HALIFAX, TUESDAY, APRIL 6, 2021

COMMITTEE OF THE WHOLE ON SUPPLY

4:18 P.M.

CHAIR

Susan Leblanc

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

The honourable Government House Leader.

HON. GEOFF MACLELLAN: Madam Chair, we will continue Resolution E10, the Estimates of the Department of Health and Wellness.

THE CHAIR: The honourable member for Cape Breton Centre.

KENDRA COOMBES: Last week, my colleague from Dartmouth North was discussing with the Minister of Health and Wellness regarding miscarriages, and, specifically, the member mentioned Cape Breton and what happens in the Cape Breton Regional Municipality. I was actually the individual who texted the member for Dartmouth North regarding my own experience, where I was taken by Emergency Health Services to Glace Bay Hospital while I was suffering a miscarriage. They were directed to send me to Glace Bay because I was not yet at 20 weeks, instead of taking me to Cape Breton Regional Hospital.

Long story short, I ended up at the Regional Hospital because I needed to see my gynecologist, and I needed a D&C done. So I would like to ask the Minister of Health and Wellness: What is the plan to make sure that people having miscarriages aren’t shuttled between emergency rooms unnecessarily?

HON. ZACH CHURCHILL: I’d like to thank the member very much for sharing that story. It is a good thing that more folks are talking about this. Our family went through one as well. Our first child was a miscarriage, and we didn’t realize at the time how prevalent it was because it’s not always something that people are willing to talk about, so I very much appreciate the member coming forward and sharing that experience.

I can’t speak to the clinical decisions or EHS decisions that were made at the time in terms of transferring the member to Glace Bay. That isn’t something that I would have information on and I’m not sure what information the medical team would have been working with at the time, but it would have made sense for the member to eventually get to the Cape Breton Regional Hospital because that is where the gynecology support is. It is usually at our regional hospitals that gynecology support exists, and of course at the IWK Health Centre. Once it is determined clinically that it is a miscarriage that’s happening - because it’s not always immediately evident, based on what I’ve heard from clinicians - then the determination would be to send whoever the patient is to the appropriate location where the gynecological support is.

KENDRA COOMBES: I believe that is my point, that we want to ensure that individuals who are having miscarriages are not shuttled unnecessarily to emergency rooms. I would like to ask the minister: How many doctors in Nova Scotia have now been trained to be able to prescribe the pharmaceutical abortion pill?

ZACH CHURCHILL: We don’t have that answer in the room, but we’ll get that for the member. The reason - and I benefit from having our deputy as a physician, so I benefit from having him in the room here - but the reason why individuals would be transferred to emergency departments would be if it’s unclear what the cause of the abdominal pain is - and there can be multiple causes for that, not only a miscarriage - there would be a clinical decision made to get the patient to the appropriate place for assessment and then, when it’s determined that a miscarriage or something is happening with the fetus, the patient would be brought to the appropriate place.

The reason that people would go to the emergency department first would be to ensure that it’s not appendicitis or other health issues that may be causing abdominal pain. I don’t know that it’s always clear to the physician.

KENDRA COOMBES: Moving on from miscarriages and gynecological problems and issues, it has been promised that the New Waterford Hospital emergency department would remain open during the duration of the Cape Breton Regional Healthcare Redevelopment Project. That, in fact, has not happened. It has been closed. In fact, the emergency room has been closed for 538 unscheduled hours over 2019-2020.

My question to the minister is: Could he explain what work is under way to ensure that this number is reduced to zero?

ZACH CHURCHILL: Just getting brought up to speed on that situation. There were renovations for the New Waterford emergency department that impacted closure for a number of months. To reopen requires availability of emergency department physicians who are willing to work at that facility.

KENDRA COOMBES: I’d like to continue on this line. It is my understanding that those physicians, as well as nurses, are now working at the Glace Bay Hospital and haven’t been given a date and time when they would be going back to New Waterford.

My question to the minister is: Does he know the date when the workers who have often worked in the New Waterford Hospital and are now working in Glace Bay will be back in New Waterford?

[4:30 p.m.]

ZACH CHURCHILL: That would be a determination of the physicians. The physicians who did move to practise in Glace Bay have chosen to date to remain in Glace Bay. Of course, we’d need physicians willing to return to the New Waterford site in order to properly staff the emergency department.

KENDRA COOMBES: I’d like to talk about visits to emergency rooms and also emergency standards.

My question to the minister is: Does he support the regular publishing of emergency room department standards, and what action is he taking to make this possible?

ZACH CHURCHILL: Can the member clarify specifically what standards she is referring to? The Nova Scotia Health Authority does report on a number of metrics, and we can direct the member to those if she could be specific on which ones she’s looking for.

KENDRA COOMBES: That’s okay. We’ll go on to something else.

I want to talk about death rates - unexpected death rates, I should say. The unexpected death rate at the CBRM hospitals has been the highest in the country for three years in a row now. I understand that there is a review under way at the health authority to get to the bottom of this.

My question to the Minister of Health and Wellness is: When will this review be available?

ZACH CHURCHILL: That report is currently under way. Those working on the report have not provided us with a timeline on completion, but they are doing a complete review of administration from an administrative and clinical standpoint, and there will be recommendations that do come from that report.

We do not know when those are going to be finalized, as I believe the committee wanted some flexibility to ensure that they could get to the bottom of the issue and not be limited on time to complete the scope of their review.

KENDRA COOMBES: I appreciate that. My question to the Minister of Health and Wellness is: Will it be made public when it is available?

ZACH CHURCHILL: Once that review is completed, there certainly will be major elements of that report that are available to the public, minus any issues that would be an issue or a concern from a privacy perspective.

KENDRA COOMBES: Since issues were just brought up, my question to the minister would be: Will he be able to share what is known about the issues at this time?

ZACH CHURCHILL: We do have to wait for that review to be completed to speak to the specifics of it. Staff in the room just did confirm with me that that is a qualitative review, so that does fall under the same legislation that the Northwood review would have fallen under. There will be privacy elements with parts of the review, and that’s to protect the individuals who are providing information. I suspect the recommendations will be made public.

KENDRA COOMBES: A group of local doctors has begun their own review because they are concerned that the health authority’s review may not be looking wide enough beyond the issues and the data provided to the Canadian Institute for Health Information. They are concerned that Cape Bretoners may be avoiding seeking medical attention because of a fear rooted in the death rates.

Madam Chair, my question to the minister, if he would be so obliging to answer this, is: Is the health authority considering widening the review to include factors that affect Cape Breton, such as poverty and obesity?

ZACH CHURCHILL: That would be part of the clinical aspect of the review.

KENDRA COOMBES: Nothing like a quick question and an answer.

I want to move along to a labour question, if I might, within long-term care. At the beginning of June last year, Quebec’s government launched a recruitment drive backed by the full power of the government and funded fully to get 10,000 personal support workers, equivalent workers, paid them $21 per hour for training, increased wages to $26 an hour, and worked to deploy these workers into nursing homes.

British Columbia’s government took action at the very outset of the pandemic to provide full-time work and increased the wage of $21.75 per hour for personal support workers in long-term care to stabilize the workforce.

My question to the minister is: Did the Department of Health and Wellness and the minister consider any similar compensation strategies for Nova Scotia?

ZACH CHURCHILL: We don’t oversee the contract negotiations with our continuing care assistants (CCAs) in our long-term care system. The Department of Labour Relations is responsible for that for all government departments.

I can speak to the recruitment and retention efforts that the department does take responsibility for and work on. It’s true that we do have more physicians right now than we have a supply of CCAs in the province, so there is labour demand in this field.

We are running a pilot program that was launched to support people who are certified CCAs and they do have their skills and experience assessed through the Recognition of Prior Learning program. That pilot program will support up to 200 people by waiving their assessment phase fees, and is reducing education fees by about $800.

Over the last five years, close to 300 people have become certified through that program. In October, a second year of the bursary program for CCAs was also launched. The bursary provides up to $4,000 to enroll in continuing care programs through the NSCC and private career colleges. To date, we’ve had 115 bursaries that have been made available, in addition to the 100 bursaries that were awarded in 2019-2020. This fills the recommendation made by the long-term care panel.

In 2019-20, the government implemented a marketing campaign to promote the CCA role in Nova Scotia, increasing enrolment in the training programs. In September 2019, the CCA Entry to Practice policy was amended to allow retired nurses and internationally educated nurses to be granted CCA equivalency, provided they meet certain criteria. We’re working with the Health Care Human Resources Sector Council on a recruitment and retention strategy for the sector overall. That also involves our overall nursing strategy. This has been an area that the department has been focused on from a recruitment and retention perspective. Labour Relations would be a lead, if the member does have questions on labour and related files or the contract negotiation.

KENDRA COOMBES: I want to continue on with this line of questioning because I think it’s important that, as a department, one would hope that you would be advocating on behalf of the staff that is under long-term care in the Department of Health and Wellness.

[4:45 p.m.]

Compensation for frontline staff and management in long-term care can be as much as 30 per cent to 40 per cent lower than the same or equivalent roles in the Nova Scotia Health Authority. The Nursing Homes of Nova Scotia Association has asked the Department of Health and Wellness to conduct a full compensation review of all long-term care roles.

Can the minister talk about what work is under way in this regard within advocacy from your department?

ZACH CHURCHILL: Just to clarify, that information was incorrect. CCAs with the certification are paid the same across long-term care and acute care.

KENDRA COOMBES: I just hope that the minister would be advocating on behalf of those whom he represents within the Department of Health and Wellness.

THE CHAIR: Order, please. The time for the NDP caucus has elapsed.

The honourable member for Argyle-Barrington.

COLTON LEBLANC: I thank the minister and his staff for joining us this afternoon for the committee.

Before I dive into my specific questions, I do want to follow up on the minister’s comments this afternoon in Question Period in response to a question from my colleague from Dartmouth East about cataract surgeries. The minister said we’re even providing billing codes to private providers here in HRM to help us deal with this backlog. Also, it’s stated that the department is enlisting support from private clinics.

I just want to make sure. Can the minister clarify that they’re opening up the billing codes for private practitioners specifically for cataract surgeries?

ZACH CHURCHILL: That is happening in specific locations in the Central Zone, and we’ve also reduced the wait time in the Valley.

COLTON LEBLANC: My follow-up question to the minister is: Why wouldn’t we do the same for our mental health practitioners?

ZACH CHURCHILL: That was done for cataracts, recognizing that the wait times in Nova Scotia were the highest for those surgeries, higher than the majority of other surgeries, if not all of them. When it comes to mental health wait times, those have been reduced through government initiatives, so we’ve reduced the acute wait times down to the national standard of seven days, and the median wait is now five days, and for the urgent ones, they’re getting within two days.

The non-urgent wait times for mental health supports have been reduced by - I believe they were over a year - and those have been reduced to a median of 14 days. We have done substantial work to dramatically reduce the wait times for mental health in the province. Of course, there’s more that does need to be done on this, which is why in the budget we had some key areas of investment in and specific focus on mental health issues.

As the member would be aware, we are expanding virtual care options for mental health. We’ve already brought in a 24/7 crisis line with a central intake system, which didn’t exist before. There were previously over 100 different numbers that people had to call to access mental health support, depending on where they were at in the province. We now have one central intake, which has helped us very much reduce the wait times as dramatically as we have.

We’re also looking at expanding the support for withdrawal and addictions. Each region will be provided the resources to establish an addiction withdrawal hub for the inpatient/outpatient needs of those dealing with addiction and no-harm withdrawal management.

In this budget, we are also expanding access to sexual trauma therapy to Nova Scotians. These are on top of the investments that we’ve made really heavily with mental health supports in our schools to support our children and adolescents. There have been significant investments made.

The wait times are now at or below, in most circumstances, the national standards for wait times. This budget will see further enhancement in these supports. We also provide significant community-based funding for those local organizations that provide community and peer-to-peer-based mental health support.

COLTON LEBLANC: I guess if we’re doing so well and we have the ability and the means to do better, I don’t think we should just settle for average or settle for the standard. I think if we have the means to open up to private practitioners, we should be a leader in doing so. That’s something that I strongly urge the minister and his government to do.

Changing gears, I do want to speak about the prehospital emergency health system in our province. This is something that’s obviously near and dear to my heart, as a former paramedic, recognizing the role that paramedics have within our health care system, but also recognizing as an elected official the importance of the system for our constituents and for the health care system as a whole.

Listening, whether it be to the constituent coming through my office, or speaking with anybody at all, for that matter, is trying to put myself in their shoes. That’s something that I can obviously relate to, not only the paramedics themselves but patients and their families that I hear of, as well as health care workers who are expressing their concern with the system.

My first question is just a quick-fire question to the minister: How many paramedics are currently employed by Emergency Medical Care?

ZACH CHURCHILL: Roughly 1,200.

COLTON LEBLANC: My question for the minister is: How many are currently on leave for a variety of reasons right now?

ZACH CHURCHILL: We can get that number for the member.

COLTON LEBLANC: It’s been communicated to me that there are about 200 paramedics off for a variety of reasons. The 21 paramedics being hired who were alluded to earlier today in Question Period is a drop in the bucket of what the workforce that’s off is currently. Quick math: If there’s 200 off, that means there’s one-sixth of the paramedic staffing complement that’s off work right now.

When the Fitch report was released, it wasn’t really acknowledged that staffing was an issue. My question for the minister now is: Now knowing what’s been communicated to me, at least - and I believe other members of this House have stated it today as well - knowing that there’s 200 paramedics off, is staffing a significant issue right now for the system?

ZACH CHURCHILL: As the holders of the contract with EMC, who employ our paramedic workforce - as the member would know, they’re not employees of the department or the NSHA. They’re employees of EMC. It is stipulated in their contract that they do have to maintain adequate staffing levels to meet the needs of our system. That is a responsibility that EMC does have. They are very active in recruitment efforts and student placements, as well.

We have furthered the accountability metrics in the contract, in line with the Fitch report recommendations, to ensure greater accountability with EMC in meeting the needs of the system.

COLTON LEBLANC: I guess one-sixth of the workforce missing without any sick calls, without any new injuries, without any vacation requests, without any hiccups in the system - that raises a flag for me that staffing may not be as adequate as desired.

As I’ve previously mentioned in this House, paramedics - both new and old - have been expressing to me and to my other caucus colleagues that they’re looking for an out. This is deeply troubling for me to hear, as they’re former colleagues, but also, again, as an elected official looking at this system from an exterior perspective now. This may be news to the minister, but this is the reality.

My question for the minister is: What’s the plan for the province to retain our current hardworking and dedicated paramedics?

ZACH CHURCHILL: Again, our expectations are that the contractor maintains a workforce suitable to meet the needs of the system. Nova Scotia actually does have more paramedics per capita than the national average. The national average is 100 paramedics to 100,000 citizens or residents. In Nova Scotia, we’re 36 per cent above the national average, so we do have 136 paramedics per 100,000 residents.

In terms of looking at the staffing complement - and we are looking to see if the member’s number is accurate on sick leave - we are close to 40 per cent above the national average for the amount of paramedics per capita. That’s a positive indicator to me.

Furthermore, we know that more have been hired this year and that more are being hired in either May or June, depending on when those interviews and those processes complete. The indication right now that we have is that EMC is fulfilling its contract obligation to ensure that there is a full complement.

COLTON LEBLANC: I hope wholeheartedly that other provinces and other jurisdictions are not experiencing the system issues we are, but they quite honestly may be experiencing similar ones. If they have less human resources than us, it just blows my mind what challenges they’re experiencing.

[5:00 p.m.]

I do want to pivot to the infamous off-load guideline directive. Last week in Question Period, on March 31^st - and I can table this - the Premier stated, and I quote, that “off-load times are limited to 30 minutes.” We have heard 20 minutes. We have heard 30 minutes. My experience is 20 minutes.

For the record, I just want to clarify. Is it 20 minutes, or is it 30 minutes?

ZACH CHURCHILL: Just to the member’s previous point, of course the role of Opposition is always to point out deficiencies in the system and push a perspective, in the case of the current Opposition members, that everything is in crisis and needs repair. That can oftentimes be the public perception as well, when the anecdotal examples that we see are tragic, or we hear about the times the systems have failed, or that we lost people, in the worst-case scenarios.

That’s why it’s so important in government to really pay attention to the data, to understand the lay of the land in the situation beyond individual people’s frustrations, to understand how the system is fully functioning and what our capacity is to deliver these services.

Fitch & Associates recognized our system - and this is despite all the personal frustrations - as being a top-class system that is responsive to the needs of people. We are above the national average when it comes to staffing levels.

We have even seen the Code Critical alerts reduce significantly in recent weeks. I’m sure the member has seen that. We have to base our opinions on the experts, on the data and the data points on the staffing complement that I have seen to date. Perhaps there are other data that I need to be made aware of. The data doesn’t paint as negative a story as the member does. The fact remains that this system is saving lives in Nova Scotia and is supporting people despite system challenges and individual frustrations and sometimes failures.

When it comes to the off-loading question, this is an issue that has persisted for some time. It’s multi-faceted, as we have talked about before. We believe there are some solutions for where the off-load challenges are most acute in the province. That would be, primarily - based on the numbers I have seen - the Halifax Infirmary. That would be most challenging site. There are other ones as well in the Halifax Regional Municipality and outside of HRM.

We are looking at solutions with the Health Authority right now on that. I believe we’ll hopefully have some recommendations coming from them in the very near future.

COLTON LEBLANC: I’m trying to gather my thoughts here right now, because with the minister’s last comment trying to say that I’m always trying to be negative about the system that so many across the province are passionate about - that’s a little bit of a low blow.

You know what? I was among those frontline workers who were saving lives, and I actually continue to speak to those individuals, dedicated paramedics across our province. It’s not such a rosy picture that may be portrayed out there. It’s the reality.

I encourage the minister to maybe reach out to constituents, and I can put the minister in contact with my constituents, whether it be in Argyle or Barrington. I have a number of paramedic stations - I have three paramedic stations in my vast constituency. When they have an unstaffed ambulance base, or ambulances that are gone vacant for hours, at great lengths, when I have doctors who are calling my office at the very regional hospital that the member and I share who are explaining crisis situations to me - I’m not fearmongering, and neither are members of my caucus. It’s the reality of the system.

This issue is not new. I worked in the system that we’re discussing right now. I’m just a little blown away at the minister’s comments trying to say that I’m always trying to be so negative here. It’s the reality of the system, a system that’s so important to the health care system that Nova Scotians rely on when they need it.

So in the same vein of off-load guidelines, I do want to ask the Minister of Health and Wellness: What are the current off-load statistics in our province?

ZACH CHURCHILL: We have confirmed that the member’s number of 200 paramedics being off on sick leave is not accurate. That number is currently at 120. There’s an 80‑person difference there between what the member has and what the stats are from EMC.

The off-load time ‑ but honestly, I haven’t seen ‑ I do have to take the bait on this, because all I’ve heard from the Opposition is that we do have a system that is in constant crisis, where people are imperiled, that does not adequately respond to the needs of Nova Scotians. I haven’t heard the member or other members of his caucus speak to the times ‑ the paramedics that the member and I both know, who I do speak with, who have saved the lives of others in our community. That happens as well, but I haven’t heard the member speak once about those situations.

I do believe that there is a political bias coming from the Opposition. The political focus is on health care, strictly. They are stacking their political future on the perception that Nova Scotia’s health care system is failing all over, is failing everybody, and is in a constant state of crisis. I’m sorry, but I don’t share that perspective. There is enough evidence in Hansard to suggest that what I am saying about what is being portrayed by the members opposite is accurate.

Yes, we have some challenges in our health care system. There is not a health care system in the world that doesn’t. We have pressures on our health care system. We have it in our emergency departments, we have it in our ambulatory care systems, and we have it in access to primary care. These are real. They exist. These challenges will persist, and we need to have well-thought-out solutions to them.

We have made substantial gains in health care ‑ improving access to it and enhancing the services that Nova Scotians receive. If you do talk to people whose lives have been saved by a paramedic, or by a doctor in the emergency department, or by an early diagnosis and the incredible care that our oncology gives people in this province, or the world‑class support that our kids get at the IWK Health Centre, which saves lives of young people each and every day ‑ if you do take into consideration the reality of that system, then it is very difficult to say that all is doom and gloom, as the members opposite do.

Listen, that is recognizing that there are challenges and frustrations and not everybody is happy with the health care system, but we have made substantial and demonstrable improvements with access to primary care. We’ve recruited, on average, 130 doctors a year. We’ve attached 180,000 patients. We have some of the best-equipped ambulances that exist, that are proudly produced in Yarmouth, in my home constituency.

Fitch & Associates recognized the quality of our ambulances and how incredible they are, the responsiveness of our paramedics, and how well they do despite the challenges that they face. We are going to continue to tackle the real challenges that exist to further improve the system, but my comments about the perception that the members opposite are choosing to push, I think, are obvious. Anyone listening to these debates or who wants to take the time to read Hansard will see that.

Let’s be honest, the Party opposite is staking their political future on people believing that the health care system is a complete failure. That is evidenced every single day that questions are asked. So if that’s the position you are going to take, stand firmly behind it and we will go to the polls on it. That’s how it’s going to happen if people are going to make a determination.

I have a lot more confidence in the system. I’ve talked to people whose lives the system has saved. I’ve talked to some family members of people whose lives weren’t saved, as well, but we have to recognize that there are multiple sides to that coin.

In terms of the standards that we’re putting in place, there are two standards that we’ve mandated the health authority to follow. One is a 12-hour standard for emergency department in-patient flow, and a 30-minute standard for ambulances to the NSHA from the drop-off point.

COLTON LEBLANC: I like to dream and most times it’s not in colour. You know what? I’ll say it how it is. It sounds to me that the minister may be disengaged with the reality of health care in our province. When you have 60,000 Nova Scotians without a family doctor, when you have an exorbitant amount of off-load delays - in 2018, at least, part of my answer I was trying to get to is an hour and 27 minutes - the average, according to the Fitch report. As the system has continued to progress - I expect that it’s worse. But the minister did not provide that answer.

When you have paramedics on the side of the highway, one in Yarmouth, let’s say one in Liverpool, one up in Blockhouse - that’s not an ideal system. For the minister to try to portray myself and my caucus colleagues for standing up for Nova Scotians, who expect us to be the voice of reason, and for an emergency health system that they so rely on in times of crisis, I can’t wrap my mind around that. If the minister wants to try to portray us as stake in the ground for whatever political gains or an election or whatnot, he’s disengaged with the reality of the system and health care in our province. If you don’t have health, what do you have?

I want to know from the minister what is the difference between the 2019 directive and the 2021 directive? When was the 2021 directive effective?

THE CHAIR: Just a note to the member asking questions for the PC caucus and the minister, as well as the committee members, there’s about five minutes left before we take the mandatory COVID-19 break.

ZACH CHURCHILL: Again, in terms of what the members opposite are trying to push as the perception, the member said there was a 119-minute average off-load wait time. That’s not accurate. That was 55 minutes, and in the last two months that has been reduced to 45 minutes. We are already seeing some improvements on the off-load wait time in the province and that’s a result of both directives that have gone out and the subsequent work that the health authority has done.

A difference in this directive is that we’ve established a greater line of accountability with the health authority, whereby they’re meeting regularly with the deputy minister and we’ve put timelines in place for them to complete this work. Some of the work that’s happened prior to Fitch, that is assisting with the reduction in wait times in the last little bit - and there have been jumps in that, particularly during COVID-19, without question. But the averages are coming down, which is what we want to see.

[5:15 p.m.]

We’ve added and will continue to add community paramedics in rural areas and dedicated to communities, with specific training designated for the community that they will be serving. We’ve implemented a Direct to Chairs policy for low-acuity patients who are placed in the waiting room of the emergency department, allowing paramedics to leave quickly and not be required to stay. For patients who are kept in ambulance hallways, EHS does stay with them in teams of two. Patients are being actively treated by those clinicians. In some cases, paramedic teams may double up in the ambulance hallway, but only if it meets the clinical safety and quality criteria.

Obviously, EHS is also working more closely with the emergency department staff, their charge nurses, and doctors, to identify patients who are deteriorating. EHS is reducing the inflow to emergency departments by maximizing use of the Special Patient Program, which is a program that creates unique care plans to keep patients out of the hospital.

Twenty-five per cent of 911 calls are ad hoc and they do treat and release, which keeps patients out of the hospitals, and the low-acuity 911 calls are decanted, when they’re able, to the 811 telehealth services. These are things that were happening before, based on the previous directive to reduce off-load wait times or take some of the pressure off the emergency departments. As a result of the Fitch report and the contract negotiations, we’re adding a 24/7 nurse and physician in the communication centre - that’s happened already - to assist public paramedics and medical first responders.

We’re working to provide multiple patient pathways that benefit patients and their families so that it’s not always to the emergency department. We’re adding medical transport service through a pilot. This would be the non-ambulance vehicles to transport non-urgent cases to and from hospitals. We’re enhancing the standardized data that helps track and plan patient movement through the emergency department.

The Nova Scotia Health Authority is also creating a triage-driven protocol to expedite care, whereby a registered nurse can treat and release, which could eliminate the need for a patient to see a physician in the emergency department, and they’re creating clinical pathways that allow a nurse to draw blood and request certain X-rays, start IVs, and/or give medication for pain or heart attacks before a physician.

The NSHA is also looking at increasing emergency department space and capacity at the Halifax Infirmary and in Colchester, which are two of the emergency departments with the worst off-load times in the province, and increasing nursing resources at the Halifax Infirmary, Colchester, and Dartmouth General, dedicated to improve patient flow within the emergency department.

There is a comprehensive set of steps that are being implemented right now, as we speak . . .

THE CHAIR: Order, please. The time has come for us to take the mandatory COVID-19 break. We will take a 15-minute break at this point. We’ll see you back here at 5:33 p.m.

[5:18 p.m. The committee recessed.]

[5:34 p.m. The committee reconvened.]

THE CHAIR: I now call the committee back to order.

The honourable member for Argyle-Barrington with 28 minutes remaining.

COLTON LEBLANC: I do want to go back and do a quick fact check for the record.

The number that I was referring to about the 200 paramedics being off work was dated from March 3, 2021. Paramedics report to me that they received a video message from senior management indicating that at that time there were 200 paramedics off work for a variety of reasons. I am happy to learn that in a bit over a month 80 have returned to work.

Regarding my question regarding off-load times, it was an hour and 27 minutes again and it is on Page 83 of the Fitch report, and I quote: “Due to the lengthy off-load times averaging one hour and 27 minutes . . .” and it goes on. So that information was, in fact, factual and accurate.

Again, on the off-load guidelines, my question to the minister is: When did the 2019 directive expire?

ZACH CHURCHILL: There weren’t 200 paramedics that were off. There were close to - at one point there was non-paramedic staff that were off, as well, but that number still wouldn’t be at 200. That’s just for the record on that.

The first directive has not expired. It didn’t expire. There was a rearranging of priorities, of course, during COVID-19, as the system reshaped itself to meet the unknown demands of the pandemic. That’s when we did see - while we were seeing some decline after the first directive, based on the initiatives I mentioned earlier - some of those numbers did go back up at our problem sites during COVID-19, so there was no expiry on the first order. However, we felt it pertinent to issue a second order with more accountability measures in place to address this issue.

COLTON LEBLANC: Just a bit more clarification on that. My question to the minister is: Is the 2021 directive in addition to the 2019, or is it just an amendment of what previously existed, to enhance what we previously had?

ZACH CHURCHILL: It’s a new directive reinforcing the initial directive.

COLTON LEBLANC: My last question on that: So the 2019 directive hasn’t been repealed, then?

ZACH CHURCHILL: Correct.

COLTON LEBLANC: I have growing concerns with the cost of the health of Nova Scotians, as well as the pocketbooks of taxpayers in our province, regarding the redacted cost and apparently the exponentially growing cost of off-load delays.

My question for the minister is: On Page 1 in the 2018 Fitch report, why is the cost of off-load delays redacted?

ZACH CHURCHILL: The office of the minister does not make a determination on redacted content. That goes through the Freedom of Information Officer.

COLTON LEBLANC: Switching gears a little bit here, the government doesn’t always make it easy for the Opposition or the public to find data and we must do some digging. My first question on annual reports is: Why did the department stop the publication of EHS annual reports after 2011-2012?

ZACH CHURCHILL: I can’t speak to a decision that was made in 2012 before our government was in office, but I can tell the member that in accordance with the new contract signed with EMC, based on feedback from Fitch & Associates, there will be annual reporting from EMC.

COLTON LEBLANC: My question is: When are those annual reports going to start? Are they going to be effective in 2020-2021 or are they going to be made available retroactively? Are we going to have to wait until next fiscal year to see that first report?

ZACH CHURCHILL: The report will be for 2021 and should be available for the public in approximately a year.

COLTON LEBLANC: I want to dive into the matter of a performance-based contract and look at what it includes for the contract between the Province of Nova Scotia and Emergency Medical Care. It’s noted in the Fitch report that it includes wages, benefit increases, consumables.

Can the minister say if there’s anything else that’s included and if there’s a management fee associated with this contract?

ZACH CHURCHILL: In terms of the reporting accountability, it’s no longer just going to be performance standards that are monitored, but clinical outcomes. We will be, we believe, one of the first jurisdictions in the country to do that, to include that as part of the reporting. There is a management fee with EMC, as there would be with a host of private companies that do work for the government. The Victorian Order of Nurses would be an example, road builders would have management fees, the Nova Scotia International Ferry Partnership would be another one that had a management fee. That’s the only management fee that the Party has had an issue with, considering the plethora of them across government services.

COLTON LEBLANC: Mr. Chair, if the minister wanted to just talk about the budget that we’re talking about here instead of making allusions of politicizing something that’s being politicized, or in his mind at least trying to be politicized, it would be nice if we could actually focus on the topic here and discuss this budget.

Regarding the performance of this said contract, are there any penalties for the operator not meeting response targets?

ZACH CHURCHILL: There are, and I agree with the member. I’d like this conversation to be focused on the budget. That’s what Estimates are for. I’m not sure that that’s where others asking the questions have been focused.

COLTON LEBLANC: Considering that this system considers over $100 million of our health care budget, we’re talking about a budget line within the purview - in the jurisdiction of - the Department of Health and Wellness. That’s exactly what we’re doing.

[5:45 p.m.]

So regarding the performance or the penalties, can the minister outline what the penalties are for the operator when they do not meet response targets, such as for transfers and emergency calls?

ZACH CHURCHILL: There are penalties. I’m being informed by staff that whether they will be made available to the public is currently going through a Freedom of Information process.

COLTON LEBLANC: Do we know how often these targets are not being met at present?

ZACH CHURCHILL: The contract has only been active for five days. Could the member specify which standards he’s looking for?

COLTON LEBLANC: Response times, whether it’s for interfacility transfers or emergency calls in the community. Even though we have a new contract, entertain data that’s been within the last year.

ZACH CHURCHILL: That information would be available in the quarterly reporting of the contract, so in three months there would be a report on that.

COLTON LEBLANC: The minister actually, in part, answered my next question. To confirm: The minister and his department receives data from the operating company - from EMC - on a quarterly basis. That’s correct?

ZACH CHURCHILL: I do have the data for the last quarter available for the member. The staff corrected me. It’s actually monthly reporting that EMC provides us, not quarterly. They will be reporting to the department on clinical for the first time, and response times monthly.

In terms of what the average response times are for the last quarter, 10.5 minutes for emergencies and 15 minutes for urgent cases. The standards that we have in place are nine minutes for emergency and 15 minutes.

COLTON LEBLANC: I guess there are probably data that are being compiled for certain reasons, whether it be Central, Northern, Eastern, or Western Zones of the system, and I imagine there’s some variance in that, particularly in rural regions of our province. I question whether the minister is satisfied with the data that was presented to him from the last quarter and after his review of that data.

ZACH CHURCHILL: In terms of what the average standards are, we’re very close to meeting those. We are meeting those in urgent cases, and 10.5 minutes to nine, so we are over. My expectation would be that we be within that standard and get that down to nine minutes on average. Of course, when you’re looking at averages, that’s one story. When you’re looking at the individual cases, that’s an entirely different story.

The cases - one would be the one that was reported in the media recently, where there was a death and, according to the widow, a 40-minute wait time. When that happens, there is a qualitative review that takes place, which includes an administrative review and a clinical review, which are both ongoing right now. Obviously, those aren’t the cases that anybody wants to hear about, when those tragedies occur, but when they do there is a process in place to review and make recommendations to improve the system. Overall, I would say we’re getting close to meeting the standards, on average, but of course when there is an individual case that is above that and where there’s a tragic outcome, it’s incumbent upon us to conduct that review and make appropriate determinations as a result of those.

COLTON LEBLANC: My heart breaks for Mr. MacPhee’s family, as well as April George’s family. My sympathy goes to both of their families and the communities impacted by both heartbreaking stories of the last number of months here. I think it’s very fair to say that 34 minutes, a mere three kilometres away from the busiest hospital - not only in the province but in the Atlantic region - is completely unacceptable. I question how many other unfortunate incidents similar to the last two I cited have actually taken place over the last number of years. My question is: What would be an appropriate response time for an emergency for somebody living in urban Halifax?

ZACH CHURCHILL: Let me echo sympathies and condolences to those families as well. We can all imagine the turmoil of those last minutes while people waited for help. Those are the worst-case scenarios that we can hear about. We do owe it to those families and the deceased to conduct those reviews to figure out exactly what happened and why, and using a clinical and operational perspective on that to try and ensure that they don’t happen again. In terms of what would be acceptable from my perspective, I would have to lean on what the standards that the professionals in the field have set for response times, which would be nine and 15 minutes.

COLTON LEBLANC: I understand we live in a vast province that has these geographic challenges, so nine minutes or 15 minutes is not quite possible in certain parts of the province, so there’s a variance there in response times.

I dread the day that my phone will ring or I’ll receive an email that my community has been impacted and my constituents have been negatively impacted by a similar situation as we’ve been discussing over the last few moments here. That’s why I am so passionate about this issue, as well as my caucus colleagues. I think of all corners of my constituency, whether it be in the Kemptville area or if it’s in the Pubnicos or if it’s in the Clark’s Harbour-Barrington region. At times, you have an ambulance in Yarmouth and the next one up is in Barrington. As the minister would very well know, that’s highway driving. It’s probably a good 40 minutes. Just driving off each of those peninsulas adds a significant amount of time and adds a number of challenges within the system. Response times aren’t nine minutes or 15 minutes. Again, I have grave concern that all of these incidents have happened in other parts of the province, they have a significant chance of happening here.

Does the minister have data specifically on rural response times?

ZACH CHURCHILL: We do have that data. It’s broken down by zone. Again, these are averages, which is not every case, but the averages are how we track this.

Response times in each zone: average response time in Central is 10.5 for emergency, and for urgent 15.7; for Eastern Zone it is 8.7, which is below the standard. That’s for emergency, and urgent is 12.3. This is for the last quarter. In Northern Zone it is 12.2 and 17.7; and for Western it is 10.7 for emergency and urgent is 17.1.

COLTON LEBLANC: I want to talk a little bit more about the system and how it’s been updated or revamped with the number of recommendations from the Fitch report. Just for clarification, there have been 68 recommendations and it’s 64 recommendations and that 45 have been implemented. I just want to make sure that we’re all on the same page here - is it 64 or 68 that we have? I understand there are four that aren’t being implemented.

ZACH CHURCHILL: There are 68 recommendations, 64 of which we are going to complete, 45 of which have been completed or begun.

Also, I will point out that while Fitch recommended higher average response times, they recommended in the report for urban, 11 minutes and 16 minutes. We’ve kept our standards at nine and 15. Fitch recommended the average response time for rural emergency and urgent responses to be at 16 minutes and 21 minutes. We have kept them at 15 minutes and 20 minutes. Fitch asked for more time for the average response time standard, and we have kept them what they were previously.

[6:00 p.m.]

COLTON LEBLANC: Obviously, the whole health care system has to be engaged in essentially tackling the issues across the health care sector, whether it be long-term care, primary care, emergency rooms, or the EHS system. That’s alluded to in the Fitch report by Fitch themselves and partly how to look at addressing the long off-load delays.

I guess, in the two minutes and a bit that I’m left with this round of questioning, I’m wondering, in the minister’s opinion, what’s the timeline for Nova Scotians to see a realistic change to the system so that we’re not hearing about the Code Criticals that are still happening, we’re not hearing about transfers that are being delayed or missed, and there’s alternative means that have to be creatively thought of by care teams. There’s huge regions of the province that go with sparse ambulance coverage.

I’m just wondering, what’s the realistic goal that we can say by this date, or we hope that by this date, we’ll have some appreciable change?

ZACH CHURCHILL: We have seen implementation of some of these changes. We’re moving forward with 45 out of the 64 recommendations, including the introduction of the non-ambulatory transport vehicles, expanding the scope of practice for paramedics, and putting additional resources into our emergency departments. I think among the most important are the accountability measures in the contract and ensuring that dollars above a certain profit for the company are reinvested into the system to improve it.

We have also hired more paramedics, and that hiring will continue. We have issued a second strong directive to the Health Authority on off-load times. My expectation for improvements on that is for them to be as quickly as possible. I’m expecting to see some changes within a month or two of issuing that directive . . .

THE CHAIR: Order, please. The time for the member for Argyle-Barrington has elapsed.

The honourable Leader of the New Democratic Party.

GARY BURRILL: I would like to direct a few questions to the minister in the area of budgets and policy on long-term care, beginning with the work and recommendations of the expert panel. It’s over two years now since that document was issued, and it’s a year and some since the last report, which provided people of the province with an update on the work coming out of the expert panel. This budget contains a lot of investment that’s related to that work, and yet the details on the progress of the recommendations coming out of the expert panel are not immediately clear from the budget documents.

In light of the very significant budgetary and other decisions that are being debated currently in this whole area of continuing care, I want to ask the minister if he could commit during this present legislative session to providing the House with some manner of update on the work that’s ongoing to implement the recommendations of the expert panel?

ZACH CHURCHILL: There will be a full report issued later this Spring, but I can go over some of the initiatives that have been ongoing as a result of the panel’s recommendations for the member. We have been meeting with the sector as well to validate some of these directions, and the feedback has been positive on progress to date from the sector.

We have invested in the long-term care assistant role. That was based on sector feedback and recognizing its critical importance to the pandemic response. That’s $5 million of the panel funding that has gone towards that.

Regulations were amended to allow nurse practitioners to work independently as primary care providers in long-term care. Recruitment has begun in the Northern Region for a nurse practitioner for long-term care.

There has been a recruitment campaign for CCAs that we have undergone. That initiative will continue. The bursary program has continued, and the RPL pilot was launched. A broader marketing campaign was developed. As soon as facilities are able to open to Communications Nova Scotia folks, we’ll have people take local pictures to accompany the story that the sector is sharing on these implementations.

We’re working with the Health Care Human Resource Sector Council to finalize a further recruitment and retention plan. We’re working with the Health Association of Nova Scotia to hire zonal wound care clinicians to provide support to our continuing care providers.

There are innovation pilot projects that are currently under way to test approaches to working with those with challenging behaviours. The Nursing Homes of Nova Scotia Association, in collaboration with the Health Care Human Resource Sector Council, has reviewed funding from the department to create an online knowledge hub that will highlight recruitment and retention strategies as well as working with complex behaviours.

There has been a review of vacant residential care facility (RCF) beds. That’s in its final stages. There has been policy development to further address primary care coverage in long-term care settings. A review of the existing legislative framework has already begun. The interRAI procurement has advanced through 2020. The Department of Health and Wellness has made significant capital investments to support facilities with safety equipment such as ceiling lifts.

These are some of the moves that have happened as a result of the long-term care panel recommendations. Furthermore, we have also responded to the Northwood review as well as the Infection Prevention and Control report, which resulted in millions being invested in capital upgrades in our long-term care facilities to keep COVID out during subsequent waves, after Wave 1. At Northwood, they’re all single rooms now. There have been barriers and personal protective equipment (PPE) provided in long-term care facilities. As well, vaccinations, of course, have been a priority for long-term care. That’s where the greatest risk exists for COVID spread.

That is a brief highlight of some of the initiatives that we have undergone since the long-term care panel and the Infection Prevention and Control Canada (IPAC) and Northwood reports. There will be a full report that’s provided later in the Spring.

GARY BURRILL: I think the minister will recognize that it’s a pretty significant budgetary increase to go to $27.8 million at that line to implement findings of the expert panel. I think the minister would agree, too, that it’s the job of the House to evaluate whether or not this allocation is sufficient to the description of the work that it’s attached to. Therefore, it seems to me that the House would be able to do a much better job of carrying out its responsibilities of making this judgment if the update containing the real detail and more of the line-by-line explanations of the sort that the minister just provided, if that were provided during the session of the House when the budget itself is being evaluated.

Would the minister not agree with me that that’s a reasonable request to make?

ZACH CHURCHILL: Sure thing, and we can go through that line by line now. This would be specific to the long‑term care expert panel on funding. We’ll get the IPAC and the Northwood budgets as well. We’ll get that for him as well.

I can go through the line-by-line budget for long‑term care expert panel funding increases. There has been $10.3 million allocated to hire long‑term care assistants to support the care team with resident activities of daily living. There has been over $6.4 million to expand the access to allied health care providers and make sure that that is equitable across the sector in the province. That would be physiotherapists and other allied health providers.

There has been $5.4 million to implement primary care coverage in nursing homes. There has been $3 million for the recruitment and retention strategy. There has been over $2 million to dedicate space and specialized programming specifically for young adults in our long‑term care facilities. There has been just under a half a million dollars assigned to full-time LPNs to residential care facilities. There has been $150,000 budgeted to establish behavioural management units in each zone to support residents experiencing responsive behaviours. We will get the itemized list from the IPAC and Northwood reports, as well, and attach budgetary figures to that.

Overall, our long‑term care budget has now met the milestone of exceeding $1 billion. That is a result of a major influx in spending, not just for these initiatives but also for the renovation of over 700 spaces in our system and the building of 238 new spaces. Those are not the final capital announcements that we’ll be making as a government.

I have the IPAC information here, but I do want to review it quickly before I speak to it to the Chamber. Those are the numbers that I have from the long‑term care expert panel.

GARY BURRILL: Those supplementary numbers that the minister has, perhaps it would be okay for them to be tabled?

ZACH CHURCHILL: Happy to table the budgetary information.

GARY BURRILL: I just would like to ask a few clarifying questions from the budget highlights document. The long‑term care and home care section there, that first bullet, the $22.6 million increase, refers to including long‑term care assistance, expanding insights, access to allied health providers, and implementing primary care coverage in nursing homes. Could the minister speak to which of these programs are new programs?

ZACH CHURCHILL: While these would not be new initiatives to the system, they will be new services provided to certain regions of the province that didn’t previously have access to them.

[6:15 p.m.]

We brought in the long-term care assistant program in 2019 and this budget expands that. Allied health care providers, I believe, have been around in certain areas for a while, but we are expanding that service to ensure that there’s equitable access to them in every region, which didn’t happen before.

The wound care is a brand new initiative. If the member was looking for one brand new initiative that wasn’t just an expansion, it would be the wound care.

Just to follow up on the response to the IPAC recommendations, we can go through that very quickly for the member. Most of the recommendations on Northwood and IPAC have been implemented. The number of residents in Northwood has been reduced to accommodate all single rooms. There have been changes to 17 other facilities across the province, as well, to increase the number of single rooms available.

We’ve implemented the Wave 2 Plan for continuing care for the pandemic. Some of the key actions that were undertaken include additional funding for improved cleaning and infection control and personal protective equipment. We’ve extended the employee and family assistance program to long-term care workers and over 2,000 new employees have been enrolled in that.

Funding has been dedicated for management staff and IPAC clinical resources for long-term care facilities. Visiting all nursing homes and reviewing each facility’s pandemic plans happened in advance of the second wave to ensure that the new standards were being followed.

Funding was dedicated for occupational health and safety support for licensed facilities and assistance is provided to the facilities in the event of an outbreak, with coordination of staff testing and monitoring happening as a result of that, coordinated through Public Health.

Funding for professional staff education through an online platform called Brightspace for infection prevention has happened as well. There’s a forecast for those costs of approximately $30 million in the 2020-21 budget. That’s forecast at over $33.5 million for 2021-22.

GARY BURRILL: Staying with this same first bullet at the $22.6 million, could the minister provide some sense of the number of long-term care assistants that are being hired under this line and some approximation of the length of time that they’re being hired for.

ZACH CHURCHILL: There are over 200 employees who have been brought into that program.

GARY BURRILL: Moving down these same bullets under long-term care and home care, the next line is the $12.3 million for extending the regional care centres. Could the minister provide some sense of what is being covered with this $12.3 million?

ZACH CHURCHILL: I’d like to thank the member for the question. The regional care centres are dedicated spaces at each regional hospital, and that is to relocate residents who test positive for COVID-19, to get them out of the facility and minimize spread.

That number - the $12.3 million - would be primarily for the staff to staff those facilities - the nursing complement and the other staffing supports that would be required - the operational expenses as a result of that, and the transport expenses. There are 72 designated regional care unit beds within Nova Scotia hospitals and the Ocean View Continuing Care Centre.

To date, because we’ve managed to keep COVID-19 out of our facilities in subsequent ways - and I’ll knock on wood for that - we have not seen any admissions, so that budget would be contingent on utilization of those spaces. Today, we have not had to utilize the regional care centres, but they remain there in the event that we do.

GARY BURRILL: Thank you. Yes, I understand that about the plan and the situation with the regional care centres, and I appreciate the explanation that that number is by and large related to potential staffing.

In the budgeting for the regional care centres - and that provision for staffing - does this envision new staffing, or people who are already elsewhere somewhere in the health care system?

ZACH CHURCHILL: It’s budgeting to have enhanced staffing available - new resources to accommodate those centres.

GARY BURRILL: So if the minister’s staff is following me in the budget highlights document, just skipping the next one below and coming to the $6 million increase to support continuing care with COVID-19-related expenses.

I wonder if the Minister of Health and Wellness could provide some examples of the kind of expenses that this line envisions?

ZACH CHURCHILL: There’s a host of things that would be covered under that: personal protective equipment, funding for additional cleaning, equipment, capital expenditures, staffing, purchasing of medical supplies like oxygen tanks, IVs and medication carts, plexiglass barriers - these sorts of measures as outlined by the IPAC report.

GARY BURRILL: I’m just trying to understand the mechanism by which this transfer to facilities operates. How does it work? Funds under this line, are they directly forwarded to the administrators of facilities, or does it work some other way?

ZACH CHURCHILL: The operators would submit a claim and we would fund it.

GARY BURRILL: And presumably a large share of that claim would relate to staffing expenses, especially in the present situation. Could the minister speak to what kind of accountability mechanisms are in place to ensure that the improved COVID-19-related staffing levels that this line envisions are, in fact, being delivered?

ZACH CHURCHILL: Fairly basic accountability measures: the need to provide receipts and proof of expense, inspections - those have been happening virtually through the COVID-19 period, as well as audits.

GARY BURRILL: So just continuing down this same list in the same document, next we come to $3.9 million to support long-term care facilities with lost revenues during the pandemic. Could the minister speak to some of the circumstances in which facilities would have lost revenues during the pandemic? What is the kind of thing that this line has in mind?

ZACH CHURCHILL: That is to cover a small vacancy that we need to manage risk in our long-term care facilities. In all of our facilities, while we do have the regional care centres that we transport COVID-19 patients to - which we thankfully haven’t had to use yet - each facility is required to have a small space to accommodate any potential positive cases before they’re transferred to isolate them from as many other staff and residents as they can.

This is to provide funding in relation to the loss of revenue that our facilities would have to accommodate the IPAC protocols of having small vacancies to put patients that are positive in.

GARY BURRILL: Just on the bottom of that same page, the line “$500,000 to advance the blueprint for change in long-term care,” would the minister be good enough to ask the department to table or otherwise provide an update on the work that’s taking place under this category?

ZACH CHURCHILL: We can table this information, but essentially that $500,000 would be for primary stakeholder engagement and utilization of expert consultants as we further build the blueprint for change in long-term care. Those would be the two primary expenses under that item.

THE CHAIR: The Committee of the Whole on Supply will now pause for the 15 minute COVID-19 break.

[6:33 p.m. The committee recessed.]

[6:48 p.m. The committee reconvened.]

THE CHAIR: Order, please.

The honourable Leader of the New Democratic Party, with about 30 minutes remaining.

GARY BURRILL: I just want to first make sure that we had the same understanding about that last point on the $500,000 for the blueprint for change in long-term care. In addition to the minister’s answer, the minister agrees - did I understand right? - that the Department of Health and Wellness will provide, either by tabling or directly to our caucus, an update on the work that’s being done with that blueprint?

THE CHAIR: The honourable minister seems to be muted - oh, no, he’s not. He’s not muted, he’s just talking.

ZACH CHURCHILL: Can you hear me? Okay. Yes, the report will be available later this Spring - the full report on the progress of the long-term care panel recommendations in the blueprint.

GARY BURRILL: Madam Chair, the mute button is not entirely without advantages. (Laughter)

I would like to switch over to ask one question. Out of the documents supplied with the budget papers, titled Summary 2020-21 COVID‑19 Response, in the Health and Wellness numbers there, maybe one third of the way down that list, under Long-Term Care Support, there’s an amount for $31,411,000.

I would like to ask the same question as the previous one about this. Would the minister undertake to have a breakdown of this $31.4 million either tabled to the House or directed to our caucus?

ZACH CHURCHILL: Similar expenses to what we talked about in the $6-million reference - PPE, additional cleaning, equipment, staffing, those sorts of things.

GARY BURRILL: I’m wondering if the minister would be able, though, to undertake to provide us with a written breakdown of what that $31.4 million is referring to.

ZACH CHURCHILL: Happy to provide the member of the House with a general breakdown of those expenses.

GARY BURRILL: Leaving the numbers in the budget documents themselves, I’m thinking about the announcement last year about the people who were going to be moved from an alternate level of care arrangements in hospitals to a new temporary unit as part of a strategy of freeing up hospital space - a lot of discussion about that at the time of its announcement. I wonder if the minister could provide us some update on where we are with that approach.

ZACH CHURCHILL: The community transition unit was brought in to deal with access and flow pressures to ensure that we have capacity to deal with acute in-hospital service in our hospitals. The unit does have space for up to 50 clients, and that’s in two floors of the hospital that we are utilizing now - two floors of the hotel that’s being used.

GARY BURRILL: So I understand, then, that the model was designed to provide this kind of accommodation for up to 50. Can the minister tell us how many people have been involved in this model to this point?

ZACH CHURCHILL: There have been 30 patients who have been able to leverage the unit. There have been over 240 who were assessed, and of those, 30 met the criteria and choose to do this. Many of those other patients who were assessed were also discharged closely after that assessment.

GARY BURRILL: Just to make sure that I understand this right, is the minister saying that the number presently is 30, or that 30 people in total have been part of this arrangement to date?

ZACH CHURCHILL: That number is a total number. Again, that’s after 243 have been assessed for a room.

GARY BURRILL: Could the minister also provide a sense of the cost parameters, the budget for running this temporary Alternative Level of Care (ALC) model to this point?

ZACH CHURCHILL: That would be $1.2 million.

THE CHAIR: The honourable minister - the honourable member for Halifax Chebucto.

GARY BURRILL: I’ll remind the Chair that the member for Colchester-Musquodoboit Valley and I are the only two real ministers in the House.

THE CHAIR: That’s why I said it.

GARY BURRILL: We spoke a little bit earlier about the regional care unit (RCU) model. I wanted to ask the minister a little bit about the thinking that led to that approach. I understand what the minister said earlier, that this was a plan that, to this point, has not had to be operationalized, thankfully.

I’m wondering about the thinking behind the development of the plan. We know that it requires fragile residents to be moved out of their homes, and that this is only the case for those who, with their families, permit it. But I wonder if the minister could speak some to why the RCU model was chosen in the first place and what kind of models for this model, what kind of research or other jurisdictions or places where this had been tried - what is it that recommended this as the road forward for us in Nova Scotia?

[7:00 p.m.]

ZACH CHURCHILL: The rationale, obviously, is to isolate positive COVID-19 patients, separate them from other residents in our long-term care facilities, and ensure they’re given the appropriate medical attention in our hospitals. The recommendation came from the infection prevention and control reporting recommendations.

GARY BURRILL: I’d like to ask the minister: Is there research in the department about the choice of that model that it would be possible for the department to present?

ZACH CHURCHILL: This would have been a result of consultations with Public Health, lessons learned from Wave 1 of the virus, jurisdictional reviews of our neighbours in Atlantic Canada, and utilization of principles of infection, prevention, and control.

GARY BURRILL: Are there then any research documents related to this recommendation that the department would be able to provide?

ZACH CHURCHILL: As the member would know, there was no one definitive playbook for COVID-19 management that would have guided the department’s activity list. It was, as I mentioned previously, based on the best advice from public health officials, jurisdictional reviews from Atlantic Canada, conversations with our counterparts.

There was a report that came out of Ontario where they were affected very dramatically by spread in long-term care facilities. That also had this as a recommendation. If the member is looking for public health literature on this, that is one document that we utilized and made a determination to - particularly after Northwood - make adjustments to reduce risk of spread in our facilities. This one is pretty obvious, I think.

GARY BURRILL: I want to ask a facilities question. Not very long ago, we saw that the Municipality of Guysborough had to sell the long-term care facility that it had in fact owned. Can the minister explain if there is any support within the department that’s provided directly to municipalities who are in an ownership position with these kinds of public assets to be able to maintain that position?

ZACH CHURCHILL: Every facility, whether it is not-for-profit, provided by a private provider, or municipally owned, is treated equally in the province. They’re able to make themselves available to the same supports as every other facility.

GARY BURRILL: Does that mean to say, then, that there would be no specific place that a municipality that found itself in the position of the Municipality of Guysborough, in this kind of situation - no particular place in the department, when they found themselves not able to remain in their position as the owners of that publicly-owned facility, that they would be able to turn to for help in order to be able to maintain their position as the owners of the publicly-owned long-term care facility?

ZACH CHURCHILL: In this particular case, the department did have conversations with the municipality, so I’m told. This happened pre-COVID and before my time here. The municipality made it very clear that they wanted to get out of the long-term care business. We are seeing this with other municipalities that do own those facilities, that there has been a trend of them choosing to either sell or get out of that business entirely.

GARY BURRILL: Thinking more about the general question of facilities, particularly new facilities, can the minister tell us about the timeline for tendering the newly-announced capital investments in long-term care and when he is expecting to see those RFPs go out?

ZACH CHURCHILL: Our thoughts are that that’s happening imminently, but we’re going to get a more specific timeline for the member.

Just to follow up on the Guysborough issue, there was no request for funding. It wasn’t a matter of funding with that particular issue. There was a decision made at the municipal level and there was no request for funding that came into our department. So it wasn’t a funding‑related issue with that issue.

GARY BURRILL: And was there more that the minister wished to say about the timing of the tenders for the new facilities?

ZACH CHURCHILL: We are going to get the member a timeline on that. I am being told by the room within the next couple of months, but we will get a specific timeline for that for the member and the House.

GARY BURRILL: Thank you. Just to make sure I’ve understood that right, is the minister undertaking to make that information available to our caucus within - did you say two months?

ZACH CHURCHILL: We have just confirmed that it is going to be within the next two months. That is as precise as we are able to be on that.

GARY BURRILL: Thank you. That is the conclusion of the questions I have about long‑term care. I have a number of questions in related areas for the minister.

First, when one of the sessions concluded the other evening, the member for Dartmouth North was asking about something that is a continuing priority in our Party, both federally and provincially. That is universal pharmacare.

We know that there are reliable estimates from multiple sources that in the area of one in four people in our province don’t take their medications as prescribed or don’t fulfill their prescriptions because they can’t afford to do that. We know that the federal governing Liberal Party has been promising to implement universal pharmacare and to really move on this for ‑ well, a long, long time.

I wonder if I could ask the minister to speak about what his government’s approach has been to this work of meeting and connecting with the federal government and finally making universal pharmacare a reality for the people of our province?

ZACH CHURCHILL: We have committed to work with the federal government and other jurisdictions. I recently just had a conversation related to this in the last ministers’ conference call that I participated in. It sounds like this is a project that the federal government is very committed to moving forward on. They have a willing partner to ensure that the best interests of Nova Scotians are met as we work with them and other provinces on the establishment of this.

GARY BURRILL: This is, of course, very important and there have been numerous provincial and federal mandates in which we have heard lots of declarations about people being in favour of it, and yet we still find ourselves the only country with Medicare in the OECD‑related countries that doesn’t, in fact, have a pharmacare program.

I would like to ask the minister: Is this, in fact, a priority for him in the period when he is Minister of Health and Wellness and, if so, what concrete measures of real advocacy to bring this onto the screen and make it a reality is he taking part in now? Does he have it in his plans and on his screen for the rest of his tenure?

ZACH CHURCHILL: This is a priority of the federal government which we have committed to work with them on. We are going to be working with them through this process in the attempt to improve access to pharmacare for people in the province. They are very focused on implementation of this. We have committed to being right there with them through conversations and planning and implementation.

[7:15 p.m.]

GARY BURRILL: I would also like to return to the subject that the minister was exchanging about with the previous representative from the Progressive Conservative caucus about the tragic events to do with the MacPhee family. I understood from the minister’s answers in the House and in that exchange that there are two investigations into the EHS response that day last September.

I missed if the minister had said what the timeline is on when those investigations will be completed. Is there a timeline about that that the minister could inform us of?

ZACH CHURCHILL: No, and just before I move to this subject I do feel it important to note that Nova Scotia does have a Pharmacare Program and Family and Seniors’ Pharmacare Programs, which we have invested in and expanded. Nova Scotia does have these programs in place and we’re committed to working with the federal government to see if there’s potential to further expand those.

The tragic situation with the MacPhee family is undergoing two investigations. Those are being led by the provider, Emergency Medical Care Inc. (EMC). They are doing that. That’s the process they take. That wasn’t as a result of a directive from the department. They began those, I believe, shortly after the incident.

I know the timelines can vary, depending on the circumstances that they are investigating, but we can check with EMC to see if they have a timeline for those reports.

GARY BURRILL: And is the minister undertaking that that timeline information will be tabled with the House or conveyed to our caucus when it’s available?

ZACH CHURCHILL: We just actually heard from EMC in the room. It should be completed within the next couple of weeks.

GARY BURRILL: And will the minister undertake that the findings of those twin investigations will be made public?

THE CHAIR: Order, please. The time for the NDP caucus has elapsed. I will now move to the PC caucus.

The honourable member for Argyle-Barrington.

COLTON LEBLANC: I would be interested in hearing the minister’s response to the question from the member for Halifax Chebucto, so I’ll give him the opportunity if he could provide that response to the committee, please.

ZACH CHURCHILL: There is not a clear black and white answer to this. The way the process is being explained to me is that it does depend on the content and the privacy requirements that the operator would have to follow.

COLTON LEBLANC: I guess in the same vein, my question for the minister is: Are there other investigations that are being conducted similar to the ones that have been referred to by my colleague from the NDP?

ZACH CHURCHILL: Further to my last answer, the EMC would also meet with the family to go over the information with the family as well. The family does receive this information. Again, it depends on the content of the review and privacy considerations whether anything would be available for public consumption.

We believe that there are other clinical investigations going on. Those would be through Dr. Travers at EMC. We aren’t aware of how many at this point, but we can see if we can get an answer to that.

COLTON LEBLANC: Is the minister made aware of these findings, and does he have an opportunity to comment on the findings of the reports?

ZACH CHURCHILL: The department staff would be made aware, and if recommendations impact policy, legislative, regulatory development from the department, then the minister would be made aware.

COLTON LEBLANC: I want to go back and follow up on my first line of questioning regarding the offload guidelines. I just want to make sure, because in my past professional experience, it was 20 minutes. In a Global News story from April 1^st, it was 20 minutes. I just want to make sure I’m understanding. Is it 20 minutes for an off-load or is it 30 minutes? I understand it’s 90 per cent of the time or whatnot, but I just want to make sure. Is it 20 minutes or 30 minutes?

ZACH CHURCHILL: The answer would be 30 minutes.

COLTON LEBLANC: That’s a policy change that has changed over the last number of months, I guess? Is that correct?

ZACH CHURCHILL: That has been the consistent number in both directives written by a previous minister and me.

COLTON LEBLANC: Thank you very much for that clarification. On the topic of annual reports, I’m just wondering why the department in 2013 didn’t reinstate them after a previous government had ceased their publications?

ZACH CHURCHILL: I can’t speak to that decision. It’s a little before my time here. However, what I can say is that they are being mandated in the new contract with EMC.

COLTON LEBLANC: I guess, having read through the Fitch report and speaking with patients’ families, other health care workers, and paramedics themselves, there’s a little bit of concern that maybe the 2018 data that’s reflected in the report may not reflect the realities of a 2021 system.

Has there been any consideration at the department level to extrapolate data and do a comparison analysis of what’s presented in that report and what’s in front of the minister and department staff now, to compare apples to apples on this file?

ZACH CHURCHILL: I’m not clear on the question. If the member could expand on that, please?

COLTON LEBLANC: Fitch & Associates did their investigation and collection of data back three years ago. Here we are three years later with a much different system - a system that has evolved and changed in many different ways.

Even before the report was released, there were a couple of people actually questioning if the report would be, in fact, 100 per cent reflective of the needs of today’s system. I guess I’m just trying to see if off-load times are different then and now, if human resources are different then and now, and if response times are different then and now. I’m just looking at it through that lens there.

ZACH CHURCHILL: We do have access to that data. It’s consistent from 2018 to present.

COLTON LEBLANC: I think when the minister was wrapping up during my first round, my question was: When’s change coming? When is appreciable change going to be seen in all aspects of this system here?

The minister alluded to, as quickly as possible in a month or two after the directive. I think you just got cut off. I wanted to give him the opportunity to restate that answer and provide the details that are required.

[7:30 p.m.]

ZACH CHURCHILL: Yes, I expected immediate work on this. I spoke with the CEO and the Chair at the time of the Health Authority. We wanted imminent action, and we have seen over the last two months improvements in off-load times. They have gone on average from 55 minutes to 47 minutes. We want to get that down to 30 minutes. As I mentioned, we expect some more substantial changes two months after the directive being issued.

COLTON LEBLANC: I guess tying into the off-load delays and with this directive, are there any consequences for the Health Authority for not meeting those targets?

ZACH CHURCHILL: There’s no punitive consequences. There is an expectation that the directive is met with increased accountability in this directive with reporting directly to the deputy. We’ll be expecting a report from the Health Authority very soon, and progress will be monitored.

COLTON LEBLANC: How often is that data going to be communicated by the Nova Scotia Health Authority to the department? Is that data going to be made public?

ZACH CHURCHILL: Those are reported monthly, and it is available to the public.

COLTON LEBLANC: The minister spoke about new accountability measures that are built into the foundation of this new contract. I’m wondering if the minister can explain a little bit more of the accountability, whether it is going to be increased oversight and whatnot when it comes to not only the financial side of this service but also the patient outcome side, which has been alluded to, or the clinical measures of this system?

ZACH CHURCHILL: So, two areas where there’s enhanced accountability here. One would be in the contract with EMC. For the first time, we’re bringing in clinical outcome standards. That will be new to the contract. We’re increasing the reporting requirements. With the contract with EMC, there are monetary penalties if they’re not meeting the standards as outlined in the contracts. There are penalties in the EMC contract for noncompliance.

For the accountability with the off-load directive to the Nova Scotia Health Authority, there is increased reporting into the department on their performance, and of course, there are performance appraisals of senior leadership within the Health Authority. Those would be the broad-based, high-level accountability tools that we have in place.

COLTON LEBLANC: I’m very interested to learn how these clinical outcomes are going to be measured. Obviously, if a patient has a favourable outcome, I’m sure that’s a good checkmark. What’s the picture going to look like? Is it going to be taking response times into consideration? Treatment or on-scene time? A number of different factors that are looked at in the delivery of the care by paramedics.

ZACH CHURCHILL: The evaluation framework is currently being developed, but essentially, we’ll track patient outcomes: whether the patient was properly treated, whether they were stabilized or improved or whether they deteriorated, and whether the health care provider provided the appropriate treatment at the time. At a high level, that’s essentially what we’re going to be evaluating: what happened to the patient. That evaluation is currently being developed.

COLTON LEBLANC: I guess I’m looking at - obviously that’s a more favourable measurement tool, but are there any identified downfalls to that measuring tool?

ZACH CHURCHILL: I think what we want to be evaluating here is how we did from a patient care perspective. Did the system respond to the needs of the patient appropriately? Did that patient improve as a result of that treatment? Did they deteriorate? Did the system provide them with what they needed? I don’t see any downfalls to that.

I think that’s where the system should be focused. It shouldn’t just be response times, which don’t tell the whole story. It should be on what happened to that patient in our care. How were they treated, and were they helped or not? That will help us better assess the system and its impact on the lives of people in the province.

COLTON LEBLANC: I do have a couple of questions on the 19 remaining recommendations to be implemented. I’ll ask both at the same time.

My first one is: Will there be any legislative changes required for this to happen? And part B to that question: How long before the remaining recommendations are implemented?

[7:45 p.m.]

ZACH CHURCHILL: In terms of legislation, our team is reviewing legislative framework right now to determine whether any legislative changes will be required. Fitch indicated that there might be, but we are in the process of determining whether that is a necessity or not, for implementation.

In terms of the timeline for the additional recommendations, it will vary. Some will be implemented throughout the lifecycle of the contract. Others are being initiated through pilot. The non-ambulatory vehicle transport would be an example of that, and the community paramedic program would be another example.

The timeline on expanding those or fully implementing them will really be dependent on the findings of the pilots. So we’re not able to give definitive timelines on all of these, as the discovery process, through the pilots in particular, will inform when and how those programs can be expanded.

THE CHAIR: Order, please. We are going to take our 15-minute COVID-19 break, so we will return at 8:04 p.m.

[7:49 p.m. The committee recessed.]

[8:04 p.m. The committee reconvened.]

THE CHAIR: The Committee of the Whole on Supply will now resume.

The honourable member for Argyle-Barrington.

COLTON LEBLANC: My question continues on the recommendations. I’m wondering if the department will make it public and communicate what four recommendations won’t be implemented out of the 68?

ZACH CHURCHILL: I need the member to repeat the question, please.

COLTON LEBLANC: I’m inquiring which four recommendations will not be implemented and if they will be made public.

ZACH CHURCHILL: I do have that list right here and that list was made public during the technical briefing on the Fitch report recommendations, so this is a matter for public consumption now.

Recommendations not being implemented. One: moving the Workers’ Compensation Program from the Department of Health and Wellness to Emergency Medical Care Inc. There are costs related to government legislation that’s beyond the control of EMCI, and EHS and EMCI work closely together to find ways to reduce issues related to Workers’ Compensation. So, Workers’ Compensation will not be moving from the department.

The expansion of the scope of services of the adult critical care team to include pediatrics will not be moved forward with. We don’t believe this is necessary, as EHS already has its own specialty pediatrics team that will continue to provide high quality care for children in the province.

Fitch asked us to consider eliminating the cross-training of the neonatal and pediatric ICU nurses, while creating a small group of each specialty to be trained for flight. We don’t believe this is necessary, as EHS wishes to maintain the existing specialty pediatrics and neonatal teams that will continue to provide the care that they’ve been providing to the province.

They wanted to change the communications centre to a civilian model, which we are not moving forward with at this time. If there was a decision to move to that, and those jurisdictions do it under a civilian format, there tends to be cost savings there but that’s not an interest we have right now. If we ever did move in this direction it would involve consultation with our stakeholders before it is determined to do that.

Those would be the four that we are not moving with and those have been reported publicly.

COLTON LEBLANC: If memory serves me correctly, there was a recommendation that spoke about CPR and basic first aid before graduation, so I expect that would be one of the recommendations. Obviously, it’s not one of the four that’s not being implemented. Looking at when that would be rolled out into our high schools?

ZACH CHURCHILL: That recommendation isn’t something we can initiate on our own, through EMC or the Department of Health and Wellness. I do know that the Department of Education and Early Childhood Development, even prior to Fitch, had been in consultation with the Heart and Stroke Foundation and cardiovascular clinicians on enhancing teaching in this way. I know those conversations were ongoing in the Department of Education and Early Childhood Development even prior to Fitch. That one does fall outside the scope of the Department of Health and Wellness and EMC, but I do know that the Department of Education and Early Childhood Development has been discussing that issue.

COLTON LEBLANC: On the topic of CPR and AEDs, I was very happy to hear the government take part of the legislative idea from my MLA colleague for Queens-Shelburne and the efforts of Brody Kouwenberg on his advocacy to get AEDs in schools. Is the government entertaining legislation to include AEDs to be mandatory in other parts of our other buildings in our province?

ZACH CHURCHILL: It wasn’t a legislative requirement to put AEDs in schools. It didn’t require legislation to do that, it required the budget to do it. That came from a directive from the department and the accompanying budget. We’re not considering any legislation at this time around AEDs. We do have a fairly robust AED availability in Nova Scotia. It’s about 1,300 pieces of equipment that are on the registry and they’re available in communities. I’ll double check with staff here because my memory might be wrong on this but I do believe that in public buildings, where we know that there are high risk individuals, AEDs are provided there. That was the case in schools even before the mandate to put them everywhere.

COLTON LEBLANC: I want to go back to something the minister said and I believe other members had said, as well, regarding expanding the scope of practice for paramedics. Is it necessarily an expansion of the scope or rather the ability for paramedics to work at their full scope? I know it’s been mentioned - treat and release - that doesn’t necessarily require new skills or medications to be administered, rather just policy changes.

I am just looking for clarification on the expansion of the scope of practice principle that has been mentioned previously.

[8:15 p.m.]

ZACH CHURCHILL: We would consider this to be an expansion of their scope of practice in some key areas. One, utilizing community paramedics to respond to non-urgent community cases. An example would be someone who’s post-operative who might be experiencing a discharge or infection or something like that. Paramedics would be allowed to respond to those.

Enhancing paramedics’ scope to utilize them in nursing homes, where they will deal with patients in nursing homes with the intention of providing the support they need to keep them out of the emergency department, as well as the ability to independently treat and release patients instead of bringing them to the emergency department.

We would consider that, broadly speaking, to be an expansion of scope of practice.

COLTON LEBLANC: Another vital ask of paramedics that has been long advocated for by their union is about powered stretchers. A long-awaited announcement was made back in, I believe, September of 2019 - I was a newbie in the Legislature at the time - regarding the procurement of a number of power stretchers and power load systems.

I’m just wondering when will the remainder of the fleet be equipped with that equipment?

ZACH CHURCHILL: That work is ongoing. Currently, 50 per cent of our ambulances have been equipped with power stretchers and power loaders.

COLTON LEBLANC: I guess there’s no definite time frame that the remainder of the 50 per cent of the fleet will be completed?

ZACH CHURCHILL: We can expect more procurements every year on this front and more retrofits to bring more power loaders and power stretchers into the system. It just depends on the availability of the budget and budgetary pressures on our ability to invest. There is money that’s found every year to increase the capacity with these devices. We’re already at 50 per cent and the member will see more of those included every fiscal.

COLTON LEBLANC: I’m happy to hear that. Quite frankly, the return on investment and the injury reduction, based on these pieces of equipment, is quite impressive. If you look at Niagara, 78 per cent injury reduction and a return on investment in 5.8 years. In Winnipeg, 71 per cent injury reduction and return on investment in three years, and that’s from the Fitch report. I am, however, perplexed that the return on investment is redacted from the Fitch report for our province.

Going to another branch of our system, the EHS system, is the Community First Responder Program. I’m wondering if there will be any changes. I know it’s discussed briefly in the Fitch report, but I’m looking to see if there will be any changes made to that program specifically.

ZACH CHURCHILL: The Community First Responder Program was suspended during COVID-19 to allow COVID-19 training to happen with our emergency first responders. We are in phase three of getting all those folks back into the system. Phase one was in areas that were furthest from ambulances. Phase two prioritized areas where there are higher cardiovascular incidents, statistically, and phase three is the rest. We’re expecting all those folks to be back and volunteering in the system by the end of the month, actually, so that would be a significant change. That training has happened and they are all going to be able to be deployed in the system by the end of the month, and about 50 per cent are able to be deployed right now.

COLTON LEBLANC: Just a little bit further on that line of questioning. Will there be any extension of the roles and responsibilities that medical first responders do to complement the jobs of paramedics within the EHS system?

ZACH CHURCHILL: There will be enhanced clinical support for those individuals who are responding to calls that will be in the communications centre, with the nurse and the physician, as in line with the Fitch report, so their access to expert medical advice is being enhanced.

COLTON LEBLANC: I’ve heard concerns from different agencies that at times they feel like they’re filling a gap that they shouldn’t be filling. You could send 50 medical first responders, it just doesn’t change the fact of prolonged response time, for example.

I’m wondering if the department is looking at various other supports to help the medical first responder agencies that not only volunteer their time, but fundraise to support repairs on their vehicles, the usage of fuel, and whatnot.

ZACH CHURCHILL: Our government does provide support to those agencies. That is primarily through the Department of Municipal Affairs and the grants that are made available every year for equipment. I know there have been some substantial grants for new vehicles as well.

One more thought on that. The previous Minister of Municipal Affairs, I believe, increased that budget pretty significantly as well. I don’t recall the specifics, but it may have been double.

COLTON LEBLANC: I guess through Municipal Affairs it is more specifically for fire suppression equipment, or if it’s a ground search and rescue organization, for equipment specific to that. I think those grants are very much welcomed when it comes to the fire suppression side of the services that many of these first responder agencies do, but do not necessarily supplement the energy and the fuel and the usage of the vehicles themselves.

I do want to take a few moments to talk about the new medical transport service. If the minister can briefly explain what this service is going to look like, or actually looks like, because it’s being rolled out now?

ZACH CHURCHILL: The simple explanation for this would be to utilize non‑ambulatory vehicles for the transport of non‑urgent and stable patients. That can be from hospital to hospital or from hospital to home. It will eventually free up time pressures that are on our ambulances, because not all these patients require ambulances for that sort of transport. It will free up paramedics’ time and ambulatory time.

We are currently running a pilot with four vans, and the House could expect, based on a successful pilot, which I anticipate, that program to be expanded.

COLTON LEBLANC: Just quickly, I am wondering if the minister has the cost of this pilot program and when it is expected to complete its pilot phase?

ZACH CHURCHILL: The pilot is being run through EMC. We are just going to double check with them on the cost of the pilot. We don’t have that in the room.

COLTON LEBLANC: Thank you, Mr. Chair. I guess in certain instances it could be perceived as medical, but in other situations it doesn’t really sound like a medical transport service. It sounds a little bit like a reinventing of an arm’s-length Uber service. Even in the Fitch report, on Page 54 it talks about - that the car service could be operated by EMC or contracted to a taxi agency.

There are taxis in different parts of the province, there are bus services in various parts of the province, there is Uber, and there are community transit networks. I am just wondering if the government and the department are going to be entertaining the idea of making policy changes along with the NSHA that would enable alternative modes of transport, like I had mentioned, beyond the medical transport service?

[8:30 p.m.]

ZACH CHURCHILL: We have no plans to utilize, or to entrust the care of patients to, private taxis or Ubers. We’re using accessible vans that are equipped with certain medical devices. In some cases, when paramedics have been on leave and are easing their way back into the system, they will also be utilized for this service, but we’ll be ensuring the highest quality standard and managing this service through the EMC command centre to ensure that the service delivery is also linked in with the management of our ambulatory system.

There are no plans to entrust this to Uber drivers. That’s not the intention. It’s to have the appropriate vehicle that can take care of patients and perhaps their loved ones, that’s fully accessible for them, and that’s equipped with appropriate devices and personnel.

COLTON LEBLANC: It does outline in the Fitch report that NSHA should be ordering resources based on “medical necessity,” defined as ensuring that the right mode of transport is dispatched for the right patient, such as car service, wheelchair van, ALS ambulance, or multi-patient bus.

I’m not insinuating that it’s a complete dependence on Uber, but again, when we’re looking at medical necessity, whether there be opportunity for, again, alternative modes of transport, that taxi could be utilized or whatnot.

I guess quickly on patient transport fees, I want to confirm that there are not going to be any changes to the fees currently being administered.

ZACH CHURCHILL: There’s no planned change in the user fees.

COLTON LEBLANC: Great, thank you, Mr. Chair. I do wish I had more time, but I want to talk about another important topic: preventive care. Particularly, just quickly with the few moments that remain, it is about diabetes in our province.

We know that in 2019, 11 per cent of our population, or 113,000 Nova Scotians, were diagnosed with diabetes. That number is expected to rise to 137,000, which would be 14 per cent in 2029.

I’m not going to go through the litany of the impacts on individuals’ health and subsequent costs on the health care system. I’m looking to see if the department is looking at new technology that exists out there, such as the continuous glucose monitoring devices that may have a positive impact for certain patients. Can the minister respond to that, please?

ZACH CHURCHILL: Okay, I’m getting a lot of information in the room here, but essentially - I’m running out of time - preventive health is part of our curriculum in our schools. Public Health does campaigns to encourage people to not smoke and to eat properly. As well, we have taxed certain products - like cigarettes, for example - to encourage the right behaviour for preventive health.

THE CHAIR: Time for the PC caucus has elapsed.

The honourable Leader of the New Democratic Party.

GARY BURRILL: Thank you, Mr. Chair. I would like to just continue where we were with the minister before this most recent hour that the Progressive Conservatives have led.

I would like to go back, just quickly, to the minister’s comments about universal Pharmacare. We had had an exchange about Pharmacare. I had asked about where the government of the province was providing leadership to interface with the federal government’s commitment to moving in this direction - what was happening, what we could look forward to. The minister offered a subsequent comment about, well, we have this kind of pharmaceutical coverage and that kind of pharmaceutical coverage and various programs in Nova Scotia.

I want to just make real clear, the minister is not saying, is he, that in his view, Nova Scotia is a jurisdiction that has universal Pharmacare?

ZACH CHURCHILL: They’ve indicated this is a priority. They want to see a national universal Pharmacare program, and Nova Scotia has committed to working with them toward that goal, ensuring that the pharmaceutical needs of our population are prioritized in those conversations.

GARY BURRILL: Great, thanks. I just wanted to make sure that there wasn’t any unclarity about that point.

I’d like to ask a couple of questions about ambulances, one dimension about ambulances, and that is the question of fees. We know that in 2021, the department wrote off over $4.7 million in uncollected fees, and that these came from two items: EMC ambulance fees and primary health care information licensing fees.

Could the minister direct the department to inform us what part of that $4.7 million was for the ambulance fees themselves?

ZACH CHURCHILL: It’s $2.7 million.

GARY BURRILL: Thank you. That’s helpful information. Thinking along these same lines: Does the department have a projection for how much it anticipates ambulance fees could be written off in 2021-22?

ZACH CHURCHILL: We don’t have that. That would come through EMC. They determine what’s collectable and what’s not collectable. There is a time frame on that, but we don’t have that projected at this point.

GARY BURRILL: Would the minister agree with me that in terms of budget projections, this would be an important and potentially useful projection for the department to have?

ZACH CHURCHILL: The reason it’s not practical to forecast that is because there are certain reasons why EMCI can’t collect those fees - if someone passes away, those fees aren’t collected, or if somebody moves out of province, they can’t collect those. There’s no practical way to forecast how many folks owing are going to perish or move away. They do know that after 150 days, I think on average, past the due date whether they’re going to be able to collect or not.

I wonder if the member is thinking this is a line link to the low-income reimbursement program of ambulatory fees. That is separate. That is not what the budget line item that he’s referencing is. This is just write-offs - people who they’re not going to be able to collect from for various reasons, primarily death and people moving.

GARY BURRILL: Thank you for clarifying that. Yet it must also be true that a significant percentage of the ambulance fees that are written off would be written off because they were uncollectable for financial, and therefore presumably income-related, reasons. We know that people apply to have the fees waived if it would impose a financial hardship.

Does the department know, and would the department be able to communicate to us, the percentage of bills for EHS services that are waived for income-related reasons?

ZACH CHURCHILL: We’re not able to produce that number quickly, but we will get that from EMCI. Again, the write-off number that he is referencing - these would not be related to income-based issues. They would be related to an inability to collect based primarily on the two factors I previously mentioned. However, we do have the reimbursement program for those who suffer financial hardship and who are unable to pay, and we might have that number. Just let me check on this and we might have that number right now.

[8:45 p.m.]

We do have those figures. I’d like to thank the staff for producing the stuff so quickly. In 2019-20, there were well over $1.5 million worth of fees that were waived, and that was related to close to 13,000 invoices. This is a program that close to 13,000 Nova Scotians utilized last year, and they would have been reimbursed over $1.5 million in ambulance fees.

GARY BURRILL: Thank you to the staff for producing that number so quickly. It’s an important number. I can’t imagine staff could do this on the spot, but would it be possible to provide us with a breakdown of how much of those waived fees are related to low-income financial hardship category waivers?

ZACH CHURCHILL: That would be 100 per cent of those. It’s all based on income criteria.

GARY BURRILL: Thank you. I hadn’t understood that. I thought it was possible that that also included the category the minister spoke of earlier, where fees are waived in the case of a patient passing away. That’s a good clarification.

We know that the income-related fee waiving takes place in response to an application that a person makes. Would it be possible for the department to provide us information about the percentage of those applications which in fact do result in a waiver of fees?

ZACH CHURCHILL: The criteria that’s used are based on Statistics Canada low-income measures. Evidence of their household income has to be provided by the individual, and 100 per cent of people who apply and meet that income threshold as defined by Statistics Canada are able to waive their ambulatory fees.

GARY BURRILL: I understand that, and one would expect that. What I’m wondering is if there is a percentage of applications that are in fact rejected, and what might that percentage be?

ZACH CHURCHILL: We don’t have the number of applications that come in that are rejected, but it would be all of them that don’t meet the income criteria. You do have to meet the income criteria as specified by Statistics Canada, and 100 per cent of those who meet that criteria and apply are given a waiver. For other individuals, we also do have no-interest payment plans whereby EMC will work with the patient and identify a payment plan that the patient is able to afford to recoup those costs, as well. There is a high degree of flexibility with repayment for individuals who are having a hard time paying those fees. Circumstantial financial hardship could be a factor, as well.

THE CHAIR: Just before you go, I heard a little bit of background noise there. Could you please make sure everybody is on mute? Please and thank you.

GARY BURRILL: I want to ask about another important program, unrelatedly, the Nova Scotia Insulin Pump Program, established a number of years ago when our Party was in office. It’s a significant program in the help it offers to families and individuals to afford the cost of insulin pumps, which as the minister knows, can be very expensive propositions.

The budget of this program has been decreasing year after year. Families are still being left with incredible bills, often, for these important devices. Here are the numbers: in 2014, the program received $5.3 million; in 2015, $2.3 million; in 2016, $1.5 million; in 2017, just under $1 million; and from 2018 through to this year, it’s still under $1 million.

Can the minister provide the explanation for these year-after-year decreases, over the last seven years, in the Nova Scotia Insulin Pump Program?

ZACH CHURCHILL: This is a program for those who have diabetes and are 25 years old and younger. The budget is consistent with the utilization, so the reason the budget has gone down is because utilization has gone down. Fewer people aged 25 and under have been in need of this, which is a good health care story.

GARY BURRILL: That is a good health care story, but it doesn’t change the fact that those people to whom the program applies are still paying very large amounts of money, often more than the families are able to afford.

If we have a decreasing usage, which makes sense as the minister explains it, why wouldn’t it make more sense to keep the budget allotment as it was and provide a greater percentage of the expenses for insulin pumps to each participant in the program rather than diminishing the program because the total number of patients in the program had declined?

ZACH CHURCHILL: As the member referenced, this was a very good program that the previous NDP government set up. We’re still following the framework that was set up under that government. It is based around utilization. It’s very exciting that utilization is going down for people 25 and under with Type 1 diabetes.

There is a scale of financial support available to the families, so it’s not one size fits all. In the application process, it’s determined how many dependants they have and what their financial abilities are, and that will determine the scale of the financial support that is made available. There is flexibility to support those with greater financial need.

GARY BURRILL: Yes, I understand that, but it doesn’t answer the question. Why would it not be better to simply hold the program’s budget allocation steady, and when you have a decreasing number of participants in the program, increase significantly the allotment that is provided to each family?

ZACH CHURCHILL: Because the program is set up based on utilization, so when utilization goes down or goes up, that would impact the disbursement. But as I mentioned, there is responsiveness within the program, based on the financial needs of the family. So if utilization is going down, and the overall budget is going down, that does not mean that the families are not getting the scale of support based on their financial needs because they are getting scaled support based on that.

GARY BURRILL: I would now like to ask a geographically specific question about palliative care services on the South Shore. We know that in Halifax and in many other regions of the province, there are dedicated palliative care beds in hospitals or in palliative care centres where we have dedicated spaces for people at the closing chapters of their lives so that chapter can be experienced with maximum dignity.

This is not the case at the moment in Lunenburg and Queens Counties. There’s no palliative centre there. There are no designated palliative care beds in a hospital. This means that sometimes the final days or the final hours of a patient’s life are spent in an emergency room. Of course, the staff working in these locations are caring people, but they sometimes have no alternative in these circumstances except to leave the patient alone at this moment of the closing of their lives. It’s not unheard of that they should be in an open hall because there isn’t any other space dedicated to support them. There have been a lot of significant efforts to develop a South Shore palliative care centre.

I would like to ask the minister: Is this on the radar? Is this a priority? Is this something that the department can see moving towards in the upcoming period?

ZACH CHURCHILL: That’s a very good point. We have been working as a government to expand palliative care options where there have been deserts for that sort of care. That has happened in Cape Breton, Halifax, Kentville, and Yarmouth as well. Beds have been made available in the hospital for the hospice society.

There is a recognized gap in the South Shore, and government is working on a plan to fill that gap. I would ask the member not to force me to get ahead of any announcements in this area, please.

GARY BURRILL: An announcement of this sort would certainly be universally welcomed. We know that the South Shore does have one of the oldest populations in the province. I wouldn’t ask the minister to get ahead of himself, but I would ask him: What concrete supports are, in the present moment, being put in place to fill this gap in the provision of palliative care services on the South Shore?

ZACH CHURCHILL: We have been in the process of identifying the demand in that area, and a plan is being put together. I hope the member can stay tuned until a future date for more information on this important subject.

[9:00 p.m.]

GARY BURRILL: I want to assure the minister, Mr. Chair, that I’m always tuned. I’d like to ask a primary care question in the few moments that we have left. So many of the health care concerns that I’m sure are directed to the minister - certainly that are directed to all MLAs, to the government, to the department - have to do with the provision of primary care. We know that one of the roads that could improve our capacity to provide primary care across the province would be the incorporating into the provision of care in Nova Scotia on a wider basis - certainly more than we’re doing at the moment - of physician assistants.

I want to ask the minister: What progress are we making in the province on the proposal to really, seriously incorporate - as so many other jurisdictions have done successfully - the profession and the work of physician assistants in Nova Scotia?

ZACH CHURCHILL: I appreciate the question. That is an area of interest for the province. Our focus to date has been on the expansion of our nurse practitioner complement. We have increased that complement every year. There’s now 238 that are practising, and they can practise even as the primary care provider in some circumstances, for patients.

We are monitoring the burgeoning use of physician assistants, and that is a topic of interest, for sure, for the department.

GARY BURRILL: It’s a legitimate question, surely, for the minister: Why is it that we can’t proceed on both the nurse practitioner and the physician assistant fronts at once? Plainly, these are related professions, both of which have an important role in filling the pronounced gaps we have in the provision of primary care in the province.

Why would it not be possible for the Department of Health and Wellness to be moving with greater focus and energy than it has provided to date on the physician assistant front, even while work continues to integrate nurse practitioners, as surely we need to do, more comprehensively?

ZACH CHURCHILL: I mean, obviously, to move on that, consultation engagement will need to happen with our physicians and stakeholders in the medical community. Our focus to date has been on enhancing access to primary care through - and this is in line with where I think the public’s priorities are - with recruitment, retention of family physicians. By expanding scope of practice for nurse practitioners, as well as pharmacists. That’s where the focus has been. So, we are . . .

THE CHAIR: Order, please. The time allotted for the consideration of Supply today has elapsed.

The honourable Government House Leader.

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

THE CHAIR: The motion is carried.

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

[The committee adjourned at 9:04 p.m.]