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March 26, 2021
Supply
Meeting topics: 
Committee of the Whole on Supply - Legislative Chamber (12857)

 

 

 

 

HALIFAX, FRIDAY, MARCH 26, 2021

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

12:35 P.M.

 

THE CHAIR

Susan Leblanc

 

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

 

The honourable Government House Leader.

 

HON. GEOFF MACLELLAN: Madam Chair, would you please call the Estimates for the Department of Health and Wellness.

 

Resolution E10 - Resolved, that a sum not exceeding $5,332,752,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.

 

THE CHAIR: I now invite the Minister of Health and Wellness to make some opening comments if he wishes to and to introduce his staff to the members of the committee, if that’s applicable.

 

HON. ZACH CHURCHILL: I am pleased to introduce the estimates for the Department of Health and Wellness for the 2021-22 fiscal year. Thank you for the opportunity to speak about the important work that’s being done by the department.

 

With me virtually today are two officials who will help us take a closer look at the department’s budget. Joining me are Dr. Kevin Orrell, Deputy Minister of the Department of Health and Wellness, and Shelley Bonang, Chief Financial Officer for the department.

 

Nova Scotians tell us each and every day that health care is their top priority, and it’s also our government’s. We have listened to Nova Scotians, and government has made significant investments in these key areas in Budget 2021-22: keeping us safe during the pandemic, training and recruiting doctors and health care professionals, expanding access points of primary care, helping Nova Scotians with their mental health, and supporting our senior population.

 

To do this, the budget of Health and Wellness has increased this year by $510 million. That is representative of about 10 per cent of the overall budget of the Department of Health and Wellness. The department’s budget is about 43 per cent of government’s total spending overall. In Budget 2021-22, the Department of Health and Wellness will spend its $5.3 billion budget in these proportions: 38.6 per cent to the two Health Authorities for health care services, 19.1 per cent towards continuing care, 18.8 per cent to compensate our doctors, 6.7 for Pharmacare programs and other pharmaceutical services, 4.3 per cent for mental health and addictions, 3.1 per cent for emergency health systems, and the remaining 10 per cent for various other costs such as amortization.

 

We would like to take some time, obviously, to talk about COVID‑19 and the pandemic. It has really been very impactful to Nova Scotian families. Our lives have changed dramatically since a year ago as this disease swept around the world and into our province. We should never forget about the 66 lives that were lost due to this pandemic, and of course our sympathy and condolences and our hearts are with each and every one of the families that have been impacted, those who perished, and those who were impacted in acute and severe ways as well.

 

While we have been fortunate to be among the safest places in the world throughout the pandemic, the impacts still weigh heavily on us. It’s a stark reminder to each of us of what this virus can do if it’s not properly managed. Many people thought that because our case numbers were low, we were out of the woods, but the death of an 80-year-old woman earlier this month due to the pandemic shows that we can never let our guard down. We can’t forget what is happening around us and how quickly our own situation could change if we do become complacent.

 

The public health measures that we have in place are still important for Nova Scotians to follow. That’s physical distancing, masking, keeping your social circles small and within the public health limits, staying home when you’re feeling ill, doing testing, and washing your hands and following proper hygiene. These sorts of initiatives have kept us safe and will continue to keep us safe as we roll out our vaccine and as we work towards defeating this pandemic. By this time next year, government will have spent about $1 billion in resources to fight the COVID‑19 virus.

 

This year, the department will spend $275 million directly on COVID‑19 measures. Government’s costs include spending on personal protective equipment to keep our health care providers and citizens safe, making changes at long-term care homes, strengthening our infection prevention and control, to help businesses and the economy, and to launch our pandemic vaccination program.

 

[12:45 p.m.]

 

The government is committed to ensuring that every Nova Scotian who wants a COVID‑19 vaccination has an opportunity to receive it. Our target is to have everyone who wishes to get this vaccine, and we do expect a high turnout, to get their first dose by the end of June. That is contingent on the supply chain of the vaccine not being disrupted. Everything is contingent on that supply, but if supply stays up and continues to increase as we’ve seen, then we will be able to get shots in arms by June. We’re expecting to receive one million doses between April and June 30th.

 

Once initial vaccinations are completed, vaccination with the second dose will continue into the Fall. I want to thank the hundreds of volunteers who are helping in the vaccination effort and those that are helping with our rapid testing sites and the staff that are working on our clinical testing sites. I also want to thank the hundreds of nurses and doctors who came out of retirement to help us roll out this program.

 

Our goal is to have 75 per cent of Nova Scotians fully vaccinated, because that will allow us to reach herd immunity. We will reach this goal mainly by vaccinating people from oldest to youngest, because age is the biggest risk factor. We started with Nova Scotians in their 80s and above and will continue to vaccinate people by decreasing age until we have completed. This budget sets aside $24.2 million for the vaccination effort.

 

Public Health, led by Dr. Robert Strang, has worked very hard during the pandemic to keep us all safe, to give good advice and recommendations to government and to do the same for the public. I want to thank all the staff at Public Health and the Department of Health and Wellness and the health authorities for their amazing work during the pandemic. I recently visited a vaccination site at the IWK Health Centre which was running so very smoothly, and it was really exciting to see people excited about getting their vaccines. These efforts are ramping up exponentially each and every day.

 

It’s been a 24/7 operation. Public Health has really demonstrated a high level of competence and commitment to seeing the province through this and working with government to do so.

 

Year-round, I do want to thank Public Health as well because they do keep us safe and healthy through disease surveillance, illness prevention, and many other efforts that they have in place. Funding for the Public Health office at the department will increase this year, I’m happy to announce. We are adding $5.7 million to Public Health over the next four years. This investment will increase to $14 million a year. This investment will be used for new positions, communicable disease prevention and control, healthy communities and population health surveillance.

 

As I noted earlier, the biggest risk factor related to COVID-19 is age. We continue to mourn the 57 people who died in our long-term care homes during the pandemic, and they will not be forgotten. We initiated reviews of what happened at Northwood, in infection prevention and control for the long-term care sector, and the majority of the recommendations from the reviews are currently in place and helped protect our long-term care centres during the second wave of the pandemic. The department has worked hard in protecting the long-term care sector’s most vulnerable, and we will continue to work hard in 2021-22.

 

We have learned a lot from the pandemic. We recognize the quality and availability of long-term care needs to improve, and that’s exactly what we will do. For the first time, government will spend more than $1 billion for continuing care in our province. That is a very large investment milestone for the province.

 

Continuing Care encompasses long-term care, such as nursing homes and home care. Home care offers home and community support, such as nursing services, personal care, light housekeeping, respite, and palliative care services at home. The services provided by Continuing Care are vital to the daily lives of tens of thousands of Nova Scotians.

 

The government is making a multi-year commitment to infrastructure renewal and improving services in our long-term care homes. Building on recommendations from the minister’s expert panel on long-term care and with input from the long-term care and home care sectors, the department is leading the development of a five-year blueprint to transform the system to better meet the needs of these Nova Scotians. The blueprint will address barriers related to choice and flexibility, infrastructure, workforce development, and sustainability. It will further focus on family-centred care and service excellence.

 

This year, we will provide an additional $22.6 million to further implement the recommendations of the expert panel. This funding will include long-term care assistance, expanding access to allied health providers, and implementing primary care coverage in nursing homes.

 

We know staff recruiting has been a challenge for this sector, and this year we’ll also provide a continuing care assistant bursary program for a third year to allow more opportunities for successful applicants to receive a bursary of $4,000 for full-time students and $2,000 for part-time students.

 

We have 8,000 people living in the publicly funded long-term care sector. Each one of those is a mother, a father, a brother or sister, grandmother, or grandfather, and throughout their lives they have built this province and really deserve the best that we have to offer them. That’s why we’re building 400 new beds and replacing more than 700 in the system so they have modern, well-equipped facilities which are better protected against the spread of infectious disease, and where they can live quality lives.

 

New long-term care facilities are currently being built in Mahone Bay, Meteghan, and Eskasoni, as well as in New Waterford and North Sydney as part of the Cape Breton Regional Municipality redevelopment plan. Northwood will build a new facility with 100 beds, and facilities in Musquodoboit Harbour, Chester, Bridgetown, Berwick, Sydney, and Chéticamp have been identified for major renovation or replacement as well.

 

The pandemic was tough on the mental health of Nova Scotians. We know that through the data. The province was also, during that time, shaken by the terrible mass shooting at Portapique, and all these factors together obviously contributed to some challenges for many people in our province. We did see a 30 per cent increase in calls to our mental health crisis line - which is available 24/7 - over the last year. Government expanded mental health resources to give Nova Scotians the critical mental health care that they need, and these resources were delivered in person, via phone, text, or online. We met people’s needs in the method that was best for them.

 

Mental health continues to be a priority for the government, and we are entering a new phase of mental health services in Nova Scotia. Government is investing over $330 million in mental health in this budget, an increase of $20 million. This is a 5.2 per cent increase, and it’s the largest budget for mental health that we’ve had in our province’s history.

 

The new Office of Mental Health and Addictions will report directly to the Minister of Health and Wellness, and the Office will be led by a Chief Mental Health and Addictions Officer, who will provide leadership and coordination of activities across agencies, departments, and partners to improve mental health outcomes for Nova Scotians. Its 15-member staff will provide focus to the critical work needed to expand access to mental health services and programs in communities in every part of the province.

 

Budget 2021-22 provides funding for some of the new, innovative services the Office will provide, including single-session therapy, addictions management hubs, implementing a new model of care for sexual assault trauma therapy, and patient-focused e-mental health services will be expanded as well. We will also work on enhanced access to treatment and harm reduction services for people with addictions.

 

I’ll give you an overview of the two new programs that we are funding. Single-session therapy is a new, easily accessible service that will be launched this year. It focuses on addressing an immediate issue the same day with trained staff and without referral. Addictions withdrawal management hubs are service delivery hubs that will provide a number of services, including an in-person assessment of withdrawal management needs, outpatient withdrawal management, recovery skill supports, brief intervention and harm reduction support, and support for family involvement and care. There will be hubs in every single health care zone in the province.

 

With these programs, the new Office of Mental Health and Addictions and our commitment to improving the mental health of Nova Scotians, this is an innovative and exciting time in this critical area. We know that Nova Scotians are looking for more supports.

Government is continuing the modernization of our health system in the province as well. This year’s budget includes funding in the capital plan for the QEII New Generation project and CBRM health care development projects. The QEII New Generation project is the largest health care infrastructure project ever developed in Nova Scotia. It’s a multi-year project designed to help ensure the health care needs of Nova Scotians are met for the next 50 years-plus. The project is progressing very well.

 

If you have visited Dartmouth General Hospital, you can see the impact of the project. The hospital is larger now, with new operating rooms and 48 beds, which are all new, and the new entrance area. The CBRM health care redevelopment is transforming health care in industrial Cape Breton. The Cape Breton Regional Hospital is undergoing expansion and renovations, and will have a new emergency department, a critical care unit, and a cancer centre.

 

The Glace Bay Hospital is being improved with renovations at the emergency department and the surgical suite. New Waterford and Northside are getting new health centres, with New Waterford’s project an innovative hub that includes a high school, a nursing home and the health centre, and the Northside project will also get a new nursing home.

 

The capital plan invests close to $180 million this year on redevelopment projects. There are other modernization projects across the province, including Pugwash, Amherst, Yarmouth - we’re looking at expanding the ER there - Bridgewater, and Halifax. This is in addition to the dialysis expansion program with new renovated seats in Halifax, Dartmouth, Kentville, Glace Bay, Digby, Amherst, and Sydney. There are currently 163 dialysis stations in Nova Scotia, serving more than 870 patients, with more coming. The dialysis program is also expanding home dialysis so Nova Scotians who need this lifesaving service can do so in the comfort of their own home.

 

To ensure the best health care staff are able to work in new and exciting facilities, we are expanding training for doctors and nurses. We’re also making investments in training more doctors by providing over $12 million to Dalhousie Medical School for a number of initiatives. They include continued funding for 16 seats at the medical school that were added last year, increased funding for the next cohort of 10 family medicine residents, and increased funding for the third cohort of 15 specialty residency placements.

 

We are also recruiting and retaining doctors with an attractive compensation package. Family physicians, emergency medicine doctors, and anaesthetists will become the highest paid in Atlantic Canada. Over the life of the new master agreement, doctors will receive over $135 million more in compensation here in the province of Nova Scotia.

 

Government has attached more than 180,000 Nova Scotians to a primary care provider since the Need a Family Practice Registry was established. Numbers on the registry have declined each year until the past year, when the pandemic impacted our province in a number of ways. It did disrupt our system, it did disrupt our international doctor recruitment, as a result of closed borders, and made it challenging to go out and recruit new physicians. But that work has not stopped and we continue hard to recruit new doctors.

 

The number has also gone up this year, we know now, because of surveys conducted with those on the patient waiting lists who are waiting for a family doctor. Thirty per cent of the 60,000 that are there now are either new to the province or new to the community they’re living in. We have had an increase in population here. That was one unforeseen beneficial outcome of the pandemic and a result of how well Nova Scotians did and how well the pandemic was managed here. So, there are some good elements to the story as well, because we do have new people here in the province and we will continue to attach them to family physicians.

 

Our province’s health workforce of 45,000 employees, nurses, and doctors are well-trained and dedicated and caring. Nurses make up the highest proportion of the workforce, about 15,000 staff. We are ensuring a steady supply of nurses by continuing the funding for 70 nursing seats in Cape Breton and at Dalhousie, and some of those are at the Yarmouth campus.

 

To help Nova Scotians get better access to primary health care, we are looking at further ways to ensure that pharmacists, paramedics, and other professions work to the full scope of their practice. We’ve expanded the scope of practice for pharmacists and they are able to prescribe birth control and medication for urinary tract infections and shingles and also renew prescriptions for 180 days. So far, that program has been a success.

 

We have expanded the scope of practice for our nurse practitioners and we’re currently running a pilot program to expand the scope of practice for RNs as well. These are just some of the initiatives this government has undertaken to ensure we have a modern, well-equipped health care system with the best staff possible.

 

[1:00 p.m.]

 

In conclusion, the government is focused on health care priorities that are important to Nova Scotians in every single community in the province. This budget continues government’s investments in the key areas of continuing care, mental health, doctor-patient attachment, and modernization of our system.

 

I will touch on some of the issues that are happening in this department. I do want to thank the thousands of health care workers in the province who really demonstrated their courage and their commitment to the people of the province each and every year, but particularly over this last year. It was a very scary year for everybody, and our health care providers were still out there on the front lines servicing Nova Scotians and making sure people are taken care of. I want to thank them all for doing such an amazing job.

 

I do want to thank the staff of the health authority and the leadership there and also the leadership and the staff here in the department. I’ve only been here for a few weeks now and my impression is that there is a group of capable, strong people who are working tirelessly each and every day to make sure that the pandemic continues to be managed, as well as all these other priority areas that Nova Scotians expect us to take action on.

 

I do want to thank the staff here at the department and the health authority for the incredible job that they do.

 

With that, Madam Chair, I hand the floor over to you.

 

THE CHAIR: Just before we begin the questioning, I just want to outline a couple of things.

 

Because we are in this new online format, and we are trying to sync up with the subcommittee, we will be taking strict breaks at every hour. At the three-hour mark, we will take a break. If someone is in the middle of answering a question, then I’ll try to interrupt before they begin. I’m going to try to ride that time a little bit, just so you know.

 

Also, I ask, especially, minister, for you, when you’re ready to answer a question, just give me a little wave and then I will recognize you so that you can have time to consult with people. For the folks in the Opposition who are asking questions, if you are giving your time to someone else and there is more than one person asking questions in the hour, then I just ask the next person to give me a little wave, too. You can use your printed-out hand or you can use your real hand, but please don’t use your Zoom hand.

 

The honourable member for Pictou West.

 

KARLA MACFARLANE: Just before I begin, I want to mention to the Minister of Health and Wellness that I find when he sits up closer when he speaks, I can hear but then when he sits back, I can’t. I know he has to be comfortable, too, but I just notice he’s kind of going in and out. I’m sure we’ll get through, no problem.

 

I do want to thank the minister for his words and comments, as well as his colleagues for joining us today - Kevin Orrell and Shelley Bonang. I also want to take a few moments to recognize all the frontline workers out there, all the allied health care professionals. It’s been a very challenging year. Together, we’re getting through it. There are a lot of good stories, but there are a lot of sad stories as well.

 

We often say no one comes through our doors unless it’s something bad. I hope through Estimates that we’ll be able to get answers to fill in some of the gaps where we as MLAs, and Opposition specifically, deal with day to day.

 

I’m going to start right off with a question to the minister with regard to doctor recruitment and retention. I think it’s always good to have a refresher because it’s forever changing, as well. I’m just wondering if the minister can provide basically: What are the new efforts that are being conducted and implemented in retaining doctors? As a follow-up to that, not just basically recruiting, but making sure that we retain them and that they hang their hat here and start their families here.

 

ZACH CHURCHILL: There is a whole host of recruitment and retention tools that we do have in place, so I will itemize those for the member. As I mentioned in my opening comments and at various points in Question Period, we have essentially a 20 per cent remuneration increase for family physicians, for emergency doctors, and for specialists like anaesthetists, which now makes Nova Scotia the jurisdiction that has the most competitive compensation package in all of Atlantic Canada.

 

The member would know we have invested heavily in training more doctors here in Nova Scotia. We’ve expanded the family medicine seats as well as the specialty seats at Dalhousie, so there are 15 new seats this year at Dalhousie for specialties.

 

We have a very robust bursary and repayment program for those doctors who choose to stay and practice in high-need areas. The amounts are pretty significant for the family medicine bursary - that can get to $60,000 - and the International Medical Graduate (IMG) residency program has funding attached to that as well. We’ve also made it easier for internationally trained physicians to come to Nova Scotia.

 

We’ve reduced the red tape barriers that were preventing some folks from coming out. We’ve established a new physician immigration stream - and this is something the member and I spoke about in the House as well already - whereby the department staff work directly with family physicians to help them through the federal immigration process in an expedited fashion. That has been very helpful. We’ve had over 80 doctors - or close to that, I believe - close to 90 doctors who have come through in that program, and the efforts are still ongoing, at the community level as well.

 

There have been grants provided through the Department of Communities, Culture and Heritage to support local community efforts to recruit and retain family physicians and specialists, which I think has had a lot of success bringing members of the community together.

 

Municipalities have often partnered in funding for this, as well. In my community, the Chamber of Commerce has also been involved with the recruitment efforts to really have that localized focus on doctor recruitment and retention, which I think is very valuable. We all know how important a welcoming environment is in our communities, particularly for our international practitioners who come here without the social network, extended family, and support.

 

We’ve developed a really great relationship with Doctors Nova Scotia that I think is going to prove to be very useful in the coming months to look at additional steps that we can take. Patient attachment and access to primary care is beyond just recruiting physicians, although that is obviously a key factor.

 

We’ll be working with Doctors Nova Scotia to find ways to attach more patients to the doctors who are currently here in the system, because that’s a really important component of what we need to do, as well, to meet the demand.

 

Also, we have expanded other access points to primary care so that those Nova Scotians without a family doctor can receive certain primary care services by nurse practitioners, by pharmacists. We’re looking at expanding the scope of practice for other health care professionals as well.

 

THE CHAIR: Just before we continue, we’ve had a change of plans. Instead, after the member asks the question, I will automatically recognize the minister and then the minister can just turn his microphone on, or go off mute, when he’s ready to answer.

 

The honourable member for Pictou West.

 

KARLA MACFARLANE: I thank the minister for his remarks. I didn’t hear anything particularly new compared to what doctor recruiters for Nova Scotia have been doing in the past decade or so, really.

 

What I would like to discuss or find out is whether or not the doctor recruiters for Nova Scotia have been involved in or have taken advantage of any virtual conferences to recruit doctors. Just a quick, simple yes or no is fine.

 

ZACH CHURCHILL: The answer would be yes.

 

KARLA MACFARLANE: That’s great to hear. Can the minister please tell me when those took place and what the results of those conferences were?

 

ZACH CHURCHILL: They’ve been doing ongoing efforts and engaging virtual recruitment throughout the year. We could check with the Nova Scotia Health Authority to see if they have the list or the schedule of those activities.

 

KARLA MACFARLANE: That would be most helpful. I think it’s really crucial that we identify in this modern world how many doctors or any allied health care professionals we’re able to recruit through virtual means. Making any plans for the future, I think it’s crucial in determining how we gauge how many people we did retain through those virtual meetings.

 

You mentioned earlier that your relationship is growing with Doctors Nova Scotia and I have been privileged, as well, to meet with them a number of times and certainly praise them for the work they’re doing and their positive outlook.

 

[1:15 p.m.]

 

There are very concerning matters that they brought up. One that they often spoke of and said it’s more serious than what most of us would think, but discrimination and racism for many of our international doctors who are coming here is one of the reasons why they exit. I’m wondering if you could elaborate on that. I’m sure you’re well aware. And what is your plan, as minister, to stop this so that we will retain and be a welcoming province, which I think we are, but why is this happening and what are your plans to combat it? Thank you.

 

ZACH CHURCHILL: Thank you, Madam Chair. Obviously, those are terrible stories to hear. You do get pockets of this sort of sentiment with Nova Scotia still to this day, which is extremely unfortunate. Of course, this is a priority for us, as a government. I’m very proud that our Premier has established the new Office of Equity and Anti-Racism Initiatives, so we have established a new partnership with that new department and we’ll be working with them. Of course, there has been work ongoing in this regard to date.

 

We do obviously get feedback from physicians who experience this and work with our recruiters locally to help develop strategies to manage situations like this. It’s also important that the community support aspect of this strategy is really key to helping deal with these sorts of problems, as well, because you bring the community together to establish a social network of support for these docs.

 

I know these community organizations are connecting soccer families with other soccer families, connecting doctors and their children with folks who share interests, whether it’s sports or arts, music or whatever. I think there would be community focus in support of our community initiatives as a big part of this as well. But we all have a role to play to push back against racism when we hear it. Some people don’t realize that they are being racist in the way they speak or in the way they talk or they way they are interpreting things. Of course, our education system is our best weapon against that to teach our children about inclusiveness and the responsibility they have as people to each other, so we put a lot of work in that.

 

I know when I was at the Department of Education and Early Childhood Development that was a big focus because this is a broad societal issue. It doesn’t just affect doctor recruitment - it affects other parts of our society as well.

 

I think the new Office of Equity and Anti-Racism Initiatives will further assist us in all departments to develop effective strategies to combat this.

 

One thing I have been impressed with is that - again, I don’t have any data on this, but it seems that there is less of it with every younger generation that is getting used to seeing more diversity on TV, more diversity in the Legislature. I have a lot of hope in our future generations that they will continue us on the path of, hopefully, eliminating these sorts of antiquated and tragic sentiments that do still exist.

 

KARLA MACFARLANE: I thank the minister for his comments. I do, as well, agree that it’s more of a broad societal issue. However, we need to come up with a plan for international doctors that are coming here to ensure that they have a sense of belonging and purpose. One of the things that I’ve always spoken about is doing mandatory exit interviews. It’s a two-pronged reason, really, because it’s not just to hear, perhaps, the challenges and difficulties of what they experience and why they’re exiting, but as well to hear the good things and the suggestions and the comments.

 

I’m wondering if you have any intentions - or the Department of Health and Wellness has any intentions - to make exit interviews mandatory, which would be of benefit to the department in moving forward and fixing the mistakes that we’re recognizing and witnessing now.

 

ZACH CHURCHILL: The Department of Health and Wellness shares the goal of having mandatory exit interviews as well.

 

Can the member hear me okay?

 

KARLA MACFARLANE: I can now.

 

ZACH CHURCHILL: We do share your view that those should be mandatory, so we are working with the health authority to achieve that.

 

KARLA MACFARLANE: I am extremely pleased to hear that. You know, it’s easy for me to say I wish it had happened a number of years ago, but I’m really happy to see that it will be mandatory because I think, again, it will be beneficial to everyone.

 

Is there - just wondering, sort of - a total of what percentage of the budget is spent on our recruiters - doctor recruiters - as well as wages and everything that they spend on marketing and advertising to get doctors here? I’m wondering what that budget is, approximately.

 

ZACH CHURCHILL: That wouldn’t be reflected in the Department of Health and Wellness’s budget. That would be in the health authority’s budget, but we will try to track that down through the health authority for the member.

 

KARLA MACFARLANE: I look forward to that information because we want to definitely ensure that we’re - for a lack of better words - getting bang for our buck and making sure they’re fulfilling their roles. I know that it is hard. I know across Canada it’s hard to recruit, but there are provinces that are doing much better than us in recruiting.

 

I know that the new pay model for our doctors has changed a bit. I’m wondering if the Minister of Health and Wellness can confirm: are we currently still the highest-paying province for doctors in Atlantic Canada?

 

ZACH CHURCHILL: In most professions. For anaesthesia, family medicine, ER docs.

 

KARLA MACFARLANE: What about our specialists?

 

ZACH CHURCHILL: Yes, for some specialists.

 

KARLA MACFARLANE: Is there one particular profession specialist that is lacking that is causing concern due to not making nearly the income that another province is? I know recently, or a year ago, I recall losing a radiologist from Nova Scotia - from the Valley area, to be honest - who was doing fairly well - making $300,000-$350,000 - and went to Vancouver to make $900,000 and some. Just curious if you know of any particular profession or specialist that’s lagging behind?

 

ZACH CHURCHILL: Not where we’re experiencing any lack of supply. One of the key areas - and this is one of the most competitive fields to get people from - is anaesthesia. That’s why it was really critical particularly to bring that group up.

 

Nova Scotia, with a population of just under a million, is not going to compete with the B.C.s, the Albertas, the Ontarios - who have larger populations, obviously, and of course a stronger tax base. We really do have to measure ourselves from the compensation point with our peer group. Those would be primarily Atlantic Canada and the Prairies. We now have the highest compensation in some key fields where we really wanted to focus our recruitment and retention: anaesthesia, our emergency department doctors, and family physicians.

 

We do have the highest amount of doctors per capita in the country, which is something that we all should be very proud of. There are, of course, factors that contribute to that, like having the IWK Health Centre, which does serve the region. We don’t have a shortage of doctors here. We have done pretty well with recruitment and retention and keeping our stock up.

 

As I say, until this year, the trend was going in the right direction, having fewer and fewer patients who were unattached. But for some understandable factors - having 18 internationally-trained doctors who are waiting to get into the province because of COVID‑19 is an issue that we’re experiencing this year.

 

Of course, the good news is that we have more people coming to the province. Compensation is one thing. In key fields, we do have the most competitive remuneration. But even competing against B.C., Ontario, and Alberta, we do have a lot to offer in terms of cost of living here. Compensation is obviously really important, but we still have other ways to compete with those larger provinces.

 

I think being identified as one of the safest places to be in the world during the pandemic is a good part of our story.

 

KARLA MACFARLANE: I appreciate the minister’s comments. I don’t necessarily agree with much of it.

 

I guess one of my questions coming out of those comments would be - there’s no doubt that when the minister offers these ratios, that we have more doctors per capita - that’s fine, but we also have a population in Nova Scotia, just a little under a million, I guess, but an elderly population, and perhaps not one of the healthiest populations.

 

Look, at the end of the day, we’re all responsible for ourselves and looking after ourselves, but we do expect our tax dollars to go towards a top-notch health care system. If you don’t have your health, you’ve got nothing.

 

I’m sorry to disagree, but there is a huge lack of doctors. We have over 60,000 people that we know of who are waiting for a doctor. I’m sure we could add at least another 30,000 or 40,000 to that who have not signed up.

 

One of the numbers that I keep hearing the minister and the department put out is that we have attached 180,000 to doctors. There’s some conflicting beliefs in that. I hope that maybe we can get the truth today around that.

 

Out of those 180,000 individuals whom we hear have been attached to a doctor, are the minister and the department considering nurse practitioners as doctors? Or is that truly 180,000 individuals attached to doctors? I’m just trying to get those numbers clarified.

 

ZACH CHURCHILL: I thank the member for the question. We will be updating that list as well, so we’ll see if there are any changes, and if we do get back in the right trend in terms of patient attachment.

Doctor recruitment is one thing, and we have done very well with doctor recruitment. I believe there have been 550 - someone in the room will correct me if I’m wrong here - in the last four years alone, but we also need to attach patients to those doctors as well. Practice is changing a bit with a newer generation of doctors for good reason, to ensure high quality care with patients. We do need to increase the attachment, as well, to the current doctors who are in the system. We have tried ways to incentivize doctors to take on more patients, as well, and this is something that we’ll be working with Doctors Nova Scotia on too, and I think they’re really excited to look at some potential options there with the department to increase attachments to doctors who are currently in the system.

 

In terms of the patients who are attached, the member is correct. Some of those would include nurse practitioners. The vast majority of them are with a family physician, though, so a smaller number would be attached to a nurse practitioner as their primary care provider, but the majority of that would be to a family doctor.

 

KARLA MACFARLANE: Just trying to figure out the numbers here. They just don’t seem to add up. I wasn’t the best in math, but I certainly got by.

 

I’m trying to figure out - right now we have over 60,000 that are on the list, and so if I’m on the list right now, I could expect to get a call. Even though I’m calling and I’m thinking that I’m registering for a doctor, it is quite possible that I could get a call and be told that I don’t have a doctor but I have a nurse practitioner. I’m wondering, where can the public actually see the breakdown of how many people on that list are actually being attached to a doctor and how many are actually being attached to a nurse practitioner?

 

I just want to clarify here. Both are obviously very worthy and needed and I admire both professions, that’s for sure, but I think that there’s a false pretense when people are calling that number and they think they’re signing up for a doctor, and then they find out that they’ve been attached to a nurse practitioner. Actually, that happened to me, and I have an amazing nurse practitioner, but I think there’s a little bit of false pretense there that people are not being attached to a doctor. Just wondering if you can provide me the numbers on those attachments.

 

ZACH CHURCHILL: We can track down the specifics on the number of patients who are attached a nurse practitioner, but this is exciting. This is important, and I’ve heard Nova Scotians asking for access to nurse practitioners since I was first elected in 2010. These are highly capable primary care practitioners who are allowing us to serve the primary care needs of more Nova Scotians, so this is something to celebrate.

 

It is a choice, so patients are offered the choice to receive the care of a nurse practitioner, but they can as well - as in your case, the patient could say no and wait on the list for a family physician to open up. This is a choice that’s being offered to Nova Scotians. I think it’s a - I mean, the fact that people are taking this up, it shows that the public has confidence in nurse practitioners. I know we have confidence in our nurse practitioners and their capabilities, so this is part of the overall plan to create more primary care access points for people, recognizing that practice is changing a bit for doctors, that it is competitive to family doctors globally right now, and expanding the scope of practice for other professionals like nurse practitioners, pharmacists, RNs, and looking at even expanding the scope of practice for paramedics. These are good things because it’s expanding options and access points for people for their primary care.

 

KARLA MACFARLANE: Just quickly, I totally agree. Nurse practitioners are fabulous and they are so needed. Again, I’m so happy to have mine, but with that, and acknowledging the great work they do, why is it that currently on your government website you are only looking to recruit three? Really? We are only in need of three nurse practitioners right now in Nova Scotia? I think there are a lot of places that would love to have a nurse practitioner. So if the minister could answer that for me.

 

ZACH CHURCHILL: The member is referring to, I think, the positions that are open with the Nova Scotia Health Authority. They are filling their complement, so perhaps there are only three that they need to fill their complement, but I will tell the member that in the last number of years since we’ve been in government, there have been over 230 nurse practitioners hired into the province and since 2011 that would represent close to a 90 per cent increase in nurse practitioners in the province.

 

We have hired nurse practitioners every single year, we’ve expanded their scope of practice, and the contingent of nurse practitioners has increased close to 90 per cent, which I think is really exciting and is helping us create better primary care options for people.

 

We have a really good strategy for recruitment of these folks, as well, that includes the Nurse Practitioner Education Incentive, which was announced in 2018, to increase the provincial supply of nurse practitioners, particularly in areas of the greatest need of primary care. The incentive covers the salaries of registered nurses while they attend the Dalhousie nurse practitioner program on a full‑time basis, and in return the recipients will commit to work in a designated geographical area for up to five years.

 

A discrepancy that we haven’t talked about in terms of patient attachment is that there are geographical discrepancies in the province. We do have the most doctors per capita and the majority of them are obviously in Metro. Where we’re having patient attachment issues is primarily in rural and remote areas, and that is also a challenge - finding practitioners who are willing to move to these locations and work there. That is why we want to train more people ‑ people from Nova Scotia, as well, from these communities who are willing to go back.

 

I know Clare, in particular, has had a great community program where I think even the municipalities are supporting folks who want to go do family medicine and they come back into the community. Community strategies really do matter here, as well.

 

The other thing I’ve heard from family doctors is that employment for spouses can be a challenge. It might be a household of two professionals ‑ doctors, engineers - and the employment for a spouse can be a barrier in some areas of the province, as well. So there are some natural challenges there to getting to these more difficult areas, which is why I think the nurse practitioner program is particularly important for rural Nova Scotians’ access to primary care.

 

THE CHAIR: Order. We will now take our scheduled 15-minute break. We will return at 1:55 p.m.

 

[1:40 p.m. The committee recessed.]

 

[1:55 p.m. The committee reconvened.]

 

THE CHAIR: Order, please. I’m going to pass the floor back over to the member for Pictou West to continue with questioning, with 22 minutes remaining in her time. So over to you, honourable member.

 

The honourable member for Pictou West.

 

KARLA MACFARLANE: Thank you very much, Mr. Chair. I think we were just following up with the nurse practitioners. The minister was commenting on how beneficial they would be in rural areas and I couldn’t agree more.

 

What incentives are the minister’s department providing to ensure that an allied health care professional, such as a nurse practitioner, would want to go to a rural area?

 

ZACH CHURCHILL: The bursary program is tied to practicing in a high-need area. That is one incentive for sure that we have in place. I also do have the numbers, if the member is interested, on the Health Authority’s recruitment budget, if the member would like me to go through those.

 

There is over $2 million, almost $2.2 million, in the Health Authority’s recruitment budget; $1.6 million of that is related to staffing, and $1.12 million is related to recruitment activities, such as site visits, relocation support for physicians, the allowance they get for that in recruitment events.

 

KARLA MACFARLANE: Great. Moving along here, I’m just going to sidetrack for a moment because I want to ask a question with regard to long-term care facilities. Specifically, I’d like to go to one that - there was a proposal about eight years ago or so from the long-term care facility in Chéticamp, a constituency that my colleague for Inverness represents. I know he has been in the Legislature a lot longer than me, advocating for necessary renovations that need to happen there. In fact, I believe they were probably shovel-ready at least four years ago.

 

I do understand that it appears, anyway, that they are on your list of your investment of $8.5 million that you plan to spend on nursing homes. That would take you up to the year 2024-25. I would like, though, confirmation of this funding approval for that specific long-term care facility, and if it in fact completes all the relations that they listed basically in their original proposal. So just confirmation, and if it’s the proposal that they put forward probably about eight years ago.

 

ZACH CHURCHILL: That facility, Foyer Pere Fiset, is scheduled on our current list for major renovations. They are essentially going to get, for the older part of the facility, a brand-new space.

[2:00 p.m.]

 

KARLA MACFARLANE: If the minister could just elaborate a little bit more. A new space - are we looking at, right now, rooms where there are double individuals, that they will have their own individual rooms with washrooms? I know that my colleague was advocating for that. We just want clarity.

 

This is big news. They’ve been waiting for over eight years to receive this news. Further details are definitely justified, considering that, like I said, they’ve been waiting eight years, and they’ve been shovel-ready for four. I’m just trying to figure out what the details actually contain, if it’s a whole new building or are we just modifying rooms to make individual rooms? What exactly does that entail?

 

ZACH CHURCHILL: We are in the design phase right now. The strategic infrastructure branch of the department is actually in consultation with the community in terms of what that design is going to look like.

 

Essentially, the older part of the Foyer Pere Fiset is going to be completely replaced. Since 2007, any new facilities have not had single bathrooms available for people, and single occupancy.

 

We’re in the design phase right now, and obviously as more information comes out on what the design is going to look like, the community will be informed. I am told that the community is feeling positive about the progress that’s been made.

 

KARLA MACFARLANE: I hope those comments clarify. Certainly, congratulations to that community and the hard work of the MLA there for advocating for this investment.

 

I would like to go back to doctor recruitment and retention. I know that in 2012, there was a Shaping our Physician Workforce 10-year forecast. It was stated at the time that over 900 doctors, 31 per cent of current doctors, were expected to retire in 2021. This is very relevant to right now. I’m curious if this is still the case or what those new percentages are.

 

ZACH CHURCHILL: I’m being told that that information is housed with Doctors Nova Scotia, so we can check with them and see if there are any updated figures, but the deputy has informed me that a number of physicians that were planning on retiring have actually stuck around during the pandemic for a number of reasons, to either keep their practice going or to mentor new doctors, or to provide additional services to the community. I do want to thank those doctors who have stuck through this, who were planning on retiring and providing additional support to the communities that they have.

Some of the staff who track this information, I believe, have been redeployed for COVID-related initiatives, so we’re going to track down and see if we have any absolute updated numbers on that, so we’ll get back to the member.

 

KARLA MACFARLANE: I thank the minister for that. That would be most helpful if we could get that information.

 

Looking at how much money has been going into the Transition into/out of Practice model, I think better known as TiP-ToP, just wondering: What have the results been with this since COVID-19?

 

ZACH CHURCHILL: The deputy has informed me that there are transition plans in place for those physicians and surgical specialists who are transitioning out, so they will oftentimes make room in their schedule for the replacements to come in and provide that transition, and will transfer on a percentage basis the patients over to those new folks.

 

KARLA MACFARLANE: I guess from that response I’m going to assume that because of COVID-19 much has not changed, that it’s still been smooth transitions. I just want to confirm: Have there been any difficulties because of COVID-19, or have these transitions been running as smoothly as ever?

 

ZACH CHURCHILL: The deputy has informed me that the one impact to this process has been tracking, because folks who were dealing with the tracking have been redeployed for COVID-related activities, I’m learning today. This seems to be one of the areas where COVID-19 redeployment has impacted tracking work.

 

KARLA MACFARLANE: The redeployment, has that been possibly the cause of surgery delays and testing, and particularly cancer screening testing?

 

ZACH CHURCHILL: There were no delays in the urgent or acute surgeries that were required - cancer surgeries, for example.

 

There were delays in elective surgeries. As I mentioned earlier today, 95 per cent of those have either happened or have been booked. That was a result of the system shifting capacity around to prepare for what could have been major waves at that point. That’s what the models indicated.

 

We would have gotten them if we didn’t have strong Public Health policies and if people weren’t doing their part to follow the Public Health protocols. Preparing the system to respond, potentially, to the acute needs of a pandemic did impact service delivery, but not in the acute or urgent sectors. It was in the elective, primarily, and in screening and in data tracking.

 

I do want to say how impressive it was to watch the Health Authority work with Public Health and the department to prepare the system to deal with potentially high volumes of COVID-19 patients. That was very impressive to watch. I think it was very good evidence of the efficiency that can be achieved with having a singular authority in the system to run the operational side of health.

 

I do want to commend them on their rapid response and the efforts they took to prepare the system to potentially meet higher levels of cases and severe cases in Wave 1. As we have managed the pandemic better than most places in the world, regular services and programming have come back online and the system is catching up.

 

THE CHAIR: The honourable member for Pictou West, with about five minutes left.

 

KARLA MACFARLANE: I thought I had until 2:22 p.m.

 

THE CHAIR: I have until 2:17 p.m.

 

KARLA MACFARLANE: Oh, okay. That’s a good segue with the minister’s comments right into the fact that I have to disagree that we’re back on track, particularly with the colon cancer screening kits.

 

It’s very frustrating for me to be at the age that I’m at and know that there’s a ton of people out there who have not received their kits. In fact, I mentioned it yesterday during Question Period - that there are people actually on these Zoom meetings with us in the House who have not received their kits. We know as month by month goes by, the chances of having such a disease increase.

 

We know that people are not caught up with pap tests. I realize that my colleague for Cumberland North today brought that up in Question Period too.

 

I’m curious and just would like to ask for a final time: When will all of the colon screening test kits be delivered, and what are you doing to bring awareness and promotion to the fact that they have been delayed and ensuring that they will be caught up?

 

ZACH CHURCHILL: The specific impact here was related to the lab capacity . . .

 

THE CHAIR: Order, just for one second, minister. You’re a little muddled in your microphone. If you could just start over. I was having a hard time hearing you. Please and thank you.

 

ZACH CHURCHILL: In terms of why screening was impacted, it was because of lab capacity. Obviously, we had to use our lab capacity for COVID-19 testing. Resources in the labs were redirected for COVID-19 testing during the pandemic, so there’s still lab capacity that’s engaged with that. The deputy has informed me that we are working to get back on schedule for the screenings.

 

[2:15 p.m.]

 

We know this is a serious issue for people. We do have to weigh the needs of resource deployment for the pandemic, and obviously testing has been a key part of our strategy. It’s helped us track the waves and respond appropriately with public health measures. I do believe that was the right decision to make as we faced the brunt of the pandemic. As more vaccines are rolled out, as we get to herd immunity, that lab capacity will keep working back over to screening. That work has begun. The Health Authority is working on doing their very best to get back on schedule for the screening because we know that is critical for people.

 

I do know that Nova Scotians can understand the requirements and the pressure on the system related to the pandemic, and testing, of course, has been absolutely paramount to having a successful strategy.

 

KARLA MACFARLANE: Thank you for that answer. I think it was the first time that I actually had an honest answer with regard to resources being deployed to other areas within the health care system. Hopefully it’s a lesson learned, though, that we’ll need to have a better plan if a second pandemic - hopefully not - comes around.

 

Quickly, I just want to know how much money has been spent on lawsuits with associations. We know there has been, definitely, with Doctors Nova Scotia. If you could just give me a quick figure on what the cost has been on lawsuits. Thank you.

 

ZACH CHURCHILL: The deputy’s just informed me that anyone who’s not getting the kits on their birthday, they can call in and request a kit and one will be sent to them - the colon cancer screening kits.

 

THE CHAIR: Order. That concludes - not to cut you off on the question, it’s an important question, absolutely, for everyone - but we’re on to our next hour of questions for the honourable Minister of Health and Wellness.

 

I will now pass the floor over to the member for Dartmouth North.

 

SUSAN LEBLANC: Thank you, Mr. Chair, and thank you, minister, so far, for the answers you’ve provided. I feel like I’m talking into the ether, but there we go. Somewhere out there you’re listening to me right now, even though I can’t see you.

 

I would like to begin by asking some questions about mental health and addictions services. The COVID-19 pandemic, the toll it is having on older people in this province, the effects on residents and staff in long-term care and frontline work, and all of the other life stresses that Nova Scotians have dealt with over the last year are all underpinned by an acute and dangerous impact on our mental health. This has exposed the chasms in our mental health system, and I believe that a bright side of all of this is that Nova Scotians are beginning to expect better.

 

More people in this province have reported higher rates of anxiety than anywhere else in Canada since the COVID-19 pandemic began. Twenty-seven per cent of Nova Scotians describe their anxiety level as high. That’s a 20 per cent jump from pre-pandemic levels. Also, 16 per cent of Nova Scotians have reported high levels of depression since the pandemic, more than double the pre-pandemic level of seven per cent.

 

This budget’s mental health line is $336 million. As you know, our mental health bill of rights - that’s the NDP’s Mental Health Bill of Rights - commits the province to spending 10 per cent of the health budget on mental health to be aligned with what is recommended by the World Health Organization. The figure this year in this budget is only 6.3 per cent. In fact, that appears to have gone down since last year, when it was 6.7 per cent of the global health budget.

 

My first question is: Do you agree that we should meet international targets for mental health and make our mental health budget 10 per cent of our entire health budget?

 

ZACH CHURCHILL: I do believe that’s a laudable goal. We have increased mental health spending significantly this year, so we do have the highest budget for mental health services than we’ve ever had before. That does include the development of a new officer for mental health, which will be a clinician and will help quarterback and further develop our mental health supports across departments.

 

Also, what’s not reflected in the health budget are the investments in mental health supports that we’ve put in place in our schools through our [Inaudible] of education funding. We’ve made major investments as a government, as the current chair of committee would know, to bring in child and youth care practitioners, mental health clinicians, youth psychologists, guidance counsellors. That is not reflected here.

 

I think if you consider all the other supports that are available, we very well might be at that 10 per cent.

 

Another reason why that percentage in the Department of Health and Wellness went down, even at a point-percentage-wise while we’re increasing the actual amount, is because of the other major investments that have been made through this budget - in particular, money for COVID-19 response and COVID-19 management and also the additional $100 million that we’ve put into our long-term care, which is another major focus of the government.

 

It’s important to clarify that the number in the Department of Health and Wellness has gone up. The budget in the Department of Health and Wellness is not reflective of all the mental health supports that we have invested in as a government. The percentage has dropped but that’s because we’ve had to invest so much into COVID-19 measures and, of course, there’s the single greatest increase in long-term care investments in our province’s history as well.

 

SUSAN LEBLANC: The minister has outlined some spending in other departments. If I may, it would be great to get a breakdown of the mental health allotments in other government departments so that we can get a true picture of that. If that is something I could request, that could be sent to our caucus when there’s a chance, that would be terrific.

 

Many parts of the province, particularly in rural areas, are plagued by long wait times for mental health services. We know there has been improvement in these wait times but we also know, and it’s been widely acknowledged at the Health Committee and the Public Accounts Committee, that there is still much more work to be done.

 

I understand that much of these challenges have to do with some of the human resource challenges, with hiring the right practitioners in the right places. I’m wondering if the minister could talk a little bit about those challenges in detail.

 

ZACH CHURCHILL: Just in terms of requesting information from other departments, that is why we go through this 40-hour Estimates process, so the member will have opportunities to ask the same question with any department that she chooses to, so I will leave that up to other departments to provide the member, upon request.

 

One thing I also neglected to mention was part of the investment in long-term care is also involved along with the health care providers, like physiotherapists and like mental health clinicians. That figure is also reflected in the long-term care budget. There is support there for mental health for our long-term care facilities.

 

SUSAN LEBLANC: I am going to ask that question again to the minister about the resource challenges in mental health in rural areas of Nova Scotia. I’m wondering if - honestly, I’m not sure if you are done talking about that or if there’s a possibility of getting an answer to that - so, just a bit about the challenges of hiring the right practitioners in the right places in rural Nova Scotia for mental health care.

 

ZACH CHURCHILL: Thank you, member. I did answer your first question and not your second. Thanks for your patience.

 

We have had a more central [Inaudible] which we created and we also had a [Inaudible] investment and there has been a $9.5 million investment for the expansion of community-based supports, which did include the hiring of 35 clinical full-time equivalents and nine more clinical full-time equivalents for First Nations communities, so we have had some success in hiring.

 

We experienced this in the Department of Education and Early Childhood Development. There is a shortage in some mental health fields, in psychology and psychiatry. That seems to be a broad-based shortage across North America. I believe there is an overarching supply issue there, and on top of that, sometimes it’s more difficult to recruit people to rural communities.

 

We have managed to, despite some of those challenges, actually reduce the wait times for those seeking urgent and non-urgent care when it comes to mental health. The non-urgent care wait times have improved, as most adults and children and adolescents are provided service within the national standard now, which is much better than we were before. That is two weeks for children and adolescents, and the median wait time is 26 days for adults. Again, that’s for non-urgent cases.

 

For the urgent cases, we have reduced the wait times significantly for adults who are experiencing an urgent mental health issue. That median wait time has been reduced to two days, and urgent for children and adolescents has been reduced to five days. We have seen some major improvements in the wait times.

 

I think we’ve also reduced all the wait times for opioid addictions as well. We have seen some success in this area. To help us recruit psychiatrists to rural areas, we have provided additional compensation incentives to help recruit folks to rural areas and have their residency placement program put practitioners in rural Nova Scotia to get them familiar with communities, meet the communities, and hopefully learn to love those communities.

 

I just know, based on some local experience I’ve had in Yarmouth, that program can be very successful in communities, but there still does remain a macro challenge in this field because of the supply, and of course the other challenge of getting those folks into rural communities. Hopefully higher compensation and our recruitment and retention efforts will continue to help with that.

 

SUSAN LEBLANC: Thank you to the minister for that answer. I know you did list some numbers there at the beginning of the answer, and so I’m just wondering if you can tell us what increase in mental health human resources has been committed to in this budget, and if it’s possible to break down that increase between the new 15 staff positions in the new office and other clinician or therapist positions outside of that office.

 

THE CHAIR: While the Minister of Health and Wellness deliberates, I notice that the PC caucus quorum increased by one. The good member for Inverness had his new addition on there, so I just wanted to congratulate him on the baby and growing the population in Cape Breton. One more proud Cape Bretoner for the mix. He was on there, but I think he’s gone.

 

Anyway, I’ll pass it back over to the Minister of Health and Wellness.

 

ZACH CHURCHILL: Cape Bretoners. You guys love each other. Congratulations to the member for Inverness as well. I saw the baby on screen here yesterday, I believe, and I just really want to congratulate the member for Inverness and his family on the beautiful new one. Well done.

 

I do have a breakdown of the FTEs for the Office of Mental Health and Addictions. There are eight new FTEs that are new hires to the system, and there are seven FTEs that will be transferred into that office, so 15 new to these positions in total. I have names here. I don’t think the member needs the names, but that’s the breakdown of numbers of new positions.

 

[2:30 p.m.]

 

SUSAN LEBLANC: Thank you for that. I am wondering if there are other increases in mental health human resources that are outside of that office, on-the-ground clinicians in various places in the province.

 

ZACH CHURCHILL: Those would have been the positions that I mentioned before ‑ 35 new mental health clinicians for the general system and nine new mental health clinicians for our First Nations system.

 

SUSAN LEBLANC: Okay, great. Thank you for that clarification.

 

I just want to go back for a second on the wait times, again acknowledging that there have been improvements, but I just want to note that the wait times for non‑urgent and, I believe, urgent visits in Cape Breton, for instance, are still weeks and weeks and weeks; much longer than the national standard. It is 84 days for the first appointment, for instance, in industrial Cape Breton, and long waits for both the first and second appointments. So, when we talk about the improvements in getting access to mental health services, we cannot forget that that is to see someone for the first time and then what happens after that is also a long journey.

 

I want to talk for a moment about the new single session therapy service that was talked about in the Budget Address yesterday, and we’ve heard about. This is, I hope, modelled from the sort of walk‑in clinic pilot that happened. I am happy to see this, but I’d like a little bit of information about it.

 

The Budget Address referenced trained staff that will provide the service. First, can the minister talk about who this staff will be? Not, obviously, actual people but what will their qualifications be for those positions?

 

ZACH CHURCHILL: The wait times have been reduced in Cape Breton, but I do believe the new positions and strategies that we have in place are going to be useful to increasing a timely response to this. The single session would be modelled after, based on my understanding, the walk‑in clinic pilot and so it would be a replica of that model.

 

We have also hired ‑ I forgot to mention this in response to the member’s questions about the full-time equivalents - but there has also been an additional 24 FTEs that have been created for the sexual trauma support as well, so those would be additional FTEs to the ones that I mentioned already.

 

SUSAN LEBLANC: Thank you to the minister. Sorry, the question I had asked was what qualifications will the trained staff in the single-session therapy system have? If it is being modelled on the walk‑in pilot then I presume those staff are social workers, but I’d love to have confirmation on that.

 

I am wondering if the service will be offered in person or if it’s going to be virtual or a combination of those two, and I am also wondering where it will be located.

 

ZACH CHURCHILL: There will be a mix of professionals there, so there are some social workers that will be part of this network. Also mental health commissions, as well, and they will all have to meet the licensing standards of their profession.

 

SUSAN LEBLANC: Will the service be in-person or virtual or a combination of the two? Where will it be located? Will there be more than one location? If so, where are the locations for the service?

 

ZACH CHURCHILL: That will be determined through the design and procurement process that we will be initiating once the budget is passed.

 

SUSAN LEBLANC: That was my next question. When is the service expected to be available and what is the timeline? If you’re beginning to plan it after the budget is passed - if the minister doesn’t know when it will be started, does the minister have a target for a timeline?

 

ZACH CHURCHILL: We’ve actually moved quite quickly on the establishment of the mental health officer position. We have in place to fill that in the imminent future. Once that office is established, once the provincial budget is passed, these are all priority projects. I don’t have a timeline right now, but staff will be giving me one once they have assembled that office.

 

SUSAN LEBLANC: The budget address outlined $5.9 million for an e-mental health and addictions action plan. My first question is: What is this? What programs will it include?

 

ZACH CHURCHILL: I have a document that I do want to reference specifically that has the specifics in terms of the mental health strategy. I do want to wait for staff to provide me with that so I can go over the specifics of that with the member.

 

SUSAN LEBLANC: What I understood the minister to say there is that he would get back to me on that one in this session. I’m going to skip ahead to something that should be more familiar to the minister at this moment.

 

Three Nova Scotia Health Authority mental health offices are being moved out of downtown Dartmouth and relocated to Portland Hills. What monitoring of access or collecting of community input is being planned to evaluate the impacts of this change?

 

ZACH CHURCHILL: This is something that the member and I have chatted a little bit about.

 

There was a decision made. The history on that, as the member knows, is all three leases in three separate mental health and addictions facilities were up. There was a clinical decision made to amalgamate those services to provide better wraparound and holistic care to people. The only location that met the procurement criteria, the only acceptable space, was outside of the downtown core, so that is the one that the health authority went with.

 

It does have access to Halifax Transit, but I do realize, based on my conversations with multiple members from Dartmouth, that there are still some access concerns, so the health authority has committed to providing satellite services to the downtown area. We’re happy to link the member up with the health authority to go over the specifics. I actually think the health authority has been in contact with the member, if I’m not mistaken, and has committed to keeping her up to date on that. But if the member does need any support in ensuring that that connection is happening, she can let us know here at the department and we’ll make sure she’s in contact with them.

 

SUSAN LEBLANC: I’m really happy to hear that because to date we have not received a commitment but if that’s what the minister is saying then I’m really excited and I know my colleagues in Dartmouth will also be excited, or at least my colleague from Dartmouth South will be excited.

 

That’s great, that was one of my questions, if we could get a commitment on that today. I do know the history of the decision. There has been some amazing explanation given for that. Again, I’d like to take this opportunity to thank those members of the public service in the Department of Health and Wellness and Nova Scotia Health who have been extremely patient and generous with their time to explain everything that went into that decision-making process. I get it, but nonetheless I feel like that was a flawed procurement process.

 

I think in general that we, as the government, and as elected officials, need to examine what we mean when we say something is accessible. It’s not just about physical accessibility. I think that should be a goal of ours, as a group of legislators, moving forward.

 

However, all that being said, I am - we are happy to hear that there has been a commitment and I have not heard from Nova Scotia Health about it, so I’ll check my email after this discussion.

 

I would like to dig a little deeper into the decision-making. I’m wondering if the minister can talk at all about what stakeholder or community consultation took place either in developing the terms of the request for proposal or in selecting the site. I’m not talking about the clinicians - I am talking about the clinicians but I am also talking about the users of the services or other community organizations that serve that population. Thank you.

 

ZACH CHURCHILL: That decision was made before my time here and it was made at the health authority, not within the department. The deputy has informed me that part of that process included an outreach team that I believe is meeting with patients and stakeholders in the area. Also, another development I was just informed of is the North End Community Health Centre, which is looking at expanding options for folks in downtown as well. So there seem to be a few moving parts on this but the focus does seem to be on ensuring that folks who require those services in the downtown who might have trouble accessing the new location are accommodated.

 

SUSAN LEBLANC: Well, fantastic. I’m really pleased to hear that. The minister will know that there is no province-wide mobile emergency mental health crisis response service in Nova Scotia. We have that mobile emergency mental health in HRM but not throughout Nova Scotia. This means that thousands of Nova Scotians each year are met by uninformed police officers when what they really need is a mental health professional.

 

Does the minister’s department collect any data on police wellness checks and how many may have a mental health need related to them?

 

[2:45 p.m.]

 

ZACH CHURCHILL: I am not aware that that data is collected by the department.

 

THE CHAIR: Can you repeat that, minister? We couldn’t hear you.

 

ZACH CHURCHILL: I’m not aware of any data of that nature that’s collected in the department.

 

SUSAN LEBLANC: Has the department looked into expanding the in-person response component - the mobile mental health crisis service - to other parts of the province?

 

ZACH CHURCHILL: That option does definitely remain on the table. We do want to lean heavily on the advice of the new office that we’re creating here to provide direction in terms of those responses, so the role of that office is going to be to coordinate the cross-department responses to mental health issues, so we’re at the beginning stages of building that office, and we will have a person very similar to Dr. Strang, who directs the efforts of Public Health, a clinician who will be focused on directing the efforts of mental health services. That very well might be an area where we consider expansion.

 

SUSAN LEBLANC: Before I ask my next question, I just want to say that I made a mistake in my words earlier, and I said uninformed police, and I meant to say uniformed police. I was one letter off and it makes a big difference. I apologize for that.

 

Thank you for the minister’s answer. I wanted to talk about the mental health crisis line that takes calls 24/7 from any part of the province. We know that it does have a component of in-person response in HRM, as I just mentioned. What kind of performance targets exist for that service?

 

ZACH CHURCHILL: That would be conducted by the Nova Scotia Health Authority, so we can connect the member with information from Nova Scotia Health Authority related to that.

 

SUSAN LEBLANC: That would be great, and I also am wondering - and I suppose this is Nova Scotia Health Authority too - but if the department can provide us with an evaluation of the mental health crisis line service, if there is one, could be provided to our caucus.

 

Also wondering if there’s been an increase in resourcing to the program in this particular budget, in dollars or in staffing.

 

ZACH CHURCHILL: As I did mention earlier, there was an increase of about 30 per cent in terms of demand on the 24/7 crisis line, so resources were redeployed to staff the crisis line so there was an initial $1.6 million that was sent over in dollars and 15 full-time equivalents were there as well. The response times of when someone picked up was under two minutes and if someone leaves a voicemail it is under 30 minutes. So those are the response time targets that we are hitting right now. Those were the resources that were redeployed to the crisis line.

 

SUSAN LEBLANC: I want to go back to the actual mobile mental health crisis. So, in terms of that program, where people call and perhaps a clinician and a plainclothes police officer is dispatched to the call, I have heard from a number of folks who work in mental health in HRM, and also heard from my constituents who use this service, that many people have to wait for an answer when they call and that an in-person team cannot always get to everyone because they might be tied up with an existing call.

 

I am wondering if you can provide information on the wait times on the mobile in person unit and how many people need an in person visit but have to wait or are simply not helped in person.

 

ZACH CHURCHILL: We are seeing if we can get that data for the member.

 

SUSAN LEBLANC: Just to clarify, when the minister says they are seeing if they can get the data, does that mean I am going to get it in this session or it will be forwarded at another time? I just want to know how to balance my questions.

 

ZACH CHURCHILL: Our intention is to get it as soon as possible [Inaudible]

 

THE CHAIR: Minister, we lost you again. Can you repeat that?

 

ZACH CHURCHILL: Our efforts are to get that in real time so requests have been sent to staff right now and our expectation is we can get this information back as quickly as possible to the member. So, yeah, absolutely, we want to get that back to you in the session if that data exists.

 

SUSAN LEBLANC: The Minister of Health and Wellness’s mandate letter includes the following point under the Office of Mental Health and Addictions: “administer mental health and addictions granting programs”. Is there an increase in the budget for those grants?

 

ZACH CHURCHILL: There is an increase of approximately $600,000.

 

THE CHAIR: We are at the moment now where we need to take our mandatory COVID 15-minute break. It is now 2:54. We will come back at 3:09 p.m.

 

[2:54 The committee recessed.]

 

[3:09 p.m. The committee reconvened.]

 

THE CHAIR: Order. I just want to ensure that the Minister of Health and Wellness is with us and ready to proceed.

 

He is. We’re good.

 

We have 23 minutes left for the NDP. I will now pass it back over to the honourable member for Dartmouth North.

 

SUSAN LEBLANC: Thank you, Mr. Chair. When we last spoke, the minister had just said that there was a $600,000 increase in the budget for the grant programs for Mental Health and Addictions.

 

Any increase is something, but it seems like a small amount of money for these important projects. As folks here would know, the granting process is difficult and uncertain for so many essential community-based organizations. Is there expanded core funding to community mental health and addictions support organizations in this budget?

 

ZACH CHURCHILL: We did track down numbers. We are coming off of a $1.6 million increase in investment in the Mental Health Foundation which does provide grants to community organizations, and beyond the figure I provided to the member, that is the limit on the increase this year.

 

SUSAN LEBLANC: Thank you for that answer. I am wondering about core funding. This is something I have spoken about a lot in this House in terms of arts and culture funding and in other departments, but it doesn’t matter what part of the not-for-profit sector we are talking about, the fact is that not-for-profit organizations who are doing such excellent work spend way too much of their time writing grants and hoping for fairly unstable funding.

 

My question for the minister is: Is there expanded core funding to community mental health and addictions support organizations? The money you just mentioned, is that core money or is that money going towards core funding for those other organizations?

 

ZACH CHURCHILL: There is in total now - and this includes the $1.6 million increase from last year and the increase I mentioned today - $9 million in core funding that does go to these organizations - and that is every single year in their budgets. Right now, that is accumulated to $9 million, annually.

 

SUSAN LEBLANC: I am going to switch gears a little bit here. It has recently come to light that Gambling Awareness Nova Scotia has been dissolved and that its funding has been rerouted into the general mental health and addictions stream, including to overdose prevention services. According to the Chair of Gambling Risk Informed Nova Scotia, this move was a way to deal with the “profound lack of funding for mental health in Nova Scotia.”

 

First question is: How much money is being diverted from Gambling Awareness Nova Scotia?

 

ZACH CHURCHILL: That would be the entire budget, which is approximately $6 million - it is over $6.6 million. All of that funding is being redistributed to frontline services, so the entire budget has been redeployed, and the decision was to do that because it was a more effective way to provide frontline services to support people dealing with these issues.

 

[3:15 p.m.]

 

SUSAN LEBLANC: I understand that some of the money is being diverted to make investments in overdose prevention. Was it considered to fund both Gambling Awareness Nova Scotia and overdose prevention? Why, or why not, or why is it an either/or?

 

ZACH CHURCHILL: This is an argument that we continue to have with the NDP and I think that the difference in approach here is on our side there is a little more recognition that the financial resources of this province are finite. There is not an unlimited purse which we can dip our hands to, an ideal world where we can pay for every single thing nor we can pay for every single thing.

 

We have to use the resources we have in the most effective manner possible. It was deemed to be more effective in terms of treatment and support for people to divert these funds to frontline services and training in this area to help build our capacity.

 

SUSAN LEBLANC: I knew this debate was going to come up rather sooner than later in these budget sessions, but I just want to remind the minister that the NDP caucus does not believe in unlimited spending, but rather targeted, smart investment. Really, I wasn’t asking about more money. I was just asking why both of those things couldn’t be funded.

 

I know that concerns have been raised about the establishment of online gambling sites in Nova Scotia. We heard a lot about that in Question Period today. I understand that the sites are expected to launch this Spring - is that still the case?

 

ZACH CHURCHILL: Yes, they will be launching this Spring. I also have a breakdown of where those dollars are going. . .

 

THE CHAIR: Minister, I’m sorry to interrupt you. Can you just repeat that last phrase you said. We lost you. You just got muffled again. If you could repeat that, it would be great.

 

ZACH CHURCHILL: Yes, those sites will be launched this Spring. I do have a breakdown of where that $6.6 million is being redeployed in the system from the Gambling Awareness Foundation. I wouldn’t mind going over those for the member. I do believe she’d be interested.

 

One million is going into additional mental health system supports; $1.8 million is going into treatment and recovery programs; $1.3 million is going into suicide prevention; $800,000 is going into supports for First Nations communities; and $1million is going to support children and youth. Those would be the broad baskets where those dollars are being redeployed.

 

SUSAN LEBLANC: I’d like to thank the minister for that breakdown. That is very helpful.

 

Going back to the gambling questions: considering that Gambling Awareness Nova Scotia has been dissolved, what replacement services will be put in place to support people living with a gambling addiction when those sites are live?

 

ZACH CHURCHILL: We do provide funding to the Gambling Support Network, which is another organization. Those funds were redeployed in the system for frontline services, as I mentioned.

 

Of course, as we know, gambling addiction is oftentimes associated with other mental health issues as well. Those folks have access to the variety of mental health supports that we do have available through the health care system. Those supports have been enhanced over the years and are being further enhanced in this budget, particularly in the area of virtual care, the single session. Those would be the two that are most applicable to the situation.

 

SUSAN LEBLANC: Mr. Chair, the minister may have heard me ask the Premier about this in Question Period today, but I would like to talk to the minister about it as well. Recently researchers at Dalhousie convened a group of health professionals and policy-makers, harm reduction advocates, people who use drugs, and experts, to create a policy statement on access to safe supply in Nova Scotia.

 

This is something that I wrote to the previous Minister of Health and Wellness about last year and something that is happening quite a lot - there is a lot of work going on about it in my own constituency of Dartmouth North. Dartmouth North has just been named one of the pilot locations for the MySafe Project, which will offer hydromorphone, I think, available in a vending machine as part of a safe supply pilot project, which is pretty exciting.

 

I just wanted to ask the minister: Could he provide an update toward the work on safe supply of drugs in Nova Scotia?

 

ZACH CHURCHILL: Could the member repeat that question, please?

 

SUSAN LEBLANC: Sure. Recently at Dalhousie University there was a group convened that was made up of health professionals, policy-makers, people who use drugs, harm reduction advocates, and other experts to create a policy statement on access to safe supply of drugs in Nova Scotia. I was saying that in Dartmouth North - well it is something that I have been interested in and I wrote about to the previous Minister of Health and Wellness - the member for Antigonish, that Minister of Health and Wellness - in Dartmouth North the community has been selected as a location for the MySafe Project pilot which will bring a vending machine, hydromorphone that will be delivered through a vending machine to the people who are in the pilot project.

My question to the minister really is: I am wondering, could you provide an update toward Nova Scotia’s work on providing a safe supply of drugs here in this province?

 

ZACH CHURCHILL: I thank the member for the question. There have been increased resources put into this area. In this budget there has been investment in the addictions hubs and withdrawal management services that will be now delivered in every single region in the province. So, these are new investments, and also, I believe, will be reflected in last year’s budget - under Mental Health, I believe there was an increase of about $35 million for pharmaceutical access in this area as well.

 

SUSAN LEBLANC: Great, thank you for that answer. Could the minister just talk a little bit more about those addictions hubs? He mentioned that they will be in every region, so, the four zones of the province, or will there be more than that? If he can - if there is any more description about those, that would be great to hear about.

 

ZACH CHURCHILL: To answer the member’s question - yes, they will be in the four health zones.

 

SUSAN LEBLANC: I just realized that I forgot to ask a question that was connected to others that I was asking earlier - that was about the organizations that receive core funding for mental health and addictions work. I was wondering if the Minister of Health and Wellness could provide a list of the mental health and addictions organizations that receive either grants or core funding from the department, and the amount that they receive.

 

ZACH CHURCHILL: We will have that for the member in short order.

 

SUSAN LEBLANC: Thank you very much. Of course, COVID-19 has been incredibly difficult for the mental health of all Nova Scotians, but it has had an acute impact on the mental health of our frontline workers. Can the minister talk about what approach the department has taken, or is taking, as an employer of frontline health providers when it comes to the support of their mental health and wellness, in particular - yes - during the height of the pandemic and continuing to now?

 

ZACH CHURCHILL: I thank the member for the question. So, there were various supports that were put in place. Our frontline workers in the health care system are not technically employees of the Department of Health and Wellness, they are employees of the Health Authority, and the Health Authority did set up a mental health line for all their employees in the system; that was set up for the IWK as well. There was an Employee and Family Assistance Program set up for continuing care staff, and there were webinars that were provided through the Health Authority to support people dealing with mental health issues as well.

 

On the government side - so, on our side - for staff who do work under the government departments directly, the Public Service Commission did set up an office of mental health with the intention of supporting the staff who required supports in that area.

 

[3:30 p.m.]

 

SUSAN LEBLANC: I am wondering if there were any specific mental health supports made available for the staff who were working during the Northwood outbreak?

 

ZACH CHURCHILL: Yes, there were counselling services set up for the staff at Northwood, and there were other long-term care workers as well, and they were also supported by the Occupational Health and Safety nurses.

 

THE CHAIR: The honourable member for Dartmouth North, you have about 30 seconds

 

SUSAN LEBLANC: Thank you. I will just talk about the question I am going to ask when next I am allowed to ask a full question. It will be about long-term care residents and the unimaginable burden of isolation and loneliness they have borne since the pandemic began and ongoing . . .

 

THE CHAIR: Order. We now move back to the PC caucus. It is now 3:32 p.m.

 

The honourable member for Pictou West.

 

KARLA MACFARLANE: Thank you, Mr. Chair. I believe when we were wrapping up the last time we were still on the discussion around doctors and nurse practitioners, but I think more importantly we were getting into not an easy topic to talk about but nonetheless one that we need to address because of taxpayers’ money being spent on lawsuits - I am just wondering: How much has been spent in the last year or two with regard to lawsuits on associations such as Doctors Nova Scotia?

 

ZACH CHURCHILL: There is no impact to our budget related to lawsuits.

 

KARLA MACFARLANE: I will come back to that later on.

 

We do know, though, that KPMG has been hired by NSHA in order to help with consultations on doctor recruitment and retention. I am wondering: Could the minister provide an update on how that is going and what the costs have been? I know that there would have to be some type of approval on budget for this and I am just curious what that was.

 

ZACH CHURCHILL: There was no additional money provided to the Health Authority from the department for those consulting services. They did acquire those consulting services, that would have been at the direction of the board and they would have utilized their standing budget for that.

 

KARLA MACFARLANE: Madam Chair, just looking at surgery wait times, as we know that has also been a very interesting and disappointing discussion for many Nova Scotians.

 

Have there ever been talks or discussions about renting space from the private sector?

 

ZACH CHURCHILL: We do utilize, and I do have contracts for, additional facilities to accommodate space pressure, for certain surgeries.

 

KARLA MACFARLANE: Could the minister elaborate on that, where those services are provided - are they all in the HRM area?

 

ZACH CHURCHILL: The specific areas where outside space has been utilized - one where there was pre-COVID-19, in Scotia Surgery, which is a private facility that was leased to get through the foot and ankle surgeries. We are currently negotiating with the Atlantic Eye Institute. We have had a backlog of cataract surgeries in Nova Scotia as a result of COVID-19 and we are engaging with them to utilize that institute on a contract to deal with the backlog in cataract surgeries.

 

KARLA MACFARLANE: Madam Chair, I thank the minister for that. Maybe he can confirm, but I am pretty sure that both of those private companies are located in the HRM area, while we are looking across the board, from Yarmouth to Cape North, in Nova Scotia the backlog for surgeries is elevated right across the board.

 

What is the plan to reduce surgeries? Will you be looking into more private companies to help out or do you have another plan to combat, really, this mess?

 

ZACH CHURCHILL: There is a lot happening in this area. Right now, we are benefiting from the leadership of Dr. Orrell as deputy, who is actually an orthopedic surgeon who has provided the department great leadership on this.

 

The reason why we are not utilizing private clinics outside of HRM is because they do not exist. Right now, HRM is the only area in Nova Scotia where there are private facilities that we can contract to help with the backlogs here. So that would be the answer to the member’s question about why we are not doing this in rural Nova Scotia. It is just that they do not exist in the private sector.

 

There is a pretty comprehensive plan to continue to improve surgical wait times. There has been tens of millions of dollars that have been invested. We recently just had a federal announcement of $4 billion, $127 million of which are coming to Nova Scotia to also assist with surgical wait times.

 

Finding efficiencies in the system is pretty important. In terms of finding efficiencies, the way we are approaching it is better preparation for surgeries; better preparation, pre-surgery. This helps with reducing cancellations. There are shorter stays in the hospital and a focus on reorganization to have more efficient use of the bed space. Schedules are reviewed regularly to find efficiencies in the scheduling. There has been an extension of the operating days, as well.

 

Another factor that impacts our surgeries would be access to anesthetists. Obviously, the access of anesthetists - you can’t do surgeries without that. Having a more competitive renumeration framework is helpful with that. I know that the province and the Health Authority and community groups have been really working hard on the anesthetist recruitment and finding locums to fill in any gaps in our anesthetists contingent.

 

Those are some of the initiatives that are being taken right now to reduce wait times. We have reduced surgical wait times in a number of fields, including in ortho. Over the years, we have had significant improvements there and there is $23 million which is seeing an increase of an additional $2 million into orthopedic wait times, orthopedic surgeries as well, which is going to surgical supplies, system enabling costs, physicians, additional human resources, and the pre-habilitation work that I mentioned earlier.

 

[3:45 p.m.]

 

KARLA MACFARLANE: Madam Chair, a lot of information, good information there from the minister. In particular, I would like to go back to the $127 million you said that the federal government is giving - how will that be broken down between rural areas and the HRM?

 

ZACH CHURCHILL: That money is going to be deployed to the regional hospitals that provide surgeries and it will be allocated on a needs basis. So, where the biggest wait times are, where the majority of resources are needed to deal with those wait times, that is how this funding will be allocated.

 

KARLA MACFARLANE: Thank you very much. Madam Chair, since we are on the discussion of surgeries, I want to bring up a topic that I am very passionate about and would love to see improvement in Nova Scotia because it matters to everyone - that is oral health care. I think we underestimate the value of oral health care and how it really affects our lives as we move forward, right from birth onward.

 

What I am seeing right now, the wait time for oral surgeries for five-year-olds and under, is 18 months - 18 months to have a child who is five and under get into surgery. This is a huge issue. We need to do a better job of promoting and advocating for children to take good care of their teeth. But let us face it, we have all been there, when our parents yelled at us, and we are doing it with our children and so on and so on.

 

I want to know what the minister has to say about that - 18 months to get in for oral surgery for those children five and under.

 

ZACH CHURCHILL: I do have a meeting coming up with the president of the dental association, so this is something I would not mind chatting with them on a bit more. I am not a clinician in this area but that does seem to be a fairly long wait time for surgery in this area. I do want to get some more information from the dentists in the field and get their perspective on it.

 

But there have been increases in the remuneration for pediatric dentists. Of course, we think that is going to help with the preventive measures. That is really where you get your bang for your buck and the mystery is preventing these situations from happening but there is - is the sound coming through okay?

 

THE CHAIR: Pardon me, I have been looking down, but it seems fine to me. I will stop if I can’t hear you, unless the member for Pictou West needs me to stop more.

 

KARLA MACFARLANE: No, we are good.

 

ZACH CHURCHILL: I can review some of the investments in the budget towards our children’s dental program. There is $6.5 million for the dental program itself. We do have, if the member goes to the budget the special dental plans for cleft palate , that is in the realm of $250,000; special dental plans for those with special needs is $376,000; dental surgeries is budgeted for about $1.6 million; and the list does go on. If the member does want to familiarize herself with the budget documents, she can see the specific investments in the children’s dental program.

 

KARLA MACFARLANE: Madam Chair, I thank the minister. I am aware of those investments. I do not believe the investments are enough; actually, I think they are far from being enough. Again, I think we underestimate the value of proper oral health care. In fact one of the biggest concerns I have, and I am very frustrated, one of the things I think that Nova Scotia actually has a problem with in a number of departments is that there is a lack of consistency, whether we are talking about schools, whether we are talking about regional hospitals, services are not consistent across this province.

 

One of the things that frustrates me, and I think is so unfair is the fluoride rinsing treatment. I did have an opportunity to meet with the Dental Association of Nova Scotia, I did have an opportunity to meet with the College of Dental Hygienists and I heard it from both of them. For example, and I am not trying to point fingers, but I am going to point this out, I know that the schools in the constituency of the Minister of Health and Wellness are receiving fluoride, but they are not in Pictou County and other places within this province. I think we need a consistent plan.

 

I am wondering if the minister can share with me why the inconsistency and if he agrees that we need to have a proper plan so that every child, whether in Primary or Grade 1, they are all getting fluoride treatments.

ZACH CHURCHILL: So, this is the first I have heard of there being inconsistency in the fluoride program. I am being told that part of it might be related to volunteerism. Volunteers might be leaned on to provide this program - but I can confirm that.

 

I do know that it was delayed during COVID-19 for obvious reasons. We did not want people around other people’s mouths this past year, but that is something that we can look into, that is new information for me. Happy to hear that my community is receiving the fluoride treatments, but I do need a better understanding why there would be inconsistencies there, and what would cause that.

 

There is budgeted through our department just under $1 million for that program. I would need to get some more information on that.

 

KARLA MACFARLANE: My understanding is that there are only 12 dental hygienists - public dental hygienists - in Nova Scotia. Can you confirm that, please?

 

ZACH CHURCHILL: I am being told that information would be housed by the association, so we can check with them and see if we can confirm that.

 

KARLA MACFARLANE: Okay, I am pretty sure there are 12, so let us just, hypothetically - I know, but I am pretty sure there are 12. I am just curious, with a population of almost a million, and those public health dental hygienists - would you say that 12 is enough?

 

ZACH CHURCHILL: I mean, really, it would depend on the assessment of the clinicians to better understand that.

 

KARLA MACFARLANE: There is probably - you can see the passion of why I am so adamant about proper oral health care. I do not think enough information is getting out when there are new births. I do not think there is enough information, perhaps, going home, or perhaps it is a lack of being attentive. We all know we can’t change human nature, and some children are looked after better than others. This is why we have to step up to the plate, because I believe having a proper plan would actually reduce our costs in oral surgeries.

 

I am wondering why we are not investing more in dental hygienists. I know that they have become a self-regulated organization, but yet we never have - perhaps we have had the discussions - not while I was here. Why are they not covered - dental hygienists not covered - under MSI?

 

ZACH CHURCHILL: The work that dental hygienists do can be billed to MSI, but they do have to be connected to a doctor - to a dentist. There are very few, I believe, in the province who are not connected to a doctor, but they can bill for those services and they do bill for those services through MSI.

 

KARLA MACFARLANE: Yes, I understand that, minister, but in the new legislation that we created for them to go independent, the word “independent” is actually in the legislation which would make many of them have more - perhaps would actually have more - incentive to go out on their own if they could be covered by MSI without being under the umbrella of a dentist. So, I would just like to mention that for your consideration.

 

[4:00 p.m.]

 

I think that the importance of having dental hygienists is they provide great triage care and they would do a great job in remote areas in rural Nova Scotia, and I think some of them would be very happy to open up their own clinics if they were covered by MSI. I think we would absolutely see a reduction in children under five having to wait 18 months to get surgery, and lose their baby teeth and the pain and the agony they go through.

 

That brings me to why, for the last number of years, numerous times I have continued to introduce the bill, the chief dental officer of health. After a few years of doing that I recognized that the Liberal government did end up hiring someone to consult. I do not know who that individual was. We had such difficulty finding that individual, only to learn that whoever it was, they were basically hired for only two days a week. I have no idea what they have done, but recently someone new was hired.

 

I wonder if you could expand on that role and tell me exactly what this new individual is going to be doing and what they are following up on from the past person who was hired.

 

ZACH CHURCHILL: In the department we have hired a dental consultant. I am not sure if that is the position that the member is talking about. That individual is hired on a part-time basis to provide some guidance to the department.

 

Back to the issue around the dental hygienists - we would not make any changes in that regard without full consultation with the sector. Again, I am not an expert in this field but when we are talking about oral health care I do think that having the attachment to the doctors is pretty important for having that complete care that is offered.

 

I don’t know, from a clinical perspective, if that would be the best-case scenario in terms of ensuring that our people are getting the complete scope of oral health that they require. There would not be any changes to that Act without full consultation with dentists and dental hygienists as well. Of course, we would like to see a consensus from the oral health community if there were to be any substantial changes like that to how the oral health system operates here in the province.

 

KARLA MACFARLANE: Madam Chair, I would like to ask at this point, how much time do I have left?

 

THE CHAIR: We are taking a break at 4:09 p.m., but in terms of after your break, I will let you know in just one second.

 

KARLA MACFARLANE: Okay, I will go on with my question then. Just getting back to the value of dental hygienists in comparison to nurse practitioners and the value they would both be in rural areas. For a number of years, I was mentioning in the Chamber how I felt we should have a nurse practitioner in every ER across this province.

 

I believe that a year or two ago there was a pilot program that the Liberal government initiated. I am just wondering - are we fulfilling that pilot program and noticing great success with it and plan to put a nurse practitioner in all the ERs across this province?

 

ZACH CHURCHILL: That falls under the jurisdiction of the Health Authority to determine operational capacity and the FTE deployment. Those deployments are based on need and we do trust the Health Authority to do proper assessment on that and allocate nurse practitioners where they are most needed. I am not sure where they are or if they are in every emergency department at this point.

 

KARLA MACFARLANE: I will just refresh the memory of the minister. The minister at the time for the Department of Health and Wellness was indicating that that was the goal - to make sure there was an NP in every ER so that it would lighten the load in our emergency departments and try to get the traffic to flow through faster.

 

I hope that you will revisit that and look at that as a means. Truly, not much has changed or improved. We certainly are all aware that because of what we are seeing with our paramedics and the struggles that they are going through, and I know my colleague for Argyle-Barrington will be following up later with questions on that.

 

I just want to move quickly to Pictou County and touch base on a few issues that are happening here. The first one I want to discuss, because I was cut off during Question Period. We know that I have been advocating for the last eight years to expand our dialysis unit in the Town of Pictou at the Sutherland Harris Memorial Hospital.

 

We have four chairs. We just had a large available space come to us because of our new clinic, so we have lots of room. We knew this was going to be happening, and that is why years ago we started advocating to expand.

 

I have been told year after year by different Ministers of Health and Wellness that it is being reviewed; it is being looked at. Let us just cut to the chase and let us find out what exactly is happening with the Pictou dialysis unit and what is the potential of expanding those chairs there.

 

THE CHAIR: Order. We are going to take our mandated 15-minute break, which gives the minister plenty of time to consider his answer.

 

We will take 15 minutes. We will be back at 4:24 p.m.

 

[4:09 p.m. The committee recessed.]

 

[4:25 p.m. The committee reconvened.]

 

THE CHAIR: Order please. I will let the member for Pictou West know that she has 23 minutes left.

 

The honourable Minister of Health and Wellness.

 

ZACH CHURCHILL: Thank you, Madam Chair. There has been an expansion of dialysis in Nova Scotia. The focus has been on getting to communities that needed to travel further to access dialysis; that has been the key focus, to increase access points.

 

There have been six station expansions at Dartmouth General; there are new projects under way in six stations in Digby; 12 in Kentville; six in Berwick; and more in HRM to deal with capacity; four additional ones going into the Northside, in Glace Bay; 12 stations going into Bridgewater; design is under way on the Cumberland Regional Health Centre in Amherst; and we are also exploring 12 station dialysis units for the redevelopment as well. There currently are no plans in place to expand the stations in the Pictou area.

 

I will be up front with the member that this is a program that is continually monitored, and the demand is continually assessed. I am not saying there couldn’t be in the future, but currently there are no plans. The focus has been on these other areas, and the majority of these areas, particularly the rural areas, were areas that did not have close access points for dialysis.

 

KARLA MACFARLANE: I realize that the minister is new to this portfolio, but his comments with more chairs/units being in the HRM area due to demand - no wonder because everyone from rural areas is going there. I know dozens of people who have to go there.

 

If they are lucky enough, from Pictou County they may get to go to Antigonish, drive through storms - I have a friend who is 87 years old who has to drive - or drive over Mount Thom to Truro. It is really unacceptable.

 

The MLAs from Pictou County have all been advocating for this. We are in agreement that it just has to happen somewhere in Pictou County, whether that is at the Aberdeen Regional Hospital, or whether we expand in the Town of Pictou, whatever it may be, this needs to happen soon. I mean, it is so frustrating, going on eight years of advocating, all of us. To see that the most recent investments - it is kind of ironic that they have all, except for one, I think, landed in constituencies that are represented by Liberal members. I don’t know - coincidence? I am just not sure. It is definitely frustrating.

 

At this point, I just want a yes or no if the minister, along with his colleagues who spearhead and investigate where these units go and where these expansions happen, if we can set a time and date that is conducive for all of us, in the very near future, to have the minister agree to come to Pictou County and sit down, and let us get the ball rolling on this so the people of Pictou County know that we are working hard to get them, and they deserve them - will he commit to meeting with us?

 

[4:30 p.m.]

 

ZACH CHURCHILL: I want to be clear - it is erroneous to suggest that the political stripe of a community impacts the decisions to provide dialysis. In fact, we brought in nephrologists who served as consultants to the Department of Health and Wellness and the NHA on assessing where the supply pressures were and how to respond to those. So, I do want to clarify the record for that with the member, and, as she mentioned, it is not just Liberal ridings that have received expansions, PC ridings have as well.

 

I do have updated information for the member on the virtual activities that have been conducted. She asked earlier about what the recruiters have been doing for virtual activities for recruitment.

 

KARLA MACFARLANE: Sorry, Madam Chair, I really appreciate that, and I will get that information later, but I am going to focus in my last number of minutes on my constituency of Pictou West and my colleagues from Pictou Centre and Pictou East and ask a few questions with regard to this area.

 

I will continue on. In 2014, the Minister of Health and Wellness at the time assured us that there was a temporary closure on our mental health unit at the Aberdeen Hospital in New Glasgow. We were promised that it was temporary but, as we all know, within a few months the truth came out and they were closing it for good.

 

I would say that if we looked at statistics, Pictou County has seen far too many suicides, far too many. I know that probably in one month, I think that I knew four to five people who committed suicide, the youngest being nine years old. This is something that I know all MLAs are dealing with across this province, but unfortunately in Pictou County we have had services after services, and resources after resources, taken from us.

 

We had our mental health unit taken from us. We were told, back last March, that our Pictou Detox located in the Town of Pictou was closing just temporarily due to COVID-19, and I was told it was going to open in June, and then I was told it was going to be August, and then I was told it was not going to open at all. I did not go out, make a big stink - I trusted; I listened.

 

They said: We promise you that we will have something for you at the Aberdeen Hospital. We will have a new detox with six beds - eight beds - by the end of November. No, no, nothing in November, nothing in December. I reached out again. Renos are happening the end of January, end of February. The last I heard when I contacted in February was: We are getting ready to prepare a statement for you. I have not heard anything since.

 

It is shameful. People are dying here. People need help. There are not enough resources and dedication. When you do - when you finally can access help, it is great, but the resources are not there. So, I want to know what the minister’s plan is for (a) to provide more mental health resources for the residents of Pictou County, and (b) I would like to know when our new detox unit is going to be ready and open for service at the Aberdeen Hospital. Thank you.

 

ZACH CHURCHILL: We are trying to get a timeline from the Health Authority on when those renovations are going to be complete. It might take until next week to get that information for the member, but we’ll try to do that as quickly as possible because the plans are still there to do the renovations at the Aberdeen to accommodate the mental health facility.

 

In the meantime, there are services people can access right now and there is not a wait time for them. They are located in Springhill. This is an interim measure until the new facility is in place. If the member does know of anybody who does require mental health services those services are available to people in her community. It is in Springhill but there is not a wait time for those right now - and that is only an interim measure until the facility is properly renovated.

 

I did mention in my opening comments that we are also investing in addictions withdrawal hubs. There will be one in every single health region of the province that will service people in the member’s community. We will try to get the timeline on that capital project. I am being told that we can get it for you next week from the Health Authority.

 

KARLA MACFARLANE: Madam Chair, I tried to look for it in the capital budget and I did not see anything. That is what worries me, are we just being led on again like we were in 2014 - misled. We, as MLAs in Pictou County, go out and share the narrative in good faith, of what the narrative is that the NSHA and the Department of Health and Wellness are telling us.

 

It was very wrong for us to have to go out and tell everyone that it was temporary - oh, that was our mental health unit, it is just temporary. And then our detox centre - oh, it is just being closed temporarily for COVID-19.

 

I am sure you can understand and relate that I have very little faith at this point, very little faith that it is going to be there, especially when I do not see anything in the budget. I trust if the minister says it is going to be done, that you will get the information next week,

I will wait for that and look forward to that.

 

When you mentioned, though, the single session therapies - I think that is a good thing. I think so. However, you mentioned that there would be one in every zone. This sounds like a plan; you have already put the money aside for it - where in the Northern Zone do you plan to have this?

 

ZACH CHURCHILL: Another important piece of information in terms of the member’s constituents who want to access the mental health supports, the interim ones available in Springhill, is that they can do that themselves from the Central Intake system. If the member is aware of anybody who is looking for those services, refer them to the Central Intake system and they will be able to do that if they are able to.

 

I do not ask the member to have faith - believing without evidence on this issue at all. The money for the renovation at Aberdeen is budgeted for. It is not in the department budget; it is in the Health Authority budget. It would be under the capital grants and renovations part of that budget. The money is allocated there. That is the money they will be utilizing for that.

 

The Northern Zone, the withdrawal hub will be in the Truro location, which is I think the most centralized spot for that.

 

KARLA MACFARLANE: I am going to go back for a moment. I had another question around oral health care that I missed. Again, it is very concerning. I seem to focus on the youth with oral health care as well as seniors, and everyone absolutely in between too. I think the most vulnerable usually are youth waiting for surgeries and then our seniors.

 

I have two wonderful long-term care facilities located in Pictou West, with absolutely wonderful employees who work there and try so hard. The reality is that many of the residents in these long-term care facilities are not eating because of poor oral health care. There is no coverage. We are ignoring their oral health care. As you know, when you do not have good oral health care, it affects your diet, and it affects your mental state, your whole personality and attitude - everything.

 

I want to ask the minister: What is his department doing to alleviate some of the concerns with our long-term care facilities to ensure that they receive proper oral health care?

 

[4:45 p.m.]

 

ZACH CHURCHILL: As part of the long-term care expert panel’s recommendations, increasing access of primary care providers was a recommendation. We are moving to a model that will have 24/7 primary care coverage. Right now, that does not include dentists; however, they can be referred by the primary care providers to the appropriate medical professionals if they require and that should be covered by their health plans.

 

So, there is a recognized gap there. That was recognized by the long-term care panel. We are in the process of implementing those recommendations and the access to primary care is key among them and there is going to be access, 24/7 primary care.

 

KARLA MACFALANE: Just to be clear, minister, I just want to give a quick example because this is sort of foreign territory to me. If I am a resident of a long-term care facility - I pay to be there or it is covered - and they discover that I need dental assistance, are you telling me that it is automatically covered?

 

ZACH CHURCHILL: There is basic oral care coverage for residents, yes.

 

KARLA MACFARLANE: What does basic oral care consist of?

 

ZACH CHURCHILL: There is a number of things that covers, but emergencies are included, cleaning is included, the assessment is included, and dental caries is included.

 

THE CHAIR: Order. The time for questions by the PC caucus has expired.

The honourable member for Dartmouth North, from the NDP, with 37 minutes remaining.

 

SUSAN LEBLANC: I am going to go back to the question that I had slowly been getting out before my time ran out last time - still under the subject of mental health.

 

As I was saying, long-term care residents have also borne an unimaginable burden of isolation and loneliness since the pandemic began, and it is ongoing. They continue to endure long hours without access to loved ones or normal life.

 

What targeted mental health support was made available to residents in licensed care?

 

ZACH CHURCHILL: I am sure all of us were getting calls from our residents in long-term care facilities during the first lockdown. That situation did become very challenging for many people. It was a call that the government and Public Health made, particularly after Northwood [Inaudible] our residents and staff from the pandemic, but there were other mental health consequences without question.

 

There were adjustments made, designed to improve the mental health conditions of the residents during that time. Government did invest in the iPad program, an $800,000 investment to provide the virtual access point to people outside of their facility, so that was provided to them, recognizing the limitations on that, but that was one step that was taken.

 

There were designated care providers who were brought in. They have also been prioritized in the Phase I vaccinations, part of our long-term care vaccination plan. Residents can receive up to two caregivers, which I know was a big help, particularly for the folks who were feeling isolated, who were isolated.

 

Also, the volunteer and entertainment programs were enhanced during this time to increase socialization and entertainment, to assist with anxiety and depression as well.

 

The transportation program was brought in to get residents outside of their facilities. Many of them struggle with just being stuck there, so there was a transportation program that was brought in to allow them to get outside and travel around.

 

To get our long-term care facilities back to normal as quickly as possible we are of course prioritizing the vaccination rollout, residents and our staff there, to get them vaccinated and doing serial testing as well to keep them safe. The designated caregivers are also prioritized for vaccination. The goal is to get the situation back to normal there as quickly as possible.

 

SUSAN LEBLANC: Mr. Chair, it sounds like there were no professional mental health supports offered to residents, recognizing that I am sure those programs that the minister has mentioned did make some difference to residents.

 

I am wondering if it is something the department would consider, to make an investment in providing mental health clinicians to residents in long-term care during the pandemic.

 

ZACH CHURCHILL: So, there was access to social workers and an access to counselling during that time. I know it was particularly an issue in the Northwood situation where, I believe, those services were most utilized, but there were counselling and social work services that were deployed to support our long-term care residents.

 

SUSAN LEBLANC: I just want to clarify that those services that the minister has just mentioned were new services. It is not something that is normally provided at Northwood, and obviously if there was a need recognized for them, wondering if, again, the department would consider continuing that type of service for residents in long-term care facilities during the pandemic.

 

ZACH CHURCHILL: Those services were new, and they will - our plan is to keep them available to long-term care residents. There will be a review of those services to see if any additional enhancements need to take place.

 

SUSAN LEBLANC: In the same vein, has there been any mental health resources or support increased and targeted to seniors living in communities who may be isolated from family, social supports, and health or mental services during this time?

 

ZACH CHURCHILL: There was funding provided to communities for outreach and support for individuals who were struggling as well. That money did come from the federal government, so that was part of the Safe Restart funding that we received from the feds. That money was deployed here in Nova Scotia to community organizations that helped fill the role of supporting individuals in dealing with challenging times. I know that was $3.4 million, and there was an additional $2.5 million in this budget. So, $3.4 million in last year’s budget was deployed, and there is an additional $2.5 million.

 

I know, like, in my community, I think the Rotary Club was one of the organizations that received that funding to conduct Meals on Wheels and other programming for seniors. There was funding available for community organizations to help support individuals struggling.

 

SUSAN LEBLANC: Great. Thank you for that, as I was going to ask for an example of some of the types of organizations, but that helps.

 

Does the Department of Health and Wellness keep statistics on how many Nova Scotians do not have access to counselling or therapy through private drug plans? And, if you do keep the statistics, or if it does keep the statistics, could those be provided?

 

ZACH CHURCHILL: We do not collect statistics on private plans here in the public Department of Health and Wellness, no.

 

SUSAN LEBLANC: So, just to clarify that - from the other direction - so, we do not know how many people have access to a private health plan in Nova Scotia?

 

[5:00 p.m.]

 

ZACH CHURCHILL: We do not track private health plans, that is correct. We cannot.

 

SUSAN LEBLANC: Our office received an FOI recently that contained information about the number of beds in mental health and addictions units that are occupied by patients considered alternate level of care. At any given time, there are as many as 75, 80, or more mental health beds in the province occupied by people who would be better served at a different level of care. Sometimes, this means they could be living independently, but there simply is not appropriate housing available in the community. The numbers appear to worsen from when the data first started being collected. Does the department track the cost of mental health ALC beds being used in this way?

 

ZACH CHURCHILL: Staff did a great job of mining that information very quickly for the member.

 

There are currently 63 individuals who are in beds with mental health-related issues. They are primarily in the Central Zone. One of the challenges we are trying to tackle in the department and the Health Authority is the patient flow issue. This is a challenge across the board in most regions. This is affecting off-loading times, and there is a domino effect on the system. We are working with the Health Authority and our long-term care providers to improve patient flow and making sure people are getting to the right beds at the right time for the right reason.

 

In terms of admittance for mental health, the advice we are getting from mental health clinicians is that the old strategy of admissions and putting people into hospitals and putting people in beds, while that might be necessary for a small number of individuals, for the majority of people dealing with mental health issues, it is actually better to provide the correct amount of service to allow them to stay and remain supported in the community. The new mental health programming that we are going to bring in is going to have that as a key strategy to make sure that people who do not need to be admitted into hospital, people who would be better served with local community-based treatment, can receive it that way as well. I believe that will give better treatment to individuals dealing with these issues and, also, relieve some pressure on our bed space as well.

 

SUSAN LEBLANC: Thank you for that answer. Interestingly enough, the minister is speaking my language here, about people being better served in community and supported in their community, which brings me back around to the old question of mental health supports in downtown Dartmouth and Dartmouth North.

 

I had a visitor to my office a couple of weeks ago who came in to sign the petition about the subject and he was outraged that those services would be taken from downtown Dartmouth where there are many other services that people who have mental health disorders use. Many of them use Margaret’s House, for instance, which is a soup kitchen which is right in downtown Dartmouth, another example is the library where folks go to use the internet and - anyway, talking my language, “people being helped in community.”

 

Speaking of Dartmouth North, I am going to ask a question about primary care in Dartmouth North, for something a little different. In Dartmouth North we have extremely high levels of low incomes, high social deprivation, high unemployment, high mental health and addictions disorders - and not a heck of a lot of primary care. Unlike one of the members of this House, we do have a couple of primary care doctors in Dartmouth North, but when you look at the matrix that the Nova Scotia Health Authority has laid out in terms of population and primary care providers, we are really behind.

 

Our numbers on the 811 registry were high for a long time, it dropped a little bit and now we are climbing again. But we also know in Dartmouth North that many people do not access the 811 registry. In fact, I had a few conversations in the last couple of weeks with people who have thought they were on the 811 registry and then called me about their place and it was discovered they were not on the registry. So, it is hard to know about those numbers and it can be hard to trust those numbers.

 

Last year in Budget Estimates I was really looking forward to some announcements about the continued investment in primary care in Nova Scotia. I believe it was two budgets ago where there was a $10 million investment in new primary care centres and my understanding was that Dartmouth North was being looked at for such a thing in a community that would really benefit from a collaborative community health centre. Then last year during Budget Estimates I clarified with the then Minister of Health and Wellness that in fact there was really no new money for new health centres - you know, bricks and mortar situation.

 

That was super disappointing obviously and I do not think I see any money in the budget this year either. I am just wondering if the minister can talk a little bit about that and about what the strategy is for primary care right now. Is the strategy moving away from collaborative care centres, the NSHA turnkey health homes and whatnot, I’m wondering if the minister can just talk a little bit about them.

 

ZACH CHURCHILL: So, we do have a collaborative care clinic in Dartmouth North which, I am told, is being run very successfully. Also, the patient attachment numbers in Dartmouth North are very high, so we have about 97.7 per cent of patients in Dartmouth North who are attached to a primary care provider. The number that are not is 453 out of approximately 20,000 in that zone. That is a very high attachment rate, especially compared to other parts of the province. Our focus right now in terms of new investments are to target areas where there is a lower attachment rate, and where we have greater struggles with recruitment and attachment.

 

The numbers are pretty strong in Dartmouth North. I know that is always cold comfort for the 453 people who are still looking, but we do have a high concentration of physicians here in Halifax. The real gaps in attachment - or access to primary care and attachment to family physicians - right now is in rural Nova Scotia. That is where the focus will be on the attachment issue. Our investments are going to follow where the need is.

 

SUSAN LEBLANC: I am not going to get in a big fight with the minister, Mr. Chair, because we have been doing so well with mental health satellite services today. So, I am not going to really pick at this, but I will say for sure there are more than 400 people in Dartmouth North who are not attached to primary care. That is because there are many people in Dartmouth North who simply are not accessing any system; they are not even aware of the 811 Need a Family Practice registry. There are plenty of reasons why people are not using that service.

 

Before I speak of that service, I also want to say that last year a community group that I am involved with in Dartmouth North did an informal survey where we - I forget how many responses we got - but we literally stood at the Sobeys at Christmastime and we stopped people and asked them about their attachment to primary care. A good number - and, again, this is super informal - a good number of people had primary care attachment well outside of Dartmouth North. We are talking Mineville, we are talking about Bedford and Hammonds Plains, which if you have a car and you really need a doctor, you are going go there. But, again, that is not the case for a huge amount of people in certain areas of the constituency.

 

Oh, I forgot my point that I left behind there for a second.

 

Oh yes, speaking of the 811 system, I am wondering if the minister is aware of these reports of folks dropping off the list, I mean, were thinking they had registered, but then them not being registered or them not being able to be found. I have heard informal reports that this type of thing happens quite often, so I am wondering, is the minister aware of this issue?

 

[5:15 p.m.]

 

ZACH CHURCHILL: Mr. Chair, it does feel when people without doctors are calling me that that is the reality of the situation, but the numbers do tell a different story. If the member was chatting with people in her community during or before September 2019, pre-pandemic, the unattached number was at 950. So, over the last year that number has been reduced to 450, so if the member was discussing or gathering anecdotal data, in 2019 that number would have been higher but there has been success in attaching patients on that list.

 

The issue of people dropping off the list, I chatted with staff here who oversee that process. That does not usually happen. So if you are talking to constituents who have been dropped off the list, if they fill out a consent form for you we can take a look at that in the department and help you with those case files if that is of interest to you, because we certainly do not want that to be happening.

 

We do need people to register on this. It does need to be proactive. The data on these lists are driving investment decisions, so we are happy to work with the member, too, if she does not believe that people are accessing this, to help with promotions for it in her area. We can work with you on that as well and encourage the member to promote the importance of doing that.

 

Right now, the numbers as we look at them are pretty favourable. HRM, generally speaking, has a very high attachment percentage, particularly compared to all parts of the province, where we have a hard time recruiting and we have a hard time with retention.

 

SUSAN LEBLANC: Yes, it would be great to actually take this conversation off-line because I think there is more to it. I know that I speak with members of the Nova Scotia Health Authority on a regular basis who definitely do acknowledge that the 811 numbers do not tell the whole story, so I would love to speak with the minister about that at another time.

 

For now, I am going to change course a little bit on these questions and turn to long-term care. The Quality-improvement Review report from Northwood’s experience in the first wave of the pandemic recommended, as many other reports have for many years, and as is committed to in the NDP’s 2018 Care and Dignity Act, that has been ignored by this government, that the department “Set and fund standard minimum care hours based on resident complexity across all facilities. Increase care hours to include previously evidenced levels.”

 

A whole host of research and reports from this province and beyond has supported the idea that minimum standards of care in long-term care facilities need to be increased. Doug Ford’s government in Ontario last year committed to implementing a four-hour per day standard of care in long-term care homes by 2024.

 

My first question to the minister is - of course, residents’ care needs will vary widely, depending on their particular needs, the home’s demographics and other variables, and at the same time government, as a regulator, has a role to ensure a minimum standard and it is plainly obvious that we are falling short in many, many instances in providing minimum standards of care to long-term care residents: Can the minister explain the work toward establishing this minimum standard and what hurdles remain?

 

THE CHAIR: Order. 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 report progress and beg leave to sit again.

 

THE CHAIR: The motion is carried.

 

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

 

[The committee adjourned at 5:25 p.m.]