HALIFAX, WEDNESDAY, APRIL 6, 2022

COMMITTEE OF THE WHOLE ON SUPPLY

5:15 P.M.

CHAIR

Angela Simmonds

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

The honourable Government House Leader.

HON. KIM MASLAND: Madam 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 of the Department of Health and Wellness, pursuant to the Estimate.

THE CHAIR: The honourable member for Clayton Park West.

RAFAH DICOSTANZO: Maybe I should start, just to make sure that the minister is there, because yesterday I had to start three times. If the minister could introduce who’s with her, I would be happy to stand up and ask my first question.

HON. MICHELLE THOMPSON: I’m here. Shelley Bonang is here, Jeannine Lagassé, the deputy minister is here, and Dr. Kevin Orrell from the Office of Healthcare Professionals Recruitment is here.

RAFAH DICOSTANZO: Thank you to the minister, and welcome again.

My first question is going to be on the Bayers Lake outpatient centre. I hope I can get as many updates as possible. First of all, how is the project going? Where are we? When is the expected opening date? Let’s start with that, and I have many other questions.

MICHELLE THOMPSON: They currently are under construction. There is an expected substantial completion scheduled for August 2023, and a final completion of February 2024.

RAFAH DICOSTANZO: Sorry, you said August 2023. What will be ready in August 2023? If you can just give us a list.

MICHELLE THOMPSON: Bayers Lake Community Outpatient Centre will include primary care services, 24 dialysis stations, diagnostic imaging, and blood collection services. The substantial completion date is Summer 2023. That’s what you can expect.

RAFAH DICOSTANZO: This is amazing news, and I’m very grateful. We know that this outpatient centre is a P3 model. I just want to make sure there are no overruns in the maintenance of the P3 - if you can elaborate to make sure that we’re on target to the established contract.

MICHELLE THOMPSON: The project is on schedule, and there are no issues at this time to report.

RAFAH DICOSTANZO: Thank you to the minister for that. So we’re guaranteed that the cost for this project will stay the same as of August when the government takes it over. Is that correct?

MICHELLE THOMPSON: As far as I know. You may want to confirm that with our friends in Public Works when you have the opportunity to speak with them.

RAFAH DICOSTANZO: I’ll make sure - I will ask that same question. You listed the services that we will have. I did not hear that there will be a walk-in clinic, which was promised as well. Can I get a confirmation that there will be a walk-in clinic at this location?

MICHELLE THOMPSON: There will be primary care access at that facility, yes.

RAFAH DICOSTANZO: The primary access - if I can get a list of how many doctors. August is going to be here very fast. What are the plans for this primary?

I know my constituents are looking forward to that because I’ve been hearing a lot of issues recently with Clayton Park West. In the last four years, honestly, I did not get many issues with lack of family doctors. We do have that issue and I’ve had about seven or eight e-mails in the last month alone. There must be family doctors who are retiring or closing. I know there was one on Lacewood Drive that closed.

I just want to know as much as possible about this. I keep calling it a walk-in clinic or primary health. Can you explain how that one is going to be offered? Will there be doctors, nurses, a nurse practitioner? What do you anticipate at the Bayers Lake outpatient in the primary care?

MICHELLE THOMPSON: The scheduled opening of that facility is August 2023. There will be ongoing work over the period of time of construction to define that model. I don’t have those details right now. Those are things that we will be working on as the time progresses and there will be more to say further into the project.

RAFAH DICOSTANZO: I know that I’ve asked this question before, but we know the pressure that is on our emergency at the HI and also at Cobequid. I can’t imagine building a whole new hospital or outpatient centre without offering emergency services when we know we have such pressure.

People are waiting long, long hours at emergency. It makes sense that this walk-in clinic will be some kind of a triage for minor emergencies - an ear infection or bladder infection. These can be treated at a walk-in clinic. What’s important to me is that we offer a 24-hour service at this centre. That is the least that we should expect if we’re not going to have a proper emergency room similar to Cobequid and we’re building this amazing facility but will not offer the service.

Is there money so that we can have a 24-hour service as a triage for emergencies at the outpatient centre?

MICHELLE THOMPSON: I know that you’ve asked me this question before. No, it will not be a 24-hour emergency. It is a primary care treatment centre for episodic complaints, as you say, but what it will do is provide access to people so they don’t have to go to emergency rooms throughout the Central Zone in order to access the care that they need.

It’s the right care by the right provider in the right place. There are no plans to extend this to a 24-hour service.

RAFAH DICOSTANZO: What would be the cost if we offered it as 24 hours? Why are we not looking at this? We just fast-tracked I don’t know how many buildings - 20 buildings in the area of Kearney Lake and another 10 buildings just by Sobeys. I have also another development at the Mount with 7,000 people and we’re not spending the money to offer them health services in the area.

If I can have a figure for what the cost would be we extended the hours to 24 hours. What are we looking at and why are we not including that?

MICHELLE THOMPSON: To my earlier point, there’s no money in the budget for that so the estimated cost is not available. It will be a centre that has urgent treatment primary care so that people can get the care they need but there is no intention to create a 24-hour emergency care facility there similar to the previous government’s plan.

RAFAH DICOSTANZO: Thank you to the minister. I’m going to be fighting for this until I’m blue in the face because it is important to the whole area and the expansion. We have the highest number of constituents in a small area, but they have the least of facilities. This is a brand-new facility that can service them, and we need to look to the future. When this was announced in 2017, the population was a lot less than it is now and we need to look to the future.

We have an opportunity to help our emergency departments at Halifax Infirmary with this one. If it’s not in the budget this year, will it be in the budget next year?

MICHELLE THOMPSON: We can ask this 100 times but the answer for right now is going to be that there is no expectation that that will be a 24-hour facility. I can’t really predict next year’s budget. We’re concerned to get through this one. I can’t really answer that with any certainty, but I don’t think there are any plans to extend that right at this time, no.

RAFAH DICOSTANZO: Maybe the minister can give me some idea if recruitment is under way for that outpatient centre. It’s only a year away, in a few months.

MICHELLE THOMPSON: Yes, there’s recruitment under way for all of the facilities across the province and certainly this one is no different.

RAFAH DICOSTANZO: Is the minister able to give me a number of what staff - what do we need for this outpatient centre to be staffed properly? A list of the number of nurses, number of physicians, number of specialists - do we have an idea of what is needed for this outpatient centre?

MICHELLE THOMPSON: I feel confident that primary health care is recruiting to the needs of that clinic. To your point, we’ll continue to plan for the area expansion, and we’ll see over the next year how that progresses but there is no firm staffing model at this time.

RAFAH DICOSTANZO: You gave me the list, but we don’t know how many doctors for each of these services that you are offering that are being housed at this outpatient centre? I can’t believe that that wasn’t part of the plan.

Do we have the list or an updated list of what is going in that outpatient centre? If you don’t have it now, I’m happy to get it tomorrow from the department. We should have a list of how many doctors, how many nurses that this outpatient centre is going to house. That is part of the projection or the planning.

[5:30 p.m.]

MICHELLE THOMPSON: I will look back and see what your government’s plan was, when I get a second.

RAFAH DICOSTANZO: I thank the minister for that. I’m sure that information is there, and we can have that as our baseline and hopefully if there’s an increase in demand, some increase in the number of doctors and nurses for that outpatient centre.

I’m so excited for a new outpatient centre in that area and state-of-the-art health care that is coming to our riding and so many ridings in the area that are in need of that.

I have another question also. When this project was planned, at the beginning, when announced, there was a big hype about transit. How are people going to get to it? Has the department been in touch with HRM to make sure there are bus services to this outpatient centre?

MICHELLE THOMPSON: That would be a question that would be better answered by our colleagues in Municipal Affairs and Housing to see what sorts of planning they’ve been doing with the HRM.

RAFAH DICOSTANZO: So there’s no negotiation right now, or working with the city? Who is in charge of this project? Isn’t that one of the items on their list, that they need to make sure that people can access these services? Isn’t that part of the teamwork, that they make sure there are buses or access?

I also know that there is access to the wilderness area. They want to have some from the parking lot. Is that also on the plan, if anybody knows that, as well?

MICHELLE THOMPSON: This is a cross-government project. Nova Scotia Lands and Public Works, as well as our municipal counterparts, are looking after this. Nova Scotia Lands and Public Works are actually responsible for the project itself. It does cross several departments. The transit to these facilities is not something that Department of Health and Wellness would have purview over.

RAFAH DICOSTANZO: I will move away from Bayers Lake, but I really look forward to figuring out how many doctors, nurses - a list of what was planned for this centre, so we can use that as our baseline. I wish you all the luck for making this project come to fruition in August, as promised. I look forward to that day.

My second question is about family doctors in Clayton Park. Honestly, this is my fifth year as an MLA, and at the beginning I thought myself one of the luckiest MLAs because I didn’t get many inquiries about unattached patients. I had very few inquiries. But in the last couple of months, I’ve had more than in four years. Something has happened.

Can somebody tell me if we’ve lost - I know the Lacewood Medical Centre closed - if somebody can tell me how many doctors in my area, what are the changes? What is happening? Why am I hearing more about this issue?

MICHELLE THOMPSON: To the earlier point, there is the population growth, as you mentioned, in the area, which is contributing. There was also a physician with a large-sized panel who is not able to work, has retired. That practice is closed. We are actively recruiting to those positions. There are some active discussions happening now around physicians in that area.

RAFAH DICOSTANZO: I also wanted to know how many doctors in our area are going to retire. Do we have a number for Halifax West, and what are the number of patients who are with those retiring doctors? I know my doctor has notified you that he wants to retire in the next few years, but what other doctors, and how many, in my region, in my district?

MICHELLE THOMPSON: We don’t always know when physicians are going to retire. They’re independent practitioners. While we work with them, it is at their discretion whether or not they will let us know. There’s no way for us to know with certainty how many physicians - I’m not sure the boundaries of your constituency, but they don’t have to tell us if they’re going to retire. It is a courtesy to us and a courtesy to patients.

That’s information that we don’t currently have. We do know that there are a number of physicians across the province by age that are nearing what we would assume would be the age of retirement, but we can’t anticipate if they don’t tell us directly what their plans are.

THE CHAIR: The honourable member for Northside-Westmount.

FRED TILLEY: Good afternoon, minister. Thank you for being here and answering some questions. My questions will be around the health development in Northside-Westmount. I’m just wondering if we can get a timeline or an idea if things are on track with the development at Northside.

MICHELLE THOMPSON: There were some delays, but it is currently in the design phase of the project.

FRED TILLEY: Can we get a timeline as to when we can expect construction to begin?

MICHELLE THOMPSON: Again, we’re in the design. I don’t have the exact date for the construction start, but the final completion, the expectation would be that it would be April 2026. This is fairly recent, but in terms of the design, I’ll just make sure that that doesn’t get pushed out a little bit as a result. Final completion is April 2026.

FRED TILLEY: I’m going to start, during my consultations within my riding, I had an opportunity to speak with many of the physicians that are going to be working in the collaborative practice at Northside. I’m hopeful that they are being included in the design phase. I’m glad to hear that we’re still in the design phase because I know they had some concerns with design. Can you just confirm that the local physicians are currently involved in the design?

MICHELLE THOMPSON: There have been a number of physicians who have been engaged in the process. Dr. Orrell, initially, was one of the physicians who was leading that process and says that Dr. Elwood MacMullin is now leading that work, and there has been stakeholder engagement across the physicians group already.

If there are physicians with particular concerns, I think it would be best for them to reach out to Dr. MacMullin in regard to that. The new model of care has started at the urgent treatment centre in the Northside already. I think it’s a benefit. I have heard really wonderful things about that centre.

FRED TILLEY: Minister, you’re absolutely right. The urgent care facility at Northside is going very well. I’m hearing lots of positive comments about that. I’m looking forward to the time when they can move into the new facility and expand the operation. It’s really a great way to deliver care.

I just want to go back on the completion date, just want to confirm April 2026. Will that include the health care facility as well as the long-term care facility - and I’m assuming the laundry will be finished prior to that because it’s well under way, from what I can see.

MICHELLE THOMPSON: There are a number of things that obviously are happening now. The final completion date is April 2026, but the substantial completion date is April 2025, so there will be some movement into the facility initially, and then that final year will be around cleanup, whatever odds and ends there are in the project to tie up loose ends. You can expect to see people moving into that facility in 2025.

FRED TILLEY: That’s good news, minister. Similar to my colleague, can you just confirm the services that will be offered in the urgent care/health care complex, please?

MICHELLE THOMPSON: There will be an urgent treatment centre there, similar to what you’re experiencing now. There are laundry services there that are expected, and there will also be long-term care beds as part of that project as well.

[5:45 p.m.]

FRED TILLEY: Under the urgent care piece, I’m assuming that’s going to include X-ray, blood work, endoscopy. Can you just elaborate on the services that will be available under urgent care?

MICHELLE THOMPSON: There will be at the urgent treatment centre - there are some short-stay beds, long-term care facilities, there will be diagnostic imaging, and lab. It currently is not slated for endoscopy. Do they currently do that now at that facility, are you aware?

FRED TILLEY: Yes.

MICHELLE THOMPSON: We’ll have to look into that. It’s not on our list, so I’ll have to follow up with that.

FRED TILLEY: I just wanted to confirm on blood work as well. Will blood work be part?

MICHELLE THOMPSON: Yes, there will be lab services there.

FRED TILLEY: Great, thank you. I didn’t put two and two together with lab services but now I do, so that’s great.

For the residents of Northside-Westmount I think is going to be a great addition to the services. I’m not sure if you mentioned - I just wanted to confirm - I believe it’s 60 beds in the long-term care facility.

MICHELLE THOMPSON: There are 60 beds allocated to that facility.

FRED TILLEY: Minister, maybe if I can just turn my question a little bit towards the future of Northside General Hospital. Has any planning or thought gone into what will happen with Northside General upon the 2026 full completion?

MICHELLE THOMPSON: Thank you to the member. There is no option for it to be repurposed. The understanding is that it will actually be taken down.

FRED TILLEY: I guess does that mean that a full assessment - and I know this is not your department, but some community members have mentioned to me the possibility that maybe it could be used to help with the housing shortage, some affordable housing. I know the building is old, but I just wanted to see if there has been a full assessment on it.

MICHELLE THOMPSON: Apparently there was preliminary work done when the project was being considered and developed. At that time, and I suspect going forward, there would have been a lot done to that facility in order to bring it up to code and various things.

If there’s a community group that’s interested, it wouldn’t necessarily come through us. I think there are a number of challenges around the facility in bringing it to a code that would allow it for housing or another facility, a health care facility.

FRED TILLEY: I would suspect the same thing with that property, but it is a wonderful property with great views so perhaps there could be some other future use for the property.

To switch gears back to the collaborative centre - similar to my colleague, can you confirm the number of physicians who will work out of the new collaborative centre?

MICHELLE THOMPSON: I think the current model that you have would be somewhat of an indication in terms of who would be there in an urgent centre but the fullness of that has not been fully explored - not explored, but those numbers aren’t finalized. It would include physicians, nurses, you’d also have that DI staff as well as lab staff.

I think that over time there is some time between the opening, and they will continue to look at that and primary care will continue to build that model.

FRED TILLEY: Thank you, minister for that answer. As a person who is not involved in health care, can you confirm that it would include such things as X-ray and ultrasound? Is there anything else that would be included in DI?

MICHELLE THOMPSON: There are plans for X-ray. In terms of the ultrasound, whether it is portable or whether is one that would typically be in the DI department, I don’t think we have that level of detail yet, but there would be - I can’t imagine there wouldn’t be a portable, allowing some diagnostic capability in the facility for ultrasound.

FRED TILLEY: I do know that at the current facility, there is an ultrasound department. Again, I don’t know the extent of the equipment that they have and the different tests that they’re able to run. I would hope that the level of service would be similar to what is currently offered now in the Northside. Can you confirm that?

MICHELLE THOMPSON: We do feel that it will be similar, that it will be a similar service, yes.

FRED TILLEY: Just a quick question around the budget. I know costs have risen. Is everything still on budget for that project?

MICHELLE THOMPSON: As far as we know now, today, we feel that it is within the budget. As it continues, we’ll see. Certainly, that will be the goal, to keep it on budget as we move forward.

FRED TILLEY: Minister, thank you for the answers to those questions around the Northside Health redevelopment. I live about three minutes from the facility. When I head towards North Sydney, I drive by it daily. Every time I drive by, I get excited about what the future is going to bring for health care on the Northside. The community is really looking forward to that development and I hope that we’re able to bring it to fruition in that time that you have laid out. Thanks for your answers, and I appreciate your time. Best of luck with the rest of your questioning.

THE CHAIR: The round of questioning for the Liberal caucus has come to an end at this point. Now I would like to pass it over to the NDP caucus.

The honourable member for Halifax Citadel-Sable Island.

LISA LACHANCE: I’m really happy to be here this evening. I’m going to start off by actually returning to the issue of gender-affirming care. I know my colleague, and I thank my colleague, the honourable member for Dartmouth North for initially raising this issue a couple of nights ago. I think it’s a critical issue for many Nova Scotians, and the discussion a couple of nights ago, I watched and read. It intrigued me, so I would like to follow up on some of the issues raised.

I understand from looking at what was said before, that the gender-affirming care policy is under review at the Department of Health and Wellness. I’m wondering if you can clarify what this means. Is this a formal review? Has there been a project charter established? Who, in terms of what division, is leading the work? What are the timelines?

MICHELLE THOMPSON: This work is being jointly led by the Department of Health and Wellness and the Office of Addictions and Mental Health. It’s a joint partnership. Currently, there’s a jurisdictional scan of other provinces and countries in terms of the work that’s happening. There generally is not a project charter that’s developed for a policy review.

There’s been some consultation with the Halifax Sexual Health Centre, some advocates across the province, and Gender Affirming Care Nova Scotia, I think, is the name of the folks who recently developed that policy. That’s the early work that’s happening, but we’re very committed to moving this work forward in a meaningful way.

LISA LACHANCE: I’m wondering if you can also outline what you have for expected timelines and when and how the consultation process will be formalized.

MICHELLE THOMPSON: The work, obviously, is currently underway, so the jurisdictional scan that is being undertaken should be completed within the next two weeks. Then the engagement will begin in the next little bit and be wrapped up by the end of June. We hope that over the Summer there will be stakeholder engagement will continue, that there will be a draft policy by the Fall, and it will be socialized with members from the transgender community, as well as practitioners.

LISA LACHANCE: That’s very encouraging to have those firm timelines. I did have one more follow-up on organizational stuff, and then I’ll move on to other questions.

I’m wondering, within the two departments, who is responsible for this work? What division? I am just really curious, as many community members have also expressed concern to me as well. I’m curious about having the issue of gender-affirming care under the Office of Addictions and Mental Health.

MICHELLE THOMPSON: The work is carried on jointly, but it is the primary care division that’s managing the program, and we are consulting with the Office of Addictions and Mental Health, and also working with the Diversity and Social Inclusion division. The lead is primary care, but we are collaborating within the department with both of those divisions.

LISA LACHANCE: (Inaudible) . . . the discussion in terms of a renewed policy going forward.

As you know, in Nova Scotia, in fact, general practitioners - family physicians and nurse practitioners - it’s within their scope of practice to prescribe hormone therapy. However, what most members of the community note is that a lot of GPs and nurse practitioners are actually quite hesitant to go to the full scope of their practice. In that case, folks have to wait to see someone who is more of a specialist, and it creates an unnecessary backlog.

I have the WPATH Version 7 full guidelines and directives to table, so I will quote from them throughout this. They say:

“Given the multidisciplinary needs of transsexual, transgender, and gender-nonconforming people seeking hormone therapy, as well as the difficulties associated with fragmentation of care in general . . . WPATH strongly encourages the increased training and involvement of primary care providers in the area of feminizing/masculinizing hormone therapy.”

Given that we have this capacity, but it’s underutilized in Nova Scotia, I’m wondering if the department has undertaken any work to examine how to enhance the capacity of primary care providers to work with hormone replacement therapy.

[6:00 p.m.]

MICHELLE THOMPSON: That is part of the work that we need to do going forward - not only supporting primary care clinicians with the skills and the competence, but, really, the confidence. That is part of the work that will be happening, in terms of what’s happening in other jurisdictions.

What is the best way for us to support clinicians and understanding what the barriers are? Speaking for myself, I think it would probably be a competence issue and wanting to make sure that they do the right thing. Building in a good support network, as well, for those primary care providers who would be offering that service in the community - I think that is a major part of the work that has to be undertaken.

LISA LACHANCE: I agree. I think that the question of continuing medical education and continuing education credits for different regulated professions do give us a sense of the types of support that medical professionals often need in order to practise to their full scope.

I’m hoping that as you look at those assessments across jurisdictions about what can be done, you’ll consider both the issue around competency in providing 2SLGBTQ+ health care in general and then, secondary, the specific hormone replacement therapy.

I’m wondering if there’s been any consideration of expanding to other primary care providers. One example would be pharmacists. Again, quoting from the WPATH criteria:

“In selected circumstances, it can be acceptable practice to provide hormones to patients who have not fulfilled these criteria. Examples include facilitating the provision of monitored therapy using hormones of known quality . . . or to patients who have already established themselves in their affirmed gender and who have a history of prior hormone use.”

It’s very similar to how pharmacists can renew your birth control if you’ve been on it for years. Really, there’s no need to be going back to health care providers, especially given the lack of access in Nova Scotia. I’m just wondering if you’ve thought of expanding this provision to other health care providers.

MICHELLE THOMPSON: Those are great points and that will be part of the larger scope of the work that will be undertaken. We will work with and engage the Pharmacy Association of Nova Scotia, as well as the College of Pharmacists. We’ll need to work with them.

That may be a next step. It may be the priority that we want to establish a good, competent primary care provider network first and then move forward. That work will be undertaken and that will likely be part of the plan, although it may not be part of the immediate plan.

LISA LACHANCE: There are probably other areas where folks could be involved in this, but definitely the College of Pharmacy at Dalhousie is doing a lot of work - at Dalhousie, nationally, and internationally - on enhancing 2SLGBT competency amongst pharmacists. I think they would be an enthusiastic partner in that work, for sure.

One other aspect of the WPATH guidelines that we don’t have here in Nova Scotia is the issue of informed consent. I think that a lot of folks feel pretty insulted that they can’t just see their primary health care provider to talk about gender-affirming care, but they actually have to seek attestations. For many people, it really hearkens back to the consideration of our health needs as less than other health needs. I know that our sexuality and our gender identities are some kind of extra-special sickness that needs scrutiny.

I’m wondering if you could speak about what you’re thinking about in terms of informed consent versus the current model in Nova Scotia.

MICHELLE THOMPSON: We understand and have heard that there are a number of barriers in the policy, and we’re committed to improving that, which is what has prompted the work that has already started. We want to reduce the barriers. We want to support transgender and gender-affirming care in our province. That work will be ongoing. We are committed to improving it and we do understand that there are a number of barriers that are faced.

LISA LACHANCE: I’m sorry, I might have missed this in the minister’s answer. Just to clarify, are you looking at the issue of consent and reducing that as one of the barriers?

I’ll launch another question before I sit down again. One of the things that we have heard a lot of from folks, particularly at the sexual health clinic, is that, in fact, they are so underfunded, and they actually support thousands of Nova Scotians who are seeking gender-affirming care. I’m wondering about enhanced and stabilized funding for community health centres to enable better gender-affirming care in Nova Scotia.

MICHELLE THOMPSON: What I would say is that we are reviewing - we do have the latest version of the WPATH standards as well, and we are committed to reviewing all matters of access, as well as barriers. That would also include a financial review as we move forward with the policy.

LISA LACHANCE: As I have been working with the community and talking about gender-affirming care, one other area where I understand that we theoretically have good capacity in Nova Scotia but it’s not in practice, is amongst surgeons in the province to do top surgery here in Nova Scotia. That’s, of course, square-bracketing around issues of OR times and the strain we’re currently in, in terms of surgeries being pushed back, pushed back, pushed back.

If we were in an alternate space where we were on time for surgeries in the province and people had access to ORs, has this issue been considered in the department - that we actually have the capacity to do top surgeries instead of sending people to Montreal, but that they’re not happening in the province?

MICHELLE THOMPSON: The top surgeries are available in Nova Scotia, to your point, as well as Montreal. There have been some early discussions with the plastic surgeons around how we can increase capacity in the province to support that. Of course, we do have some system strain right now, as you mentioned, but there have been some preliminary discussions about that.

LISA LACHANCE: The other discussion I’ve had with stakeholders is around bottom surgeries - we don’t actually have the capacity, as I understand it, to do those surgeries here in Nova Scotia. However, stakeholders have kind of marked a path of how to get there, in terms of having a surgical fellow be aligned with the Dalhousie Faculty of Medicine, as well as Nova Scotia Health Authority, to fund that position to really work on both their own skills.

It’s how we can do that in Nova Scotia, and then how to expand that to beyond the one person, beyond the surgical fellow. I’m wondering if those discussions have taken place in the department.

MICHELLE THOMPSON: There are a couple of things that are important to talk about with bottom surgeries. One is that when we review, we need to make sure that there is a standard of care that is maintained. When we speak about competence in terms of clinicians - and I don’t want to disrespect any of our clinicians, but we want to ensure that there are enough surgeries on an annual basis in order for them to maintain their competencies.

Often in health care, health care workers need to perform certain procedures a certain number of times in a period of time in order to maintain their competency.

It’s not that we’re against having it, it’s a matter of fully understanding whether or not folks who would be involved in that work and those procedures would be able to maintain their competency. We do really want to ensure that people get the very best care they can. I can’t guarantee that that would be offered here, which is why we do send folks to Montreal because we know that the competency is maintained in that facility.

LISA LACHANCE: Some of the areas or other gaps that are present in Nova Scotia when you compare it to the current WPATH guidelines, in terms of Version 7, there are some procedures that are not covered in Nova Scotia. They are not eligible, whether you would get them here or in Montreal or wherever. Those include facial feminization, liposuction, and voice pitch surgery.

As you consider expanding gender-affirming care, I’m wondering if you’ve looked at these procedures, as well as tracheal shaves.

MICHELLE THOMPSON: The issues you raise around some of those services, the voice pitch surgery - those things will be considered as well, as we go through the WPATH standards. We will use those standards to see what we’re able to provide in the province as our standard of care, given the capacity and the skill sets that we have. We will be using those standards to guide and inform the work.

LISA LACHANCE: That’s great to hear and I know that will make a big difference for a lot of folks. I have friends who have actually left the province because of the restricted access to the types of gender-affirming care that would be covered here in Nova Scotia. I think it’s really important, especially if we can make a commitment to the WPATH guidelines. As you know, Version 8 is coming out probably this summer, so it gives us sort of a constant, international standard to which we can compare the care that we offer in Nova Scotia.

I’m just going to go back to a couple of procedure process questions. I just wanted to say too that we have been trying to do a lot of this work from my constituency office, in terms of consulting and engaging, and we have had a chance to speak with the deputy minister of health in the Yukon, as well as the folks from insured services in the Yukon. We have had no luck in speaking with anybody, for months, from the Department of Health and Wellness in terms of insured services, physician services, or Medavie, in terms of MSI.

I may not be right. I’m going to ask a question. My understanding is that decisions about procedures and surgeries that are covered are made by a panel at MSI. Is this true, and then how would that intersect with this process that you’re laying out that is ongoing around gender affirming care in Nova Scotia?

MICHELLE THOMPSON: The decisions that are made are aligned with the policy, so that’s why that policy work is necessary for us to undertake. If there’s a need or a want for you to speak with someone in the department, you’re certainly welcome to reach out to Deputy Minister Lagassé in order to work and talk to the department directly.

LISA LACHANCE: I will take you up on that offer. I think at this point I’m actually going to switch off gender-affirming care for a little while and go into some more questions that are more general.

The Doctors Nova Scotia master agreement is expiring soon. I’m wondering what you anticipate in terms of the process - the conversations that are going to be present when you’re negotiating the Doctors Nova Scotia master agreement.

[6:15 p.m.]

MICHELLE THOMPSON: We are in early discussions in the department about our upcoming negotiations, but they are a little way out, so we’re just in very preliminary stages of those discussions now.

LISA LACHANCE: Is there anything you can say about those preliminary stages in terms of how you’re integrating perhaps the need to recruit and retain with considerations of those discussions or how you’re engaging with relevant stakeholders before you go into that work.

MICHELLE THOMPSON: There are a couple of things to that. We do have a relationship; we meet on a regular basis with Doctors Nova Scotia just to see how things are going and work across the system.

In terms of stakeholders, we did the tour in terms of the physicians. We also have the Office of Healthcare Professionals Recruitment as well - they do a lot of work on the ground. We certainly get a lot of feedback from patients across the province as well. In January of this year, every person on the Need a Family Practice Registry was phoned and spoken to directly about whether or not they still required a family physician or a nurse practitioner.

There is ongoing communication and frontline voices and lived experience that inform how we understand what’s happening on the ground. We share that with Doctors Nova Scotia on a regular basis and they share feedback with us. That would be how we roll on a regular basis. The preliminary discussions are simply that, getting ready for negotiations when the contact is expired.

LISA LACHANCE: You mentioned the process that’s recently been undertaken to validate the wait-list, where folks were receiving phone calls and being offered virtual care. I have a few questions around that process. If people accept the offer to access virtual care, how do they still figure on the list for an in-person health care provider, and how have virtual care services been evaluated?

MICHELLE THOMPSON: The folks who are on the Need a Family Practice Registry and who have access to virtual care - they remain on the list. It’s not an either/or. They receive the opportunity to receive virtual care while they are on the list.

There is currently - we’ve undertaken - the Nova Scotia Health Innovation Hub is doing a fulsome evaluation of the virtual care. So that is in progress.

LISA LACHANCE: Can you talk a bit about that evaluation, about the metrics being used? Are you looking at patient outcomes, patient experience, provider experience? If you could describe a bit more fully the evaluation question and how it’s being explored.

MICHELLE THOMPSON: That fulsome evaluation is being carried out by researchers. What we expect is that it will include experience, to your point around not only provider but patient experience. We would want to know utilization. We would also want to know about the appropriateness and the timeliness of care.

I have confidence in that research ability to do a fulsome evaluation to help us understand the program and where it’s strong and where it can be improved.

LISA LACHANCE: As you’re getting the evaluation, which I’m really pleased to hear is under way and looking forward, I assume that there will always - well, you can tell me. Will there always be a virtual care component of health care in Nova Scotia, going forward? Do you have a sense of the size of that, and anything around timing, whether we’re looking at it growing over the next four years of the fiscal plan, maintaining, or decreasing as more professionals are in Nova Scotia?

MICHELLE THOMPSON: I do believe that virtual care - and I think the department agrees as well - is going to be with us moving forward. It’s proven to be very effective for a number of people in the province. We know it’s not for everybody.

There is a $14.5 million investment in this budget to expand virtual care across the province for people who are attached to a primary care provider, for walk-in clinics, also for people who are unattached. There will be ongoing evaluation. We always want to make sure that it’s appropriate care that patients are receiving. That will be ongoing - understanding barriers, seeing where it’s working well, understanding the gaps.

It is here to stay. I think it’s very effective for a large number of people.

LISA LACHANCE: Do you anticipate ongoing budget increases to support virtual care?

MICHELLE THOMPSON: I think the next year will tell us. Once we get what our next steps will be, whether we will maximize it or whether there are more places for us to go - I think it’s hard for me to answer that today, but certainly it is a modality that I think is important. We need to wait for the evaluation and we need to really understand the utilization and how this year goes before I could really answer that surely.

LISA LACHANCE: As the Conservative Government has noted, they’ve made a number of investments to try to deal with some of the backlog and bottlenecks in the system. I guess I’m concerned because I see a trend in funding - maybe not large, although sometimes it is - of opting for private providers; the use of Scotia Surgery, for instance. I know that there are providers who are helping with the paramedic transfer situation. Virtual care, while it uses medical professionals, it also relies on systems that are privately provided.

I’m also concerned, I hear a lot from folks who are giving up waiting for MRIs because they’re in so much pain, or ultrasounds because they’re too concerned of waiting in the public system, so they go and access private care. I also know other folks, certainly constituents of mine, who don’t have a family doctor and want access to primary care and can’t get into a walk-in clinic, so they actually pay the $50 fee to access a private provider, such as through Maple.

Of course, I want people to have access to care, and I understand it is a system-wide reboot that’s needed. But on the other hand, I’m concerned that this is a slippery slope, where we actually don’t build public capacity.

I’m wondering if the minister could share her concerns about the privatization of health care in Nova Scotia in terms of replacing public services, but also the fact that in terms of things like the online platform Maple or going out of province for knee surgery, that sort of thing, that we’re creating a system where some folks can pay to access faster care than others.

MICHELLE THOMPSON: I’d just like to start very respectfully - I know that language and words are very important to the member opposite, and I would really appreciate it if you would refer to the government as Progressive Conservative government. I know we’ve talked about that several times before in the House, and it’s a respect issue for me, and I would really appreciate it if you would honour that and if you would refer to our government as the Progressive Conservative government. Very respectfully, I would ask that.

What I would say is that what we do always is maximize the publicly funded opportunities that we have. Some of the folks we work with, like Scotia Surgery, allow us to increase capacity. When we work with those folks, it is still publicly funded. It’s not private care. The people who go there don’t have any different costs than they would if they accessed the publicly-funded system. This is simply an opportunity for us to expand our services and ensure that we can provide service in a timely manner.

We always want to look at what our capacity is, but to your point, we know that there are people who need those surgeries, and if they have a lower acuity level in particular, it could take us a very long time to get to them. We can’t leave any stone unturned. Right now the only outside-of-province care that people would receive is if we don’t actually offer it here, and that is publicly funded. We would support people through an approval process.

There is no privatization of the care. The private clinics that exist are not under the purview of the department and we don’t support or fund them other than to contract services from them. It’s a subtle difference. It’s really important. People aren’t paying for private care, it’s actually publicly-funded care that they receive.

[6:30 p.m.]

LISA LACHANCE: I know that there are people who spend their career studying the definition of public services and privatization of health care, so we can probably go back and forth on this. I do think that if you’re talking about health infrastructure that is privately created and owned and invested in, that that is a type of privatization, or that is accessing private facilities for health care. I do actually think that those platforms matter, whether they’re online or in person. The infrastructure matters.

I will let this question go, but I think just as important as the principle around what as a government

I will let this question go, but I think just as important as the principle around what we as a government are supposed to provide to citizens is being really conscious of the choices that we’re making in the face of a health care crisis. I will continue to be concerned about who’s delivering services.

As well, I wanted to ask about a campaign promise by the Progressive Conservatives to create an independent health care auditor. I’m wondering if you could provide me with an update on that.

MICHELLE THOMPSON: Thank you to the member for raising that. There have been ongoing discussions about the creation of that position. There will be more to say about that in the coming months, but we are committed to realizing that platform promise.

LISA LACHANCE: That’s really good to hear. I think that would be an important part of the system, especially as we both face and address a crisis and resolve the crisis.

I wanted to ask about the issue of home liquor delivery. The minister referenced ongoing discussions between Public Health and other departments about this potential decision or the extension of this decision. I’m wondering if the minister can explain what advice was given from Public Health on the policy.

MICHELLE THOMPSON: Thank you to the member for the question. There was some collaboration and there continues to be, when we work across government with our partners. There were various things that were discussed in terms of the Public Health approach. Examples would be age protection, limits on hours of delivery, and certainly, the approach to marketing.

There are ongoing discussions with this new program. We’re committed to working with our partners and trying to strike that balance between both priorities.

LISA LACHANCE: I’m wondering if you can speak a little bit more about the substantive policy issues that Public Health has raised about this initiative.

MICHELLE THOMPSON: I’m sorry, I didn’t catch that question. Could I ask the member to repeat that? I apologize. I didn’t hear.

LISA LACHANCE: Sure. It’s certainly very helpful to hear about the ongoing process, but I’m wondering if you could - and I guess I’ll add on a bit of a question - articulate what departments are engaged in those conversations, and what are some of the more substantive policy issues that have been raised from Public Health?

MICHELLE THOMPSON: The Department of Finance and Treasury Board reached out to Public Health. They’re also working with the Office of Addictions and Mental Health. Some of the things that were raised were around the monitoring, supporting education and training for professionals, and looking at jurisdictional scan to ensure that we were in line and supporting a modern and progressive policy.

LISA LACHANCE: The minister has spoken, I think tonight, in reference to other areas - the creation of a division on diversity, equity, and inclusion, as well as an equity analysis the department undertakes during policy development and review.

I do think that the Department of Health and Wellness has had a series of structures around diversity and inclusion, diversity consultants. At one point I think there was a manager position specifically for 2SLGBTQIA+ health equity. A lot of these things, along with the mental health division, disappeared under the Liberals. I’m happy to hear that that’s coming back.

I’m just wondering if you could talk a bit about the constitution of the DEI division, what their responsibilities will be, and how other divisions are mandated to use their expertise, and if you could table a copy of the equity analysis that is done.

MICHELLE THOMPSON: Thank you to the member for the question. There’s a lot there; I hope I can cover it all.

The division has eight to 10 people in there. I don’t have the exact number in front of me. They’re currently working on a health equity framework that needs to be completed by 2023. Community engagement with equity seeking folks is a cornerstone of the work that division is doing.

As well, they’re responsible for doing education within the Department of Health and Wellness, but across departments so that there’s integration of the work that’s happening and working with Nova Scotia Health Authority, as well as the IWK, to improve policies and ensure that there’s a diverse and inclusive culture developing in both Department of Health and Wellness and Nova Scotia Health.

LISA LACHANCE: I suspect this mandate might only extend within the Department of Health and Wellness. Just to clarify, could the minister explain how divisions and other folks are mandated to use the expertise, and is there any equity analysis happening now that’s formalized in a framework?

MICHELLE THOMPSON: The equity analysis that happens now - I think we would say it needs to be matured. We do work very hard to ensure that there is no exclusion. I think to the point that that health equity framework will help us mature in our capacity to do that.

The equity division works across departments and sits at the executive leadership team works across divisions in the Department of Health and Wellness, but there is also a network of similar positions across interdepartmental departments, and those folks have formed a network and they report into the deputy minister table.

We continue to strive to do better, but we are building networks and building pathways and relationships in order to improve our focus in the department.

LISA LACHANCE: I just want to ask one more time if the minister could clarify the process by which the expertise of this group is used. I understand about being part of an interdepartmental network, sitting at the executive table, but when a division is working on policy, what happens with that team?

I’m going to add one last question. As many people were in the community, I was surprised and disappointed not to see an increase in the budget for prideHealth. I’m just wondering if the minister could speak to that decision.

MICHELLE THOMPSON: Just in terms of how the division would do its work, if there a business case presented to the Department of Health and Wellness, the EDI division team would review that to ensure that there are no barriers created for those equity-seeking folks. Also, the business case itself, when you submit it, there are a number of prompts and questions that support the person who is submitting the business case to help them look at their business case to ensure that they are considering equity, diversity, and inclusion.

To your question around prideHealth, Nova Scotia Health Authority is doing a substantive review right now of prideHealth to better understand what some of the needs may be, and we will move on from there.

LISA LACHANCE: With that, I’d like to cede the remainder of my time to the member for Cumberland North.

THE CHAIR: The honourable member for Cumberland North.

ELIZABETH SMITH-MCCROSSIN: Thank you, I look forward to having a little bit of time to ask some questions on behalf of the people I represent in Cumberland North. I think the minister’s very well aware of the unique situation that we have up in Cumberland County.

[6:45 p.m.]

We historically have shared clinical services with southern New Brunswick for decades. We’ve enjoyed that relationship back and forth. Many southern New Brunswick residents receive health care in Nova Scotia for things like surgery, obstetrics, ENT, and then many of our residents historically have gone to Moncton for oncology and renal care, specifically.

We’ve seen a deterioration of these reciprocal services and a real threat, recently, with our dialysis patients - whom I’m sure the minister is aware of. Due to the nursing shortage in Moncton, some of our renal patients were actually told that within two weeks, they were no longer going to have dialysis available.

It caused quite a panic. Thankfully our renal team here met with the New Brunswick renal team and put that fire out very quickly, but it did place an increased pressure on getting the dialysis unit built at Cumberland Regional sooner than later.

I’m wondering if the minister would be able to update me on the timeline for the new dialysis unit at Cumberland Regional, and has there been an increase in urgency to get that done based on the increasing pressures from New Brunswick?

MICHELLE THOMPSON: We certainly appreciate the work that Nova Scotia Health Authority and the Department of Health and Wellness did in supporting those patients and trying to find some alternative space for them.

The feasibility study for the dialysis unit was delayed - the permanent one - so we are currently looking for a temporary space while that larger project unfolds to support those patients.

ELIZABETH SMITH-MCCROSSIN: Thank you, minister. I know everyone’s working very hard. I’m just curious about the relationship between our Department of Health and Wellness and the New Brunswick Department of Health.

Can the minister share what the reciprocal agreements are and has there been any disruption and conflict with those reciprocal agreements? Not just with the care between Cumberland and Westmorland, but also the IWK?

MICHELLE THOMPSON: There are operational agreements with the Nova Scotia Health Authority and the health services in New Brunswick. The Atlantic deputy ministers meet on a regular basis to talk about areas of common concern, so the relationship is unchanged.

ELIZABETH SMITH-MCCROSSIN: Thank you, minister. The reason I asked that more direct question is that a year ago during Estimates, I had asked a question about the disruption in services between New Brunswick and Nova Scotia. It was alluded to that New Brunswick owes Nova Scotia a great deal of money from these reciprocal agreements.

There has been a definite shift, and I don’t think it’s just pandemic related. There has been a definite change in the accessibility of clinical health services to the people of Cumberland County, specifically for oncology services. So again, based on what is best for the patient and the family, we always try to ensure that health care services are provided, based on what is best for the patient and the family.

Our local family physicians, their normal referral patterns for oncology were always to New Brunswick, to Moncton oncologists. As you know, it’s only a 40-minute drive. So the referral patterns were always there and that has changed. Now our young people, we have several people with breast cancer and other types of cancers that would normally travel 40 minutes for radiation and chemotherapy, now have to travel to Halifax and stay here, find accommodations, and be away from their family during a very challenging time, which just two years ago always went to Moncton, 40 minutes away.

Does Nova Scotia owe an outstanding amount of money to New Brunswick or vice versa - does New Brunswick owe an outstanding amount of money to Nova Scotia? Is that causing some conflict behind the scenes and patients are getting the effect of that?

MICHELLE THOMPSON: There is ongoing reciprocal billing between all the provinces. There are reciprocal agreements and there’s no significant disruption in that process.

Some of what we may be seeing from New Brunswick is that they are experiencing the same HHR issues that we are experiencing and over time, we may need to look at referral pathways in terms of whether or not they need to change, based on the capacity that New Brunswick has and our capacity. There is nothing out of the ordinary in regard to billing that would affect service.

ELIZABETH SMITH-MCCROSSIN: Thank you, minister. That’s something that I would love to see us do some study on, and ideally, have a Maritime clinical health services plan, not just a Nova Scotia one.

In my opinion, what I have seen happen to the people that I represent is that there has been a clear violation of the Canada Health Act, in that people have been denied clinical health services in neighbouring provinces. We have denied clinical health services to people in neighbouring New Brunswick. It’s a clear violation of one of the principles in the Canada Health Act.

I don’t know if the minister can let me know, is there any sort of ongoing Maritime or Atlantic clinical health services plan to ensure that there’s no disruption in care, regardless of interprovincial borders?

THE CHAIR: Order. The time for questioning has expired for the NDP caucus and our Independent member for this round. We will now move on to the next round for the Liberal caucus.

The honourable member for Kings South.

HON. KEITH IRVING: First of all, I want to thank the minister. I know this is a gruelling process and a very difficult department to manage. We are fortunate to have people like you, minister, who are willing to tackle the challenge of managing health care. It’s not a portfolio many people seek in any province across this country. Thank you very much for taking this on, on behalf of Nova Scotians.

I’m going to take just a few minutes with the budget book, so you may want to get that in front of you and get your officials that might be able to help us with a few questions around the numbers in the budget book. I guess I’ll begin first off on the overall budget for the Department of Health and Wellness.

I took note that there are no staff increases at all in the Department of Health and Wellness - 253 FTEs within the system. I was a bit surprised by that number, that we wouldn’t see some increase given the challenges in health care and the ambitions of this government to fix health care - as has been proudly stated - and that fixing health care was going to involve transformation and planning.

I’m wondering if the minister could perhaps expand on why no additional staff are needed in the Department of Health and Wellness.

MICHELLE THOMPSON: I thank the member for the question, and I do appreciate your comments earlier. It is a privilege to be of service as the Minister of Health and Wellness. I do appreciate your kindness.

There are a couple of things. I think if you look across the Department of Health and Wellness historically, with one department, and now we’re kind of branched off and there’s three ministries. We have the Office of Addictions and Mental Health, the Department of Health and Wellness, as well as Seniors and Long-Term Care.

I think if you look at them, you’ll see that there has been an increase. There have been some additions, but we really are trying to redirect the work with our partners at Nova Scotia Health Authority and IWK to the front line. We are trying to be fiscally responsible and efficient in looking for opportunities for us to do that.

[7:00 p.m.]

I think if you look over the (Inaudible) of all three departments, you will see there is an increase as a result of our focus on health care.

KEITH IRVING: Thank you, minister. I did note the additional FTEs in long-term care - I think it was 33 - and also in the Office of Addictions and Mental Health.

I’d like to move to page 13.4 of your budget. Given the pandemic and the burden on Public Health and the incredible amount of work done by the Chief Medical Officer of Health, I was wondering why that line item is showing an underspend of about $347,000, or 14 per cent, for the Chief Medical Officer of Health?

MICHELLE THOMPSON: The money that you see there - the underspend is actually some vacancies in Chief Medical Officer of Health complement, and we are currently in a recruitment process in order to realize the full complement in that office.

KEITH IRVING: Moving to the last three line items under Public Health Program and Services, there seems to be some realignment in the line items. You seem to be adding a public health administration line, keeping the health promotion administration line, and eliminating the communicable disease prevention, which was considerably underspent, budgeted at $737,000 and only $31,000 was spent.

Along with that, perhaps you could also inform the House of the 10 new FTEs at this department and what those FTEs will be doing.

MICHELLE THOMPSON: There has been some new money last year for public health renewal, so there has been some realigning that has been happening, so the new positions are being annualized this year. That’s the fluctuation that you’re seeing.

KEITH IRVING: Just a follow-up to that. In terms of the significant underspend in communicable disease prevention and then now collapsing that into a broader budget, could you just provide a bit of background on the considerable underspend there?

MICHELLE THOMPSON: This group was fully redeployed to COVID response, so that would account for some of the variance there. That’s where it would be, they were fully redeployed for COVID response.

KEITH IRVING: Do you anticipate continuing to have resources to fund the work that that division was carrying out, or do you anticipate COVID meaning that no work will go on with respect to communicable disease prevention?

MICHELLE THOMPSON: The Public Health Department does continue to do communicable disease work and they are moving to regular programming from COVID-19 as they are able. That work will re-establish itself as we move through this COVID-19 time.

KEITH IRVING: Thank you very much, minister. I think we’ve all recognized that Public Health and all of its preventive work is something that has been underfunded for quite some time and COVID-19 has really shone a light on the importance of that work.

Now moving to Page 13.5 with respect to the Corporate and Health Workforce section, in terms of Programs and Services. Forgive me, I don’t know what Health Services Emergency Management and Administration Services - what work is entailed by the work under that line item?

MICHELLE THOMPSON: That division is a coordination of emergency response and services for the health system.

KEITH IRVING: Okay, thank you, minister. I guess it may be self-evident but maybe you could clarify it for me: We’ve got an underspend there of about $1.75 million, or 23 per cent of the budget was not spent there. Could the minister provide a reason for that?

MICHELLE THOMPSON: Similarly, those resources in that space were redeployed to the COVID-19 response.

KEITH IRVING: Thank you, minister. So if those resources were redeployed for COVID-19 response, where would that money be found in the budget then, in terms of the actual spending?

MICHELLE THOMPSON: It would be under other programs, under Public Health. I believe it is Page 13.9.

KEITH IRVING: Great, thank you very much, minister. Moving on to Page 13.6, Digital Health, Analytics and Privacy. It’s described as the information management that enables evidence-based, informed health care decision making, which I think we can all support and certainly is an important element in our quest to fix health care.

Again, noticeably it was underspent and because of that underspending, we are now reducing the budget for digital health analytics and privacy by some 16 per cent, or $1.2 million. There also appears to be 14 staffing cuts. I’m wondering if this is a change in priority or has something moved around within the budget to account for the lowering of the budget and the staffing cuts.

MICHELLE THOMPSON: Some of these positions went to the Department of Seniors and Long-Term Care, so that would be the folks that looked after Seascape, which is a platform used by continuing care. Then there was a realignment of epidemiologists that went to Public Health. There’s no reduction, no cuts. It is a reallocation.

[7:15 p.m.]

KEITH IRVING: Moving on to 13.7, Quality and Patient Safety, an area that I think is of interest to anybody involved in the health system and I think we’re all striving for quality and the utmost in patient safety. This administration is being cut by 34 per cent in this budget. I am wondering if the minister could explain why we are cutting quality and patient safety?

MICHELLE THOMPSON: That is not a cut, it was the Safe Restart money that we received from the federal government. It was one-time funding in 2021-22. It was the COVID-19 response. There were services rendered and they’re no longer required.

KEITH IRVING: I find that interesting from the perspective of what I’ve always found frustrating about our budget documents - the limited number of line items, particularly in the Department of Health and Wellness - that this one item would receive a line item for a one-time-only program. But I’ll leave that to the masters of the budget book and move on here.

Going to Physician Services, I’m wondering if the minister can give us what percentage increase year over year is expected because of the physician contract. Presumably they have an inflation adjustment from the last fiscal year to this fiscal year. What would be that inflationary increase in doctor fees year over year?

MICHELLE THOMPSON: It’s a 2 per cent increase year over year.

KEITH IRVING: I notice in Physician Services, the overall budget is increasing by about $35 million to the number which I always have found an amazing number. I think Nova Scotians would take some interest that physicians are costing us $1,380,560,000.

So that budget is increasing by 3.5 per cent. We know now that 2 per cent of that is the inflationary costs of the fees from doctors. If the Physician Services budget is only increasing by 1.5 per cent, what story is that saying in terms of your estimation that we will be able to hire additional physicians - and we’re budgeting for additional physicians? Is this not telling Nova Scotians that you’re not that optimistic, that we’re not going to able to increase the number of physicians except by about 1.5 per cent?

MICHELLE THOMPSON: I’m going to do my best to translate this for you, so forgive me.

That is based on our current complement. As utilization increases, then the budget would increase and create a pressure moving forward. That it not a cap that we would recruit to. We would exceed that if we’re able is what I would say. If that helps.

KEITH IRVING: Okay, I guess that helps. I do understand, minister, the challenge of doctor recruitment is very difficult to move. I know that you and your colleagues are doing your utmost best, as previous Ministers of Health and Wellness have done in the past.

I think if one is anticipating filling positions and anticipating hiring doctors in the province, that in normal accounting practices you would be carrying them in the budget as opposed to leaving it to utilization pressure to be added to the budget, as going over budget going forward. I’ll leave that. It is telling a story, I think, in the budgeting here that this is a particularly difficult challenge and that we’re not as optimistic as we hope.

Let’s move one to 13.8 - Emergency Health Services. Ground ambulance operations was significantly over budget by about $3.5 million. I think I calculated that out at about 265 per cent over budget and, maybe for the sake of time, medical quality control is also significantly over budget, in a similar tune - $1.8 million versus $3.5 million on the actuals.

Could the minister explain why such significant cost over-runs in those areas?

MICHELLE THOMPSON: There was some additional operating funding that was required - $2.8 million - and then there was a medical oversight operation, so medical oversight physician compensation framework was retroactive. It was a retroactive payment for 2019, 2020, and 2021.

KEITH IRVING: Thank you, minister. I am not sure that I fully understood exactly the difference in what those were. I don’t know what medical quality control is, but maybe the minister could take a second attempt at helping me understand.

In doing that, I’ll add a supplementary: Because of the increases in medical quality control, or the over-spend there, you have chosen to increase that budget, more than doubling medical quality control, but the ground ambulance operations, which ran significantly over budget by $3.5 million - you have not increased the budget for that line item.

Could the minister shed a little light on a non-medical person in terms of exactly what is going on there between those two different line items and the adjustments to future estimates, based on actuals?

MICHELLE THOMPSON: The additional operating funding was $2.8 million and that was one-time funding. There were a variety of things: evergreening items, electronic patient record solution, booking and routing software. Just a number of one-time investment items.

The medical oversight, medical quality control, that is the provincial medical director and has overall responsibility for managing and directing clinical activities at EHS programs in the province. There was compensation. The compensation framework required a retroactive payment from 2019 and 2020 and then again in 2021.

KEITH IRVING: Alright, thank you, minister.

I was wondering if the minister could inform the House of the new $4 million on bilateral initiatives. What is that new activity?

MICHELLE THOMPSON: It’s actually the same amount of money. It is just a difference in terms of how the cash flows from the bilateral agreement. There is no change in the actual amount. It’s just a cash-flow issue - the way it flows.

KEITH IRVING: My apologies, minister - just a second and let me find that. The Estimate Book, on 13.8, is showing a new line item of Bilateral Initiatives. There is no previous estimate or previous forecast. It’s a new line item of $4 million. Are you suggesting that’s coming out of another line item, or is this new money?

MICHELLE THOMPSON: It is medical transport services, and it’s been reallocated in the Estimates Book. There is no change. It’s simply how it’s been allocated in the book.

KEITH IRVING: Thank you, minister. I’ll move now to 13.11, under the Nova Scotia Health Authority. I’ll just repeat a little pet peeve I have with our budgets - I expressed these concerns in my days at the Treasury Board table. A $1.9-billion transfer to the Nova Scotia Health Authority is rendered down to nine lines in this budget. It’s very difficult for you, and for us, I think, to give oversight into the Nova Scotia Health Authority. Anyway, we’ve not been able to change that over the years, and it is what it is.

There are two line items in the Nova Scotia Health Authority budget - one is taking a significant cut. Other Acute Care Expenditures is being reduced by 16 per cent to $114 million, and in Primary Health Care, the budget’s being increased by a similar amount, or 38 per cent. Is there a change in activities, or just a change in the classifications of those budget line items?

MICHELLE THOMPSON: The Other under the Acute Care expenditures was actually Safe Restart money, so that’s why you’re seeing a decrease in that budget line. The Primary Care increase that you’re seeing is related to the investments in virtual care, hospice, and the newcomer health plan.

[7:30 p.m.]

KEITH IRVING: I do note that this is an area of the budget where the Nova Scotia Health Authority provides no FTE information. I’d like to suggest to you and perhaps members of your staff and to the Department of Finance and Treasury Board that we maybe ask the Nova Scotia Health Authority to provide a bit more detail - and the IWK Health Centre - with respect to FTEs, so we can understand and actually physically see your government’s commitment to putting more staff on the front lines. It’s very difficult, obviously, to see that in this budget.

My final question - if I don’t add a supplementary - is in 13.12, with respect to hospital infrastructure. Minister, forgive me - I think one of my colleagues was asking this earlier, and I’m sure in previous hours perhaps others have asked. In terms of the major capital builds that the department is undertaking, to your knowledge, are those projects on schedule?

MICHELLE THOMPSON: Yes, we believe that all those projects are on schedule.

KEITH IRVING: The numbers are telling a different story here. The estimate for hospital infrastructure was $99 million. The actual that was spent was $47 million. Now, in 2022-23, $126 million is anticipated to be spent.

The reason I’m asking these questions is that it has always been challenging with respect to capital, in my experience - I remember the former Deputy Minister of Finance and Treasury Board talking about the snowplowing effects of capital projects. They obviously are optimistic and tell us as politicians that projects are moving along, we’ve got no problems, you need all this money in your budget to get the projects completed, everything’s on time. Then, at the end of the year - in the case of this budget - we’re seeing that half the money was spent and creating the snowplowing effect of creating pressures in future years.

I offer that up as a bit of advice for the minister, and maybe perhaps there is a clear reason why hospital infrastructure was underspent by some 50 per cent or $47 million, but my fear and my experience is pointing to projects potentially falling behind. Certainly, there are reasons like COVID-19, et cetera, but the numbers seem to be saying that these projects are falling behind. I don’t know if the minister wants to comment on that or not.

MICHELLE THOMPSON: Just a couple of things. In general, cash flows were realigned to fit the construction schedule. Overall, we feel there was some delay with COVID-19, but the project management team feels that it is recoverable at this time. There was also some health and management supply that was pushed to operating rather than a capital investment stream. That would account for some of that.

KEITH IRVING: Thank you very much, minister. I want to thank you for your responses today on my somewhat detailed questions with respect to the budget book. As I indicated, the budget tells a story and I always enjoy digging into the numbers to help tell the story to Nova Scotians. I want to thank you for your time and wish you all the best in the remaining time in Estimates. I know it is a gruelling process. I believe the record for the Minister of Health and Wellness is somewhere around 24 hours (Interruption) 32? Minister, you’re almost halfway.

Anyway, I wish you all the best for that and continued luck in terms of the challenges the health care system has. I think we’re all cheering for improvement. It’s not going to mean that we in Opposition will stop our job at holding things to account. Again, I want to thank you for your responses this afternoon, this evening, and before I turn it over to a colleague, I understand it might be a worthwhile time to take a break. I’ll leave that for you to respond to. Thank you.

MICHELLE THOMPSON: Thank you very much. I think it would be great just to have a 10-minute break, if you don’t mind.

THE CHAIR: We’ll recess for 10 minutes.

[7:38 p.m. The committee recessed.]

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

THE CHAIR: I call the committee back to order.

The honourable member for Yarmouth.

HON. ZACH CHURCHILL: Minister, thank you so much for entertaining our questions tonight. I do want to take a moment to thank the support staff in the room with you. I know how hard everyone in that department has been working, particularly over the last two years as we combat this pandemic. I certainly know the overtime hours, the lack of vacation, and the supreme dedication and commitment to serving Nova Scotians through this very difficult time and giving good advice to the government. I do want to express my thanks and appreciation for those folks.

Minister, I do have some questions around the current epidemiology on COVID-19. We have seen a pretty rapid spike in the virus. We are seeing a positivity rate that is close to 30 per cent - what we’re hearing reported publicly. Of course, we used to be in a situation in Nova Scotia where we didn’t necessarily know someone that had COVID-19. Now everybody knows a lot of people who have contracted the virus.

We are seeing more deaths in these last two waves than in previous waves in Nova Scotia. We’re also seeing major impacts to hospital capacity. I know how quickly that happens. I did serve as minister during the Delta wave, and very rapidly our hospitals - and our ICUs particularly - can reach capacity and create major operational pressures that impact service delivery, from surgeries to MRIs to lab tests.

I don’t believe that the current epidemiology modelling has been presented to the public. I, at least, haven’t seen it. If I’ve missed that, I apologize. Could the minister please share with the House the modelling for epidemiology so that we can have a look at that?

MICHELLE THOMPSON: There is no updated modelling. It’s been a while since that has been done. We do use the weekly updates. There will be an update available tomorrow that will have the most up-to-date numbers. Also, Dr. Strang will have some availability tomorrow, as well, to contextualize the numbers.

ZACH CHURCHILL: Perhaps the minister could inform the House of the rationale behind not using modelling for the epidemiology anymore, particularly at a time when we’re seeing very rapid spread, major transmission, and major operational consequential impacts across the health care system.

MICHELLE THOMPSON: One of the things that’s made modelling very difficult and less helpful across the waves of the pandemic is that there are different levels of transmissibility, different times of incubation periods, et cetera. Each wave has presented and had different characteristics and variants. It actually hasn’t been overly helpful; it’s not as predictive as people may think. That’s why it hasn’t been updated.

ZACH CHRCHILL: One area where I know the modelling was very critical was for hospitalizations, in terms of maintaining capacity in our hospitals and making sure we weren’t getting over capacity. That’s absolutely critical, I believe, for planning responses: redeployment of staff, finding available space in the system, and available beds in hospitals to look after people.

Certainly, the department would still be doing modelling on hospitalizations and doing some anticipation in terms of what that may look like based on the current spread of the virus and hospitalization rate. Could the minister please share with the House the modelling on hospitalizations?

MICHELLE THOMPSON: That modelling is currently being updated now so I don’t have anything to share at this point. But there will be modelling that is continued to the Nova Scotia Health Authority folks.

ZACH CHURCHILL: Well certainly there would be active updating of hospitalizations, they are happening fairly regularly. We have had a number of hospitalizations during these previous waves; we are experiencing more deaths. For many the illness certainly doesn’t demonstrate as being severe but for some it does, and we are hearing concerning reports about staffing levels.

I would be surprised if the minister doesn’t have modelling available or that’s not top of mind, considering that those models and understanding the hospitalization rate has been a key factor in determining the Public Health and operational response to COVID-19. Considering the CEO of the Nova Scotia Health Authority has not presented this information to the public, that is concerning.

I would ask the minister to update the public as soon as possible on that. We are at a point in the pandemic where the government strategy is to trust people to make the right decisions and live with caution. Overall, that’s a fairly understandable position to take. I do recognize that the public mood is such that people want to be over with this pandemic, be done with it and get back to normal. But the fact remains that this pandemic might not be done with us, no matter how we feel or how tired of it we are.

Certainly, preserving our hospital capacity, our critical services that are provided from heart surgeries to emergency department response, is absolutely critical to save lives and to deliver the service that people expect to get in their moments of highest need.

I will ask the minister again to inform us if she doesn’t have the updated modelling or numbers in front of her. If she could inform the House the role that that modelling plays, and hospitalizations play, in factoring into her recommendations to the Premier, as far as a Public Health response goes around COVID-19.

If she could inform us how she is utilizing that to advise the Premier and government and how hospitalizations are impacting their decisions, that would be very helpful for the House.

MICHELLE THOMPSON: We are in touch on a daily basis with Nova Scotia Health Authority and we check in with Public Health. There is an emergency operations centre that is stood up and they meet on a regular basis, three days a week at a minimum, in order to monitor the system. We are in constant contact about the system capacity and what’s happening.

That’s the information that comes to me through the department. We continue to work with our NSHA partners to support them in terms of protecting urgent and emergency services which continue. There is very good communication between the two departments, so we have a sense of what’s happening at Nova Scotia Health.

ZACH CHURCHILL: I certainly don’t doubt that there’s good interdepartmental communication on this. When we were in government, we did build some very good systems with the Nova Scotia Health Authority to track, understand, create modelling, and provide rapid response to the system. I’m very happy to hear that that work is continuing.

[8:00 p.m.]

My concern is around what’s being portrayed to the public. As I mentioned in my previous comments, we are at a point where the government feels that it’s necessary to empower the public without rules or restrictions to make their own decision.

At the same time, the government is restricting the flow of information to the public. There has been a demonstrable change in information flow to the public from previous phases in this pandemic. Particularly under the previous government where the public was given daily briefings, where the CEO of the Nova Scotia Health Authority actually presented the hospitalization modelling to the public so that they understood the impacts to the health care system that COVID-19 was having. Then that could then inform their own personal behaviour.

A concern that is certainly developing in my mind and, I believe, in the minds of individuals in the Liberal caucus is, if the public is not getting the critical information they need to make informed decisions on their behaviour, we may find ourselves in a very problematic situation whereby the public feels safer than they should in relation to the threat of COVID-19 and the risk level to our health care system, even if COVID-19 has taken more people in the last 8 months than ever before.

The threat of COVID-19 to certain individuals is still grave. There is also a greater threat to the operations of our health care system. We just read in CBC today that we have the most people out ever with COVID-19 themselves in our health care system with hundreds of staff - I believe the number was 600 or 800. According to the Nova Scotia Health Authority, this is the largest cohort of staff that have ever been out of the system in the last two years.

Could the minister please help myself and the House understand how we are arming the public with the information that they need to make appropriate decisions for their own well-being and the well-being of their families and the well-being of the health care system when we’re taking information away? When the minister is not presenting these figures regularly, nor the Premier, to the public, when the CEO of the Nova Scotia Health Authority has never presented information on operational impacts from COVID-19 to the public?

There is a big gap in terms of the information that the public is receiving now. It’s affecting behaviour in a demonstrable way. Go out and shop right now. Go to a restaurant. Count how many people are wearing masks now compared to previous months. People are making their own decisions, but I don’t believe they’re being well informed in making those decisions.

Anecdotally, when I’m out and about I see a lot less people wearing masks than before, at a time when we have more transmissible variants, at a time when this virus is killing more people, at a time when it’s having a greater impact on the operations of our health care system than ever before in this pandemic.

We had a friend in Kings North, he died waiting for heart surgery recently. This is happening, it’s impacting people’s lives in other ways other than the virus itself. Something we’re having a very hard time wrapping our heads around is why, if we want the public to make good decisions on this, are we taking critical information away from them?

THE CHAIR: The honourable member for Halifax Citadel-Sable Island.

LISA LACHANCE: Thank you to the minister and to staff for still being available for questions. I actually wanted to return to some questions we were talking about regarding the role of the diversity, equity and inclusion division. I realized that I wasn’t clear on the answer, so I wanted to ask it again.

Within that division, are there specific roles and expertise for different communities? For instance, for the African Nova Scotian community, for 2SLGBTQ communities, places for youth. I’m wondering what specific roles there are in that division and, as well, if in that division those folks are also authorized and able or accountable for undertaking community consultations in terms of being able to stay connected to the issues that matter to the communities, that they are then trying to translate into health policy issues? How else is the department helping them maintain their expertise in diversity, equity and inclusion?

MICHELLE THOMPSON: There are designated positions within the division for people who are equity-seeking individuals. We seek out folks with lived experience. We’re currently looking for African Nova Scotian consultants and First Nations consultants. There is currently not a 2SLGBTQIA+ individual yet, but we continue to recruit to the department.

Community consultation is a cornerstone of the work that needs to happen in order to stay connected to community and to build relationships. I think that will capture most of the questions.

LISA LACHANCE: Just to be clear, will there be a designated position for 2SLGBTQ community? You referenced equity-seeking individuals within the provincial scope of employment equity the 2SLGBTQ community is not included. Just wondering if there will be a designated position.

I also asked about how was the team provided time to be in community and what other kinds of ways - is there a training plan? How are people maintaining their expertise and building their skills?

MICHELLE THOMPSON: The staff who work in the department - the director has extensive experience in terms of work around equity diversity and inclusion. The staff are hired because they have lived experience and are competent, so ongoing professional development is available to the staff as well. So the division is only evolving and we’re constantly reassessing. The staffing is - we don’t currently have someone who represents 2LGBTQIA+ community and we will continue to work in community and understand the needs moving forward.

LISA LACHANCE: I will just say that it’s really not clear to me if the answer is yes or no. If the answer is no, there’s not currently someone who represents that community or brings that forward. Is the intent to have a designated position?

MICHELLE THOMPSON: At this time the staffing complement is currently complete, so the number of people - there are a number of people, we do have an equity, diversity and inclusion committee that meets on a regular basis within the department. There are people from broad-based communities who sit at that committee and provide lived experience as part of the work of the division of the EDI crew. Again, we continue to recruit to those positions when they become available but there’s currently no vacant positions.

LISA LACHANCE: I would take from that, too, that there’s perhaps no real intent to target the hiring of anyone from the 2SLGBTQ+ community, which is concerning and disappointing. I think I have been making my case for the absence of this in government policy and programs, particularly if the intent is to actually offer better gender-affirming care, I think having someone on staff. I really want to also make the distinction between a designated position as a consultant role, as I know it, in the provincial civil service, versus an employee committee.

Employee committees are super important, and actually I founded the employee committees at federal government departments, and actually I co-founded the provincial Public Service Employee Network - super important. They offer opportunities to connect, engage, everything from social opportunities to thinking about what makes a better workplace, but they are simply not the place in which you can get your policy and program expertise. If you’re not investing in it, you’re not going to have it. I would just leave that with you, that that’s really concerning to me.

I was pleased to hear the reference of the work that’s being undertaken with the health research hub, and I’m wondering if the minister can talk about other projects with the hub, and how else the department is working with the amazing health researchers that we have here in Nova Scotia.

MICHELLE THOMPSON: I can give you a little bit of insight into that Health Innovation and Research Hub, and I would also direct anyone who’s interested.

[8:15 p.m.]

If you simply Google “Nova Scotia Research Innovation Hub Showcase,” what it will do is provide two links. Last month we were able to have two days to celebrate some of the research initiatives that are happening. The first thing that struck me is that when we came into the showcase, there was a PowerPoint that rolled and rolled - really, it felt endless - of the number of practitioners across all designations in our province, health care providers, and researchers, and the innovative work that they’re doing. Not jut frontline clinicians, but also university-based folks and entrepreneurs as well.

At that showcase, we highlighted technology, the innovation hub, and some of the technology advancements. We looked at robotics as an example. We looked at a new piece of equipment - I don’t know what the name of it is, but it was actually a light that would look at blood flow in limbs of all colours. It was really essential.

That was designed by a wound specialist. Typically, a lot of the equipment that we have works best on white skin, but she’s created a technology that is not affected by any sort of pigmentation, so it actually creates equitable outcomes across all skin colours, which is really essential.

It’s transferred from her phone and can go remotely to a practitioner and specialist, and she created that because of the experience of her grandfather living in rural Newfoundland. That was quite inspiring. There was a number of different - I don’t want to highlight just some. I would really encourage you to go look.

The next day, what we did was highlight entrepreneurial, research, and innovation partnerships. That’s where you may have heard about the collaborative model where nurse practitioners and pharmacists are working together as an example to provide primary care.

This Innovation and Research Hub is a place where folks who have good ideas can come, their proposals can be supported, they can help with a variety of different supports in order to help people move their ideas forward and help develop proof of concept. It is a wonderful organization. We’re so grateful and lucky to have it. I don’t want to misrepresent or underrepresent their work, but if you went to their website, I think you would be really pleased with the work that’s happening there.

LISA LACHANCE: I do remember seeing reporting from the Hub, which seems really interesting now. I’m just trying to find and remind myself where the Hub is funded from. Is it funded and represented in the Estimates book?

The other new initiative that I want to ask about is the new announcement for the creation of the Tajikeimik, which is the First Nations Mi’kmaw mental health initiative that was created with $2 million. Just wondering where that’s also found in the Estimates book.

MICHELLE THOMPSON: The health research innovation hub is actually funded through Nova Scotia Health Authority so we would not have a line item specific to that in our budget.

I’ll leave the specifics about the Tajikeimik funding to the Minister of the Office of Addictions and Mental Health but it was actually a pre-budget funding announcement. It also is not reflected in the budget book.

LISA LACHANCE: Just to clarify, I’m looking at 13.11 with the Nova Scotia Health Authority table and again I would echo the honourable member for Kings South in terms of the difficulty of diving into huge departmental budgets with very limited line items. Within, are you aware of where within the Nova Scotia Health Authority table the money resides? I don’t know if it’s in operations or have you and was it founded with one time money, or do you know if that’s an ongoing expense?

MICHELLE THOMPSON: That would be under the Operations line item in the Nova Scotia Health Authority.

LISA LACHANCE: Now I’d like to turn and invite the minister to comment on how the Department of Health and Wellness is responding to the calls to justice from the Truth and Reconciliation Commission and the Call to Action from the National Inquiry into Missing and Murdered Indigenous Women and Girls.

As you’re undertaking enormous health care recruitments, how are you seeking out Indigenous health care providers? How are you increasing the competencies of all health care providers who work with Indigenous folks? Also, how are you looking at retention of health care professionals in Indigenous communities?

MICHELLE THOMPSON: I’ll give you an overview. There is a health equity partnership that has been struck with the Department of Health and Wellness and Nova Scotia Health Authority to address issues of systemic racism in the health care system. We are committed to providing culturally competent and safe care and we are working in that partnership to do that. The equity, diversity and inclusion branch at the Department of Health and Wellness is leading that work.

In terms of growing our workforce, there are designated seats for First Nations and African Nova Scotian people to attend a variety of health programs throughout the province.

In terms of the Truth and Reconciliation work, there has been identification of recommendations for health and that is reported to the executive team on a regular basis, as well as L‘nu Affairs, on the progress of those items. Also there’s our relationship with Tajikeimik, which is the First Nation health organization and is made up of a number of all of the health directors from First Nation communities, I think, as well as a leadership team for that First Nation Health - not necessarily authority but for First Nation health and wellness, they have oversight. That’s some of the work that’s been happening in the department.

LISA LACHANCE: Thank you, that’s a helpful overview. You talked about the drive and the commitment to provide culturally competent and safe care and that this is being lead out of the EDI division. I’m wondering specifically what kind of projects they are undertaking this year, if we have a few examples of their work.

I’m also wondering that aside from student seats, if you could also speak to the Office of Healthcare Professionals Recruitment. Are there goals within the recruitment that’s going on, with folks going across the country, international, for either residents or professionals to come to Nova Scotia?

MICHELLE THOMPSON: There are two funded positions. There are First Nation consultants working, one at the IWK and one at Nova Scotia Health Authority. Part of their work is to support improving cultural competency and safety in those organizations and their work.

We are also looking at navigation and interpretation services as well. They are currently under consideration in terms of how we best support. We do know that there are education modules that are available, both at the Department of Health and Wellness, as well as Nova Scotia Health Authority, to support individuals in learning more and reflecting on their own experiences and their own bias and trying to create some personal awareness.

I would just ask the member if she could repeat the second part of her question about the Office of Healthcare Professionals Recruitment? I didn’t quite catch that.

LISA LACHANCE: To the minister and also to the Office of Healthcare Professionals Recruitment: in terms of recruiting Indigenous health care providers and medical residents, is there a specific goal around that? Is there specific work being done in that way, as we seek to grow the health provider population?

MICHELLE THOMPSON: There is some collaboration. We do have First Nations and African Nova Scotian students who are hired within the department to give them experience in the department over the Summer break. There’s been a number of one-on-ones with students from First Nations communities, who are outstanding either scholastically or with their community, to encourage them to enter into health care professions.

The Office of Healthcare Professionals Recruitment and retention does work with Tajikeimik around health workforce planning to make sure their work is informed from community. There is a designated chair in Aboriginal health at CBU that is there as a result of provincial funding. There are a number of initiatives. I think we know that there’s still a lot to do, but we feel pleased with these initial steps.

[8:30 p.m.]

LISA LACHANCE: I’m going to change gears a little bit. I understand that there had been a dental health working group within the Department of Health and Wellness and, obviously, with other partners, leading towards the development of a provincial oral health strategy. I’m wondering if that’s still a departmental project and still under way. If it is, could you talk a bit about where the work is at?

MICHELLE THOMPSON: It is still a priority of the department. The Department of Health and Wellness, Public Health, pharmaceutical services, and extended health benefits are planning the work to look at an oral health action plan. We’re still in the early stages of that work.

LISA LACHANCE: I wanted to just ask about a couple of items in the minister’s mandate letter. I’m wondering about updates.

There was, in the mandate letter, the action of conducting “a full review of the formulary that decides what drugs are covered and which are not, to ensure the formulary meets the needs of Nova Scotians”. I’m wondering, has this been undertaken? What’s the timeline for this? Can the minister comment on what drugs are being considered for addition or deletion?

MICHELLE THOMPSON: We are doing a process review. There is some jurisdictional work happening. The majority of the listings are Pan-Canadian, but we still want to ensure that we understand what other provinces are doing as well. So that work is under way.

LISA LACHANCE: I’ll just follow up on that and ask if there’s a target date for completion of that review. If so, what is the target date?

I also wanted to ask about another mandate letter item where the minister has been requested to work with the Minister of Agriculture to examine how to reduce the cost of healthy foods for Nova Scotians. I’m wondering if that work is under way, and again, what steps are being taken, and if there’s a timeline associated with that work.

MICHELLE THOMPSON: In terms of the pharmaceutical review, some of the work will be completed by the Fall, but the Pan-Canadian process will carry on into the next year.

In terms of the work with Agriculture, Public Health is doing some work with Agriculture. They have a working relationship. That may be something that could be asked of the Minister of Agriculture in terms of the work that’s happening in his department - I don’t know that intimately - and how we are supporting.

LISA LACHANCE: Thank you for that. I’m wondering too, perhaps the minister could actually take on that follow-up to provide the House with information about that project and the timelines behind it and what activities are being undertaken.

I just wanted to ask a couple of questions under Emergency Health Services. I know that over the past year, we started, the Province started funding private operators to provide some services that traditionally would have been offered through EHS in terms of patient transfers.

I’m wondering what data the department has on that. What are you tracking? Is it decreasing patient wait times? Is it increasing patient outcomes? What sort of evaluation is happening, and what’s the intent for that program going forward?

MICHELLE THOMPSON: Thank you. There are no private operators - I’m not sure what the member’s referring to. I think it may be the expansion of the patient transferring units as well as the multiple patient transfer units. These are low acuity patients who are being transferred between facilities. They then don’t need to use ambulances and emergency personnel in order to ensure these transfers happen.

LISA LACHANCE: Thank you to the minister. I will follow up on that because I’m sure that I even read some of the language around RFPs for those services. I will follow up with the minister on that to seek more clarification.

I’m coming to the end of my questions for now and just wanted to offer some commentary, a small plea, and hear from the minister what’s happening in the department. We are clearly in a health care crisis, and there’s a commitment to fix health care in Nova Scotia. The types of challenges that Nova Scotia’s facing, while exacerbated by the pandemic, have been faced by other health care systems.

There have been other major efforts across Canada and in different jurisdictions, in other countries, to reform health systems. So much so there’s actually a body of research and practice around organizational readiness for change and how you undertake large scale changes in health systems. We actually have a few of probably the globe’s best and most well-known researchers in this area who are associated with Dalhousie, and the IWK, and NS Health Authority, so we have a lot of that capacity here.

I’m just wondering if the minister could comment on what sort of work has been done to assess the organizational readiness for change within the health system writ large, for the changes that are being sought. And, if there’s a model that being used to help guide decision making through this process?

[8:45 p.m.]

MICHELLE THOMPSON: That’s not a small question, that’s for sure. We could probably talk for a long time about that.

What I want to say is that there are a number of things. We did start out as a new government going across the province in the Speak Up for Healthcare tour to hear from individuals directly about how they were feeling. That was really essential. I certainly had my own assumptions and bias going into that tour as a previous health care worker. Spending time with hundreds of health care workers across those days was really an important start for us.

What I will tell you is that health care workers are tired, but they are willing and excited about change. For a long time, there’s been a lack of foresight and a significant under-investment in our health care system, and we felt that acutely as frontline health care providers and leaders in the system.

We do have a streamlined leadership team, and we do know that transformation is required. There will be some change management and employee engagement supports as we move transformation forward.

LISA LACHANCE: It’s true, I did ask the minister a very big question about organizational readiness for change and would love to have the chance to talk more about that in the coming months.

At this point, I’m going to end questioning and cede the remainder of this hour to the honourable member for Cumberland North.

THE CHAIR: The honourable member for Cumberland North.

ELIZABETH SMITH-MCCROSSIN: Minister, as I ended the last session, the last question I had asked was about collaboration and Maritime clinical health services plan. I don’t know if she remembers that question - it was last hour - but I’m just wondering what sort of clinical planning is done in collaboration with our fellow Maritime provinces.

MICHELLE THOMPSON: There is operational planning that happens between health authorities. The deputy tables meet on a regular basis with our Atlantic counterparts. There are a number of strategy groups, including Atlantic HHR group, and certainly the Council of Atlantic Premiers sit and talk, and I can assure you that health care would be on their agenda on a regular basis. Those are some of the ways that we work together with our Atlantic counterparts.

ELIZABETH SMITH-MCCROSSIN: I’ll move on to another area that’s really important, but I do want to just emphasize how important that is, particularly to the people who live in Cumberland County, because we have a long history of sharing clinical services with our neighbouring province, and the suffering that I’ve seen since the beginning of the pandemic with cancellations of very important life-saving treatments, specialist appointments, it’s been very hard watching the suffering that’s ensued. Just to emphasize the importance of us working together with our fellow provinces.

Just for a moment, one of the biggest pressures I think across the province, definitely in Cumberland County, mostly at our regional centre but also, my colleague in Cumberland South, they’re definitely feeling it too, and that’s the shortage of registered nurses. Northern Region is the only region in Nova Scotia that doesn’t have a registered nursing program.

I’m wondering if the department has given consideration to creating a satellite site similar to what Yarmouth has with the Dalhousie Nursing Program, possibly maybe St. F.X. or CBU, that’s where my daughter is studying nursing right now, could create a satellite site in the Northern Zone which may help to alleviate future pressures for registered nurses.

MICHELLE THOMPSON: There are no current plans to expand satellite sites at this time.

ELIZABETH SMITH-MCCROSSIN: Hopefully that’s something that will be considered. The Northern Zone is equally as important as all the other three zones in the province, and we want to make sure that our hospitals and community nursing positions can be filled, and right now they definitely cannot be.

On the same topic around nurses and recruitment, we do have a huge problem with recruitment. I won’t go into the details of some of the negative experiences nurses have had in trying to find employment in our area, but we have excellent representation in the Northern Zone as far as leadership - whether it’s Bethany McCormick or Dr. Aaron Smith, highly skilled professionals. However, there’s only two of them and they are responsible for Truro, Pictou, and Cumberland.

I’m wondering if the minister can share when her government is going to be fulfilling one of the election promises. It’s something that we discussed for a long time in caucus, when I was a member of the PC caucus, about the importance of bringing local decision making back.

There’s no doubt in my mind that one of the contributing factors to our current shortage of registered nurses is the fact that there’s no ability to hire locally. All the people who have applied in the past have to go through a provincial process. I’ve had many nurses who said they applied and never, ever got a return email or phone call. It’s very discouraging for us to hear that locally when we have such a huge demand.

I do know that Bethany McCormick of the Northern Zone has made some significant changes there and was also really shocked to see that on average it was taking 92 days to hire a registered nurse in the province of Nova Scotia.

I’m wondering, we want our local management at our regional hospital to be able to hire nurses when they are needed and not have to rely on people out of a Halifax office and a human resources department to make those kinds of decisions. We would love to see that level of bureaucracy removed and have some local decision-making ability.

Can the minister give us a timeline of when we would expect to see local decision making at our regional hospitals in Cumberland and throughout Nova Scotia?

MICHELLE THOMPSON: Certainly, we did hear about that from a number of frontline staff on the tour. I know that the Nova Scotia Health Authority is currently undertaking a review.

ELIZABETH SMITH-MCCROSSIN: The Nova Scotia Health Authority is taking a review - can you clarify what that means? Does that mean it’s no longer a priority for your government? That there’s not a leadership focus of local decision making any longer? I don’t understand “Nova Scotia Health Authority is taking a review.”

MICHELLE THOMPSON: That’s an operational piece. We don’t do that at the Department of Health and Wellness. Nova Scotia Health Authority is reviewing their hiring practices, that’s where that responsibility sits.

ELIZABETH SMITH-MCCROSSIN: Maybe I misunderstood. Definitely the conversations that I was part of when we planned the PC platform was there was a need for local decision making, so that regional hospitals had the ability to make decisions and not rely on waiting for someone from a central office in Halifax. That kind of change requires leadership - similar to when the Premier made the decision to change the health board. I’m not sure, maybe it’s a discussion that you need to have more.

I’m not getting a feeling that there’s any longer a focus on having local decision making in our health care system. I don’t know if you can clarify that.

MICHELLE THOMPSON: There are clinical service plans that are under development which will bring the voice of local jurisdictions and look at the needs of communities. The health leadership team has been in touch with a number of sites - probably all of the sites in fact - as well as the number of community groups in order to hear firsthand what some of the accomplishments and challenges are.

There is excellent contact with frontline folks, and local decision makers, and local operators, in terms of understanding what’s happening. I’m confident in that process and the clinical services plans will be developed.

ELIZABETH SMITH-MCCROSSIN: Okay, well, it doesn’t sound like there’s any plan for local decision making from what I’m hearing from the minister. It sounds like you’re confident in the way things are being done, and that is certainly not what we had discussed over the last four years. It’s certainly not what I think the health care system needs to actually create the changes that we need to see.

We certainly have not seen success with recruitment - I could just share story after story after story where nurses applied and never got a call back. Again, 92 days to hire a nurse? There’s way too much bureaucracy for that. If a manager for each regional hospital who knows their own staffing needs had the ability to hire - anyway, that’s the direction I thought the government was taking. Maybe I misunderstood, or maybe there’s been a change. Disappointing if that is not the direction that is any longer going to be taken.

I will ask another question about nursing before I move on. I’ve mentioned this before: one of the significant challenges and barriers to hiring a full complement of nursing staff is the current rules around nurses that are on leave of absence. We were told last Fall that there were a certain number of vacancies - I can’t remember the exact number, but let’s say it was around 15 registered nurse vacancies - and when the local community recruited nurses, they weren’t offered full-time positions.

The nurses that we tried to recruit said to me personally, why would I leave a full-time job with full benefits to come to the regional, to Nova Scotia, where I’m only offered a 0.6 or 0.8? Yes, they would have gotten full-time hours through casual, and through the need, but they’re not being offered full-time positions.

One of the reasons that we were told, the local stakeholders, was because of all of the nurses that had taken leave of absence. Some were off because of cancer diagnosis, we had one registered nurse off for about five years and unfortunately passed away. During that whole period of her cancer diagnosis, that particular unit was not allowed to replace her full-time position.

In many cases, nurses are taking leave for either other jobs to try them out, or they’re maybe taking leave to be a travel nurse somewhere, or maybe they’re taking a leave of absence due to illness - there are many, various reasons. Sometimes they even take a leave of absence to take a position within the health authority, such as One Patient One Record, or other positions, but they can’t be replaced. It’s really a barrier to recruitment. Can the minister share what would be a solution to that problem?

MICHELLE THOMPSON: What I would say to that is that there are full-time jobs, they’re not permanent jobs. I don’t think it would be fair at all to let somebody go who’s off on a leave of absence or sick time in order to replace that person with somebody who needs a job.

[9:00 p.m.]

People have jobs. They have insured benefits. They have protections in order that when you do go off sick or you take a leave of absence, you maintain your job. We certainly would never consider letting somebody go who was on a leave in order to put someone in their job permanently.

They are full-time hours, it’s just not permanent work. I’m not really sure what the member would expect. I don’t think it is to let somebody go because they’re on a leave.

ELIZABETH SMITH-MCCROSSIN: What am I supposed to tell the community that has a number of nursing beds or medical beds closed because there’s a nursing shortage? What am I supposed to tell the mother who says she’s convinced her daughter to move back to Nova Scotia to take the job to help reopen the beds at the hospital, but they won’t offer her a full-time position?

We have numerous beds closed. I’m asking you: What is the solution to that? Of course, I would never say that if somebody’s off because of a cancer diagnosis that you give away their job. What I am saying is that there has to be a solution so that we can staff our units.

Nurses are women - over 90 per cent of nurses are female - and the fact is that all nurses know that there has been a culture for decades where nurses have not been offered full-time positions, but rather many part-time positions and casual. We all know, because the Nova Scotia Health Authority told me in the Fall that there were 13 to 15 full-time nurses needed. Yet, none of the people who said that they were willing to come were offered full-time jobs with benefits and guaranteed hours.

I don’t have the solution. I’m asking you what could a solution be so that we can open our beds? It’s not fair to the community to have the surgical unit shut down and closed, operating beds closed, further lengthening the time - you know all this - step-down unit beds closed, emergency room under huge pressures, beds reduced there. All of the reason is because there’s a nursing shortage. Yet I’m being told that they can’t hire full-time nurses despite 15 vacancies.

I’m putting it back to you: what are some solutions? How can we fix this problem? There’s clearly a barrier. We want to attract and recruit nurses, but we need to be able to offer them full-time. Nurses deserve that.

THE CHAIR: I’ll remind the member for Cumberland North not to refer to the minister as “you”.

MICHELLE THOMPSON: What I would say to the member is that is some of the work that needs to happen at Nova Scotia Health Authority. We need to work more collaboratively with the facilities, but we also need to work collaboratively with the unions to make sure that we don’t have any contractual issues there.

To your point, there are some vacancies that are difficult to fill as a result of the fact that they are not permanent, but that work will sit with Nova Scotia Health Authority as well as the unions and the sites to problem-solve those in a way that best suits those facilities.

ELIZABETH SMITH-MCCROSSIN: With all due respect, minister, you are the minister for our health services and Nova Scotia Health Authority is under your purview. When the minister gives an answer that that is under the Nova Scotia Health Authority’s responsibility, that falls under the minister’s responsibility.

Anyway, I realize that the minister hasn’t been in the position for a long time yet and there’s a lot left to learn, I’m sure. But this is a barrier that I believe the government - we need to find a solution. I’m sure Cumberland Regional is not the only hospital in Nova Scotia that’s struggling to fill positions and recruit because of the barrier of the vacancies and leaves of absence. Hopefully, by identifying this problem, there will be solutions found.

The last question I wanted to ask the minister is around physician recruitment. That continues to be probably one of the biggest problems in our area. I did hear the minister mention earlier that physicians are independent practitioners and they don’t have to say when they’re going to retire, but my understanding is that there is a human resources physicians plan, or that one would have been made.

What most businesses do - and I would hope that our government is doing this - is to have a plan for human resources for our physicians. That would include doing a survey and talking with existing physicians to find out what is their plan. Obviously, things arise like illness and poor health, but if we know in a community that if a physician is planning on working five more years or three more years or 10 more years, then proper staffing can be planned for that. I’ll end on those thoughts.

THE CHAIR: The honourable member for Annapolis.

CARMAN KERR: My first questions are around EHS. Not unique to Annapolis, but I do represent Annapolis Royal - an area, according to many constituents and paramedics, that was considered a priority post at one point. It’s now without coverage several times a day. Most paramedics I speak to often talk about spending more time in Halifax and outside the region than within it.

As the minister knows - we discussed it last night - my area is struggling with one of the highest rates of unattached residents to primary care. We’re suffering from a closure at the Middleton emergency department, and paramedics are suffering as well.

My first question to the minister is: Could she give me more detail on why or how Annapolis has gone from a priority post for paramedics to being without coverage on a regular basis?

MICHELLE THOMPSON: In terms of a priority post, I’m not familiar with that designation or language. It’s not something that we would use commonly now. I think it may have been terminology, respectfully, that was used a little bit further in the past.

What happens is that there’s a system status plan for the province, and that system status plan moves trucks and paramedics as required. That really is a minute-by-minute plan based on the need and the demand in the system. We do know that the system status plan needs review, and we will be carrying that out in the coming months to understand how best to support the EHS system.

CARMAN KERR: I want to thank the minister for that response and am looking forward to what comes out of that review.

Paramedics are certainly not immune to the cost of living increases and inflation and at $35 an hour they are struggling even more to make their careers make sense. Is there a budget increase or an accommodation for a pay raise for paramedics?

MICHELLE THOMPSON: There is a 2 per cent increase this year, based on the contractual agreement that was negotiated. The contract is up in October 2023, and we’ll respect the bargaining process at that time.

CARMAN KERR: I want to thank the minister for that response. Beyond the 2 per cent increase, the paramedics I am speaking to do not have short-term or long-term disability coverage. I just wonder if the minister or the department has discussed having their disability covered.

MICHELLE THOMPSON: We have heard from paramedics in the past as well. That is something that I’ll have to look more deeply into the department. I don’t have it at my fingertips right now.

CARMAN KERR: Thank you. With respect to the temporary restricted licences for paramedics, do we have an update on how many of those licences have been issued throughout the province?

MICHELLE THOMPSON: That program is relatively new and we would have to reach out to the college in order to get that information as they are the registering body.

CARMAN KERR: Thank you. I guess if you go to the college for those answers, if there’s a breakdown county-wide or zone-wide, that would be appreciated.

[9:15 p.m.]

As far as the temporary restricted licences, whose responsibility is it to supervise those restricted employees? Is it the paramedics?

MICHELLE THOMPSON: The paramedics with a graduate licence would have to be paired with a fully licensed paramedic, which is similar to the programs that happen in other professional designations. It’s a similar process with registered nurses, so when you have a graduate licence, you do need to work with a registered nurse.

There are some caveats around what you are able to - whether or not you are able to work alone, et cetera. It would be a similar process so they would be working with a licensed paramedic as they wait for their full licence.

CARMAN KERR: Thank you to the minister. We have an office of physician recruitment and retention. I just wonder if the minister or the department have ever considered an office of retention and recruitment for paramedics.

MICHELLE THOMPSON: Thank you to the member. The title is actually the Office of Healthcare Professionals Recruitment. Paramedics, and paramedic recruitment do come under the purview of the office.

CARMAN KERR: Pardon me and thank you for the clarification.

I’m pleased, like a lot of people, to see this budget address the CCA salary increases. Do all CCAs qualify for this pay increase?

MICHELLE THOMPSON: The majority of this work does sit with the Minister of Seniors and Long-Term Care, but I do know that all Department of Health and Wellness-funded or Seniors and Long-Term Care-funded CCAs are eligible for the pay increase, yes.

CARMAN KERR: I may have to ask this of the Minister of Seniors and Long-Term Care at another time.

For CCAs with years of experience, are they able to leverage this experience in lieu of training to receive the same pay increase?

MICHELLE THOMPSON: I do think that it would be best if you asked the Minister of Seniors and Long-Term Care about the particulars about that program. I don’t want to be elusive, but I think she has a much better handle on that program and how it was rolled out.

CARMAN KERR: That is a fair response. I will ask the other minister.

There’s mention in the budget of working with the Michener Institute to explore innovative ways to train more health care professionals. Could the minister give us more detail on this relationship, and a status update?

MICHELLE THOMPSON: We have entered a memorandum of understanding between the Department of Health and Wellness, Department of Advanced Education, and the Michener Institute. Staff from each of those organizations are currently working on the details and things. It’s early days, but there will be more to say in the coming months about that partnership. We’re really excited about it.

CARMAN KERR: I’m excited that the minister is excited.

My next question is in regard to the Fitch report. Working as a CA for a few years, I heard a lot about the Fitch report. I wonder if the minister could provide maybe an itemized update on how much of the report has been implemented to date.

MICHELLE THOMPSON: I don’t know if the member realizes what a feat it is to be excited this far into Estimates. I’m glad that you’re excited that I’m excited. It’s a monumental effort, I have to say at this point.

To the member’s question, there were 65 recommendations out of the 68 that are complete or scheduled to be completed in the near future. There are only three recommendations that were not going to be implemented - I don’t know if you want to know what they are. Probably.

To move the Worker’s Compensation program from the Department of Health and Wellness to EMCI, which isn’t feasible; related to our legislation, expanding scope of services to the adult critical care team to include pediatrics, but Nova Scotia already has a very highly trained specialist pediatric LifeFlight team; and then consider eliminating the cross training of the neonatal and pediatric ICU nurses.

Nova Scotia already provides highly trained, critical care, specialty LifeFlight teams. Those are the three recommendations that were not taken out of the 68. The other 65 are either implemented or in progress.

CARMAN KERR: I think we can all celebrate or appreciate all the work that has been done on both sides of the House for that, so thank you for that update.

There’s mention in the budget of hospice service support. The member for Digby-Annapolis and I share an appreciation and hope for the Fundy Hospice in Cornwallis. Could the minister elaborate on what service support includes?

MICHELLE THOMPSON: Essentially the service supports are really the operational funding required to run the hospice.

CARMAN KERR: Thank you to the minister. I guess my last question would be with physician assistants. I’ve had maybe a dozen requests or inquiries over the last eight months. I believe there is a Nova Scotia physician assistant implementation plan? It’s a long phrase. Ten years ago it was developed, I think there was a pilot for physician assistants in the province.

My question to the minister would be, what is in this plan for physician assistants? Is it part of our health strategy going forward?

MICHELLE THOMPSON: Thank you for the question. There are three physician assistants who work at the QEII, in the orthopedics division that was stood up early in the COVID-19 response and anecdotally it’s been seen as very effective but we will be undertaking or are just in the early stages of evaluating that program.

CARMAN KERR: I just want to thank the minister for three nights of questions and thank you very much.

THE CHAIR: The honourable member for Cumberland North.

ELIZABETH SMITH-MCCROSSIN: Thank you, Madam Chair. Back to the minister. We’re almost done, I think there’s four minutes and 14 seconds left tonight.

Just to follow up on my comment/question regarding the physician recruitment plan and physician human resources planning. Can the minister share with us whether there is currently a physician resource plan that would clearly show how many physicians we are looking to recruit for the province of Nova Scotia? I’m specifically interested in the communities of Pugwash and Amherst for Cumberland North.

MICHELLE THOMPSON: There is a working resource plan that the Office of Healthcare Professionals Recruitment is using. The hope is that the plan will be a bit more strategic in nature. What I can say is that the hope is that we will be recruiting at least 100 new physicians to Nova Scotia this year and working in communities where the needs are greatest.

That’s what I would say: the office continues to work with local community groups, Nova Scotia Health Authority, and municipalities around identification of gaps in physician services, as well as nurse practitioner services in the province.

ELIZABETH SMITH-MCCROSSIN: Maybe that will be something that can be shared publicly with us here in the House. My last question is regarding paramedics and Medavie. Can the minister share what Medavie/Blue Cross is accountable for, to EHS and to the government, specifically around response times? What is the expected response time and if they’re not able to achieve that, what is the penalty to the company for not providing that service to Nova Scotians?

MICHELLE THOMPSON: Sorry, talking away . . .

THE CHAIR: Order. It is now 9:29 p.m. and we have concluded our review of the Estimates for the evening.

The honourable Government House Leader.

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

THE CHAIR: The motion is carried.

The committee will now rise and report to the House.

[The committee adjourned at 9:30 p.m.]