HALIFAX, THURSDAY, APRIL 7, 2022

COMMITTEE OF THE WHOLE ON SUPPLY

3:30 P.M.

CHAIR

Angela Simmonds

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

The honourable Government House Leader.

HON. KIM MASLAND: Thank you, 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.

I’ll resume with the Liberals for 38 minutes.

The honourable member for Yarmouth.

HON. ZACH CHURCHILL: Thank you very much, Madam Chair. Thanks again, minister, and thank you to the staff who are supporting you in answering these questions.

I do want to pick up from where we left off last night, around reporting of COVID-19 data, at a time when we’re shifting our COVID-19 response to more individualized responsibility, less focus on government restrictions, and more focused on individuals making their own decisions.

I certainly understand the rationale of the public mood shifting. It’s very hard to even bring in restrictions because people may not follow them. However, we do maintain that having access to regular information is critical to informing the public properly so that they are making the best decisions for themselves, and aren’t just living in a way where they are ignoring the risks associated with COVID-19 - to themselves, to their family members, and to those most vulnerable in our society.

We did used to see regular reporting every single day, or more regularly. Why has the government shifted its strategy in reporting data at a time when they are focused more on individuals making their own decisions in this regard?

THE CHAIR: The honourable Minister of Health and Wellness.

HON. MICHELLE THOMPSON: I thank the member for the question. Dr. Strang and his team are still very much engaged in the pandemic response. I want to make that very clear. Even though they are not visible, as you can imagine, there’s a lot of work that happens in the background.

Public Health’s approach to managing the pandemic has changed. We’re not in the acute or emergency response phase of the pandemic anymore. To your point, restrictions and mandates played a really important role in our early response - especially before our vaccines and while we were trying to understand the characteristics of the virus and the impacts - but Public Health restrictions were never meant to be in place forever.

We’ve moved to a place where there’s a high level of immunity, mostly from vaccine, but some from infection as well. We know much more about how the virus is transmitted and who is most at risk.

From that we’ve now decided, with supporting Public Health, that weekly access to epidemiological information is what Dr. Strang and the team are using and it’s what we will continue to report.

ZACH CHURCHILL: As a Party, we’re not calling for more restrictions. That’s been clear with how we’ve communicated. I just said restrictions won’t make sense if the public mood is not onside with them. However, information to help inform people’s decisions is absolutely critical.

I had the great honour and experience of working with Public Health for six months during the Delta wave as we developed and executed the most successful vaccine program in the country, particularly from the viewpoint of equity.

During my time in working with them, I know that the level of risk that Public Health was willing to take wasn’t very high. There was certainly a desire to communicate very, very regularly so that people were being updated. Moving to a weekly reporting structure at a time when we’re having more deaths than ever before, more hospitalizations, and a far greater spread of COVID-19 is very curious.

It’s very inconsistent with what I understand Public Health’s viewpoint to be on this. Certainly, maybe things have changed. Does the minister really believe that not having daily reporting on numbers is helpful when we’re trying to inform the public on their own decisions? Or does she worry that if it’s perceived that the government isn’t taking COVID-19 very seriously, the public won’t take it very seriously.

I do think that’s happening a little bit right now. If you go out and you shop, it was once the case where the majority of people were wearing masks, which is a very good protective layer from COVID-19. We’ve experienced that here in the House ourselves. Our masks have protected us from massive transmission of this virus. We’ve experienced that recently here in our place of work, where the Speaker has mandated this.

If you do go out in the public, that’s not happening as much as it was. Now mask wearing certainly is becoming less used. Does the minister have concerns that by not reporting more regularly and by not having Public Health officials and the Premier or the appropriate minister available through live streaming to the public, this may be sending the wrong message at the wrong time in relation to where we’re at in this pandemic?

This is also coinciding with the government’s marketing campaign to get out, get back to shopping, to get back to normal. That’s also happening right now. I can’t see Public Health advising the government to run a marketing campaign to get out and be active, and do as much as you can at the same time that Dr. Strang is advising people to limit your social circles, wear your masks, and be safe.

There do seem to be some major discrepancies here with the messaging from Public Health and the actions of the government. Part of me does wonder if we are not putting the Premier and Dr. Strang on live-streamed press conferencing anymore because there might be a disagreement there. I think that’s a legitimate question.

I’d like the minister to share with the House her thoughts on this matter. There does seem to be very clear discrepancies between Public Health messaging, government marketing and messaging around COVID’s out there, be safe - but also limiting the amount of information that the public is getting in relation to COVID. I think it might be sending the wrong message at the wrong time. I think the government is making decisions based on the public mood and not necessarily around the science or around the risks, particularly to our hospitals.

Again, we had eight deaths this week. That number of deaths in one week, at one time would have elicited a very fierce response from the PCs when they were in Opposition. I remember being accused by the Party opposite of killing people when we had a much lower level of deaths in the province. Now that they’re in, they’re running media campaigns to get people out and live normal lives.

I do think there are major discrepancies here in terms of what’s needed to preserve the integrity of our hospitals and what’s being discussed. I’d like to know the minister’s real thoughts on this. Particularly, I note that the minister has a clinical background and is very familiar with the state of our hospitals, and is very familiar with our hospitals when they are experiencing an influx of COVID patients, and are unable to respond appropriately, because of a lack of resources and staffing - to heart attacks, to injuries from car accidents, and other problems. I really would like to know the minister’s genuine thoughts on this situation.

MICHELLE THOMPSON: I would like to thank the member opposite for his tenure as Minister of Health and Wellness, but that does not make you an expert in terms of how we move forward. We work with Public Health in the same way that the former minister works with Public Health. I think to suggest that anything has been held back or misrepresented that would jeopardize public safety is quite insulting.

Public Health’s approach to managing the pandemic has changed. In the early days, the goal was that we would identify and isolate every case, and the case information was reported every day for us to better understand what was happening. This isn’t the approach that currently fits in the place and time we are in this pandemic. Public Health isn’t trying to identify every case anymore. They are looking at severe outcomes like hospitalizations and death, to your point, and this trends over time. We know that when there are waves that this is going to happen.

The shift from daily to weekly reporting is happening in every other jurisdiction across the country - in other provinces, not just in Nova Scotia - because it is a best practice in Public Health surveillance and monitoring outside an acute pandemic response.

As we sit here, Dr. Shelley Deeks and Dr. Robert Strang are doing a livestream presentation to contextualize where we are in the pandemic, and for people to understand where we are currently - the weekly data, and how it informs the decisions that are made with Public Health. Also, so that people can understand their risk and how they move forward, and to do some of the predicting about where we believe that we are going to be in this wave.

We know that age and health status are the biggest factors for severe outcomes. Similarly, over the last two years, we have built knowledge and understanding in the public about what it takes for us to protect ourselves and others based on our risk. Our population is highly immunized. I don’t think it’s fair to compare each wave as apples to apples. They are apples to oranges, and we continue to work with Public Health. We listen to their advice, we trust their expertise, and we will continue to do that.

This is the second time that the member opposite has brought up system strain, and I feel compelled to speak about that. The system strain pre-existed before COVID-19. I was part of that system, and I felt it acutely. The time to invest in health care workers and in the system was eight years ago, seven years ago, six years ago, five years ago. I could go on. This budget today is about investing in health care and in health care workers.

[3:45 p.m.]

The system strain that we see - of course there’s COVID on top of a system that was strained, because there were subsequent, numerous budgets that were balanced on the back of health care, and on the back of health care workers, in order to achieve that. That resulted in a really tough and impossible HHR and aging infrastructure.

The system is a continuum, as you know, and as the members in the House know. I’m just going to give you an example. Our access and flow are very dependent on our partners in long-term care, which is the sector where I left prior to being elected. We need a robust staff in long-term care, and we need a number of beds. We needed to invest in that sector a number of years ago.

In 2015, there was a reduction in the budget to long-term care and small equipment, which caused long-term care administrators to have to take money out of their operations, which were already tight and already stressed. In 2016, the former government took one per cent of our global budget and told us we could only take it out of the tiny wedge of 30 per cent of our operations.

Operations in long-term care facilities are heat, lights, food, supplies, snow removal, and all the things it takes to create a home-like environment, as well as provide skilled nursing care. We weren’t allowed to realize that reduction from our staffing, because I think the former government realized we were already at bare-bone staffing. That was the exact same year that the long-term care program requirements were enhanced in that long-term care, which is the reason and the only way we can get a licence.

In the facility I worked in, I lost over $100,000 out of my operating budget - the same year that I then had to meet program standard requirements that were enhanced.

I just want to tell the member that the following year, there was no capital investment in our long-term care facilities. There was no opportunity for us to do that. When we did complain in 2016 about the funding cuts and the impact that it had, the previous Minister of Health and Wellness, and the previous Premier, said that we were complaining and that we could really manage it, and home care was the priority. So instead of investing in home care and instead of investing in long-term care, we robbed Peter to pay Paul.

In 2018, because we had been underfunded for a period of time - because we had a lack of resources - all of a sudden there was a wound care crisis. Really, that was a symptom of a sector that had been underfunded chronically. With that wound care crisis, we then had a loss of reputation, and it became more and more difficult to recruit.

You can see that the budget that we’ve put forward is very system focused. We are very worried about the system. These HHR problems did not start when we took government. They started a number of years ago, so the time to be worried about the system is today, and it was eight years ago. I appreciate that we have a very stretched system. I understand that and I worry about my colleagues.

We are committed. But to suggest that this moving forward in the pandemic is not respectful of the system, or doesn’t really undertake or consider system strain, is not the case at all. We are here because there was no investment. Then on top of that, we had a pandemic that further stretched and burnt out our health care workers.

I sat in the House last week listening to the members opposite take credit for all the wonderful things that have happened - credit where credit is due. I think that some of the system strain that we are seeing right now can be laid firmly and squarely at the feet of the members opposite, given their investments in the health care over the last eight years.

ZACH CHURCHILL: It’s interesting that the minister mentioned budgets and cuts, because I will remind the minister that during my tenure as minister, we actually increased the health budget more than the increase in this budget that’s being presented.

Furthermore, for the member to suggest that there has been neglect, I believe now that she’s in the position as minister, she has a better perception or a broader perception on the system challenges. They’re real and they’re not just real in Nova Scotia, they’re real across the Western hemisphere. Certainly, they didn’t start now. They also didn’t start eight years ago.

But we did increase investment in health care. There was focus on areas where we needed, particularly around doctor recruitment - actually, many of the issues that were listed in this budget. I said in my debate in Supply, while this government pats themselves on the back and attacks the previous government, the majority of the items in this budget are actually continuations or regurgitations of the previous government announcements.

I’ll remind the Minister of Health and Wellness and the Minister of Seniors and Long-Term Care, look at the investment in long-term care beds. It’s 500 beds. Exactly what the previous government had committed to. This budget increase for health is actually less than the budget increases you saw under the previous government - and the budgetary record will actually reflect that

To the minister’s point about the relationship between the elected government and Public Health being the same, that’s not what I’m seeing. I don’t want to keep looking at the past, we do have to look forward, but the previous government was arm in arm with Public Health, doing daily press conferences together, live streamed to the public. There were no discrepancies between government messaging and Public Health advice, which we’re seeing now. If that’s not an obvious difference between the relationship that existed between the elected officials and Public Health, I don’t know what can make that starker for the members opposite.

It’s clear to me that there is a difference now. That’s fine. I certainly do hope that this government is taking the advice of Public Health. They’re very capable people who have been working long, overtime hours trying to manage this pandemic and I know are very personally invested in our success.

I’ve heard the Premier stand up in the House and say, oh, it’s happening everywhere, cases are rising everywhere, you know - it is what it is.

There was a time when Nova Scotia bucked the trend across the world, where we weren’t leading in case-rate increases. We were leading because we weren’t having any cases. The situation is very different now. I know it’s a different time. It’s a different stage in the pandemic. The approaches do need to change.

We do have higher levels of vaccination. This is good. By the way, it’s because of a vaccine plan that the Party opposite attacked when I was minister, that they’re now taking credit for. Thank you again. Very flattering.

The question we’re asking here is around information sharing and the marketing campaign that’s going on from the government that is very different than the messaging that’s coming from Public Health. I think it’s worth noting that. Certainly, it’s not just this Party that’s talking about the strain on our health care system now. We’re seeing more people out than ever before. This is coming from the unions. We have 600 or 800 people out right now. This is certainly impacting service delivery, I’m sure, in a number of areas. We’ve heard from a number of people who have experienced delays in their surgery - critical surgeries as well.

I do remember some of the members opposite, including the current Minister of Community Services, asking us very direct questions during Estimates and Question Period about impacts to surgeries and other services provided in our hospitals. I remember the Premier saying in his victory speech that the government doesn’t get a pass on health care just because there’s a pandemic. We might all remember those statements. The government doesn’t get a pass because there’s a pandemic. Now, of course, that the government’s elected, they are standing behind the challenges caused by the pandemic. Again, you get more perspective when you sit in those seats, for sure.

Can the minister please run through the impact to elective surgery wait times? How many weeks, months, years is the current wave of COVID and its impact on our service delivery having specifically on surgical wait times? Could she please update the House?

MICHELLE THOMPSON: We do recognize that it’s very concerning, frustrating and challenging for patients, staff, physicians and surgical programs related to the services that have been affected repeatedly throughout the pandemic. However, as you noted, surgical reductions are necessary at this time to create sufficient in-patient capacity.

Urgent and emergent surgeries continue. They are triaged and prioritized. The Nova Scotia Health Authority is working now around the planning that is required to scale up those services very quickly: talking with the providers, looking at capacity across the province, understanding how best they can start very quickly, and looking at using available beds so that if there are opportunities, that surgeries are unnecessarily cancelled.

The folks who work in a hospital have done an incredible job triaging and prioritizing and supporting patients across Nova Scotia, and they continue to do that. They are ready as soon as staffing is available, and staffing will change, based on where there are outbreaks in hospitals, in terms of staffing. Even though they are not happening, the planning is there. They have become very good at scaling up and scaling down, as they need to be, and being redeployed, and then deployed back.

What I would say is that I trust that team, that we know there are current disruptions, and for the foreseeable future there may be some disruptions - they are not broadly across the province. I have a friend who had surgery yesterday that was an elective surgery, so not all surgeries are being disrupted. There will be pockets of disruptions and I trust the team to re-prioritize those surgeries and get them done as quickly as possible.

ZACH CHURCHILL: Could the minister please be specific on where these pockets of elective surgeries are that are being impacted? This is information that’s important for the House and for Nova Scotians. Also, could the minister report to the House right now on our ICU capacity? How many of our ICU beds currently have COVID-19 patients in them, and how is that impacting our emergency services available for people who are experiencing acute health care issues?

MICHELLE THOMPSON: Today, there are 56 people in the province who are hospitalized. There are 10 in the ICU and there’s one person at the IWK. The capacity in that system is running at about 100 per cent and the ICU, I think, is just slightly below that.

ZACH CHURCHILL: I very much appreciate that, and of course, that’s an area of constant concern. I do think that’s information that should be made to the public if the reports are coming only weekly. They should be included in that, in terms of ICU capacity and impacts, particularly if there are certain hospitals that are being impacted, because individuals seeking that emergency care need to be informed in terms of where they should go. I do hope that’s included in the information that’s shared with the public.

[4:00 p.m.]

I did ask the minister to go through the very specific pockets where surgeries are being impacted. I’d also like to know whether those are orthopedic surgeries or other surgeries, any details the minister can give us. She did mention this was a bigger issue in certain areas, so can the minister please share with the House which regions are experiencing delays in procedures the most?

MICHELLE THOMPSON: Currently, the disruptions are primarily in the Central Zone. They are across all surgeries, so there’s not one service that is more impacted than the other, is what I would say.

ZACH CHURCHILL: I’d like to thank the minister. What per cent of surgeries are being impacted right now, because of the state of COVID?

MICHELLE THOMPSON: Since December, until two days ago, there were 5,500 cancellations of surgeries. Forty per cent have been completed, 11 per cent have been given a new date, 2 per cent were competed as emergency surgeries, and there have been about 21 per cent that have been removed from the list for various reasons.

ZACH CHURCHILL: I very much appreciate the answer to that question, minister. In terms of reporting on hospitalizations and system impacts, one thing that had been previously done was that the then-CEO, Brendan Carr, did present information to the public. Would the minister consider allowing the CEO of the Nova Scotia Health Authority to present that information to the public as well in terms of hospitalizations, system impacts? That was a very helpful communication tool to help put the situation in perspective for people, and also help manage people’s expectations on what services were going to be impacted or which ICUs were being impacted the most.

We have not seen the CEO of the Health Authority do that level of public reporting, but I certainly believe that would be valuable in terms of informing the public. Is that something that the minister would consider doing?

MICHELLE THOMPSON: There are regular communications about system disruptions. That’s sent out through various social media and press release channels. It’s not a matter of allowing or not allowing someone to speak on behalf of the Nova Scotia Health Authority. The communication channels are through press release.

The other thing that we need to be really careful of is that we saw in previous waves of the pandemic where people, when they had those regular system status updates, chose not to go to hospital, chose not to seek care because they felt that maybe they would be too busy or there weren’t services or what have you. We want people to understand where the best place is to go for service. So if there’s a place that’s closed, of course we want people to know that so they don’t waste time.

What we want to reassure Nova Scotians of all the time is that if they need medical assistance, if they need medical care, they should go, regardless of what our capacity is, regardless of what that is. We need people to come to hospital so that they don’t wait or have health care issues that are not planned.

There are a number of ways that we communicate - through social media and as well through press releases - that help identify where any system disruptions are to support Nova Scotians in making decisions of where and how to seek care.

ZACH CHURCHILL: One of the most successful communication tools that was utilized was the live press conferences, where I think the viewership got up to over 250,000. I know the social media channels through the Nova Scotia Health Authority, the department, Communications Nova Scotia, nothing touched the reach that we had in terms of a broad-based audience.

Having the CEO, who is responsible and should be held accountable for operational decisions and impacts, available to answer questions to media directly was certainly valuable - not only from an information sharing perspective but also from an accountability perspective. I know that accountability was a major theme for this Party. We haven’t seen any real movement to make the system or the individuals more accountable yet, but hopefully that will come.

I do think that’s a tool the minister should consider, primarily because of their reach that was achieved and how many people were tuned in at one time. It’s much more effective than the local press releases or social media posts that go out, based on the metrics that CNS look at anyway.

One area where people were surprised to not see much action in the budget was around ambulatory care and paramedics. Certainly, that situation has gotten worse over the last eight months. I know the minister will make the point validly that those problems have not started recently. There are long standing trends there. I know it was certainly a focus in the election. There was also a paramedic on the front of the budget but there wasn’t much substance in the budget in terms of increasing any investment in this area.

I know one of the key challenges that the system has experienced in terms of impacting ambulance response times, or the Off-load times, particularly at the QEII - there was a plan in place to have Off-load teams consisting of two additional paramedics and two additional nurses, and also someone to manage the bed placement to help with the situation. I don’t believe that any of those off-load initiatives have been moved forward. There very well might be a good reason for that. I’d like to give the minister a chance to update us on the Off-load situation at the QEII and why those initiatives weren’t pursued.

MICHELLE THOMPSON: There was an investment of $12 million in the paramedic workforce towards EHS and paramedicine. There’s also $10.2 million that was invested in access and flow.

The Off-load teams have been stood up. They were stood up in December and they’re operational. There’s been the creation of a small 10-bed unit at the Halifax Infirmary, which supports access and flow. There’s also been investment made in the command centres.

One of the biggest things that we need to look at in terms of where we invest is in our paramedics, of course. Also, access and flow allows us to make sure that patients are taken under the care of the hospital quickly, and return the paramedics to the trucks and then back into the system for emergency response.

There has been significant investment, and investments across the system actually allows . . .

THE CHAIR: Order. I will now turn it back over to the Liberals.

The honourable member for Fairview-Clayton Park.

HON. PATRICIA ARAB: I’d like to do a bit of a continuation from where my colleague left off regarding ambulatory services and EMTs in general.

There’s a 12-hour standard, as the minister knows, for emergency departments to in-patient and 30-minute standard for ambulances to NSHA care. In March 2021, the then-minister issued a new, more detailed directive to the NSHA on patient flow and ambulance Off-loads, emphasizing the need for timely transfer of patients out of the emergency departments and into in-patient facilities. The timely transfer of patients from ambulances to the care of the NSHA, allowed paramedics and ambulances to then return to service.

I’m curious if the minister could let us know if the 12-hour standard is being met and can we get a breakdown by health zone?

MICHELLE THOMPSON: The short answer is that they are not consistently meeting Off-load times across the province, for a variety of reasons. The NSHA keeps those metrics so we will be able to get those.

To the member’s point around those teams, it’s very important - the investment in the command centre and the 10-bed unit that has been stood up at Halifax Infirmary - in order to support access and flow, not only people coming in but also people waiting to go home.

[4:15 p.m.]

There’s been a considerable amount of planning and work to understand where the clogs are and how we can best support access and flow.

It is a metric that we continue to, the Nova Scotia Health Authority and the EHS continue to try to meet. There have been a lot of discussions about where and how best to navigate that.

I understand that a ministerial directive is really important because it shows folks that it is top of mind. We have to make sure that we invest, enable and empower people to make those decisions that best allow them to do the work in the organizations where they are. There has been considerable investment, a $10 million investment in access and flow to support front line workers in achieving those off-load and admission times.

PATRICIA ARAB: If the minister can’t really extrapolate on the numbers at this time, can she commit to getting that for the House - the breakdown by health zone - and also which hospitals are above the standard. I’d like to get that commitment from the minister.

MICHELLE THOMPSON: In terms of the Off-load times, there was a total, provincially, of 34 per cent that met the standard 34 per cent of the time. Western Zone met the standard 47 per cent of the time. These are for Off-loads. Northern Zone, 41 per cent. Eastern Zone, 49 per cent. We don’t have the 12-hour data. We’ll have to reach out to the Nova Scotia Health Authority for that.

PATRICIA ARAB: Just to be clear, that’s the data for the 30-minute standard?

MICHELLE THOMPSON: Yes, for the Off-load time.

PATRICIA ARAB: Recently, a bill came forward to the House, which will extend the scope of practice to allow nurse practitioners to admit patients to hospital. Knowing this, what role will nurses have in reducing Off-load intervals?

MICHELLE THOMPSON: It will depend on where nurse practitioners are working. I think where we will see the greatest influence in nurse practitioner admissions is actually in rural communities. We know that physicians and nurse practitioners can admit, so I think that’s where you’ll see people being admitted to hospital more regularly.

Because nurse practitioners can also discharge, what it does is it allows us to have another practitioner who can support people. Perhaps you see someone in emergency and you don’t have time to write your admission orders because you need to move on to the next person in order to see them. If there’s a collaborative practice between those nurses and physicians, the nurse practitioner would probably have time to write those orders.

When you double up the people who can write admission orders and support patients in going into in-patient beds, it actually helps the flow in the emergency rooms. Allowing them to discharge is important - having them move and create new space in hospital - but also being able to admit, frees up other practitioners to do other work in the hospital. It’s about leveraging scope of practice and being efficient in terms of how we do that work.

It will vary a little bit, in terms of where people have nurse practitioners, but I do think it will have a very positive impact, especially for folks who are on stretchers for an extended period of time. Stretchers aren’t bad and they are there for a reason. What we really want to do is when there’s a bed available is to get people off those stretchers and into those more comfortable beds - particularly our frail, elderly folks who are at high risk of wounds.

PATRICIA ARAB: If I understand the minister correctly, the intention of the bill is more empowering legislation for nurse practitioners specifically, but is not part of any tool or plan to address Off-load times.

MICHELLE THOMPSON: I think any time that we add a practitioner in the system, it has the capacity to assess and admit, it could impact flow in the hospital, absolutely. Is it exactly for that reason? No. Is that part of the reason? Yes. It increases the scope of practice, so it supports people getting the care they need in a timely fashion. Off-load times would be part of it, but Off-load time actually just puts you on a stretcher in the emergency room.

Where I think it would have the greatest impact would be around that period of time to admission, so that people are not waiting for physicians or other practitioners who can admit, to write orders at the end of their shift or partway through their shift. There may be an opportunity to be more efficient with that.

Off-load requires that there be a stretcher available and staff able to take that person under the care of Nova Scotia Health, whereas allowing a nurse practitioner to admit to hospital actually allows us to move patients into hospital, out of the emergency room.

PATRICIA ARAB: Nova Scotians are very aware of the pressures on our ambulatory system and the pressures that we have with Off-load times, specifically at the QEII. This is impacting ambulance response time across the province.

In July, a new pilot program was launched at the QEII Health Sciences Centre Halifax Infirmary site to improve patient flow and reduce the amount of time ambulances are waiting at the hospital’s emergency department. Again, once a person gets on a stretcher, it doesn’t mean that the EMT’s job is done. They wait with them until that person is able to be under the care of somebody in the emergency services department.

I’m wondering if the minister could let us know if the new full-time equivalent positions been staffed. Those positions should have been filled by August. As of October, staff are being reallocated, so what is the update on that program?

MICHELLE THOMPSON: I think the pilot program that the member is referring to is the off-load time at Halifax Infirmary. That team has been stood up. It was stood up in December.

PATRICIA ARAB: You’ll have to speak in layman’s terms. I’m not sure what you mean by “stood up.”

MICHELLE THOMPSON: It’s staffed.

PATRICIA ARAB: Thanks, I appreciate that. I’m curious if there are any plans to extend this model, or the Dartmouth model, to the Cobequid Community Health Centre to address their off-load wait times.

MICHELLE THOMPSON: Off-load teams are one strategy that works in the Halifax Infirmary, as an example, but that doesn’t mean that they are the tool that would be the best in all places.

We do have a command centre. We’re doing an evaluation of that project to see the effectiveness of it before we decide whether to scale it to other places. The hope would be that as access and flow improve over a period of time, those off-load teams would be less necessary, so that we would move to a place where off-load teams were not necessarily required because we have slack in the system that allows us to admit patients.

I would say that it is one tool. It’s something that we’re looking at. We’re also trying to understand, through the command center, the work that’s happening and what some unique solutions may be. We want to support facilities. Instead of applying one thing to every place, we want facilities to be able to problem-solve and talk to us about what would be the right solution in their facility.

PATRICIA ARAB: If it’s not a one-size-fits-all, I’m wondering if the minister would be willing to maybe brag a little bit about the other possibilities and the other options that they are considering in order to address these issues.

MICHELLE THOMPSON: Just speaking to some of the uniqueness of different facilities - this list is obviously not exhaustive, but in different areas it really does depend on the reason for access and flow.

For some facilities, it may be making sure that there are patient transfer units in the community so we can allow people to be discharged in a timely way - making sure that people leave the hospitals at a reasonable time in the day at discharge time in order to have them transferred home. It could be looking at length of stay. There may be practices in certain facilities where people go beyond their recommended length of stay for a variety of reasons. It could be that we enhance home care in order for people to transition home.

There are a number of different things, which is why I say that not one size fits all. Sometimes it’s at the front end, when you are in an emergency department and it’s overcapacity and we need those off-load times. At other times, it’s around what the patterns are in the facilities in order for us to make sure that the community and long-term care supports are in place so that people can actually move out of the hospital to create more space.

I think there’s a difference between rural and urban, in many cases. I think there’s also a difference in terms of the community assets and the staffing that people have in different communities. It is really hard.

Everything is on the table. If there’s a tool that works at Halifax Infirmary and we think it would be useful at the Cape Breton Regional Hospital, then we would use that. We want to share what’s been successful with health care providers across the province so they know what’s available, but we also want to allow them to be innovative, in terms of what they feel would be helpful in order to specifically address their access and flow issues.

PATRICIA ARAB: Speaking of our rural hospitals, we know, as the minister does as well, that they are also facing high off-load times. For example, the Colchester East Hants Health Centre in Truro trucks were waiting for over three and a half hours to off-load patients.

I’m curious if there’s anything specific that’s being looked at to help hospitals like Colchester to reduce their off-load intervals.

MICHELLE THOMPSON: There is an off-load team at Colchester. I’m not sure when the three-hour wait was but there was an area in the facility called (Inaudible) five, that when initially opened, wasn’t staffed for a variety of reasons, but now it is fully staffed. Those would be two examples of supporting that emergency room access and flow in that facility.

PATRICIA ARAB: Madam Chair, in the budget there’s no reference to the Fitch report, EMCI, ambulatory services, or paramedics. I know that we’ve touched on all of these during these last few hours of Estimates. But there is a budget increase for emergency health services of $12 million for this coming year.

I’m wondering if the minister can please explain what this particular increase is for.

[4:30 p.m.]

MICHELLE THOMPSON: Emergency Health Services - there are a number of things. There’s $5.4 million investment in wage increases from the contract, as well as the patient transfer unit staffing model, EHS benefits, the new holiday that was introduced in September. That’s the $5.4 million of that $11.9 million.

Medical Oversight Operations - medical physician oversight compensation is there. There’s $630,000 for provincial programs like LifeFlight. Then there are some bilateral agreements there - money for the medical transport unit as well.

PATRICIA ARAB: Excuse me if I have missed it, but I didn’t hear if there was any true enhancement to the current agreement. Is any of this keeping in line with COVID costs - increased costs and service delivery?

MICHELLE THOMPSON: Maybe just clarify the question. Was it related to COVID investments that you are asking about, or new investments, or both?

PATRICIA ARAB: I’m asking about the specific $12 million increase for Emergency Health Services. Is any of that a true enhancement of the current agreement or is any of it being used? Or is it there to keep up with increasing costs that have come up because of COVID and service delivery?

MICHELLE THOMPSON: There is the patient transfer unit staffing model, which is 28 non-paramedic drivers, so that was a pilot that’s now been annualized. The NTS is annualized, but the patient transfer unit is new in the budget. Then we would be working with the contract to make sure that we honour the current contract, so there would be a pay increase included in this budget.

PATRICIA ARAB: Does the minister have what percentage of a pay increase that would be?

MICHELLE THOMPSON: It was a 2 per cent increase in November 2021. Then there will be a 1.5 per cent increase in November 2022.

PATRICIA ARAB: I told you we would be back to Healthcare Professionals and Recruitment before I was done, because now we’re talking about an industry that has chronic vacancies, which is paramedic services. The Office of Healthcare Professionals and Recruitment says that there are 29 permanent paramedic vacancies. The paramedics’ union believe there are over 200-plus vacancies due to burnout or sick leave. I’m wondering if the minister can tell me the true numbers. We know of the 29 permanent vacancies, but can she confirm how many paramedics are on leave due to sick leave and/or burnout?

MICHELLE THOMPSON: There are 29 permanent vacancies in EHS, but there are a number of staff who are off related to health-related vacancies. That number is around 270. Twenty-one of those folks are in the com centre working. That gives you a sense of what’s happening.

PATRICIA ARAB: I’m curious as to what the plan is to recruit more paramedics. I know that in this budget, the government has given a significant increase to CCAs in the province in the hopes of retaining and attracting more to fill the need there. Is an increase of salary part of that recruitment plan for more paramedics, and what else is there?

MICHELLE THOMPSON: There are a number of things that are happening. It’s going to take a multi-pronged approach in order to address this, and we are very focused on supporting paramedics. I’ll just go through some of the initiatives.

One of the things that happened is we worked with the College of Paramedics that now provides a restricted temporary licence. Before, when a class graduated, it would take a number of months in order for them to work on the trucks, waiting for them to pass this national exam. Similar to other health care professionals, the college now offers a restricted temporary licence that allows paramedic graduates to work immediately, which is great, because then they don’t lose their skills while they wait for all the paperwork.

We did include some non - to train persons who are not licensed paramedics for the communication officer role as well, so the communication officer role can now be filled by non-paramedics. There’s also one paramedic and one driver staffing model for the patient transfer units, which brings up that second paramedic in order to work on transfer or emergency units.

There is a workforce planning task force that has identified short- and long-term staffing solutions for recruitment and retention, and it’s a very active committee. It meets regularly. That would be the Department of Health and Wellness, the college, the union, and Nova Scotia Health working together with paramedics to try to support the workforce.

EMCI also has a comprehensive paramedic recruitment. There’s an employee referral program and there are financial incentives for new paramedic hires. We’re working with the office. There’s an EHS mentorship program. There’s an EHS employee advisory committee.

There has been a lot of effort put into the paramedic workforce. We are going to honour the current collective agreement and we’ll go through negotiations. While money is one part, I do think that there are other things that need to be addressed in the system.

We’re working hard with paramedics and we’re working hard to support them so we’re hopeful. The other thing is that during the pandemic the class size was only at a 50 per cent capacity, which really impacted our ability to hire. Now that we’re moving through, the enrollment will come back up to where it was typically before the pandemic.

PATRICIA ARAB: By no means am I trying to pit health care professionals against one another. I certainly understand the confines of bargaining of collective agreements, but in a non-bargained pay raise, CCAs were given a 23 per cent raise. So money clearly was a factor in that decision. Well deserved, but again, I’m curious where we have a similar situation with the burnout of paramedics, the lack of people going into the profession like the access, can paramedics look forward to possibly something that is given as an incentive outside of their collective agreement?

MICHELLE THOMPSON: I want to be clear that we value paramedics very much and I know that money is a part of everyone’s concerns when we look at negotiations. I don’t want to speak too much on behalf of the Minister of Seniors and Long-term Care because I know she’s going to have an opportunity to speak.

But I will say, very respectfully, appreciating that there’s always more to do, that the paramedics in Nova Scotia are competitively waged amongst their Atlantic colleagues. I just say that as a fact. The CCAs in our province were absolutely not competitively waged. They were the lowest CCA pay wages in the country, and certainly not competitive with our Atlantic partners.

It was really important that we addressed that in order to support. I don’t have the stats in front of me, but I would say that the vacancy rates are not similar. There is a significant shortage for continuing care assistants in the province. There are strategies, particular to the recruitment of that skill set, of that group of individuals.

We will continue to work with paramedics to understand what it is that they would like, what they need, how we can support, but I do want to be clear that the paramedics are competitively waged and the continuing care assistants in this province were not.

PATRICIA ARAB: The minister mentioned EMCI. I’m hoping that she can clearly articulate the standards and expectations that have been set out for EMCI as the employer.

MICHELLE THOMPSON: The new contract does provide system and service improvements with a clinical focus to ensure that there are positive patient outcomes. It’s not simply based on response times, as it was in the previous contracts. Standards remain intact but there are some clinical key performance indicators that have significantly increased from 3 to 50 between the contract in 2009 and 2021. There are reporting structures in place to monitor those key performance indicators. There are discussions. We’re under discussion with the employer to have to report some of the more particular KPIs publicly.

PATRICIA ARAB: If I could just ask the minister: What is the intended outcome for these standards? What do you hope, realistically, will come of them?

[4:45 p.m.]

MICHELLE THOMPSON: I think that at a high level, we would expect them to meet the KPIs and that we would have a high-functioning EHS system. Those standards were put in place when the contract was signed. The expectation is that they would meet them, and where there are gaps, there would be a clear plan by the employer to talk about how they’re going to address that now.

We’re very willing and open to working with the employer in order to support them, if there’s a barrier that they are facing that we can assist with. It would be to have a high-functioning, quality EHS system - which we do to a large extent - that meets its KPIs on a regular basis.

PATRICIA ARAB: Thank you to the minister for indulging me. I’ll just ask her to indulge me again, as someone who is not an expert in any of this. What happens if they don’t meet the expectations? Are there consequences? What choices do we have? I don’t know if I’m articulating it properly. What happens if they don’t meet their expectations? I’ll just leave it at that.

MICHELLE THOMPSON: If EMCI fails to meet response time standards in a month, they receive a warning. If it’s a second consecutive month, they receive a second warning. If it’s a third month in a row that they fail to meet the standards, there is a penalty that is issued by the department. That fine increases by $1,000 for every month following that they don’t meet the response time standards. That would be one of the penalties that would be involved.

PATRICIA ARAB: I think if I heard correctly, the minister said that the penalty increases by $1,000. What is the base-level penalty? What is the first penalty?

MICHELLE THOMPSON: It’s $10,000.

PATRCIA ARAB: Has this happened before? Have we seen instances where EMCI has received multiple warnings and then been penalized?

MICHELLE THOMPSON: Currently, there have not been penalties issued. What we’re doing is working with the employer to look at the system issues that are affecting their ability to meet response times. When it is the fault of them, that they don’t meet response times, that’s one scenario. There are times when there’s an exception process where they don’t meet the response times because of things outside of their control - so there are some system pressures that may influence or will influence their ability to meet those times. We are currently working with the employer, with the company, in order to address some of the issues and support them moving towards those response times.

PATRICIA ARAB: I want to go back to hospital closures again, in relation to response times. A call in the parking lot in Digby during a hospital closure means a trip to Yarmouth. The same is true for a hospital in Middleton. These closures are more prevalent in the Western Zone of the province when what should be a 10-minute call can turn into a two- to three-hour call.

What is the department currently doing to address this issue?

MICHELLE THOMPSON: There are a number of things that are happening. The Health Authority works closely with EMCI and coms, so they would let them know about any closures. The system status plan is constantly updated, minute by minute really, in order to support the available services and communities, as well as EHS.

We do know that when emergency rooms are closed there are longer commutes. We also know that we have world-class paramedics - they’re top of the line. Emergency care happens in the ambulances while people are travelling to the care that they require in hospital.

Sometimes it’s a nursing issue, which is why emergency departments are closed, and sometimes it’s a physician issue. Certainly, the Office of Healthcare Professionals Recruitment is working in those communities to understand with NSH where the needs are - whether it’s nursing or physicians - and supporting recruitment in those specific facilities.

PATRICIA ARAB: Again, maybe the minister can indulge me. Is there anything within this budget that specifically addresses emergency room closures

I remember the conversation that was had - I don’t remember which caucus it was. It’s definitely a conversation that I’ve had many times with nurses who work in more rural communities. There are certain services that can’t be delivered at an emergency room, so people don’t always go to the one closest to them, whether it’s open or not. They’re taken to the emergency room that has the capabilities of handling whatever health situation they’re dealing with.

For all of those instances that a rural emergency room could handle, is there anything in the budget that is specifically targeted to keeping those ERs open? Or is it mainly a lack of personnel?

MICHELLE THOMPSON: Again, there are a number of things that are happening. Even though there’s not a line item that says keep emergency departments open, there are a number of things that will support that.

Particularly in our rural communities, the new incentive programs that were included, those are to attract physicians, and maintain and retain physicians particularly in rural communities outside of HRM.

We want to increase people’s access to primary care. A good example of that would be the Northside Urgent Treatment Centre. People can get care in their community at that urgent treatment centre. There’s also one in Parrsboro. Those two things have been very, very well received by the communities and they’re very pleased with those.

The nursing students - offering all nursing students a job right off the bat, and certainly the work that the office is doing with the Department of Labour, Skills and Immigration. We know that if it’s a nursing issue, we can’t grow our own nurses fast enough. The expansion of seats is really great, and we want to continue that to grow our own folks, but we are going to have to address some of our HHR issues through immigration.

There was just a mission to several countries with good uptake. We’re working with a number of different individuals in both the private sector and the Department of Labour, Skills and Immigration to look at how we can bring skilled health care workers to the province.

It is an HHR issue, so it’s going to take a little while, but there are a number of initiatives that are happening in order to address the vacancies.

PATRICIA ARAB: I thank the minister for her answer. Recently it was announced that more civilians will be hired into the EHS system - and I think the minister alluded to that in one of her previous answers - specifically the communication system. This was a recommendation out of the Fitch report that was not accepted by government. Can the minister explain the change?

MICHELLE THOMPSON: The EHS civilian communication officers - it’s considered best practice, the practice of hiring civilians. That was one of the Fitch reports that we chose to implement. This change, again, was supported through that consultation. The International Academies of Emergency Dispatch has reported that the use of civilian communication officers who utilize emergency dispatch protocols generally perform better than paramedics and are less likely to deviate from protocol.

What this also does is - because the capacity was only for people with previous paramedicine experience - it allows us to broaden our swath and open that position up to a variety of different people, and then they will receive training. We were happy to adopt that. It is deemed best practice and it allows us to staff that communication centre, which also supports paramedics on the ground.

PATRICIA ARAB: If the communication system was being staffed by individuals who are trained in paramedicine, and now civilians are going to be able to be trained specifically to take over that communication system, does that allow the paramedics who were previously doing it to filter back into the system and be working on the ground as paramedics?

[5:00 p.m.]

MICHELLE THOMPSON: If those paramedics working there chose to go back into the field, certainly they would be welcome to do that, but what it does primarily is open up the pool of people who can actually apply for those positions. When you only have one skill set that’s able to apply to that, and there’s already a shortage, you can’t recruit. There just aren’t enough people. What it does allow us to do is to train and skill a variety of different people who can come into those positions in order for us to staff the com centre.

PATRICIA ARAB: Could the minister let us know what stakeholders were consulted when making the decision, and if the paramedics’ union was consulted specifically.

MICHELLE THOMPSON: The EHS communications folks are in a different union than the paramedics. The consultation happened through the recommendations that were adopted through Fitch. Certainly, anecdotally, the paramedics who I have regular contact with are really pleased at that change. I think there were some people that were concerned about it, but we’ve had good feedback about that change and people are looking forward to having that com centre staffed.

PATRICIA ARAB: I think either I or the minster missed who the stakeholders were who were consulted.

MICHELLE THOMPSON: The Fitch report was undertaken by the previous government, to have experts come in and do consultation around supporting EHS. That report was accepted and all but three recommendations from that Fitch report were accepted and implemented. It was an opportunity to improve the system based on expertise that was contracted to advise government.

PATRICIA ARAB: I’m sorry, I don’t mean to be dense. The Fitch report was what was followed. There wasn’t stakeholder consultation, is that correct?

MICHELLE THOMPSON: That’s correct.

PATRICIA ARAB: In the little bit of time that I have left, I want to go back to COVID, and mainly the communications piece around COVID. You’ve heard us continuously ask for more information - asking that Nova Scotians be informed of the data so that we can make proper decisions on what we’re going to do and how we’re going to do it. We need to learn how to live with COVID. We need to know what we’re living with.

Repeatedly, we hear back that Nova Scotians know how to deal with COVID, that Nova Scotians know what they’re supposed to do, and that the government and Public Health encourage Nova Scotians to do what they know how to do already.

I want to talk specifically about a video that was put out from CNS that talked about getting back out there. It was a video that was encouraging Nova Scotians to get back out into the province to start living their lives again, to get back out onto the streets. I’m wondering if the Department of Health and Wellness was consulted at all in the messaging around that video?

MICHELLE THOMPSON: There was some communication between the two departments. That consultation happened a little over a month ago.

PATRICIA ARAB: I’m sorry, this is the first time that I’ve had to use this, but I did not hear the minster’s answer to that question.

MICHELLE THOMPSON: Can you hear me okay?

PATRICIA ARAB: Yes.

MICHELLE THOMPSON: There was some consultation between the departments and that consultation occurred just over a month ago.

PATRICIA ARAB: In the consultations, did the Department of Health and Wellness give recommendations to CNS in the development of that commercial?

MICHELLE THOMPSON: There was back and forth with the department about how best to roll that out, of course, trying to ease out of this pandemic. There was consultation between the departments, in terms of the campaign, for sure, yes.

PATRICIA ARAB: In this video, there are a number of situations that are displayed that don’t necessarily fall in line with the recommendations that Public Health is giving to us: being in crowded arenas, being in large crowds, not everybody wearing masks. But Dr. Strang repeatedly says that he recommends keeping your mask on, keeping your numbers small. Again, did the Department of Health and Wellness sign off on this video and the messaging that it’s sending?

MICHELLE THOMPSON: My sincere apologies - I’ve been talking, and I actually can’t remember the question. I do apologize. If you could repeat the question, I would appreciate it. It’s been a long however-many hours, I’d say.

PATRICIA ARAB: Not to worry. Again, the messaging that is sent out in that video conflicts with the recommendations that we have been hearing from Dr. Strang and Public Health, so I’m curious if the Department of Health and Wellness signed off on that video, in spite of the mixed messaging that exists there?

MICHELLE THOMPSON: Thank you for repeating the question. It is a consumer confidence video that was put out by a different department than the Department of Health and Wellness, and it was reviewed. It was released at a time when restrictions were lifted.

We appreciate that there is a rise in cases right now, but it is a consumer confidence video, and Public Health was in consultation with Communications Nova Scotia regarding the video.

PATRICIA ARAB: I don’t mean to continue to belabour this point, but you have a government message that goes against Public Health recommendations. I understand that the mandates are gone. Nobody is expecting the mandates to come back, but government is on the record saying that they follow Public Health recommendations, and that the public should follow Public Health recommendations, but here we have a piece of media from the government that is showcasing situations and scenarios that are going against the recommendations of Public Health.

Has the video been pulled? Is there any direction from the Department of Health and Wellness or Public Health that that video should be pulled and no longer be viewed by Nova Scotians, given the increase in cases?

MICHELLE THOMPSON: That decision around that video actually sits with the Department of Economic Development, and . . .

THE CHAIR: Order. The time for questions from the Official Opposition has now ended.

The honourable member for Cape Breton Centre-Whitney Pier.

KENDRA COOMBES: Thank you, Mx. Chair. To follow the rules, we are going to cede our time to the Liberal caucus, should they need it.

THE CHAIR: I would also like to inquire at this point if the minister would like a break.

MICHELLE THOMPSON: Thank you. I would appreciate it if we could take maybe 10 minutes, if you wouldn’t mind.

THE CHAIR: That sounds great. The committee will be in recess for 10 minutes and will resume at 5:22 p.m.

PATRICIA ARAB: Mx. Chair, can I get the time of the start of the committee, please?

THE CHAIR: 3:31 p.m.

PATRICIA ARAB: This is our first break?

THE CHAIR: Yes, it is.

PATRICIA ARAB: Thank you.

[5:11 p.m. The committee recessed.]

[5:23 p.m. The committee reconvened.]

THE CHAIR: Order. The Committee of the Whole on Supply will resume.

The honourable member for Fairview-Clayton Park.

PATRICIA ARAB: Thank you, Mx. Chair. I would like to pick up where we left off before our break, asking the minister if there has been any discussion to have the video removed or pulled so that it can’t be viewed, now that the numbers are off and the messaging isn’t really in alignment with Public Health.

MICHELLE THOMPSON: To my knowledge, there has been no intention to pull that. It has been launched with the Healthy Habits campaign, as well, to support people in making choices. We do continue to recommend Public Health measures, as we said. That Healthy Habits campaign is running parallel to the campaign that you spoke of. Currently, there is no directive that I’m aware of to have that pulled. That may be something to ask the Minister of Economic Development.

PATRICIA ARAB: Well, Mx. Chair, I’m asking the Minister of Health and Wellness because even though the video was not created by her department, she is the one who is responsible for the health and wellness of our communities and of our province - something that I know that she takes very seriously.

It’s hard for me to listen to the sidestep, that this is something about Healthy Habits and this is something that is the Department of Economic Development. I don’t envy the position that the minister is in, but ultimately, when you have the government saying that we should be following the recommendations, so not mandates, not directives, the recommendations of Public Health on one hand, and then they sign off on a video that is not following those recommendations, it’s hard to justify the two.

I’m going to take the minister out of that uncomfortable situation and ask her if she’s actually hearing from any health care professionals in response to the specific video, and if they have an issue with it.

MICHELLE THOMPSON: I have not heard from anybody about that campaign.

PATRICIA ARAB: Does the Department of Health and Wellness feel the need to do something to offset that, or was the video that was done by the Premier and Dr. Strang the response to that particular video?

MICHELLE THOMPSON: There is a parallel campaign called Staying Healthy: Habits campaign that was launched in collaboration with that. I don’t know if the member is aware of that campaign, but it is a social media campaign that has also been launched. It’s a balanced approach so that people can make the choices around the risk that they are able to assume. That’s what I would say - that’s been the parallel program that’s been launched.

PATRICIA ARAB: No, I have not seen that video, so perhaps whomever is in charge should look at the algorithms and the push that out there, because the Staying Healthy: Habits is not being viewed nearly as much. I’d like to know the stats on how many times that’s been viewed. What’s definitely been shared and what’s been put out there is the Let’s Get Back Out There video.

If the minister hasn’t heard specifically from health care professionals, I have heard from health care professionals who are quite upset with that campaign, with that video, and the mixed messaging that it sends to Nova Scotians.

We are fortunate enough to be fully informed, fully immersed in this in one way or another and know the differences, but it’s very naïve to think that you can be saying one thing and then showing something else and expect Nova Scotians to know what they’re supposed to do.

With that, I will sign it off to the member for Hammonds Plains-Lucasville.

THE CHAIR: The honourable member for Hammonds Plains-Lucasville.

HON. BEN JESSOME: Please pass on my thanks to your staff. It’s been a while, but welcome to your first set of Estimates. It won’t perhaps be the last.

I’m going to jump around a little bit here and ask a few questions that constituents have presented to me, as well as a few questions I’ve formed on my own, based on some of the feedback that we’ve gone through at this point.

Firstly, can the minister discuss any interventions the department is undertaking to enhance cross-disciplinary care when it comes to patient investigations? The context is around gynecological issues often being misdiagnosed as GI issues, resulting in misguided treatment - so the confusion that exists because of a need for more interdisciplinary collaboration between specialists.

[5:30 p.m.]

MICHELLE THOMPSON: I don’t know if I fully understand it, but I’ll do my best to answer it.

In my experience, there is cross-departmental collaboration between family physicians, our emergency room physicians, and specialty physicians. Usually if someone has a family physician or a nurse practitioner, they would be the person who kind of coordinates their care. They would go for a variety of different investigations.

I’m not really clear on the context, but it’s been my experience that we do work collaboratively. Folks that don’t have a primary care provider, initially there would be virtual care. If there was a diagnosis that was significant, we would work to the best of our ability to support that person in having regular access to make sure they have specialty care who would then take on their care assignment.

I don’t know if that answers it. Maybe if there’s another piece of clarity that I need, I would appreciate that.

BEN JESSOME: I guess perhaps it’s not about being overly specific. I know that the family doctor is often the connector and there is certainly some degree of collaboration amongst health care providers of different sorts.

We end up in situations where your family doctor requests the specialist visit. You go in - you don’t necessarily get answers to your questions, and then it goes back. Then you’re waiting several months to connect with, perhaps, the next specialist or reconnect with your family doctor.

Is there anything that the minister can describe by way of enhancing the collaborative practices that exist? I guess the specific context would be GI issues being intertwined with gynecological issues. It doesn’t have to be something super specific, but is the department doing anything to breed a higher level of interdisciplinary and cross-disciplinary collaboration amongst health care professionals?

MICHELLE THOMPSON: Again, I’m going to do my best to answer that question.

The primary care provider would have a referral pathway depending on the presenting complaint of the individual, as would an emergency physician or perhaps a physician at a walk-in clinic. The assessment is done, and based on that original assessment, that primary care provider would decide whether or not it was in their scope of practice and then refer to a specialist.

Sometimes you can get referred to two specialists at once. Sometimes you get referred to a specialist who exhausts their investigative pathway. Then, if it’s not deemed to be a diagnosis within their specialty, the care is then transferred to another specialist for further investigation. Sometimes you can have a diagnostic investigation that actually will capture things that are useful to both specialties.

I think we’re always trying and working hard. We want to make sure that patients have the right care at the right time by the right provider. What I would say is that if there is a specific instance, and if you would like to speak to me about it, we can certainly try and dig down. My experience is that yes, we want it to work.

One of the big investments that we heard on the health care tour was around the need for technology in order to create a health home for people so that physicians and nurse practitioners, and all these folks, can look at that One Patient One Record, and have the information that they need around when they’ve accessed the service, health care system, when they have done it, and why.

I think we heard loud and clear from our health care providers that is a necessity, not only for patient care and outcomes, but for them to do their work really efficiently and also as a recruitment tool. That will be a major effort in terms of modernizing and digitalizing our patient record.

BEN JESSOME: In the Estimates for the Department of Advanced Education, the Minister of Advanced Education had referenced the increased number of residency seats in our medical school that was initiated in 2019. He referenced them as temporary and now permanent, when I asked him what changes, what new things, were being offered to advance the education of health care professionals. Again, he referenced those seats as temporary.

Can the minister weigh in to clarify what those were? That’s not my understanding.

MICHELLE THOMPSON: There were 15 added in 2021, and those seats are permanent. Was it the medical school that you were specifically asking about?

BEN JESSOME: Yes. It was a pretty definitive statement that they were temporary and now permanent, so I just wanted to make sure that they are intended to be permanent positions. They have been for some years.

Through the Chair, if there was a distinction, can we just recognize that? If not, if it was said in error, then that’s fine too. I just wanted to clarify that.

MICHELLE THOMPSON: Those 15 new positions added in 2021 are permanent.

BEN JESSOME: Thank you, minister. There’s a newly revamped ambition around doctor recruitment. I’m wondering if the minister can elaborate on what new initiatives, what new tools are available? What makes this new office distinctly different from the operational scenario that has existed for some time?

There have been incentives for local communities to try to help support the recruitment efforts of physicians, there’s tuition relief, there are incentives to drive recruits to under-serviced areas of the province. Those things are all pre-existing, available options to deploy, with respect to doctor recruitment. Given that there has been this newly branded entity around physician recruitment, can the minister explain what is new and improved?

MICHELLE THOMPSON: The office itself is new. It has dedicated resources and while physician recruitment is an important aspect of the work that happens in that office, it actually is across the continuum of health care workers. The office has dedicated resources. They work very closely with a number of partners, like the Department of Health and Wellness, Nova Scotia Health, Doctors Nova Scotia, the Department of Seniors and Long-Term Care, and the Department of Labour, Skills and Immigration.

It really is a group of individuals who are solely responsible for looking at the needs in the health care system, coordinating a variety of approaches, monitoring, recruiting and talking to people, and bringing them in.

It has always been a little bit off to the side on a number of people’s desks, but this has allowed us to really focus. It’s the mandate of the office. They work in collaboration with recruiters and community navigators. It really is a recruitment hub. I would say that is the biggest change - these dedicated resources with a clear mandate. They’re empowered to work across government departments, but also in communities to ensure that we have an adequate health care workforce.

BEN JESSOME: Respectfully, that language, that organizational description, sounds very familiar. I don’t say that facetiously. I have met with recruitment staff before. There have been specific entities that pre-existed our government. The tools that these offices have deployed over time pre-existed our time in office.

I guess I would really appreciate it if the minister could dig a little deeper to add some specific details. Is there an increased budget for X? Is there more tuition relief that is going to be deployed? Are there particulars? Again, respectfully, it sounded very general and sounded very familiar.

Having met with some of these recruitment staff in the past, it would be lovely to have some more depth to, specifically, new items that should be described if this is, in fact, something that’s new and advanced, and is going to deal with a challenge that successive governments have had to face over the years.

[5:45 p.m.]

MICHELLE THOMPSON: On a short-term basis, there would be some things, particularly as the office is stood up, looking at the incentives, as you mentioned, that did not have a terrific uptake - so changing that model and making sure that there are incentives for rural physicians in order to come to the province and work. We’ll phase out the previous programs.

Again - laser focused and working through. We had a number of people initially who really had to do some system navigation. Once the office opened, there were a number of people who reached out, and continue to reach out, because they’re caught up in the bureaucracy, and trying to figure out how to move through the system. That has not existed in the past. Certainly, that was not the experience of the folks who the office is working with.

Looking to an intermediate - how do we move those pathways? As an example, we’re increasing the practice-ready assessment, availability, working with the College of Physicians and Surgeons, reaching out to the other colleges to look at barriers and moving that. That has not happened in the past. Or if it has happened, it has been ad hoc and not coordinated, and respectfully, not overly successful. Dedicated resources with a clear mandate allow us to create expectations and create relationships and move things forward.

In the long term, we need to look at policy and strategy around how we recruit, working with physician services around ongoing contracts. The physicians alone in this province are $1 billion. We need a number of physicians, and we need a number of health care workers across the system. So we need a very focused and coordinated effort to make sure that we are supporting the facilities in our province and working with them.

The other thing I would say is that Dr. Orrell sits as part of the health leadership team. Not only is he working within the office, but he’s also working across the system to understand the needs, and in that agile decision-making group that allows us to make quicker decisions, and reduce delays, bureaucracy and red tape.

It has been effective so far. We do feel that it’s new, and the mandate of the office is very clear. As it grows and matures, we feel it’s only going to get stronger and better. Those would be some of the things that I would point to as direct examples.

BEN JESSOME: We’re getting a little deeper, and I appreciate that. The minister referenced incentives as being adjusted, evaluated. Can the minister comment specifically on what incentives are expected to change and what new incentives might be available for deployment?

MICHELLE THOMPSON: To the incentives for physicians specifically, the new primary care physician and specialist incentive program will replace the debt assistance, the family medicine bursary, and the tuition relief programs. I’m not sure if you’re familiar, but the primary care physician incentive is a total of $125,000 for eligible physicians who provide at least 50 per cent of front-facing patient, office-based primary care. So that’s $25,000 on signing and then $20,000 at the end of each year that they are there for service for five years.

The new specialist incentive is intended to recruit specialists with the same remuneration. These are for people who will set up practices outside of HRM, with the exception of Eastern Shore. We know that there are gaps in our rural health care facilities and our communities. We recognize that there are some in HRM as well. We do find that we want to incentivize people to live in our rural communities, to settle and raise families. That would be the major difference in terms of the incentives for physicians.

BEN JESSOME: Is there something that the minister can direct me to in order to dig a little deeper on my own? Again, it sounds very familiar. We all know that rural recruitment is a subject of great consideration and has been for successive governments. We were very intentional about trying to place doctors based on need. Of course, we end up at a place where we realize that physicians are private business owners as well. That needs to be considered. I guess let’s dig a little deeper into that rural piece and what is specifically going to be different.

The navigation piece - if there’s red tape or bureaucracy - that’s one thing, but ultimately, what is the government offering? What is this new office offering to physicians specifically? The back end of things - the operational side of getting a physician to work wherever in the province - is not something that the recruits should have to be concerned about, or should be something that’s flashy and enticing for our recruits. Is it a larger incentive? Is it housing? Is it start-up costs? Is it moving costs? What is that carrot that the government believes is going to ensure that rural recruitment can be successful?

MICHELLE THOMPSON: The answer is going to be fairly similar. These incentives replace previous incentives, and they’re quite generous in terms of their approach. There is a sign-on bonus for physicians who settle in rural communities who have 50 per cent front-facing. Then after every year of return to service, they get a $20,000 bonus. I’m not really clear. They are brand-new incentives. They shouldn’t be familiar. If you want to ask more questions to the office, you’re certainly welcome to reach out to Dr. Orrell if you want to do that. That’s what I would say. I don’t think I’m quite catching your drift. I can certainly talk to you when we’re in the House.

BEN JESSOME: We’ll move on to an update on OPOR. What’s the latest and greatest there?

MICHELLE THOMPSON: What I can say is that we are in an active procurement process, so that really limits my ability to provide any other further information other than that. It’s just part of the rules of procurement. I don’t want to evade the question. I’m just not able to share any more than that at this time.

BEN JESSOME: I appreciate that, minister. I guess it was just wishful, hopeful thinking that we were beyond that. We’ll move on for now.

Considering we’re bringing more people to Nova Scotia, and the intent is to continue on that trend, and continue to increase the population - both with respect to inter-provincial migration as well as international migration to Nova Scotia - what is the department doing to ensure that the transfer of records for new Nova Scotians is happening effectively and consistently so there is continuity of care for our newest Nova Scotians?

MICHELLE THOMPSON: Our personal health information, each of us, is our own. If people are coming to us, then it is the responsibility for them to work with the health care provider that they leave in order to get consent and gain the records that they have. If people are leaving to go somewhere else, then again, they would access their own records and they would be able to take their information with them. That is not something that we would necessarily do.

If there’s a patient who’s visiting here or comes here, we would have to have a signed consent form if they were hospitalized, as an example, and then reach out to the corresponding practitioner or authority to get their information in that instant. It’s the responsibility of the individual to get their health record and take it with them just as it would be, yours or mine, if we were moving out of the province to take our information with us to the next practitioner.

BEN JESSOME: Is the cost, at least from a Nova Scotia perspective, to acquire your own records consistent or have there been increases to the cost of acquiring your medical records?

MICHELLE THOMPSON: Generally, if you were to get your health care records from a facility - maybe a hospital, a long-term care facility or what have you - then there would be a policy around accessing personal health information. There generally is an administrative fee. They’re not an exorbitant amount. It really is simply that.

For practitioners, if we’re looking at physicians as an example, there would be guidelines, which would outline from Doctors Nova Scotia what the process and fee schedule could look like. That would be up to the individual practitioner.

BEN JESSOME: Thank you, minister. The schedule that exists for everyday Nova Scotians - someone who loses their family doctor and is looking for a new practice to make their home - there is a schedule of costs that exists. Has there been any increase to that schedule of costs for the general public?

[6:00 p.m.]

MICHELLE THOMPSON: In terms of the schedule, that is set by Doctors Nova Scotia, so I have no idea if that is a separate entity from us as well. That would be something that the member could check.

In terms of Doctors Nova Scotia, physicians are responsible, if their practice closes, to make sure that the files are available to their patients. The physician can sometimes do that through their office as they wind down and close, but there is a practice apparently where they actually will give the records to a third party, with confidentiality agreements, and the patient has to deal directly with that third party in order to access their records. I think that the information you need sits with Doctors Nova Scotia.

BEN JESSOME: Thank you. What is included in this budget, the next year of the department’s ambitions with respect to digitizing the environment related to things like scheduling appointments, referrals, acquiring results about X-rays and ultrasounds for example - anything that is happening with respect to efficiencies in accessing health records and results?

MICHELLE THOMPSON: To the member’s point - there is a budget allocation to look at efficiencies around centralized booking for surgeries, as an example. I am trying to create those efficiencies. There’s $880,000 that will be used to plan and prepare for centralized booking to ensure that there’s efficiency, and to support reducing wait times.

BEN JESSOME: How about with respect to the archaic practice of having to sign - I’m thinking back to a constituent who had to fill out forms and fax them in or mail them in to receive a CD ROM copy of an X-ray that they had. Are there any upgrades to that scenario that I might have missed or may be on the horizon?

MICHELLE THOMPSON: No, there’s nothing in this budget for that.

BEN JESSOME: Can the minister elaborate on the piece of her budget that focuses on the Nova Scotia Brotherhood Initiative and how that may be expanded or evolve?

I have actually had the privilege of sitting in on some of those gatherings and hearing directly from the men in Upper Hammonds Plains who collaborate. I’m just wondering what we should see with respect to expanding that program as projected in the budget.

MICHELLE THOMPSON: Thanks for your patience. I was looking for an email that I had in Estimates a couple of days ago, but it took me a second to find it.

There was a total of $845,000 investment in the Nova Scotia Brotherhood Initiative, and also for the Sisterhood Initiative. I’m just going to read a bit from the email that I received from the Brotherhood Initiative about the work that they’re planning to do.

As you know, the Brotherhood provides culturally appropriate clinical services to African Nova Scotian men via a primary health care model. The model considers and incorporates determinants of health as a core focus in supporting the community.

The Brotherhood focuses much of its activity on working with Black men in the Central Zone, but does have reach across the province via virtual means. The technology has enabled the team to offer primary care virtual appointments and online programming.

Some of the work that they plan to do and continue to do with the increase would be health promotion - offering information to Black men to promote awareness and invite positive health behaviour change. An example of this would be the Upper Hammonds Plains prostate cancer support group. This ongoing relationship with a support group for Black men enables a sharing of information, as well as coping and support.

Community connection - the Brotherhood Initiative has a central hub that enables sharing of information and trust-building with the Black community in the health care system. An example of this work is the close partnership with the Health Association of African Canadians (HAAC) and the Association of Black Social Workers. They collaborate to support community. They offer primary care. The team supports Black men with access to primary care.

Navigation - the Brotherhood Initiative also works closely with colleagues in the acute care system - particularly the Nova Scotia hospital in Abbie J. Lane - to support patient integration into community via groups, housing, and access for family members.

They are currently doing an evaluation on the work that they are doing as well. They advocate with and for men in the justice system. They partner with the Department of Addictions and Mental Health on newly minted, transcultural, psychiatry programs supporting rapid access to care for men in need. They do offer significant mental health supports, via BarberShop Talks. The list goes on. They are really a tremendous asset to our province and in their communities.

The formation of the Nova Scotia Sisterhood Initiative will mirror much of the approach and the related success of the Brotherhood Initiative and work closely with community to form a team of providers who are culturally and gender-specific to provide access to care for Black women in Nova Scotia. This work will be grounded in a similar framework and model as noted by the Brotherhood Initiative.

There will be family physician, community liaison, wellness navigator, psychiatry clinical team member, mental health counsellor, team lead, and a clerical team position. That’s not all of it, but that’s just a sampling of the work that the Nova Scotia Brotherhood Initiative does, and how they will expand to create the Sisterhood Initiative.

BEN JESSOME: That’s exciting. I’m going to pass the mic to the member for Sydney-Membertou. Maybe the minister can answer, yes or no, if that funding is permanent or they’ll have to come back looking for it every year.

MICHELLE THOMPSON: That is permanent funding.

THE CHAIR: The honourable member for Sydney-Membertou.

HON. DEREK MOMBOURQUETTE: Thank you, Madam Chair. I don’t have very much time. There’s never enough time to talk about health care in Cape Breton, for home.

To the minister, I do appreciate the conversations that we’ve had. I also appreciate the folks who are in the room with you. Some of them are from home. A lot of work has happened in the CBRM in the last number of years, so I want to start by thanking them and just how much we all appreciate the work that they’ve done.

I’ve got about 11 minutes left in our time here. I’m hoping my colleague will give me a few minutes with the time for the NDP. I’ve asked this in the House already. I’m going to be kind of all over the place because I’m not going to take up too much time.

CBRM redevelopment is amazing. What we’re seeing in the community is transformational when it comes to health care. First and foremost, it’s about health care but also, we’re seeing a big boom in the community when it comes to opportunities as part of the redevelopment. What’s happening at the regional with the cancer centre, critical care in the ER, and the mother and infant unit is amazing. The credit really goes to the medical professionals, both in the department and the folks on the ground at home. A big piece of that is the cancer centre.

I asked this minister this before and I’m going to ask her again because I have this opportunity in Estimates. The Cape Breton Regional Hospital Foundation, and advocates in the community, have been advocating for a new PET/CT scan for our cancer centre. For members of the House, the current cancer centre in Cape Breton was built to support 16,000 Cape Bretoners looking for care. There are 40,000 Cape Bretoners a year who are accessing that centre.

Many Cape Bretoners have to travel to get that test. Again, a lot of money has been raised for the equipment. They are looking for the operational costs from the government. I don’t want to get into the past, but we committed to it just before the election that we would do it. I’m looking for a commitment from this government to continue that promise to the folks in the Cape Breton Regional Hospital Foundation and the volunteers.

[6:15 p.m.]

My question to the minister is: Can she confirm in this budget that the PET/CT scan is there or that the funding is there to keep that commitment?

MICHELLE THOMPSON: I thank the member for the question. I do know that decision is under review. It is a little bit slower because of the COVID situation. I know that it is being reviewed, but I don’t have the decision point today.

DEREK MOMBOURQUETTE: I appreciate that. I’ll continue to advocate. That will probably be one of the most frequent questions that you’ll hear from me. I look forward to the day that you and I can sit down and have a conversation about health care, and doctor recruitment. Some of the things that are happening in Cape Breton are very consistent to initiatives that are being looked at around the province.

Cape Breton overall was doing fairly well when it came to patient attachment, especially up in some of the rural areas. When you look at Cheticamp, Inverness and into the Baddeck areas over the years, it was fairly strong. I haven’t looked at the numbers, to be honest, in the last month or so, so I don’t know if they’ve changed. Sydney used to be very strong too. We lost some physicians in the community, so of course, that changes the dynamics. There has always been a strong recruitment drive on the Island, similar to what other, successive governments have done. We’re always looking at new initiatives to try to recruit doctors on the Island.

One of the things that has been talked about is a medical school. There’s a lot of conversation that is happening now in the community. There’s some advocacy coming out of CBU to look at, potentially, what a medical school could look like. I’ve had a number of physicians in the community reach out to me in the last weeks asking my opinion on it. I think it would be absolutely amazing for Cape Breton if there could be a medical school connected with CBU. Whether that’s a relationship through Dalhousie and CBU - I’m not sure how that would work. I’m just looking for some comments from what medical professionals are talking to me about with a potential medical school in Cape Breton.

MICHELLE THOMPSON: I do know that there was some funding allocated through the Department of Labour and Advanced Education for health sciences for CBU, but I don’t have any further information regarding the initiative that you mentioned.

DEREK MOMBOURQUETTE: I appreciate that the first two questions I had are under review and you’ll have some decisions to make. Again, I will continue to promote the Island.

I’m going to be a little bit all over the place. One of the big issues in Sydney in the last little while - and some of the people in the room would be aware of this because I was talking about it - was the walk-in clinic in Sydney. There was a walk-in clinic in Sydney that eventually ended up closing. For the record, we worked tirelessly to try to do whatever we could to support that. The government of the day told us - they came out pretty hard against us - that they were going to save that walk-in clinic, and the walk-in clinic closed just recently.

I know that there’s the unattached clinic. I’m hearing from residents, that’s great. These were investments that were made over the years to help support patient attachment in Sydney. I know people are getting calls. I think it’s great. Staff in the department went right to work immediately to try to alleviate the issue in Sydney, because we really did have high patient attachment. Then, as I said, we had a number of physicians who - unfortunately we had one pass away, and then we had others who retired.

What else are you looking at? Are you looking at expanding the unattached clinic? What other initiatives within the budget are there to support not only people in Sydney but the people in the CBRM to get access to a doctor? I know the Northside decision was a decision that was reviewed during our time, and you approved it in your time. That’s a great move for the Northside when it comes to that, but I’m looking for other initiatives you have planned for the greater Sydney area and the CBRM.

MICHELLE THOMPSON: The walk-in clinic that you mentioned closed as a result of retirement. We certainly continue to recruit to the area to support the attachment of patients. We want people to have a primary care provider. To your point, the Northside Urgent Treatment Centre was terrific. The rural physician incentives, we are very hopeful will help. They’re generous, and there has been a great deal of interest in them in terms of where people can settle. The other thing isn’t directly to your point, but there will be a fifth day added in the ORs in Sydney to support surgery wait times.

Also, there’s a new weight management clinic as well that is being offered to help support people in terms of their ability to maintain a healthy weight, particularly for those patients on the orthopedic surgery list. Similarly, it would be almost like a chronic disease clinic where people have support around lifestyle factors, good education and support in terms of addressing their weight management.

DEREK MOMBOURQUETTE: I’m really running out of time. I’m hearing I have 17 more minutes. Perfect, I’ll use some of that too. Let’s talk about the infrastructure - hospital redevelopment in CBRM. As I said, cancer centre, critical care unit, ER, mother-infant unit, hospice - it has been pretty amazing. There have been a lot of amazing volunteers working with our medical professionals on the ground. I always said it myself, we didn’t wave a wand and say this is what we think is right. I look at Dr. Orrell, Dr. Brake - the list goes on and on of folks who were involved with the redevelopment in the entire CBRM.

How are we doing, particularly with the Cape Breton Regional Hospital? Are we on target for construction? It may be more of a Department of Public Works question, but I’m just looking for a bit of an update on where we’re at on the redevelopment, particularly with the Cape Breton Regional Hospital.

MICHELLE THOMPSON: You’ll be happy to know that those projects remain on schedule. There may be delays here and there, but certainly nothing that would jeopardize the timeline of the project.

DEREK MOMBOURQUETTE: I have 16 seconds left, and I think I’m going to stop there for now. I do appreciate the opportunity if we could have a conversation in the future about the Island.

THE CHAIR: Order. That ends the hour for the Liberal caucus. Now we’ll ask if you want the 17 minutes remaining.

DEREK MOMBOURQUETTE: I’m just going to finish my thought.

THE CHAIR: The honourable member for Sydney-Membertou.

DEREK MOMBOURQUETTE: Thank you. Just to finish off, I appreciate that you have spent the last five-ish days doing this. It’s a trend for health ministers, that’s for sure. I can appreciate that between Question Period and all of this it’s a lot. On behalf of all of us, I thank you and your staff. There are a lot of other questions that I’ll have when it comes to the Island and across Nova Scotia.

Like I said, in other initiatives, governments bring in new incentives to help recruit and retain professionals. Governments have done it in the past. Governments will do it in the future. Really, time will tell. It’s going to be a challenge, not only for Nova Scotia but it’s also a challenge right across North America. Everybody’s recruiting and trying to compete in the same pool. I look forward to seeing how things unfold.

I am happy to see in the budget that there are additional nursing seats that have been included at CBU. We did 60, and I think there’s another additional 28, which is good. I’m sure that, like in the past, those students will be offered positions to come work at home, which is great.

I’ll leave it there. I believe the NDP are finished. Unfortunately, we’re going to have to say that you’re finished with your Estimates for now, minister. I’m going to close it off now so that the minister can read her final statement.

THE CHAIR: The honourable Minister of Health and Wellness for her closing.

MICHELLE THOMPSON: Thank you very much. I just want to thank all of you for your questions. I hope that we were able to provide a better understanding of the health care system through our answers. We’ve been taking notes of outstanding questions and some of the really good points that have been brought up by the members opposite.

People are the heart of health care. Whether it be patients or staff or families, we must keep people first. As I noted previously, the health care system of today was built in the last century. It has not kept pace with changing demographics, necessary technology, our workers’ desire for work/life balance, or a need for innovation and improving facilities. Our vision for Nova Scotia is to have a patient-centred, culturally competent, modern streamlined health care system where people will get the right care in the right place by the right provider. Budget 2022-23 and the investments over the last six months have put us firmly on the road to this goal.

I want to thank health care workers, staff at Department of Health and Wellness and Nova Scotia Health for the monumental effort that they have given during COVID-19. You have adapted to every challenge that COVID has presented, and I want to acknowledge each of you for working so diligently. I know things have been very difficult over the last number of years, long before COVID. I know first-hand what it feels like to be at the front lines of health care and feel unsupported or unheard. The problems in health care developed over a number of years, and we continue to work toward repairing them.

I want to assure people in the health care system that our government started our tenure by listening, and we will continue to listen. It will take time to get underneath chronic problems and create sustainable solutions, but we will. We will become a magnet for health care workers, and we will be accountable to you and to Nova Scotians. We will invest in you, and also in the needed infrastructure and IT solutions. We will work in communities to support health care needs and improve access to health care.

You will see the leadership team. You will see the Premier. You will see the three ministers of the health care continuum - the Minister of Seniors and Long-term Care, the Minister responsible for the Office of Addictions and Mental Health, and I - over the course of our roles in our respective departments. We want to stay connected, and we will continue to listen as we continue to make changes that are meaningful to improve health care.

As I wrap up my first Estimates experience - and I am quite happy to do so - I want to thank my caucus and Cabinet colleagues for their continued support. While I am here as the Minister of Health and Wellness, I want to acknowledge their ongoing support and belief in our collective mandate. I am very grateful to the Premier as well for entrusting me to this portfolio and giving me the opportunity to serve Nova Scotia as the Minister of Health and Wellness.

I want to thank the small but mighty army that supports me at the Department of Health and Wellness and Nova Scotia Health who work tirelessly for Nova Scotians. Little did I know as a health care worker and health care leader that these dedicated and committed folks work as constantly as they do behind the scenes.

[6:30 p.m.]

I’d like to end by thanking my family, who have watched a good portion of these Estimates - I’m sure for the first and last time. Your texts and encouragement have really been helpful, and you hung in there with me. Just knowing that you’re there made it easier.

I will now happily read the Budget Resolution.

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.

Resolution E29 - Resolved that a sum not exceeding $9,839,000 be granted to the Lieutenant Governor to defray expenses in respect of the Office of Healthcare Professionals Recruitment, pursuant to the Estimate.

THE CHAIR: We’ll call a recess for 10 minutes.

[6:30 p.m. The committee recessed.]

[6:46 p.m. The committee reconvened.]

THE CHAIR: I call the committee to order. Just as a matter of housekeeping, before we move on from Health and Wellness, the minister has read the resolution.

Shall the resolution carry?

The resolution is carried.

The honourable Government House Leader.

HON. KIM MASLAND: Madam Chair, would you please call the Estimates for the Department of Seniors and Long-term Care.

Resolution E37 - Resolved, that a sum not exceeding $1,204,270,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Seniors and Long-term Care, pursuant to the Estimate.

THE CHAIR: I will now invite the Minister of Seniors and Long-term Care to make opening comments up to an hour, and to introduce her staff and committee.

The honourable Minister of Seniors and Long-term Care.

HON. BARBARA ADAMS: Good evening, everyone. It is my pleasure to be here tonight to speak with you as the first minister of the newly created Nova Scotia Department of Seniors and Long-term Care. I welcome this opportunity to talk about the amazing staff, caregivers, students, and volunteers in the continuing care sector and the work they do with our department staff on behalf of all Nova Scotians.

Today I have the following staff with me: Tracey Barbrick, the Associate Deputy Minister of Seniors and Long-term Care; Jason Varner, Executive Director of Finance supporting the Department of Seniors and Long-term Care; and Deputy Minister Paul LaFleche, who’s also the Deputy Minister of Municipal Affairs and Housing.

I would like to take a moment to thank Tracey, Jason, Paul, and all of our staff at the department for their extremely hard work and dedication through this legislative session and over the past seven months as we launched the new department. The work they are responsible for is vitally important for improving the quality of life for all Nova Scotians as we age, especially as we navigate the ever-changing COVID-19 landscape.

I’ll begin today by focusing on the details of my department’s budget. Our (Inaudible) is $1.2 billion. This represents an increased investment of $142.5 million in this year’s budget, with the following expenses for the department.

Service delivery and supports: $4.8 million. This funds inspections, monitoring, and compliance of nursing homes and adult protection.

Home and community care, including at-home nursing and home support services: $348 million. This includes direct funding programs, the adult day program, equipment programs, senior safety officers, age-friendly community grants, and almost $30 million for the new seniors’ care grant for low-income seniors over the age of 65.

Long-term care, including nursing home care and client expenses: $841 million. The Department of Seniors and Long-term Care: $2.4 million, including 39 positive-aging grants. Adult protection, to provide investigation and intervention when required for hundreds of Nova Scotians each year: $3.1 million, which is part of service delivery and supports. Finally, administration, corporate support, and strategic initiatives: $3.4 million to help ensure Nova Scotians have access to the care that they need.

Since our department is new, I would like to spend a few minutes speaking about what we are here to accomplish. The Department of Seniors and Long-term Care was created as a stand-alone department to find solutions to help fix problems created by historic cuts in funding and a lack of planning, oversight, and infrastructure investment.

These problems include unacceptably long wait times to access continuing care services for both home care and long-term care; insufficient staffing ratios to cover the increasingly more complex needs of the frail elderly; and escalating physical and psychological stressors on our long-term care, home care, health care, and non-health care staff, families, students, and volunteers.

Our government wants to reverse (Inaudible) and lack of strategic planning. Our government wants to invest properly in health care and to make sure older Nova Scotians have the care they need when they need it. Families, caregivers, care staff, and stakeholders have been calling for the governments to ensure that there is strong governance and equity in both home care and long-term care programs and services across the Province of Nova Scotia.

In addition, our government is committed to expanding our focus beyond the understandable and critical care needs and investment in the need to look after the frail elderly. That is our priority but in our sector in particular the needs of Nova Scotians in continuing care extends well beyond those who are living in long-term residential care or those who are receiving home care. It encompasses so much more and so many more people. As someone who has devoted my entire life to looking after the elderly, I know that there are three other equally important links in the continuing care chain of care.

Our new department has also put an equal emphasis and priority on looking after our staff as well. Another strong link in the continuing care sector is the focus on supporting our caregivers - the family and volunteers who do so much for Nova Scotians. Finally, the fourth link in the chain is the departmental supports, governance, and accountability that must be there to make sure everything works the way it is supposed to.

We have highly energized, loyal, and compassionate employees with expertise in assessing and caring for the frail elderly and those with dementia and mental health conditions; expertise in communicating changing needs to those in primary health care, emergency health care, emergency departments with family and other allied health professionals; and expertise in managing the complexities of palliative care with clients, families, and other caregivers; expertise in educating, training, and collaborating with family, caregivers, students, and volunteers; expertise in managing the challenging occupational health and safety challenges, both psychological and physical.

We have expertise in managing all aspects of a client’s determinants of health, including activities of daily living, dietary, vision, hearing, speech, dental, pharmacological, environmental, mobility assessment, equipment, and social needs; expertise in participating in strategic planning and policy decision-making; and expertise in safety practices including pressure injury reduction, WHMIS, patient and facility equipment, lifting practices, and patient transfers.

This expertise extends across home care, residential care, long-term care, adult protection, and the construction and project management of new facilities and maintenance of the current ones. The areas of administration, staffing, recruitment, governance, and oversight.

Older Nova Scotians have spent a lifetime building our province, teaching young people, and making our communities a better place to live. They have earned our respect and it is our responsibility to repay those contributions with the highest possible level of dignity and care. By bringing the Department of Seniors together with the Continuing Care branch in a new department, we are demonstrating our enhanced commitment to provide more help for Nova Scotians of all ages and levels of ability, from Dr. Ken Rockwood’s frailty level 1 all the way up to frailty level 9.

Since the majority of those we serve are older Nova Scotians, it is a natural fit to have the Department of Seniors in with the Department of Continuing Care, a fit that you will find in many jurisdictions across the country. With the (Inaudible) and with the innovative new approaches we are taking, we will systematically address the problems that have persisted in continuing care for over a decade.

What is in front of us right now is an opportunity to build a best in class system, an opportunity to be a Canadian leader, especially with the movement towards national long-term care guidelines and strategy. Our system will be more responsive and deliver the care people need, where they need it and in the right way. That means offering programs and services that meet the needs of a diverse and ever-changing population, both those who need care and their caregivers and family - and the staff.

We will build a system that is accountable and transparent. That means reviewing and improving board governance, creating new legislation, policies and programs for both home care, long-term care and adult protection, writing new contracts and funding models for both long-term care and home care to ensure greater equity and accountability across the province.

It also means being willing to do things differently and to use technology and other tools to support continuous improvement. We will build the right workforce and better support the workforce staff that we already have. That means significantly improving staffing levels across the system, heavily investing in continuing care, assistant recruitment, education and workplace safety and respecting and valuing a culturally diverse workforce for all employees.

We moved swiftly, all while creating a new department that is literally still under construction. Despite the enormous challenges, I am pleased to report that all of that work is well under way. In just seven short months, my department has accomplished a great deal and initiated some of the most progressive initiatives ever seen in the history of this province for continuing care.

[7:00 p.m.]

We have made key investments that form the foundation for better health care now and into the future (Inaudible) to present in 2017 a five-year strategic plan for long-term care. (Inaudible) the previous government cut the budget for continuing care for two straight years and failed to increase it beyond 1.5 per cent for the next three years.

The previous government cancelled the continuing care assistant grant as soon as they were elected in 2013, bringing the grant back not until 2020, under enormous pressure, after under-training CCAs by well over 4,000 over the past eight years. But they brought it back for only 150 students a year, at 50 per cent of the grant. I promised when we first became a government that we would walk the talk when it came to the CCA grant, not just talk the talk - and we certainly did.

The previous government couldn’t tell us how many single or double room beds there were in long-term care, nor how many CCAs we had, because it took eight years before they brought in the CCA registry. They never did accurately count the number of single and double beds - we did.

The previous government also failed to respond to the fact that 50 per cent of newly trained CCAs left the sector within the first five years, primarily due to low wages and excessive work loads, and that’s prior to COVID-19.

The previous government did not implement (Inaudible) discussed this as far back as 2018, or other measures, such as mandatory continuing care staffing, vacancy and illness reports, as discussed by the Minister of Health and Wellness as far back as 2019.

Madam Chair, you cannot fix what you don’t acknowledge and what you don’t measure. We will do both. The number of RNs employed in long-term care between 2012 and 2021 dropped by 13 per cent in long-term care and by 42 (Inaudible). This created extraordinary pressures on home care nursing and VON, particularly because there was such an increased pressure to discharge early from hospital, especially for those with wounds.

The most critical shortage we have now in health care is a shortage of continuing care assistants in the acute and continuing care sector. The previous government declared that their Home First program was their (Inaudible) their focus for (Inaudible) straight years was on home care.

(Inaudible) Health also said back in 2019, after the Minister’s Expert Advisory Panel on Long Term Care reports were coming out, that they would now shift their focus to long-term care - just before the pandemic hit.

As this was happening the number of CCAs - the backbone of our home care and long-term care industries - dropped by 38 per cent from 2012 to 2021, after the previous government cancelled the CCA grant in 2013. This has resulted in countless hospital beds being closed. This has resulted in countless long-term care beds being closed. This has resulted in staff being burned out, mandated to work late, not getting their vacation, and taking off the sick days that they so richly deserve, but feel too guilty to take.

When we became a government, we took immediate action to address continuing care assistant salaries, CCA training, the grant, recruitment, and worker retention for both home care and long-term care. We felt that it was especially important to have adult protection, investigation, and compliance as part of our new department because they are part of the team responsible for the safety and protection of seniors. Their work is crucial to our success.

We focused on these improvements because we know that fixing continuing care helps all areas of the health care system. This has a domino effect. When you don’t build enough long-term care beds and fail to properly staff and invest in home care services, you fail seniors, and their families suffer. Those seniors end up in acute care while they wait for a long-term care bed.

Madam Chair, in 2019, the number of people waiting from hospital for a long-term care bed rose to over 700 seniors and others who are younger adults. Not everyone in long-term care is an older senior. The government of the day changed the rules on who could get into long-term care and get on the wait-list. Then they said that they had reduced the wait-list by changing the rules. That’s not investment.

Our improvements mean that people are not going to have to wait as long for their (Inaudible) as the people who need to get into long-term care are going to get in there out of acute care beds. That will make those beds available for surgeries and other critical procedures.

It means that ambulances will be able to do transfers when they get to the emergency department. They won’t have to sit for hours on end waiting for an emergency room bed because the emergency room staff are waiting for an acute care bed. It also means that our loving caregivers aren’t continually asked to do more than they can possibly do to care for a loved one.

This is a sector that has been neglected for too long - but no longer. We need to provide care in a way that is safe, inclusive, and accountable to the families and staff who care for our loved ones. The Premier’s mandate letter clearly lays out where we need to focus our efforts.

His mandate letter said that we need, and will, build or renovate 2,500 single beds in Nova Scotia and ensure that spouses are placed together, whether they’re in regular long-term care facilities or in the veterans’ buildings. We’re actually on track for 2,800 beds, or rooms, for our seniors and others, and perhaps more with the possible help from the federal government.

We are working with all 29 facilities approved for these new builds, and we are currently evaluating interested builders for our 500 new beds for HRM. We are going to update decades-old legislation to improve client care, transparency, and accountability of this billion-dollar sector. This includes legislating, an increase in staffing ratios in long-term care to a minimum of 4.1 hours of nursing care per resident per day.

My mandate letter says to ensure that there is sufficient and equitable staffing in home care, long-term care, and adult protection across the province. My mandate letter says that we should, and will, obtain funding from the federal government to ensure new long-term care and home care contract (Inaudible) responsible practices, and to be leaders in the level of care we provide.

My mandate letter (Inaudible) to stay in their homes longer through the new $500 seniors grant that can be used to pay for things like snow removal, lawn mowing, and grocery delivery. Finally, upgrading the training process for continuing care assistant health professionals by paying 100 per cent of the tuition and books for 2,000 students through traditional and new work, and learn models of care and training for CCAs that will include the two-year return of work service agreement after graduation, and to increase funding to allow over-hiring of staff to allow for more part-time and full-time employment opportunities.

Lastly, safety training and increased funds for our injured staff to access more rehabilitative services than ever before. These are not small tasks, but they are strategic, and they are necessary. Most importantly, they are achievable, and it is what Nova Scotians deserve.

We will need to collaborate more closely with other departments, sector leaders, advocates, family, and workers. We need to improve accountability in governance at our long-term care and home care facilities and agencies to ensure value for taxpayer dollars and quality of care. We also need to complete the implementation of the recommendations from the Expert Advisory Panel on Long Term Care.

These are innovations that we are committed to seeing through. I want to personally thank all of the members of the panel for their commitment to this effort and their ongoing support of our department. Today I am pleased to report that all of this work is well under way. Let me tell you a little bit about what we have done over the past seven months.

Perhaps our greatest achievement so far is getting continuing care assistants the pay raise they deserve. As of February 10, 2022, Nova Scotia’s continuing care assistants became the highest paid in Atlantic Canada. We are investing more than $66 million to give these hard-working, dedicated professionals a significant increase in pay and, in some cases, up to 23 per cent.

I have said it before and I will say it again, we must do a better job of taking care of the people who care for our loved ones, and it starts by putting our money where our mouth is. For far too long, continuing care assistants have sacrificed their physical and mental health, their social life, and their family time. They have gone without vacations and days off and felt guilty if they stayed home, or when they were sick or injured. They stepped up in a big way through chronic staffing shortages and the pandemic. They deserve to be heard, valued, and respected - as do all staff, all employees in home care, long-term care, adult protection, and those involved in the Department of Seniors and Long-Term Care.

Before we announced the raise for CCAs was coming, the Premier and I met with almost 500 continuing care assistants on a Zoom call. It was a difficult conversation, but worse than that it was heart-breaking. I stayed on the line for more than an hour and a half after the Premier had to leave to listen, but make no mistake, I have been listening for the past 40 years. I did not need to be convinced of their concerns or the validity of their fears.

I, along with the Minister of Health and Wellness and the Minister of Mental Health and Addictions, have all worked in long-term care under the previous government. We needed no convincing. We were there. The professionals that we talked to told their own deeply personal and painful stories about the exhaustion, fear, frustration, heartache, and physical injury they were experiencing as part of their everyday jobs.

Try to imagine working in a field like long-term care where every single client you have will eventually pass away. I just spent five days in hospital sitting beside my mother while she passed away, and it ripped my heart out to watch her final days. Long-term care staff do this every single day. It is a work stressor unlike any other.

The CCAs talked about struggling to pay their bills. Some home care workers told us that if their car broke down, not only could they not work, but they couldn’t afford to get their car fixed. All continuing care assistants and all continuing care staff want to do is to make a difference and to be valued for the incredible care they provide to their clients and their families. It’s a primarily female-dominated professional body that is tired of being underpaid and taken for granted.

In fact, staffing shortages anywhere in the continuing care sector negatively impacts everyone who works there, from the cleaning staff to the maintenance workers who fix a broken wheelchair. I could not be prouder of the fact that for CCAs, we will be making their lives significantly better for them by taking away some of those financial worries. That is how we say thank you for all that they have done - not just by words but with actions.

It is also a critical part of how we will make continuing care a more attractive career so that we can recruit students and retain the wonderful workers that we have. We know we’re going to need a lot more people to care for Nova Scotians as we age. Our population is getting older, and is amongst the oldest in the country. Today there are over 200,000 Nova Scotians over the age of 65 in our province. That number is only going to increase. They all have every right to expect a continuing care system that will meet their needs. When people need care, they deserve the best care - and the staff deserve the same.

That’s why we’re committed to hiring more than 1,400 new continuing care assistants and 600 nurses. It is perhaps the most daunting assignment in my mandate letter. To get there, we will be innovative and leave no stone unturned. This year, we are investing $17.2 million to support recruitment, retention, and training efforts in continuing care. This includes a 100 per cent tuition reimbursement for 2,000 CCAs, a targeted immigration strategy, recognition of prior learning, work and learn opportunities, and professional development. Recruiters are strolling across the country right now, and around the globe, to find the people we need who want to come to our beautiful province.

Through the Health Association of Nova Scotia (HANS), we have hired six CCA recruiters, and international missions are currently under way to find the staff that we need. I want to thank HANS for taking on this important project so quickly. We wish them the best of success.

We’re also ready to help with relocation costs for up to 200 Canadian or internationally trained CCAs to make the transition to Nova Scotia more welcoming for them and their families. Hiring more staff and showing that we value and care about the staff already working in the system will have direct positive impacts, creating a healthier workplace, and improving the quality of life for residents and staff.

I have spent much of my life working alongside the very people we are trying to hire. To them I say, I know you. I’ve worked beside you. Nova Scotian seniors and others in long-term care and home care need you. Their families need you. We all need you. The work is challenging, there is no doubt about it, but it is also extremely rewarding.

We know there are many out there with valuable and transferable skills who are looking for meaningful work, who we very much need and want. We know that you may have been discouraged - especially over the last couple of years during COVID - but we want you to come back to help us build back the sector pride we all once enjoyed and so richly deserve.

That’s why we are increasing the number of eligible participants in our recognition of prior learning program. We’re investing in professional development opportunities for staff, better scheduling practises and access to physiotherapy, occupational therapy, social

work services, and psychological services for those who were injured or ill in the workplace. We have provided funding to long-term care facilities so they can offer casual and part-time employees full-time positions or hire more staff to provide direct care.

[7:15 p.m.]

In home care, we will be piloting guaranteed hours, new technology, and new ways of delivering care to provide improved scheduling and more consistent earnings for our wonderful home support employees.

Nova Scotians deserve to know that they will get the right level of care when they need long-term care. The long-term care expert panel was asked by the then-Minister of Health and Wellness when he empaneled them to comment on staffing ratios, but without sufficient Nova Scotia-generated data, the panel wasn’t able to do so. However, our government listened to the experts: the staff in long-term care, their unions, the families, and the residents themselves.

Our commitment was made to make sure that every nursing home resident gets 4.1 hours of direct care per resident per day. That’s an increase across the province. To get there, we will need to fund facilities so that they can hire the staff they need to get to the level of care that they need to deliver. In this budget, to achieve that goal, we are investing $25.1 million to increase staffing levels to establish a standard of at least 4.1 hours of nursing care per resident per day, as of the time we took over as government. This will greatly improve the quality of care for residents.

With this additional investment, we intend to hire roughly 441 new CCAs, 85 LPNs, and 23 new RNs. That’s roughly 549 new staff. More staff means more time per resident, better and more comprehensive care for our loved ones, and better working conditions for our staff, making it a healthier and safer place for them to be.

This is also about bringing an equitable level of care to long-term care facilities across the province. It is the beginning of our commitment to ensure quality care for every resident of long-term care in the province.

Ensuring every nursing home facility gets to 4.1 hours of care is only the beginning. Residential care facilities are also a part of our commitment to quality. Home care and long-term care aren’t the answer. Nova Scotians need to know that government will provide a safe and supportive environment. Residential care facility staff have also benefitted from the continuing care assistant wage increase. We will continue to move forward on implementing the expert panel’s recommendations, and residential care facilities will see (Inaudible) in quality of care as well. It is a step in the right direction towards improving the lives of residents.

Many of our new hires will be graduating students, and this budget extends support to them as well. We are providing much-needed tuition support for CCAs currently in the program through $3.1 million in tuition reimbursements for existing students. That’s part of a $17.1-million investment in recruitment and retention, including tuition relief, to bring more than 1,000 CCA students into the system this year. Over the next two years, we will invest in the free education of more than 2,000 CCA students for our sector.

We have expanded opportunities for flexible studies and more hands-on work experience by introducing a work-and-learn education model for CCAs. This allows students to apply their skills and directly contribute to the delivery of care in home care agencies and long-term care facilities sooner.

Student CCAs are already in the workforce through a new work-to-learn program partnership. Amy Lake is one of the more than 90 continuing care students working in long-term care facilities under the tuition support and work-and-learn program. She’s working at Dykeland Lodge in Windsor while she completes her training. Amy says this program has given her an opportunity she wouldn’t have had otherwise. Now she is able to further her education without financial concerns and stress on her family. We need more people like Amy.

With these tuition supports and the CCA raise, we are making sure that young people seek continuing care as a rewarding career opportunity in Nova Scotia.

At the same time that we work to attract more people to a career in continuing care, we also need to plan for the future. As I said a few moments ago, our population is aging. That means that more and more Nova Scotians are going to need continuing care as they age. In fact, by the time I turn 80, there will be twice the number of seniors in Nova Scotia as there are right now.

Right now, there are just under about 2,000 people on the wait-list for a room in long-term care and that is obviously far too high. If we don’t do something now, we will be in even worse shape down the road. In fact, this should have been started a decade ago. Seniors deserve to access appropriate care as they age. For many, that can be a combination of home care and family caregiver supports, assistive equipment, and other funding programs.

We all know that sometimes home care and family supports are no longer enough, and someone needs to move into long-term care - not in a hospital bed and not at home without the necessary supports. That’s why we are leaving no stone unturned.

This budget invests $11 million in more than 190 long-term care temporary spaces, including converting private assisted living spaces or vacant Veterans Affairs bed spaces, among other opportunities. This is creating more bed capacity and supports the patient flow in the acute, chronic health care system. Spaces that were going unused are now giving more seniors a home, proper care, and peace of mind for both them and their families. We’re doing this to help address the problem now, as we continue to meet and exceed our goal of building or renovating 2,500 single-bed rooms in long-term care.

Right now, we are on track to build or renovate 2,800 new rooms for residents in long-term care, and we are always looking at ways to add more. Our government is developing an infrastructure renewal plan that will help operators maintain aging infrastructure and establish a process for identifying and prioritizing future capital investments in a strategic way. All our new builds will be at least 25 per cent more energy efficient than current building codes require. This will reduce greenhouse gas emissions, lower energy bills, and make the facilities more comfortable for residents.

Our government called for the renovation or construction of 2,500 beds in August of 2020. The Liberal Government then repeated our announcement (Inaudible) more than 29 projects were approved, and they will be completed by our government in the coming years. I want residents in all those communities to know that this government will deliver modern, comfortable facilities for our loved ones.

Of course, construction of this magnitude takes time, so we will need to be patient and persistent on our building projects, but we will move as quickly as possible. As we move toward this ambitious goal, it is important to appreciate the impact these projects will have beyond long-term care and in communities across the province. These are major construction projects. They represent thousands of good-paying jobs over several years. Through wages and spending on materials, these projects collectively will have a significant impact on our economy and the prosperity of many Nova Scotians.

Most of this is happening in rural Nova Scotia, where it creates a triple win. It improves the quality of the facility, employs people during construction, and increases the number of health care professionals and others in the area, once opened. It is one of the many reasons why the province of Nova Scotia’s future is so bright.

We know that once all of these places in long-term care are open, and as support needs for seniors at home continue to grow, we will need even more people to care for our loved ones than ever before. This brings me back to our recruitment efforts and one aspect that we have not yet talked about: significantly increasing salaries is important. Free tuition and the ability for students to earn as they learn is a key part of our recruitment efforts. On-the-job safety also has to be a top priority and like many issues in continuing care it has been neglected for far too long.

Simply put, we need to do a better job of taking care of the people who care for our loved ones. That is why the government is investing in workplace safety. Having worked as a physiotherapist in acute care, home care, and continuing care, and in the private sector for as many years as I did, I know all too well the injury rate in the continuing care sector is unacceptably high. They are the highest rates of injuries among all Nova Scotian workers. This needs to change. No one wants to get hurt on the job and no one should.

If people think there’s a likelihood that they are going to get hurt at some point in their career, fewer people are going to want to work in this sector. Ensuring a safe work environment with practices that will prevent workplace injuries and that support a more timely return after an injury are key to attracting and retaining workers. This also helps keep staffing levels up, which means better care for Nova Scotians. That’s why we are investing an additional $3 million in workplace safety, equipment, and training to support home care and long-term care staff. It is a classic case of where an ounce of prevention is worth a pound of cure.

Making this investment now is not only the right thing to do, it has the potential to save government money later by helping to slow the exorbitant growth of Workers’ Compensation Board injury premiums in the province of Nova Scotia. Caring for our loved ones is hard, physical work and we owe it to everyone who works in the continuing care sector to do whatever we can to protect them. We need to have enough staff, the right safety equipment, and the time and training to do things safely.

We are taking a forward-looking, forward-thinking, strategic approach to solutions for the continuing care sector. We clearly identified this in the plan that we released in August 2020, and then again in July 2021 as part of our election platform, and in my September 2021 ministerial mandate letter from the Premier of Nova Scotia, and then again in the 2022-23 budget. These are innovative, long-term, strategic investments designed to deliver now and into the future.

With that in mind, it is impossible not to appreciate that costs are on the rise. Costs have always risen and there’s no reason to believe that will change down the road. That is why it is so hard to believe that never in the history of funding for long-term care has there been a mechanism to help the sector with those increasing costs. That omission ends today with this budget. We are guaranteeing increases linked to the Consumer Price Index on non-wage operations for all licensed long-term care facilities. This applies whether they have had a service level agreement with the Department of Seniors and Long-Term Care or Nova Scotia Health.

This provides consistency regardless of agreement arrangement. This year’s Consumer Price Index funding adjustment means facilities will receive an extra $2.2 million to cover rising costs. From where I sit, that is a decision that just makes sense and is long overdue. As we review the funding model for home care agencies this year, we will determine the best approach to address the issue in their sector as well.

At this point, I think it’s only appropriate to take a moment to reflect on the pandemic and what we have all been through over the past two years - what the families have been through, what the staff have been through, and what our loved ones in long-term care and home care have been through. COVID-19 has been hard on everyone, but it has been especially hard for those older Nova Scotians and those older folks who are caring for a loved one at home without the resources that they need.

[7:30 p.m.]

Restrictions from activities and social isolation have taken a toll on seniors, especially for those in long-term care and for everyone separated for months on end. For facility staff the pandemic has made staffing shortages even worse, through illness and isolation requirements needed to keep them as safe as possible. I really can’t say enough how grateful I am to everyone who stepped up and continues to step up during the pandemic, from volunteers to workers sacrificing evenings, weekends, and vacations.

I think the reason we fared as well as we did is due mostly, if not entirely, to their compassionate dedication, their love for each other, and those they care for and work with. Once again and now, Nova Scotians took care of each other the way we always do. We put others ahead of ourselves and we followed Dr. Strang and Public Health’s directions and continue to do so. We were leaders and inspiration to others, and I am so grateful for that.

There are almost too many people and organizations to thank, but I would like to point out two. As the Omicron wave variant took hold, we faced (Inaudible) we put out an urgent call for help and as always (Inaudible) Through the government’s emergency assistance, a team of 10 people were sent (Inaudible) our hardest hit facilities.

We also asked for help from our province’s nursing and CCA students and they responded with inspirational leadership and support. Hundreds of future health care staff jumped into action and did their practical student placements in long-term care facilities. After the first placements ended, I heard from many students, instructors, facility staff and residents themselves about how successful that went. For students in particular, it was an eye-opening, educational and humbling experience. Some even said they wanted to change their career path and work in continuing care, and we will welcome every single one of them.

For staff, it was a desperately needed emotional and physical break that allowed them to not work overtime or to enjoy a day off. For the government, it was a significant relief to know that residents were getting the care they needed and that our students would step up in a big way when they were called upon to do so. I am so proud of every one of them. I want to personally thank the Red Cross and all of those students for their compassion and support. We could not have made it through without you.

Sadly, and frustratingly, the pandemic isn’t over. The virus is out there. The government and our department still have much to do to make sure Nova Scotians are as protected as possible. For long-term care facilities, that means that we are continuing to provide support as needed, on a daily basis.

This budget has $15 million to continue additional staffing for long-term care assistants in facilities due to COVID-19 Public Health directives. Our home support aids programs have also been extended to help address staffing pressures made worse by the pandemic.

We will need to continue to make sure there is funding for environmental cleaning, personal protective equipment, isolation pay, and other COVID-related expenses or tools that will further support infection prevention and control. These will always be top priorities.

I sincerely hope that this is the last budget where we have to spend so much on COVID-19 protection. We will always make sure our providers, staff, and families have what they need to keep our loved ones safe.

One of the things that I have already said today is how proud I am of how quick the Premier and the (Inaudible) take action after the election. We could have waited until this budget to start making the changes Nova Scotians voted for, but we decided instead to take action immediately. No better example of this and how we have followed through on our platform, and my letter mandated to create the Seniors Care Grant. It was the first action I had the privilege of taking as minister, and the program has already enjoyed significant success.

The idea for the Seniors Care Grant comes from the fact that we know many Nova Scotian seniors from all diverse populations face challenges staying in their homes. In fact, as a physiotherapist, I know that when balance deteriorates as we age and one progresses from Clinical Frailty Scale levels 2 and 3 to levels 4 and 5, the first functional limitations become the inability to walk on uneven surfaces, gravel, grass, inclines - for example, snow shovelling, lawn mowing. This means that loved ones need help with these higher-level activities of daily living, but our families are not around like they were when I was younger.

Often seniors just need a helping hand with these small but important jobs here and there, especially those that require a two-handed grip with lifting or carrying combined with ambulation. These are jobs like snow shovelling, grocery, and prescription delivery, and making small household repairs - the things that make your home safer and more comfortable.

Now, thanks to this grant, eligible seniors can apply to receive up to $500 every year to help make these types of expenses bearable. This investment makes it easier for older Nova Scotians to maintain and afford their homes with the dignity they deserve.

This program became available December 1, 2021, and more than 20,000 grants have been issued so far. That is a total of over $10.3 million straight into the pockets of Nova Scotian seniors in just under four months. This year, we are committing almost $30 million towards the Seniors Care Grant.

To qualify, Nova Scotians must be 65 years of age or older. They must live independently or with their spouse or partner in a home they own or rent. If asked, they need a lease or even a bill with their name on it to show they own or rent their home - and a household income of $37,500 or less.

Seniors apply once a year for the grant based on what they have spent or expect to spend on help with these small jobs around the home each year. We know that many Nova Scotians, especially in rural areas, don’t necessarily hire businesses to help with their chores. They usually hire a neighbour, a friend or family member, or the teenager down the street. That’s just fine with us. Receipts need to be saved but these can be anything from an official receipt to a signed and dated note on a piece of paper.

We have tried to make this program and application process as simple as possible. Anyone with any questions about the grant can simply call our office and we will help walk them through it. I am very proud of this program, and I want to see as many seniors as possible use it and have the money back in their pockets.

You can apply online at www.novascotia.ca/seniorscaregrant or you can apply by mail or by fax. Paper applications are also available at Access Nova Scotia centres, at all MLA offices, or you can call: 1-800-670-4357 to request that an application form be mailed to you. That same phone number will also connect you to my amazingly helpful staff who can help answer questions and walk you through the process. The deadline for this year’s application is May 31, 2022, so tell all your friends and neighbours.

This is the first year of the program and we are always looking at ways to make improvements to make it even better. I sincerely hope that everyone who is eligible applies. I encourage everyone else, including all of the members in the Chamber, to help us spread the word about this program.

The Seniors Care Grant is just the beginning of the programs we offer to help support the social and economic well-being of older and frail adults.

The Adult Day Program may be one of our best and least heralded supports for seniors and their families. They are offering a range of activities in a safe and caring social environment to help seniors and adults with disabilities live at home as independently as possible. They also offer important respite time for caregivers.

Activities at adult day programs include music, painting, exercise, craft, games, outings, and much more. Some of these programs are specifically designed for people with certain conditions such as brain injuries or dementia, and they can be effectively transitioning tools for those from home care into long-term care.

The Age-Friendly Communities Grants through the Department of Seniors and Long-Term Care provide funding for projects that help older Nova Scotians stay active, healthy, and engaged in their communities. The programs provide funding for community-wide efforts to create age-friendly environments and to promote healthy aging. These grants also support community-driven initiatives that will positively impact the lives of older Nova Scotians across the province. The grant provides funding up to $25,000 per initiative. I am pleased to be able to report that we have just provided more than $600,000 in funding to 39 amazing projects across the province.

We know that community organizations are working hard to support older Nova Scotians during the pandemic and before. That’s why we have invested an extra $200,000 to 300,000 in the program in 2021-22, providing grants to dozens more projects than ever before.

The Seniors’ Safety Program addresses the safety concerns of seniors by promoting education and awareness about seniors abuse prevention, crime prevention, and safety and health issues. In addition to this, seniors’ safety coordinators respond to referrals of seniors at risk in the community, and they build trusting relationships. If a senior wants or needs help, the seniors’ safety officers help them access resources and supports that they need to live a safer and more comfortable life.

Seniors’ safety coordinators are often co-located with police, enhancing (Inaudible) law enforcement and seniors at risk. My colleague, Kim Masland, the Minister of Public Works, worked at one time as a seniors’ safety coordinator in Queens. The stories she had (Inaudible) this program is to support those who are . . .

THE CHAIR: Order. I would ask the honourable Minister of Department of Seniors and Long-Term Care to refrain from referring to personal names in their address.

The honourable member of Seniors and Long-Term Care.

BARBARA ADAMS: I apologize. My colleague, the Minister of Public Works, worked at one time as a seniors’ safety coordinator in Queens. The stories she has shared with me make it clear how critical this program (Inaudible) who are in need of compassion and support. Nothing makes me angrier than when I hear about an older Nova Scotian being abused - physical, mental, emotional, financial, sexual abuse. It comes in many forms.

I am sure every member here today agrees that there is simply no place for any type of abuse in our province. It is unacceptable, and it is our duty to do everything we can to make sure older Nova Scotians are safe and protected.

We also produce - and all of you have copies in the Legislature - the Positive Aging Directory. This directory is a valuable and comprehensive information directory published each year by the Department of Seniors and Long-Term Care to give Nova Scotians quick and easy access to the many programs (Inaudible) in the province of Nova Scotia. The directory is also an essential source of information for those who work with seniors - many of whom help keep the directory listings accurate and up to date.

[7:45 p.m.]

This year, you will notice an insert in this year’s positive aging directory that includes a Fitness in the Kitchen exercise handout. Ironically, this handout was created by myself and fellow home care physiotherapist Kathy Crane, who worked with me at PhysioCare at Home while we volunteered with Community Links when we created the Fitness in the Kitchen exercise handout to go into the calendars. The valuable work that our department (Inaudible) living. I think the work that they do is vital to Nova Scotians.

This is just a recap of what government is doing to support seniors, to solve the longstanding problems facing the continuing care sector for over a decade. What our government and department have accomplished amounts to significant progress under very difficult circumstances.

Together we have endured the pandemic and Public Health restrictions for more than two years. Once again, we are facing significant economic and staffing challenges. To get to where we are today has been a tremendous effort by a great many people. Once (Inaudible) and all of the talented and hard-working staff in the Department of Seniors and Long-term Care for their tireless efforts.

I would like to make a special shout-out to my associate deputy minister, Tracey Barbrick. After leading the COVID-19 response, she was finally going to get a vacation after two years of sleeping in her office and being on call every day. One week into that vacation, the Omicron wave hit us. When she was called to come back off of her vacation early, she didn’t hesitate. For that, I thank her, and all Nova Scotians do.

I’d also like to thank Vicki Elliott-Lopez for all her work in our department. She recently moved on to use her incredible skills to address a much simpler department, the Department of Municipal Affairs and Housing. Only kidding. I also want to thank Dr. Strang and Public Health for working so closely with our staff to help keep Nova Scotians as safe as possible.

I also want to thank our partners throughout the health care system, and all the stakeholders and advocacy groups, union representatives, the staff who care so deeply for our loved ones, and the families that count on us to provide high-quality care, and the residents themselves. The Health Association of Nova Scotia (Inaudible), all the educational institutions, ACE, the staff that train our students, the foundations, the fundraising groups that support all our long-term care and home care organizations - thank you to you all.

If we are truly (Inaudible) status of best-in-class care for Nova Scotians (Inaudible) together. Collaboration is the cornerstone of any health professional and certainly the cornerstone of my approach to being minister. I want to hear from anyone who has a good idea to improve the level of care Nova Scotians receive. It doesn’t matter if the idea comes from a homecare worker . . . (Interruption)

THE CHAIR: Order. Order. The time for opening statements by the honourable Minister of Seniors and Long-term Care has elapsed.

It is now time to turn to questions from the Official Opposition.

The honourable member for Bedford Basin.

HON. KELLY REGAN: Thank you very much, Mx. Chair. First of all, I would like to ask the minister to table a copy of her speech. We had numerous dropouts during the speech. There were a lot of times that we just simply couldn’t hear her, so if she could table a copy of her speech, then we can actually read what she said and find out what was in the speech.

I would just like to say that I echo the minister’s comments about Tracey Barbrick and Vicki Elliott-Lopez. Tracey was my associate deputy minister at the Department of Community Services. She was fantastic and she stepped into the breach to work overseeing the vaccination rollout under our government. I just simply could not say enough good things about Tracey Barbrick.

I had the pleasure of working with Vicki Elliott-Lopez at the Department of Labour and Advanced Education back 100 years ago. Although Vicki hasn’t aged at all, I have. She’s just a simply wonderful person and I want to echo the minister’s comments there.

Because we just have a short 14 minutes here, I’m going to just start with some short snappers. I’m just looking for some information from the minister.

I’m just checking to see how many long-term care homes in the province and how many homes for special care or that aren’t long-term care homes but where seniors are, in fact, living.

BARBARA ADAMS: Could I ask the member to repeat that question. The difficulty in hearing is going both ways apparently.

KELLY REGAN: How many long-term care homes in the province and how many homes for special care or other residences where seniors are living but aren’t considered long-term care homes?

BARBARA ADAMS: I thank the member for the question. As the member would know, we have 132 long-term care facilities in the province of Nova Scotia. We have 7,500 nursing homes. We have 4,100 residential care facilities in the province. We have 16 that are combined both nursing homes, as well as residential care.

KELLY REGAN: You said there are 7,500 nursing homes?

BARBARA ADAMS: We have 132 long-term care facilities. Seventy-five of them are nursing homes; 41 are residential care facilities; and 16 are a combination where they have both long-term care beds, as well as residential care level beds in them.

KELLY REGAN: Thank you. How many long-term care homes are currently not taking new residents?

BARBARA ADAMS: As the member would know, the numbers are usually changing. Right at the moment, there are 13 that are not admitting.

KELLY REGAN: Can the minister please identify how many of those that are not taking new residents are taking it because of the COVID situation and how many are taking it because of the staffing situation?

BARBARA ADAMS: For all of those facilities, because of the long-standing staffing shortages, it’s a combination of both. So there’s no way to say it’s just one or the other because it’s always both.

KELLY REGAN: Well, minister, I find that interesting because in February when we had 34 homes not taking new residents, we were told that 17 were because of COVID and 17 were because of staffing. Could the minister clarify how it was that in February they were evenly split but now it’s a combination for the 13 that remain?

BARBARA ADAMS: The reason for the fact that it’s a combination now is that some staff are not off because they have COVID-19, it’s because they are in isolation because someone else that they have been in contact with has. That’s the difference.

KELLY REGAN: In those homes where we’ve identified that staff are off due to COVID-19, is there in fact COVID-19 in the nursing home or is it because of a contact that the staff have outside the facility?

BARBARA ADAMS: Thank you for the question. In those particular cases, there are cases of COVID-19 in those particular facilities.

It’s really important to focus on the fact that over the past two years, as the member would know, there’s a lot of money that’s going in to make sure those facilities are as safe as possible. Some of the examples are the long-term care assistants who are in those facilities in order to help support the staffing challenges that are there.

There is infection control that is always there to designate support for the staff when these situations occur. There’s also the environmental funding support that’s ongoing. Of course, there is the PPE that is continuing to be distributed the same as it has been in the past. Certainly, there has been always the surge capacity funding and the administrative funding support that goes into these facilities to make sure the staff are as supported as possible. In the cases where we’ve had the most challenges, we have certainly not hesitated to bring in (Inaudible) needs of the residents are dealt with as quickly as possible.

KELLY REGAN: Of the 151 people who have died of COVID since December 8^th, during the Omicron wave, can the minister identify how many of them were seniors?

BARBARA ADAMS: Thank you to the member for the question. The member would have to ask the Department of Public Health for that breakdown of information.

KELLY REGAN: I just want to make sure that I understand that the Minister of Seniors and Long-Term Care says she doesn’t know how many seniors have died of COVID since December 8^th?

BARBARA ADAMS: The responsibility for reporting of that data is the Department of Public Health and the Minister of Health and Wellness. It isn’t that this minister doesn’t know the answer - it’s that it is not my responsibility to report on that data. Considering that the Minister of Health and Wellness was just in Estimates for the last 15 hours, that would have been a good opportunity to ask that question.

KELLY REGAN: I just want to make sure that I understand the minister’s answer. The minister’s answer when I asked her how many seniors - and she is the minister of Seniors and Long-Term Care - have died of the Omicron variant since December 8^th, her answer is that of course she knows but she’s not going to tell me. Is that what the minister actually just said here now?

BARBARA ADAMS: As the member would know, Public Health is responsible for the reporting of that information. So, I’m going to refer the member back to the Department of Public Health.

KELLY REGAN: Thank you, Mx. Chair. I will take it that the minister doesn’t know, or she doesn’t want to answer, or she doesn’t want to actually say the words how many seniors have died of the Omicron variant since December 8^th, which is quite astounding.

I will just point out that this is the opportunity for the Opposition to ask ministers questions. So every time she says, “as the member would know,” I am asking her questions because I want to know what she knows.

[8:00 p.m.]

So let me be clear, I’m asking the minister questions. I want to know if she has the answer to this. She doesn’t have to say, “as the member would know” because you know what? I’m not the Minister of Seniors and Long-Term Care.

THE CHAIR: I would ask the honourable member for Bedford Basin if there’s an additional question.

KELLY REGAN: I can stand up and make speeches as long as I want. I have four minutes here and I can stand up here and make points to the minister if I want to. That’s the way it works in here, Mx. Chair.

Now, how many CCAs are currently employed in long-term care homes here in Nova Scotia? Is that up or down from last year?

THE CHAIR: The honourable Minister of Seniors and Long-term Care. Do you have a response to that question, or should we continue on with questions?

BARBARA ADAMS: We’re looking for the exact number right now. As soon as my staff have that answer, I will be able to provide that information. We do want to be sure that we have the exact number and that we’re quoting correctly.

KELLY REGAN: Thank you to the minister for that. In terms of CCAs, how many were off last week due to COVID?

BARBARA ADAMS: What I can tell the member is that in the past, the staff sickness and vacancy survey that was put out for the 132 facilities was put in place by the previous government as a voluntary survey.

THE CHAIR: Order. It is now 8:03 p.m. It is time for the conclusion of the Committee of the Whole House on Supply for the day.

The honourable Government House Leader.

HON. KIM MASLAND: Mx. Chair, I move that the committee do now rise and that you report progress and beg leave to sit again.

THE CHAIR: The motion is carried.

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

[The committee adjourned at 8:04 p.m.]