have available. Especially in the insured services that we’re providing as a province.

GARY BURRILL: Then just one other related operational question about the expanded scope for pharmacists. Does the minister have any concern, or is there concern at all in the life of the department, about potential ethical conflicts of interest with pharmacists being possibly inclined in issuing prescriptions towards the products of their own stores? One can envision a situation where a pharmacist would have a greater interest in prescribing products that are prominently featured on their own shelves in a way that a physician wouldn’t have that particular kind of interest. Not that physicians are immune from the pressures of the pharmaceutical industry, but the pressure that is on them from the pharmaceutical industry in that way would certainly be less direct. Is this a concern at all, in the minister’s view?

[8:45 p.m.]

RANDY DELOREY: Becoming aware of potentially unethical behaviours, we’ll say, is a risk of many professions, but I think it also represents, by and large, the exception rather than the norm. In many professions there are cases that can be pointed to where individuals abuse the responsibility and do not meet the high expectations of a professional - and those professionals are recognized by being part of a professional body that governs them, so of course there would be standards and expectations that would be in place to ensure that that unethical type of behaviour is not undertaken.

In terms of some of the actual prescriptions and citizens’ ability to fill prescriptions, obviously as a province we have programs. Often the insurance companies, whether it’s the provincial or private insurance that individuals have when they go in to receive - again, they would be pursuing the prescription that would be covered by their insurance. If it’s not covered, they may not be able to purchase, so there are some other economic variables that also constrain the potential for the scenario that the member had noted.

From a provincial perspective, Mr. Chair, we do focus on targeting. Even today, as part of that, we’ve seen significant savings in our pharmaceutical expenses, based upon programs that allow for generic switching. If, in the traditional model, a physician prescribed a brand name drug for which there is a generic alternative - recognizing that generic drugs are chemically identical to the brand name alternative, but at a much lower cost - the pharmacist is able to substitute the actual product to ensure that the provincial pharmaceutical program, while meeting the health care needs of the citizen, is done in the most economic way possible.

That model and program and expectation and behaviour are already well established within the pharmacist industry in the province.

GARY BURRILL: Thank you for that series of explanations. I hope I didn’t leave the misimpression that I think the expanded scope of practice for pharmacists is anything but a great idea. It is a great idea, but as with any real, major change in the landscape of the front lines, it is apt to have dissonances. We hear about these dissonances some, so I wanted to ask about their reflections in the budget.

I also would like to go back to a subject that has been part of this Estimates discussion, both earlier and with my Progressive Conservative colleagues. It is about the great Nova Scotia problem of diabetes. That report from Diabetes Canada in 2019, with its really staggering figure that at 11.2 per cent of the population we are now significantly above the Canadian average - it gives anyone real pause to take in. That means that a tenth of our population is engaged in the struggle with diabetes.

We also know that we have, as the minister and I talked about last week, very serious problems about regional concentrations. We have parts of the province where diabetes and diabetes-related health problems are a very significant part of the constellation of health problems that are being dealt with. We have rural health practices and hospitals where patient after patient after patient is being treated for something that has a pretty significant relationship to diabetes.

As one who has spent a lot of time in hospitals in different areas, you don’t have to be a genius to notice that this is the case in the rural areas in a way that it is not the case in the city. It’s the case in lower-income areas in a way that it’s not the case in areas of higher incomes. It’s a real area that calls for focus and energy in health care policy in the province.

Thinking about this subject, I wanted to ask the minister first, just in a general way, if I could ask him at this late hour to reflect a little about how our budget might look different for health care in Nova Scotia if we had an incidence of diabetes at the Canadian average. What would we be saving? What kind of a significant change would we be looking at?

RANDY DELOREY: I thank the member for this very interesting question. While it’s specifically focused on diabetes, the essence of the question that has been brought to the floor here could arguably be applied to many other chronic illnesses, particularly those that may have a preventive element. Earlier this evening, a member from the PC caucus was raising a similar question about the preventive focus in the health care system. Although the specific question here is talking about diabetes and what kind of transformative effect on our overarching health care budget if the clinical and/or societal costs of such a chronic illness were dramatically reduced in the province - again, the same could be applied to other types of chronic illnesses as well.

While I don’t have the breakdown of all the clinical costs associated with diabetes to run through the analysis even quickly on a napkin or a sticky note here to meet the member’s specific question, the principle or the essence of the question - I can note that I acknowledge what the member’s getting at there. Again, the member can correct me if I’m mistaken in understanding what he’s hoping to communicate here and try to focus some efforts on this preventive side.

What are those steps? I think some of those things, if we look at chronic conditions like diabetes or diabetes-related - the member mentioned that in hospitals, conversely, you have people with conditions that can be risk factors or increase your risk factors for diabetes.

One of these challenging things with chronic illness is that there are increased negative health outcomes by having the condition. There are times where you have other conditions that have negative health outcomes that can lead to other chronic illnesses. One thing I think, as I understand it in conversations with various health professionals, is the role of - again, it’s back to basics in many respects - it’s exercise and diet as two very significant contributing factors to living a very healthy life.

I should note on the record that each day when the member enters Estimates, he acknowledges the important role of exercise and movement in health. He offers myself and the staff here and, in fact, encourages, he not just offers but encourages, taking that time which, from a health perspective, is good, proper behaviour when sitting for long periods of time, to get up, stretch, and so forth. He is very clearly in tune with some of the interventions that can have positive health outcomes; those things, again, include diet and exercise. It then begs the question back to, I think, where we started our Estimates debates with the member opposite last week, which is this whole question of the social determinants of health.

I believe that is the very first set of questions where some data that stemmed out of social determinants of health. So, then I go back to that and say okay, what are some things that we’re trying to do? Well, it’s rolling out healthy food programs in our schools to target our youth.

We recognize there are two significant variables that are challenges to someone’s financials; we’ve talked frequently in my time here and we talked about the social determinants, about the programming like at DCS this year for increased investments to provide more funding to those lowest income Nova Scotians to help support. So, that’s one area, to put more money to help offset some of those financial barriers to reaching the desired - what people would aspire to be able to consume for their food - versus you know, is there still more work to be done? Of course, there is. We will always, I think, strive as a province to improve the quality of life for all our citizens.

I do stand by this budget with my colleagues, that the Minister of Finance and Treasury Board introduced last week. These investments, particularly in our social programming, are good investments to help address some of these areas. One is the accessibility in terms of financial - within financial reach - and we have had some of the investments done in my sister departments within the government. The other is that sometimes people have the financial means, but they don’t have the education, the culture, or the awareness. You know, if you didn’t grow up with that - people who have grown up in and around a healthy lifestyle, they are more apt to emulate and continue on with that healthy lifestyle, and those who haven’t - and it’s not always financial means that drive unhealthy lifestyles.

Investments and programs like the healthy breakfast programs being rolled out in our schools across the province, regardless of socio-economics, number one is making sure that there is nutrition available for those students in a non-judgmental way, because the program is available to all students. It’s a way that takes stigma out of the equation, and so those youth who need access to that nutrition are able to get it because they need it, but it is also a way to introduce healthy eating options to other youth who may not otherwise choose the healthy option.

I think, clearly, and I’ve certainly seen with my children in school, when the healthy option is the only option being presented to them, they are hungry kids and they are going to eat that fruit or vegetable; just don’t put the chips on the table or they will go there first.

GARY BURRILL: I don’t think it’s an exaggeration to say that how we are doing on the matter of diabetes prevention is a pretty good measure of how we are doing on health care outcomes in the province as a whole. It is a matter of great significance for us.

I would like to ask the minister: Can the minister point to specific prevention-related measures in the budget related to diabetes since surely this is really where the advances in the war are to be made?

[9:00 p.m.]

RANDY DELOREY: I guess if we go back to the earliest stage of intervention as per my previous response, I won’t go into detail on those again but those investments in social programs to provide more funding to help support those, particularly, dietary access points for Nova Scotians, and with youth, for influencing and informing healthy choices to help offset some of those early risk factors that would manifest. That would be one aspect of government’s investments in these types of programs.

We also have diabetes clinics throughout the province, not quite preventive in the early stages but certainly to help offset and to help manage and monitor and minimize the harms to those living with diabetes. One of the things they do have is a significant dietary component to those programs within those diabetes clinics.

Again, I know it’s not quite preventive in the way that the member is insinuating, in terms of preventing new cases of diabetes, but certainly it’s the type of preventive - as opposed to acute - interventions, by having those dietitians in the diabetes clinics and other supports available to work with those living with diabetes, to build their lifestyle in sports, so it is preventive in the sense of preventing the more acute problems associated with diabetes, to do what they can to slow the onset and the other health complications that are known to potentially occur with this particular disease. We do have investments like that.

These programs, though, are operational programs that get run through the Nova Scotia Health Authority.

GARY BURRILL: In characterizing the government’s general approach to diabetes, would the minister say that the thrust of the department’s focus is more on the treatment side or more on the prevention side?

RANDY DELOREY: I would suggest, as with the bulk of our health care system, as is the case in much of the Western world, as the member for Sydney River-Mira-Louisbourg mentioned earlier this evening, about the tendency of our health care system to be an acute care system and treatment focused. That, Madam Chair, is an accurate description. I don’t think anyone can stand on this floor and dispute that obvious fact. It is one of the great challenges of Western medical or health program delivery, in so much as we have so much investment and advancements on treatment and they achieve many great, positive outcomes. They save lives but they draw so much of the financial resources that get put into the health system to save those lives.

The challenges, the rate of that advancement and the expectations of society for governments, particularly in jurisdictions like Canada that have a socialized health care program, or provincial or government-delivered health program, those challenges are quite acute because people expect our programs to deliver the latest and advanced treatments, so it does often continue to focus on the acute.

I think the member can appreciate why. The preventive program becomes a challenge to garner the broad public support for those preventive measures because to redirect such a substantive portion of the existing health budgets towards the degree of the preventive programs, you don’t see the results immediately. My personal assessment on that is that the general population doesn’t accept that type of shift. In principle they accept it but in practice, when governments or organizations attempt to make that shift, there’s always somebody who needs that acute care service delivery. That shows up on the front page and we as a caring and compassionate society turn and redirect our funding.

I think that’s a contributing factor for how the system has evolved and developed an acute care focus. I hope to instill some confidence in my colleagues opposite and on this side of the Legislature, as well, some confidence in the fact that, number one, we recognize that challenge. I submit to the Legislature that we’re up to that challenge to continue to make advancements, to recognize and invest on that side of the equation.

As a department, one of the exercises we went through in the fiscal year just ending was an exercise in renewing our vision and mission within the department, which is an important step, if sometimes overlooked in large organizations - to have that vision, to help guide the foundation of the decisions that we make. The vision of the department is about healthy Nova Scotians. That is meant in the broadest sense possible, and that is to help bridge and open those discussions and focus points on those areas the member has highlighted.

The other reason I think that the member should have some optimism is seeing things like - we’ve talked about it the last number of years that I’ve been in the portfolio of Health and Wellness - an area of the health system that has been for far too long overlooked. We’ve had lots of conversations here about mental health and addictions. The health care system has been built around physical health, so getting new services and programs expanded are always trying to break into that system. We recognize that and we’ve been investing significantly over the last number of years. Not just that we’re investing generally in mental health and addictions services, but if you look at where we’ve really, really targeted those investments, it has been in early stage.

It is in the youth side of the equation, but we believe that that investment in youth not only pays long-term dividends, as those youth are identified and thus, once identified, you can have the early interventions, you can build the tools for them to manage their mental health challenges, which are often described as chronic illnesses - much like diabetes - to make those interventions and live a healthy and productive life, which reduces the demand on the system in the future.

Not only does it reduce the demand on the system in the future, those individuals as youth have the tools to live a healthy life based upon the early identification and interventions, but also in the immediate term. Those individuals, if they’re managed in the early stages, they don’t move on to acute mental health challenges, which reduces the demand in the existing system. Those investments in youth are also an investment in the acute system by reducing the demands at that point. That’s that vision.

We do show, I think, in our health system, a recognition and a willingness to target. It’s just easier in new program space than it is to move from an existing program, so the model is very heavily focused on the acute system, as I’ve noted.

THE CHAIR: Order. Time has lapsed for the NDP. We will move on to the PC caucus.

The honourable member for Northside-Westmount.

MURRAY RYAN: Before I begin, they say “seeing is believing, experience is everything.” Up until about five years ago, I had heard many of the issues and problems in health care, but it didn’t truly resonate with me. Over the last five years, having personal experiences in relation to my elderly parents, I got to see first-hand a lot of these challenges and a lot of the issues in the health care system, which really brought it into focus.

Before I begin, I want to personally thank our medical community. The care our doctors, nurses, paramedics, and all the support staff provide is first class. Our professionals are just that - professionals. Dealing with patients and families, often when they’re at their most vulnerable, and the understanding, patience and time given is second only to the high level at which they do their jobs. Caregivers also deserve mention. They’re often the unsung heroes of our elderly.

Last week, Madam Chair, I thought for a moment that we were in the presence of President Trump. In a line of questioning from my just-departed colleague, the member for Halifax Chebucto, the minister responded that the capital plan was a big investment, historic in nature. What was missing was the other side of the equation: that we have historic problems and that our health care system is in big crisis.

People want to know what this government is going to do about access, what this government is going to do about doctor shortages, not five years from now. Nova Scotians are lining up at the door, they just can’t get in.

Before the holidays, I had an opportunity to sit down with the Cape Breton redevelopment team. The plan that they laid out is an ambitious plan, indeed, with six new buildings and a parking lot. There are a lot of moving parts and, as a consequence, the potential for a lot of problems.

The minister says that doctors want new facilities, that this will help in attracting doctors. Shortages are first with family doctors. They operate, no pun intended, primarily from their offices and, as such, I wonder what bearing new health centres have with attracting these new family doctors. Shouldn’t the family doctor issue be dealt with first? Hospitals are struggling to be staffed now in their existing buildings.

If this redevelopment in the CBRM is the solution, then my question to the minister is: What took so long?

RANDY DELOREY: I thank the member and actually welcome the member to his first Estimates debate. I would like to acknowledge the strong opening recognizing the many health care professionals. I think that’s an important part of what we do, and then the opportunity to do so. I want to just make note of that and acknowledge the appreciation that those health care professionals have when that acknowledgement is made, not just by politicians, but any Nova Scotian.

As politicians I think we have a unique opportunity and a public forum to make those acknowledgements, as the member just did in his first opportunity here, at least in this Chamber, for Estimates debate. I’m not sure if he was in the other Chamber previously.

That said, in terms of the questions and concerns that he has raised, first of all, we do recognize those health care challenges. We do recognize the challenges and, in particular, the importance of having a particular focus on primary care access and family physicians. What is the role? Well, in many cases those family physicians in our communities, particularly in our less urban populations, provide the in-patient care within our hospital facilities, as well, and they do provide a broader scope of services and care.

To the member’s comment that there are actually family physicians who are providing that in-patient care in our community hospitals and even in some of our regional hospitals, although some of them have moved on to the specialist hospitalist model. Those providing in-patient care are our family physicians, as well. So, that’s that connection, through the clinical expertise.

The notion of what we do and what we need to do now, we’ve been doing. In my tenure - it’s coming up on three years in June since I’ve been appointed in this role as the Minister of Health and Wellness - and I still have the bruises, in particular of those early days, from people looking for change and initiatives within the health system.

I continue - on the floor of this Legislature in Question Period, in the public, in Estimates debate - to explain exactly what our initiatives were. Those include changes around our compensation and incentive programs, listening to front-line health care workers to help inform what those initiatives might need to be.

[9:15 p.m.]

The ones around compensation, we believe, were really early initiatives to get immediate response. Initiatives partnering with my colleague, the Minister of Immigration, to pursue other avenues, to streamline and make Nova Scotia a more attractive place for international recruits has been quite successful. I believe at the last check over 54 physicians have come through those streams, I think, in about two years from when we announced that program. That’s a new stream of physicians able to come here and practise and we’re seeing the results of those early stage initiatives. Enough to address all the concerns and challenges in and of themselves? No. So we launched other programs, as I’ve said, incentive programs.

We recognize, though, that really underlining much of the challenge - because it’s a challenge not unique to Nova Scotia, despite what we as citizens would think, based upon what you would have read in the media. At the time the challenges in health care in Nova Scotia presented as though somehow it was unique and that the challenges here are a Nova Scotia-bred challenge, when the reality is - and I think we’re starting to see this more in the media across the country - people almost mocked me when I would make those comments - that these challenges are the challenges that my colleagues across the country share, and that is the availability, in many cases, of physicians and other health care professionals.

How do we, in a country or a society, the Western world, respond to the demand that outstrips the supply of qualified health care professionals? We can continue to do the things which we’ve been trying to do, which is recruit and draw them from other sources and we’re doing that. But the other is we have to actually increase the supply and to my knowledge, Nova Scotia is the only jurisdiction expanding both our medical school and our residency seats, to help address that particular supply challenge.

The member is right. Those investments, which we announced in 2017 that we were going to be pursuing, will take some time to establish. It took some time to actually design and get the support networks, the preceptors, to support the delivery of these programs, their partners at Dalhousie University and the Nova Scotia Health Authority. It took a year or so to get that work done. Then the residents have to give a year’s notice for the application process within the CaRMS program, so that year goes by as the application processes to fill those seats.

In July 2019 the first set of residents came to the province, based upon that expansion of 10 family physicians, 15 specialist residency positions. The second cohort will be coming this July. That first cohort of family physicians will be graduating in a year’s time and we know that about 80 per cent of residents stay where they’ve trained, for a variety of reasons. I won’t go into the details unless the member wants me to but the research does show that including research that I read from MarDocs - Maritime Resident Doctors - that makes that indication, that 75 per cent to 80 per cent stay. So of those 10 family physicians we can expect eight of them staying here in the province to provide care and we’ve had those physicians when we took this opportunity to expand, we expanded to the one zone that has no family residents available, that is Northern Zone, which also has one of the highest challenges with attachment of residents to primary care services.

We are confident that we will continue to see, based upon the investments in the programs and the policy that we’ve been designing and implementing over the last number of years, we’ve planted the seeds and we are reaping some of the early and mid-term investments and programs that we’ve delivered. We’re seeing those results.

What do I point to? The member talked about people lining up. Well, fair enough. We accept that there are people, using his analogy of lining up, still registering on the 811 Need a Family Practice list, but over the last 14 months or so we’ve seen the number of Nova Scotians looking to be attached drop by about 20 per cent. That means we’re having success, a 20 per cent improvement in our attachment rate - or a 20 per cent reduction in those looking for primary care access.

So what we realize as we dig into that information is, obviously, it has not been equally distributed. In particular, Northern and Western Zones have not equally benefited from the attachments that have been taking place over the last year or so, so we’ve got to come back, re-establish some focused initiatives that can help offset and address that discrepancy. I think, for Northern Zone, that expansion in the residency program is a good benefit that we know will be coming onstream and we’ll see that serving that area. We still have to deal with and address some of the challenges in Western Zone and Northern Zone for the short term.

I hope that answers the questions and concerns that were brought by the member.

MURRAY RYAN: Related to the redevelopment on the Northside, several of the staff have come to me over the last several months wondering what will become of them, what will happen to the support staff, be it the cleaners, kitchen staff, receptionists. They’re wondering if their positions will simply transfer over to the new facility with short-term stay beds, long-term care bed facility, and the clinic itself.

RANDY DELOREY: First, I acknowledge that the facility in Northside will continue to be a Nova Scotia Health Authority facility. The services offered would continue to be offered by Nova Scotia Health Authority employees. That relationship and transfer from one facility to another - I can’t get into a lot of details, mostly because it is governed by the collective agreement between the employer, the Nova Scotia Health Authority, and the unions representing those various specific employees. In terms of the infrastructure, it will continue to be a Nova Scotia Health Authority facility. The services and the contractual obligations of the Health Authority - when a move from one physical location to another location takes place, they would have to adhere to the parameters of that collective agreement. I just don’t have that level of detail here with me to share with the member. If he wants to go in a little further, I just don’t have that level of detail but can assure the member that it is tied to the obligation that the employer, Nova Scotia Health Authority, would have with the unions representing those employees.

MURRAY RYAN: Recently I had a constituent who passed away while waiting for appropriate housing. Their existing accommodations were, shall we say, lacking. The individual required visits by Continuing Care. I realize that housing is not part of the minister’s portfolio, but what I’m wondering about is, Continuing Care in this instance could not provide the needed services, as the person’s accommodation lacked a fully functioning washroom. As a result, this person’s health care was compromised. While housing falls under a separate department, I’m wondering what type of communication exists between the Department of Health and Wellness and the Department of Municipal Affairs and Housing in relation to cases like this. If there is an individual that’s in some sort of precarious health situation, is there a mechanism whereby the Department of Health and Wellness and the necessary individuals can reach out to Housing to try and fast-track these individuals?

RANDY DELOREY: I thank the member for this truly important question. It ties into probably one of the main themes that we’ve actually had throughout Estimates this year, which is sort of that question of social determinants of health. As the member rightly noted, housing does not fall under the Department of Health and Wellness, and yet housing insecurity, inadequate or problematic housing, can have a significant impact on both the physical and mental health of individual citizens.

One of the examples - and I think it’s relevant because it actually comes from Cape Breton. As the member would know, one of the areas in our investments, particularly to help improve attachment and primary care services, is the focus on collaborative care practices and establishing those collaborative care teams throughout the province. We now have, I believe, 84 or 85 collaborative practices throughout the province. In the earlier stages, about two years ago, in having one established in Cape Breton, I remember receiving feedback from one of the sites.

I will put the caveat that this was second- or third-hand - I did not hear directly from the physician - that they were joining the collaborative practice because that seemed to be the thing to attract the younger physicians into practice in the community. It was what was needed. That collaborative practice also included the nurses, as well as a social worker at this particular practice. A more experienced physician was unsure as to what the purpose was, they were used to a traditional model of practice that’s really been around as the predominant model of care since the dawn of Medicare in the 1960s.

What they said was, they realized there was a particular patient that was a recurring patient in this physician’s practice, with respiratory illness. They would come, get diagnosed, get a prescription, go home, and in three or six months - whatever the time frame - they would often be coming back with respiratory illness, get diagnosed again, treated, and so on. They had a social worker as part of the program - that social worker, as part of that collaborative practice team, engaged with the patient and discovered through those conversations that, in fact, that patient of this physician, of this collaborative practice, had a leaky roof, which meant there was a lot of moisture and water damage on the inside of the home. That particular instance, then, led to air quality issues that turned out to be the challenge leading to the health issue that the physician had been treating on a recurring basis. The social worker, as part of that practice, was able to connect, then, with Housing and programs that were able to repair and get some of the upgrades that were needed to address the root cause, ultimately the root cause, of the environmental cause of the respiratory illness.

I use that as an example, which coincidentally happened to come, as it was explained to me, from Cape Breton, but it ties into not the Continuing Care branch but with the broad sense of other means and mechanisms within the health system to tie into housing, certainly, and particularly through our collaborative practice investments that those opportunities exist, especially those ones that have a social worker.

What I’ve heard from physicians with the social workers is that they’re able to identify and tap into those things that the physician both doesn’t have the expertise to tease that out, nor do they have the time because they have to move on to the next patient. Their expertise and responsibility is to diagnose the health issues of the individual, and that’s why these collaborative practices have that value proposition.

That said, as we step back a little bit further, are there other avenues? Certainly, as a department - and I’ve talked about this a little bit before - we’re trying to really, truly genuinely break down those silos. Social deputies do meet on a regular basis within government to try to take down those. If the department is aware of challenges and the housing things and it’s not happening organically at the front lines, that those connections are not being made, then as we become aware, we’re able to engage at the senior levels to make sure that those connections do happen. Will there be times that the connections don’t happen? Will we be able to find a situation where it doesn’t? Probably, unfortunately. But I encourage all members here, if cases do come through your constituency office, let us know. We will engage. Indeed, the minster responsible for housing sits right behind me in the Legislature. We turn around and have those conversations while we sit here in the Legislature from time to time, as well.

[9:30 p.m.]

MURRAY RYAN: I thank the minister for the answer. I will now hand off to my colleague from Cumberland North.

THE CHAIR: The honourable member for Cumberland North.

ELIZABETH SMITH-MCCROSSIN: Thank you, Madam Chair. I’m wondering if the Minister of Health and Wellness would be able to give me a timeline of when the Pugwash hospital facility is expected to be built and break ground.

RANDY DELOREY: Madam Chair, is it possible we could extend Estimates into a couple of weeks’ time? Suffice to say we’re at a bit of a critical juncture point with some approvals, so I am not in a position to disclose right now but I can, with all sincerity, say it’s getting very, very close to the point where there will be an announcement that I think the member and her constituents will be very pleased with at that time.

ELIZABETH SMITH-MCCROSSIN: I’m wondering if the minister might consider looking at the funding for the Cumberland crisis health care team that is through Cumberland Mental Health Authority. Currently it’s not funded 24/7, so because our regional hospital does not have acute care beds for mentally ill patients, they must all be transferred out to Truro or other regional hospitals.

We do have in place a crisis team. So, if our emergency physician has someone who is unstable, they can call upon the crisis team who will come up, do an assessment, and determine - basically to help their mental health specialist who will help to determine if that person requires an acute care bed in another hospital, or they also sometimes will say they’re stable enough that we can keep them here and we will make arrangements so that they are seen by our local psychiatrist or a therapist, sometimes as soon as the next day.

Because it is not funded 24/7, there are many gaps where someone will come into the emergency department and the emergency physician and nurses do not have that crisis team support. If there’s not an acute care bed available in another regional hospital, then that person is oftentimes discharged without any supports or community resources arranged.

I’m wondering if the minister would be willing to take a look at the funding for the Cumberland crisis team and consider funding that so that we would have staff available 24/7.

RANDY DELOREY: As the member would know, I think this specific operational funding piece does come through our partner with the Nova Scotia Health Authority. We’ve made significant operational increased investment this year for them to meet their operational needs. Again, not every operational or specific program at sites comes to my attention, so I’m not sure what, if any, plans they have with that particular site and that particular program team.

What I will promise the member is that we will reach out in my next conversation or I will have staff reach out to have conversations about what that proposal from the site looks like, if it’s within the plans for this year or not, and we’ll certainly evaluate the business proposal that I’m assuming the local site has already advanced within the Health Authority.

The other thing that I think came up briefly with the question from the member for Sydney River-Mira-Louisbourg was about the notion of the restructuring within the Nova Scotia Health Authority and that realignment of regional autonomy. As they are focused on doing that and getting those pieces out, I think the goal would be that these types of questions will more smoothly run through the Health Authority system at the local sites and not have to necessarily come to the floor of the Legislature to chat about.

ELIZABETH SMITH-MCCROSSIN: I know it was already addressed briefly today in Question Period but I feel one of the most pressing issues in the health care system in Cumberland North is that at our regional hospital we often have a lack of nurses. That results many times in bed closures. Last summer there were four step-down unit beds closed for a period of time and then most recently, in the last couple of months in 2019 and early 2020, where four beds needed to be closed and not used on our obstetric unit.

I realize in this budget there is increased funding for increases in nursing education, which is wonderful, but we’re looking at the results of that not being for three to four years.

I’m wondering if the Minister of Health and Wellness and his department would be willing to allocate more resources to support and look at the nursing staff at Cumberland Regional Health Care Centre to address why there is a shortage, how can we retain the existing nurses that we have, and maybe look at job satisfaction. What are the factors of why we are losing nurses and how can we work to retain the ones we have and attract more? By losing our nurses and having our shortages we are compromising care.

I know that our Minister of Health and Wellness is a well-researched and an educated man. I’d like to table a document. It’s an article that looks at the importance of having adequate nursing staffing. One of the quotes says that nursing staffing consistently has been shown to influence outcomes. This growing body of evidence relates higher than average levels of nursing human capital results in improved patient outcomes.

You could also take from that that lower nursing staffing would result in worse health outcomes, which is obviously what I’m very concerned about.

I’m wondering if the minister would be willing to take a look at that problem at Cumberland Regional, and I’m sure it’s across the province. I’m concerned that our lack of nursing staffing is affecting patient health outcomes negatively.

RANDY DELOREY: I thank the member for the question. I believe she rightly acknowledged two things. One is the positive impact the expansion of nursing education will have and, of course, within that expansion it does take time for that education, much like the investments in our medical program, which I won’t go into again here. It will take time, but that time will come, so it is the forward-looking supply piece that is probably one of our best initiatives. That is not being seen, to my knowledge, in other jurisdictions.

The other piece that was referenced was that sometimes the challenge, particularly around chronic vacancies - and in this specific question it was on nurses – but broadly, with any health profession, there are certain areas that have had more difficulty over time in filling vacancies. That happens elsewhere.

Rather than committing specifically on Cumberland, I can advise the member that within the Department of Health and Wellness we do have a team that focuses on health human resources planning. That is, in part, what led to the announcement of the additional nursing seats, based upon the research they had done, and the various methods of building that workforce to meet not just today’s demands but the future demands, recognizing the aging population of the workforce and so on, that we will continue to see some challenges there.

Recognizing that, a recommendation came forward, in part. So the work is under way to do these things to provide the - tools wouldn’t be the appropriate term - but to provide these resources, the staffing resources, as a supply of health human resources available so that our partners at the IWK and the Nova Scotia Health Authority have the ability to fill the vacancies to deliver the care that we all recognize Nova Scotians need and deserve. That work is an active part of what we do.

Another avenue where particularly the nursing side comes into play to inform the investments and the decisions we make is the nursing strategy. We have a table where many stakeholders actually sit, including the Nurses’ Union, the college, I believe, sits there, as well, the employers - the Health Authority and the IWK - as well as the Department of Health and Wellness. They have a budget for strategic nursing investments and they collectively come to prioritize. That’s actually a stream that led to the expansion of the nurse practitioner funding program and the incentive around that for some of the rural communities. We have a number of avenues and approaches that we delve into.

Although it may not always seem that way on the ground, I think the member may be aware that - gosh, it might be about a year ago, it might even be 18 months ago - there were some concerns raised by nurses in a particular unit at that hospital. I committed to going up and visiting and hearing first-hand - and the conversation wasn’t just about that, I heard broadly. Based on that, I hope the member recognized that I do appreciate and I haven’t forgotten that meeting or my other visits to that hospital and hearing from front-line health care workers. As in that particular instance, I think the Health Authority did have work under way to address the concerns that were brought forward. They wouldn’t have been able to move as quickly on the initiative if it was just me triggering it at the point. Certainly, I did trigger engaging, inquiring and asking questions but there was work under way, as well.

I think that does happen more frequently than people may realize. I love to take the credit, as all the changes that are positive when someone raises a concern that they bring to my attention and then shortly thereafter it’s moving in the direction they hoped for. But in those instances where it moves really quickly, the Health Authority and our partners are likely already well under way with the work and just weren’t at a point where they could announce or deliver it. I’m hopeful that this will be a similar type of situation but, again, I hope this information I provided about our broad efforts around health human resources fits within the theme of what the member was asking, Madam Chair.

ELIZABETH SMITH-MCCROSSIN: I do appreciate the minister’s comments. There’s no question that the minister has a very significant influence. I really appreciated when he did come to Cumberland Regional to look at the medical unit and the staffing concerns then and it made a huge difference, so the minister must never underestimate his influence. When he does get involved, people stand up and take notice and it really helps.

I’ll just ask the last question before my colleague takes over. I’m not sure if the minister is aware, so I’ll table this document. It came to my attention recently that the Fluoride Mouth Rinse Program was stopped in at least one part of Cumberland. In my constituency some of the elementary schools have stopped, due to a shortage. The notice said that a supply shortage of fluoride mouth rinse has left Public Health without enough rinse to offer fluoride programs for the school year, therefore, it is even more important to make sure children visit their dentist.

They decided to stop the program and they’ll start it up again in the Fall, but they’re going to change it to a fluoride varnish program. It also says the new program will target those students who will benefit the most from this treatment, which I would take to mean that not all students will receive it.

I’m wondering if the minister is aware of that and if he might be able to look into it. Also my question would be: Will Public Health staff still be delivering this program or will teachers be expected to provide the fluoride varnish program?

RANDY DELOREY: I thank the member for raising that point on the floor. In fact, that is true and as the communication noted, this restructuring within the program is related to a supply issue with a product that was being utilized. Again, circumstances outside of anyone’s control, so Public Health has engaged to find other ways to deliver the programming.

[9:45 p.m.]

It will continue to be administered by Public Health officials. If anyone has educators, teachers or staff, within schools that are concerned that somehow we would be moving a program into it, it would still be run by Public Health officials to meet those needs. In light of the change in product and the delivery models, we do have to evaluate. That’s the work that’s under way, to determine how to deliver that new program based on the new products and the delivery mechanism that’s a bit different.

ELIZABETH SMITH-MCCROSSIN: We’ll pass over to my colleague from Cape Breton-Richmond.

THE CHAIR: The honourable member for Cape Breton-Richmond.

ALANA PAON: I’ve just been told that I’m the final gun on the way home here, as far as the last evening goes. I’ll take it easy on you. I’d rather have just a conversation, not throw out a whole bunch of statistics and so forth, but just kind of have a conversation in the way that my constituents have conversations with me when they come forward and have concerns.

One of the things that we’re all very well aware of is the constant closure of ERs. I had asked the minister a question with regard to this last week. This past weekend was not an abnormal situation. It’s becoming far too standardized that we see not only the Strait Richmond close - our local hospital - but we also see, at the same time, that the St. Anne’s centre is also closed, too, and they have an ER, obviously, in their facility. When both of these facilities are closed at the same time, and they’re the only hospitals within Cape Breton-Richmond, that’s leaving us, leaving constituents at risk.

We’re about an hour and a half away, basically, from St. Martha’s or from the Cape Breton Regional in Sydney, and an hour and a half is an awful long way to go when you’re having a heart attack or a stroke or any kind of health care crisis and you’re having to be taken by ambulance. In fact, I worry that something very serious is going to happen one of these days and unfortunately somebody is not going to get the care that they need when they need it.

Could the minister please comment on and tell me what is being done - and I’m specifically talking about Cape Breton-Richmond. What’s being done to try to rectify this problem? It’s nursing shortages at St. Anne’s, mostly, and it’s physician shortages at the Strait Richmond. I’d really like to know what the minister has as far as a response for that.

RANDY DELOREY: I thank the member for the question. Living not too far away, I’m well aware of the challenges, not just in the broad sense of my scope as minister, but as an MLA in the Strait region, so, quite familiar with the sites that are referenced.

As the member, I think, would know, that is a common challenge, a common conversation with communities across the province. Indeed, you see it in other provinces, as well, in similar-sized rural communities. It is in an environment where the demand for qualified health professionals outstrips the supply available. Those health professionals are choosing the locations where they want to practise. When all locations have demand, people readily accept those health care professionals to meet that demand in those communities.

I know there’s only a limited amount of time so I won’t rehash much of what I said before, but what we’re doing is investing in our compensation framework, which makes us far more competitive on the regional Atlantic level for some of our highest demands, including family physicians who would serve in these hospitals. We’ve rolled out a new compensation program, particularly for in-patient services and emergency services, as part of the Master Agreement. That agreement was just signed in the Fall, so we’re hopeful, as part of the recruitment that the Health Authority’s doing, that having a stronger compensation package will support communities like the Richmond area.

On the nursing side, as I’ve mentioned, we have expanded training opportunities recently in Cape Breton, with the intention of having close-to-home training opportunities. Richmond is lucky in the sense that they have another nursing training program on the other side which would be in Antigonish at St. F.X. University.

To give the member some optimism that the recruitment efforts for the NSHA do work, despite very long-standing recruitment challenges for qualified RNs in Canso, my understanding is that recently they have two or three new nurses who have expressed interest to sign up and go to that community. Again, hopefully, as the problem is addressed in one community, those efforts can continue.

Again, it does show success that that recruitment team with the Nova Scotia Health Authority does know what they’re doing but it is at a time when demand outstrips supply. It’s a very competitive environment and we are doing everything we can as a province to both grow our own and attract others to the province in all qualified health professions.

ALANA PAON: Thank you, minister, for your response. This has been a long-standing issue. I recognize that programs and initiatives probably should have been in place 20 years ago. I think that whether or not either side of the floor really wants to agree on that, that’s the reality of the situation. It really has put us and the people in this province in a really difficult situation.

One of the aspects of the closures that are going on right now with the Strait Richmond in particular, is that the doctor they do have on staff for the ER during the week - I mean, he is working 96 hours already, so he is there, basically, on the weekdays and he needs some time off, just like the rest of us. The problem is that we don’t have any coverage on the weekends and we are so short of nurses, basically, to take shifts at St. Anne’s, that if something goes wrong or somebody gets sick or any of those things, then there are unexpected closures that happen there, as well.

So, going back to the Strait, that period of time on weekends when a physician is not available, usually what happens, as I understand, is that a physician can come in on a locum but the amount that is being offered in compensation to a physician to be on call - to come in for an emergency at the Strait is just - I couldn’t believe it, the small compensation that these very highly-trained professionals are being offered in order to ensure that the emergency room stays open during those periods of time.

Would the minister please let me know if there is anything being done to try to improve the conditions and the compensation for those doctors that we already have in my community in Cape Breton-Richmond, so that it makes it much more attractive to them to be able to keep themselves on call during that period of time when we don’t have a full-time physician on staff at the hospital?

RANDY DELOREY: I guess the member noted - and I appreciate that she noted one of those challenges related to remuneration, compensation for physicians. That is something we recognized in 2018, as a province, based upon feedback and going out and listening. That’s why in March of 2018 we announced an almost $40 million investment targeted at compensation increases and incentives. That investment that was announced at that time was to bridge us through the negotiation period in the updated Master Agreement.

While we would legally be entitled to have just continued to fund physicians based upon the Master Agreement that had been in place, we recognized the challenges and the concerns and listened to those physicians and their bargaining agent, Doctors Nova Scotia, and we came up with an interim increased investment of almost $40 million. That bridged into our 2019 Master Agreement, signed in the Fall. That Master Agreement sees increases targeted at some of our highest vacancies, that includes family and emergency physicians, which are most relevant to the member’s community, who will have increased compensation through this new agreement to be the highest-paid physicians in Atlantic Canada, based upon this agreement. That makes us far more competitive.

I think in addition to that, as we know, we have locum incentives and others that are part of the negotiations that took place, as well, so we’ve provided in that Master Agreement increased funding and supports for those physicians who would be providing emergency department services, even on a locum or an interim basis. Again, this was all done in feedback from physicians and their bargaining agent, Doctors Nova Scotia. Over 90 per cent - I’m trying to think if it was as high as 96 per cent, but it was definitely over 90 per cent - voted in favour of this Master Agreement, recognizing the significant investments and particularly targeted investments, in those areas of most need, like family physicians and the emergency room physicians, in addition to some specialists, but they aren’t relevant to the specific questions the member raised.

ALANA PAON: Thank you, minister. So just to be clear, again, it’s very positive that, obviously, in the Master Agreement 2019 that the ER physicians were looking at better remuneration but, again, the real problems are the family physicians who are having to bridge the gap when that one ER physician that we have, and we’re so thankful to have him, but if something were to happen to him then we’d be in real trouble.

Again, I’d like to ask the minister two basic questions. One would be: What does a family physician in my area, the Strait area, what are they compensated as far as a locum goes? This means the doctor’s at home, he gets a call, he has to come into the ER because there has been a car accident or some horrible situation. So, he comes in just on that call and then needs to return home. I’d like to know what the remuneration is for that.

I would also like to know if remuneration for those locums are equal across all the NSHA or if we are in a different compensation zone in the Strait.

RANDY DELOREY: I was just looking through the materials to see if we have that breakdown specifically in the Richmond area. Again, I guess at the highest level I can certainly articulate to the member, Madam Chair, that the compensation is governed by the Master Agreement or the contract that was negotiated by Doctors Nova Scotia on behalf of physicians. Over 90 per cent of physicians accepted that Master Agreement, which is a fairly significant vote of confidence, I think, in the final product that was negotiated between government and the bargaining agent on behalf of physicians throughout the province in Nova Scotia.

That investment, as in my previous response, was made based upon input, feedback. It will lead to being highest-paid emergency doctor rates. The locum, I think the member might be inquiring about on-call? I believe the updated contract moves the on-call compensation to $300 for a weekday and $400 for weekend coverage. That would be the weekend requirement. If they’re a fee-for-service physician, they would, of course, get paid for the services delivered in between. That $300 to $400 would be whether there was any activity performed or not. The on-call stipend of $400 for the weekend would be whether there was a call or not, and then fee-for-service for the services provided.

ALANA PAON: I’m going to move focus here to the fact that we’ve gotten some unfortunate news. We’ve known it for a little while now that we’re going to be losing another two doctors. It always seems that we’re doing two steps forward, one step back. Two incredible, young physicians that are located in L’Ardoise. We were very hopeful that we would be able to keep these physicians for an extended period of time, that they could invest in the community. I know that circumstances being what they are, there’s all kinds of circumstances why perhaps physicians will leave for family situations or wanting to take on positions elsewhere where, perhaps, they are better compensated. The numbers - and I don’t have them here in front of me - it’s approximately between 450 and 500 people in the Strait area, that encompasses a portion of my constituency, Cape Breton-Richmond, that are without a family physician.

Based on what we know for approximate patient load per physician, this is going to put the area within Cape Breton-Richmond, and many people - it’s not just constituents in L’Ardoise that utilize these services, it’s all the constituents - they’re driving from Isle Madame, sometimes, to go down to L’Ardoise to be able to access primary care. I know that you do have some programs in place, but when it comes to crisis situations like this, where you have physicians who make a decision to leave within a certain period of notice, is there anything that the department has in place to be able to take immediate action in trying to fill that gap? The amount of people that are going to be left without primary care is going to affect exactly what we’re talking about with putting more pressure on the ERs, both on Isle Madame and in Lower River. We’re increasing the problem there. The other portion of the problem is that sometimes it’s not open. It’s a very convoluted problem.

What I would like to ask the minister is: Besides the investments that we know of, is there any kind of more localized or, perhaps, any kind of partnerships between local government, local community groups and the NSHA to really jump on something like that when there’s an urgency? I would say that this is an urgent situation, to try to fill that gap as immediately as possible.

THE CHAIR: I’d like to remind the member to address the Chair, speak through the Chair.

The honourable Minister of Health and Wellness.

RANDY DELOREY: Welcome to my world in terms of the complexity and the challenges of addressing these types of situations that present themselves as part of the ongoing challenges we have in recruiting and maintaining. As the member said, in some instances we may just establish new health care professionals in an area and the demand introduces itself in another part of the province in a nearby community or elsewhere.

As far as the recruitment and the collaboration within community environments, certainly that’s a part of the community program to help support and encourage communities with programs to help with their promotions through the Department of Communities, Culture and Heritage, not through Health and Wellness, to help support the programs. They’ve had a couple of calls, I believe, in the current fiscal year for those grants to support communities. Each community was able to tailor their proposals for the supports. I was at the announcements in Truro, Pictou, and Antigonish. I’m not sure if the Port Hawkesbury and Richmond areas had an application that was successful or not. Again, it was in the Communities, Culture and Heritage portfolio. In terms of having communities and having a connection, that was something we really focused on in the last year, to try to build, and we look forward to continuing to build those connections into communities.

We know that when the recruiting team is busy and they bring a prospective health care professional to a community, having those linkages and connections - I know, and in fact, it was my colleague, the member for Clare-Digby, even in the years before I was appointed to this portfolio, talked about the efforts that were being made in his community and region to build that community advocacy piece. I did establish - not quite as formalized as what was done there - a relationship with the local recruiter and said, whenever the recruiter brings a physician to town, if they want to pop in and meet. We invited the representatives from both the municipality of the town and the county to attend. Usually the warden and mayor attend on behalf of their councils, or they send an alternate. We’re able to provide that overview and oversight. The feedback is overwhelmingly positive, both from the municipal representatives to get to know about a potential recruit, but also from the prospective health care providers in having those senior people within the community take the time out of their day to go and show how welcome they are going to be. Those types of initiatives do take place.

If there was an ability to do it more quickly it would be done. The fact is, we are tied to the availability of the supply. The recruitment efforts are ongoing. The Health Authority and the recruitment teams know the challenges. They’re making every effort to attract those physicians, to meet those vacancies.

One of the things, though - not where there’s an immediate transition that takes place, but in areas, Madam Chair, where there seems to be more of a chronic issue and larger scale for a long period of time, we know they have access centres set up. They’re clinics, essentially - access clinics, I guess the NSHA is calling them - where they do provide primary health care services for those unattached patients in the region. If there’s more of a bit of a prolonged vacancy in the area with a large demand, we do have those set up to support so that while you’re on the wait-list, you do have an entry point. It’s not attached primary care, but it’s the next best thing for the interim. Once you get attached, you move out of that primary care clinic and then into others.

There are some new models and new initiatives that the NSHA has been developing and rolling out in some communities. It’s not quite that immediate ability to turnkey solve the issue of a physician retiring or leaving a practice. I don’t believe there’s really a means. If there was a way to do that, we would have had it filled before the physician actually completed their term so there would be a continuity of care for the residents.

ALANA PAON: I speak about this often to some folks at home. We’re out there trying to recruit physicians who have obviously grown up in other areas. We’re always welcoming to newcomers in our area. We have so many young, brilliant minds that are within our school systems. There are kids that I know - and I have one in mind in particular who is so intelligent and is wanting so badly to be going into medicine. You just know, because that child is from a certain socio-economic background, that their chances of being able to achieve that goal - it’s not impossible, but it’s going to be very difficult. Here you have a child who already lives in the community, maybe extended family . . .

THE CHAIR: Order. The time has lapsed.

The honourable Leader of the New Democratic Party.

GARY BURRILL: Thank you, Madam Chair. I’d like to invite the member for Cape Breton-Richmond to continue to direct the discussion during the rest of the NDP’s time.

THE CHAIR: The honourable member for Cape Breton-Richmond.

ALANA PAON: I’m trying to regain my train of thought, there. I was speaking with regard to children who are keen and have the smarts to be able to get through a medical program. We already have them invested in home. They want to stay home, they want to return home, they want to go and get an education, they want to become a physician, but the chances of them doing so without assistance is going to be very difficult.

When you look at it this way, when you have somebody who’s already invested in community, maybe a young person, somebody who’s going to have to go away and come back after they get educated. If you have somebody who already knows the community, knows the traditions, knows the culture, maybe even actually speaks - I’m in an Acadian community, or partially an Acadian community - someone who even speaks the language, it’s tremendously valuable that you don’t have to really sell the extras to that individual. You don’t have to sell the concept of community and what a great place it would be to live.

I understand this is not an immediate solution to the problem, but I always wonder why it is that we don’t have a program available to young people, where we’re actually going in and recruiting our own children within our own school systems that we know want to go into medicine, but just don’t have - I won’t say they don’t have the means, they just have so many barriers in place. Why are we not offering them a helping hand up and really guaranteeing ourselves right from the get-go that we would probably be investing in future physicians that would stay, would return and would stay, in the community that they were born in.

If the minister could maybe give me a bit of a response on that, Madam Chair, I’d appreciate it.

RANDY DELOREY: I’m pleased to be able to inform and provide a little more detail about the fact that we’ve already taken those steps. We announced in the Summer of 2019 that we we’re expanding the Dalhousie MD program. We had the capacity in 2019-20 academic year to add four seats to the medical school program and an additional 12 seats are going to be added in September 2020, for a total of 16 additional Nova Scotia medical student seats as part of Dalhousie’s MD program.

The other thing, and this is the part that I think many people forget about that announcement, is that the focus of those 16 new seats are to be targeted towards Nova Scotia rural, Indigenous and African Nova Scotian students, very much in line with the suggestions made by the member to focus on individuals that may be underrepresented in our medical community. This particular investment meets that need. Within the Dalhousie and the recruitment programs and initiatives, efforts are certainly looking at being able to make those connections upstream. It’s easy for us to say that these seats are targeted and the selection criteria will factor in those characteristics of rural, African Nova Scotian and Mi’kmaw students; however, if the students don’t apply, if they don’t see themselves as being, for whatever reason, capable of meeting the academic criteria, then it becomes a challenge. There are efforts to also expand that.

[10:15 p.m.]

The other thing to note is, I think, in some populations there’s a misconception as to the current enrolment of students that are in the Dalhousie Medical School. There seems to be a perception that we do not fill those seats with Nova Scotia students. In fact, the vast majority of the students attending Dalhousie Medical School are Nova Scotia residents. The very large number of those students that we are educating are our own.

However, it is unfortunate that not every Nova Scotian who is interested is able to get a seat every year. Those are the stories that you hear. So it’s not that someone from a different country or a different province is taking the seat or to the extent that, in particular, Prince Edward Island, but they pay for some seats to be delivered here in Halifax.

THE CHAIR: Minister, I ask that you do your concluding remarks and then do your resolution.

RANDY DELOREY: Well, I guess I don’t have a lot of concluding remarks, but I do acknowledge the intent and particular time period that we have to have the resolution read. Suffice to say I hope that answered the question from the member for Cape Breton-Richmond. If she would like to learn more information about the Dalhousie Medical School or the Dalhousie MD program she can reach out to the department and we can fill in that information, Madam Chair.

As it relates, I do want to quickly acknowledge the hard work of the many health professionals throughout the health system. I appreciate their support in program delivery each and every day on behalf of Nova Scotians. As it relates to the budget, I want to thank all staff, those here with me, the Deputy Minister and CFO for the Department of Health and Wellness but also all staff that have been working extended hours to support our efforts to answer the questions that the members of the Legislature have brought to the floor as part of the 20 hours on Estimates debate, not quite as long as last year, so it must clearly show the positive progress we’ve been making in our health care program.

With that, Madam Chair, I would like to move Resolution E11.

THE CHAIR: Shall Resolution E11 stand?

The resolution stands.

The time allotted for consideration of Supply today has elapsed.

The honourable Government House Leader.

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

THE CHAIR: The motion is carried.

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

[The committee adjourned at 10:18 p.m.]