HALIFAX, MONDAY, APRIL 4, 2022

COMMITTEE OF THE WHOLE ON SUPPLY

5:26 P.M.

CHAIR

Colton LeBlanc

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

It is now 5:27 p.m. The committee must rise to report to the House before the hour of adjournment which today is 10:00 p.m.

The honourable Government House Leader.

HON. KIM MASLAND: Mr. Chair, would you please call Resolution E11.

Resolution E11 - Resolved, that a sum not exceeding $4,266,326,000 be granted to the Lieutenant Governor to defray expenses in respect to the Department of Health and Wellness, pursuant to the Estimate.

THE CHAIR: We have 35 minutes left with the Liberal caucus.

The honourable member for Timberlea-Prospect.

HON. IAIN RANKIN: I just have one topic I would like to cover in a short time before I pass it over to my colleagues. That’s around availability and access to midwives.

I have asked about it in Question Period, and I know more recently my colleague for Dartmouth North posed a question as well. Having experienced the service that they offer - we had Jessica, Zoe, Theresa, and Shannon provide excellent care. It was really tremendous to be able to have that access and a privilege. Learning about the wait-list and many people, and people that I know, are trying to get access in the HRM area, but there’s parts of our province that don’t have any access at all.

I’m not going to pontificate on the attributes and the reasons why they’re so valuable. I know that the minister has a health background and knows probably more than I do about it.

There are only 17 registered midwives in the province: in Antigonish, on the South Shore, and then again in HRM. For families who are in Cape Breton or the Annapolis Valley or in other regions, they can’t access the care. I just want to table a document. On November 3^rd, I asked the Premier if he planned on extending midwifery across the province, and he said, quote “We need to increase access and we need more of them.” I’ll table that.

Since the Premier committed to expanding this, I’m hoping that you can point to where in the budget we can find this increase for midwife access.

THE CHAIR: I recognize the Minister for Health and Wellness

HON. MICHELLE THOMPSON: There is no new money in the budget this year for midwifery expansion. However, we are committed to continuing to work with our partners at Nova Scotia Health and the IWK around the service.

For a short period of time, I lived in Scotland. I had the good fortune, and when our first child was born, our care was entirely delivered by midwives. It is a valuable service, and although there’s nothing this year, we are interested in seeing how we can expand.

IAIN RANKIN: The Premier also said that he’d be happy to work with him, which is me, on that, to make sure that it’s balanced across the province. I think given that the Premier has given his word of certainty that he’ll make sure it’s balanced across the province, there are key areas that don’t have access to this service, so I do think it’s important to potentially go to the Treasury Board. I’ve been on the Treasury Board, I know there’s a lot of room in restructuring budgets, especially in the Department of Health and Wellness, and I think there is an issue around equality of access to health care, especially something that’s as important for women’s health.

We had nothing but midwives deliver, actually as well, because the RN came late, and the baby was already born at home. I think that a lot of people believe that it’s just home births. It was the case for us, but the majority of them still take place at the IWK, and we need access to midwives, so again I’d ask the minister if she could commit to finding the funding to ensure that we have equality of access to midwives across the province, please.

[5:30 p.m.]

MICHELLE THOMPSON: What I will say is that I will continue to work with the Nova Scotia Health Authority and the IWK to see what our opportunities are to expand. I don’t even know off the top of my head the availability of midwives, as an example, so I think it would be something that we would need to look into a little bit further, but I agree. I think it’s an important part of women’s health. They are a wonderful service, so again, we will continue to look at that over the course of the next number of months.

THE CHAIR: The honourable member for Bedford Basin.

HON. KELLY REGAN: If we could just start off with some quick questions here about Bedford, simply the number of patients who are without doctors in the Bedford area. I think bundled in with that, in terms of reporting, is usually Hammonds Plains as well, but if we could just get that number.

MICHELLE THOMPSON: We will endeavour to get that information for the member. We tend to keep the statistics by zone, so I’ll have to see how deeply we can dig down in order to get that information.

KELLY REGAN: I should know because I’m Chair of a committee.

We have a number of doctors in Bedford who are either beyond their 60s or in their 60s, and I know I’ve chatted with Dr. Orrell about this before, but we have some who would like to retire or reduce their number of patients. I’m just wondering, what are we doing to encourage doctors to stay, because a lot of them do have high patient numbers? If one of those comes off, that’s a huge number of patients who suddenly do not have a doctor. What are we doing to make it attractive to doctors who would like to transition to fewer patients, but we would like to keep them working? Is there anything that we’re doing to encourage doctors to either a) stay on, or b) take a reduced load and stay on a bit longer? I think if they all leave at once, we’re going to be in big trouble.

MICHELLE THOMPSON: We do know that there are a number of physicians, not just in Bedford but across the province, who are 60 years of age and over, so we’re working with those physicians to understand what their estimated retirement plans may be.

Ideally, what we would do is work with Doctors Nova Scotia. There’s a mentorship program we’re discussing developing. It’s almost that transition into practice. How do we get new doctors in and support them as they build their practice with these physicians who are nearing retirement who want to reduce their hours?

With Doctors Nova Scotia, we’re looking at a program transitioning folks in, but also how we transition people out in a way that still allows us to use those skills and raise, not just the numbers in the practice, but also the skill mentorship with more of the junior physicians.

KELLY REGAN: In terms of walk-in clinics, once upon a time we had a lot of walk-in clinics in my area, which, I would note has shrunk considerably over the years. I think I’m the only person in the House now who’s served three different constituencies because every time I turn around, it gets made smaller and they rename it.

In terms of walk-in clinics, once upon a time all of the doctors who were in private practice got together and they had a clinic. They had after-hours coverage, they had weekend coverage. Doctors would only have to serve maybe one evening and one Saturday a month, or one Sunday a month, that kind of thing. It worked out really well. I could be exaggerating the number, but I think there were about 30 doctors that were all involved in this. It was between Bedford, Sackville and Fall River.

Then, when a previous government sort of encouraged people to set up walk-in clinics, what happened was that all these doctors would be sitting there on their Monday night and no one would be coming in because everybody was going to the new walk-in clinic, so they stopped offering the after-hours services and did it with weekends.

So then we had the walk-in clinics, but now, of course, we wanted to get more people attached to family doctors, so we don’t have the number of walk-in clinics anymore. The result is that people are going to the Cobequid Multi-Service Centre if they have something as simple as an ear infection or something like that, so people get jammed up there instead.

I’m just wondering what are the plans for walk-in clinics? It seems to me that every time, it’s like whack-a-mole. As soon as we try to fix one problem, another one pops up over here.

MICHELLE THOMPSON: There’s a couple of things that have happened. Often in those practice models, it is the business model, generally, of the physicians as opposed to us mandating how they would work. That would have been the way that things were done in the past.

The walk-in clinics now, we’ve done a couple of things to try and improve access because we know that they are so busy. We have extended virtual care codes, as an example, to the walk-in clinics to allow physicians to generally speak to patients on the phone, if that’s a preference that they have.

We’re also looking, in terms of the Alternative Payment Plan contracts that we have, at how we can work with physicians around the accountability to offer some after-hour and weekend coverage, as well, within their practice. It is a work in progress. It does vary across the province. It varies across communities, based on the physician complement they have and the business model that they have.

It certainly is a valuable service and I know that the emergency room physicians are anxiously waiting for us to find different solutions in a number of communities across the province.

KELLY REGAN: In the past, the now-member for Sackville-Uniacke frequently talked about extending the hours at the Cobequid Multi-Service Centre, the last time I checked, closes at midnight but it might close earlier now, I’m not quite sure. There was discussion about the need to extend the Cobequid Multi-Service Centre to 24-hour care. I was just inquiring if you could give us an update on those plans.

MICHELLE THOMPSON: We know that there is a lot of congestion around the Cobequid Centre, as you mentioned. It is difficult to extend the hours, mostly because of staffing issues related to the operations, and we also know that there is no Admissions there, so we do need to continue to have pathways to other tertiary-care facilities in Metro.

The other things that we’ve been looking at are there has been some innovation done around how do we increase Pharmacare access, things like we have a proof-of-concept of a nurse practitioner and a pharmacist clinic that’s running very, very well in Pictou County. We are watching that very closely to see if there’s an opportunity for us to roll that model out across the province as another means for less urgent - for those folks that need episodic care within the scope of practice of a nurse practitioner and a pharmacist.

KELLY REGAN: The minister will probably remember that in the last House session I did bring forward the issue of lack of access to OB/GYNs. I was wondering if the minister could update us on what is going on with that because I know we did have some open positions there. I will just say that the constituent that I raised the issue about did get an appointment. It’s booked. I don’t think she has actually had it yet. The last time I checked she hadn’t had it yet, but she never did get a letter response back from the department and she has mentioned that to me several times. I know that the minister very kindly made sure that she did get an appointment, but I think she was looking to hear back from the department as well. I will just raise that with you on that particular issue.

I am wondering if you could, in fact, update us on what the situation is with OB/GYNs and, of course, with the opportunity for people to have some of their fertility or surrogacy costs picked up by the taxpayer. It begs the question, are we opening the door financially to a group of people but we are not opening it to everybody? In fact, it’s difficult to get into the fertility clinic and there is only one clinic that is doing that work in the province. Maybe if you could just speak a bit about what’s happening there so we can better understand, because for women in their 30s and 40s, a wait time is a critical issue.

MICHELLE THOMPSON: I will start with the OB/GYN, the chronic pelvic pain clinic. We did do a site visit there. Of course, the shared person that we’ve been supporting working with - I was quite anxious when we toured the IWK to go and visit the clinic. We spent a long time there, actually, speaking with the physicians. They do have an extensive wait time. It is around 18 months and we talked to the physicians about what could possibly make things better. They do have a nurse practitioner who’s included in the clinic now, who is actually doing triaging to look at the number of referrals, date of referral, and the reason for the referral. That has been helpful, and it has allowed them to reprioritize the list.

Also, we talked about making sure that the referrals are appropriate. Sometimes referrals come in for things that perhaps could be seen at a regional site, but referral pathways can be habitual sometimes, by physicians, so making sure that everybody that’s on the list actually needs to be at that specific facility or clinic.

[5:45 p.m.]

They’ve also created a 12-week program for women who have chronic pelvic pain. This is a 12-week program where they are followed by a physician to create a wellness plan, to introduce treatment and make sure the treatment is effective, with the view that once that 12-week program is over, they would then transition either to their family physician to continue with care or to a regional obstetrician or gynecologist.

We do know that there are some pressures around that. That clinic in particular is a subspecialty of OB/GYN. It is a difficult-to-recruit subspecialty but certainly we are always open to that. I keep track of that clinic fairly closely just to see what the supports are.

In terms of the fertility clinic, I will admit that my knowledge of that clinic is not quite as deep. It is a private clinic, so I think that would be, in terms of being able to access that or increasing services, that actually would be part of the business model of that clinic. It would be driven by the demand and their ability to recruit to their service as well.

I appreciate your point about that window as it narrows. Hopefully this will also be an incentive for those physicians to see that there will be more opportunity and recruit to their business.

KELLY REGAN: This is my final question. The Minister of Seniors and Long-term Care has referenced in a letter to the Health Committee that nurse practitioners are going to be hired to deliver health care at long-term care homes. I was wondering how many had been hired.

In the letter, she also referenced that the nurse practitioners could also be delivering health care to the surrounding community. I was just wondering if you could speak about how that would work practically, in terms of if the community would be coming into the long-term care centre to do that. I hadn’t heard that mentioned anywhere else, and I was wondering how that would work.

MICHELLE THOMPSON: I don’t have the exact numbers. That’s in the other book that I have, when I was covering for the minister last week. What I will tell you of that is that a portion of the work that the nurse practitioners are doing - when you question Minister Adams, you’ll be able to ask that specifically - but in total, when they’re shared, some of the work that they would do would be primary care. They would work in a variety of different settings in order to support primary care.

I will say, just from my background in long-term care, that it will really be an important service to have those nurse practitioners in the facilities. You can, number one, get care in a timely fashion for residents, and also prevent some transfers to hospitals.

As an example, where I worked, we had access to a primary care provider on a daily basis during those early days of COVID-19 and as a result we had next to no transfers to hospitals. Residents were able to receive the care they needed right in the facility and we were able to update families on a very regular basis as a result of that.

It is an effective program and it does take away from having to transfer residents to emergency, which is really important. It’s not always the best place. The other portion of the time that the nurse practitioners will be working, they could be working in a variety of different settings.

I’ll make sure Minister Adams knows you’re going to ask that question.

KELLY REGAN: I asked you this question, not Minister Adams, because you are responsible for the Office of Health Care Professionals Recruitment, right? I just want to be clear that that’s why I wasn’t intending to ask her about it. I was intending to ask you because you have the person who is the head of that particular office here, sitting with you.

You don’t have those numbers? If we don’t have those numbers here today, could I request that I get those?

MICHELLE THOMPSON: Sure. We do have numbers around the nurse practitioners, but the recruitment pieces would be for Dr. Orrell to look at, the recruitment processes. Certainly, the number that have been just hired - I think the number is 13 - but the cumulative number I don’t have. We would be happy to get those.

THE CHAIR: The honourable member for Annapolis.

CARMAN KERR: I want to thank the minister and senior staff for being here today. Since October of last year, Soldiers’ Memorial Hospital in Middleton has suffered overnight closures in the Emergency Department for the last number of months, as mentioned. Many constituents, town council, paramedics, have all come to my office quite concerned. I guess my first question to the minister is: Is there any update or could she provide an update maybe on Middleton Soldiers’ Memorial Hospital?

MICHELLE THOMPSON: I know that we’ve been back and forth a couple of times about it, top of mind for the folks in your constituency.

There has been some work done in terms of the surrounding hospitals and what coverage they are able to offer. Usually, for the most part, the closures at the Soldiers’ Memorial Hospital are related to physicians. One of the things that we have taken on is to look at incentives for physicians when we bring them in to actually incent them to stay in rural communities. It’s going to be very important for us to reward physicians who are willing to work in those communities, so that’s one of the things. It’s very early days of that program.

The other issue is that we’re, in your area in particular, looking for family physicians who have a particular interest in emergency room medicine so that they can cover not just - I know you have a number of primary care issues as well - we’re looking at physicians who have an interest in both family practice as well as working in the Emergency Department to increase access across both of those access points.

CARMAN KERR: An easy segue, I know it’s early days for incentives, but could you elaborate more on specifics for incentives for those physicians you mentioned?

MICHELLE THOMPSON: I’ll tell you a little bit about the incentives. The total incentive amount is $125,000 per participant. With an initial payment of $25,000 upon signing a Return of Service - there is a Return of Service component to the contract - and then five annual payments of $20,000 at the end of each year of service. It’s not a prepaid bonus. We are allowing around $3 million in the budget for that, thinking that we would have about 100 physicians per year enrolling in that program. Of course, every 100, over the years, it will sunset so there will be some people come off it as the program grows and it’s wildly successful.

CARMAN KERR: I hope that program is wildly successful as you do. Are we suggesting that it’s $3 million for Middleton? No? (Interruptions) I may do but nice try. I guess some more pointed questions that I have been asked several times and I honestly don’t have the answer, is the closure of emergency in Middleton in evenings, is that being considered as a more permanent move? Is that a temporary move? Can you elaborate on the position of the department?

MICHELLE THOMPSON: There is no intention to have a new model where it would be closed in the evening. It is around a resource issue of people. Certainly, always looking for different ways for people to have access. Again, looking at the different proof of concept, urgent treatment centres that we started or maybe nurse practitioners and pharmacists. It is early days in those programs but always looking for ways to improve access but there are no plans to alter the hours on a permanent basis.

CARMAN KERR: Great news, I will pass that on, so thank you to the minister.

I guess switching gears or maybe it is another segue. As the minister knows, I’ve mentioned the village of Lawrencetown has worked hard on developing a community health centre. It’s a brand-new facility, it has five rooms, fully furnished - it’s a bit of a plug, isn’t it - completely renovated, wi-fi is covered, lights are on. It’s attached to a pharmacy by a pharmacist who owns multiple locations. I have mentioned this to Dr. Orrell as well and I appreciate speaking to both of you about this.

My question is with the pilots, what is the criteria for the pilot program with the pharmacies and how will that roll out?

MICHELLE THOMPSON: Thank you, that was a good plug. It’s nice to know it’s move-in ready, that’s what I would say, yes. Really, it’s around the availability of the practitioners is one of the issues that would be a stumbling block. We certainly continue to recruit so that we can improve access in areas of highest need, which of course we know there is a particular need in your zone, in your area.

We do have the two clinics, in Pictou and Truro, and they are proof of concepts so we’ll be doing some early evaluations and ongoing, but we do feel that will be something we’ll be able to roll out in the future.

CARMAN KERR: Hear the minister is aware of the high need in my area.

Just to speak to what was just mentioned, evaluation of those initial two locations, could the minister elaborate on what may be involved in that assessment? Is it patient experience and service delivery value and so on and so forth?

THE CHAIR: For the members, we have about five minutes left in this round before you could go to the NDP caucus.

MICHELLE THOMPSON: The Nova Scotia Health Research & Innovation is doing a full evaluation but to your point, there are things that we are looking at: what are the things, what are the reasons that people access that service; maximizing scope of practice or are there things that are beyond scope; patient satisfaction. The early indications we have are that it has been very successful, and people are really pleased.

We see a lot of people, particularly those who have diabetes as an example, who are accessing that service for care. I think the pharmacist in Pictou County would tell you that she gets a lot of home baked goods, lots of flowers. There’s quantitative data but there’s qualitative data as well, so we’ll be looking at both of those things. But the early days have shown that it has been very successful so far.

CARMAN KERR: I don’t know if I asked clearly enough but if I report back to this group in Lawrencetown, they’ve got everything lined up and they are ready to go for the last year and a half. Is there a window or timeline that they can expect that this pilot will be assessed properly and then move on to the next location?

MICHELLE THOMPSON: What I would say is it is really more around the availability. I think we know, for the most part, that it is going to be a successful model. There will be tweaks along the way. I think the issue is really around the availability of practitioners.

Certainly, we’ll continue to have conversations with you and the area to see who is there. On-the-ground information that you have to offer us will be really helpful in terms of whether or not there are people from your community who are in training programs or if there is some way you might know somebody who would be interested to come into the area. We’re happy to continue to have those discussions.

[6:00 p.m.]

CARMAN KERR: I have two nurse practitioners who want to practise in that location, so I’ll let the minister know.

I only have a couple of minutes here. I have a constituent who has had three aneurysms, needing urgent surgery - and I know a number of MLAs would experience similar things - they couldn’t find an ICU bed I believe the first time. The second time, apparently there was limited OR time. The surgery is fairly lengthy, and I’m no medical professional, but I wonder, are longer surgeries or procedures being restricted, or because they’re harder to staff potentially, would that lead to this kind of situation?

MICHELLE THOMPSON: The length of the surgery is not a deciding factor. What decides it really is around the availability of beds and post-admission. If it is an elective surgery and you require admission following, if there are some staffing issues, then it would be more difficult. However, if it was an urgent or emergent surgery, there would be no denial of service for that; those continue. The aneurysm would be triaged by the cardiovascular surgeon, and that would move the person in terms of priority.

CARMAN KERR: I may only have room for one more question. So switching to virtual care, my riding of Annapolis, we have hundreds of people without internet and cell service. I mentioned that in the last QP. I guess in the budget, is there - at the MLA office, we do a lot of education around virtual care, showing people how to sign up, where to sign up, that sort of thing. I can’t help but think that someone would be better suited to go through that or alongside our office. Is there anything in the budget that would help the community - a program, walk-through virtual care and maybe a PR campaign around virtual care?

THE CHAIR: Order, please. The time for the Liberal caucus for this round has expired.

Now, off to the NDP caucus. The honourable member for Dartmouth North.

SUSAN LEBLANC: I’m happy to be back for another energetic round of questions. Have no fear, colleague: I will ask a similar question. We’ll get your answer eventually.

I did want to start with a couple of things about midwives and a few of the things that I have heard, just in the last half an hour.

My pitch for midwives is slightly different than my honourable colleague’s. When I had my babies, my family doctor felt she was beyond the child - she was definitely beyond the child-bearing years - beyond the child delivering years. Because I was a geriatric mother - swear to God - she referred me to the perinatal centre. I had two perfectly healthy - thank goodness - pregnancies, mostly normal births. But I’m willing to bet that my visits to the perinatal centre cost a heck of a lot more than going to a regular family physician or to a midwife.

So I wonder just how many people are in the situation where either if someone doesn’t have a family physician in general - which we know there’s 86,000 - or the family doctor is not delivering babies or following pregnancies, how much money are we spending through the excellent - don’t get me wrong - care at the perinatal centre when we could be saving a lot of money and the care could be even more than a once-a-month appointment. I just wanted to know if that’s being considered when we think about a midwife program expanding.

The other thing I wanted to ask was, the minister mentioned, we need to find midwives. I know several midwives who would love to practise in Nova Scotia who just can’t because of the lack of a robust program here. So number one, could midwives be included in the Office of Health Care Professionals Recruitment, but also is there any consideration of opening a training centre for midwives? Since we have such an amazing women’s and children’s hospital here, is there a thought that that could help with a midwife program, to do actual training here?

MICHELLE THOMPSON: What I would say is that in this budget year, there hasn’t been any money designated for that, but certainly we are open to understanding the cost-effectiveness of midwives and, of course, interested in learning more.

It is a very specialized program, so I’m not sure that in a short term or even in an intermediate term that we would be able to stand up an education program until such time that we would have a more robust midwife service across the province. I think there’s more to say on it. I think there’s work that could happen in metro as well, but also what would it look like in rural communities? I think there’s more to do on that, but it will take some planning in order to understand what a model of care would look like across the province.

SUSAN LEBLANC: I also wanted to ask about the OB/GYNs that my colleague from Bedford Basin was asking about. Thank you for answering the questions about the endometriosis clinic. I will reference the bill that I tabled last week, I think I’m allowed to do that. Am I allowed to do that, Clerk? Can I talk about bills? No? Not even in Estimates?

Anyway, bringing awareness to endometriosis. I just read today, my NDP colleague in Ontario, Suze Morrison, who tabled and got the bill passed in Ontario, has just announced that she will not be running in the upcoming provincial election in Ontario because of her endometriosis and the journey that she’s on with it. She’s making that announcement to bring further awareness to it.

I’m wondering if there is an active recruitment of OB/GYNs. You mentioned that endometriosis carries a subspecialty, but in general, is there an active recruitment of OB/GYNs for across the province?

MICHELLE THOMPSON: Certainly there is, across the province, not just in HRM but also in the outlying regional hospitals specifically. We are always looking for specialists, particularly OB/GYNs to enhance the program. To your point, women’s health is very important, and we know that the wait times can be long in certain areas, so we’re committed to getting the right folks in place. Also, I think particularly in rural Nova Scotia, really understanding what the scope of practice is for our family physicians so that when we talk about utilizing the scope of practice for all health care practitioners, we want to also include our family practice physicians as well, particularly in rural Nova Scotia, so that there are no unnecessary referrals to specialty services.

SUSAN LEBLANC: I want to ask a little bit about physician recruitment now. The first question I have is related to the answers you were offering the Liberal caucus, and that incentive program that you referenced. Can you clarify that is for rural physicians? Is it for family physicians only or also specialists? Also, how do you define rural in that case?

MICHELLE THOMPSON: It is both for specialists outside of - basically the boundaries outside of HRM, with the exception of Eastern Shore, because that gets pulled in as well, and the incentives are the same for specialists and for family practice physicians.

SUSAN LEBLANC: When that incentive program was devised, is it competitive with other provinces or other jurisdictions?

MICHELLE THOMPSON: It is competitive. It’s not the highest in the country but it is very competitive in Atlantic Canada. I think Newfoundland is a little bit higher, and there are a couple of provinces out west, but it is very competitive within the market to other provinces, yes.

SUSAN LEBLANC: I’m going to speak about this a little bit later, too, I think so forgive me if I repeat myself. When the member for Annapolis was speaking - when I was hearing his questions - I thought it sounded a lot like what’s happening in Dartmouth North. When you think about those two jurisdictions, Annapolis is extremely different than Dartmouth North.

However, I think that there is sort of a case to be made with deeply rural areas - Annapolis obviously has a town, but it’s a big constituency with a lot of rural areas - and very urban inner-city, high needs areas.

What I mean by that is that in the same way that you might have a lot of convincing to get a physician to go to Annapolis - although frankly if I were a physician, it might be one of the first places I go because it’s so beautiful there - but you’d have to incentivize the moving and getting a person to move with their family.

It feels as difficult, to get someone to come to an area where the population is extremely marginalized. Where the types of illnesses are related to poverty and to mental health and addictions. I’m not talking about across the board but in a big pocket of the constituency I represent, that is the fact. People don’t have cars, they can’t get out of Dartmouth North to get to a doctor somewhere else so if they don’t have a physician in the actual community, it’s really hard.

I’m just wondering if that’s been given any thought. Obviously, I’m making that case for my community, and I will do so more later. Is that a thing that exists? Is that a consideration or is it just, the Central Zone has the most, so we have to figure out how to serve the rural areas in the other zones before we go back to Central Zone. Or is there some give and take?

MICHELLE THOMPSON: There’s a lot in that question. What I would say is a couple of things.

I think that there are practitioners who have preferences coming into the province. We all have preferences in terms of where we like to work and places that we want to avoid. What I would say is as practitioners come to us, we want to match them with the places they want to work the most. There are some physicians who would thrive in that environment and I’m sure you know some of them.

I don’t think there’s just one way that we would address that. We have an active recruitment. We’ve signalled that the province is open for business. We want physicians here not just simply to work but also for the work/life balance. We’ve had some luck when we promote the province as well as our communities and things like that.

I think there’re other ways that we can build teams. This might be a good spot: I’ve reached back out to the Brotherhood, as one example, because I didn’t have a lot of information for you the other day and I wanted to make sure I represented the voice of the Brotherhood and the community.

This would be a prime example of how an investment would build a team that would also attract primary care providers. If you’d indulge me, I’d just like to tell you a little bit about the program.

[6:15 p.m.]

The Nova Scotia Brotherhood Initiative provides culturally appropriate clinical services to African Nova Scotian men via a primary health care model. This model considers and incorporates the determinants of health as a core focus in supporting the community. The Brotherhood focuses much of its activity on working with Black men in the Central Zone but has a reach across the province via virtual means. Technology has enabled this team to offer virtual primary care appointments and online programming. There is further potential for expansion into other zones via partnership with key community groups and primary care colleagues across the province.

The Brotherhood has demonstrated improved access to care in a culturally supportive environment with five core pillars. The first is health promotion offering health information to Black men to promote awareness and invite positive health behaviour change. An example of this is a partnership with the Upper Hammonds Plains prostate cancer support group, and this ongoing relationship with support groups for Black men enables sharing of information as well as coping and support tools and is linked to the national prostate cancer group.

There’s a community connection as well. The Brotherhood is a central hub that enables sharing of information and building trust within the Black community and the health care system. An example of this work is the close partnership with the Health Association of African Canadians and the Association of Black Social Workers. These collaborations foster deep connections and promote the health and wellness of Black Nova Scotians synergistically, including an upcoming screening event at the end of April at the Black Cultural Centre.

They talk about primary care. The team supports Black men with access to primary care via a family physician who is of African descent. This access point is for patients without a primary care provider, for those needing to access added supports in a culturally supportive environment.

They offer navigation as well. They work closely with colleagues in acute care, primarily the Nova Scotia Hospital and Abbie J. Lane, to support patient integration into communities. And evaluation, so access to data. Nova Scotians’ specific health information is an ongoing challenge, and the Brotherhood evaluates its work and seeks to advocate.

In addition to those core functions, there are a few other items they wanted to share: Advocating with and for men in the justice system, the Brotherhood offers a quarterly anger management program, which is 10 weeks and is designed specifically for Black men; partnering with the Office of Addictions and Mental Health, a newly minted, transcultural psychiatry program supporting rapid access to care for men in need; significant mental health supports via Barbershop Talks.

Men’s Health League is a community advisory and feedback mechanism, and they have multiple locations in North Preston, East Preston, Cherry Brook, Lake Loon, Dartmouth North, Halifax, Upper Hammonds Plains and a hub site in West End Halifax.

The expansion of this is important, but also now the Sisterhood. The formation of the Nova Scotia Sisterhood Initiative will mirror much of the approach and the related success of the Brotherhood in much the same ways. Research consistently demonstrates that when a female lead in the family is healthy, the entire family has better outcomes, so we know when we raise women, we raise everyone.

Base research by Dr. Ingrid Waldron demonstrates that mental health issues are a concern within Black Nova Scotian women, including stress and worrying about their brothers, partners, and themselves in a racialized environment. This would be a primary example of when we invest, it allows us to attract a variety of practitioners to support the work that’s happening around this organization.

I think these are very important. It works at a determinants level, it works in the community and it allows and enables people who know their communities well to be responsive to the need. This is important work that we need to continue to do. I know it’s not exactly what you’re looking for, but I think it’s an important place for us to talk about how we can - it’s attractive. If you can work in a team as a health care provider, the success builds on the success. That’s what I would say.

SUSAN LEBLANC: Yes, like I said, I think the program is amazing and that team - we shared an office kitchen, so I got to know them really well, how they were working - Dr. Ron and Mario and Dwayne and other visitors that would come over. I miss them. I’m really excited and I hope the Sisterhood expands in Dartmouth North. It is exactly that kind of thing that I envision, a centre in Dartmouth North that has a Brotherhood and a Sisterhood in it, clinics or whatever, but also the same place has a couple of other NPs and another physician, social worker, diabetes person - I apologize, I don’t know what they’re called, but you know what I mean. One of those health homes that have the collaborative practice. It is the dream but I will get to that later.

I just wanted to go back to - the Progressive Conservative platform promised increased pay for family doctors and a program that contributes to doctors’ retirement funds, but we haven’t heard an announcement about that. So I am just wondering if those programs are underway and what details can be provided.

MICHELLE THOMPSON: The retirement fund for physicians is under development currently. There will be more to say as we move through, but we have begun the early steps of that. There will be more to say, but it is not imminent. It will be a little bit of time, but before the end of the year we will be able to announce - around the change of the year, we will be able to announce more about it, but the work is underway.

SUSAN LEBLANC: Is the increased pay the incentive fund or is there also a new agreement in the works for doctors?

MICHELLE THOMPSON: There was new funding available in the last master agreement and the next master agreement will be in 2023, and it will need to be renegotiated. We are always open to different things and the incentives are an increase, but we will work through this master agreement and then we will go into the next negotiations.

SUSAN LEBLANC: Getting back to doctor recruitment or staying with doctor recruitment for a minute more, can you explain the vacancy system? You were talking about when a physician comes to you, you try to match them to where they would like to practice, what works for them. But my understanding is in some areas there are vacancies and then there are not vacancies, and what I mean is - I don’t mean at a clinic, a doctor has left so there is a vacancy, that kind of vacancy - but in terms of contracts and Alternative Payment Plans.

When I’ve talked to people at Nova Scotia Health they will say, we have a vacancy for all of the Dartmouth part of central zone right now, so that vacancy could go anywhere on that side, or, we don’t have a vacancy right now, or there will be a vacancy in Halifax but it can’t be transferred to Dartmouth. Those kinds of things. But again, it’s not for a specific clinic, but it seems to be a system approach to doctor recruitment or management.

I am wondering if someone can shed a little light on how that works, and how does it work in central zone, and is it different in other zones?

MICHELLE THOMPSON: Again, there is art and science. I will give you the science, and I will tell you the art. We have 51 community clusters and those are boundaries that are used in the department. Twenty-nine of those are considered understaffed. You take the population of the cluster and you divide it by a panel of 1350, and it gives you the number of physicians that you would need - that’s the science.

But there are variables, as well, that we have to consider - demographics, burden of disease in certain communities. Sometimes there may be physicians that don’t want to work a full panel, so that is where the art comes in.

But always working with community, and that is one of the things that we committed that we wanted to hear from community in terms of what their needs were and work with them as opposed to mandating what happens.

That voice has been very important, which is why we did the tour. We still stay very connected to communities. Dr. Orrell does a lot of tours, Karen Oldfield and Deputy Minister Lagassé are on the road a lot visiting hospitals, talking to community groups, trying to understand what their needs are, so that we are very intentional, but the straight math, that’s how we would do it, and then there would be art and uniqueness around how we would facilitate in community.

SUSAN LEBLANC: Like all good things, art and science have a combo contribution.

According to a CBC News investigation, the number of health care vacancies has increased by about 24 per cent in the last six months. The data shows that in March 2022, there were about 2,540 vacancies across all fields, an increase of 492 positions since the new recruitment office was formed. That doesn’t include vacancies at the IWK. Nearly 300 registered nurse positions have opened up since the PCs formed government, since your caucus formed government. The NSNU says that around 25 per cent of nurses in the province hope to retire within the next five years.

Can the minister explain what the plan is to fill those nursing positions, and what is the explanation for the jump?

MICHELLE THOMPSON: There’s a lot in that question as well. I will tell you that COVID‑19 has been very difficult on a number of folks. There have been folks, perhaps - I know a couple myself - who just need a break from the profession for a period of time to rest. I want to acknowledge that because it has been a very difficult couple of years. The system was really stretched prior to COVID‑19. We talk about COVID‑19, and we have all had our experiences.

Certainly, I know that the folks in the Department of Health and Wellness have worked very hard as well. I will tell you that at the front lines it has been very taxing. We have been asked to do things as health care providers that we would not normally have ever been asked to do, like separating families, as an example. During COVID‑19, that was probably one of the most difficult things we had to do - to separate people when they were in hospital or long-term care from their families for safety reasons.

I think that there’s a degree of burn out and a need to rest. I hope that those folks are not lost for good, that they will return.

We did recently increase seats, and I know that the previous government increased seats as well in the nursing program. We need to continue to do that. It is really important that we have a solid immigration stream, and that’s one of the things that the office is looking at - how we create easier pathways for people to come in. We could take 1,000 nurses today.

We have offered every nursing student for the next five years a job. I spoke with a hospital today, I was on a conference call with them, and they were really pleased that they had recruited a large number of nurses from a graduating class. They were thrilled. I think they were expecting 23, which is pretty significant.

We also want to look at a mentorship program for nurses. Twenty-three nurses is wonderful, 23 new nurses is terrific, but we also want to make sure that there’s expertise and wisdom in the system to support them as they transition to practising their skills.

The other thing that we see is that a lot of vacancies have internal movement. There are a lot of requirements around the collective agreement in terms of posting, and then somebody fills a position and they have to post that position. We have a lot of internal movement, really with a priority to getting people outside the system into the system in order to fill those gaps. That is why the vacancies are a bit of a moving target because people are moving inside the system.

Those would be some of the things that we would be doing to address that. It’s going to take some time. There’s no question about it, but there is an urgency to it because to the point we know that people are tired.

SUSAN LEBLANC: I heard a little bit about this in the Public Accounts Committee. I’m wondering if you could talk a little bit about what is actually happening in terms of the immigration stream. Is Dr. Orrell - and I’m sorry, I’m not asking you this question directly, it’s very strange - is Dr. Orrell meeting with the Department of Labour, Skills and Immigration? Is there a set thing that nurses from outside of the country are given - these are the things you need to do, and this is what we can do for you? Is that in place yet, or is that just under way? If it’s not in place, do we have a timeline for that?

[6:30 p.m.]

MICHELLE THOMPSON: There are a number of things happening, we have to work across government in order to tackle this problem. There’s no question.

Dr. Orrell’s department does work closely - recently Labour, Skills and Immigration, Dr. Orrell’s office, and the Department of Seniors and Long-term Care worked together and did a mission. They were in Singapore, Dubai, and London looking at bringing folks here and doing some recruitment.

We also have to work with our federal counterparts, so we are looking specifically at building an immigration stream targeted in particular places. The Philippines, as an example, would be a place where we would like to work.

One of the things we’re interested in is not just taking the health care workers but also settling families. How can we bring families here? What are the opportunities for the partners of the individuals who are coming, as well as the students? There’s no shortage of work. Are there skilled trades? Could we use partners as an example as early childhood educators? What are the opportunities in our province? Then helping folks settle, so families can settle together, which will also be part of the retention piece.

There is a lot of work under way, trying to get our wheels going. We’re working at it, and then understanding all of the different steps in the immigration process and where are the opportunities to streamline them so we’re not reinventing the wheel every single time. There’s a lot of bureaucratic stuff there that we have to work through, but once we get going, we’re hopeful that it will be more of a steady stream of folks to come in to the - and there’s private business helping with - there’s a number of different partners that are trying to help, because it’s to their benefit as well.

SUSAN LEBLANC: Last thing about recruitment. I’m just wondering at the - I thought it was Public Accounts Committee, but maybe it was Health Committee - Dr. Orrell had mentioned that the office wasn’t able to tell the committee updated numbers on vacancies, and you just mentioned, using nursing as an example, that it is a moving target. I’m just wondering in general, and this goes back to what we talked about the other day in terms of communication to the public and easing of anxiety with good communication, I’m wondering if you or the department could consider the value of tracking and reporting vacancies, maybe not internally, but higher-level numbers, so that we can get a sense over time of improvement or the opposite.

In terms of the public, it’s a general anxiety-easing thing when we see that things are getting better or the tide is turning, that kind of thing.

MICHELLE THOMPSON: We are working on a dashboard to track and report vacancies at a high level. It will never be perfect, but it will give us a sense of where we’re going, and it will also trend it as well, so that people can see whether we’re trending up or down or if we’re staying level. There is work being undertaken in terms of creating a dashboard, and we would do it so people would understand what the difference - not just health care workers, but what they would be by designation.

SUSAN LEBLANC: That’s great. I want to turn to paramedics. I have been meeting with paramedics, with unions - actually both the dispatchers and the IUOE. I know lots of paramedics, and I’ve heard some harrowing stories. Going back to the stories that we’ve heard in the news - the gentleman in West End Halifax who died waiting for an ambulance, to the gentleman who waited in his driveway for three hours for an ambulance in Dartmouth North. I’ve heard stories of paramedics who are menstruating and bleed through their uniforms because they literally can’t stop to take a break. I’ve heard of paramedics having to pull over with sirens on to pee at the Irving or whatever. It just seems completely untenable, working in that situation, and then we add on the stress of the actual job, which I can’t even imagine.

It’s a dire situation. My understanding, and what we know, is that paramedics in Nova Scotia are paid much less than in lots of other places. Every paramedic, it is said, has an exit plan right now, and it is getting worse and worse.

Paramedics are working 12, 14, or 16 hours a day without breaks at all, driving from call to call, and it’s not uncommon for paramedics to be the only truck in a zone. I’m sure you get these too, but I’m tagged on the Code Criticals, so my phone will blow up once in a while with constant Code Criticals. It’s really concerning, both for, obviously, the people who need the ambulances and the paramedics, but also for the workers themselves.

I’m wondering what is in the budget to improve the lives of paramedics and therefore that part of the health care system this year.

MICHELLE THOMPSON: I too have heard a lot from paramedics. I spent half an hour with a paramedic yesterday, actually, to sit and talk about his experience and listen to some of the ideas.

There is a $12 million increase in the budget for paramedics specifically. It’s for the EHS system. I would say that there are other improvements that we’re investing in. As an example, there’s around $14 million that we’re investing in access and flow. That’s important because it supports offload time, as an example. It gets paramedics not waiting in emergency rooms to offload patients and get back out.

There have been a number of things that we have done. We’ve increased the patient transfer units, which has been successful and allowed the paramedics to respond to emergency calls. There’s the multi-patient transfer as well as the patient transfer units. We currently have a committee that’s working at the Department of Health and Wellness, so the Department of Health and Wellness is there, the College of Paramedics, and the Nova Scotia Health Authority. The union is there as well, as well as the folks who work in the department.

Through that table, we’ve been able to identify some easy, quick things that we can do that support paramedics. One of the things would be the graduated licence. It allows paramedics, once they complete their program, to get out on the truck sooner and work, so that we’re not waiting for extended periods of time. There are a number of things.

We also, because there are a number of paramedics off - not just the vacancies, but actually off - for the musculoskeletal reasons that people would be off - we have invested in power stretchers and power loaders in order to support them and reduce the risk of injury.

The actual employer themselves have recently struck a committee where they now have paramedics from the field who are working with them in order to create some solutions.

We also have to look at the education component. During the pandemic there was only 50 per cent class enrollment. They generally graduate about 100 a year and that was down to 50, so we’ll be able to register the full complement of paramedics in the upcoming courses and looking at what are the opportunities to offer that program in a different way to attract more people into the profession.

There are a number of things we’re doing. We stay as close as we can with paramedics to talk about them, to realize their situation. Their pay is competitive within the Atlantic provinces. We want to continue to work with them around that when the negotiations come up again, but their pay is competitive with their counterparts locally in the Atlantic provinces.

Also there are a number of programs I’ve looked into - I can’t name them off the top of my head - looked into the mental health supports within the company around how we support paramedics with their stress. We also have to look at what are our opportunities for international recruitment. We know that the most like paramedic programs are the paramedics who work in Britain and the paramedics who work in Australia, so also looking at where are opportunities to emigrate and able to train up very quickly.

The paramedic file, that work around paramedicine and emergency response is top of mind for me, and so we continue to work and hear directly from paramedics to try and improve the system and improve their work life as well as response times.

SUSAN LEBLANC: It’s great to hear that the pay is competitive with Atlantic provinces, but the fact is that Ontario and Québec are not Atlantic provinces, and they’re not very far away. So lots of people go there and go up north. I talked to a paramedic the other day who was offered a position in some work camp where they wouldn’t even be on a truck, that they would sit in a clinic, two weeks on, two weeks off. I forget how bananas the pay was, but it was like way more than what they make here, and this is an advanced care paramedic.

The only reason they weren’t taking the job at this moment was because they had just purchased a house, which is really nice, and they wanted to settle in Nova Scotia. That is obviously a real thing, that people want a work/life balance, versus travel into the north for two weeks on, two weeks off. But nonetheless, someone in a different position, maybe someone who is not quite ready to settle down, you can just see why someone would take that job pretty quickly.

So yes, I get it. I have a bit of trouble with “we’re competitive with the Atlantic provinces”, because number one, Nova Scotia is a bit different than the other Atlantic provinces, in terms of costs and what we pay for, what we have to pay for here - rents are higher, housing is much higher. It’s not that much different now than in Ontario, frankly, or Québec, so I just put that out there.

The minister has talked about innovation and how amazing our health care system is, which I totally agree with. I see a day where, with investment in people that we could have the place where everyone wants to come, because the pay is good, and the surfing is good. I keep using surfing as an example, but you know what I mean. It’s the best of both worlds, and people don’t have to choose one or the other.

Speaking of the graduated licence, I just had someone contact me last week who is a paramedic student, who had heard about this graduated licence but had no luck in finding any information about it. She asked her instructors; they didn’t know anything about it. She asked another paramedic; they didn’t know anything about it. When will the details of that program be offered? Is there any sense that possibly working paramedics who already have their full licences are a little wary of the program because it might mean extra work in an already overburdened system for them? Is that part of why it’s not taking off?

MICHELLE THOMPSON: It’s not a program, it would be through the college; they are a regulated profession. The College of Paramedics would issue a licence and so that’s where they’d look for the information in regard to that. It would be through their college when they go to have licensing.

[6:45 p.m.]

I think, actually, when I speak with paramedics, they’re pleased that these new grads are on the trucks sooner. The reason being that sometimes there is a lag of up to six months so they’re actually coming out of school, they’re working while their education’s fresh and new and they’re going to have to orientate those folks when we hire them, regardless. The sooner we get them into the field, the better, because everything’s there. They’re not getting rusty. They’re not waiting six months.

It’s similar with all of our new graduates in our programs. We know that we have novice practitioners, and we know that, as health care providers, we have a responsibility to mentor and train and pull them up and put them in situations where they feel supported. It’s not an unusual thing for us in health care. We anticipate these graduates as they come along - and students as well. We do a lot of work with students.

We know that they’re our future colleagues, our time off, all of those things so there already is a culture of training. I would direct that person that you were talking to directly to the college for more information.

SUSAN LEBLANC: I just wanted to go back to the change that was made with the dispatchers. The other day in Question Period, I asked the minister about this. One of the comments that she made was that this will free up paramedics.

I understand that this is a Fitch Report recommendation, but the paramedics that I’ve spoken to, retired and also current, have basically said that essentially the system that we have right now is a gold standard, gold-star system where we have paramedics or former paramedics on the phones. None of those paramedics would work on trucks if they weren’t on the phones. They’re done with the trucks for whatever reason. They can’t be on the trucks anymore because they’re injured. Whatever.

The idea that when you call 911 and get put through to the paramedic dispatch, you’re talking to an actual trained paramedic who can talk you through delivering a baby or CPR or whatever when you’re waiting for the ambulance. It seems like this standard is so great that why would we go to a best practice when this a better practice.

Given that it’s not going to free up paramedics because none of them are going to leave the phones and go back to the trucks, can the minister talk a little bit about the concerns that folks have with this change?

MICHELLE THOMPSON: The practice of hiring civilians as communication officers is actually considered best practice. The International Academies of Emergency Dispatchers says that it’s reported that civilians utilize emergency dispatch protocols better and they generally perform better in situations than paramedics because they’re less likely to deviate from the protocols.

It is considered best practice and it’s part of the Fitch Report. We’re not not going to hire paramedics but right now it’s a very narrow opportunity for us to employ people as a requirement. If we have civilians in the dispatch centre, it allows us to fill chronic vacancies that are there and is actually better ground support.

That communications centre is now staffed by a physician. They’ll call it “The Doc In the Box”. It provides real-time support. There is a registered nurse coming on. There’s no downside to it, I guess is what I would say. If the International Academies of Emergency Dispatchers - that’s where the information came from and that’s where the recommendation came from. That’s what we have followed. Again, it will allow us to fill chronic vacancies and support the ground operations of the paramedics who are in the field.

SUSAN LEBLANC: Is there a budget savings? Is there a savings to the program?

MICHELLE THOMPSON: No.

SUSAN LEBLANC: Moving on to ER closures. Another favourite topic, I’m sure. The minister will know that ER closures have increased year over year in the last number of years. What is the plan to address ER closures in Nova Scotia?

MICHELLE THOMPSON: The short answer is recruitment, recruitment, recruitment is what I would say. I think we’ve talked about the models of care that we have, and I think we all understand and know that the care that perhaps - look I grew up in rural Cape Breton - so the care that I had and the service that was delivered in my community may not look the same going into the future.

We want to make sure that people in their communities have the right care at the right time and that they have clear pathways to the next level of care. Whether that’s regional care or whether that’s tertiary care. We’re looking at a variety of models. What are the reasons people go to Emergency? What are the times they go to Emergency? Would they be better served by primary care access?

Also, marrying with the paramedics, how do we support emergency care in the community across the continuum. One of the priorities is a sustainable rural health strategy which we are working on now with what are the non-negotiables that we continue to have but what are some of the negotiables based on the community and what works best for them. That is a work in progress, but we continue to understand how we’re going to move forward.

But recruitment is a key part of that, sometimes facilities are closed because of a nursing shortage and sometimes they’re closed because of a physician shortage. Again, understanding the community and the needs of that community and recruiting to those needs.

SUSAN LEBLANC: The Fitch Report recommended an ER closure plan similar to other jurisdictions. I understand this kind of plan would allow the number of unplanned closures to decrease. I’m just wondering if that’s part of the strategy. If the government is looking at this plan and if so, when would that be in place?

MICHELLE THOMPSON: I think further to the discussion beforehand, it really is around a strategy, a rural health care strategy particularly, and understanding what the needs of the communities are.

Parrsboro is a prime example where that community now is serviced by an Urgent Treatment Centre, and they’re thrilled with the service that’s being provided. That has been very responsive to the community’s needs, we talked to the community about the services that would be provided there and they’re very content with that service knowing that there’s emergency care very close by.

I don’t think it’s going to be this is just the way it is in every place. We have to work with communities and understand why people are going to Emergency. Is it an issue with access to primary care and if not, how do we then create really clear pathways to make sure people can get the care they need whether that’s through paramedicine on the way to a regional hospital or a tertiary centre?

SUSAN LEBLANC: Maybe a dumb question, but if an ER is closed, how do you track whether someone would go there? Does that make sense? For instance, if I need to go to the ER and I’m in New Waterford, but the ER is closed, then how do you know that I would be going there at 7:00 at night? How do we know what we don’t know?

Are people being tracked? Obviously, someone is going to find care somewhere, generally. Maybe if I’m in New Waterford and I have a sore toe, I might not go to the regional that night, I might wait overnight and go somewhere the next day. But, in general, if I need care and I don’t have it because the Emergency Room is closed in my community, then how does the government know, how do you know, how does the department know when people are using care and how does it fit into the strategy? I’m sorry. I guess the best way to ask it is, how do we know what we don’t know?

MICHELLE THOMPSON: This is what I will tell you. First of all, we can trend when facilities are open. Generally, we stick to how many - in an emergency room we would look at the CTAS. We would look at how many of that triage score that you get - one, two, three, four, five.

If the emergency room is closed in a rural hospital, even if that emergency room was open, as an example, and I had a certain illness, let’s say a stroke, as an example, I would always bypass that hospital, because I need care that allows me to have a CT scan and get medication within a certain amount of time. So there are certain things that will always bypass community hospitals. What we can see over time is to trend what facilities are being used for and why.

The other thing we will see is the Nova Scotia Health Authority can track the number of people who are presenting to the emergency room with CTAS threes are like 3+ and 3-, and then the fours and the fives of the triage scores that are presenting to hospital. That’s something we need to drill down even more.

If we see a community, as an example, they are open three evenings a week, when they were typically open, and we see that it’s for episodic care, that it’s for things that typically could be dealt with in an urgent treatment centre or a walk-in clinic, then we need to talk to the community about what it is that they require. So it really is around tailoring the services. Some things in those smaller hospitals will always bypass, sometimes trauma will always bypass, heart attacks will always bypass because the specialty care they need is actually at the regional centre. I did see the art and the science again - but they are looking at the pathways that people are taking, and how we anticipate and predict the services that are required in communities.

THE CHAIR: Five minutes and 45 seconds left in this round.

SUSAN LEBLANC: That’s actually quite helpful, even though my question was very difficult.

So urgent care centres, I love the idea, very similar to collaborative emergency centres that the NDP introduced several years ago - can’t help but say that - but yes, a great idea and I love it. I’d love one in Dartmouth North, but we’ll get to that later.

Seriously though, speaking of community health care - so this is a little bit different than what we have been talking about - but I do want to ask about this. The minister will know that there are six active, fully community-owned and/or -operated health centres in Nova Scotia. They are in Chester, Clare, Antigonish, L’Ardoise, Yarmouth and north end Halifax, and north end Halifax has a little satellite in north end Dartmouth, actually.

These centres are unique and effective because they are owned and operated by the community, allowing communities to define what they need health-wise, which is what the minister was just saying about what’s the best care for a community, the art and science. Nova Scotia community health centres receive little or no operational funding from the government; 88 per cent of Nova Scotia community health centres report very significant operational pressures affecting their ability to meet the demand for health and social services.

So my questions are: Is there an increase in funding to community health centres in this budget? That’s the first one.

MICHELLE THOMPSON: There is no increase this year in the budget, but we have been working with some of these facilities around business cases and bridge funding in order to support them. I think that moving forward, we can’t get everything done this year, but we certainly are working, and I have lots of invitations when I can finally move around again, after the House, to go visit some of these facilities and see the work they do.

SUSAN LEBLANC: The Nova Scotia Association of Community Health Centres has a long-standing ask for operational funding to stabilize the important centres. That’s for the association, the umbrella organization. Is there money in the budget for that organization? If not, why not?

MICHELLE THOMPSON: There is no increased funding to the association that we are aware of, but we, again, continue to look at business cases to see what the potential opportunities are and what those community centres need.

[7:00 p.m.]

SUSAN LEBLANC: Sorry, Mr. Chair. Is there a plan or strategy at the department level to grow the number of community health centres in Nova Scotia? I know that in the past, my understanding is that in Nova Scotia Health, community-based or community-run with boards of directors health centres, have kind of been less prioritized and, in fact, not funded - no new ones have been funded, in my understanding. I am wondering if that is something that you are looking at again or if that is still the sort of situation at Nova Scotia Health?

MICHELLE THOMPSON: What I would say is that there, again, there isn’t any one model that we are looking at. There is a variety of different resources across the province and so community health centres is one in certain communities whereas others have different resources.

Again, to the point of, across the province, looking at what we have available and working with people around the services that are offered in that community - who does it and how it is delivered - and trying to be as agile as we can in terms of working and supporting access to care for people based on the community needs.

THE CHAIR: The honourable member for Cape Breton Centre-Whitney Pier.

KENDRA COOMBES: Yes, I’m going to have to pick this up after, but I do want to discuss the polices regarding individuals experiencing miscarriages.

My first question is: Is the minister aware of the policy where individuals experiencing miscarriages under 20 weeks are often sent to a hospital that does not have OB/GYN access?

THE CHAIR: Order, please. The time for the New Democratic Party caucus this round has expired.

What I would like to do is propose a short five-minute recess to allow the minister and staff a quick break if it is agreed upon by members.

Hearing none, we will recess for a five-minute break.

[7:02 p.m. The committee recessed.]

[7:16 p.m. The committee resumed.]

THE CHAIR: Order, please. We are back with the Liberal caucus. The honourable member for Fairview-Clayton Park.

HON. PATRICIA ARAB: Last week the Minister of Health and Wellness said that they have a target of recruiting approximately 153 physicians every year to keep pace with the Need a Family Practice Registry and current specialist vacancies. My first question for tonight is, are we on track to meet this goal?

MICHELLE THOMPSON: Dr. Orrell assures me we are on track.

PATRICIA ARAB: Where are these doctors coming from?

MICHELLE THOMPSON: The short answer is wherever we can find them. We’re working with the residents that are in our province now and actively recruiting them. We have an active recruiting campaign and we’re speaking to a number of physicians, internationally-trained physicians and physicians from other jurisdictions. We’re certainly trying to continue the momentum that we have and reaching out. We’ve had a number of people reach out to the office. They know that we’re actively recruiting. In addition to the health care facilities that we have, we’re also trying to sell the beautiful province and the quality of life that we have. There’s a lot of interest in that as well. Health care practitioners are tired across the country, so sometimes a change is as good as a rest. It’s a multi-pronged approach, is what I would say.

PATRICIA ARAB: With these different recruiting prongs, I’m wondering if the minister would be able to let us know the targets for recruitment, domestically versus internationally.

MICHELLE THOMPSON: If we look at the recruitment last year as kind of a guide, 60 came from Nova Scotia, 59 from other parts of Canada and 48 were international recruits. It would probably be about the same. We generally maintain 70 per cent of our residents that graduate in Nova Scotia. There’s no limit. We’re not fussy, as long as they are credentialed and they’re able to work in the province.

PATRICIA ARAB: We also learned last week that 189 family doctors in our system are over the age of 65 and expected retirements in the coming years. This is in addition to current vacancies.

We also know you require approximately three new doctors for every one old-school doctor who retires, according to the CEO of the office, as most family doctors are not full FTEs and work elsewhere in the health care system.

Last week you confirmed that there will be some modelling completed through the resourcing plan. I’m curious if the minister could tell us what that plan is.

MICHELLE THOMPSON: Earlier in the discussion, we talked about the 51 community clusters. I’m not sure if you were here when we discussed that.

There are 51 community clusters. What we would look at is the population in those clusters and we would divide that by a panel of 1350, as an example, to understand what we need. The other thing that we need to look at is, depending on the demographics and the epidemiology of disease burden in each of the areas -

If you are in an area where you have a number of young families, as an example, it’s a little bit different kind of practice than, perhaps, if you’re living in a community that has a high population of people with co-morbid illness. You have to look at that. We’re not one-for-one, just like the doctors are not one-for-one, in terms of the care that we require.

The other thing that we see - that is sometimes complicating, but it’s important to the physicians that we recruit - is that, particularly in the rural or in the regional centres, we have family physicians who want to work so much in their office, but they also maybe want to deliver babies. Or maybe they want to work in an emergency room. Or maybe they want to do palliative care or oncology. We also have to work with people around how we cover the hospitals, as well as give access to primary care.

Again, to the art and the science of it, you can kind of tally up. Then there are other physicians who continue to work above their panels. Some of the other work we need to do is to look at the current patient care assignments - the panels that physicians are caring for - and making sure there’s no latent capacity. What that provides is an opportunity, if there are people who aren’t carrying a full panel to raise them. There’s a number of moving parts to it. It’s hard to give you an exact number, but those are some of the things that go into this physician resource plan that we’re developing.

PATRICIA ARAB: Again, I don’t want to put words in the minister’s mouth. There is an art and a science, as she said, to this. The plan itself for the 51 community clusters - are they done geographically? Are they specific to our different health zones? Would each health zone have a different plan?

Maybe if she could expand on her answer a bit, just in the specifics of how each of these areas is going to be looked at, and is this something that would be made available to the public?

MICHELLE THOMPSON: It is a geographic breakdown. The community clusters have been historic in the province. They have existed for a period of time, and they do look at geographic areas. It would be based on population size and proximity and things like that.

The dashboard is under development now, so that we can look at where we are and what the target is and where we’re trending in terms of recruitment across different designations of health care providers.

PATRICIA ARAB: So the dashboard would be something that would be public facing, that we could track? Would these requirements be listed or would it be just, these are the targets that we are meeting, or would you be able to see the parameters as to what you are looking for?

MICHELLE THOMPSON: We would have a forward-facing dashboard that the public could have a look at and we would be talking about the targets. It may be per zone. Sometimes we have physicians that would work in the Northern Zone. We may have a physician that would work part-time in Truro and part-time in Amherst or Springhill, as an example.

We would do it by zone in terms of what the target is and where we are and how we’re trending - whether we’re trending up or trending down - if we have exceeded or haven’t met our targets, so people would have a sense of where we were going in terms of the recruitment efforts.

PATRICIA ARAB: As you are giving me the answers, I’m trying to formulate how I want to ask the question, so sometimes it’s not going to come out very clearly, but other than the targets, will those factors of why these doctors are going here or what the needs are beyond this front-facing dashboard, or would it just be the numbers? Would it be that there is a need for GPs or the breakdown of the different factors that you’re looking at?

You are saying - again, going back to these 51 community clusters - you are going to look at the demographics - if they are young families or they are individuals with co-morbidities or there is a large seniors population. Are those factors going to be reflected in this dashboard or is it just going to be numbers? We want 58 doctors here and we want 58 GPs and 25 - GPs are the first thing that come to mind, there are so many others - anesthesiologists. Is it going to be broken down just by that or is it going to be also the factors of why these specialties, why these positions are there, and the number?

MICHELLE THOMPSON: We would break it down in terms of family physicians versus specialists, in terms of where they would work. The specialists, likely, will be around the regional centres. That’s where you would most anticipate, although there are some anomalies, where people may work virtually or whatever, but you would expect that we would see mostly around the regional centres. We would have a breakdown of specialists, family medicine, nurse practitioners, nurses, et cetera, so that people have a sense of what we’re recruiting to. It would mostly be by zone and you would have a sense of family doctors versus specialists.

PATRICIA ARAB: When discussing the new Primary Care Physician Incentive Program, the minister mentioned last week that doctors will have targets and one of the targets she mentioned as an example would be panel size. In an APP contract, doctors must shadow bill 80 per cent of the panel size in their contract, which is then audited. I’m curious. Can the minister tell me how many doctors currently in an APP reach their contract obligations?

MICHELLE THOMPSON: That’s an excellent question. What I would say is that we are currently looking into that now, as part of our system performance measures. We feel that there is what I would call latent capacity in the system. We feel that there is an ability for us to increase the capacity of the number that not all but some physicians are seeing. That is part of the work that we are doing now around trying to estimate and understand access to primary care and how many primary care providers we require. That will be ongoing work but it certainly is top of mind in the department right now.

PATRICIA ARAB: Is that something that maybe I can get the minister to commit to reporting back to the House, the Legislature? I’m sure you won’t have it by the end of Estimates. If you do, that would be great, but something that we can continue to talk on or see where we are with that?

[7:30 p.m.]

MICHELLE THOMPSON: What I’d say is that we will be able to report at a very high level. What we also need to be careful about is that we don’t have any identifying characteristics. We need to be able to work with individuals and support their practice and understand that if there are barriers in terms of the panel size.

At a high level we would look at that and hope we have that percentage mark you would see over time on how we trend.

PATRICIA ARAB: Along similar lines, I’m wondering if the minister could tell me how many doctors in Nova Scotia are maintaining a panel load of 1,350?

MICHELLE THOMPSON: Everyone that is on a full-time APP should carry a minimum panel of 1,350 patients. Some have more. There will be some that have more, and I wouldn’t be able to ascertain that right off the bat. If you work less than an FTE in your practice, then your panel is pro-rated in order to kind of carry a panel. If you look at it in total, if we add up all the numbers, there is equivalent to 287 APPs, but that could be 350 doctors who are working in part. The total is 287 APPs.

We do have fee for services as well so it’s not going to give you the full picture.

PATRICIA ARAB: Perhaps the crux of the primary care matter isn’t just recruitment and retention, if I may be so bold, but better patient attachment. In Nova Scotia we have one of the highest per capita rates of family physicians in our country but our wait-list keeps on growing and growing.

My question is: How is the department incentivising patient attachment?

MICHELLE THOMPSON: There’re a couple of things there. First of all, we would look, in terms of understanding or continuing to understand the latent capacity of the system, where we are able to pull people up.

The incentives for the rural physicians in particular, in order to get those incentives, you need to be office-based and at least 50 per cent of your time has to be patient facing. There are some incentives there. There is some work to be done in collaboration with Doctors Nova Scotia and we’ll be beginning that work in the near future to kind of understand.

Even though we have the highest number of doctors per capita, it doesn’t mean that we have enough yet but we are continuing to work on that resource plan and understand what it is that we need exactly.

PATRICIA ARAB: That leads into my next question which is if the team is still working with Doctors Nova Scotia to introduce the blended capitation model to create greater patient attachment?

MICHELLE THOMPSON: Yes, we are working with Doctors Nova Scotia around blended cap.

PATRICIA ARAB: Is there any update or metrics of success in this that the minister can talk to us about?

MICHELLE THOMPSON: The blended capitation model has just started. It was delayed due to COVID-19, so we’re just starting that project now.

PATRICIA ARAB: Can I ask you where it is in the budget?

MICHELLE THOMPSON: It’s under the alternative payment plan line.

PATRICIA ARAB: How are we increasing the scope of practice for other allied health professionals?

MICHELLE THOMPSON: The work that happens when we look at the fullness of scope happens with the colleges. It’s usually college driven.

I’ll give you a couple of examples. We are working around registered nurses being able to prescribe, as an example. There was a pilot project, and we are looking at scaling that up. We just introduced legislation around the Hospitals Act to allow nurse practitioners to admit to hospital. Pharmacists are certainly another really good example of how we’re expanding scope of practice - their immunization capacity, their ability to assess and treat - initial treatment for Lyme disease. They’ve been doing some point-of-care testing.

We heard a lot on the tour about maximizing scope of practice. Those are some of the tangible things we’ve been able to do, and we’ll continue to do. It really is in collaboration with the professional associations and colleges.

PATRICIA ARAB: I can’t write my notes as fast as you recognize me.

I’m curious - I believe the Critic for the NDP mentioned collaborative care centres, but I’m curious what your department’s goals are around collaborative care centres.

MICHELLE THOMPSON: There is no intention at this time to increase the number, but what we need to do is look at where the coverage areas are, where these collaborative care centres are, and maximize the care that they’re offering, to your point around making sure there’s better access to primary care and making sure that folks are attached. We would continue to work with the system we have now, making sure it’s staffed, but there is no attempt at this point to increase.

PATRICIA ARAB: So no increase in the number of collaborative care centres that exist, but within the current collaborative care centres, what are the goals in order to maximize the most effective use of all the clinicians who work within them?

MICHELLE THOMPSON: I think what I would say about that is that we want to ensure that we have the right mix of individuals. When I used to work in front-line health care, we used to talk about time and talent. We want to make sure that those clinics are open for the most amount of access and the right amount of time, and also the right amount of talent.

What are the skillsets that the community would most benefit from? That doesn’t necessarily need to look the same in every community. Of course, we can anticipate what some of the fundamental care providers would be and we want those clinics to be working to the maximum capacity. What are the opportunities across the system? Who are the right people in those areas? It really is to maximize the function in those current facilities.

PATRICIA ARAB: Last week the minister confirmed that the Office of Health Care Professionals Recruitment will be increasing from 4.6 FTEs to 33 FTEs and that these are net new positions to the department. I’m wondering if the NSHA will have any more involvement in the recruitment of health care professionals and why?

MICHELLE THOMPSON: Oh yes, yes. We need to be integrated across the system. They need to tell us what they need - the IWK as well. We need to understand what the needs are. It’s very integrated.

Dr. Orrell, Deputy Minister Lagassé, CEO Oldfield and the administrator, Janet Davidson, they sit on essentially a weekly basis and navigate the health care system together with the Department of Health and Wellness, NSHA, and Physician Recruitment and Retention. Absolutely, we work in lockstep with them. It’s really important that that integration, that system-wide integration, continues.

PATRICIA ARAB: I’m wondering if the minister can indulge me in the role of these 33 new FTEs and what sort of role they will play. Who are we looking at?

MICHELLE THOMPSON: There would be a number of different positions. I’ll give you a sense of what some of them are. Of course, we would need data analysts to understand. We would look at strategists and policy analysts and there would be project managers and coordinators, as well as recruiters. That would make up the majority of the folks that are there.

PATRICIA ARAB: I’m curious if there are any teams that would be dedicated to specific, in-demand occupations - doctors, nurses, CCAs?

MICHELLE THOMPSON: Yes, there would be. We have specific leads for physicians and paramedics, and then we would have one specific for the various nursing designations as well. They would work and be focused on those professions.

PATRICIA ARAB: I want to put down recruitment for a little bit. I feel like we’ll come back to it before the minister is done.

I want to talk a little bit on surgical wait times. At a recent Public Accounts Committee meeting the health system leadership team confirmed that we have a surgery backlog, with over 27,200 Nova Scotians waiting for surgeries, which is the highest number of people on the wait-list in the past five years. I’m curious if the minister can tell me if that number is still correct, so 27,200? If not, what is the new number?

[7:45 p.m.]

MICHELLE THOMPSON: That is a very recent number. It’s not today’s number, but it would be in the same ballpark, yes.

PATRICIA ARAB: Given the nature of this most recent wave of COVID‑19 and the number of health care professionals who are not able to go to work and the pausing of surgeries due to that, perhaps the minister would be willing to get us an updated number even though this one is only a few weeks old.

MICHELLE THOMPSON: Certainly, I’ll get that. It is a fairly recent number, so we don’t anticipate that it would be very different, but we can ask to get it, yes.

PATRICIA ARAB: What surgeries have the greatest wait times, and how many Nova Scotians are waiting for each procedure?

MICHELLE THOMPSON: Urgent and emergent surgeries continue to happen on a timeline. I don’t have the exact number of people who are on each list. The longest wait times are for hip replacement, knee replacement, cataract, cardiovascular surgery, brain surgery, colorectal cancer, lung cancer, and breast cancer.

PATRICIA ARAB: Would the minister or anybody on her staff have the numbers attached to those surgeries?

MICHELLE THOMPSON: We’ll have to get those for you.

PATRICIA ARAB: Maybe at the same time, we could know by zone, what the breakdown is by zone, and perhaps the minister would already have that information, specifically, if you can get it for me. In general, what are the greatest wait times by zone?

MICHELLE THOMPSON: We can talk to the Nova Scotia Health Authority and get that information.

PATRICIA ARAB: Ms. Oldfield told the Public Accounts Committee that ORs are very close to returning to 100 per cent capacity, but again, as I mentioned, the impact of COVID‑19 means that there are still health care workers across the province unable to report to work. We’ve learned recently that there are over 800 NSHA employees out because of COVID‑19. I’m curious if the minister knows, or could get for me, how many surgeries have been delayed during this particular wave of COVID‑19 due to staffing pressures.

MICHELLE THOMPSON: That also would be something we’ll have to get. I don’t have it off the top of my head.

PATRICIA ARAB: You don’t have it off the top of your head? You don’t have all of this right there? I can’t imagine.

During the same Public Accounts Committee meeting, NSHA CEO Oldfield said it will be impossible to extend operating room hours, as promised by the Premier, because the province doesn’t have enough people to staff surgical teams.

Can the minister please expand and explain why this government is not able to deliver on the 24/7 OR commitments?

MICHELLE THOMPSON: What I would say is that we aren’t able to deliver yet. Certainly, we’ve had a significant wave of Omicron. We know that we have significant vacancies, but we are making investments through the budget to extend OR hours outside of banking hours, is what we would call it.

What’s going to happen is that’s going to happen incrementally over time. It’s not an all or nothing. We will continue to work towards that - very focused on getting those surgical wait times down. I’m confident that there’s a plan under development now that will look at how we incrementally - and we tackle that list. We have to be very focused in terms of how we tackle it and move forward with it. I think there will be more to say about that as time goes on.

PATRICIA ARAB: One of the solutions that was proposed during the election campaign was to send patients to privately-owned surgical clinics - one of the examples was Scotia Surgery - or to other jurisdictions outside of the province. I’m curious if the minister could tell me what procedures would be outsourced to other Atlantic provinces, what surgical expertise exists outside of Nova Scotia that can’t be fulfilled here and how many Nova Scotians would this impact and at what cost?

MICHELLE THOMPSON: Currently, the only medical concerns that we would send patients outside of the hospital or to other provinces are things that we are not able to do here. It would be a service that is not available here. Those are the only folks who we currently send outside of the province.

PATRICIA ARAB: If the minister could explain what types of surgeries are those? What’s currently being sent out of province? What do we currently not have the expertise for in-province, in terms of surgeries?

MICHELLE THOMPSON: Predominantly, the patients that we would have to transfer would be some cancer surgeries that are only available, as an example, in New Brunswick, some gender-affirming care surgeries. Folks have to go to Montreal in order to obtain the care. Then we would have individuals for some transplants. We are able to do some transplants here but not all, so some of those folks would have to go to larger centres in Ontario.

PATRICIA ARAB: The minister must know that I want to home in on all of those, but we’ll keep it a little high level. Perhaps she could tell me how many Nova Scotians this impacts.

MICHELLE THOMPSON: We’ll have to get the numbers for you, specifically. There were 62 gender-affirming surgery approvals for 2020 and 115 approvals in 2021 for gender-affirming surgeries.

PATRICIA ARAB: The minister will get me the others, the transplants and the cancers, that total number. Okay.

Do you know the cost of these out-of-province surgeries?

MICHELLE THOMPSON: That is a bit complicated to answer. Out-of-province care was around $12 million but we have reciprocal billing, so there may be people from other provinces who received care here. There may be people who received care there, so it’s a little bit difficult. We may be paying the balance in some cases. It’s not linear, is what I would say. Roughly, there’s about $12 million a year that we would spend on out-of-province care. It’s difficult to nail it down.

PATRICIA ARAB: How many procedures have been outsourced to a private clinic in the province, so far?

MICHELLE THOMPSON: We’ll have to get the Nova Scotia Health Authority number, but the IWK is roughly 500 cases at about $600 per case. It’s about $821,000. So 500 cases . . . (Interruption)

THE CHAIR: Order, please. There’s chatter in the Chamber.

[8:00 p.m.]

MICHELLE THOMPSON: So 500 cases for Scotia Surgery and that is roughly $821,000 that is covered by the province for surgeries. We’ll look with NSHA for the rest.

PATRICIA ARAB: I’m wondering if the minister could let me know how many, approximately, planned surgeries will be outsourced to a private clinic in-province?

MICHELLE THOMPSON: That is what we’re planning for, the 500 surgeries. That’s the cost that would cost at the IWK, for Scotia Surgery.

PATRICIA ARAB: The 500 is planned and you will get me the number of planned surgeries for the NSHA with the cost.

There haven’t been any procedures that have already been outsourced to a private surgical clinic?

MICHELLE THOMPSON: With Scotia Surgery we started around October and we have roughly 300 surgeries that were completed there. We also work with the Halifax Vision Surgical Centre and up to January 26, 2022, since the beginning of COVID-19, there were 1,096 surgeries completed there.

PATRICIA ARAB: Does the minister have the total costs for these already completed surgeries?

MICHELLE THOMPSON: At Scotia Surgery, that would be $340,000. Moving into the costs I told you earlier, for next year, we don’t have that cost for the vision centre. We can get it though.

PATRICIA ARAB: Along the same lines, procedures that are planned to be outsourced outside of Atlantic Canada, can the minister let me know how many Nova Scotians will this impact?

MICHELLE THOMPSON: In terms of addressing the surgical backlog itself, those surgeries that we’re currently sending people outside of the province for are people that have to go because these surgeries are available there. In terms of the surgical backlog itself, what we’re doing now is creating a plan where we’re looking at every available option in the province, first of all within our health care system. What are the available operating theatres, potential units that we can hive off and use specifically for inpatient units and a centralized registry in order to tackle that, the system?

After that, we would look out in concentric circles around what other OR theatres and staff are available to do day procedures and things like that in order to maximize. I think it’s two different things. Currently we are not looking - although we could, in terms of other people’s capacity, because we know wait-lists are significant across the province. The federal government just gave a ton of money to provinces to address their backlogs. We would only currently send people out for surgeries that they can’t actually attain here.

PATRICIA ARAB: Again, under the Hope for Health platform planks, the government committed to meeting the benchmark standards for surgical wait times within 18 months of being elected. We’re now nine months away from reaching that commitment. I’m curious if the minister thinks this will be reached?

MICHELLE THOMPSON: I am confident that our team is going to work very hard to achieve that goal. Certainly, the Premier’s expectation is that we’ll do everything in our power to meet that goal. There is some budget funding - $10,400,00 in order to support that work. Again, Omicron has certainly been a different variant for us and has caused some disruptions. However, I will say it’s not an excuse; it’s a reason to dig in and look at innovative ways for us to keep going because we know that the surgical backlog is important and people on that wait-list need their surgeries. We are still going to work towards that goal, and we will leave no stone unturned in order to reach it.

PATRICIA ARAB: Given the roadblocks that have been hit, and COVID-19 being one of them, I can completely appreciate that the minister is going to strive to meet that 18-month benchmark. What would be a realistic time frame, given the things that have happened over the last six months?

MICHELLE THOMPSON: What I would say is we still are in the middle of the planning process. We have made a significant investment and put money aside to achieve that. As the plan develops, we will be transparent with the plan. I’m not ready to throw in the towel is what I’ll tell you; I’m not ready to say we can’t meet it. We need to spend some time, we need to look at our resources, we need to really consider all of our options. What I would say is that with that investment and with that effort, there will be more to say when the plan is fully developed.

PATRICIA ARAB: I appreciate the minister’s answer to that, but when we’re halfway through a timeline that was given by her Premier, our Premier, in a campaign, it’s hard to rely back on a plan that’s in process without wanting to have a bit of detail on what that plan is. That’s okay; we’ll leave that for right now.

One of the other promises that was made during the campaign was full transparency, and the minister in her last answer did allude to that. Specifically in the platform it was reporting in real time the number of surgeries taking place in a day, what type of surgeries, how each day’s numbers impacted the wait-list. I’m curious if that’s still a commitment that will be met and, if so, where it is in the budget.

MICHELLE THOMPSON: The intention is to move forward and have the dashboard. One of the precursors to that work is actually the central intake. There’s money put aside for central intake for us to understand what surgeries people are waiting for and how we allocate to make sure there’s equitable access. It will definitely come, but there are some steps we need to do in advance of that before that’s fully functional and ready to be published.

PATRICIA ARAB: Apart from the money that’s put into the central intake, is there anywhere specifically in this budget where that dashboard and what’s needed for it is accounted for?

MICHELLE THOMPSON: The money that’s allocated towards that would actually be in the Nova Scotia Health operational budget.

PATRICIA ARAB: The government of Nova Scotia already has a website that tracks wait times for health care delivery like cancer services, screening, diagnoses and treatment, for diagnostic imaging and tests, internal medicine referrals and intervention, surgery and surgeon consultations - will this tool be extended to include real-time results? This current dashboard, will that be extended to include real-time results?

MICHELLE THOMPSON: I don’t think those metrics would be on a day-to-day basis. We would continue to report them as we are reporting them now.

PATRICIA ARAB: One of the things said by the Premier - and I won’t quote it because I don’t have it to table it - was just because there’s a pandemic doesn’t mean that the government gets a free pass.

Thinking of all the things that the minister has had to focus on in terms of her department, the benchmarks that were set for her in an election campaign and then what she has had to learn and face, what she knows from her own experiences, and the fact that, indeed, we have had one of the worst waves of the pandemic in the last two years. Is that a fair assessment and is that a motivator to be able to still meet those benchmarks, or can Nova Scotians expect things to be a little bit more realistic?

MICHELLE THOMPSON: I think there are a couple of things there. We have continued to work on a number of different initiatives. We can’t solve everything.

I would say the expectation is from the Premier to me, to the department, that we continue as many services as possible, that we continue our work. Despite the waves of the pandemic - and there has been a heroic effort in terms of what health care workers in Nova Scotia Health and the Department of Health and Wellness have managed - we have also continued to move initiatives forward.

Some of it is not visible in terms of forward-facing, but the foundational work that requires us to get that done before we do the forward-facing work has continued, to the credit of the people in the department.

While there have been some front-facing services that have been disrupted as a result of Omicron and overcapacity in hospital and staffing shortages, there has been other necessary and vital work that has continued behind the scenes in order to continue to move those initiatives forward. So it hasn’t really been an all or nothing. Again to the department’s credit, in Nova Scotia Health they continue to work towards the foundational work that has to happen.

I feel that in some ways we’re still on track and there are things that we will need to catch up on. We are committed to continuing that work to make sure that we meet as close to - or wouldn’t it be ideal if we exceed those targets as we move forward?

PATRICIA ARAB: Believe it or not, when it comes to our health care system, all of us want it to be successful. All of us want a system that is healthy, that is supported, regardless of who is in government or what politics are being played.

COVID-19 has had a huge impact on our system. I appreciate that things are happening behind the scenes and foundations are being laid, but we have a real problem not only with health care workers who are unable to attend work because of a COVID-19 diagnosis, like COVID-19 positives, but also the fatigue that they’ve felt.

We’ll keep it on surgery for the rest of my time, but this is going to be something that I’ll want to talk about throughout the health care system. Are you looking at any of the metrics of burnout of people who don’t want to be in the profession anymore or who are going to need to take time off? These are surgeons, these are nurses, these are front-line workers who will directly impact how quickly we’re able to deliver or work on our surgical wait-list times. So there’s a new factor - is there any data, do you have any idea of what that is and how it will impact our wait-lists?

MICHELLE THOMPSON: I feel fairly confident there’s no way for us to say that we have a tool that measures burnout rates. What we heard, what I hear on a regular basis is that people are very tired. You know they continue to face a different challenge with every wave that we have so we understand that.

From an employer perspective, we are mindful that people need rest and we are looking at ways that we can support them. So what are the supports that we can offer at work and also what are the opportunities through EAP programs, insured benefits for those folks who participate, to encourage people to look after themselves, particularly on their days off?

[8:15 p.m.]

We know it’s an issue, the people in our health care system are what make it run well. We have to have an eye to a number of things. There is their own well-being and looking at the workplace culture as well, to be supportive in the moment - things like the mentorship program as an example and as we develop that, making sure people utilize their benefits, allowing people to have a voice. When you have no agency over your workplace it is really, really difficult. So making sure that people have an opportunity to contribute and problem solve and have decision-making capacity at the front lines and in units, which have been missing for a very long time.

PATRICIA ARAB: Mr. Chair, I do appreciate the minister’s answer on that, but we are living in a reality where we have large numbers of our health care workers who are off - and they are not off on stress leave, they are not off on vacation, they are not off on time off, they are off because they are COVID-19 positive.

How is the system supported when you have X number of people off - 800 plus people off? And then you have the burnout. You have people who need to have professional development or need to have days off and need to take vacations and still attack a surgical wait-list, like the challenges that are in the system. How do you balance this unknown factor that has come in - this X factor that has come in which is the large number of people out on sick leave because of the pandemic? How do you factor that in to still meet your goals? Again, we can talk specifically on surgical wait times, but this is obviously something that impacts the entire system.

MICHELLE THOMPSON: Again, back to the art and science of it all. The science of it tells us that we always protect those urgent in emergent care because people (Interruption)

THE CHAIR: Order, please. Time for the Liberal caucus has expired.

The honourable member for Cape Breton Centre-Whitney Pier.

KENDRA COOMBES: I want to go back to what they were discussing the last time, before we actually got to discuss it and that is regarding individuals experiencing miscarriages. It is going to be convoluted a little, so bear with us.

Is the minister aware of the policy that individuals experiencing miscarriages under 20 weeks are often redirected from hospitals such as the Cape Breton Regional Hospital, that has OB/GYN capacity, to hospitals that do not have those facilities?

MICHELLE THOMPSON: I haven’t recently read it, but I do believe in my experiences as an emergency nurse that that was, in fact, the case from years ago. We would support and care for people experiencing miscarriages in the facilities and not necessarily have immediate OB/GYN care but perhaps there would be a referral process, if necessary.

KENDRA COOMBES: As someone who has gone through this process - I had a miscarriage. I was miscarrying and I was in severe pain and I was taken by paramedics who wanted to send me to the Regional, but because I was under 20 weeks, they were told to direct me to another hospital, the Glace Bay Hospital which did not have those capabilities of the OB/GYN. I spent from 7 o’clock in the night until 7 o’clock the next morning at the Glace Bay Hospital to then, in severe pain, heavily medicated, be redirected to the Regional Hospital to the OB/GYN for a D&C to be done.

I have spoken to many women, many individuals experiencing pregnancy loss who have had the same experience. It is already a traumatic experience that is happening to you, but you are sent to a hospital that doesn’t have the capabilities to actually help you - to provide health care to you and then, only after hours and hours and maybe a day, maybe two days, you are finally directed to a hospital that can actually help you.

I am asking with regards to this policy, that it seems to be in effect because otherwise I don’t think they would have sent me to the regional: Would the minister and the office look at changing these types of policies that cause further trauma?

MICHELLE THOMPSON: What I would say is that that would be something that we would work very closely with the NSHA, to look at the clinical protocols and the clinical pathways to ensure that we do have trauma-informed care and that people get the care that they need where they need it. That would be an operational policy that we would discuss with the Nova Scotia Health Authority.

THE CHAIR: The honourable member for Dartmouth North.

SUSAN LEBLANC: I just want to ask a few more questions about collaborative care centres.

Before the break, we were talking about community health centres. In the last little while, there’s been some announcements - this year, there was an announcement about a collaborative care centre in Eastern Passage. In previous years under the Liberal government, one year not too long ago, there was quite a big investment in the budget for collaborative care centres which I guess probably by now have opened.

I’m wondering if there’s any line in the budget this year for new collaborative care centres or urgent care centres, even? Or if there’re both, I would love to know if there’re both or one or the other, please.

MICHELLE THOMPSON: There is no money in the budget this year to expand. The collaborative care centres are part of the operational budget of primary care for the Nova Scotia Health Authority. We would have to look at what’s available in each of those centres and understand the needs, I guess is what I would say. That would work through the funding at the Nova Scotia Health Authority.

SUSAN LEBLANC: Can you just take me through that a little bit? I understand that the health authority has its own budget, but it comes from the department. When the department allocates money to the health authority, is it for certain budget lines? They present you a budget and then you say okay, yes, here it is, these billion dollars that’re going to the health authority or whatever, you know what it is for.

Therefore, my question is: In terms of where they would expand or add to, that kind of thing, is there a way for the department to influence that or is that totally left up to the health authority?

MICHELLE THOMPSON: It does happen under the operational funding in the Nova Scotia Health Authority. Keeping in mind that we do have that health leadership team now. The Department of Health and Wellness, Office of Health Care Professionals Recruitment, and Nova Scotia Health’s CEO and administrator and they do sit together, and they do some oversight.

What I would say is things change as we go. Operationally, we can adapt is what I would say. The urgent treatment centre, as an example, or Parrsboro - things like that. Sometimes when we have vacancies and closures, it is a bit of a moving target. It’s a very dynamic environment in terms of how they manage that.

We would look at the needs. We would look at the current staffing and what the ideal staffing would be and work towards making sure that they were fully functional in terms of their ability. Unless there’s a particular one, if you know what I mean, it’s kind of hard to say but they can negotiate and adapt operationally, if required. So there is some leeway, and that would be done at that health leadership team table, if that is clear.

SUSAN LEBLANC: I ask this because in Dartmouth North, we have what is called the Community Health Planning Team - I think that’s what we’re called now. I’ve been on that organization, or that team, for five years and it is essentially made up of residents. It had some backbone support from Between the Bridges. It does have backbone support from Between the Bridges, but mostly residents and people who have been working to increase health services in the community for many, many years.

It’s an amazing team but we do have support from Nova Scotia Health. There’s a couple of folks from NSHA who attend the meetings monthly, but we’ve been advocating for a new collaborative care centre, a new primary care support, and allied health professional support, for several years.

I guess the only reason I’m telling you this now, minister, is that I am going to invite all of you over to Dartmouth North for a meeting in the near future - Mr. Comer has already been invited, this is the second time he has heard about this this week - because it’s exactly what I’ve been talking about, in terms of social determinants of health and all of that stuff. It’s the kind of thing that is flexible - not to sound desperate, but it’s like we’ll do anything, we’ll take anything. I don’t mean it like that, but there is a flexibility to the work that we’re doing. I wanted to tell you more, but that’s the reason I am asking. For several years we’d get into Budget Estimates and one year there is $13 million and the next year there is no money. I am curious how that is determined.

The B part, and this is totally unscripted, but it occurred to me in this moment, when health care in Nova Scotia is fixed, when we get 100 doctors recruited, and 1,000 nurses, and all of that stuff, what’s the next thing? What makes the health care system really tick? Obviously, we need the people, but in your view, what would a really well-functioning, healthy health system look like in Nova Scotia?

MICHELLE THOMPSON: That is the biggest question in the entire world that you just . . . (Interruption) It is so good.

First of all, I just want to be clear, this budget does support the mandate, that there are some really front-facing access, and flow issues, and surgical wait times, and things we really need to address, because we know that people are suffering. There are people who need hip and knee replacements, and they are in pain and we want to get all of that stuff. But in a perfect world, what’s next is, to your point, around the population health.

At that population health level, when we look at the social determinants of health, and to me that starts prenatally, so how do we support people in a prenatal period, how do we support families, not just with nutrition and delivery, and all of those things, but how do we look at the wellness of a family as a whole? This is the public health nurse in me that gets really excited as well.

I will tell you, I tell my Cabinet colleagues often that I am actually the Minister of Health Care, or perhaps the Minister of Illness, if you look at that, and all of them are the Ministers of Health, if you really want to look at a social determinants level.

[8:30 p.m.]

We talk about the necessity of economic development, and we talk about the importance of education and what opportunities that opens and how we can support kids right at ages and stages. We look at mental health, we look at seniors in long-term care and the job opportunities that are available in the care economy which I know you spoke about before. It’s just such a big question but that is the exciting work. There is the front-facing health care work you absolutely have to tend to so people get the care they need when they need it. But how do we set Nova Scotia on a trajectory of health so that over time our need for those services (Inaudible)?

As we kind of move through, we create this plan, we need to look at population health outcomes, then we need to look at system outcomes, and then we need to look at individual outcomes. That work is developing. I know that’s really high level, but it is important and we have to look at the system in that way. That population health is what is going to move us to a trajectory of health and that really is where we sit in the social determinant. That’s the exciting work.

I don’t have an answer for that, we haven’t figured that out yet but certainly that’s what excites me as well about the health portfolio.

SUSAN LEBLANC: I’m going to switch to governance of NSHA for a moment. The minister might remember the struggle that led to the board of Nova Scotia Health Authority voting in 2018 to open its meetings to the public and make its minutes publicly available. At the time the board chair explained that the move was crucial in building public trust in how decisions about our health system were made. Can the minister explain how this transparency mechanism will be replaced under the new leadership model?

MICHELLE THOMPSON: I know that it came up at Public Accounts Committee the other day when I watched the replay. What I would say is your points are well taken and certainly the health leadership team has talked about how the functions of the board continue under the role of the administrator.

What is the mechanism that we are transparent with people and that we report back? I would say that we haven’t really nailed down exactly what that is but discussions have taken place. It is very important to us. We get caught up in the day-to-day work and moving forward and trying to make change but the communication piece is really important. To your point, there will be more to say about that but we appreciate that you brought that up and brought it to our attention.

SUSAN LEBLANC: Another thing that I brought up at Public Accounts Committee is the lack of diversity in the new health leadership teams since the Premier dismissed the 14-member board of Nova Scotia Health.

For instance, OmiSoore Dryden was the first Black person to sit on the board. At the time of her dismissal, she said, “There are concerns across various communities, there seems to be a dismissal of the concerns around representation. Why isn’t equity and inclusion central to the plan you’re rolling out?”

She was dismissed along with Stephen Augustine who was the first Mi’kmaw Nova Scotia Health Director. The African Nova Scotian Black Family has called for Dr. Dryden to be appointed to the new health leadership team. Can the minister respond to these concerns?

MICHELLE THOMPSON: Certainly, we did hear when the board was dissolved. There’s been several initiatives that we’ve started. First of all, we are building relationships, particularly with the Health Association of African Canadians as well as Tajikeimik.

I’ve been able to meet with both of those organizations to talk about the lack of representation that we currently have and what representation could look like so those historical voices are heard. It’s really important that we acknowledge that and that historical voices are heard and acknowledged, and we take action in terms of what the communities need.

We are working. I know that CEO Oldfield has hosted and talked to people of colour about their experiences as health care workers and we continue to hear from patients, equity-seeking individuals who come through as patients. There has been a lot of relationship building, there is an equity, diversity and inclusion division at the Department of Health and Wellness who have done a ton of stakeholder gathering in terms of how we work, how we move forward with race-based data collection as well.

Building trust and understanding community needs is part of that, and also recognizing that representation across all departments is very key and important. Again, we have to work with community in order to understand how best to support that. I don’t think there’s one thing. We’re committed to improving that and learning and listening and doing better moving forward.

SUSAN LEBLANC: I would say that - this is something my colleague did reply to, a similar answer at Public Accounts, and that is - I think the difference is between talking to communities and actually having someone from the community helping to make decisions, like being on a leadership team, at that leadership level, I think is really important. That’s what we miss with the dismissal of Dr. OmiSoore Dryden. I’ll just put that out there.

I want to move on to virtual care. The first thing I want to do is give an example of one of my constituents who contacted me two weeks or so ago. She was in a panic because she has some medication that’s prescribed by, I guess, a psychiatrist - it was mental health medication that she was running out of. When she went to get an appointment to get the prescription renewed, the doctor, I guess, had left the province. The doctor was gone, and she didn’t realize that that was happening. She tried to get connected to some other prescriber. She went to a walk-in clinic. Nobody could prescribe this type of medication because of the nature of it.

I contacted the minister’s EA - not yours, but the minister responsible for the Office of Addictions and Mental Health’s EA - who also dug right in and tried to help her and get her connected to Maple, the virtual care, and in fact they couldn’t prescribe the medication for her. There were a lot of bumps along the road. It was partly to do with the particular medication but also to do with primary care physicians, or physicians not being able to prescribe certain things. It was a big mess. I think she has been able to get it all sorted at this point, but it took several days, and she was running out of her medication, which would have obviously had major impacts.

My first question about virtual care is, the minister has talked about expansion, and there’s money in the budget to expand virtual care, but does that include this type of expansion, so that there will be access to physicians who can prescribe medications that specialists would be able to prescribe or can only prescribe? I don’t even know how it all works, but is the expansion going to address issues like this?

MICHELLE THOMPSON: That sounds to me that that is a specialist requirement. If virtual care couldn’t - if you contacted a couple of primary care providers, it’s obviously a specialty service. There are opportunities for people to see their specialist virtually. I think that is a very specific case in terms of whether that person should have been referred to another psychiatrist who has the ability to refer. I think there are other pathways.

That may actually be a case where someone does have to go to the emergency room in order to access a psychiatrist on call, simply because of the nature of it, because there may be an assessment. I’m not really familiar with the case, I’m just kind of surmising. There may be times that that is an urgent or emergent issue that has to go in order to access those speciality services, if the specialist is no longer available. Certainly, around other medications, maybe more typical or common medications, we would look at expanding the scope community pharmacists to be able to do that.

Walk-in clinics are an opportunity for some prescription renewals and, of course, Maple. I think that’s a specific case that may actually require going to the emergency room in the absence of a lateral move to another psychiatric specialist.

.SUSAN LEBLANC: Our office received some records through the FOI process that showed survey results from people who have been invited to sign up for virtual care. From a Nova Scotia Health survey of people who did not use the service, 7 per cent said they had difficulties joining and 3 per cent said they have internet connectivity issues.

For my money, it’s really concerning that we’re leaning on a private for-profit company to provide health care when it’s not totally accessible to people who don’t have a computer or a smart phone. Obviously, I really believe in virtual care and that it’s extremely convenient and important and I think it’s a big part of the way forward, I absolutely do. I don’t want to make any mistake about that, but if it’s leaving people behind, then there’s an issue.

I’m wondering if the minister can respond to that, and does the department have any information about what I referenced in terms of the barriers that people are experiencing with the virtual care program?

MICHELLE THOMPSON: There are a couple of things that I would like to talk about with that.

There are a couple of initiatives to your point. There is a proof of concept that’s happening now where virtual care is actually being offered in a library. There’re opportunities there. The folks who work at the library have been trained to support people to access virtual care and there are private spaces. The early days of that have shown some positive results.

Certainly, we know that libraries are the heart of a community and offer a lot of services to folks and in some ways accessible, not only in urban centres but also in some of our rural centres. It is a good idea and we’re hopeful that it works.

There is a phone option - a land line option - if people have that to be able to access by land line. That would be another option people would have. It’s also one of the reasons that we’re looking at that pharmacy model. Having a nurse practitioner in a pharmacy and how can we expand that across the province so that people have access to both of those. Virtual care isn’t for everybody. We understand that. There’s a certain group of people who do well with it and love it, but we also know it’s not accessible for everyone.

The Nova Scotia Innovation Hub is currently looking at a full evaluation of virtual care and understanding what’s working well and where some of the barriers are and how we can change. That isn’t available right now, but it is under way, just to have a better understanding of how we can improve it.

SUSAN LEBLANC: Great. Awesome. The library thing is a great idea.

When the pandemic first began in Dartmouth North, connectivity and access to information was huge, and a huge barrier for people. There was an outbreak and Public Health stood up a testing site - this was in the early, early days - and literally we went around and put posters up on lamp poles and on the doors of apartment buildings to tell people about it because there was no way to get information out to folks.

Our library is really central to our community actually. One of the things that has come out of the pandemic in terms of community groups meeting together and collaborating is this idea of a virtual booth. I think it’s part of a project, in fact the GEO Nova Scotia project, Getting Everyone Online, also came out of the pandemic.

[8:45 p.m.]

They just announced a Getting Everyone Online, a GEO Nova Scotia, board of directors, so it sounds like it’s being funded. The idea of a virtual booth being able to be placed in a library or in a community centre or that kind of thing, where people could go in, have a private space to have an appointment of any kind, really - a therapy appointment, a virtual care appointment, a social work appointment, whatever, - because in communities like Dartmouth North and lots of communities across the province, the issue is that either you don’t have a computer, you don’t have enough money for the internet, you don’t have a good cellphone, or you live in a situation where it’s not safe for you to be taking or making a phone call or a doctor’s appointment at all. I think this idea is one whose time has come.

I did get an email from a social worker who works in Dartmouth North. She expressed that she had concerns about VirtualCareNS being rolled out to people on the 811 list because, at least at this time, it said that to participate people needed to be able to access the internet through a computer or mobile device and have a current email address on file with the registry.

What she said in her email to me was: as you know, my clients often do not have one or both of these requirements, due to social inequality, and this program further exacerbates this issue; furthermore, I have elderly clients who have been on the wait-list for years who do not and will not ever get an email and regularly have to go to the ER for non-emergencies.

On another note, did you notice the slew of new doctors accepting patients last year in Dartmouth only had applications submittable online or by email? The health inequities continue to grow and grow for our most vulnerable community members.

I’m wondering if you can respond to that and, in fact, if Dr. Orrell would like to respond through you about the recruitment issue or if a new doctor comes in and there’s panels opening up, if there is a way to ensure that those panels are open in an equitable way, not just by online applications. That’s one question.

The other question is: Can you explain whether the virtual program is, in fact, telephone accessible? My understanding was it was not telephone accessible and that was a different type of care. I’d just like to hear a clarification on that.

MICHELLE THOMPSON: There’s a variety of answers to that question. In terms of the telephone accessibility, it is available, the landline. If you need some information about that, we can get it for you.

In terms of some of the work that’s happening, like libraries as an example, for some people it would be an opportunity for them to help them set up an email account. There are some people that that would be reasonable for.

Again, the resource of 811 is available for people to contact if they’re having trouble accessing virtual care. That would be a conduit where people could reach out and call 811 and talk about some of the issues that they’re experiencing and have them be navigated through that.

The other issue that I would say is that we do take some people off the list and assign them to a practice. Some people find the practice on their own. There’s a variety of different ways, but there is a requirement that there are unattached patients for our new GPs, that they would take some people off that list in order to shorten the list.

SUSAN LEBLANC: I’ll leave that there for now.

The budget documents explain that there’s $14.5 million more to make virtual care available to everyone on the Need a Family Practice Registry and expand the kind of care available through virtual care.

I’m wondering if the minister can provide a breakdown of the $14.5 million. Is the contract with Maple? Is it an annual, ongoing cost? Will that repeat every year? Was there an analysis done to compare the cost of the contract to developing a service in house?

MICHELLE THOMPSON: There’s $6.25 million to further increase virtual care to include primary consults with specialists - physios, OTs, and nurse practitioners - and $6.25 million to provide Nova Scotians on the wait-list immediate access to virtual care, and almost a million, $988,000, to create a new chronic disease treatment prevention program focusing on chronic illness, based on the INSPIRED model of COPD patients. That’s the breakdown of the investment in virtual care.

I would say, without getting a whole bunch of consultation, that we really don’t have the platform or the ability to build and move out a platform and the resources that a pre-existing platform would have.

It does take a lot of work and we would need a lot of digital support, so we would look at contracting a service rather than building it in house and trying to manage it and all of the stuff that goes with that - cybersecurity and keeping it up, and things I don’t understand. It would be easier to contract a service.

SUSAN LEBLANC: The only thing I didn’t hear was the answer to the question: How much of that investment will be a recurring investment year after year?

MICHELLE THOMPSON: It is a recurring investment, yes.

SUSAN LEBLANC: I’m wondering if the minister can provide an update to the One Person, One Record program. What’s the current timeline? When can we expect it to be online, as it were?

MICHELLE THOMPSON: What I will say about that is that we are currently under an active procurement and there will be more to say later. I’m not really able to say a whole lot about it because of that procurement process.

SUSAN LEBLANC: I want to turn my attention now to gender-affirming care. In recent years the department appears to have taken the approach of expanding coverage of gender-affirming surgeries after there were human rights challenges that affirm the right not to be discriminated against based on gender identity.

Others have suggested that a review needs to take place, together with the trans community, that would proactively create a list of surgeries. Others, still, have suggested that the department should use the threshold of funding whatever a patient and health care provider together decide is medically necessary.

I’m wondering, first, if the minister can explain the department’s current approach, and what is being looked at in the way of increasing or expanding trans people’s access to gender-affirming surgeries?

MICHELLE THOMPSON: We do have a policy at the Department of Health and Wellness that is currently under review. There has been some early stakeholder gathering, which, of course, would be with the transgender community. We’re committed to looking at that work.

The current policy is based on the WPATH Standards of Care and we do continue to follow that. We know that there are some gender-affirming surgeries and care that can happen in Nova Scotia, but there are some who require expertise that is outside of our province. We are committed to reviewing the policy, working with community, understanding what the needs are, and moving forward. That’s what I would say, we’re in the early stages of that work.

SUSAN LEBLANC: WPATH is about to release a new set of standards of care. It’s good to know that Nova Scotia is using the standards of care now. Is the province prepared to use the new standard as a way to set the policy?

MICHELLE THOMPSON: Yes, that is the best practice and the best standard of care that we have. So yes, of course we will move with the standards as they move.

SUSAN LEBLANC: I’m interested to know about the consultations with the transgender community, if you could say a little bit more about that, that would be great - like what groups you’re meeting with, and that kind of thing. As the minister mentioned, a serious part of the dynamic in Nova Scotia is the access to actual specialists in Nova Scotia. People travel to the clinic in Montréal, often, to access care. I wonder if there’s anything being done to improve the access to gender-affirming surgeries right here in Nova Scotia?

MICHELLE THOMPSON: In terms of the care that is offered outside of the province, as you know, it’s extremely specialized. I would say that we are open to hearing from physicians in Nova Scotia who are interested in delivering that care. What will be important, it’s not just obtaining the skill, it’s around maintaining competency as well.

I don’t really know what the volume of care provision is in Montréal, but I think it would be important on a go-forward basis, as we looked at the program - it’s one thing to gain the skill, but can we maintain competence based on our current population and the demand on the service? We want people to have the absolute best care they can have.

We’re just checking with the department around those early consultations. We have been contacted. There are a couple of advocates who recently have had some ideas about how the policy will change, and I know we’re in the process of setting up a meeting to reach out and speak with them. We will check in terms of who’s already been consulted and I will get back to you.

SUSAN LEBLANC: That would be great if we can get that list, and also let me put a plug in for a public consultation. I think there’s lots of folks in Nova Scotia who are advocating around gender-affirming care, but there’s only a few organizations and so there are lots of people who have personal experience, and people who are advocating for their kids. So a public consultation, in my mind, makes a lot of sense. I think we’d get a really good variety of thought and ideas.

I had a meeting, I guess it was in the Fall, with a public servant in the Yukon. The Yukon has the most expansive gender-affirming care policy in the country. Speaking of jurisdictions where there’s not a bunch of specialists, essentially when I talked to the public servant, they said essentially, they don’t do anything, any of the surgeries, in the Yukon. They send everyone to Vancouver. That’s just a part of their gender-affirming care, everyone goes to Vancouver, everyone’s flights are paid for, everyone gets a companion to go - it’s a really excellent policy.

I’m wondering if the department looks at other jurisdictions when setting our policy around gender-affirming care?

[9:00 p.m.]

MICHELLE THOMPSON: Yes, we do. For most of the programs that we offer, we do a jurisdictional scan to see what other places are doing.

SUSAN LEBLANC: I hope you’re looking at the Yukon because it is the best - in Canada anyway.

It’s my understanding that decisions about what procedures and surgeries are covered are made by a panel at MSI. I’m wondering if the minister can tell us whether this panel consults with communities about coverage.

MICHELLE THOMPSON: The role of MSI is really to enforce the policy that is set by the department. The review that we would make would influence how they would review the applications. It’s the Department of Health and Wellness that sets the policy, not MSI.

SUSAN LEBLANC: WPATH advocates for a principle of informed consent when providing gender-affirming care - how is this principle incorporated into Nova Scotia’s MSI coverage policies? I’m wondering if you can speak about that and if you have a timeline also on the policy review.

MICHELLE THOMPSON: I’m not familiar enough with the standards to speak to the first part of your question.

The timeline - I would say it has started. I think right now there have been a few disruptions related to the sitting of the House and Omicron and a number of things. It’s not going to be a protracted experience. We want to move forward with that. We know that there are some gaps, and we’re certainly open to hearing, but we want to make sure that there’s adequate consultation at the same time. It has to be done well, and I think the department is committed to that.

SUSAN LEBLANC: Changing topics again, the Nova Scotia Federation of Labour estimates that 26 per cent of Nova Scotians do not take their medications as prescribed because they can’t afford to. The federal government has been promising to implement a universal Pharmacare for years and years, and we have heard a kind of commitment to that at the federal level. Can the minister please talk about what her government’s approach has been to this work taking place at the federal level - has there been any work thus far?

MICHELLE THOMPSON: There is a pharmaceutical interjurisdictional committee that exists. Through our Federal/Provincial/Territorial networks we do continue to talk. We’re engaged in those discussions is what I would say.

SUSAN LEBLANC: Since the newsworthy announcement of the NDP and the federal Liberals joining forces - and breaking the country some would say - I’m wondering if there has been any new interest at the provincial level, if those meetings have ramped up, if there’s any talk about stuff coming up in terms of a new announcement.

I’m being sarcastic, of course, for the record, for Hansard; I don’t think it’s going to break the country.

MICHELLE THOMPSON: No, I would say there’s nothing in that new alliance yet that has come out that’s specific to this.

SUSAN LEBLANC: The minister may be surprised at this, Madam Chair, but our caucus has been advocating for physician assistants for many years and months. Physician assistants have important skills that could be used to alleviate pressures in the health care system.

Five major studies in Canada have found that physician assistants can reduce resident workload and improve discharge rates; decrease both length of stay and time to consultation; save a supervising physician - a surgical physician - an average of 204 hours per year; reduce emergency department wait times by 1.9 times and the “left without being seen” rates by 50 per cent; and increase surgical productivity by 36.7 per cent, allowing two ORs to run simultaneously.

Aside from all of that, you may know that we have physician assistants living right here in Nova Scotia who are not licensed to practise. Folks who have retired from the military, who have been practising as physician assistants, who just can’t do it here but would do it here.

I’m wondering what progress is being made on the proposal to allow physician assistants to practise more widely in Nova Scotia.

MICHELLE THOMPSON: In regard to the physician assistants, there is a pilot that’s under way. They’re currently working with orthopaedics specifically. When you said you think the world of them, I say so does Kevin Orrell. He’s talking about them himself. Yes.

We’re looking at whether or not that pilot can be developed outside of that specific skill set, that orthopaedic skill set that they have. There are two training facilities in Canada that have capacity, so we wouldn’t have to set up our own training, which is also a benefit.

The military physician assistant currently has a bit of a limited scope, so there would be some training requirements that are required. We have, through Dr. Orrell, been in contact with the College of Physicians and Surgeons to understand how we would license them. I would say that the program is under development and I’m wondering what opportunities exist.

SUSAN LEBLANC: Well, that’s helpful. It doesn’t sound like it’s a no. It sounds like there is a useful - a place for physician assistants in the system.

I’m wondering if there are any major barriers, like, I don’t know, pay scale. Is there something about physician assistants that makes it challenging or difficult to do that work to get them working in Nova Scotia?

MICHELLE THOMPSON: Certainly, there is an appetite to understand where physician assistants can complement the system. The Premier has identified that as a potential resource in the province, and there have been discussions with the national body, just understanding where and how we can integrate physician assistants into the system.

It is early, but there are pretty good conversations about how and when we could potentially use that physician assistant skill set.

SUSAN LEBLANC: I just wanted to ask a question about Lyme disease. I’m wondering if the minister can explain what investments are being made in order to ensure health care providers have the necessary resources to assess those at risk of Lyme disease, and to increase the number of familiar doctors and keep emergency rooms open, improving the availability of urgent care when someone is suffering from a tick bite or Lyme disease.

MICHELLE THOMPSON: There is ongoing education available to physicians in terms of how to assess and treat Lyme disease, but also in the Fall, pharmacists will actually have their scope expanded. I can’t remember exactly all the details, but you can take the tick or a picture of the tick, you can go in, have it assessed, and the pharmacist can prescribe preventive treatment for you. It’s a very inexpensive medication called doxycycline, very inexpensive, so they can treat you there. There is a lot more access at a community level to support people who have tick bites.

SUSAN LEBLANC: Is there any money in the budget for supporting Nova Scotia-based research and examination of global best practices on Lyme disease, in collaboration with patient groups?

MICHELLE THOMPSON: There isn’t anything specific related to Lyme disease, but there is an investment of $2 million for the Communicable Disease Prevention and Control grant at Public Health. It would enhance public health in general, but there’s nothing specific for Lyme disease.

SUSAN LEBLANC: I’m going to turn to the insulin pump program now. The insulin pump program was established by the NDP government. It helps families and individuals afford the cost of insulin pumps, which can be in the thousands of dollars, but its budget has been decreasing year over year, and families are still frequently left with massive bills for these very important devices.

It looks like in 2014, there was $5.3 million; in 2015, $2.3 million; in 2016, $1.5 million; in 2017, $987,000; and then 2018 through to this year, $815,000. I’m wondering if the minister will commit to restoring funding to this very important program. That’s the first question.

MICHELLE THOMPSON: The budget is actually based on uptake. It’s utilization based. Anybody that needs it gets it.

[9:15 p.m.]

SUSAN LEBLANC: I had a feeling you were going to say that, because ministers in the past have said that as well. I would suggest that families are still paying hundreds to thousands of dollars for these machines, and many can’t afford it. Diabetes Canada is advocating for more funding. My question is, why has it not been decided to keep the original budget of $5.3 million and increase the allotment to families so that people are paying less out of pocket? And/or why not add continuous glucose monitors, which are also important live-saving devices but also extremely expensive. Would the government consider putting the budget back to where it was in 2014 and making the money more available to more people, or covering the glucose monitors?

MICHELLE THOMPSON: What I will say is that this is a program that is close to my heart. I worked in the school board for a number of years and worked with a number of kids who were on pumps. I always marvelled at how the parents slept at night in terms of caring for their little people.

What I will say is that we are looking at the program and considering - we are having a look at the program. There’s nothing in the budget and there’s nothing to say right now. I’ve met with a number of advocacy groups, and I am aware of the concerns of the groups and the needs of the groups. That’s what I will say for now.

SUSAN LEBLANC: In my last minute, I’ll probably just begin this question, but at a committee meeting last year, Dr. Strang explained the importance of people being able to stay home from work when they’re sick.

He said: certainly from a Public Health perspective, for not just COVID-19, it’s a long-standing challenge. Whether it’s salmonella in a restaurant or influenza every year, there are a lot of reasons why people don’t stay home or are unable to stay home. It is absolutely important that we work together to recognize the barriers that may limit people’s ability to stay home and find ways to collectively reduce those barriers.

So COVID-19 has obviously compounded this issue and we see that the workplace is a significant site of transmission. Does the minister agree with the Chief Medical Officer of Health that we need to do what it takes to ensure that people can stay home when they’re sick?

MICHELLE THOMPSON: I recognize that there are a number of infection prevention and control procedures that have to be followed and that there are times that we don’t want people who are unwell if they’re in the workforce.

THE CHAIR: Order. I’ll now ask the Liberal Party to begin their questioning.

The honourable member for Halifax Atlantic.

HON. BRENDAN MAGUIRE: I thank the minister and staff for being here tonight. I know it’s going to be a long couple of weeks for all of you. I just appreciate you being here.

My question to the minster is: How many positive COVID-19 cases did we have in the month of January?

MICHELLE THOMPSON: I can tell you that between December 2021 to around the beginning of March, we had 35,707 confirmed cases of COVID-19.

BRENDAN MAGUIRE: You said 35,000, right? Is that PCR and self-reporting tests? That’s just PCR.

So the question wasn’t how many PCR positives we had. The question was how many COVID-19 positive tests we had? Nova Scotians were asked to home test and self report. That information was going to the Department of Health and Wellness, and surely you are keeping that information.

I’m asking the minister: In January, how many self-reported and PCR tests, combined COVID-19 positive tests, were there in Nova Scotia?

MICHELLE THOMPSON: We’ll have to get that number for you.

BRENDAN MAGUIRE: Also, if you could, if possible, we would like to have it sometime this week. Obviously, that information is somewhere within the Department of Health and Wellness. I don’t think it would take a lot of digging to find it. I think it would be troubling if the information took weeks or months to get, as Nova Scotians were told to self-report, and they trusted the department to keep that information.

I would also like, if possible, December, January, and February combined. You could either do it by total, or you could do a breakdown of self-reported COVID‑19 positive tests and PCR tests per month. Is that possible to get before the end of the week?

MICHELLE THOMPSON: We’ll go back to the department and ask what the timelines on that would be.

BRENDAN MAGUIRE: What happens to that information? I had COVID‑19 in December. My partner, Rena, and our three kids all tested positive. That’s five cases right there. We self-reported those cases. When I self-report my case of COVID‑19, what happens? What does the department do with those positives? Why is it different from PCR?

MICHELLE THOMPSON: That information, the self-reports, go to Nova Scotia Health, Public Health, and it’s used as part of the surveillance work that the department uses for COVID‑19.

BRENDAN MAGUIRE: When Public Health, NSHA, and the Premier - who ultimately makes the decision on the direction when it comes to COVID‑19, and obviously, the Premier is making that decision based on information he’s receiving from Public Health and NSHA - would the Premier be making those decisions based solely on PCR tests, or would he be making that decision based on self-reported and PCR tests?

MICHELLE THOMPSON: I would say all of the information that we gather around COVID‑19 is used in terms of the decision‑making process. Whatever information we collect - PCR, self-reports, number of staff, hospitalizations, capacity - it’s not just a couple of things that lead, it’s a whole group of metrics that we would use to collectively discuss and make decisions.

BRENDAN MAGUIRE: What was the reasoning behind - up until, let’s be honest, the Progressive Conservatives came into power, when reporting daily numbers, governments were reporting the positives that were coming in. Somewhere along the way, it was separated, so we’re only going to report PCR testing. I think when that happened, what I heard from people in the public was that it undermined the confidence that people had in the testing. People were saying, why are they only reporting PCR? Why are they not reporting home testing and self-testing?

My question to the minister and her staff would be why did you separate home tests versus PCR, and why the decision to not report home positives anymore?

MICHELLE THOMPSON: There are a few things to that question. What I would say is that every wave of the pandemic was different, in terms of the variant that we saw, in terms of the number of cases. When we were faced with Omicron, which came to the province quickly, suddenly, at a significantly sized event, we were dealing with a variant that we hadn’t seen before.

We know that Omicron is more contagious than other variants previous to that and had a shorter incubation period. One of the things we found is that very quickly we had to change our testing strategy. So we continued to report positive PCR tests. We did have to change our testing strategy for a period of time, so we continue to get self reports. We felt that as the Omicron wave continued that that was under-reported, to a large degree. I certainly know there’s a number of people who I knew had Omicron who did not self report.

It is a way for us to measure, it helps us do surveillance, but we knew it wasn’t a comprehensive number, so the PCR tests allowed us to look at those individuals at highest risk who were getting PCRs in the testing centres through the later part of Omicron.

BRENDAN MAGUIRE: There are a few things that confuse me in that statement, respectfully. You said that the PCRs were reflective of people who were highest risk. We don’t know that. I know that, for example, my in-laws, who are in their mid- to late-70s, tested positive for COVID-19 with a home test, and they did not do a PCR test. So the limited numbers that you have there may show that, but let’s be honest, tens of thousands, if not hundreds of thousands of Nova Scotians, probably tested positive with a home kit and some of those people, like my partner’s best friend, she and her whole family tested positive and her son, who tested positive without a PCR test, has a rare genetic disorder where he has no immune system.

To say that this is reflective of people at highest risk is certainly not true. I’m sure a lot of people who were at high risk took the PCR test, but a lot of them didn’t. A lot of them were just told, take your test and stay home.

I understand that these waves are different. What I’ll say about this is some of the statements said here were, it came on suddenly. It didn’t come on suddenly. Like every other wave of COVID-19, we saw it out west, we saw it in Ontario, and it made its way across to Nova Scotia. For some reason Nova Scotia always seemed to be one of the last provinces that was impacted by these waves, so we saw it coming.

I would say what was different about this wave was the strategy, how to deal with it - let’s not test as much anymore, let’s lift restrictions. Even today there was a report, I don’t know if you saw it, on Global News, which was quite startling. It said that every month in 2022 had a higher death rate than ever; January was terrible, February was worse than January, March was worse than February.

What I’m wondering when it comes to COVID-19 is why the sudden shift when we know the numbers are skyrocketing now, we know that more and more people are passing away, unfortunately, and yet we’re being told by the department that we have to live with it, and by the Premier that we have to live with this, yet the numbers are showing that we went from the absolute best in the country to one of the worst.

My question to you is: Why the shift? You actually think that going from the best in the country to the one of the worst in the country at handling this, is good strategy?

[9:30 p.m.]

MICHELLE THOMPSON: There’s a couple of questions in there. The testing strategy changed based on the capacity that we had, based on the numbers. In this wave, the percentage of hospitalized - not the number of cases, but the percentage of hospitalized - in the first wave it was 4.7 per cent of non-ICU, it was 2 per cent in the second wave, 6.1 per cent in the third wave, 2.1 per cent in the fourth wave, and 1.5 per cent in this current wave.

Percentage of hospitalized ICU patients was 1.4 per cent in the first wave, 0.5 per cent in the second wave, 1.8 per cent in the third wave, 0.6 per cent in the fourth wave, and 0.1 per cent in this current wave. So raw numbers are higher but the percentages are not.

The percentage of deaths was 5.9 per cent in the first wave, 0.2 per cent in the second wave, 0.7 per cent in the third wave, 0.6 per cent in the fourth wave and 0.3 per cent in this current wave. The raw numbers are larger but the percentages actually don’t show there has been a progression.

BRENDAN MAGUIRE: Here’s the thing about your statement you just made. You just said that the statistics are lower but the raw numbers are higher. Raw numbers are human beings. So the raw numbers mean more Nova Scotians got COVID-19, more Nova Scotians have died and gotten seriously ill from COVID-19 but the statistics are lower.

The other thing I will say is how can we accurately say what the numbers are when you stop testing? When you access the PCR - and home tests have been nil to none. I know it’s not on you, but this is a very serious issue. We were asking people in low-income areas at one point to come downtown to get test kits or to get a PCR test. They couldn’t, they couldn’t afford it or they had children at home; they couldn’t get on a bus with two and three children.

What I would say about the statistics is they are very inaccurate, they really are. When we know that people were encouraged not to self report and to stay home. In the end, the philosophy was, there’s no way to report it. If you test or you feel sick, you can stay home and deal with it. But a big part of that issue of staying home was, again, sick leave. Now we’re seeing more and more people in Nova Scotia that are testing positive, the raw numbers show that. I was just with a group of close friends a while back, eight of us, and six of them, me and one other person - because I already had COVID-19 and so did he - six of them got COVID-19. Not a single one of them reported it. Because there’s no way to report it. There’s no self reporting anymore.

What concerns me is when we hear things like “the statistics show”. Statistics aren’t reflective of what’s really happening on the ground. What would be more concerning to me and what should be really concerning to the department and to the government more importantly is that Global News article today where people died in January, even more people died in February, even more people died in March and they’re saying if the trend continues there’s probably going to be more people that unfortunately pass in April. We are in the middle of the sixth wave. Is it sixth now? Fifth, sorry.

I haven’t heard any acknowledgement from the government on that. All we’re hearing from the Department of Health and Wellness and even, you know, one of the things that really stuck in people’s craw during some of this stuff was that we talked about the testing capacity. The department, under your direction and under the Premier’s direction, pulled home kits out of just about everywhere. The only place in my community that really had them was the Spryfield Library and those were gone like that. It was like Popeye’s Chicken when they found out that they had home testing kits.

Yes, the kids at school got some, but you were sitting on a $100-million surplus. One hundred million dollars. Surely somebody went to the Premier and the Department of Finance and Treasury Board and said, we need more money for this, we need more money for testing. The reason I asked for the numbers in January and February is because we’re hearing that it is exponentially higher than what was being reported. Some people are estimating it’s 10 times higher.

I hope that we get those numbers this week because I think it’s extremely important. I know that it’s very tough for the department, they’ve gone through years of this. The front line workers are exhausted and they’re tired and they’ve taken abuse and they’ve been protested. The systems they put in place now are being deconstructed. We were once on the cover of Maclean’s magazine, and I know some of you probably saw that. We were being nationally recognized. I’m not just saying it because it was the former Liberal government. I wouldn’t care if it was green, purple, yellow, blue. Doesn’t matter. At that time, we were leading the country and we had amazing supports in place.

They’ve been deconstructed, and I don’t get why you would deconstruct the stuff in the middle of a pandemic with a $100-million surplus. What comes to mind when I think about this is priorities. You ran on a health care budget and that money was being used - I think we saw half-a-billion dollars was what was being used for COVID-19. The general public have asked the leaders in the community and the leaders of the province, why can’t I get access to the testing? Why can’t I have sick days when I’m sick? My answer to them is, I don’t know.

You saw a 4 per cent increase in your budget, which I think was a little surprising for most. I think we thought it was going to be considerably larger. None of that, it seems, has gone to fighting and continuing the fight against COVID-19. The government leaders and the people that are now running the government, from a political standpoint, really beat up the previous government for not spending enough, for cases spiking. I think the messaging we’re getting from the Department of Health and Wellness right now is, we’ve got other priorities.

Again, what’s happened, because of the lack of funding and resources around testing and protecting people from COVID-19, is we saw what we saw this week, which is hospitals are once again shutting down surgeries. We were through that already. Yet you sat on $100 million. Do we not see the long-term effect that’s happening here? People who should have been diagnosed with cancer, people who are sick, it’s going to take a while. I can tell you from my own personal experience, colonoscopy was over two years. There are people who are waiting three, four, five, six years for surgeries and for preventive medicine.

The backload. The issue that we’re going to have here is people are going to be completely exhausted by the time - you can shake your head, but people are going to be exhausted. The medical professionals are going to be exhausted by the time we get out of COVID-19, and then you say “Pfft”. There you go. We’re five years behind.

THE CHAIR: Order. It is now 9:40 p.m., and the House is set to adjourn at 10:00 p.m.

The honourable Government House Leader.

HON. KIM MASLAND: Madam Chair, I move that the committee do now rise and report progress and beg leave to sit again on a future date.

THE CHAIR: All those in favour? Contrary minded? Thank you.

The motion is carried.

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

[The committee adjourned at 9:40 p.m.]