HALIFAX, WEDNESDAY, APRIL 7, 2021
COMMITTEE OF THE WHOLE ON SUPPLY
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 with Resolution E10, the Estimates of the Department of Health and Wellness.
THE CHAIR: The honourable member for Cape Breton Centre.
KENDRA COOMBES Madam Chair, I’m wondering if the minister could remind us what portion of Nova Scotians have private drug coverage.
HON. ZACH CHURCHILL: We’re still working to get that figure for the member.
KENDRA COOMBES: Madam Chair, recruitment in the long-term care sector is an incredible challenge, as is acknowledged by the resources allocated in this budget. People who are working on recruiting in the sector, either locally, nationally or internationally, have spoken about the challenges of funding housing for new recruits, especially new, immigrated recruits.
Could the minister talk about what he may know about this challenge and what work is taking place here?
ZACH CHURCHILL: Could the member clarify, recruitment for which profession?
KENDRA COOMBES: I’m sorry. I’m talking about the long-term care sector.
ZACH CHURCHILL: We have had a shortage of continuing care assistants, which is creating a workforce pressure in our continuing care sector. We have been working very closely with the Department of Labour and Advanced Education to work on recruitment. We did table a bill today to make the CCA Registry for Continuing Care Assistants mandatory in the province. Currently that registry is voluntary and less than 10 per cent of our CCAs are actually registering, so that does create workforce management issues, not knowing how many certified folks we actually have in the sector. From the workforce management perspective, that bill will be very useful in the middle to long term for workforce management and for recruitment and retention purposes.
There’s also a lot of other initiatives going on for recruitment of CCAs and this isn’t just an issue in Nova Scotia. There are shortages in other jurisdictions across the country as well. In the last five years, an average of approximately 600 CCAs have been certified annually and this represents about seven per cent of the estimated workforce, so this is about what we typically educate with most of our health care providers, to regularly replenish the workforce, and the normal range is between four per cent and five per cent annually.
We’ve launched a new pilot program for people to be certified as CCAs and have their skills and experience assessed through the Recognition of Prior Learning program, the RPL process. That pilot will support up to 200 people by waiving their assessment-based fees and/or reducing the education-based fees by approximately $800. Over the last five years, close to 300 people have become certified CCAs through the RPL process. In October, the 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. There have been 115 bursaries made available in addition to 100 bursaries that were awarded in 2019-20. This was also a recommendation from the expert panel.
In 2019-20, the government implemented a marketing campaign to promote the CCA role in Nova Scotia and increasing enrolment in the training programs. In September 2019, the CCA Entry to Practice policy was also 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 Resource Sector Council on further recruitment and retention strategy for the sector overall.
Those are some highlights from the efforts we’ve put forward on recruitment and retention in this field.
KENDRA COOMBES: As much as I appreciate the minister’s comments on this, which I do, I’m specifically talking about people who are working. What are you hearing from people who are working on recruiting in this sector, either locally, nationally or internationally? They have spoken about the challenges of finding housing for new recruits, especially newly immigrated recruits. If he could, if he has any comments on that, I would greatly appreciate those.
ZACH CHURCHILL: We do have a housing department that does focus on this area. There is, particularly in rural parts of the province - I know in my area there is a supply issue with housing, not with affordable housing but with market-based housing. We do work with the Department of Infrastructure and Housing to support those who are coming in.
We also have support for new immigrants who come in to help them find housing and we have supports available through ISANS, the Immigrant Services Association of Nova Scotia. We do have those partnerships, but housing obviously falls outside of the purview of the Department of Health and Wellness. But there is a market shortage in some areas for housing, without question.
KENDRA COOMBES: I want to talk about child care and how it relates to long-term care. Child care was a huge issue for many long-term care workers in the first wave of the COVID-19 pandemic and may also be in the second wave. I was wondering if the minister could talk about what the government, what his department is considering in terms of support for child care during COVID-19 and beyond that for our long-term care workers.
ZACH CHURCHILL: I do have some experience with this, as my previous department was Education and Early Childhood Development, which oversees the regulated child care sector. The home-based child care facilities - the private facilities were still able to operate during the first lockdown. There wasn’t any evidence that there was a major pressure on the child care front. We were ready to respond with opening specific child care centres for the health care sector but the evidence wasn’t suggesting that was an issue here in Nova Scotia.
I do know there are other provinces that we were watching that did open up child care specifically for health professionals, and they didn’t have a big uptake. They opened up these centres and the centres weren’t even reaching capacity, so there wasn’t evidence that this was a pressure. It could just be people weren’t willing to send their children to child care during the pandemic, to reduce risk. That was probably an underlying factor that contributed to this.
We were only one of two provinces in the country - P.E.I. was the other - that actually funded the child care sector throughout the course of the COVID-19 lockdown and kept that sector whole. The other provinces and territories did not do that. We knew coming out of lockdown that we would require that sector to be ready to go and serve Nova Scotians. What we saw was a very quick rebound for that sector, where, I believe, if you include government subsidy and the return of clients, they had an 80 to 90 per cent uptake. They’re here at 80 to 90 per cent of the pre-COVID numbers, so we did see a very quick rebound and recovery of that sector here in Nova Scotia, and a big part of that was because of our subsidy for that sector throughout the entirety of the lockdown.
Also, I do have an answer for you on the private Pharmacare coverage. Sixty to 70 per cent of Nova Scotians have some form of private coverage, so 60 to70 per cent of Nova Scotians have private Pharmacare coverage, which is an incredible number. That’s great to hear.
Those are my comments on the child care sector.
KENDRA COOMBES: I hope the minister realizes how important child care is in growing the long-term care sector, specifically around our CCAs, as well as our licensed practical nurses (LPNs) and our registered nurses (RNs).
I’d like to turn back to - actually, stay on with CCAs. I’d like to know if the minister can tell me how many CCAs will not have received the Essential Health Care Workers Program bonus because they were working in a privately-run facility. I’m sure that he would agree with me that they, too, are essential.
ZACH CHURCHILL: One of the challenges we have is tracking how many CCAs we do have, particularly in the private sector, because there is no registry. Another example of how the registry would be helpful and important to us in terms of workforce management.
On the member’s first point about the importance of child care for the long-term care sector - absolutely true. That’s why we as a government have invested so much in child care in Nova Scotia in a number of ways - obviously, bringing in the first free, universal pre-Primary program to the province. Prior to that program, only one in three of our preschool-age children were actually accessing early learning opportunities, a major gap. Seventy-five per cent of our preschool-age kids didn’t have access to this critical programming. Now, just four years later, 100 per cent of four-year-olds in Nova Scotia have access to that program, and at the same time we did expand the regular child care sector as well.
Infant care spaces - we invested millions of dollars into ensuring that the child care spaces in Nova Scotia - not only were we creating more, but also making them more accessible. Having grants to renovate facilities to make them more accessible, to bringing in additional supports to help children on the autism spectrum that were being served by our regular child care sector, and also investing heavily in making it more affordable to families. We, in partnership with the federal government - and the federal dollars allowed us to really do a lot of incredible work in this sector, allowed us to double the income-based criteria for subsidy from $35,000 household income to $70,000 household income.
We doubled the income criteria to make more families eligible for the subsidy. It has really been an incredible success story here in Nova Scotia. We’ve created 800 new jobs for early childhood educators. We increased the wage floor for them as well. We were last in the country when it came to wages for early childhood educators and the Minister of Education and Early Childhood Development before myself brought in a wage floor that brought us above the national average. Of course, having the pre-Primary program in, having more competitive wages, has been a very good thing for that sector. We’ve invested in bursaries to train more early childhood educators, recognizing we’re creating 800 jobs for them.
For the first time in years, there is actually a wait-list to become an early childhood educator here in the province, which was very exciting. For the first time in a long time, people are seeing early childhood education as being a viable long-term career option. We’ve actually had to fund more spaces at the Nova Scotia Community College to accommodate the uptake in early childhood education. So a lot of exciting things have happened on that front, again, not directly related to this department, but I am glad the member brought it up because that was definitely an area of great passion for me and our government while I was at the Department of Education and Early Childhood Development.
I know there’s more good news that’s going to be coming from the federal government that will help support our provincial efforts to further expand child care and make it more affordable here in the province.
KENDRA COOMBES: So just to sum up what the minister has said, or to clarify it, I should say, he is unaware of how many CCAs who were working in privately run facilities that will not have received the essential health care workers’ bonus because there is no registry, if I am not mistaken on that.
Also, Madam Chair, Nova Scotia could have had access to more than $6 million in additional federal funds to raise wages for low-paid essential workers, but it didn’t. My question I want to ask the minister is: Does he know why?
ZACH CHURCHILL: We’re not familiar with that $6 million that the member is speaking about. If she could be more specific on that - it’s the first I’ve heard of that.
For the Essential Health Care Workers Program, we did work with the federal government to extend the criteria for that, and over 33,000 or 35,000 frontline employees who were working during that period did receive that. It was almost $81 million that was distributed to those folks. Furthermore, every CCA who did work in the public system, who were actively working during that time, did receive that funding.
But if the member could be specific, I’m not sure where she’s getting that $6 million that was untapped.
KENDRA COOMBES: I can. It is from the Canadian Centre for Policy Alternatives report called Picking Up the Tab. It is a complete accounting of the federal and provincial measures that were taken during COVID-19, as well as the access to emergency federal dollars.
I’m going to move on. I want to ask a question on temporary foreign workers. We’ve heard from Dr. Strang that temporary foreign workers will be prioritized in Phase 2 of the vaccine rollout. This is great, it’s good news. Vaccines may be spaced four months apart but some workers may only be in the province for that amount of time or less. My question to the minister is: Can the minister explain how the vaccination of temporary foreign workers will unfold?
ZACH CHURCHILL: So far, the plan is to have - and this is subject to change - those vaccinations administered on-site.
KENDRA COOMBES: On the same topic, workers will need information in their own language and dedicated communication in order to combat vaccine hesitancy and offer proper informed consent. My question to the minister is: What is planned in this regard?
ZACH CHURCHILL: We’re engaged in marketing campaigns to dispel myths around vaccines, to provide more scientific information on their benefits, and on the contents of them as well. We’re working with Communications Nova Scotia on that. Every individual who does receive a vaccine is required to provide informed consent, and the physician or pharmacist or practitioner who’s delivering that vaccine provides them with that information while they’re in the clinic and they provide their informed consent to proceed.
KENDRA COOMBES: With my remaining time, I would like to do some clarifying from Tuesday. On Tuesday, when the minister and I were talking, the minister stated he had no say in staffing at hospitals, specifically emergency rooms. This is with regard to the closure that has occurred in the New Waterford Consolidated Hospital, as well as - we heard it today - on the Northside, where the emergency rooms have been closed although we were promised that they would remain open while waiting for these new centres to be built.
To be clear, neither the minister nor the department has any plans to ensure the reopening of the New Waterford Consolidated emergency room. I just want to be clear on that.
ZACH CHURCHILL: The member is right in pointing out that it’s the health authority that operationalizes our emergency departments. These emergency departments can reopen, but they do require the human resources capacity to do so.
KENDRA COOMBES: Nice to know the New Waterford Consolidated Hospital emergency room will not be opening.
Another clarifying question on long-term staff. Again, on Tuesday, when the minister and I were talking on long-term care staffing, the minister stated his department does not get into the compensation received by long-term care staff, even though it has everything to do with retention and recruitment. I want to be clear: the minister and the department are not looking into policies or having discussions regarding compensation, nor is he or the department advocating for such a change, and that includes policy discussions within the department?
ZACH CHURCHILL: Just to clarify what the member said about the emergency department. For the record, I did not say that they were not going to reopen. What I said was they are able to reopen, but it does require physicians willing to go and practise there for those facilities to reopen. They are able to be reopened, but to do so we do require physicians who are willing to go and staff those emergency departments. The Nova Scotia Health Authority does oversee that operation. I just wanted to clarify that for the record, because the member took some liberty with expressing what she thought my viewpoints were.
In terms of how the collective bargaining process works, the member is right. By design, the Department of Labour Relations leads contract negotiations. There is a collective bargaining process in place. A majority of our CCAs are represented by unions, they’re unionized here, and they go through the same process other collective bargaining units go through to negotiate their contracts, which include their compensation.
It’s wise to not have that fall under the line departments like the Department of Health and Wellness or the Department of Education and Early Childhood Development or the Department of Community Services or any other department that has unionized employees that work under them. The reason is because we need those ministers, we need those departments to be focused on the work of serving Nova Scotians on policy, on legislation, on budgets, on programming, and you can’t do that when you’re embroiled in union disputes and collective bargaining.
By design, in our second term, those responsibilities were very wisely put into a single department, the Department of Labour Relations, which oversees that. That ensures that the Department of Health and Wellness, the Department of Education and Early Childhood Development, the Department of Community Services, the Department of Transportation and Active Transit, et cetera, can focus on what their mandates are, and that’s to enhance and improve services to Nova Scotians, not be engaged in the continuous cycle of collective bargaining. There’s a very good reason for that, and that’s why it’s in its own department. That was a very good decision that our previous Premier made. They go through that process fairly regularly.
That’s not to say that we are not financially supporting our CCAs or creating financial incentives for CCAs, because in fact we are, and I did go over those very specifically with the member during one of her first questions. Examples are waiving the assessment phase fees - that’s during the recognizing prior learning process; waiving $800 worth of fees for individuals, of which close to 300 have taken us up on; by bringing in a $4000 bursary to enroll in continuing care programs. We are engaged in providing financial incentives and support for people who want to train to become CCAs or enter that workforce. But that, of course, is beyond the collective bargaining process.
THE CHAIR: The member for Cape Breton Centre, with 20 seconds left.
KENDRA COOMBES: Thank you, Madam Chair. With that 20 seconds, I will say that, as much as the minister is talking about how great it is with the Department of Labour Relations, I would say that with regard to recruitment and retention, it would be great if he had the discussions and advocacy for proper compensation. With that, I will take my seat.
THE CHAIR: Order, please. The time allotted for the New Democratic Party caucus has expired. I will now move to the Progressive Conservative caucus.
The honourable member for Pictou Centre.
HON. PAT DUNN: Madam Chair, I have just one question for the minister and then I will be turning it over to my colleague from Kings North. Basically, it is just a situation that I am sure if the minister can do something about it, he certainly will. I will explain the situation.
There is a constituent of mine - I believe he is in his forties - who has a rare, permanent disease. It’s a disease causing excruciating, intense pain. The situation is that his parents, an elderly couple, must drive their son to a hospital in Sydney every Wednesday. If you can imagine, it’s a three‑hour drive on good highways from New Glasgow to a Sydney hospital, and three hours back.
He is in a chair for 45 minutes getting his chronic pain medication. He is hooked up to an IV, and what makes his service there at the hospital quicker is that he has a permanent port in his neck area. They can hook him up pretty quickly and in 45 minutes he is out of the hospital and back on the road. I think the pain medication is called ketamine and the reason why he is not driving is that there are side effects to it such as low blood pressure, blurred vision, nausea, vomiting, and it goes on. The list is long.
It is really affecting the quality of life for not only the son but, of course, the elderly parents, and it is definitely wearing on the dynamics of the family, being on a fixed income, et cetera. They have certainly endured some nasty drives this past Winter, not to mention that one day they came close to going off the road because the father fell asleep.
My office has tried to intervene and help through EA, through the department and so on, throughout the Winter. We are still hoping we might hear something, but it’s been dragging on quite some time. He was told that there was a doctor here locally that can take care of that type of business at the regional hospital here in New Glasgow. Even a trip to Antigonish or Truro would certainly be a major change from going all the way to Sydney on those single highways.
Anyway, that is the situation with him. Apparently, as I mentioned earlier, it is excruciating pain that he has to go through and life is beyond miserable if he misses a Wednesday ‑ misses a trip to Sydney, and I think that may have happened once or twice because of bad, bad weather, storms, and so on. Anyway, I’m going to leave that with the minister for just a comment.
ZACH CHURCHILL: Obviously, that sounds like a very difficult situation for the individual and their family. We’re happy to get more information on that particular case from the member and see if there are, from the clinical perspective, alternative options that can be made available.
PAT DUNN: I can provide some more information tomorrow. I would like to turn it over to my colleague from Kings North.
THE CHAIR: The honourable member for Kings North.
JOHN LOHR: Mr. Minister, it’s a privilege to start Estimates with you for a bit of time here. I guess where I would like to start is looking at your mandate letter from March 24th. I know that one of the hallmarks of the budget has been the new office of mental health and addictions. I’ll just read a letter here:
“COVID-19 has impacted our mental health - that must be addressed. The new Office of Mental Health and Addictions will provide focus to critical work needed to expand access to mental health services and programs in communities across the province.”
I know it’s in the budget. I’m just wondering if you could explain to me what the Office of Mental Health and Addictions will do.
ZACH CHURCHILL: We have seen how useful clinical leadership can be within the department. We have seen that with Dr. Strang from a Public Health perspective. We have seen that by bringing in a clinical surgeon as our deputy minister. That’s not to say anything about all the incredible public servants and experts that we have in the department, but having the clinical leadership in here quarterbacking the overarching mental health strategy, we believe, will be a valuable thing.
That office will be staffed with 15 full-time equivalent positions. The role of that office will be to work across government departments to ensure that all the departments are engaged in providing mental health services together and that there’s a clinical lens being put on our programming and our services. They will help lead further changes and investments as we expand our mental health services here in the province.
JOHN LOHR: Is this office part of the Department of Health and Wellness, or is it part of the NSHA? Where is it housed?
ZACH CHURCHILL: It is part of the Department of Health and Wellness. That will be an office here within this department. I can further expand on focus areas of this office. It will be on early childhood and adolescent mental health support and care, adult mental health support and care, family mental health support and care, workplace and community support and care, sexual health support and care, human health resources, anti-stigma efforts, addiction management and treatment, addiction prevention, and individual family and community support for complications of addiction.
We’re in the market right now looking for this individual. The job posting, I believe, went up this Tuesday. We wanted to have an expedited process to a qualified individual in as quickly as possible. Staff here at the department did a great job of getting us ready to initiate this and getting the job advertisement in the market.
We’re looking for somebody with clinical experience, understanding of community-based care, leadership experience and policy formation and accountability. We want them to be innovative and collaborative, understanding of public health and social determinants of health, understanding of early childhood, adolescent and development health needs, understanding of sexual mental health issues, understanding of population and cultural implications on mental health and understand management, treatment and prevention of addiction issues.
We are looking for a person who has specialty in these areas and has work-based experience and clinical understanding of these critical issues.
JOHN LOHR: I thank the minister for that answer. That sounds like an extraordinarily broad mandate. I’m just trying to picture the organizational chart. So the new Office for Mental Health will be directly under the Deputy Minister of Health and Wellness or will it stand alone and report directly to the minister?
I’m just imagining what you just said. I can picture in mind dotted lines to half a dozen other departments. Is that what this is? This office will have a dotted line to Community Services, a dotted line of management?
I know it’s one thing to say they will do it but I’m just wondering specifically: How will that work?
ZACH CHURCHILL: It sounds like the member nailed it. He did a great job visualizing what the organizational chart will look like. This individual will report directly to the deputy and they will be linked in with their relative counterparts in other departments who are engaged on these files. That could be other deputy ministers or executive directors in other departments.
JOHN LOHR: Mr. Minister, I know that we need to all be optimistic and think everything is going to work but boy, that sounds like an organization octopus, you could say, of lines going here and there.
What are the deliverables? How will you know if it’s effective if you can’t measure it and it didn’t happen, so to speak? I know you’ve heard that line before so what are the deliverables here? How will you measure it?
ZACH CHURCHILL: It’s not very complicated from an organizational standpoint. It’s very similar to the Chief Medical Officer, in terms of their relationship to the government and the work they do across departments to provide advice and support and to quarterback Public Health responses.
We believe this will be very helpful in terms of breaking down silos that do exist within government. You have folks in various departments that are working towards the same ends for the constituencies that they serve and this will provide some clinical support to all those departments and provide a common lens in terms of how we’re approaching mental health well-being and the various supports that governments are engaged in across the spectrum of government.
The goals of this office, and this is what the officer will be measured against, will be policy formation to enhance mental health well-being for people in the province, policy formation to support preventive measures for enhanced mental health, policy formation that addresses the social determinants of mental health and addictions, provide timely and consistent mental health care for Nova Scotians, ensuring that our system is responding in a timely way to their needs, enhance our mental health care through partnerships and integration of care delivery to ensure a culturally competent delivery system and we’ll be focused on prevention, treatment, management and addiction on individuals, families and communities and the performance metrics that we build for their evaluation will be built around these goals.
Essentially what we want to do is improve mental health outcomes for Nova Scotians, so at the end of the day. That’s the benchmark that matters the most.
JOHN LOHR: Hear, hear to that goal, Mr. Minister.
I’m just wondering, when I look at the actual budget for the Department of Health and Wellness, Page 12-2, I see a line there for Office of Mental Health and Addictions Services, and a forecast for $2,218,000. Then I look a couple lines down and I see Office of Mental Health and Addictions Services showing up as having a line in 2021 and a budget and an actual.
I’m just curious about the newness of the office. I’m just wondering what’s going on there. It shows up on two different lines.
ZACH CHURCHILL: I think I understand the member’s question: Why do we have blanks in the budget for the 2021 estimate and the 2021 forecast? It’s because this is a new office, so it is reflected in the 2021-22 budget. You will see two blank lines for the fiscal year 2021 because this was not an office that that was budgeted for, and you will see the increase for the office in the 2021 estimate.
JOHN LOHR: If you look at that line where the two blank lines are and the budget amount of $2,218,000, and you count down 10 lines on Page 12-2, you’ll see Office of Mental Health and Addictions last year had $208,000 in it and spent $220,000, and this year $227,000.
So I’m just asking - that’s the same office. If it’s new, how come it shows up as having been budgeted last year? That’s the question. I wasn’t asking about the blank lines in the first case, really. I’m asking about the numbers in the second for the new Office of Mental Health and Addictions. Was there an old Office of Mental Health and Addictions last year?
ZACH CHURCHILL: I’d like to thank the member for clarifying the question. If you go down to those lines, those are under service delivery and supports, so these are not administrative lines. That funding, which in 2021 in the forecast was $220 million, that’s actually for the supports that are in the system. I realize this is the Office of Mental Health and Addictions Services, so that is confusing to see it written that way, but that line is for the service delivery and supports, so that’s funding for the mental health clinicians, for the pharmaceuticals that would be involved in that.
Not pharmaceuticals, sorry, staff corrected me - the mental health programming administered by the Nova Scotia Health Authority, so that would be for the frontline human resources and programming supports that are available. Whereas if you go back to that initial strategic direction accountability, that’s under general administration. That would be the administrative costs. There would be no administrative costs for that office and the service delivery and supports. Those figures aren’t for a specified office of mental health and supports, so that language is confusing, but that’s actually for the services and programs and the frontline human resources themselves.
JOHN LOHR: That clarifies that considerably, thank you. I understand what you’re saying there and I realize I didn’t add the zeros in on the second set of numbers. I should have realized those were massively large numbers, yes.
Just to continue on the new Office of Mental Health and Addiction Services, and I know the minister would be aware that we’ve been following the Blueprint for Mental Health and Addictions: Building on Success for Improved Access, Integration and Continuum of Care - 2019 to 2021 which came out in October 2019, which a predecessor of the Minister of Health, who is the member for Antigonish, would have brought in.
When I read Appendix A: Summary of Actions for 2021, I don’t see in that in any place the Office of Mental Health and Addiction Services. I realize this is an overlap of a year but my question is: Does that mean that the Blueprint for Mental Health and Addictions is all done and over?
ZACH CHURCHILL: No, the introduction of this new office will continue to work on the implementation of that blueprint. That blueprint isn’t fully implemented. Also, there’s been some new information and needs that have been identified in the system through the COVID-19 pandemic and additional stress and mental health concerns that people have had. There will be adjustments to that, so this office will work to enhance the blueprint and continue with its implementation. So that is not complete yet.
JOHN LOHR: Just to confirm, the new Office of Mental Health and Addictions does not actually put boots on the ground, so to speak, if we were to use a policing term. It does not actually put anybody out in the community doing the actual work.
ZACH CHURCHILL: The focus of that office will be on the policy and program development and coordination to further enhance the work that happens on the front lines with mental health. It’s about bringing in some critical leadership on this front because it is a government priority and to focus on what the role of the department is, which is policy legislation, regulation, programming and funding. The focus will be on that but the intent will be to enhance the frontline supports, as we’ve done over the years.
Frontline supports have been enhanced. We talked about this in Question Period, about how there has been a lot of effort put into this, particularly on the acute and urgent side of mental health for those dealing with a severe illness and acute situation. We’ve reduced the wait times dramatically compared to a short time ago where people were waiting approximately a year to get in to see somebody, and that has been reduced to under a month. The median is about 15 days for urgent cases, and for the emergency situations, we have reduced that wait time down to a week. Those are within the national standard. A lot of work has gone into this.
Hiring new mental health clinicians has helped. There have been 35 new ones that have been brought into the system. That’s in the adult system. Of course, that’s not including the dozens that have been hired in our school system to provide that mental health support, counselling, and therapy to our youth and adolescents.
The role of this office is not to be frontline. It’s to be on the policy, planning, and prioritization side of things. But there have been frontline enhancements over the years. This office will help us further develop our strategies and enhance those supports over time.
The member would remember even in this budget there’s a major funding increase for supports in this area as well, which are frontline supports. Those would include an expansion of our virtual care options for Nova Scotians, bringing in, for the first time, single session therapy for the non-urgent cases where that is appropriate and bringing in additional supports for addictions and withdrawal support in each health zone - as well as enhancing the sexual assault trauma supports that are available. That would be primarily through enhancing what’s available through community organizations that are doing a very good job on that front.
We’re establishing this office here in the department to create that clinical leadership that we want to see right now. There have also been investments in the frontline supports over the years, and we have seen some demonstrable improvements in this area. That’s not to say there’s not a lot more to do. There is, but we’re making progress.
Of course, we have the central intake as well, which has made accessing these services a lot easier for Nova Scotians, where before there were literally hundreds of different phone numbers. This had been through the previous nine health authorities system that still existed when we amalgamated those authorities. We have reduced those hundreds of contact points to one central intake to make that process easier for Nova Scotians - a one-window access point for mental health services, which of course includes the 24/7 crisis line, which did see an increase in utilization during COVID‑19 last year. We responded appropriately by putting more resources there to accommodate the 30 per cent uptake in utilization.
The resources are going to the front lines as well, and this office will help us develop strategies to enhance those supports.
THE CHAIR: The member for Kings North with a minute and 10 seconds.
JOHN LOHR: Minister, you touched on many topics in your reply that I do want to ask questions on. In a minute and 10 seconds, I guess the question I would ask is: Will you be adopting a three-digit number for your mental health crisis line?
ZACH CHURCHILL: We do have a 1-800 number currently, but the three-digit phone numbers 811 and 211, they do refer people directly to the crisis line. They transfer them through. So there is access through our three-digit phone lines that we have in place this Fall.
THE CHAIR: Order, please. We will now take our 15-minute COVID-19 break. We’ll be back at 6:30 p.m.
[6:15 p.m. The House recessed.]
[6:30 p.m. The House reconvened.]
THE CHAIR: Order, please.
The honourable member for Kings North.
JOHN LOHR: So many different directions to go here. I appreciate the minister’s answer previously, and I think what I heard him say was no, they were not going to go to a 988 number for the mental health crisis line, and I think that’s unfortunate. I could have heard wrong. He did indicate a couple of other three-digit numbers. Maybe what I’ll do is just ask him to comment briefly on that, but I want to switch to another subject and I’ll ask that question too.
I’m concerned about online gambling in Nova Scotia. I know the minister knows this has been widely reported, that the Atlantic Lottery Corporation is branching into online gambling, and I’ve had some meetings with the people from GRINS, Gambling Risk Informed Nova Scotia, probably almost one meeting a year for the last number of years.
I’m just wondering, does this mean the Province thinks gambling is not as severe a problem, or the signal to go to more online gambling or to support that? I’m just wondering about the minister’s comments on that.
ZACH CHURCHILL: On your first question around the three-digit call number, I certainly wouldn’t say that’s not something that would be considered at all, so I think we’ll remain open-minded on that, and if the best advice is to move to that, that’s something that we would take under advisement, of course.
What I did say previously was that with the current three-digit numbers, the folks who answer those numbers would transfer people to the mental health crisis line if they did receive those calls. Currently, the direct number to the mental health crisis line is a 1-800 number, but let’s say we’ll take the three-digit under advisement, particularly with the new Office of Mental Health and Addictions that will be established. We’ll get some advice on whether they believe that’s a change that we need to do, so let’s just say we’ll remain open-minded to that option.
On the gambling front, I certainly wouldn’t say that the government doesn’t believe this is an issue. It can be a devastating issue for families, and I’m sure we all know individuals who struggle with addiction and gambling. It is, so I’m told, as problematic as addiction to substances. It’s very similar from a biochemical perspective in terms of what’s happening. The fact is that many Nova Scotians were using unregulated online gambling outlets that are currently available, and I believe the decision was made to provide a regulated option for those individuals who were doing it where there is oversight and intervention capacity as well.
I think the way to look at that would be a lesser evil to have the regulated option available for people, as opposed to the unregulated international options that were available. That’s the high-level rationale for allowing that to happen.
JOHN LOHR: I guess when I hear the rationale, what I think is, yes, unregulated online gambling is a problem - absolutely, 100 per cent agree. Let’s suppose - and I have no idea what the number is, but let’s suppose the dollar value of money leaving the province, let’s say for argument’s sake, it’s $100 million. It could be $10 million, it could be $1 billion, I have no idea, but maybe somebody knows.
My fear is that by having Atlantic Lotto participating, Atlantic Lotto will take a percentage of that, that’s for sure. Then let’s just say they capture 30 per cent of that, so $30 million to Atlantic Lotto, $70 million to offshore gambling. My fear is the actual result will be $125 million in total, if you know what I’m saying. You’re not reducing the problem - you’re only diverting the stream and you’re probably actually increasing the problem. Can the minister tell me if he would share that concern and how we determine if that is the case?
ZACH CHURCHILL: Gambling and other addictions - and gambling is oftentimes associated with other mental health conditions as well - this is a priority area in terms of support for government investment, so we haven’t had supports in this area. We provide anonymous outlets for people to seek help and seek help for loved ones as well without stigma and judgment. This is an area of concern.
There is a certain percentage of the Atlantic Lottery proceeds that did go into gambling awareness and prevention and that funding does go to the health authority, and the same is true for our casinos here in Nova Scotia as well.
In terms of having these unregulated outlets that people are using and there’s no control over that, folks who are going to do this are going to do this. Not everybody who’s utilizing these services are addicts either. It’s certainly not a problem for everybody, but to have that regulated option for people whereby some of the proceeds actually get reinvested into supports and services here in the province is, I do believe, a preferrable option to the utilization of unregulated outlets whereby zero per cent of proceeds are actually returned to the province and support service delivery and prevention work.
I very much appreciate the point the member has made on this issue. I think it does come down to the practicality of it. If people are going to utilize these services, what is the better option - unregulated or regulated option, an option that doesn’t utilize proceeds to reinvest into services for people who do have gambling and mental health issues or a service that does.
I believe in the principled standpoint the member has on this - I very much appreciate that - but from the practical standpoint, I do believe this is a better option from a number of perspectives. From the perspective of the individual who’s utilizing the service where they are better protected through a regulated organization that’s run locally and from a system perspective whereby a percentage of the proceeds are able to be reinvested. I do think that from that perspective this move makes sense.
JOHN LOHR: I appreciate the minister’s answer and I appreciate that he recognizes the fact that it may not be - the envelope may get bigger. That is the problem. I guess one way I could suggest to the minister that we could work on reducing the harm of gambling would be to fund GRINS and I know that GRINS did lose funding.
I’m just wondering: Will it be the intent of the minister to restore that funding to GRINS if - and I believe we’re still in a moratorium on the adoption of the online gambling but if it does happen, will the minister restore the funding or increase the funding to GRINS if there’s any way of choking off the money leaving the province or the money being spent that shouldn’t be spent by addicted gamblers to provide help to these NGOs that are working to quell or quench the problem?
ZACH CHURCHILL: There was a decision, prior to my time here, to take the funding that was being delivered through Gambling Awareness Nova Scotia and to divert that funding into actual system and programming supports on the front lines. There was a move made to take - I think it was $6.6 million annually - to actually get that into the mental health system supports. So $1 million of that has gone directly into mental health system supports, $1.8 million has gone into mental health treatment and recovery programs, $1.3 million has gone into suicide prevention, and $800,000 of those dollars have gone to support our Mi'kmaw communities to deal with gambling issues.
I do believe that reutilizing the dollars from the not-for-profit organization and redirecting those into actual system supports I do think makes sense and I do support that move because it has allowed us to enhance direct support in key areas for Nova Scotians experiencing mental health and addiction troubles and those who may be dealing with suicidal thoughts.
JOHN LOHR: I recognize and I think everyone involved recognizes that gambling is, at its heart, a mental health issue. There’s no doubt about that. But to put funds that had been generated through gambling into other mental health issues, and at the same time as considering opening up another avenue of addiction, which I believe, given the good will - the reality is that Atlantic Lotto is a strong brand and has a lot of good will in the province and people trust Atlantic Lotto - rightfully so, it’s a good provider of a gambling product. But to have them provide an online product I think means more new people will access that. There will possibly be new issues.
Mr. Minister, no, I do not agree that this is a good move. I think the mental health issues need to be funded themselves. The other programs and Gambling Awareness Foundation of Nova Scotia and GRINS should be funded. That money should be used to try and help problem gambling. We know, and I am sure you know - we all see it in our communities - how devastating it can be to families. I don’t know if there’s any need for the minister to comment any further on that.
I want to ask about eating disorders. The minister would know, I think, that actually not many people know but I’m sure the minister does, that eating disorders are actually the most common mental health issue and I know it was a few years ago that the eating disorders issue was cut in the budget.
I would like to ask the Minister of Health and Wellness: What is in the budget this year for Eating Disorders Nova Scotia, the NGO, and how is the minister’s department supporting them?
ZACH CHURCHILL: I’d like to thank the member for the question ‑ a very important conversation on the gambling front. One more thing ‑ I do think this is a safer option through Atlantic Lotto than the alternatives, but I appreciate the member not wanting to beat a dead horse on this. I feel we had a very robust conversation on this, and I very much appreciate his points. I do believe he sees the other side to it as well.
One more thing I will add on that conversation is that we also do work with the Nova Scotia Gaming Corporation. The Department of Health and Wellness has connected with them to support them with the social responsibility that they have informing them about the problems of addictive gambling. That is another link we have to that sector, where we are trying to inform its proponents of the risks, what things to look out for, and create a sense of responsibility with them as well. That is another connection on this.
There actually is new funding for the Eating Disorders NGO that the member mentioned and that came into place last year in the amount of $105,000. It was new operational funding that was provided last year and that would be in this budget as well - the same amount.
JOHN LOHR: I appreciate the minister’s comments on that. I guess the minister may be aware, but in February, Eating Disorders Nova Scotia had a peer support chat over Christmas. In February, they reported a 400 per cent increase in demand for service and there are indications that there are more severe cases.
I am just wondering ‑ the NGO Eating Disorders Nova Scotia is one thing, but I am just wondering what can the minister tell me that his department is doing to address it, and I think from that, and I don’t know if that means just tapping the demand that was there or if there is new demand, I don’t know, but I am wondering: How are these demands for service going to be met?
ZACH CHURCHILL: That is an important issue. The enhancements to our mental health supports are available to folks dealing with mental health disorders. We do know that these do tend to begin at an earlier age, which is why we have invested so heavily in additional supports in our schools, our SchoolsPlus program, and with the inclusion of mental health clinicians, school psychologists, counsellors, child youth care practitioners into our education system. Something we do know about eating disorders is that they tend to start at an earlier age, so the focus on providing those mental health supports in our schools. I believe, also is critical in terms of supporting people dealing with these. Of course, the Kids Help Phone is available as well for those dealing with these.
The expansion of our e-mental health services, the single sessions, I think, is also going to - of course, they’re also enhancing support for people dealing with eating disorders, because that is a mental health issue. The overall mainstream supports that we have in place are enhancing services available to those folks, plus we have the support staff that have been infused into our education system over the years.
JOHN LOHR: I was thinking as you were answering that, you’re in the perfect position as being formerly the Minister of Education and Early Childhood Development to answer my next question. One of the supports in the schools is SchoolsPlus, and it’s been widely seen as very successful, but when I talk to my teachers in Kings County, they’re very frustrated with SchoolsPlus.
Their frustrations are twofold. One is that they feel the information is not a two-way street. In other words, they provide information on students to the SchoolsPlus staff worker but never get any information back. The second issue they have is that in some of our local high schools here in Kings County, the SchoolsPlus individuals - there’s been a high turnover of them, and they’re overwhelmed. From what I’ve heard from the people I’ve talked to, it’s not reaching who it should reach.
Eating disorders are very common in young girls, as the minister knows. They’re extremely difficult to address, but I’m just wondering if the minister - you referred to SchoolsPlus, I believe, and I just wondered if you could tell me why there is this disparity in the effectiveness of the program in some areas versus others.
ZACH CHURCHILL: I am in a very good position to talk about this because of my previous experience and also because the mental health clinicians that are employed through the SchoolsPlus program - I think there are 54 or 56 of them - are actually employed through the Health Authority.
In terms of inconsistencies, I remember hearing issues about that. That just means we have to lean on management and ensure that the department is coordinating. You have different people working in different regions who may be approaching the job differently. Having standards in place, ensuring that management is getting staff onside with those standards and achieving consistently, I think is what we have to do on that.
If there are specific issues there, we’re happy to get some details from the member and work with the Department of Education and Early Childhood Development to see if we can be of assistance. In my experience over in that department, the regional executive directors have been very responsive to receiving local concerns from the community and responding very appropriately. My experience there is that they have been very responsive, and if there’s information to share with the health authority for our staff in those positions, we’re happy to do that as well. If we can get some more specifics from the member on that, I’m very happy to help him look into that situation.
JOHN LOHR: Mr. Minister, the specifics which I can give you exactly right now, which I have heard two or three years in a row, is that there’s only one-way communication with the SchoolsPlus staff.
You can appreciate that the SchoolsPlus staff come from a medical background, I suppose. They would say that each student they’re dealing with in their file, that’s confidential information. However, the teacher is a professional also and is providing the SchoolsPlus staff with information on the student.
What the teacher is hoping for from that SchoolsPlus staff worker is maybe a little bit of help in dealing with the issues the student is facing. Sometimes that might be as simple as knowing what the diagnosis is. This is the issue, I think, that I have heard if I can summarize it over the last couple of years - I know that the problem of turnover - hopefully that’s not one that you can deal with, other than trying to create a good work environment, but it will or won’t happen in different places.
Fundamentally, I think the SchoolsPlus staff need to be requested to provide or told it’s okay to provide the teachers involved with teaching this student the information that they’re requesting. If you understand what I’m saying, the teacher is providing the information on student behaviour or what they see or what they have observed. They’re not getting that information back on, we think this student has got Asperger’s or autism or schizophrenia or I don’t know. Do you know what I mean?
The diagnosis is something that would give the teacher a tool to better serve the student. This is what the teachers are looking for, the teachers that I have talked to. They want to sort of be able to gain some benefit in their classroom from that SchoolsPlus staff worker.
I suppose even as I talk about it, the SchoolsPlus staff worker’s focus is to help the student and not necessarily to help the teacher, if you understand what I’m saying, and I can appreciate that. But I think there should be a collegiality there. Teachers are dealing with very confidential things too, and it should be within your ability, Minister, to look into that.
THE CHAIR: You have two minutes, Mr. Lohr.
JOHN LOHR: Thank you, Madam Chair. Do you understand what I’m saying? I’m just wondering if it’s something you could look into and maybe see if you could do.
ZACH CHURCHILL: I do appreciate where the member is coming from on this, but particularly with mental health clinicians and sharing information on diagnosis, they do have to follow the privacy rules on that and they do have an obligation to protect the confidentiality of some of these issues with those students. So that probably is very much appropriate.
However, we do have behavioural experts, autism experts. We’ve put additional coaching supports in place to help our teachers as well. Child and youth care practitioners would be another example. In the majority of cases, what should be happening is these non-teaching and teaching positions would create plans to support the student with the teacher and the teacher would be involved in those conversations. That is how it is supposed to work, to provide that wraparound support for the student. It very well might be appropriate and in line with the wishes of the student that other people outside of the mental health clinician don’t know about particular diagnoses and it would be incumbent upon those mental health clinicians to protect that individual, from a privacy and confidentiality perspective.
Generally speaking, the way the system is supposed to work is wraparound care, and teachers are part of that planning.
THE CHAIR: Order. Time has elapsed for the Progressive Conservative Party. I turn it over to the NDP.
The honourable member for Dartmouth North.
SUSAN LEBLANC: Happy to be back asking some questions of the Minister of Health and Wellness. I am going to just begin with one that my colleague didn’t get finished with in her last session but, aptly, it’s about people in Dartmouth North.
So carrying on with the questions about essential workers and the health care benefit for essential workers. In Dartmouth North, we have an organization called the Freedom Foundation, a transition house. It’s a home for men facing addictions. Two workers at the Freedom Foundation were - when the pandemic sort of - last March or April, when things started really getting serious in Nova Scotia, two of the workers at Freedom Foundation moved into the house. They don’t normally live there, obviously. They lived in their own homes. They isolated from their families and they worked 12-hour shifts for 67 days in a row in order to keep the house open so that the men living in the house would have the supports they needed and be able to continue living there.
Their frontline essential workers did not receive any overtime pay and were not eligible for the Essential Health Care Workers Program benefit. My understanding at the time was it was because transition houses were not considered part of the essential health care system.
When these workers asked the government for help, they were told to ask their employer. Their employer, a not-for-profit board, was told that they did not qualify because they were funded by the wrong government department. In the end, these two amazing people, who sacrificed so much and put themselves at so much risk, did not get any benefit or any compensation for that.
My question is: Why is there no appeals process for people who feel they have been wrongly excluded from that benefit? In the case of these folks, the organization came to my office and we did a bunch of advocacy, but there was no official appeals process or way to bring it in front of the minister, except for writing a letter.
I’m wondering if the minister could talk about why there is no appeals process for the people who felt that they were wrongly excluded from the benefit.
ZACH CHURCHILL: I very much appreciate the question, and allow me to thank those folks for what sounds like an incredible level of commitment and dedication to the people they are serving. That’s very impressive to hear that story, so allow me to thank them on the record for their work.
We understand people are frustrated. We talked to a lot of people who wanted to receive this. We understand why people would want to receive bonus pay. The fact was that we had a limited, one-time envelope of funding from the federal government to distribute. There was not enough money to provide these bonuses to everybody and there were arguments to be made across the board from other essential workers. I heard from the refuse and recycling folks in my neighbourhood, from private care facilities, and from grocery stores. There was no shortage of people who believed that they should have qualified for this. I recognize the frustration and disappointment for the folks who didn’t.
The fact was that we had a limited envelope of one‑time funding that was attached with criteria from the federal government, which did create some limitations on who could receive it. We did work with the federal government to expand that criteria and our focus was on frontline health care workers here in Nova Scotia in the public system and we did manage to expand that criteria enough to reach between 33,000 and 35,000 people.
We did the very best we could. We made the best decisions possible at the time with the amount of money in that envelope that we were given.
SUSAN LEBLANC: My understanding, at least according to the Canadian Centre for Policy Alternatives (CCPA), is that the province could have accessed more federal dollars but there was $6 million, apparently, left on the table. If the minister wants to comment on that, that’s great, but I will move on.
My questions are out of order, Madam Chair, and what the minister said was a great segue into another chunk of questions I am going to ask later, but I’m going to wreck that and talk about the new CCA Registry that was announced today, or the bill for which it was tabled today. I’ll come back around to the other essential workers in a bit.
The first question I have about this is I am wondering if the minister can confirm that there will not be fees associated with the registry that the CCAs would have to pay.
ZACH CHURCHILL: I’d like to thank the member for the question. Nobody here in the department that I’ve spoken to is aware of this additional $6 million. That’s an item of confusion for us, so we would really like to know where the NDP is getting that information from and what that is based on.
Based on the understanding I have in the room here with the deputy and our CFO, we did max out the federal dollars that we were able to avail ourselves of. I would like to get some more information on that and see where that is coming from, because that doesn’t seem to be accurate, based on the information that I’m receiving. I’d be happy if the member could table any documentation that she might have on that.
In terms of the question around the CCA Registry, there will be no fee associated with the registry itself, at all.
SUSAN LEBLANC: Yes, as I said in the beginning of the question, the information was from the CCPA. I don’t have it in front of me at this moment to table, but we can certainly send the link or the article, the report to the department, to the minister. Just let me know what way is best to do that.
My next question for the minister is: I am wondering if the registry has been approved, or the idea of the registry or the plan for the registry, has been approved by the province’s privacy commissioner?
ZACH CHURCHILL: There would have been a privacy analysis conducted, which we would do on any issues that involved other people’s personal information. This registry would be similar to other registries that exist for health care professionals and early childhood educators. There are precedents for this sort of registry in the province, and this was a direct recommendation from long-term care panel experts as well.
SUSAN LEBLANC: That’s good to hear. I’m wondering if the findings or analysis that the privacy commissioner would have come up with can be provided to the House? Can it can be tabled or sent to us to the caucus offices?
Was it considered to house the registry within the department as opposed to an external body, and why or why not?
ZACH CHURCHILL: We don’t have a privacy commissioner in Nova Scotia, so there would have been a review officer who would have looked at that. We don’t have any privacy concerns. The unions were consulted, as well, and no issues arose from the consultation with the unions that I’ve been made aware of.
In terms of the registry, it will be housed with a third party. They are the group that oversees the current voluntary registry that exists now, which is the Health Association of Nova Scotia. The language in the Act would have it as the administrator and it is the third party that will be overseeing this registry. They’re the ones that oversee the current voluntary registry with CCAs right now. We’re just making that registry mandated but it is the Health Association of Nova Scotia that will be overseeing it.
SUSAN LEBLANC: I didn’t know that we no longer had a privacy commissioner in Nova Scotia. I know that we don’t have the same one as we had a while ago, but do we not have an acting privacy commissioner? I’m asking the room. I did not hear that that office had closed. I do know there were concerns about privacy from unions but if the unions have been consulted and the minister is feeling confident about that, that’s great. Just for the record, I am glad to see the government implementing recommendations from reports.
At a recent committee meeting, Dr. Robert Strang explained the importance of people being able to stay home from work when they’re sick. He said, “Certainly, from a Public Health perspective, for not just COVID-19, it’s a longstanding challenge, whether it’s salmonella in restaurant or influenza every year. There are a lot of reasons why people don’t stay home or are unable to stay home. It is absolutely important that we work together to recognize the barriers that may limit people’s ability to stay home, and find ways to collectively reduce those barriers.”
COVID-19 has compounded this issue and we see that the workplace is a major site of transmission. Just this morning, I was listening to an article on CBC about factories in Ontario and thousands of factory workers - young, 20-year-olds - in factories who are transmitting the virus at an alarming rate. My first question to the minister is: Does the minister agree with the Chief Medical Officer of Health that we need to do what it takes to ensure that people can stay home when they are sick?
ZACH CHURCHILL: Just on the review officer conversation, there have been members of the House who have referred to that office as a Privacy Commissioner inaccurately. There’s been no cutting of any office but the proper term for that individual is the Privacy Review Officer, and they operate under the Privacy Review Officer Act. Just semantics maybe, but that’s what the language is according to the legislation of that office.
In terms of the statement that Dr. Strang made, yes, we support that, which is why we brought in the isolation support program. This was to provide - working with the federal government - quick access to funding. I believe this was administered through the Department of Community Services for those who had to remain home during the pandemic. Folks were able to access funding through the isolation support program to help them follow the Public Health directives to stay home if they were feeling ill. We agree, and that was demonstrated through action and investment.
SUSAN LEBLANC: You say po-tay-to, I say po-tah-to. Let’s call the whole thing off, even it’s a Review Commissioner, there should be some written-down analysis of the review that they did of the Act, but anyway, let’s call the whole thing off, let’s not talk about it anymore. Semantics. I stand corrected.
Before I go into my next line of questioning, a quick clarification with the minister. Is that program that he’s referring to the Canada Recovery Sickness Benefit?
ZACH CHURCHILL: Hear, hear. I love the member’s sense of humour and the banter we are able to have in the House very much, particularly during these long hours. We will leave that issue alone.
In relation to the isolation support program, that was a provincially funded program. That is a program that would be accumulative to the other programs that are available for people. The federal government did have - and I believe still does have - programs available. We also worked to connect Nova Scotians, not just with the provincial supports that are available, like the isolation support program, but also the federal programs that are available, so they have full access to all the programs that are there to support them in their time of need.
SUSAN LEBLANC: I’m confused, because we ask about paid sick days in this House every day, and the minister is not talking about paid sick days. He’s talking about a different program. If that program is so useful, then why have the Premier and the minister not been referencing it every time we ask about sick days?
Obviously, my point here is to get the minister to say that it’s important that we have paid sick days in Nova Scotia. So, great, if there are people who got support from the Department of Community Services to self-isolate if they were ill, absolutely. More to the point is that an average worker who gets a tickle and a runny nose and goes, oh my God. Normally, without COVID-19, if I’ve got a little cold, I’m going to go to work even though it would be great if I didn’t have to go to work, but now it’s COVID-19. What do I do? Do I go to work? I can’t not go to work because I need the money. I wish we had paid sick days in Nova Scotia so that I could just take the day off and not spread COVID-19 to my colleagues and the people on the bus and all the people I am going to encounter in the day.
I think we can all agree that that would be the best thing for everyone, even if it wasn’t COVID-19 times. As Dr. Strang said, even if you had the flu or the common cold, it would be great if we could just take a day off and get better and not spread that around.
In terms of the Canada Recovery Sickness Benefit - the minister mentioned accessing quick federal dollars for that - unfortunately, it’s not actually quick and it’s not actually the full amount of money that you would be receiving. Here’s how to access the Canada Recovery Sickness Benefit:
1. Call in sick.
2. Create a MyCRA account, which is a total nightmare, by the way.
3. Set up a direct deposit with the CRA, which is also a nightmare.
4. Wait until the end of a one-week period for which you are applying, foregoing wages.
5. Fill out the application.
6. Wait for CRA to validate your application. To be eligible, you must have missed more than 50 per cent of your work week. If approved, wait another three to five business days. Get paid part of your lost wages, up to $500 a week.
So wouldn’t it be better, Madam Chair, to just call in sick and know that your wages are being covered and let the employer figure that out with the province? It makes a lot of sense. All that other crap is too complicated. Oh, pardon me, that is probably unparliamentary language.
THE CHAIR: Very unparliamentary.
SUSAN LEBLANC: All that other business is complicated. It takes a long time. People will get lost in that and it’s just not going to happen. Therefore, people aren’t going to take the time off that they need. Therefore, COVID-19 spreads more quickly.
Does the minister agree in principle, as a key person responsible for Nova Scotia’s health and well-being, that it is necessary to find ways for people to be able to stay home when they are sick, at all times, not just during the COVID-19 pandemic?
ZACH CHURCHILL: I think if we look at the epidemiology over the course of the last year, we’ve got very good evidence that Nova Scotians have been able to follow Public Health protocols and we have seen minimal community spread. We’ve seen minimal spread in workplaces and schools. The majority of the cases that we’ve had in subsequent waves have been related to travel or close contacts.
I think the evidence is good that Nova Scotians have been able to follow the health and safety protocols, that employers have been as accommodating as they can be, and everyone has really worked together to make us one of the safest places to be in the world.
The member mentioned what’s happening in Ontario right now and other parts of the country where we are seeing explosions of new cases, in particular the variants that are exacerbating the spread. We’ve managed to avoid that here, so far.
That’s not to say this is not a very fragile situation and everything is not on a knife’s edge, because it is and we do need people to remain vigilant and to continue to follow health and safety protocols and to follow the directives and advice from Public Health. To date, our people are doing what is necessary, making sacrifices and, I think, being accommodating to each other.
The member is absolutely right. The federal programs weren’t necessarily quick in providing money right away to people who needed money to stay home. She did go through some of the complexities of that process. They did make improvements to it, particularly with the CERB, and did do, I think, a good job of eventually streamlining that much better than at the beginning of the pandemic.
They were responsive, I think, to some of those concerns, federally, but because people in this province were in this period of waiting for those federal programs to come in, this is precisely why we brought in the isolation support program, to get money out immediately to people who needed it. There was a recognition of the original complexity of that process, the timeline involved with receiving funding, and this is precisely the reason why we brought in a provincial funding option that could get money to people more quickly, particularly while they waited for the federal dollars to get to them.
SUSAN LEBLANC: Moving on, this is a question that came to our caucus from a constituent, which I would like to put to the minister to see what explanation can be offered directly from the department. The first question is: Does the department fund the purchasing of new EHS vehicles?
ZACH CHURCHILL: Yes, we do.
SUSAN LEBLANC: Again, this is directly from a constituent. What is the logic that, along with the $165 million contract, the government should also have to pay for the ambulances, and not EHS pay for them?
ZACH CHURCHILL: The contract with the provider is for the service. The ambulances are assets of the province. They are our assets, which is why we purchase them. We do have a separate contract with Tri-Star Industries in Yarmouth, which has been producing our ambulances for years now and produce ambulances for jurisdictions across the world, actually - a very impressive company that has grown over the years, a local company. They have been involved in upgrading. They also provided portable COVID‑19 vans in the event that they were needed in communities. We also have a very big partnership with them.
The quick answer is because those assets do not belong to EMC, and the contract that we have with them is to manage the service. Those capital assets belong to the province.
SUSAN LEBLANC: How much time, Mr. Chair?
THE CHAIR: One minute and 15 seconds.
SUSAN LEBLANC: That’s very helpful. Thank you for the answer. I understand that there has been an approach of reallocating responsibility for some health areas back to regional health zones. I have heard this approach being considered or implemented for midwifery and primary care. I’m wondering what other areas will be reallocating responsibility back to regional health zones?
ZACH CHURCHILL: We’ll get an itemized list for the member. I don’t have time to go through that list right now with these seconds left.
THE CHAIR: Order, please. We have reached 7:30 p.m., time for the mandatory COVID break. We will be back with the NDP caucus and the Minister of Health and Wellness at 7:45 p.m.
[7:30 p.m. The House recessed.]
[7:45 p.m. The House reconvened.]
THE CHAIR: We will resume the Committee of the Whole on Supply with the Minister of Health and Wellness.
The honourable member for Dartmouth North, with 32 minutes remaining in the hour.
SUSAN LEBLANC: Just before I continue my questions, I would just like to bring the minister’s attention to this report which I referenced earlier. It is called Picking up the Tab: a complete accounting of federal and provincial COVID-19 measures in 2020, and that $6 million I referenced earlier is on Page 23, Table 6. It says - the table is - “Federal money not fully accessed by province.” It says that Nova Scotia did not access $6.4 million of the essential workers’ wage top-up.
I just wanted to bring your attention to that, and I will table it with the Clerk.
Going back to the reallocating responsibility to regional health zones, the minister did say before the break that he was going to provide us with a list of different services that are being reallocated to regional zones. I am just wondering if he can speak a little bit about what have been the costs associated with the strategy of centralizing and then uncentralizing certain services.
ZACH CHURCHILL: Nobody here in the department understands where those numbers are coming from from the Centre for Policy Alternatives, so we would maintain that that would be inaccurate information. If there is more documentation on that to substantiate that claim, certainly we would be interested in seeing that. But nobody here in the department understands where that figure would come from, based on our understanding we fully access the federal funding that is available for that program and actually worked with the feds to expand the criteria to reach more people.
In terms of the service changes, any costs associated with it - zero costs associated with it. It is just in terms of giving more ability in the regional centres to make local decisions without going through the tiered approval process that previously existed. That is not to say that having an integrated system is not critical. It very much is from a government’s perspective. So to break down what were essentially nine independent authorities that were oftentimes working in isolation and to integrate that system into one authority, plus the IWK Health Centre, makes complete sense.
The same rationale existed for the Education Department as well - why would we need multiple independent authorities to run a modern system in education or health? We would not, so this would be changes in terms of how management decisions are made to facilitate flexibility on the regional front to make decisions more quickly, and no costs associated with that whatsoever.
To go over the specific areas where that is happening, it would be in mental health and addictions, public health, continuing care, renal dialysis, cancer care, trauma, perioperative, critical care, emergency programming, diagnostic imaging, pathology, laboratory services, pharmacy, primary health care and chronic disease management, and women and children’s health. These would be the areas where there have been some adjustments in terms of the management decision-making ability.
SUSAN LEBLANC: Thank you for that explanation. Those are a lot of services. Those are a lot of parts of the health care system. I know it is not exhaustive. I guess it just begs the question, well, the impact - there may be no cost of centralizing everything to one system and then decentralizing back into four zones - maybe no monetary cost, but the cost of human work and reorganizing and all of that stuff, it’s got to be substantial when you’re talking about that many aspects of the system. In any case, I’m going to move on.
I’d like to ask a few questions about Lyme disease. Can the minister explain what investments are being made in order to ensure that health care providers have the necessary resources to assess those at risk of Lyme disease, increase awareness of Lyme disease in Nova Scotia, particularly related to prevention, and increase the number of familiar doctors and keep emergency rooms open, improving the availability of the urgent care needed when suffering from a tick bite or Lyme disease?
ZACH CHURCHILL: I will get to the Lyme disease question, but I just want to clarify some things on the governance question. There’s been no centralization and decentralization of the system. There’s been integration of the system, and part of that has been to allow our regional entities to have a bit more flexibility in terms of following decision-making protocol on the local level.
I did get some information wrong here. I was reading off a list here, so I want to go over those again, to clarify the record for the Chamber. The areas where the provincial decision-making and coordination would still happen would be in Mental Health and Addictions, Public Health, Continuing Care, renal, cancer care, and trauma. I said those were going to [Inaudible] have more flexibility on that. Those are the areas where we’re still maintaining provincial scope and focus. I want to clarify that.
Zone reporting and the transition the member mentioned was for perioperative, critical care, emergency programming, diagnostic imaging, pathology and laboratory services, pharmacy, primary health care, chronic disease management, and women and children’s health.
Again, this isn’t a centralization or decentralization. This is ensuring that our integrated system is working better and is responsive to the needs of Nova Scotians and the needs of local communities. The member’s characterization of these changes would be inaccurate.
On the Lyme disease front, I’m going to take a moment to discuss that and get information from our folks in the room.
THE CHAIR: The honourable member for Dartmouth North.
SUSAN LEBLANC: I think he’s actually going to come back to me, isn’t he?
THE CHAIR: The honourable Minister of Health and Wellness.
ZACH CHURCHILL: There’s been some great movement on the diagnosis front for Lyme disease. That is a difficult diagnosis, based on what I hear from clinicians. What the department has done is fund sessions on Lyme disease, on diagnosing, through Doctors Nova Scotia, as part of the continuing medical education program that doctors have to undergo. This is re-emphasized during the seasons where ticks are most prevalent.
I can speak from a local perspective on this. I know the current Minister of Community Services brought this up a lot when we were in Opposition and during our time in government. We’ve actually started to see a lot more diagnoses of Lyme disease earlier on with patients in my area, so that’s a good indication that the education that we’re funding is supporting doctors in dealing with what can be a very challenging diagnosis.
SUSAN LEBLANC: The minister will know that there are six active community-owned or -operated health centres in Nova Scotia. They’re in Chester, Clare, Antigonish, L’Ardoise, Yarmouth, and the North End of Halifax. I’m happy to say that some of the services at the North End clinic are actually being expanded into Dartmouth North, which is awesome. These centres are unique and effective because they are owned and operated by the community, in general. There are a bunch of different arrangements, but the idea is that there is a board of directors affiliated with each of the centres, allowing communities to define what they need health-wise.
Nova Scotia’s community health centres receive little to no operational funding from the government of Nova Scotia. Eighty-eight per cent of Nova Scotia community health centres report very significant operational pressures affecting their ability to meet the demand for health and social services.
My first question is: Is there an increase in funding to community health centres in this budget?
ZACH CHURCHILL: The community health clinics do operate differently across the province. Government funding for them is primarily through a grant application process, which is still there and is reflected in the overall budget. However, there have been some specific investments related to COVID‑19 for the North End Community Health Centre in particular. They received $310,000 for their work to provide mobile care support to vulnerable people, particularly helping with testing. They will be receiving an additional $175,000 to support mental health and addictions and no-harm withdrawal support for those suffering with alcoholism. Of course, some of the community health clinics that do have physicians in the North End of Halifax - that group would be the best example - they of course get provincial funding for the billing associated with the work there. That’s another area of provincial funding to those organizations when they do utilize physicians.
SUSAN LEBLANC: The work that the North End Community Health Centre has been doing during COVID‑19 has been kind of amazing. I’m glad to hear there was that increase to increase their important work, reaching out to vulnerable populations.
What I’m wondering - it sounds like any increases are project-related or purpose-related and not operational funding. The minister did say that any funding that comes from the province for those types of centres comes through granting programs. Like in arts and culture, in the granting programs, there are project grants, which are smaller amounts for specific uses, and then there’s operational funding, which is sort of day-to-day operations. I just want to get a clarification from the minister: Those grants that he mentioned, are those operational grants or are they project grants or specific use?
ZACH CHURCHILL: The grants are related to programming, but not all community health clinics are utilizing physicians. Some of them are focused on yoga and wellness.
Our funding priorities have been on primary care access, physician recruitment, scope-of-practice expansion for various frontline professionals. That’s where our focus has been in terms of funding, in those key areas, expansion of mental health services and long-term care.
Community health centres that do programming that can be very valuable to folks, they can apply for grants. In the case of the North End Community Health Centre, which has very sophisticated and, as the member said, incredible programming, they did receive funding specific to our their work during COVID‑19 for mobile testing for vulnerable populations, and they will be receiving additional funding for the work they’re doing on the mental health and addictions front.
SUSAN LEBLANC: Is there a plan or a strategy at the department to grow the number of community health centres in Nova Scotia?
ZACH CHURCHILL: Our plan is to enhance access to primary care, to hire more physicians, to improve our emergency departments. The community health care centres are not all the same. Most of them do not offer primary care options. The ones that do receive funding through physician billing. The ones that don’t, of course, don’t receive that funding. Our focus remains on enhancements of primary care and creating more access points for primary care for Nova Scotians. I believe that is very much in line with the priorities that people have in this province.
SUSAN LEBLANC: I think maybe we are talking about different things. For instance, I am talking about health centres like the North End Community Health Centre that provide access to primary care, access to mental health and addictions, social work, that kind of thing. For instance, I work with a group trying to expand primary care services in Dartmouth North and we did an amazing tour of the Preston Community Health Centre, which was a Nova Scotia Health turnkey health centre. It was owned by NSHA, run by NSHA, managed by NSHA employees, and then I believe all the health care professionals were contracted on APPs.
When we went to visit the Preston Community Health Centre and saw how amazing it was working and all of that, that seemed to be a high priority for the Nova Scotia Health Authority. I just wanted to clarify that that is still a priority for the province. That type of community health centre is what I’m talking about ‑ primary care health centres that have allied health professionals in them, where there is a holistic approach, where there is One Patient One Record within the walls of the centre, that kind of thing.
I would like to ask the minister if he can clarify that for me?
ZACH CHURCHILL: Yes, the clinics that are operationalized by the NSHA would be funded by the NSHA. That clinic would be an example of that, and clinics providing primary care funding in that way would be funded.
SUSAN LEBLANC: Okay, I’m going to move on. In recent years, the department appears to have taken the approach of expanding coverage of gender-confirming surgeries after there have been human rights challenges that affirm the right not to be discriminated against based on gender identity.
Others have suggested that a review needs to take place together with the trans community that would proactively create a list of surgeries that are covered here. Others still have suggested that the department should use the threshold of funding whatever a patient and a health care provider decide together is medically necessary.
My question for the minister is: Can the minister explain the department’s current approach and what is being looked at in the way of increasing or expanding trans people’s access to gender-confirming surgeries?
ZACH CHURCHILL: As the member referenced, the scope of what is covered has expanded and we are currently in the process of developing more local options for surgeries, looking at physicians in the province who are able to provide those surgeries to create more opportunities here within the province.
SUSAN LEBLANC: That’s great to hear, because my next question was about the fact that many gender-affirming surgeries have to be done in Montreal at a clinic there. People who are getting them, they have to get there, they have to have a support person, so it’s really great to hear that the department is looking at expanding the ability or the expertise amongst physicians to be able to perform those gender-affirming surgeries here.
I would like just to go back to this idea for a second about the idea that the threshold for funding should be whatever a patient and a doctor together decide is medically necessary. Currently, we pay for top surgery or vaginoplasty or whatever, but other types of gender-affirming procedures like an Adam’s apple shave or the idea of having breast augmentation is very complicated and there are all these weird regulations around it. It just becomes super hard to figure out the system, but also a lot of those very important gender-affirming procedures aren’t available.
I’m wondering what the minister thinks about that, and is he willing to consider that idea, that if a doctor and their patient believe or approve or whatever that a procedure is medically necessary, that the province would cover it?
ZACH CHURCHILL: On the access front, there is an issue and people have had to go to Montreal. It’s an issue of where the expertise is. It’s also a product of the size of our jurisdiction, the critical mass around the need and demand for these procedures here, so that is why this has necessitated seeking options in other provinces, but we are looking at expanding opportunities here and reaching out to physicians who may be qualified to provide these procedures.
We do have a fairly progressive policy here in the province, so when somebody undergoes the appropriate diagnosis with a medical professional, that does make them eligible for a number of procedures that are made available. There are procedures that are done by cosmetic surgeons that currently aren’t, but there is a continuous review process for what is covered and what’s not and that process will continue.
SUSAN LEBLANC: I’m glad to hear that the process is fluid, I hope. Maybe that’s a way to describe it because I would say that currently I think there are a number of procedures that are considered cosmetic when, in fact, they are essential for certain transgender people to address their dysphoria, to be able to look and pass as their gender. In many cases, those types of surgeries and procedures can be life-saving.
I think it’s good to hear that things are constantly being looked at and I encourage the minister as he takes - I’m not telling him what to do or anything, Mr. Chair, but as he takes his new portfolio in hand, that he really takes a good look at this.
In my last one minute, I’m going to start talking about fertility treatments. Many other provinces offer tax credits, direct funding or services for fertility treatment. Here in Nova Scotia, it’s not unheard of to wait an entire year before you can be seen at a private fertility clinic. What is the department doing to increase access to fertility treatments?
ZACH CHURCHILL: There are currently two provinces in the country that do that. It’s not an easy process to determine all the priority areas that we’re able to fund. Our focus has been - and I do think this is in line with the priorities of Nova Scotians - on expanding primary care service options, attaching patients to primary care providers, which is going to be an ongoing challenge that requires continuous work. That will never be done.
THE CHAIR: Order, please. The hour of questioning for the NDP caucus has completed. We now go back to the PC caucus and I have the honourable member for Kings North.
JOHN LOHR: Mr. Minister, I just want to ask you a couple of questions that may be more pertinent to the Annapolis Valley before we go back to mental health and addictions.
I had asked you in Question Period, I believe a week or two ago, about the hospice in Kentville which had suffered a major pipe break and with maybe a little more time and some extra help there you can maybe give me a bit more of an answer than I was able to get in Question Period.
I guess there are two concerns about that pipe break in the hospice. It did cause considerable damage. What is the process of - the building, as the minister knows, is very new and it shouldn’t happen, so is there any recourse on that? I understand it’s open now but only one wing of the hospice. The second wing, which suffered the damage, is not open yet. Can the minister tell me when the second wing will open?
ZACH CHURCHILL: We’re just waiting to get an update from the NSHA on the timeline there for the member.
JOHN LOHR: Did I understand the minister as saying that we will have that imminently? Is that it? You’ll have it very shortly?
ZACH CHURCHILL: Correct. We’re just waiting to hear back right now in the room.
JOHN LOHR: What we’ll do, minister, when you have that, just provide that. I’ll carry on my questioning.
One of the concerns in the Valley is another issue I raised in Question Period, which you did answer, but I would like to drill down into it a bit more. That is cataract eye surgery at Soldiers Memorial Hospital in Middleton. As the minister would know, that facility and that program is, I’m sure, doing cataract eye surgery for his constituents as well as mine, my family members as well. It’s doing a great service. There are some issues there with Soldiers Memorial that are of concern. Of course, during COVID‑19, things slowed down. There’s a long wait-list. I’m just wondering if the minister can tell me what the future is for cataract eye surgery at Soldiers Memorial in Middleton.
ZACH CHURCHILL: We have a very committed group there who did have a long wait-list for cataracts. That wait-list grew during the last year during the waves of COVID‑19. We worked with the Nova Scotia Health Authority to extend their surgical day to include two more operations a day. They are working diligently to reduce that wait-list to a better-managed situation.
JOHN LOHR: Minister, I’m very interested in the fact that you had mentioned, and I had known it was going on prior to your mentioning it, private cataract surgery in Halifax. I think there’s an interest in that in the Valley, because Soldiers Memorial is such an aging building and has some infrastructure problems, as the minister may be aware of. I’m just wondering if the minister can tell me - I know there are ophthalmologists interested in doing it too. It looks like, from what I hear, Soldiers Memorial is going to need a fairly significant investment in the building to improve air quality. That’s what I’ve heard, and I’m just wondering if the minister will comment on both things: the state of Soldiers Memorial Hospital and what the process is for another ophthalmologist to do what the ophthalmologist in Halifax has done and set up an independent health clinic.
ZACH CHURCHILL: We did get an update for the member on the hospice. All the residents are currently back, and the final work should be completed in the next two weeks. It was supposed to be completed by the beginning of April. However, there have been delays in furniture delivery, so that’s resulted in a delay of a few weeks, and that’s related to, primarily, the furniture. The majority of the work has been done, residents are back, and everything should be back to normal there in the next few weeks, I’m being told. I’m happy to get updates from the member on that situation if it doesn’t pan out that way, but that’s what we’re being told from our infrastructure folks.
In terms of the private clinics in Halifax, most private clinics existed here before. There are private clinics in other parts of the province. The same model can’t be applied there, so we’ve had to work with doctors to find other tactics to deal with the wait-list. The approach has been, and this is in working with the ophthalmologists at Soldiers Memorial Hospital, to extend their surgical day. That’s been the approach to that situation.
In terms of the capital process, the NSHA is given a capital envelope every year to address their greatest capital pressures from a maintenance perspective. What they would essentially do is make a determination through their operational folks on where the greatest capital needs are and then allocate the funding appropriately.
JOHN LOHR: I realize, Mr. Minister, we’ve got a couple of different threads going on at the same time, so maybe we’ll just go back down to one and just go through them methodically.
In terms of the hospice, was the damage covered by insurance?
ZACH CHURCHILL: The NSHA is still investigating through the insurance provider to determine what would be covered. That has yet to be determined. That conversation is ongoing.
JOHN LOHR: All right. Thank you, Mr. Minister. I guess one last question on that subject: What was the cause of the damage? I know a pipe broke but was there more to the explanation than that?
ZACH CHURCHILL: We’ll see if we can get some more specific information on that. It’s not a provincial asset, that building, but we can see if our folks have the details on what caused the pipe to burst.
JOHN LOHR: I’m sure the minister will appreciate that it is the subject of local speculation and interest.
I would just like to go back to Soldiers Memorial Hospital in Middleton. I just want to clarify that when I mentioned the air quality issues, which you haven’t commented on, it’s not an occupational health and safety issue, I understand - it’s the air is not good enough for sterilization purposes. In other words, it’s like the air around all of us, it’s full of little bits of dirt and spores and whatever.
I understand it’s a significant issue. I’m just wondering if the minister has heard that and if that is correct - that’s what I’ve heard - how it will be addressed.
ZACH CHURCHILL: We got an answer on the pipe situation. The sprinkler had water in it and it froze so that’s why the pipe burst. That’s the reason why most pipes burst, because of situations like that. I have not been made aware of any air quality concerns at that facility.
JOHN LOHR: I guess the process, Mr. Minister - and I realize you are not fully answering it, but what I would like to say is that I know there is an interest in duplicating what has happened in Halifax with private ophthalmology or having ophthalmologists offer that service in their own buildings. There’s some indication - you may be correct, I may be wrong - but there’s some indication that the aging Soldiers Memorial Hospital won’t go too much longer or may have some sort of lifespan issues.
I guess the question is: Is there any intent on your part to develop a process or any interest in doing that? There could be considerable savings for government in that process of allowing these types of cataract surgery locations to be self-managed by the providers themselves.
ZACH CHURCHILL: Our focus, obviously, is on the publicly funded system. Creating more private clinics would not fall under the scope or mandate of the department. However, with the private clinics that existed here in Halifax of their own volition, we did decide to utilize those at this time to deal with the wait-list that was exacerbated as a result of COVID‑19.
JOHN LOHR: I would like to ask a question about dialysis. Obviously, the Kentville dialysis unit is fully functional now and has been very, very well received, as the minister knows, I’m sure. Although there were some significant delays in getting it open, we’re very delighted to have it there.
I asked many questions of the member for Kings West about dialysis and hospice. I didn’t think I would ever be asking more questions now. The question that I do want to ask is about old chairs in Berwick. I believe there are four dialysis chairs in Berwick, and they would have some value still. I’m just going to ask the minister: Where are they going? What will happen to them?
ZACH CHURCHILL: The Berwick dialysis facility is being closed, with an expansion happening in Kentville.
JOHN LOHR: The actual physical chairs, though, are they going to be sent to the dump? Are you going to sell them? Are you going to send them to another unit in another part of the province? That’s the question.
ZACH CHURCHILL: We have an update. We did hear from the NSHA that there are no quality concerns at Soldiers Memorial. I believe everything is operating in good condition. That’s verbatim what we heard from the NSHA.
They’ll make a determination on the usability of those chairs, and they’ll determine if they’re able to be repurposed or not.
JOHN LOHR: Minister, I understand that there is a pilot project in the Kentville area on the transfer service. As we all know, our ambulance service is really stretched to the max. One of the things that the ambulance service has been doing is just patient transfers.
I understand there’s a pilot transfer service in Kentville. I would like an update on how that is going. Will that be expanded? Is it effective?
ZACH CHURCHILL: The pilot will help us determine that. My expectations are that it’s going to be effective and that it will be expanded unless any unforeseen circumstances arise during the pilot. We think this is a well-thought-out recommendation from Fitch & Associates, which is why we’re moving forward with it. The rationale is pretty good on this one, to not use ambulances for non-emergency transport. I think that makes sense. I think this pilot is going to go well. There will be an evaluation of it, but my expectations are that this program will be further enhanced at the end of the pilot.
JOHN LOHR: My question would be, how many vehicles are there, how many drivers, and how many trips per week is it making? How many locations besides Kentville is the pilot happening in? Is it just one vehicle in Kentville? Is there more than that? Can you provide us some details?
THE CHAIR: Order, please. We’re going to pause for our 15-minute break, and we will resume at 8:59 p.m.
[8:44 p.m. The committee recessed.]
[9:00 p.m. The committee reconvened.]
THE CHAIR: Order, Please. We will continue with the Progressive Conservatives. We have 34 minutes left.
The honourable member for Kings North.
JOHN LOHR: I guess we left it off with me asking for details about the size, scope, and activity of the transfer pilot project, in Kentville, of the minister.
ZACH CHURCHILL: Madam Chair, we do have some of those details for the member. There are currently four vans as part of the pilot, and they are servicing Kentville and the South Shore. They are operating six days a week, twelve hours a day.
In the room we do not have the information ‑ I know the member asked for how many drivers there are. EMC is managing the pilot and it would be up to them to ensure the appropriate staffing levels. We can get that information for the member, if he is interested, and provide that. Tomorrow would probably be the earliest we can provide that.
JOHN LOHR: I suspect everybody in the province is interested in the success of the program, Mr. Minister, and the details, too, but my other interest in the program is simply: How do I access it or refer people to it, and who qualifies to get to use it? Let me give you a personal example: For nearly all of the Saturday mornings at 6:30, since before Christmas, I’ve been driving someone to dialysis in Berwick. That has now stopped because the dialysis changed, but I just volunteer because Kings Point was not going.
I would like to ask the minister: How does someone like my friend, whom I was just helping out, how does an individual who might need a transfer from home to dialysis or ‑ how does that person access or how do I refer somebody to the service?
ZACH CHURCHILL: The way this process would work would be the exact same as EHS would have dealt with transfers previously with ambulances and the way they currently still do in most parts of the province outside of the pilot area. Calls would go into EMC and they make a determination on deployment of vehicles.
In this particular case, if the patient would meet the criteria that is aligned with the non‑ambulatory transport, then they would deploy that vehicle. So, it is not a program whereby citizens or patients are calling it themselves and requesting it.
So to get the member off the hook for his volunteer work there, this would operate ‑ and thank you for doing that, by the way. That is a very kind thing you are doing for your friend - through the Chair, obviously, to the member. This would operate the same way that the process would work through EMC with the ambulatory transfers, but it is just that they would be able to deploy the non‑ambulatory vans when appropriate.
JOHN LOHR: One last question, really, about this service - are these vans wheelchair-accessible? Would someone in a wheelchair be able to use the service?
ZACH CHURCHILL: They are wheelchair-accessible, yes.
THE CHAIR: Sorry. I am going to recognize you again, minister, because I may have talked over you.
The honourable Minister for Health and Wellness.
ZACH CHURCHILL: Sorry, Madam Chair, that was my fault. I spoke before I was recognized by you. Please accept my apologies for that.
They are fully accessible, yes, and any new vans that are added to the fleet will be accessible. They are produced in Yarmouth at Tri-Star Industries.
THE CHAIR: Apology gratefully accepted.
JOHN LOHR: Tri-Star is a great business. It has been there a long time, I know.
I want to change the subject a little bit. The minister, I am sure, is aware the Valley Regional Hospital ER many, many times is Code Orange, and I know other regional hospitals around the province have off-site walk-in clinics for people who would otherwise need to go to the ER. We have many, many people in our area who do not have family doctors, as the minister knows, and they need to get prescriptions refilled and stuff and they will go to the ER.
Is there consideration to putting an off-site walk-in clinic in the Kentville area to reduce the burden, or in the Valley area to reduce the burden on the Valley Regional Hospital ER?
ZACH CHURCHILL: All the walk-in clinics that we do have in the province, those are private clinics. They are not run by the Nova Scotia Health Authority - they are a product of a collective of doctors who have decided to - I am very captivated by the screen of the member for Inverness right now, if anybody else can see that - anyway, those are privately-run clinics, so those are a product of doctors coming together and choosing to start up and function under a walk-in clinic. We do have those in Halifax, I believe there are some in Cape Breton, so that would be up to the physicians to do that under current circumstances.
However, recognizing the pressure that is created with unattached patients in our emergency department, there have been efforts put forward and changes to alleviate some of that pressure, primarily with expanding the scope of practice of pharmacists to be able to renew certain prescriptions, up to a certain timeline. So that is going to help keep patients out of the emergency departments who are just there for prescription refills, expanding the scope of practice for nurse practitioners as well to support on that front.
Of course, we are going to continue to work to enhance access to primary care providers, like family physicians as well, ongoing work, ongoing challenge. I think we have made some really important strides in this area to create the conditions for success for long-term recruitment and retention here in Nova Scotia.
Again, we talked about this before. There is a challenge when we have doctors who retire, who were taking 3,000, 5,000 patients because the way physicians are practising now, which I think is for a very good reason, they are not taking the same volume of patients and of course that is because they do have other professional pressures they have to deal with - supporting our emergency departments, working through the hospitalist program, and also committing themselves to a better work/life balance as well.
What is happening is that we do have doctors retire who have a large patient panel and it does require us to recruit two, three, four, sometimes five doctors to take on that patient volume, so that is an additional challenge that we are working to overcome and working with Doctors Nova Scotia to address that issue. I think there have been some important steps to try and alleviate some of that pressure in our emergency departments and create more attachment to primary care physicians.
With the walk-in clinics, I think my experience with them has been very positive from a patient perspective, and it is hard to not see there being a market for that in other parts of the province outside of the big centres, but it would be up to those physicians to want to operate in that fashion.
JOHN LOHR: I guess I would like to, just in an effort to get some of the other questions I have done - there are so many questions I could ask about - the Annapolis Valley, as the minister knows, the Western Region is really ground zero for the doctor shortage now. We have in some communities 20 per cent of the population with no family doctor and I am sure the minister knows that. Is there anything specific that the Department of Health and Wellness is doing for these communities that are so hard hit on the Valley floor?
ZACH CHURCHILL: One of the initiatives that has been pushed in several communities to deal with the unattached patient issue in providing for those who are on the registry is providing initial support or primary care clinics. Those are available in Middleton, Kentville, Bridgewater, Berwick, and we have one in Yarmouth as well, and I believe there are others across the province. What these primary care clinics do is support those unattached patients on the registry primarily through the use of nurse practitioners with some physician oversight. They can assess prescription refills and medical advice as well. That has been one area of expansion that we have invested in and we have more than several of those clinics that have been established.
JOHN LOHR: I would like to ask the minister a question on another topic and that is Daytox. We hear from stakeholders that Daytox - many believe it does not work. The individual is in the hospital during the day, goes home at night, back to the same environment with the same triggers or whatever detox they are trying to achieve.
I would like to ask the minister: What is the plan for Daytox? Is there any plan to change that or those types of services, and does the minister see the issues?
ZACH CHURCHILL: There has been a change of clinical opinion on the approach to addictions and withdrawal treatment. Where in-patient detox treatment is necessary, this can primarily happen around those struggling with alcoholism and coming off alcohol because of the severe threats to life as a result of coming off that. Those in-patient services are available to those folks who do require it.
There has been a move away from a clinical perspective for those who do not need that in-patient service to actually have a more community-based approach to supporting withdrawal and addictions management. The reason for that is because eventually these individuals have to get back to the community, and they are going to encounter triggers, temptations, whatever they are, and the process that we have in place is to try and prepare them for that.
When it is medically necessary for in-patient care, those options are available. Again, that is primarily for people, I believe, coming off alcohol because of the biological threat of that, but there has been more of a move from a clinical perspective to focus more on community-based withdrawal and addictions management. That has been deemed to be a more appropriate and effective way to provide these supports.
JOHN LOHR: My question for the minister is: Where is the stay-in detox for alcohol addiction happening - where is it happening in the province?
ZACH CHURCHILL: We are going to get a list for the member, of hospitals that provide in-patient care. We have not been able to produce that right here, but we will provide that list to the member.
Just another reminder that we are expanding the addictions and withdrawal management supports that are available in each zone. Those are in this budget. Each zone will have a hub for addictions and withdrawal management support. This is an area where there is currently expansion happening in the province.
JOHN LOHR: I look forward to seeing the list, and I do appreciate that support for addictions and withdrawals is increasing.
I realize time is slipping away quite quickly here. I just wanted to ask if, you know - approximately a year ago now, I think there was quite a bit of talk about keeping the north end walk-in mental health clinic open in Halifax. Has there been any consideration about creating more walk-in mental health clinics around the province?
ZACH CHURCHILL: There are several areas of expansion for mental health services in this year’s budget. We have hired more mental health clinicians for the adult system and, of course, for the school system as well. We are looking at expanding our virtual care mental health supports, as well as bringing in single sessions and, of course, the addictions and withdrawal hubs, which we just spoke about, as well as the sexual trauma supports. We also do provide grant funding to local organizations that provide support for mental health. I know Laing House has been a recipient of that, as well as other organizations that do have a focus in this area, providing peer-to-peer support or other counselling therapy services.
JOHN LOHR: When you say you have hired, do you mean you have put out tenders for job applications, or have you actually filled positions? When you say you have hired, is that actual hires or putting out tenders - job descriptions, job applications?
ZACH CHURCHILL: These have been actual hires primarily through the Nova Scotia Health Authority. There have been 35 mental health clinicians who have been hired to community health services, plus nine full-time positions designated to serve First Nation communities. There is more staff delivering early intensive behavioural intervention through the Early Intensive Behavioural Intervention Program as well, and there have been 17 full-time positions, support workers and social workers, hired to primary health care teams across the province.
We also have reintroduced advanced clinical nursing specialists on our mental health teams, and that has been part of the nursing strategy. There has been investment in the psychology residency program, investments to improve recruitment and retention of psychologists, which have also included increases to the annual stipend to be competitive with other jurisdictions. We have added a child and adolescent psychology residency position, as well as created a director of training to support improvement in the Northern and Eastern Zones, where we had issues with recruitment.
On the psychiatric recruitment and retention front, there have been some investments to address some chronic vacancies that we have experienced in the province as well. There has been a master agreement increase in commitments, resulting in competitive renumeration for psychiatrists working outside the Central Zone. There has been an increase in the academic specialists psychiatric hospitals budget to support in-patient medical care for psychiatric patients.
Those are some of the highlights in terms of staffing and support for staffing and recruitment and retention for folks delivering mental health services in the province.
JOHN LOHR: When I look at Nova Scotia Health Authority’s website for jobs, and I type in for the entire province, mental health, it shows 298 vacancies. Not all of those are psychologists, but that is the number. I just printed off the first page, the first 25. That is how many job positions printed off, so I know that throughout that listing there are some clerical ones here.
I will just read you the first: social worker, Inverness; social worker, Sydney; social worker, Sydney; social worker, Sydney; registered nurse, Truro; registered nurse, Truro - all mental health - community mental health nurse, Meteghan Centre; psychologist, Yarmouth; psychologist, Sydney; registered nurse, Dartmouth; psychologist, Sydney; psychologist, Sydney; Dartmouth, community mental health nurse; mental health promoter, Bridgewater; clinical nurse leader, Sydney; registered nurse, Kentville; registered nurse, Antigonish.
I realize that is just the first 25. Psychologist, Sydney; psychologist, Bridgewater; booking and registration clerk, Lower Sackville; nurse practitioner, Sydney; clinical therapist, Sydney; psychologist, mental health, flexible around the province; nursing positions - positions plural - flexible around the province. That is one of the 298. That is a plural one - I did not even realize that was there. There are two there plural. Open until filled.
There is a staggering number of vacancies, and I know that you can cite your hires, but the existing positions are not being filled. That was printed off today, and I thought I had made a mistake of some sort. It could not be that big a number, but it is a big number.
Just a question, and to be clear, we know that job shortages, staffing shortages are happening in every industry across the province. It is no secret that it is happening everywhere. It is a demographic somewhat. What is your department doing to - when you say you have made all these new hires, how many of these existing hires have gone unfilled for a long time? I am just wondering: Are we keeping up with the human resource requirements in our Department of Health and Wellness?
ZACH CHURCHILL: That list is going to remain fluid, and it can be impacted by maternity leaves, retirements, but there has always been a supply shortage, particularly in psychology and psychiatry. That is not just this province. . .
THE SPEAKER: Order, please. The time has expired for the PC caucus.
The honourable member for Dartmouth North.
SUSAN LEBLANC: I just wanted to ask one quick question related to fertility treatment that I didn’t get in in the last allotment of time. Is there a consideration to developing or expanding fertility treatment inside the public system?
ZACH CHURCHILL: Currently that’s not one of the priority areas for the province. Our priority areas, as outlined in the budget and previous budgets, are to increase access to primary care, which is a necessity and a priority for Nova Scotians; expand mental health services; our long-term care and home care options that are available to people. There have been substantial expansions there. We have expanded Pharmacare for families and for seniors.
It’s always a challenge to balance the needs and the wants of people. I do believe the priorities we’ve had to date are in line with where the majority of folks in the province need us to invest those critical dollars. We feel confident of the priorities as they’re outlined.
SUSAN LEBLANC: I just wanted to go back to a question that I asked in one of the previous days. I asked about the medium-term outlook detailed in this year’s budget. The Path to Balance portion of this year’s economic plan includes a projection that we will achieve a balanced budget in four years. For Health and Wellness, that goes from $11.5 billion to $11.3 billion. The proportion of the drop in departmental expenses works out to be about $96 million.
I wonder if the minister could outline very specifically where those savings will come from. He mentioned when we last spoke that there was increased investment for COVID-19 protocols and that kind of thing. The expectation is that next year, God willing, we won’t have to spend money on COVID-19, but I’m wondering if the minister could be more specific about where that money is coming from or will come from, and if he can confirm or let us know if there will be any cuts to current programming aside from COVID-19 programming.
THE CHAIR: Just a quick note to committee members and the honourable minister and member for Dartmouth North: the shot clock is not accurate, so the fourth and final hour expires at 10:01 p.m., which means we have about 21 minutes left.
The honourable member for Dartmouth North.
SUSAN LEBLANC: Sorry, I retract that question. I will ask it tomorrow and now give the rest of my time for this evening to the honourable member for Cape Breton-Richmond.
THE CHAIR: The honourable member for Cape Breton-Richmond.
ALANA PAON: I thank the member for ceding some of her time to me. Minister, it’s a pleasure to be able to ask you some questions here today. I know I asked you a question earlier in the House with regard to some of the concerning statistics in the Eastern Zone, specifically that there’s been an increase in the amount of people in that zone who are in need of a family physician. I believe if the statistics are correct in my memory from the question earlier, it’s about 6,500 people - an increase of about 6,500 people who are looking for a family physician in the Eastern Zone, an increase of about 7.7 per cent.
Again, I’ll ask the minister: With all the incentives that are going on - doctors have an increase in their salaries, and all these incentive programs that we’ve been putting forward - what is the major hiccup? What is causing these massive increases to the amount of people still on our waiting list, and specifically obviously within the Eastern Zone, that is partially the area that I represent?
ZACH CHURCHILL: While we have overall seen a net increase of physicians in the province, there are zones, namely the Western and Eastern Zones, that have seen some decrease as a result of physician retirements, and in the case of the Eastern Zone, a death as well.
What we are experiencing is particularly when the old-school doctors retire, they are retiring with really large patient panels that can be 3,000 to 5,000 patients. Because of the new demands on family doctors - pressures to work in the emergency department, hospitalist opportunities that are there for them, and a different work/life balance when it comes to approaching practice, which I think overall will increase quality of care for patients - new doctors that we’re recruiting in the system tend to take significantly less patients. We find ourselves in this position where even in some areas where we are increasing the number of doctors, we do see the unattached patient list not being impacted as much as we’d like with that.
One of the things in the short to medium term that can affect this patient attachment in a positive way is that we do have the residents who are working out of Cape Breton. Hopefully, a number of them will remain there. It’s the same in the Western Zone and Yarmouth Regional. We benefit from having a residency program there. Those are great resources for recruitment for new physicians into our system.
We also do now currently have ‑ the number I’ve seen, and I’m going to get staff to confirm it - 18 physicians who are waiting to get through the assessment process for the Health Authority who have been internationally trained, to get them here. We are actually reaching out to the Health Authority to expedite that process to get those doctors here who have committed to coming. Again, I’ll correct the number if this is not right, but the number I see is 18 who have been delayed in getting here primarily because of COVID-19. We are working to get those folks here as quickly as possible.
One of the big challenges we are having when it comes to recruitment and patient attachment is the patient volume that the doctors are taking on - for justifiable reasons, of course, but it does mean you have to recruit several doctors to replace the one retired doctor who was taking that many people.
We have also seen an increase in our population here. Thirty per cent of people on that list of unattached patients who were surveyed indicated that they were either new to their community or new to the province. That’s another pressure we are having for our primary care system - an increase of people into the province, and interprovincial movement within the province as well. Folks moving to a different community and losing the attachment they had to their physicians are seeking to be attached to a new one.
I think we are creating the conditions for long‑term success here. The compensation has gone up significantly - over 20 per cent even just within the last year through the master agreement. We now have the most competitive compensation in Atlantic Canada, which we would consider to be our peer provinces in size. We do have the highest-paid compensation for emergency doctors, as well as anaesthetists and obstetrician-gynecologists, I believe.
We are very focused on training more doctors here. We’ve created 15 new family medicine seats at Dalhousie. We funded that, and that’s year over year. Also, getting our residents out to rural communities to practise and get them familiar with the wonderful communities that they have an opportunity to live and practise in. Cape Breton and Yarmouth ‑ both ends of the province outside of Halifax - benefit from that residency program. That would be high‑level commentary on some of the challenges we have on this front, and the reason why this work is so important.
The other thing we are doing to increase access points to primary care is expanding the scope of practice for pharmacists for prescription refills, as well as expanding the scope of practice for nurse practitioners. I did mention this in my response to the member for Kings North, that we have established primary care clinics across the province. They’re staffed primarily with nurse practitioners with some physician oversight. Their role is to support unattached patients on the registry with their medical needs.
Physician recruitment and the way they are practising - it’s not allowing us to always catch up with the patient volume that we want, so we are trying to create these other access points as well.
ALANA PAON: I know there has been a great deal of work and loads of incentives that have been put forward. Thank you for listing the ones that you have. Yet with all of these incentives, we still have an increase of almost 8 per cent, basically - 7.7 per cent in those who have registered for Need a Family Practice since last April.
I’ve often thought of this: I’ve spoken to so many young people within my constituency who are really interested in getting into medicine, but it’s really expensive. When you are living in a constituency where the level of poverty is still so high - again, in Cape Breton we have some of the highest levels of child poverty in all of Canada - a child basically can dream to become a doctor and maybe work really hard to get those marks, but at the end of the day - and I have plenty of my son’s friends who have gone through medicine - for many people it’s not possible, simply because of the financial burden. As much as you can get bursaries and scholarships and all these things, you still have to have access to lines of credit and so forth. Again, I know how some of my son’s friends have had to set themselves up.
I have often thought that we should be going into the schools and trying to really kind of - I don’t want to use the word “target,” but take a look at these children who have this interest or predisposition to make a great family physician. I think there’s not only the marks but also the soft skills that come along with that bedside manner. There are so many kids who want to stay home and we want to try and keep them home.
I’m wondering if there’s anything the minister might be thinking of or if I could put out there a possibility of starting a program of going into the schools and actually hand-holding some of these kids and basically creating and fostering an opportunity for them to be able to not only go to medical school - those kids are obviously already from our communities, so it’s a lot easier to encourage them to stay here, but also they are already invested, I guess is what I want to say, in the cultural component of living in rural Nova Scotia, which is not for everyone.
ZACH CHURCHILL: I very much appreciate the question from the member. Recognizing that the costs associated with attending medical school and getting through are significant, there are very generous programs in Nova Scotia to assist with that.
The focus on informing folks about these is primarily at the end of graduate level, while those folks are determining what postgraduate options they are going to pursue. But we do have a debt assistance program that provides a total of $45,000 for eligible family medicine physicians and $20,000 for specialists. There’s a Family Medicine Bursary that’s for Dalhousie Medicine residents or family medicine residents and other Canadian training programs or even in the United States who attended Dalhousie Medical School. There’s a three-year return of service contract that they sign in exchange for $60,000 and so we have had a bit of uptake on both of those programs.
We do have the Physician Tuition Relief Program, and that’s for physicians’ new practices or within seven years of completing their residency who have not previously practised in Nova Scotia. That program has a five-year return of service and the Physician Tuition Relief Program reimburses the participants for tuition paid during four years of their undergraduate medical schooling, and depending on where they practise, participants may be eligible for up to $30,000. We currently do have over 135 physicians who have active return service agreements related to that program. There are some fairly generous financial incentives from the perspective of supporting post-grad study.
We’ve also created seats here in Nova Scotia specifically for African Nova Scotian and Indigenous students who want to pursue careers in medicine, so that’s very exciting, to ensure that historically under-represented individuals in these fields have more access and opportunities to pursue careers in these.
It’s also about increasing our numbers of nurse practitioners here in the province. I believe this is another primary health care provider that we can lean on to provide service to Nova Scotians, who do incredible work. We’ve actually increased the seats at Cape Breton University for nurse practitioners from 71 to 133, so we are training more nurse practitioners as well. We encourage nurses to upskill to the nurse practitioner level as well, and they can do that in exchange for return of service contracts.
I think the member’s point is very well taken, and I think we do have some pretty generous financial incentives on the training side.
ALANA PAON: I appreciate the information from the minister. I guess my point was that although these incentives exist and these things are extremely important, there are so many children who are within the school system who would not dare to dream, I think, simply because of their current socioeconomic situation.
I guess I’m trying to encourage the minister to perhaps just take this as he wishes, but find new and inventive ways of planting that seed of being able to actually - that you can become a doctor, and you can become a doctor and stay in your province and it doesn’t matter what socioeconomic background that you’re in.
I just think that perhaps we should be doing more, just like I think we should be doing more to teach finances to children at a really, really young age, that we should be trying to do more to try and incentivize and implant that seed that they can also become a doctor, that anyone can become a doctor if you work really hard, but especially those who seem to have the predisposition, as well as the smarts, obviously, to be able to get the marks that are needed to do so.
I’m looking at the vacancy summary from October 31, 2020, and the minister had mentioned earlier with regard to the older physicians who are retiring, the newer physicians are coming in and not wanting to take on the large caseloads that the retiring physicians had had, so when I see that there are 18 family physicians on October 31, 2020 who are listed in the Eastern Zone, that we’re looking for 18 family physicians, I guess the question in my mind is: Those 18 doctors, are they replacing the six physicians? We’re looking at a three-to-one ratio for the patient load that the new doctors are willing to take on. It really is kind of panic-inducing, a little bit, that we’re going to have to find three doctors . . .
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 and that you 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. We will be back at 10:16 p.m. after our COVID break.
[The committee adjourned at 9:57 p.m.]