HALIFAX, TUESDAY, MARCH 30, 2021
COMMITTEE OF THE WHOLE ON SUPPLY
Hon. Geoff MacLellan
THE CHAIR: Order, please. I welcome back members. We’re set to continue the Estimates for the Department of Health and Wellness: Resolution E10. I will now turn the floor over to the member of the NDP for Dartmouth North with 23 minutes remaining.
SUSAN LEBLANC: Hello again, minister. I would like to start my questions asking about ambulance services.
In this budget, it estimates a $16 million increase in ambulance services. My first question is: Is $10 million for the new Emergency Health Services contract?
HON. ZACH CHURCHILL: I can confirm that yes, that is the case.
SUSAN LEBLANC: What is the remaining $6 million? What is that reflective of?
ZACH CHURCHILL: The majority of that would be for an increase in wages for staff.
SUSAN LEBLANC: Will the department be hiring any more paramedics?
ZACH CHURCHILL [Inaudible] does not hire paramedics. They’re hired through the contract provider.
SUSAN LEBLANC: Noted. Does the minister know if more paramedics will be hired with the new contract?
ZACH CHURCHILL: We can get that information from the company that hires our paramedics.
SUSAN LEBLANC: That’s great. I thank the minister for that answer. Looking forward to that information. Changing speed here, I want to talk a little bit about health justice.
Just as systemic racism appears in our justice system and our education system and in other insidious ways, there are both structural and institutional reasons that race and racism are key social determinants of health. I know there are a lot of people who have spent a lot of time providing input on an African Nova Scotian Health Strategy, including the Health Association of African Canadians and the African Nova Scotian Decade for People of African Descent Coalition.
Recently, our office filed a freedom of information request for an update on the progress towards this very overdue strategy and the response was that there were no records available. My first question is: Is that correct, that there is no African Nova Scotian Health Strategy?
ZACH CHURCHILL: I’d like to thank the member for the question. Our government is, and has been, committed to improving health reporting to inform a better understanding of what diverse populations in our province do require to be healthy – both preventive care and for treatment as well. We are focused right now on the collection of race-based identifier data to assist with the development of this understanding. Planning activities are underway with the Department of Communities, Culture, and Heritage and our department for the collection and use of this information to determine the best ways to approach health and equity monitoring so we better understand the differences in health and health care outcomes across the various subgroups of our population here in Nova Scotia.
This project will represent the fulfillment of the commitment to do this by government. This commitment was made in 2019 through the Count Us In: Nova Scotia’s Action Plan in Response to the International Decade for People of African Descent, 2015-2024. In the 2020-21 budget, there was also an increase of approximately $500,000 to support this data collection process, technologies, and also to have legislative compliance, including MSI health card administration changes, to assist with this as well.
SUSAN LEBLANC: I just want to get a yes or a no from the minister. Is it correct there is no African Nova Scotian Health Strategy? My next question, my B Part question is: when will it be implemented? But I have a whole bunch of questions about race-based data too. I would like the minister to just clarify what he has just said. Is the government in the province currently now collecting that data? Is that a thing that is actually happening now? Or is it still being planned and will be implemented soon? I just would like some clarification on that.
ZACH CHURCHILL: It is still under development right now. We have issued the orders in the department. However, the next phase of this is consultation with the community on this framework.
SUSAN LEBLANC: I just didn’t hear the last thing that the minister said. He said consultation and I didn’t make out - could you ask him to . . .
ZACH CHURCHILL: The consultation with those communities is going to begin very soon. We are still in the developmental phase of the data collection. Community consultation is next.
I do have an answer from our EHS system on the number of paramedics who are going to be hired. There recently have been 21 recent new hires to the system and there are more that the company is planning on hiring in May. We have seen an increase in the contingent of paramedics by 21 to date, with more coming in May.
SUSAN LEBLANC: The minister just referred to the fact that consultation is about to take place. Respectfully, we know that there is already a plan put to the government by members of the African Nova Scotian community and leaders in the African Nova Scotian community. Could that not be the consultation that is needed?
The question about collecting race-based data has been one that has been asked of the government for many, many years. I suggest that, obviously, the Province wants to get it right, but the time for talking should be quickly drawing to a close. The time for action is now.
If the minister could provide us with an approximate timeline of when data would actually be collected, that would be great. Thanks.
ZACH CHURCHILL: We’re still in early days of community consultation. We are in receipt of the information that the member also referenced. That was received on behalf of the health authority. We don’t have any conclusive timelines at this point, as community consultation is in the early stages.
SUSAN LEBLANC: I just want to say that I find this very disappointing. This has been something that we’ve been talking about for several years now, at least in our caucus in my time here. I know that beyond that, the community has been talking about it for a lot longer.
I just want to make sure the minister understands how vitally important this data collection is. The fact that it’s not being done now is, essentially, an act of systemic racism. I guess what I want to know from the minister is: I want a commitment to this work and that it’s going to happen quickly and that it’s a high priority for him.
ZACH CHURCHILL: We can confirm that this is a priority for the department. We’ve already begun work moving towards this level of data collection. I believe that community consultation is absolutely critical to getting this right. We will proceed as planned with community consultation on this.
SUSAN LEBLANC: I just want to ask the minister about the back to balance plan that this budget is kicking off.
The province’s medium-term outlook detailed in this year’s budget is the Path to Balance. A portion of this year’s economic plan includes the projection that we will achieve a balanced budget in four years. That’s 2024-25. The four-year fiscal plan shows a drop in departmental expenses after this year from $11.5 billion to $11.3 billion.
The Department of Health and Wellness is 46 per cent of this year’s total departmental expenses. This proportion of the drop in departmental expenses works out to be just over $96 million.
My first question is: Where will these savings be coming from?
ZACH CHURCHILL: COVID expenses would be the quick answer to that question, so there is no plan to reduce any programming service or health delivery in any way. We currently have approximately $300 million in our budget dedicated to our COVID response, and the expectation is, of course, once vaccinations are rolled out, once all the resources that were put into the various logistical requirements that we have been following, that that number can be reduced by $96 million.
SUSAN LEBLANC: Great. So now I am going to switch again to long-term care. When we last met, I think last week, I had started by asking the minister about the recommended 4.1 hours per resident as a minimum standard in long-term care and referenced that even Doug Ford’s government in Ontario committed last year to implementing the four-hour-a-day standard in all long-term care homes in Ontario by 2024.
I just wanted to ask, again, the question because I just want to make sure that I was clear about it: Will the department legislate a 4.1 minimum standards legislation for long-term care - 4.1 hours?
ZACH CHURCHILL: That was not one of the recommendations that came from our long-term care panel here in Nova Scotia. While Ontario has decided to move with one universal figure for this, we will be taking a more nuanced approach here in Nova Scotia. The reason is because one size does not fit all with our residents of our long-term care facilities. Those hours can really be impacted, and the need for them can really be impacted by the size of the institution, the geography, as well as the acuity of patients. So how we will be approaching this is utilizing an international assessment tool called interRAI and patients will be assessed upon entry into our system and of course during their progression through the long-term care system.
We are going to have what I believe is a more thoughtful and nuanced approach to this, treating the situation based on the individual needs of the patient and the individual needs of the facilities.
SUSAN LEBLANC: That is good to know, that the province will not be implementing a minimum standard of 4.1 hours per resident.
The minister may know that health coalitions representing over 1 million Canadians, including the Nova Scotia Health Coalition, recently released a legal opinion on federal standards and funding for long-term care. If implemented, the reforms would bring long-term residential care into the mainstream of the Canadian health care system. The opinion recommends putting in place standards that would improve the quality of long-term care, improve long-term care accountability, and take the profit out of long-term care. Is the government doing any work together with the federal government to bring into place federal standards for long-term care?
ZACH CHURCHILL: We’re not moving forward with standardized hours of care. It was not part of the recommendations that came from our expert panel on long-term care, so we appreciate that this is something Ontario is doing. We believe our residents and our system will be better served by having a more individualized approach because those hours of care really depend on the acuity of the patient. The acuity of patients differs from patient to patient. The size and availability of staff in facilities are also different and we think it’s very important to actually have a more individualized approach to this. That makes more sense from the resident’s perspective.
We are in conversations with the federation as well as the federal government and are in discussions about potential standards that can be applied nationally.
SUSAN LEBLANC: That’s good to hear. I’d like to take a moment to remember the 57 residents of long-term care who died due to COVID-19 in Nova Scotia. I would like to note that though we have done relatively well here in Nova Scotia, I want to push back against the assertion that Nova Scotia is some kind of perfect example of the COVID-19 response. That’s hard to hear when you would be a family member or a loved one of someone who has died.
It is clear that what happened, mainly at Northwood, was a tragedy. This is why NSGEU and the NDP caucus called for a public inquiry into the deaths at Northwood. We joined the call. Will the minister or the department commit to releasing the entire quality review report from Northwood, where the department has previously only released the recommendations of that report?
ZACH CHURCHILL: I want to emphasize our condolences for all those who were impacted by this tragedy, including a member of our own caucus. That was a tragedy, I think, that touched the hearts and minds of Nova Scotians everywhere. It reminded us very clearly of the stakes of this pandemic and did confirm for us the need to always prioritize the preservation of human life during this pandemic. I am proud of the response that government has taken through this to do that and the changes that we’ve undergone in our long-term care system have protected those residents. As strict and as tough as they have been, they have preserved life in Waves 2 and 3 of this pandemic.
Our long-term care system will never look the same again here in Nova Scotia. An infectious disease spread is now going to be part of every single design element of our system. I appreciate the member’s request to have the entire quality review released. It is against the law here in Nova Scotia to do that. That would be in contradiction of the Act. The rationale for that is to protect the individuals who are providing information. We obviously want staff, residents, family members to be able to provide forthright, honest information and to be protected from anybody knowing exactly what they have said. They need to know that they can speak to those conducting these investigations in confidence and with privacy.
We are not able to do that because it does contravene the laws of the province and the laws of the province are there to protect people who do share information and to ensure that what they are sharing remains private. I do believe there is sound rationale for that and we don’t want to disincentivize people from providing feedback as honestly as they can because sometimes that can include feedback that involves their employer, as an example, or it involves a staff person who oversees their care. We want to make sure that the balance of all those relationships is preserved and that people are …
THE CHAIR: Order, please. That concludes the New Democratic Party’s time for this first hour. We now move to the Progressive Conservative caucus with one hour ‑ the next hour.
The honourable member for Pictou West.
KARLA MACFARLANE: Thank you, Mr. Chair, and welcome today to the minister and his colleagues. I will be just asking a few questions before I will be turning it over to my colleague.
Just to have it on the record, we left the other day with concerns and discussing how oral health care plays a huge part in our province because it’s totally underfunded. We were speaking about our seniors and I know that the minister wants to speak on this and make some corrections with regard to the amount of care that our seniors actually receive in long‑term care facilities for oral health care. I would like to give him the opportunity to speak on that first and then I will follow up with a few other questions.
ZACH CHURCHILL: I would like to thank the member for the opportunity to clarify and I very much appreciate that. We spoke about that before the beginning of Estimates today.
I did provide some inaccurate or incorrect information to the House related to dental coverage. I was informed by staff that basic cleaning did happen on site. I misinterpreted that to mean that basic coverage was given to those staff for ‑ through our dental program. That was incorrect and I do want to clarify for the record that, while basic cleaning happens on site, there is no coverage through our senior dental program at this time for basic care. That would be provided through the dentist. That is a topic that I am now interested in seeking more information on because I do believe that the member’s ‑ I can understand why the member would have concerns in this area.
I also wanted to clarify another couple of points for the member that arose in our discussions: (1) I did inform the member that we did not collect or track the number of Nova Scotians who have private health insurance and while that is correct, I can provide the member with an estimation that we do have in the department. So we do have an estimation that is based on some assumptions. While we don’t track that, the estimation is that 60 to 70 per cent of Nova Scotians have private health care coverage.
In our discussion about school‑based fluoride program, the MLA for Pictou West also had indicated that the Nova Scotia Health Authority employs 12 dental assistants. I can confirm that the number is 15 and that is three to five per each zone.
The member also asked for the list of virtual physician recruitment activities that the NSHA’s doctor recruiters have participated in and I do have a list that I can go through in detail, if the member would like, of over 50 events that they have participated in. I’m sure I don’t need to reference each one for the member unless she’s very keen, but there are 54 in total that they participated in. Those are the follow-ups I have for the member and I
appreciate her allotting me some time to provide that to the House and make some clarifications.
KARLA MACFARLANE: I want to thank the minister for those clarifications, and in particular the one around senior care and oral health care. I know that the frontline workers, the continuing care assistants (CCAs) and licensed practical nurses (LPNs) and everyone, they do a great job of looking after our seniors. However, we do need to find a way that allows those residents in long-term care facilities to at least get to a dental hygienist at least once a year for a proper cleaning and assessment in case there’s further work that needs to be done. Thanks to the minister, and thanks for acknowledging that it’s not 12 dental hygienists but it’s 15. I appreciate that. I did take that number from the government website, so you may want to make sure that’s changed. That’s good to see, that there’s an increase in public dental hygienists. I’m happy to see that.
Moving on to just a couple other questions I want to ask. The first one is a local concern I have, and it’s something that I think we’re going to have to sincerely look at changing. There’s a mother of a special needs adult who is currently living in a group home, a wonderful individual who obviously felt the anxiety, though, of not being able to see family at the time around COVID-19, and having trouble just with anxiety and outbursts, and it was very difficult for this individual, but they were able to have the doctor provide CBD oil, twice daily, actually, and it has - for some it just works fabulous, others it does not, but for this particular special needs adult, he is doing tremendously with these two doses a day.
It’s not currently covered by the Family Pharmacare Program, so I’m wondering: Why is it not covered? Why are we not advocating to have this covered? We’re selling it at NSLCs, we’re having doctors that can prescribe it, but we’re not covering it for those who actually need it to combat some of their health conditions, and in this case, there was great improvement seen with this special needs adult. We need to start advocating for those individuals, because their parents and family members are not always going to be here. I’m hoping that maybe the minister can weigh in on this conversation.
I know that it comes down to not having - I guess it would be through Health Canada, under the federal Food and Drugs Act regulations. But again, why are we not having approval from them, but yet we’re allowed to sell it if you’re 19 and older, and prescribe it?
ZACH CHURCHILL: We do have a process through the Formulary of our Pharmacare program - what is made available under those pretty strict medical assessments. We would trust the process to rightly determine which products would be available for that and which wouldn’t. This, of course, would be a very non-traditional product. It is sold for recreational use in the province. You do not require a prescription for utilization. I’m certain there would need to be some more scientific research done before CBD oil would be included in the Formulary.
KARLA MACFARLANE: I am really perplexed by this, because we do know that Veterans Affairs covers our veterans with it, so I am really confused about it, and I’m hoping that maybe we can start advocating to have this covered for medical needs. Maybe I am missing something, and I very well could be, but my understanding from these parents is that they just do not understand how they have a cousin who is a veteran or whatever and be covered, but yet their son cannot be covered medically. I am just wondering if you have any comments to that.
ZACH CHURCHILL: For any drug to be approved for our Pharmacare program, it does need to be approved by Health Canada. CBD has not been approved through Health Canada, so we would not be able to provide coverage through our Pharmacare program at this time. It cannot be included in the Formulary until Health Canada approves it as a drug.
KARLA MACFARLANE: I will do a further investigation on that, and perhaps ask the question some other time.
I did want to go to the fact that Pictou West, as the minister is aware - back in March our detox and addiction centre was removed, and I know we discussed this the other day and we were told that it was due to COVID, and we kept being delayed, and then finally they came out with the truth - no, it is not reopening. Not in Pictou anyway, but that it would be in New Glasgow, but we still have not seen any real action and faith in that it is going to open. But the minister did mention the other day that he feels strongly that it will, and that renovations are happening - so we hope so.
I’ve been working very closely with a number of individuals who were dependent on that detox centre, and a lot of people who have a history of using narcotic prescriptions but do not have doctors, those individuals need to be followed by a doctor, and many of them cannot be seen properly by a walk-in clinic.
I just really want to ask: What are we doing to ensure that these individuals who have a very long history of using narcotics and need that service, what are we doing for them? They do not have any transportation to get to Springhill, so what advice would you give them?
ZACH CHURCHILL: I do want to confirm for the member that that facility is going to be replaced in Aberdeen. The funding for that facility has remained in the budget and will be repurposed for the new facility, so that option for those dealing with addictions will be available. And, furthermore, we are enhancing the withdrawal programs that we provide in each region. This is an area where we have made some, I think, substantial steps in the right direction, and this budget will help us further support those dealing with addictions and withdrawal and ensuring a no-harm approach when supporting them.
KARLA MACFARLANE: What is the expected date for this new detox addiction centre to open?
ZACH CHURCHILL: The Nova Scotia Health Authority has informed us that we will have a timeline later this week that we can provide to the member.
KARLA MACFARLANE: I thank the minister for that. I look forward to the follow-up.
Great announcement today, I would say, in the sense that $5.9 million is coming to federal funding to allow the province to improve access to e-mental health and addictions supports and it says, “including reaching vulnerable populations and enable language translation for websites.” That is great news, but I am wondering specifically what it means when it says improved access to e‑mental health and addictions supports specifically. Are these people who already have counsellors and specialists who are helping them but now they can just be sure that they can do it online, or are we actually creating more access for individuals?
ZACH CHURCHILL: The improvements will be on two fronts: one on increasing access for patients, and increasing the timeliness of response.
KARLA MACFARLANE: So, just for clarification, we are not actually creating new positions, we are just making the access easier?
ZACH CHURCHILL: This will be increasing access to more clinicians.
KARLA MACFARLANE: That’s wonderful news. How many more clinicians?
ZACH CHURCHILL: This very well might be contracted out, so we do have to go through the procurement process before we know how many physicians the access will be increased to.
KARLA MACFARLANE: And that sounds great, too. So, I am assuming that the access will be for all Nova Scotians right from Yarmouth to North Sydney to wherever ‑ Cape North. I am just wondering if that is what the plan is?
ZACH CHURCHILL: From Yarmouth all the way to Meat Cove.
KARLA MACFARLANE: Okay. Great. Good, good. Madam Chair, I would like to ask another question here with regard to ‑ back just before Christmas, the Department of Health and Wellness was looking at ‑ had contracted, actually, an American company to digitize patient health records. There was a lot of controversy at the time. It looked like it was going to affect a number of ‑ up to, I think, 90 or 100 - health care workers across the province. There was a lot of confusion about it and it seemed like it was moving forward but then, all of a sudden, it was retracted. I am just wondering, what is the actual plan now? Are those records being digitized?
ZACH CHURCHILL: There was a decision by - it gets confusing because there’s the Department of Health and Wellness and there’s also the Nova Scotia Health Authority. The department’s role is legislative policy, program priority, and budget. This would have been an operational decision at the health authority level. They oversee the operations of the system.
There was a movement at one point to do this. I believe it was decided to retract that approach to ensure that the work that was being done by employees within the system continued to be done by those employees instead of being contracted out. I think a decision was made to change course on that and based on my understanding, it was primarily around labour relations and the impact on our workforce.
KARLA MACFARLANE: I agree with the minister. It does get confusing having the two different organizations. I’m sure it’s very confusing for him. I wonder at times if they should be all under one umbrella.
I have a letter stating that they had just temporarily pulled the idea of having them outsourced at the time but would be looking at it at a future time. Is that ongoing right now?
ZACH CHURCHILL: My understanding is that was cancelled, and the staff of the health authority are doing that work that they were doing before.
KARLA MACFARLANE: This is a good segue into my next question around health care records and the fact that Nova Scotians have to pay to retrieve their records, once their doctor has retired, perhaps unfortunately a sudden death. There’s a lot of concern about that, and I personally believe that all Nova Scotians should have the ability to access their health care records at any point in time and that the Nova Scotia Health Authority should be responsible for housing those records and be able to pull those records and send them to residents of Nova Scotia whenever they require.
Currently, we have a doctor - I spoke earlier during Statements about Dr. Burrill, who serviced the area of Pictou West for 36 years. He is ready to retire and has been informed that he has to send his records to a company where his patients will have to pay to retrieve them.
Not only that, though, he’s being ordered to do this, but it’s going to cost him to hire the company to do this, and he has to keep them, legally, because he owns his own private practice. So, legally he has to keep those files on hold, I think it’s for nine or 10 years, with this company. As a retired doctor, who serviced patients in Nova Scotia for 36 years, at the end of his retirement, it’s going to cost him $10,000 to $12,000, because it’s about $1,000 a year, he said, in order to pay this company to house these records.
It’s ludicrous on both ends - not just for the wonderful doctor who’s retiring and then has to take on that financial burden, but obviously for the patients who he has been looking after. Some families end up having to pay $350 to get all their files back. I always tell people: look, if you don’t have a serious health condition, don’t worry about getting your files unless there’s something in them that you need.
How are we going to improve this system? I would really like to know what the minister has to say about this because I would think that he would have to agree with me that this is an antiquated, unfair system to our medical health professionals, as well as our fellow Nova Scotians.
ZACH CHURCHILL: I’ve also received calls in my constituency office on this issue. There are a few things to chat about on this. Providing the patient records is considered an uninsured service. Doctors are able to charge an administrative fee that is essentially there to help them recoup the costs of doing this.
They are mandated to provide these records to the company that the member mentioned. That is not through department legislation - that is through the regulatory body of the College of Physicians and Surgeons.
There are steps that doctors and patients can take to reduce this burden, potentially, on patients. If there is a longer notice given to a doctor’s patients about a practice closure, that gives the patients more time in advance of the practice closure before the doctor has to provide these records to the third party to request those records.
It is really up to the doctor to recoup those or not. The reason why doctors choose to is because it’s not an insured service and they’re recouping the administrative costs of managing the record and providing that to the patient.
KARLA MACFARLANE: I am going to pass it over to my colleague, who’s in the Chamber, the member for Cole Harbour-Eastern Passage. I did just want to end it with a comment to the minister that I truly believe that the Department of Health and Wellness needs to look at this system.
It’s, like I said, an unfair system both to our health care professionals, who’ve looked after so many Nova Scotians for so many years, as well as Nova Scotians. It’s their information. They should be able to access it freely. On that note, Madam Chair, I’d like to turn it over to my colleague from Cole Harbour-Eastern Passage.
THE CHAIR: The honourable member for Cole Harbour-Eastern Passage.
BARBARA ADAMS: My questions for the minister are initially going to be to go over some of the things that have already been said during the previous budget debate. Then we’re going to move into more specific questions that I have.
The first question is: I just want the Minister of Health and Wellness to clarify exactly what he meant when he said that long-term care residents get some kind of dental care in long-term care. Can he be more specific about what that actually looks like?
ZACH CHURCHILL: The member may have missed it, but I did provide some points of clarification at the beginning of the Opposition’s hour for Estimates. I provided incorrect information to the House. Staff informed me that basic cleaning was provided through our system. I interpreted that to mean basic care as an insurable care, but there are not publicly insured dental programs for our seniors in long-term care. I did misinterpret the information that was provided to me, and I did clarify that at the beginning of this hour.
BARBARA ADAMS: I did not miss it, I did hear that comment. What I’m specifically asking now is: What does that dental care include, that you just referenced?
ZACH CHURCHILL: The basic care that happens is in-house with our CCAs, the folks who work in our long-term care facilities. They do, for the residents that require it, the daily cleaning of teeth and the mouth inspections for thrush or any other issues in the mouths of residents. They’ll do cleaning of dentures. These sorts of basic, day-to-day necessities of oral hygiene.
BARBARA ADAMS: Just for clarification, that non-medical term is brushing your teeth, so I don’t want people thinking that they are in fact getting any kind of dental care. They are getting their teeth brushed once a day, perhaps more if they have time.
What I’d like to do now, as a health professional - I’m always interested in the numbers, because that’s really, when you look at outcomes, is how we evaluate success. I’m wondering if the Minister of Health and Wellness can tell me exactly how many non-family physicians there were in the year 2018-19.
ZACH CHURCHILL: Can I seek some clarification from the member, please? Is she looking for information on non-GPs, as in specialists, surgeons, et cetera, or is she also looking for general practitioners who aren’t practicing family medicine as well?
BARBARA ADAMS: I’m specifically asking what the NSHA’s By The Numbers report, that comes out once a year, says on the line “Physicians (not family medicine).” For Canadian-trained and foreign-trained specialists, we have 1,329 and this year we have 1,525.
THE CHAIR: Order. We’re going to take our mandated 15-minute break. We will return at 4:51 p.m.
[4:36 p.m. The committee recessed.]
[4:51 p.m. The committee reconvened.]
THE CHAIR: Order, please.
The honourable member for Cole Harbour-Eastern Passage.
BARBARA ADAMS: Thank you. Just to go back to where we finished off, the NSHA publishes the Nova Scotia Health By The Numbers report every year, so we have to trust that those numbers are accurate.
I want to reference the fact that on the column for 2018 and 2019, the NSHA’s numbers for physicians who are not family doctors is 1,490. The minister said it was 1,329 and change, but that is not the number that is here.
The number of physicians in that year was 1,197, for a total of 2,687. Can the minister tell me what the total number is for Physicians (not family medicine), and for Physicians (family medicine), on the NSHA’s By The Numbers report for 2019-2020? Thank you.
ZACH CHURCHILL: Just to clarify for the House, there are different data points here on how many physicians are in the province. There is the Canadian Institute for Health Information, there is the Nova Scotia Health Authority. Of course, there is also the IWK Health Centre and the College of Physicians and Surgeons, as well. So, we are just in the room doing our math to get the most accurate number possible for the Chamber.
THE CHAIR: Thank you, minister, for that. I am wondering if it is okay if we move on to a different question and then we can come back to this? Would that be okay?
Well, let’s just say we will do that.
The honourable member for Cole Harbour‑Eastern Passage.
BARBARA ADAMS: Thank you, Madam Chair. The reason why I am asking such a detailed number question is that the government has its talking points, and I know we are moving into election mode, so accurate numbers are really important.
One of the favourite talking points is that we have hired so many physicians, or the reason there are so many people without a family doctor - which is up to over 60,000 when only a few years ago it was 6,000 - is that we have had more people move here, but when we say how many physicians there are in the province, facts matter. So, I have the details right here from the NSHA’s By The Numbers report. Not anybody else’s - I asked specifically about By The Numbers.
In 2018‑2019, the number of physicians that were recorded was 2,687. The next year, the last year that we have, the number is 2,287. That’s 400 fewer physicians in the province of Nova Scotia, according to the NSHA’s own numbers.
I’d like to ask the Minister of Health and Wellness: How can his government maintain that we have seen an increase in the number of physicians every year until COVID-19, when these numbers are pre-COVID-19?
ZACH CHURCHILL: I do have the most accurate numbers here. They do come from the College of Physicians and Surgeons. With the numbers that the member is looking at through the Nova Scotia Health Authority, those would be full-time equivalent (FTE) positions. That can also represent actual individuals who are working part-time and might show up only as a part-time FTE. It also does not include the contingent of physicians at the IWK Health Centre, because that is a separate health authority.
We do actually have two authorities operating in the health care system: the IWK Health Centre authority and the Nova Scotia Health Authority, so the most accurate information actually comes from the College of Physicians and Surgeons, which is the number that we are using here and that accounts for individual bodies, not full-time equivalents - so actual people.
In 2018, we had 1,131, according to the College, of family-licensed and in 2020 we had 1,231, so we see an increase in those two years overall. For non-family - these would be the specialists, surgeons, et cetera - in 2018, we had 1,361 and in 2020 we had 1,639. Overall, that number would be, if you include both family and non-family in 2018, 2,492 doctors and in 2020, 2,865, so that’s a net increase of doctors approximately averaging about 122 to 130 net new physicians a year. So that’s the trend that we’ve had. It’s actually net new 120 to 130 new doctors to the system a year.
Given the discrepancy between the health authority numbers that the member is referencing - first of all, it doesn’t include the IWK and, secondly, I think that number is - based on the feedback I’m getting in the room here - based on FTEs and not actual people. So, the College numbers are the most accurate and they indicate that we’ve averaged 120 to 130 new doctors a year in that time.
THE CHAIR: Just before we move on, Minister, that issue with your voice getting jumbled happened again just now. It was the first time tonight. I don’t know if maybe your sleeves are getting in the way again or whatever, but if you can just check what that might be, that would be great. Thank you.
BARBARA ADAMS: I am not more clear now, so I’ll ask the minister if he wouldn’t mind sending me a summary of what he just said because it sounds like you’re suggesting that we can’t trust the NSHA’s numbers because if one set is comparing FTEs versus another set comparing bodies, they don’t compute to the same thing because you could have a whole whack of people who are now working part-time. If Doctors Nova Scotia is counting those who are working part-time and that’s equivalent to a full-time body, then it doesn’t necessarily mean that we have more physicians in the province.
Certainly, the fact that when the government back in 2013 reported 6,000 people without a family doctor and now eight years later, after two terms of this government, you are now up to over 60,000? No one I know thinks that we have moved in the right direction.
My next question for the Minister of Health and Wellness is: We are a teaching community and province and we have an awful lot of physicians here who may be counted in that number but who are teaching, not providing medical care. I’m wondering if the minister can tell me what percentage of the current 2021-22 budget teaching positions are taking of the amount that we spent on physicians in the province of Nova Scotia.
ZACH CHURCHILL: We will ensure that the College figures that I referenced that saw an increase of approximately 370 physicians in the 2018-2020 period are provided to the member. Again, we fully trust the health authority and their numbers, but they are only one of the authorities in the system. There’s also the IWK, which would not be accounted for in those numbers. Overall, the College of Physicians and Surgeons does have the most accurate data, which accounts for both authorities for licensed practitioners.
In terms of the number of doctors who are teaching - I have the benefit that our deputy, Dr. Orrell, is a surgeon and very familiar with this – so, the vast majority of our licensed physicians are practising. The majority of those who do teach, which would be a very small number, do so part-time and they’re still licensed and still practise. That is a number that would be housed at Dalhousie, so we’ll see if we can track that down for the member. That number, we believe, would be miniscule and furthermore those folks would still, for the most part, be practicing as well as teaching.
BARBARA ADAMS: I’m a little confused. I’m looking on the budget book from page 12.9 under Health and Wellness and it says that the academic funding plan is $279 million, which is 28 per cent of the entire physician services budget. What services do we get from physicians under the academic funding plan in terms of family medicine practice, as a family doctor?
ZACH CHURCHILL: This seems to be a pretty complicated process as well. This is specifically for the specialists, physicians who are working through Dalhousie, so they are not just doing teaching. This number 279 would be their compensation, but that is for a mix of teaching, clinical, as well as research that they conduct. That figure would be specific to their compensation.
This program is specific for those - primarily specialists who come to Nova Scotia and do so through Dalhousie’s academic funding program, but they are still practising clinicians.
BARBARA ADAMS: I appreciate that. It is important when we are talking about how many physicians have come on board, that some of them are specialists, some of them are researchers, and some of them are teachers - they are not necessarily going into family practice.
My last question before the time is up is: The minister, in response to the Committee on Health, on long-term care, wrote a letter to the committee. It was not dated so I do not know what date it was sent. Currently it is considered confidential until such time as it is brought before the Committee on Health, which isn’t, unfortunately, until April, but it is a response to a question that I had posed about an update on recommendations that might or might not have been complete from the long-term care expert panel, so I am wondering if the minister would be willing to send me that information directly or to allow us to discuss it before the Health Committee, because there’s information on there that I think should be brought up during the Budget Debate.
ZACH CHURCHILL: That letter does belong to the committee. It was in response to the committee, so we’re not able to do that if we’re to follow our legislative protocols here, our procedures.
THE CHAIR: The honourable member for Cole Harbour-Eastern Shore with about 55 seconds.
BARBARA ADAMS: Thank you. It’s Cole Harbour-Eastern Passage.
THE CHAIR: My apologies.
BARBARA ADAMS: My next question for the Minister of Health and Wellness is: We’ve talked and heard the Premier mention several times about following the process for COVID-19 vaccinations, and the original plan for Phase 1 was to vaccinate everybody in long-term care.
Dr. Strang told us at a meeting we had with him two weeks ago that only 48 of the 133 long-term care facilities had been vaccinated. So I’m just wondering why there are still almost 65 per cent of long-term care facilities that have not gotten all of their vaccinations?
THE CHAIR: The honourable Minister of Health and Wellness, with about 10 seconds.
Order. That concludes the hour for the PC caucus.
We’ll now move on to the NDP caucus.
The honourable member for Dartmouth North.
SUSAN LEBLANC: I would just like to go back for a moment to the discussion we were having before the - when I ran out of time earlier. I had asked the minister about releasing the entire quality review report from Northwood, and the minister’s response was that that report couldn’t be released because that’s against the law in Nova Scotia because of the type of review it was. I just want to point out, that’s exactly why we in the NDP caucus and the NSGEU and many other stakeholders and people were calling for a public enquiry.
Now, I understand the issue of people feeling worried about their testimony or their input into such enquiries; however, I think that it’s important for all Nova Scotians to know that - or to feel that - this very serious issue is being treated with the utmost transparency, and that the folks involved and the people who had lost loved ones would be getting the full support of the province by having a full public inquiry.
It’s also the reason why the NSGEU didn’t participate in the review. That’s unfortunate because their input would have been extremely important, but they felt they couldn’t do it.
So, what I guess I’m saying is I don’t buy it, Mr. Chair. I don’t buy the minister’s explanation. I guess what I would say is I’m wondering if the minister would release the redacted version of the whole report.
ZACH CHURCHILL: This obviously happened before I was minister, so I am benefiting from some of the institutional knowledge that I have here in the room with me through the deputy minister, but the redacted version of that report was provided, which are the recommendations. So that is in following with the Quality-improvement Information Protection Act.
The reason that that process was decided to be followed, primarily, was to get the expedited information that was necessary to develop a way to plan for our long‑term care system, which it did. It provided an expedited process to learn and to adapt our strategies very quickly which, thankfully, to date and - as tough as I know it was on residents and family members and some staff - has helped us prevent COVID-19 from getting into any of our long‑term care facilities, where the greatest risk lies. In terms of a personal safety standpoint, it’s when that virus, as we’ve experienced at Northwood, gets into those facilities that the results can be catastrophic.
I do believe and support that decision that was made to have that expedited process to allow us to react as quickly as we could, and that has proven to be a wise course of action. I do also support the rationale of the law to protect people’s privacy and to protect potential ‑ even whistle-blowers in the system who are providing vital information to help us improve our system. So that is the rationale for the law.
I realize the member has indicated that she doesn’t support that rationale, but I do believe that it’s sound and it allowed us to respond very effectively to the conditions of the pandemic and prevent COVID-19 from entering a long‑term care facility, again, in the subsequent ways. Things can change very quickly, so it is critical that these protocols continue to be followed and supported in each of our long‑term care facilities because we know what the consequences are.
SUSAN LEBLANC: Just for the record, I did not say that I didn’t think people’s privacy was important. I said that I recognize that people’s privacy is important and yet many, many Nova Scotians were calling for a full public inquiry.
Moving on, while it was not the case here in Nova Scotia due to our relatively fortunate situation with COVID-19, evidence from other jurisdictions shows that the for‑profit care model for long‑term care has poor resident outcomes. Will the minister commit to including in the request for proposals (RFP) for long‑term care infrastructure projects that all new capital investments will go only to public or not‑for‑profit facilities?
ZACH CHURCHILL: For all of the replacement beds, the 738 that we announced to date, those will all be going to the current operators who are running the system. That would be a mix of for-profit and not-for-profit facilities.
The new builds that we have announced so far for the Central Zone will be going to market, so there will be an RFP process for that - and we are not going to limit our market options for those. We will be evaluating all proposals based on their merit, but of course quality and safety will be essential to the criteria that any provider needs to meet.
I do have some updated information for the member from Cole Harbour-Eastern Passage on long-term care vaccine doses that I do want to provide the House in real time while I have it. As of today, 62 per cent of our long-term care residents have had one dose. That is, 98 of our long-term care facilities have had the first dose, and 32 of our long-term care homes have had their second dose. That would be for first doses. Eight thousand four hundred fifteen residents have received that dose, which represents about 62 per cent of the population, and of those who have received their second doses, that is 4,340.
So we are getting there very rapidly. As supply has ramped up here in Nova Scotia, you have seen an exponential amount of vaccines that have gone into arms. Overall, the numbers for doses in arms, as of earlier today, would be close to 95,000. Even just today, we put 5,179 doses in arms - just today. We are starting to see that as supply is ramping up, our delivery logistics are working really well, and we are putting thousands of doses in arms each and every day. We are on the other side and getting close to the finish line with long-term care.
THE CHAIR: Just a point to the minister - the member is not in the gallery right now, so she might not receive the information that you just provided. I suspect she will be back at some point, so you may want to reiterate that again to her when she is here. Just for the record - I know you are responding to a question that she had. She is currently not here, so maybe, Minister, when you go back to the next round, you can relay that information again.
SUSAN LEBLANC: I have to say that given the fact that there is plenty of evidence from other jurisdictions that the for-profit care model is not as good, and there are poorer resident outcomes than in the not-for-profit or public models, I’m deeply disappointed that the government is not taking that into account. When we talk about safety and quality of care, if there is plenty of evidence to suggest that the care and the outcomes are poorer than for-profit, then I would suggest that that is something we should be looking at. Also, it begs the question: Why is public money going into for-profit profit lines?
On that, I would like to ask the minister: Could he provide what amount of public money goes into private long-term care facilities at this point and, if he knows, how much goes into the profit line of those facilities?
ZACH CHURCHILL: We are going to get that information for the member. It’s not in our budget documents - it’s not separated private or not-for-profit in terms of what money is allocated, but we can find that.
What I will tell the member is that every single long-term care provider in the province does have to meet the same standards of quality excellence, whether they’re profit or not-for-profit, and they all have to go through the same rigorous licensing process, so they are all treated the same and do have to uphold the exact same standards of care for their residents to remain licensed in the province of Nova Scotia.
SUSAN LEBLANC: I guess the B part of that question would be: Does the government have any ability or budget line to support not-for-profit societies to expand their long-term care residences or facilities instead of for-profit care? I guess the reason I’m asking is that some not-for-profit facilities may not be able to compete in the same way that a for-profit facility would be able to in terms of the RFP process for a variety of reasons, because they’re not stockpiling profit, basically.
I’m wondering if the government has any ability or budget line or will to support not-for-profits in terms of their expansion or their development?
ZACH CHURCHILL: As I mentioned, the host of providers who are in the system, profit or not-for-profit, are receiving funding for support in the facilities that they’re replacing. The expansion of new beds in the province, that does go to a competitive bidding process. I think that’s the best way for us to get the best bang for our buck, and to guarantee that by going through a market process. We’ll stick to public tenders and make determinations on which options would be available for Nova Scotians’ long-term care residents, without bias.
We’re not going to approach a free-market tendering process, in which we’re trying to identify the best option possible and the most efficient, from a price perspective. I think there are all kinds of problems with entering into that with an inherent bias based on who the provider is. Our bias is toward the standard of care for the patient and for the resident, and what those providers are able to accommodate for their needs. We have a number of not-for-profits here in Nova Scotia that operate successfully and provide great service, and we can say the same for the private companies that are doing it as well.
SUSAN LEBLANC: The department’s Continuing Care Strategy document regarding long-term residential care facility requirements, which was drafted in July 2009, states: “Experience from new long-term care facilities built in Nova Scotia has indicated that smaller household size and private bedrooms promote a more restful sleep for residents. There have been reports of fewer outbreaks of infection, as well as the ability to quickly limit its spread by containing the outbreak to a smaller unit.”
Last year, our own Department of Health and Wellness review of the first wave of COVID-19 states: “Research highlights the benefits of using neighbourhood-based models consisting of single occupancy rooms, separate bathrooms, and small cohort-based common areas and dining areas.”
My point here is that this is the best practice for infection control, and this has been the best practice for infection control for well over a decade. Can the minister clearly explain whether there is a commitment for a single room for every resident and what the pathway or timeline is for that? Thank you.
ZACH CHURCHILL: This is an important question. There were two reviews conducted after the Northwood tragedy - the infection prevention and control review, as well as the Northwood-specific review. Both indicated that multiple occupancy could be problematic.
In the Northwood case, the residents have been reduced by 100, so that would be a reduction of 100 beds. Since 2007, when it comes to new builds - and this remains the case and will remain the case for new builds in our current plan, the plan that is ever-expanding - they all have single-bed, single-washroom facilities. That’s part of the criteria for all new builds. That’s been the case since 2007 and that has not changed.
Any of the major retrofits or replacements that we’re doing follow those same standards - single room, single bathroom. Of course, there will be cases with couples or with individuals who desire to have a roommate, where those options are available to them, as well, to accommodate their needs.
Multiple occupancy of more than two has been reduced. All retrofits, replacement builds, and new builds have single bedroom-single washroom in them. Nothing is changing there.
We did receive some information on the profit versus not-for-profit quality from our licensing folks and there is no discrepancy, from a licensing standpoint, between a profit or a not-for-profit. We have examples of both. Northwood would be an example of a not-for-profit. Villa Saint-Joseph du Lac would be an example of a not-for-profit in my community, and also the Shannex facilities that are for-profit. There’s no discrepancy from a licensing standpoint on standards between those options. I do think it’s pertinent for us to remain unbiased in our procurement process to replace facilities and build new ones.
SUSAN LEBLANC: I thank the minister for that answer. I just wanted to clarify: everything moving forward since 2007 is a single room, single bathroom, and everything that has been more than two has been reduced to two.
I’m just wondering if the minister can let us know how many long-term care residents in Nova Scotia currently have a roommate?
ZACH CHURCHILL: That is a number that we can mine for the member and we’re doing that as quickly as possible. Just a reminder that there are still many residents who prefer to have a roommate, and that can be their spouse or partner, or for socialization, for various reasons. There still are a number of residents who prefer to have a roommate and that option will be available for them. We’ll get the number, specifically, on how many of those we still have in our system.
SUSAN LEBLANC: The need in our long-term care system is enormous, as the minister knows. First, there are around 1,300 people on the wait-list for long-term care, currently. I just want to confirm that that number is correct.
ZACH CHURCHILL: That number is accurate.
SUSAN LEBLANC: The latest figure that I’ve seen for people waiting in hospitals for long-term care placement adds roughly another 200 people to that number. Is that about current or correct?
ZACH CHURCHILL: Just under 200. There are 194.
SUSAN LEBLANC: Great. The report released by the department after the first wave of COVID-19, on the long-term care sector, explained that 42 per cent of rooms have a shared bathroom. If there are about 7,000 nursing home beds in the system, this would mean that about 2,940 of them have a shared bathroom set-up. Does the minister think that sounds correct?
ZACH CHURCHILL: It’s difficult to get to an exact percentage here as the deputy has informed me. On paper, it looks like there’s a certain number of shared bathroom facilities. In many circumstances, they are not actually shared because the patients would be using a commode in their own room, because of mobility issues.
There have also been enhanced cleaning protocols in place, based on the Infection Prevention and Control Canada (IPAC) report, so bathroom sharing is a safer situation than it was pre-pandemic, because the IPAC recommendations on timeliness of cleaning and disinfecting are in place.
SUSAN LEBLANC: Some of those shared bathroom situations would be triple- or quadruple-bunked, although that may have changed because of the new protocols in place. It’s fair to say that we would need to build a new room for half of those residents, if my numbers are correct, in order to meet the best infection prevention standard. So, around 1,470 – does that make sense?
ZACH CHURCHILL: There still are some facilities where that’s the case. They are following the new cleaning protocols. However, all of those facilities where that is happening, they’ve been prioritized for replacement. Any of the facilities where the multiple bathroom sharing is still going on, that helped us prioritize those ones for replacement. They would be on our replacement list currently.
SUSAN LEBLANC: Just to clarify what the minister’s answer was there, the facilities that still have folks sharing bathrooms, they’re being prioritized for renovation or addition of bathrooms so that everyone will have a separate bathroom? I just want to make sure that’s what you are saying.
ZACH CHURCHILL: They are being prioritized. For the bathrooms that are shared by more than two people, those have been prioritized for replacement, yes.
SUSAN LEBLANC: Okay, thank you. As we have seen in this Estimates session, math is not my strong point but we arrive at a deficit of somewhere around at least 3,000 rooms. This is not accounting for the increase in demand as our population ages, only to bring the current situation in line with the best practices for infection control. Would the minister agree that this is a roughly accurate picture of the present needs - 3,000 rooms?
ZACH CHURCHILL: That number is certainly not reflective of the numbers that we have here in the department. Where did she receive that information or how did she deduce that figure?
THE CHAIR: Order. Minister, we lost your microphone. It wasn’t working well there. Could you repeat what you just said?
ZACH CHURCHILL: I’m just wondering where that - can you hear me now?
THE CHAIR: Yes.
ZACH CHURCHILL: Okay. That number is not consistent with any figure we have here in the department. Can the member share where she either received that information or how she deduced that figure?
SUSAN LEBLANC: This is my little calculation that I was doing here. The point is, if that’s not the number you have about how many new rooms we need to have in Nova Scotia, then can you tell me what number you have?
ZACH CHURCHILL: We’re actually providing models for the long-term demand that’s going to be in the system and we’re building our capital planning around those models. As that work becomes more completed, that will inform further announcements on our long-term care plan. That number will be made available to the public so they fully understand the supply and demand issue that we’re trying to deal with. It’s a complicated modelling process that’s happening right now.
We do have 1,300 on the wait-list. There will always be a certain number of people on a wait-list. There will never be a zero there because it’s a fluid system in terms of need for those facilities. That’s why the modelling is so important, because it’s not just the wait-list figure that we can look at for understanding long-term demographic pressure and need for rooms.
THE CHAIR: We’re going to take our mandated break for COVID-19. It is now 5:51 p.m. We will return in 15 minutes at 6:06 p.m.
[5:51 p.m. The committee recessed.]
[6:06 p.m. The committee reconvened.]
THE CHAIR: Order. We are going to continue with the Committee of the Whole on Supply. I just want to ensure that the Minister of Health and Wellness is with us. He is, perfect, so I will pass the floor back over to the member for Dartmouth North to continue, with 26 minutes and 25 seconds.
SUSAN LEBLANC: I want to go back to the nursing, the long-term care residents and the long-term care beds discussion we were having before the break.
What I heard from the minister, just to recap, is that currently there is complicated modelling being done to figure out, in fact, what the deficit of rooms is in Nova Scotia. Regardless, we know that approximately 1,300 are on the waiting list and approximately 200 are in hospital waiting for placement, so that is 1,500 people waiting for rooms.
We know that this need is only going to increase with our aging population, so there are things that we do know. Sure, it is a complicated model, but also I would put forward that this minister, although he is a new minister, is part of a government that has been in power for almost eight years. I just feel like those numbers should have been crunched a long time ago, Mr. Chair.
To date the government has opened only 57 new long-term care beds in the almost eight years that it has been in power.
With all that has been discussed already, can the minister agree that this pace of building new long-term care beds has been woefully inadequate compared to the scale of the need?
ZACH CHURCHILL: This budget that we brought forward last week has reached the $1 billion milestone for investment in our continuing care system here in Nova Scotia. While Nova Scotia has had nationally the longest stays in our long-term care facilities, we know that is not always the best option for Nova Scotians. So we have actually here in Nova Scotia - we had people enter our long-term care facilities earlier than other parts of the province and stay longer.
A key to our long-term strategy - and here is where the modelling comes in as well and this is where I think the member is missing part of the conversation - is on the enhancement of our home care system as well. We know that for Nova Scotians who do have a choice, who are able and willing, staying at home can be a preferred option for them. It’s not just about expansion of major infrastructure projects for long-term care. It’s also about helping people remain in their homes for as long as possible where, generally speaking, that can be a preferred option if the situation does allow for that.
Again, these wait-lists are very fluid and they change, and we’ve been building a long-term care strategy that I think will help us deal with the demand in the system, from a long-term care perspective, and also help ensure that Nova Scotians have access to more options as they age, from a support perspective. We’ve only announced part of those plans to date, and there will be more in relation to our long-term care strategy announced as we move forward.
SUSAN LEBLANC: I won’t retract, but I will say even if we weren’t talking about the projected number of people who will need continuing care and long-term care in the province - because really we don’t know, we don’t know who will be able to stay in their homes, so I admit that that sort of projection of doom and gloom in the situation may not be accurate. But we do know that there are 1,300 people waiting for actual long-term care beds. Those folks have been designated - I need, they need - long-term care. The people in the hospital, the 200 in the hospital, they also need long-term care.
These are not people we are talking about who maybe could age in their home. We know that they can’t. While I totally agree with the minister that home care and continuing care in the home is essential to our health care system and to our aging population, our older people, I personally know many of them who want to do that and who are doing that. My own parents are in their mid-80s - I hope they don’t mind me telling you that - but they are happily in their home at the moment and without any care at this moment. They’re doing great, but that is not the case for everyone.
This line of response is getting tired, I’m sorry to say. The fact is that we have 1,500 people waiting for long-term care beds, and my question was: Given that we’ve opened 57, can the minister agree that this pace is woefully inadequate? I’ll skip that question because I didn’t get the answer anyway, but can the minister acknowledge that at this pace, it would take over 400 years to build the number of beds that are currently needed?
ZACH CHURCHILL: I can say with certainty that number is extremely exaggerated, and I’d like to know the math behind that assertion from the member.
SUSAN LEBLANC: I’m just going to do a quick little calculation here. If 57 over eight, and then 400 equals X. So X times eight - 57 times 400 - I think this is what I’m doing correctly - divided by eight. That equals 2,850, which is approximately - okay, so that’s a tiny bit more than what we have right now, but if we – okay, fine. Two hundred years, Mr. Chair. Can the minister agree that it would take 200 years to build the number of beds that are currently needed?
ZACH CHURCHILL: We’ve already reduced the member’s figures by 200 years, so that’s progress of a kind in a few minutes. I think the member’s making some assumptions that are inaccurate in evaluating the numbers here.
There are approximately 3,000 people a year who are admitted into our long-term care facilities. Again, these numbers are very fluid and they change significantly every year. Approximately one-third of our long-term residence beds become available every year and 3,000 new residents enter into that system.
We’ve also announced very extensive capital projects that are impacting over 1,000 beds here in the province - major renovations and rebuilds. Replacement beds account for about 738 of those beds. That’s because we have aging infrastructure that does need to be replaced and those residents need to have a high-quality place to live.
We’ve announced to date 236 new beds that are being infused into the system. That’s the number we’ve announced to date, but there will be more information on the long-term care strategy that’s coming. That’s on top of the work we’ve done to enhance home care for the individuals who would meet the criteria for that and who would wish to remain in their homes.
Obviously, there’s pressure on that system. We do have an aging population. To suggest that it’s going to take us 200 years to build the capacity for that pressure, I believe, is grossly inaccurate. This is why it’s so critical to do the modelling to understand what the long-term pressures are going to be and where they’re going to be. Those pressures are going to be different from region to region. That will inform a smart, long-term response to how we invest these finite resources into our long-term care system.
We now have the largest long-term care budget that we’ve ever had under any government here in Nova Scotia. It’s exceeded a billion dollars. There was $100 million infused this year to enhance the system, so to suggest that there have not been improvements in the system I do not believe is accurate.
SUSAN LEBLANC: I’m going to let this go in a second, but I just want to question the minister on what he just said about the modelling. I guess the question is: If my numbers are off - I’d like an acknowledgement about how fast I did that little calculation - then can the minister tell me either in how many years does he see this issue being dealt with or when he will know that? Will he know that before the next election, I wonder?
ZACH CHURCHILL: We can speak to some of the numbers that we have right now, pre-completion of the modelling. If the member thinks of the fact that 3,000 beds become available every year, which is one-third of the capacity - so one-third would be 3,000 - and we have 1,300 people on the wait-list, that number could change pretty rapidly. But of course, there are more people who are developing needs to come into that system.
The modelling can be complicated, which is why we have a group of people dedicated here for that. I think the bigger question is probably less around those numbers, because those numbers fluctuate pretty significantly, or can fluctuate pretty significantly but it’s more around how long people are waiting to get into the system. I think that’s a key factor in terms of responding to the needs of Nova Scotians.
Right now we have, on average, about a five-month wait to get into a long-term care facility. There are shorter-term goals to reduce that down to a three-month wait. That’s another metric of consideration that I think we need to infuse into the conversation.
SUSAN LEBLANC: Yes, that is a great point that the minister makes. I may have questions on that another time.
Moving along, the minister mentioned some of the capital spending happening soon. What amount of the $34.5-million capital spend over the next four years in long-term care is federal dollars?
ZACH CHURCHILL: We have a bit of confusion around the $34-million figure the member has. Perhaps she can identify where she is finding that on the budget.
We do have the number for funding that is available through the federal government for infrastructure for long-term care. That figure is close to $13.5 million that we’re receiving from the feds. That’s through the Investing in Canada Infrastructure Program and that would be in the identifiable capital expenditures under long-term care.
SUSAN LEBLANC: Okay, great. Could the department please provide a projection for the next, say, five to 10 years on how capital spending is anticipated to break down per year and how many beds are anticipated to be built or opened each year?
ZACH CHURCHILL: Over the life of the agreements for the major capital projects - those would be the replacements and the new long-term care facilities that are being created, over 730 for replacements and, so far, 236 for new - that would be approximately $70.5 million a year for the life of those agreements.
On top of that, there was a $10.5-million capital expense for smaller repairs and infection protection and prevention upgrades as well. There’s also the smaller capital of $10.5 million a year. When we get to the new major capital projects that were announced, that figure is going to be $70.5 million a year.
SUSAN LEBLANC: We keep hearing about an infrastructure strategy in long-term care. Since 2016, we have heard that a blueprint for continuing care is underway, but a vision has yet to emerge.
Just recently an FOI received by our office explained, regarding the recent capital investments in long-term care:
These investments are part of a larger initiative whereby a strategic plan will be developed for continued renewal in the sector. This strategic infrastructure plan will commence shortly and take the next year to complete, as it will include extensive consultation with stakeholders.
My first question is, is what’s referenced in the FOI response a new plan?
ZACH CHURCHILL: Yes.
SUSAN LEBLANC: What happened to the old plan that was being developed?
ZACH CHURCHILL: Which old plan is the member referencing?
SUSAN LEBLANC: Exactly. The infrastructure strategy that we’ve been hearing about and this blueprint for continuing care - you tell me.
ZACH CHURCHILL: We’ve been in development of a continuing care blueprint, which includes modelling capital investments for long-term care facilities, of which we’ve announced a portion to date.
The member might be referencing - there wasn’t a strategy. There was a list of facilities. I believe she’s probably referencing a list of projects under the NDP that were - that wasn’t a long-term care strategy. There was a list of infrastructure priorities. Those have changed over the years, particularly over this last year with the recommendations from IPAC that have informed capital decisions and infrastructure spending to meet the infection prevention and control needs that we have in the system.
That list, which I certainly wouldn’t call a strategy - it’s just a list of capital projects that has been fluid. There have been some adjustments, particularly informed over the last year by Northwood and the IPAC reviews and recommendations.
SUSAN LEBLANC: When this new strategic plan is being developed, what will you be seeking? What information will you be seeking from stakeholders that is not already known?
ZACH CHURCHILL: There’s sustainable information from labour on the sustainable workforce and what needs to happen from a recruitment and retention perspective. Also, following up with stakeholders on the recommendations from IPAC and looking to get information on the continuity of care . . .
THE CHAIR: Order. That concludes the hour for the NDP caucus. We now move back to the PC Caucus for one hour.
The honourable member for Cole Harbour-Eastern Passage.
BARBARA ADAMS: I have to admit that I’m rather frustrated, because I think the questions I was going to ask have to be put aside in order to clarify a lot of inaccurate statements that I keep hearing during these debates.
I’m going to start with the first one, which is that the Minister of Health and Wellness may or may not be aware that a former Minister of Health and Wellness said in 2015 - it’s on the internet - that there will be a five-year long-term care strategy for the Province of Nova Scotia published in 2017. That’s on the record. People from the NSHA, people from continuing care - I’ve talked to all stakeholders across this province. Everyone knew that long-term care strategy was supposed to be done. Never happened. The Deputy Minister of Health and Wellness said so at Health Committee. That’s on the record.
The other statement that the minister just made is that this is the largest investment in long-term care history. If I gave my children $10 a year, after 10 years I would have given them $100. If I only give them $2 a year for the first nine years, that’s $18. But then if I turn around and give them $88 in the last year, that’s the largest single investment I gave my children, but they can do the math. So can the public.
It may be this government’s largest investment, but that’s because they cut the budget in the past and they didn’t invest in long-term care, in home care, in adult protection. So, I would actually not feel very happy about having to say: We underspent on long-term care and home care for the last seven and a half years, and now, right before an election, we’re going to make promises to try to cover up the fact that we underspent.
So, Mr. Chair, I’m wondering if the Minister of Health and Wellness can tell me - because I heard him and the Premier say that they were standing on their record on long-term care - I’m wondering if the minister can tell me what Mr. Bill VanGorder said, on the day that the budget was released, on his evaluation of this government’s budget with respect to what’s in there for seniors. For reference, Bill VanGorder used to be the President of CARP Nova Scotia, and now he’s on the federal board for CARP Canada.
ZACH CHURCHILL: Thank you very much for the question. The budget currently is over $1 billion. There have been significant investments in long-term care, particularly over this last year, to execute on the recommendations that came from the IPAC and Northwood reports around infection prevention and control. There have been capital investments around increasing safety in our long-term care facilities to reduce multiple occupancy. We’ve also made announcements to expand long-term care beds in the province, in Eskasoni, Villa Acadienne, and Mahone Bay, and our budget is now over $1 billion to accommodate the newest round of infrastructure investments and the IPAC recommendations. That has influenced the largest proportion of the $100 million increased investment in long-term care in this budget.
BARBARA ADAMS: Unfortunately, the question was: Does the minister recall what Mr. Bill VanGorder said about this government’s budget on Budget Day? Since he didn’t answer the question, I’ll tell him what was said. Mr. VanGorder said, and I quote almost exactly: There is no new money for seniors in this budget.
I’m going to respond to what the minister just said about single-largest investment. I just did an example of how my kids would know if I didn’t give them very much money for seven years and then I gave them a bunch of money at the end. They’d still know that it was a bit of a misrepresentation to suggest that it’s the single-largest investment when you under-invested for the first seven years.
For the minister to suggest that a lot of this money is going to go toward infection control, I want to remind the minister of what happened at Northwood. I’m not sure if Public Health got the same calls I got, if Dr. Strang’s office or the Minister of Health and Wellness’s office got the calls, but I was getting the calls from the staff who were working there, who did not have PPE, who were asked to come to work even though they had COVID-19 symptoms because they were down to staffing around a level of 60 per cent. At one point, a lot of the staff who do cleaning were all out because they were sick. To suggest that this investment in infection control because of COVID-19 is an investment in long-term care, I think that’s misleading.
The next question I have for the minister is: We all got sent a press release by the Nova Scotia seniors’ advocates known as ACE - Advocates for the Care of the Elderly. Has the minister read that press release, and what did he think about what was sent to us by Gary MacLeod, the chair of the ACE team?
ZACH CHURCHILL: I thank the member for the question. We did provide PPE, along with a robust Wave 2 Plan for the long-term care sector and we did see success in terms of not having any cases of COVID-19 and subsequent waves from Wave 1 in our long-term care facilities.
We did implement all the recommendations from IPAC and from the Northwood review and those reports informed a very serious response. That did affect access to residents by their families, and impacted people in a number of ways. We did try to increase access virtually, with purchase of iPads, but in terms of keeping COVID-19 out, we were successful in doing that in subsequent ways. Of course, the lack of community spread increased our chances of success with that as well.
We do have a meeting scheduled with ACE, I believe, on April 12th. That meeting is already in my calendar. I very much look forward to chatting with those folks and getting their perspective on the state of services that their communities of interest receive from the health department.
BARBARA ADAMS: So again, from a mother who is watching at home, she says: How come they don’t answer your question and just go off on some other tangent that they want to talk about? I’m not sure, but the question was: Did the minister read the press release from the ACE team? I’m assuming by the non-response that the answer is no, so I’m going to quote it - not all of it and I’ll certainly table it.
I’ll just read some of it: They get a C+ grade, slightly above average. It’s not a grade that any government should want when being evaluated about the money it is willing to provide for the care of long-term care seniors. It is simply offering - these are not my words, these are someone else’s words - with nothing to gain, minor adjustments to staffing levels and services. This budget does not indicate any sense of urgency. This government is now lifting a six-year moratorium on the creation of long-term care beds.
So, if you don’t build any for year one, two, three, four, five, six and seven, you do have to build beds but to provide only 230 new beds and the renovating of seven long-term care homes that should have been renovated 10 years ago, it’s not something to be proud of. Sorry, those are my words, not his.
Gary MacLeod further observes that this budget has pushed out that very limited promise, stretching into completion dates to 2025. Average slow incremental change will not go over well with seniors who are watching to see if our new Liberal premier is serious about addressing the health crisis in long-term care.
Currently, other provincial political Parties and many researchers have noted that there is a backlog of 400 seniors waiting in hospital for long-term care and another 1,000 to 1,500 in the community already assessed as needing 24-hour care. What this government budget has done is avoid the inevitable long-term financial investment needed in the long-term care sector. They have made modest investments today while kicking the long-term care needs down the road, and for the ACE team that is a very callous approach. I will table that document so you can read it in its entirety.
Mr. Chair, I have met with the ACE team a number of times, as well as the other stakeholders in this province because I used to be one of them for the past 40 years, as a health professional.
I’m going to read, and I’ll table this document as well. This is from the ACE team as well, talking about the PC Party’s Dignity for Our Seniors plan. I’ll certainly table that and send the minister a copy.
This is from the Ace team: With respect to the PC Party’s long-term care, in comparison to what was presented in the Liberal budget, which is just a continuation of the previous Stephen McNeil administration policy of doing as little as possible for improving the quality of care for long-term care, and the NDP’s basically nonexistent plan for long-term care, I would have to rate the PC Party’s Plan as a B+, in that it is the most comprehensive plan of the three main Parties and the first real plan since the PCs’ 10-year long-term care plan under Rodney MacDonald. The PC plan of creating 2,500 badly needed new long-term care beds is the most welcoming news, along with a plan for vastly improving in-home care administered by for-profit facilities with government oversight.
Mr. Speaker, I will encourage the minister to read both those documents. I would also encourage the minister to read the Standing Committee on Health’s report on long-term care, dated January 12, 2021. I won’t quote every union representative that was there, but they had almost an hour, and those comments that they made are very similar to what Mr. Bill VanGorder said and what the ACE representatives said.
The reason why they’re all frustrated is because we’re hearing sound bites of things that are certain little pieces, talking points, but they’re missing the whole picture of what the whole puzzle looks like when you put it together. You can’t do that in long-term care.
My question to the Minister of Health and Wellness - he said that his government - unlike my Party, which has already committed to the 4.1 hours of care per senior per day in long-term care - that this long-term care expert panel did not recommend 4.1 hours of care. Can the minister tell me what his understanding is of why they didn’t make that recommendation and what his government did after what the long-term care expert panel said the day this report was released?
THE CHAIR: Before we go to the honourable Minister of Health and Wellness, just a reminder to the honourable member that you can’t use current elected representatives’ names in debate. You used the former Premier’s name in your comments. Just a reminder of that.
ZACH CHURCHILL: The reason that wasn’t included at the highest level in the long-term care panel’s recommendation was to ensure the appropriate amount of flexibility to provide individualized care and deploy resources within their facilities to accommodate the needs of the residents based on those individual needs. We are utilizing the international assessment tool interRAI to assess each and every resident upon entry and as they progress in the system to ensure that the resources and hours of staff time allocated to them are consistent in meeting their needs.
BARBARA ADAMS: In fact, I was at the press conference that day when Janice Keefe was asked that very question. Ironically, I believe it was by the ACE representative, Gary MacLeod. My recollection of what was said was not what was just answered by the minister.
The Minister of Health and Wellness at the time asked the expert panel to give staffing recommendations and they did not do that. It was the one piece of information that every stakeholder group desperately wanted. Everything else in the long-term care recommendations could have been written by any stakeholder who ever worked in long-term care because the problems were known across the board.
When Janice Keefe was asked why she hadn’t put in an hour of care per resident per day, she said there wasn’t enough information known in Nova Scotia for her to make that recommendation. That was almost two and a half years ago. The interRAI data had not been collected, it was delayed. It was supposed to come out in 2018 and 2019 and 2020. It has been delayed. There is still insufficient information, so this is a failure here to do something that should have been done right off the bat. When she said we don’t have enough information, this government should have said, good grief, we need to get it for you. That’s what I would have done.
The fact that this minister is standing on the fact that we don’t have enough information, or we’re saying it’s to allow for flexibility - they already have that flexibility. Every long-term care facility in the province has the flexibility to shift their staffing around. As a matter of fact, it is quoted by a lot of the staff in those facilities as there shouldn’t necessarily be that much flexibility. In one facility they’ve got a full-time physio and OT for 100 residents and at Northwood they’ve got less than 25 per cent of that because they do have that flexibility and they’re moving them around constantly to try to fill the hole from not enough CCAs, LPNs, RNs, and rehab and recreation staff. Again, this is the frustration, when we’re looking at a little sound bite that doesn’t accurately reflect exactly what’s going on.
I want to move on to home care. We talked a lot about long-term care, but that talks about 10,000 residents whereas in home care we’ve got three times that many. We have approximately 32,000. I used to run a home care physiotherapy and OT company. I worked in those homes and I know that 10 years ago, five years ago, if home care staff said they were coming, they actually showed up. But the trend over the past five years has been for constant cancellations, a different person showing up every day, family members having to retrain a different caregiver every day, so they really can’t go off and do their own thing because they’re there training a brand new staff person.
I’m wondering if the Minister of Health and Wellness can tell me - and if he doesn’t have the stats I can give them to him - if more or fewer people got home care last year versus the year before, in 2018-19?
ZACH CHURCHILL: We’re going to get the specific numbers for the member to go through those. We’re getting those right now.
BARABARA ADAMS: For the record, for the minister, the number of home care clients in 2018-19 was 31,688. Last year it was 30,881. This government’s Home First program, where you’re going to keep everybody home, only works if you have enough home care staff. There is not enough home care staff. Not by a long shot.
So, fewer people are getting home care than the previous year of this government before COVID-19 hit. I can tell you what happened during COVID-19; they cut out a lot of home care from those who desperately needed it to move them into long‑term care. So, if we thought home care was bad before COVID-19, it is much worse now.
The next question I have for the minister is: Is he aware if home care clients are getting more hours of care? Maybe that’s the reason why we are so stretched with home care. Over the last four years, are more hours of care being given to our home care clients or fewer?
ZACH CHURCHILL: I think there are some key facts that the member is not including in her version of the events here. One would be the impact the pandemic had on people’s willingness to allow home care workers into their homes during the lockdown period. We did see an increase of people who were denying entry of our home care workers. Government did respond by providing alternative methods for self-directed care through the Supportive Care Program and through the Caregiver Benefit program.
While we actually did see a decrease in the use of home care supports during the pandemic, for obvious reasons, we did have an increase of about 3.2 per cent in the Caregiver Benefit program. That would be families that were utilizing a family member for their care. We did see an increase of 75.5 per cent of the budget for the Supportive Care Program. That was for clients to utilize alternative or enhanced home care supports through alternative means, by hiring out other services. We did see an increase of that by about 75.5 per cent.
For the self-managed care, for those folks who are eligible for that, we did see an increase to the budget of about 15.3 per cent. Yes, during the pandemic, for a number of reasons, primarily because people denied entry of home care supports for fear of contagion, we did see an increase in utilization of benefits from those folks who were part of that program.
BARBARA ADAMS: Unfortunately, what I was asking about was the utilization of home care pre-COVID‑19. I’ll reference what the minister just said about people cancelling their care during the pandemic. The facts, actually - I’m not sure where those phone calls came from because, as the critic for home care, people were calling me constantly, being told that their home care was completely cut or cut way back because they did not have the staff. I know of almost no one who called up and said, I don’t want that care. I don’t think that what the minister said is what happened, because that’s certainly not the calls that I got, and I got a lot of calls.
What I’m referencing - and the minister said he disagreed with my version of events. I want to quote that these are numbers directly from Nova Scotia Health By the Numbers on the government’s website. Rather than asking for the numbers anymore, because it takes too long to get that response, I’ll just tell the minister.
For the average number of home care visits per person per year - this is hours, so just for reference for everyone watching - you are entitled to a maximum of 100 hours of home care per month. That would be essentially 1,200 over the year. The average person in Nova Scotia who received home care in 2016-17 received 107 hours of care in total for the year. In 2017-18, they received 104 hours of care. In 2018-19, they received 97 hours of care. In 2019-20, they received 95 hours of care.
The government’s representation that things have been improving in home care is not accurate. Fewer people are getting home care and fewer people are getting the hours of care that they, in fact, need. I know that they need that care but aren’t getting it because they are being told: You’re eligible for 80 hours of care, but we can only provide you 60. I have had home care agencies tell me, and tell the client, that they are taking on a client who needs 40 hours of care, knowing they can only give them 20 hours of care.
I’d like to ask the Minister of Health and Wellness: Is he prepared to report how many visits by home care agencies get cancelled by the agency every year? Not just because of COVID-19. We know COVID-19 messed up a lot of things. I’m talking about the last five years. What has happened to the cancellation rate in home care for the province of Nova Scotia?
ZACH CHURCHILL: We do have the percentages pre-pandemic, the increases in cancellations by the providers themselves. There has been an increase in that, and we expect that the increase from the pandemic will be similar in terms of increases, but I’ll let the member know when we receive that.
We had a 0.5 per cent increase in provider cancellations in 2018-19 and 1.9 per cent in 2019-20. During those periods, we’ve also had increases to the budgets. Also, the member’s suggestion that the resources have not increased in our home care support and community support programs isn’t accurate, and I can run through those numbers.
This would be the five-year rate of increase for investments. For home and community support spending over the last five years, that has increased by close to $50 million, which would be an increase of just under 20 per cent. The home nursing budget has increased by close to $11 million, which would be close to a 15 per cent increase. Our home support program has increased by about $5 million, which would be an increase of close to a 3.5 per cent.
The direct funding to the clients has also increased. For self-managed care, we have had an increase of approximately 55 per cent to that budget. The Supportive Care Program has seen an increase of close to 100 per cent. The Caregiver Benefit has increased by over 26.5 per cent. For community programs, the Home Oxygen Services program has received an increase of close to 5 per cent. The Adult Day funding has gone up over 37 per cent. The Bed Loan program has gone up 29.3 per cent and the wheelchair program has gone up over 51 per cent.
For community grants, we’ve seen an increase of 193 per cent to those fundings, that’s communities that support our seniors. The Caregivers Nova Scotia funding has gone up 44.4 per cent. There has been a 100 per cent increase to the Alzheimer Society, and we’ve seen substantial increases and uptake in the supports that government has made available on the home care side of our continuing care support system.
THE CHAIR: Order. We will now take our mandated 15-minute break. It is 7:11 p.m. so we will come back at 7:26 p.m.
[7:11 p.m. The committee recessed.]
[7:26 p.m. The committee reconvened.]
THE CHAIR: Order. We will resume questioning the Minister of Health and Wellness. The PC Party is asking questions.
The honourable member for Cole Harbour-Eastern Passage.
BARBARA ADAMS: I wonder, just for clarity, if the minister could very briefly repeat his answer to the last question.
ZACH CHURCHILL: I believe one of the last questions the member asked was about provider cancellations to the clients. That would be the provider cancelling the service to a client.
We have seen some small increases in cancellations from the provider. Again, I’ll go over those numbers. In 2017-18, 0.5 per cent. In 2018-19 and 2019-20 we saw increases, respectively, of 1.9 per cent of cancellations and 2.4 per cent. The sector’s telling us that is related to labour pressure, so a shortage of CCAs to provide these services. They’re running into labour pressure that has impacted that.
We have responded in a number of ways. One, of course, is with recruitment and retention initiatives and a bursary program to train more CCAs. Those efforts are ongoing. We brought in the CCA bursary program again. I believe we had 217 successful applicants for that program.
We train, on average, 600 CCAs a year. That number did go down to about 426 last year during the pandemic, but there is a recognizable labour pressure on us. It did impact these cancellations from a provider. That’s one way we respond: with recruitment and retention.
We also had clients who cancelled during the pandemic because they didn’t want to increase risk of contagion to them or their households. Looking at those situations, there has been a pretty robust government response to make sure people are getting what they need.
I’ll go through those figures again of budgetary increases for our home care and community care supports. The home and community spending has gone up by just under $50 million. That represents an increase of over 18 per cent.
The home nursing budget has been increased by 14.5 per cent, which is close to $11 million. Again, this is over five years, so this is the percentage increase over the last five years. The home support program has been increased by close to $5 million, which is just under a 3.5 per cent increase.
In response to the labour pressures and the decisions during the pandemic for the clients who cancel services, we did provide some direct funding to our clients. Those numbers have gone up as well over the years.
For self-managed care, there has been an increase of about 55 per cent to that budget. For the Supportive Care Program, there has been close to a 198 per cent increase. For the Caregiver Benefit Program there’s been an increase of 26.6 per cent. There’s been an increase in Home Oxygen of 4.8 per cent, and the Adult Day Program, of 37.1 per cent. There has been an increase in the Community Bed Loan Program by close to 30 per cent and to the wheelchair program by over 51 per cent.
There has been an increase of community grants by 193 per cent on the nose, and that funding has gone to Nova Scotia caregivers. They’ve received an increase of close to 45 per cent. There’s been a 100 per cent increase of funding to the Alzheimer Society.
We also have been bringing in the home support care worker program. These are folks who are not trained CCAs, but we are allowing our agencies to fund these non-CCAs to come in to do supportive tasks that don’t involve personal care - cleaning, meal prep, these sorts of non-personal care supports.
We are responding in a fairly robust way through supports for community and looking at alternative non-CCA supports that we can bring in, and by providing some direct funding with significant increases to our clients of the home care programs so that they can better self-manage and seek additional supports that they might need.
BARBARA ADAMS: Thank you, Madam Chair. I’ll just pick out one of the numbers that was referenced there, because it is all about perspective. A 37.1 per cent increase in the Adult Day Program was mentioned. Well, for the last year, the Adult Day Program was cancelled because of COVID-19, so a 37 per cent increase in it is not something we should be overly proud of. Certainly, any increase is nice, but that’s not a significant change.
What I was referencing and pointing out is the fact that the government had this Home First program. We won’t build long-term care because we’ll put money into home care. The minister took great pains twice to talk about the increasing amount of money that was spent, but that’s not an outcome. That’s an output. The outcome is that fewer patients got home care last year than the year before. They got fewer hours of care over the last four years prior to COVID-19.
Regardless of what money this government might have been putting in, the outcome was that fewer people got home care and they got fewer hours of care. Anybody in this community who’s getting that home care and having it cancelled, having people leave after 20 minutes but billing them for that full hour, having a different caregiver show up every time because they’re short staffed, being told you’re entitled to 20 hours but we only have staff for 10 - that’s reality. That’s what it’s really like. That’s why CARP said there was no new money. That’s why ACE said this is a failing grade, because this is not meeting the needs of Nova Scotians.
I’m going to move on, given the 15 minutes I have left. I represent Cole Harbour-Eastern Passage. I’m a very proud mother of someone in the military - both my son and his wife are in the Air Force. My son was in Kuwait, and I last week had the privilege of meeting someone else from the community, only to find out that both of them were together in Iraq during a missile strike.
I cannot begin to tell you what I feel when I go around to my community to talk to the military members. I have talked over and over again, both with the federal Minister of National Defence and locally, about the fact that I have so many people coming into the military base at Shearwater where the military member gets a family doctor and the family members get nothing, often the whole time they’re here. Then they get posted somewhere else and they go back on a list.
I mentioned it to someone from CFB Halifax and he said: Oh, it’s too bad they don’t do what we’re doing in Halifax. He said they did a pilot where they gave 100 CFB Halifax family members a subscription to Maple, an online physician service - 24-hour-a-day access, seven days a week.
I discussed this with Maple and said, how much would it cost? They gave me a number. I thought, you know, you could call 811 four or five times a year or you could have a subscription to Maple and talk to a doctor anytime you want, 24 hours a day, seven days a week, 365 days of the year. The military figured out that this was a way to provide a service to the families of military members.
I’m wondering what the Minister of Health and Wellness feels about the military’s pilot study to give anyone who came to CFB Halifax an automatic subscription to a physician service because they were going to have to go on a wait-list here to get a family doctor.
ZACH CHURCHILL: I’d like to thank the member very much for the question. I will get to the access to primary care in the member’s community, but I do just want to reference again that I believe what the member is trying to project that’s happening in the home care sector isn’t accurate and the numbers don’t reflect that.
We have seen small percentage increases in provider cancellations. We’re hearing from the sector that that is strictly and directly related to labour availability. This issue was further complicated during the COVID-19 pandemic last year during the lockdown.
Many companies experienced the competition with CERB, as well. Some people were choosing to stay home and take CERB and not work. That was a challenge that we faced in this sector. Many sectors faced that challenge.
Those numbers of percentage increases have been fairly moderate, from 0.5 to 2.4. Of course, we don’t like to see those and we’re working on recruitment and retention issues to deal with that ongoing labour pressure.
The funding increases that I did mention - the member did reference that the Adult Day Program was cancelled last year, but these are numbers over the last five years. These are the averages and substantial increases in these investments for people who need supports choosing to live at home, and this is allowing more people to do that in our province. These have been substantial increases to these budgets.
It is about creating a more robust system of support that does include community. It’s not just all contingent on the home care provider themselves. It is about creating a more robust, more complete, more wraparound service to the clients. To say that this has not been an area of priority or that we haven’t seen increased support in this area, I do not believe would be accurate.
Are there still frustrations in the system? Sure. Do some of the stakeholders have criticisms? I know they do. That’s not to suggest that I think important progress has not been made. I do think those points are very important to make.
In terms of the military protocol or option of providing Maple, I think they’re making a decision that they believe is best. We see virtual care, from a primary care perspective, as not a replacement for access to those primary care physicians or nurse practitioners but as an enhancement to those.
You may have access to virtually discussing your issues with a physician, but they do, at the end of the day, need to be able to have that hands-on observational experience to properly diagnose. I know that the deputy has a great anecdotal example of that, where he knows someone who was dealing with what he thought was psoriasis and that’s what the practitioner on the other side of the screen also thought it was, but when he did see a physician in person it was clear that it was melanoma.
There are risks with trying to replace primary care only with virtual. We see it as an enhancement tool from a primary care perspective, not a replacement. I think the greatest area of applicability here where we can see access really improve from virtual care is particularly in the mental health - counselling, therapy - side of things. That is where our real focus is, in terms of that expansion.
We are looking at expanding it of course as an enhancement to primary care. We have done that over the last number of years. Virtual care has been around since 1990. We have had significant improvements over the last year to that. We are not going back from that. That is going to continue to happen but, again, it needs to be seen as an enhancement to access to primary care, not a replacement of that.
When it does come to patient attachment in the member’s community, the member is very lucky that the military families, at least those that are enlisted, have access to doctors through the military. Not every community has that access point for so many people. It is great that the military does provide that. DND is exempt from the Canada Health Act, so they are able to conduct their health affairs differently than the provinces. As well, where we have limitations in terms of what we can do with a private company doing primary care, like Maple, there are legal limitations to what the provinces are able to do around that that do not apply to the Department of National Defence.
The member does have one of the highest patient attachment percentages in her area - not just in her riding, but in the health district there. Based on our data, from the 60,000 folks who are listed as being unattached, 1.6 per cent of people in her community are currently listed as being unattached. So, 98.4 per cent of individuals in her community are attached to a primary care provider. The unattached number is much higher in my area and it is definitely much higher in certain rural parts of the province as well. The attachment is very strong in that member’s area.
Of course, we are going to keep working to recruit and train more family doctors and GPs and nurse practitioners, and create more access points to primary care as well, which members of her community will benefit from as well as members from all communities across this province, and particularly in the areas where there is a high need and where there is a higher attachment issue with those patients who do not have access to a family physician.
BARBARA ADAMS: Mr. Chair, I will respond to what the minister just said. I appreciate that I have an attachment of 1.6 per cent. Perhaps the minister needs to be reminded that when I took over, four years ago, the unattachment rate in my community was 26 per cent - I was told that by the Department of Health and Wellness - because for some reason, the people from my communities on the 811 Need-A-Family-Doctor list were not getting phone calls when new doctors to Dartmouth or Cole Harbour where coming. We were completely left off for a very long time. As this minister knows, I fought for a year and a half to get a clinical nurse practitioner. The Minister of Health and Wellness sat across from there, gave me that funding that I begged for, and then it took me a year and a half of badgering before we got through that entire process for her to get hired.
So the reason my community has gone from an unattachment rate of 26 per cent without a doctor or family clinical nurse practitioner to 1.6 per cent is because of the work that I put into this community to make sure that that happened.
I do want to make one final comment because I am a bit riled up, Mr. Chair. The minister just said that the federal government takes care of its military family members. The least we can do is take care of the family members of those military personnel.
The minister just said, and I am quoting, I believe: The risks of replacing primary care with virtual care are a concern. I agree. He just said that he was going to do that with mental health care, which I also agree with doing. Having said that, what this government has done is allowed over 60,000 people to be without a family doctor at all. So, while there might be a risk in using virtual care, I cannot fathom for a minute that me having 24‑hour access, seven days a week, 365 days a year, where I can call up a family doctor, is not better than having no family doctor at all.
The Progressive Conservative Party of Nova Scotia, in our health care plan, has made that pledge to every Nova Scotian. You are not going to need to call 811 Need a Family Practice. You can stay on the list until you get one, but you are going to be able to call up a physician any time you need to - that certainly has less risk than not doing anything at all or having to call 811.
I just want to remind everyone that yes, we have 811 Call a Nurse. This government had a report on what physicians thought about the 811. It got held back from our Committee on Health until the day after we asked in the House about 811. Eighty per cent of physicians said they did not have faith that the information that people were provided in this province by 811 was sufficient information for them to make health decisions. We pay this private 811 company $51 a call, often to be told to call your doctor in the morning or go to emergency if your symptoms get worse.
What we are talking about in the PC Party is that we are going to give over 60,000 people access to a physician 24 hours a day, 365 days of the year, because we believe that having zero access to a physician is far more of a risk than having 24‑hour access every single day. Yes, we need to see physicians or clinical nurse practitioners in person, but we need to take care of the families of our military members. We need to take care of seniors who are tired of one issue, one visit.
I take my 91‑year‑old mother in to talk about her shoulder after a fall, but I have to come back another day to talk about the fact that her blood pressure is now dropping too low when she stands up.
Mr. Chair, the PC Party has put out a plan. I was actually hoping this government would take some of it and do it now, but I think what we are going to have to see is the people of this province are going to have to decide whether having no access to a family doctor is more of a risk than having 24‑hour a day phone access to a physician in this country any time of the day that they want.
Mr. Chair, I also want the people of Nova Scotia to decide whether they think it is better to have 230 long‑term care beds built by the current government over the next five years or over 2,500 beds built by the PC Party of Nova Scotia over the next two years - decide for yourself.
With respect to the comment that over 3,000 people get admitted into long‑term care every year, and that is how this government was seeing the wait‑list, that also means that over 3,000 people passed away in order to make room for those beds. So, the fact that 3,000 go in and 3,000 pass away, the list is still there. There are 1,500 people waiting from home for long‑term care, over two or three hundred in hospital, and umpteen numbers in hotels.
THE CHAIR: The time for the questioning for the Progressive Conservative caucus has elapsed.
The honourable member for Dartmouth North.
SUSAN LEBLANC: Thank you, Mr. Chair. I am going to leave my questioning on long‑term care for a little while because I am feeling rather generous. The minister deserves a break for a second, but I am going to ask some very important questions on another subject, which is parental health.
So, seeking help for an early pregnancy loss can mean waiting in the ER for hours, only to be referred later to the IWK where there is no emergency department for pregnancies earlier than 20 weeks. This can create a lot of unnecessary pain and waiting for people who are experiencing a miscarriage.
Are there plans to make improvements to the supports available through the IWK for early pregnancy emergencies?
ZACH CHURCHILL: I would like to thank the member for asking this very important question, and I think first it is important to state that this division of emergency department response really only exists in the metro area, where there is the division with the IWK and the regular emergency department. In every other hospital in the province, all those patients would go to the same emergency department, whether it was a gynecological issue related to pregnancy or not.
There are clinical reasons, I’m told, that patients should go to the adult emergency department, and those would be that there is a variety of factors that can contribute to the same sort of symptoms that you would have during a miscarriage - it could be an appendix issue or other clinical issue. There is some clinical rationale for the necessity of that. However, I do know that there is a quality review ongoing right now related to a case that has been reported in the media that is obviously very much linked to this issue. At this point I think it is incumbent upon us to allow that process to go forward, because those quality reviews can lead to very important recommendations for system improvement.
Right now that is what we are going to do - wait for that quality review to be completed and see if there are recommendations that come from that that can help us improve the system to provide a higher quality service.
SUSAN LEBLANC: I get that, but ultimately in HRM, where there is a significant population, if one goes to the adult emergency and it is determined that the issue is about the pregnancy, then ultimately folks are sent over to the IWK, is my understanding. I, myself, did not experience a pregnancy loss, but I found myself in the emergency room while about 19 or 20 weeks pregnant, thinking that I maybe was miscarrying, sat in the emergency room at the Dartmouth General for a long time by myself in the middle of the night, and then laid on a stretcher for long time by myself in the middle of the night and then laid on a stretcher for a long time, very scared, and then was sent by ambulance to the IWK where they determined my baby was going to be fine, thank God.
But the whole experience was terrifying. I can only imagine that had, even in the Dartmouth General Emergency which I think is a great place, in terms of emergency rooms, if there were a special room, even designated space allotted for people who are experiencing pregnancy loss until they are able to see or to get the treatment that they need - that kind of service would be very welcome I am sure.
That being said, I am wondering, is there is a timeline on the quality review that the minister just talked about?
ZACH CHURCHILL: That quality review is done by the Health Authority, so that is outside the scope of the department. As recommendations come forth that do impact that government or department policy, then those recommendations would make it to us. We do not have a timeline on that.
SUSAN LEBLANC: I want to thank the minister. I also just want to point out - I didn’t realize this because I am not in Cape Breton, but apparently what the minister has said about outside of HRM that generally folks are at the same hospital, that is not true in CBRM. If pregnancies are before 20 weeks, folks are sent to the Glace Bay Hospital and then again transferred to the Regional. That is important information to have; that is Health Authority I suppose, the other is IWK, but they are both overseen by the department. Just putting that out there - again, a really important thing to be addressed.
Moving on, why has the expansion of the midwifery services stalled?
ZACH CHURCHILL: First, I do just want to clarify - according to Dr. Orrell, who did practise in Cape Breton, the information that we are provided was not accurate. I would encourage patients to not do that. I am being told that the OB support at Glace Bay, they are not there, so it is at the Cape Breton Regional where that does happen.
In terms of midwifery, COVID-19 obviously had an impact on demand for those services, as folks weren’t bringing people into their homes as much for that. We are looking into seeing if there is a broader demand issue there that impacted numbers of midwifery, but that’s an issue I will have to get more information on before I can provide a complete response to the member.
SUSAN LEBLANC: Well, thank you to the minister for that answer. I just want to point out that with a couple of the minister’s answers he simply stated that whatever I’ve suggested or whatever I’ve asked, it just simply doesn’t happen, but the fact is it does happen. The reason I asked the question about Cape Breton is because it happened to somebody, and the person it happened to texted me and said, oh, you should ask this. Nothing is black and white. Everything is gray and I just want to acknowledge that.
I would also say about the midwifery service is, yes, midwifery services did, of course, because of our own COVID-19 guidelines, have to pause for a little while during the pandemic, but I would say definitely anecdotally, and also talking to the Association of Nova Scotia Midwives, there is a demand for midwives. There are many midwives who would like to be practising in Nova Scotia and there are many potential parents who would like to have a midwife when they get pregnant.
We know that midwifery is cheaper than regular medical care when it comes to pregnancy. We know that outcomes are excellent with midwifery care. There are less instances of needing interventions with pregnancies or births, that kind of thing. I recognize that the minister needs more information, but these are the questions I want to ask. So, when he gets the information, perhaps he could forward these answers.
Is the government planning to continue to fund midwifery, or is this an area where we can expect to see cuts? That is my first question. What are the plans for expansion of midwifery service and how long before midwifery services are accessible across the province? I reiterate that parents, potential parents, people who want to get pregnant, who are pregnant, many people are asking for midwives and wish they had them, myself included. I’m sorry to make it all about me. I had great pregnancy experiences, but boy oh boy, when I first got pregnant at the ancient, geriatric age of 38, I really wanted a midwife and there was no chance of having one. So, I’ll leave that there.
Moving on to pre‑natal classes, I would like to ask the minister: When the government decided to cancel pre‑natal classes, what did that represent in terms of cost‑savings to the province?
ZACH CHURCHILL: So, for the first question, there are no cuts to the midwifery program, and we are not planning any. That program and the $2.2 million which supports it will remain in place. There was a decision made at the NSHA in 2019 to shift the approach to prenatal education. They moved from an in-person model to providing digital resources. That was related to a continued decrease in uptake from individuals. Fewer and fewer people were utilizing that service in person, and the Health Authority made a decision to redeploy those resources digitally in an effort to make it more accessible to more people.
SUSAN LEBLANC: I just want to get this straight. The minister said that fewer people were using the services, so they transferred them to digital so more people could use them. That logic does not make sense to me. I want to go back to my question: Did the government save money on cancelling prenatal classes? Was there any analysis done about the potential unintended consequences of cancelling that service?
I know that there are organizations that still continue to provide in-person prenatal classes, like what’s now called the North Grove in Dartmouth North; it used to be the Dartmouth Family Centre. I know the Mi’kmaq Child Development Centre offers prenatal classes, and those are well-attended, well-used classes with excellent teachers. I can only imagine that they provide the new parents or the pregnant parents with lots of comfort and important information. I would also like to know if the minister has any data on how many people are actually accessing the online services.
ZACH CHURCHILL: There was no saving of money with the change in approach to prenatal education. The Health Authority was experiencing a decrease in the number of people who were participating in in-person sessions. Following the trend, and recognizing that that trend would most likely continue, they decided to redeploy those resources in a manner that they believed would create more access to families, particularly working families, working mothers, who might not be able to schedule an in-person visit but could utilize the online information on their own time, and families with either work or family pressures that they’re dealing with. The decision was made to do that.
We believe that the Health Authority does track utilization of that program. That’s not confirmed yet, but we believe that they do, and we’re going to see if we can get that information from them. I do think the rationale was to respond to a decrease in demand for the in-person prenatal classes and redeploy those resources in a way that would make them more accessible to more people.
SUSAN LEBLANC: That would be great. Thank you to the minister for finding that out.
What increases in this budget are there for prenatal or post-natal support?
ZACH CHURCHILL: The specific figures are housed in the operational budgets of the Health Authority and the IWK, so we’ll have to mine that information from both authorities.
SUSAN LEBLANC: Yes, again, that would be great to have. I appreciate that information being sent to us.
Last year the Premier indicated some willingness to look into covering the cost of IUDs for individuals without access to Pharmacare or private insurance. This was during the time of the debate on the bubble zone legislation and I’m wondering what work has been done to look at that proposal?
ZACH CHURCHILL: I thank the member for the question. IUDs, along with a list of other contraceptives, are available for coverage through the Pharmacare program, so they are in the formulary. The other ones include Depo-Provera, NuvaRing, oral contraceptives as well. They are covered through the Nova Scotia Pharmacare Program.
SUSAN LEBLANC: Would the minister support covering birth control like oral contraceptives, IUDs, and other forms of birth control that aren’t surgical under MSI? Which would mean that if one does not qualify for Family Pharmacare or one does not have health insurance - and there are many people who fit that description, who don’t have health insurance and don’t qualify for Family Pharmacare - would the minister support those forms of birth control being covered by MSI?
ZACH CHURCHILL: MSI is built to cover procedures and services, not pharmaceuticals or the device. The physician or health care practitioner who does put in an IUD, they would bill MSI for that service.
The device itself would be covered under the Pharmacare program, but for individuals that are low-income and do not have access to the Family Pharmacare program or private Pharmacare coverage, staff have told me that there is support available through the QEII Foundation, and they will help provide funding for the device itself.
To provide funding through MSI for the device would be inconsistent with the application of MSI, because it is specifically built for procedure and for service, but it does cover this procedure.
SUSAN LEBLANC: It covers the procedure to receive the IUD, but it doesn’t cover the actual piece of equipment, as it were. Medical Services Insurance does cover the abortion pill, the morning after pill, which is not a procedure, and MSI covers flu vaccines, which is not a procedure. The delivery is a procedure, but the actual little bottle of vaccine is not a procedure, so I think that there is some discrepancy in what the minister described.
My question again is: Given the fact that one-third of workers in Nova Scotia do not have access to private health coverage. I don’t know what the proportion is, but there are many people in the province who don’t have a whole bunch of money but don’t qualify for Family Pharmacare, and those who are on Family Pharmacare still have to co-pay or pay a premium or whatever, depending on the person in the program. The fact is that women’s health care, which contraception is, should be covered by the province.
I’m asking the minister if he will consider covering prescribed birth control that are not surgical procedures, because - let’s face it, who wants to have a surgery when they could take an oral contraceptive, although I shouldn’t say that because lots of people do that. Anyhow, it’s less invasive. What I’m saying is there are holes in the minister’s arguments. Will the minister commit to paying for birth control?
ZACH CHURCHILL: This is going to be a topic that we do discuss as a government. Again, MSI doesn’t cover the actual flu shot. It covers the process of administering it. It does cover the options available to women who need more measures taken. Again, that’s a procedural and service coverage, so the member wasn’t accurate in saying that the flu vaccine itself is covered. It’s the bill for the administration of it.
This is a conversation that’s ongoing, so right now there are options available to women looking for support here. Obviously, it’s covered through the Nova Scotia Pharmacare Program, as we mentioned. There are sexual health clinics that do provide supports to cover those who can’t afford it.
There’s also the QEII Foundation, so I do think in this conversation we have to take a look at all the full scope of support that’s available and identify whether there is a major gap there or not and whether MSI is the appropriate vehicle for that. It doesn’t seem to me right now that it would be, but I’ll tell the member to remain open minded on this conversation. I know the conversation is going to continue on this subject.
SUSAN LEBLANC: Who pays for the flu vaccine, then? If MSI covers the administering of the shot, the flu vaccine is free - we don’t pay for it.
I guess my last question would be: Does the minister believe that we should have a universal Pharmacare Program in Nova Scotia?
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.
We’ll take a short recess.
[The committee adjourned at 8:23 p.m.]