HALIFAX, WEDNESDAY, MARCH 30, 2022

COMMITTEE OF THE WHOLE ON SUPPLY

7:33 P.M.

CHAIR

Rafah DiCostanzo

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

The honourable Government House Leader.
 

HON. KIM MASLAND: Would you please call the Estimates for the Minister of Health and Wellness, Resolution E11.

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

THE CHAIR: I will now invite the Minister of Health and Wellness to make opening comments, for up to an hour, to introduce their staff to the members of the committee.

The honourable Minister of Health and Wellness.

HON. MICHELLE THOMPSON: Good evening. It is my privilege to introduce the Estimates for the Department of Health and Wellness for the 2022-23 fiscal year. With me today are officials from the Department of Health and Wellness who will help us examine the department’s budget in more detail.

With me today are Deputy Minister Jeannine Lagassé, Ms. Shelley Bonang, Chief Financial Officer for the Department of Health and Wellness, and Dr. Kevin Orrell, the CEO in the Office of Health Care Professionals Recruitment.

I thought I might need to stand but given the size of the Estimates Book, I think I’ll be able to work directly from it, read my speech directly from here.

When we formed government, to ensure we kept our promise to address the deficiencies in health care, Premier Houston appointed two ministers in addition to the Minister of Health and Wellness, to oversee addictions and mental health as well as seniors in long-term care.

Minister Adams leads the new Department of Seniors and Long-term Care and Minister Comer is responsible for the new Office of Addictions and Mental Health. They will both have the opportunity to speak about their department Estimates for their highlighting solutions and action for health care.

I am proud to tackle the challenges in health care with my colleagues, both of whom are health care workers. There are no silos; health care is a continuum. The health care leadership team brings viewpoints from each of their organizations and accountabilities when a decision is made. When a decision is made, it is made as a system, not in silos or what’s best for an individual organization. We have not seen this type of shared decision making in many years, if ever. All of us work closely together to improve access to care whether it be in a family practice, a psychologist’s office or in a long-term care home. Each success is shared success.

In addition to the new ministerial appointment, the new Office of Health Care Professionals Recruitment was established to ensure there was a coordinated, focused approach to recruitment. Nova Scotia has much to offer health care workers - those within and outside our borders. We are confident we will become a magnet for health care workers as our mandate evolves. Health care in all areas faces many challenges. I recently read a definition of leadership by Jennifer Katz. She described leadership as vision and service. I feel this budget offers both and I feel this government and the health leadership team leads with these principles as well.

The investments and financial commitments align with our vision for health care. Our system requires transformation, our solutions and actions must be decisive and bold to address the long-standing deterioration of our system. Our system transformation is in service to Nova Scotians and in service to the health care workers who provide care every day. We will invest in health care workers, infrastructure, technology and lay the foundation for future investments to achieve our mandate and steadily improve health care. We will build accountability into every level of health care so that as a system, we can see where we are performing well and where we need to improve.

The commitments in the Department of Health and Wellness budget are about tackling health care head on and providing the care that Nova Scotians need and deserve. Our commitment this year across the Department of Health and Wellness, the Department of Seniors and Long-term Care, and the Office of Addictions and Mental Health is an overall new investment of $412 million more or about an 8 per cent increase.

We have been honest with Nova Scotians. Fixing health care will take money and it will take time. There will need to be a combination of short, intermediate, and long-term strategies to address the gaps, but this government is committed to spending what is needed and doing what it takes to improve health care and health outcomes for Nova Scotians.

The Department of Health and Wellness itself has a 6 per cent increase of $240 million for a total budget of $4.3 billion. With the increase, Nova Scotians will have better access to primary care through virtual care. We will tackle surgical wait times in a meaningful way, expand training opportunities for nurses and continue to oversee vaccinations in our evolving pandemic response. We will actively and aggressively recruit people to health care all the while highlighting not only our investments in the ongoing transformation in health care but also the attributes of our province and the warm, welcoming, and unique communities that members of this Chamber are privileged to represent.

One of the first things I did after being named Minister of Health and Wellness was to tour many of the province’s health care facilities and talk to hundreds of frontline workers. We travelled in two teams, Deputy Minister Lagassé, CEO of Nova Scotia Health, Karen Oldfield, and I were one team and the Premier, Dr. Orrell and Janet Davidson, the administrator of Nova Scotia Health on the other. We travelled this province from Neils Harbour to Yarmouth talking directly to health care workers about their experiences, their frustrations, and their ideas. Frontline health care workers took time out of their busy days, or from their days off, to tour their facilities with us, to talk about their experiences, and to offer their solutions.

Frontline workers told us they were tired, and they were burnt out. The system has been under pressure for a long time, and COVID-19 was making things even more difficult for our health care professionals. They were stretched but determined. They were dedicated and they were all-in for change.

I want to thank the health care workers who talked to us, who pitched the Premier with their video submissions, and to those who wrote heartfelt comments and emails, for their courage in bringing these shortcomings, and the solutions, forward.

While health care workers talked about their experiences, they also brought the conversations back again and again to their patients, to the Nova Scotians they serve, and how changes could not only improve the care their patients received, but how the system could function better overall.

Sometimes I had a lump in my throat listening to them and sometimes I was angry over some things that had gone on for so long. It strengthened both leadership teams’ resolve to dig in and make meaningful, lasting change and improvements.

The information provided by frontline staff from our tour is now embedded in our decision-making, our budget-building, and in our strategic planning. Our health care workers deserve better. The investments in this budget will begin our path of transformation and give them not just better, but the best.

Fixing health care will not happen overnight. We know it will take some time to fix the issues in healthcare, some of which are longstanding. That doesn’t mean we can’t make improvements as soon as possible. That’s what we did right after I was sworn in on September 1^st.

I know we are here to debate estimates for Budget 2022-23, but I would be remiss if not telling this Chamber about the major improvements that we have made. Steps taken include: establishing the Office of Healthcare Professionals Recruitment, the Office of Addictions and Mental Health, and the Department of Seniors and Long-term Care, as I mentioned before; appointing an administrator for the Nova Scotia Health Authority; introducing a streamlined leadership team to work with frontline health care workers and system leaders to drive change; offering jobs to all graduating nurses in Nova Scotia for the next five years and developing a nursing mentorship program to support our new graduates as they transition to practice; opening urgent treatment centres in North Sydney and Parrsboro, which have received rave reviews from people during their exit survey. The North Sydney Urgent Treatment Centre has been so successful that they have added an extra day to their schedule.

We have: added new transfer vehicles and staff to double patient transfers and enabled paramedics to focus on emergency responses; expanded virtual care to everyone on the Need a Family Practice Registry; launched a recruitment campaign to attract health care professionals and creating a team of navigators to connect health care professionals with the information they need to support their move to Nova Scotia; completed extensive work at Dartmouth General Hospital under the QEII New Generation project; and piloted an innovative clinic co-led by a nurse practitioner and a pharmacist.

We hit the ground running and we have not stopped. Our bias is to action. Some of those improvements came right from the ideas or issues that we heard from health care workers on the tour. I’ll expand on one of the examples above.

Our paramedics are working flat-out. They miss breaks, meals, and work overtime. Many had COVID-19, or COVID-19 scares, and had to miss work. Recruitment has been difficult during the pandemic, so to help free up paramedics to focus on what they do best - respond to emergencies - we expanded the patient transfer system. It frees many paramedics who are tasked with moving non-critical patients between facilities to focus and use their full scope of care.

There was a change to allow recent paramedic graduates to get a temporary license to work before their final exam. This gives the system a new pool of paramedics to draw from.

[7:45 p.m.]

There was a change in the EHS call centre to move to a civilian model. Previously, this was staffed by paramedics, but the Fitch report recommended this model as it’s best practice in North America, and Nova Scotia was one of a handful of jurisdictions that do it this way. Not only does this free up more paramedics but it allows us to staff chronic vacancies that will help support ground operations.

We need to be innovative and look at all options when solving health care problems. The pandemic has presented us with unprecedented challenges. For two years, we have been on this journey, and we have encountered five waves, all different. While there were some learnings that we could carry forward as we moved through each wave, each one presented our health care system with different challenges. Each time, the Department of Health and Wellness, Nova Scotia Health, the IWK, and health care workers rose to meet these challenges with dedication, resolve, and grit. I can assure you, as someone who worked in the first 18 months of the pandemic in the front line, there were many difficult days.

The most recent Omicron wave presented us with a new variant that was more contagious and had a shorter incubation period. It arrived in our province in December 2021 with little to no warning, and on a grand scale. Despite being 20 months into the pandemic, there is no quit in the health care team. The staff at the Department of Health and Wellness, Nova Scotia Health, the IWK, and health care workers across this province were nothing short of heroic in their response. We had to move quickly - more quickly than we had before.

Since the beginning of wave 5, there have been 37,000 Nova Scotians with confirmed cases of COVID-19. We had to pivot quickly to understand this new variant and its impacts in our communities. As always, Dr. Strang and the team at Public Health provided us with expert guidance as we navigated a new stage of this pandemic. We owe him a great debt for his constant stewardship and expertise, but also for the sacrifices he has made on all of our behalf.

In addition to dealing with the community spread of COVID-19, pivoting our contact tracing, testing strategy and navigating system-capacity issues, Public Health, the Department of Health and Wellness, the IWK, and Nova Scotia Health worked tirelessly to stand up mass immunization clinics and immunized over 300,000 Nova Scotians in January and early February 2022. Many of these people were redeployed to help out in the field. They did contact tracing, delivered vaccinations, and other key work. Many others worked tirelessly over the holidays and beyond to ensure adequate testing, PPE, and vaccination were available to Nova Scotians. There was nothing held back.

I would like to thank and acknowledge those folks who came out of retirement or had skills to assist with the latest COVID-19 response. I would also like to acknowledge the family members of everyone working in health care. You too have made many sacrifices over the past two years while your loved one responded to the pandemic.

As we continue to transition through this pandemic - and we must recognize that COVID will be among us for a very long time - we must continue to work closely with Public Health to monitor the situation, as well as establish our new normal of living with COVID.

A simple “thank you” will never fully capture our gratitude for the tremendous effort put forth to manage this new variant. The response, again, was nothing short of heroic.

Part of the necessary work to transform our health care system is to address systemic racism. We must acknowledge historical wrongs and the systemic racism that has been part of our health care system. In Spring 2021, the Department of Health and Wellness created a new Division of Equity and Engagement. The division’s mandate within the department is to identify and remove systemic barriers impacting the progress, well-being, and overall sense of belonging of staff, and in particular, our equity-seeking staff.

We must acknowledge, identify, and correct the inequities that have created poor health outcomes for many communities, particularly our African Nova Scotian, First Nation communities, and immigrant communities. The division of equity, diversity, and inclusion will ensure community voices, strategic partnerships, and lived experiences continue to inform and shape the government’s vision for a more equitable health system for Nova Scotia. We are ensuring an increased partnership among the department, Nova Scotia Health, the IWK, and our system partners to create health equity.

Staff leaders for equity have now formed a table examining health inequities in the system and effective ways to address them. We are also taking a holistic approach to equity involving other key stakeholders from inside and outside the department. You cannot make progress without having communities involved, and their voices need to be heard and acted upon. These conversations are under way and are yielding great insight and ideas. We need to do better. That is clear.

We are launching the collection of race-based data in June 2022. This voluntary program will improve care to racialized communities by having data that will help us understand the different care needs of the communities. We will create a health equity framework in partnership with our stakeholders.

In this budget, we have increased funding to the Nova Scotia Brotherhood Initiative so they can expand their valuable work in providing culturally appropriate care for men of African descent. A sisterhood initiative will begin this year as well. We are expanding support to the newcomer clinic to support the health needs of immigrants and newcomers.

Minister Comer recently provided funding to Tajikeimɨk to support mental health initiatives in First Nation communities. There is much to do, and we are committed to listening, learning, and building relationships in order to address health inequity.

Budget 2022-23 has funding to plan for a central intake office for surgeries, to make allocation of operating rooms more efficient. This investment will complete 2,500 additional surgeries at the QEII Health Sciences Centre this year, expand operating room hours, add additional beds to Dartmouth General Hospital, and increase surgeries in Cape Breton. This will go a long way to reducing the backlog and the long waits people are experiencing, exacerbated by the pandemic.

Nova Scotians will have more access to care by expanding Virtual Care Nova Scotia. Each person on the Need A Family Practice Registry will get immediate access to virtual care. Virtual care is a huge success, with 60,000 people signed up so far and more than 10,000 appointments since its launch in the Fall.

We are working with Dalhousie Medical School to provide 3,500 Nova Scotians on the Need a Family Practice Registry with access to the care they need through family medicine residents. We will also expand the successful INSPIRED COPD Outreach Program and create a chronic illness treatment and prevention program, modelled after INSPIRED, to better serve Nova Scotians living with chronic disease.

New initiatives will make the health care system more efficient and effective. One effort to be more efficient is the command centre. We need to improve coordination of care so that Nova Scotians can access the care where and when they need it. We are focusing our efforts at the QEII Health Sciences Centre by opening an initial command centre to expedite patient access and flow. This will include introducing better technology supports, simpler processes, and adding new roles to expedite and coordinate patient care inside and outside of the hospital. Patients will gain access faster and will reduce unnecessary time in hospital.

Over the year, the command centre will be expanded to other sites in other parts of the province. We are also close to releasing our overall vision and action plan for health care and creating a clinical health services plan so local needs are reflected. Local communities and local health care workers understand what their communities need, and we are committed to working in and with communities to provide services that are informed by data, best practice, and responsive.

Our health care system cannot function without its most important piece - people. Budget 2022-23 will train more health care workers by adding 200 new nursing seats at Cape Breton University, Dalhousie University, St. Francis Xavier University, and Nova Scotia Community College. Just under half will be registered nurses, and the rest will be LPNs.

We are continuing support for the 70 additional nursing seats added in 2020 at Cape Breton University and Dalhousie University’s Yarmouth campus. The 16 additional medical school seats added in 2019 at Dalhousie will continue. We have entered into a new partnership with the esteemed Michener Institute to trained much-needed allied health care professionals closer to home.

There is also funding to support efforts to recruit health care professionals such as doctors and nurses. I can tell you that Dr. Orrell and a team of recruiters just returned from a successful mission to Dubai, Singapore, and the U.K. There is considerable interest from health care workers to come to Nova Scotia. Dr. Orrell and his staff are developing a long-term strategy to ensure that we have the right mix of doctors, nurses, and other professionals in our health care system.

I would also like to tell you about our two major redevelopment projects. The QEII New Generation and the Cape Breton Regional Municipality Health Care Redevelopment are generational projects that present a once-in-a-lifetime opportunity to rethink and rebuild the way we deliver health care. The projects are well under way and will set Nova Scotia up with modern, well-equipped facilities for decades. Budget 2022-23 will invest $464.6 million to support the QEII New Generation and the CBRM Health Care Redevelopment projects.

Other facilities will not be ignored. The budget also provides $122.6 million for construction, repair, and renewal of other hospital and medical facilities. We heard loud and clear that aging infrastructure and equipment that are well past their expected years of service must be updated. Investing in state-of-the-art equipment and modernizing facilities not only supports staff and patients but is a key recruitment tool for our province moving forward.

In closing, I want to assure the members of the Chamber and Nova Scotians that we will give everything we have as a government to improve health care. This is no small task. It will take time, and it will take money. There will be bumps along the way, but we are committed. The system has been allowed to deteriorate for a long time while the complexity of health care has been increasing.

Health care today is complex, and the use of technological advances and innovation have advanced treatments and intervention. We are now using robotics for surgeries. We are using virtual care in our homes and in our facilities where patient and practitioner could be hundreds of miles apart. We are leveraging professional scopes of practice. We are looking at digital solutions to streamline the patient experience. Our diagnostic imaging is becoming more and more precise.

Our health care professionals have changed too. Their options are wide, and the possibilities for their careers are very different than for those of us who started many years ago. It is inconceivable now that when I graduated from nursing school 30 years ago, there was absolutely no work. I worked as a CCA for six months before I was able to be employed on a casual basis for six years before I had full-time work.

Our system must transform and continue to respond as advances are made. We must be innovative, flexible, and resilient.

What hasn’t changed is the compassion and the dedication of our paramedics, our nurses, lab techs, CCAs, physiotherapists, OTs, social workers, ward clerks, physicians, and the folks who work in facilities management, laundry, dietary, medical records, and every other department in health care. We have the finest health care workers in the world.

This budget lays the foundation for the work ahead. It is a budget of compassion and hope and built on the voices of patients and health care workers who have shared their stories and experience with us, and offered us suggestions and solutions.

While there are challenges, I want to assure members of this Chamber and Nova Scotians that we have much to be proud of. Nova Scotia Health Authority recently hosted a two-day health innovation showcase on February 22^nd and 25^th. Over the course of these two sessions, we highlighted many innovative clinicians and innovative partnerships. Before the event, there was a PowerPoint that scrolled through many of the innovative clinicians. It was uplifting, it was encouraging, it was hopeful. Our health care system is brimming with competent, passionate innovators who will make a huge difference to patient outcomes.

[8:00 p.m.]

I want to echo the Premier’s sincere commitment that we will transform health care. There is a committed team of leaders and health care workers who are working tirelessly. I will now take my seat, and with the support of my colleagues, I’ll answer your questions.

THE CHAIR: According to the practice that has developed in this Legislature, the Opposition caucuses take turns asking questions for approximately one hour each. During a caucus’s turn, the members within a caucus may take turns examining the minister on the estimate resolution. Only the minister may answer questions. Caucuses are also expected to share time fairly with the Independent member.

To begin the examination, I now recognize the Official Opposition.

The member for Fairview-Clayton Park.

HON. PATRICIA ARAB: I’d like to thank the minister for her opening remarks. You’re going to have to bear with me a little bit, this is my first time. It might be the minister’s first time, but it’s also my first time asking questions in this Chamber. (Interruption) I was a Page, but all I did was pretend to be paying attention. (Laughter) Not that our Pages are doing that. I’m just saying that I was a renegade. I was not paying attention at all.

Anyway, sorry, I don’t want to chew up too much of my time. I have a number of questions. Obviously, this is a fulsome budget. This is a huge department. We have our current government who campaigned on health care, so a lot of campaign promises, a lot of things to dissect. I will try and do it as succinctly as possible. I don’t envy the minister, and I hope to not be a part of 27 hours - was that the former minister’s? I believe it was 27 hours. I think that might be a record. I have no intention of doing that to you, so we’ll try and be as succinct as possible.

I want to start with this hour, I’m going to talk about recruitment and retention. As of March 11^th this year, the Nova Scotia Health Authority has 2,021 vacancies. Of those, 170 are physician vacancies, which include 86 family medicine and 84 specialists, as well as 248 licensed practical nurses, 1,383 registered nurses, and 50 nurse practitioners.

The IWK has 3,100 positions, including six physicians and 56 nursing positions. In total, between the two health authorities, I’d like to know if the minister can confirm that there are 176 physician vacancies and 1,737 nurses, including licensed practical nurses, registered nurses, and nurse practitioners.

THE CHAIR: The Minister of Health and Wellness.

MICHELLE THOMPSON: The numbers are always changing, they are fluid, so I can’t tell you to the number that they are exactly that, but they would be around that. Those are the latest numbers that we have.

PATRICIA ARAB: If I could just confirm with the minister before I move on, she is saying that the numbers are the most recent numbers, those are accurate.

MICHELLE THOMPSON: Those numbers are current to last week.

PATRICIA ARAB: I’m curious as to how many NSHA and IWK staff are currently on a leave of absence and if they are accounted for in those vacancies in those numbers.

MICHELLE THOMPSON: Those are all permanent vacancies, and no temporary vacancies are reflected.

PATRICIA ARAB: Is it possible to ask the minister to get those numbers for the numbers of NSHA and IWK staff who are currently on leaves of absence, just so that we have those numbers?

MICHELLE THOMPSON: Yes, we can ask for those numbers.

PATRICIA ARAB: Thank you, Madam Chair. I’m wondering, too, if the minister doesn’t have these numbers tonight, if we could just speed up time, if you could get these numbers as well, which is how many NSHA and IWK staff are currently on sick leave due to COVID-19?

MICHELLE THOMPSON: Yes, we’ll be able to bring that today.

PATRICIA ARAB: That’s great, thank you. With that, how many of these vacancies are due to retirement? How many new patients will be added to the Need a Family Practice Registry as a result of those retirements?

MICHELLE THOMPSON: Physicians are independent practitioners and because they’re not employed by an organization, they’re not required to let us know when they are going to retire. We do make our best effort to anticipate that. However, sometimes those cards are kept close to the physician’s chest.

We are aware there are a number of physicians who are getting close to retirement age, without making too many assumptions. It would depend on the size of their practice in regard to how we would anticipate the number of patients. The practices across the provinces are different sizes, so it is very difficult for us to anticipate, other than seeing by age gradients where those folks are.

We are aware of three physicians who have indicated that they are ready to retire, and Dr. Orrell has been working with them to find replacements.

PATRICIA ARAB: Maybe we’ll just stay on this a little bit. Family practices are individual businesses. They are their own entities. Aside from looking at an age gradient that could indicate a physician who would be retiring and also relying on the onus of the patient to sign up for the family doctor wait-list, is there anything within this budget or planned that could help connect patients with a clinician - as opposed to reactionary? That is, waiting for somebody to retire, acknowledge that they are going to retire or somebody actually saying I need a family doctor, so I go on the list? Are there any things within this budget that will be more preventive?

MICHELLE THOMPSON: It’s a big question. The Need a Family Practice Registry has been in existence for several years and it is simply a list of folks. We are looking at that list now. Everyone on that list was called early on in this year to talk to them about whether or not they still need a family physician or if they need a primary care provider.

We will be looking at that list to attach it. There is no triage system currently in terms of how long people have waited or their illnesses. That’s a significant gap that’s been left over, that we are starting to address.

There are a number of issues that we are doing to attract new physicians. There are incentive programs that were recently announced. We’ve increased the practice-ready assessments as well. There’s been a larger uptake of residents in our province as a result of our recruitment efforts. There is a plan in the Office of Healthcare Professionals Recruitment that we are striving to achieve under Dr. Orrell’s direction.

PATRICIA ARAB: Thank you, Madam Chair. I appreciate the minister’s answer. Again, both of those are more reactionary.

I don’t have a family doctor, so I put my name on the Need a Family Practice Registry. My family doctor, maybe she’s going to tell the department that she’s retiring and maybe she won’t. The onus is still on a lot of unknowns. There’s a lot of cause to then react - this number is getting higher, or all of a sudden, this doctor is retiring and they haven’t found somebody to take over their practice.

Again, my question is more about if there is a plan to not rely so much on the existing numbers that you know. If the minister can be proactive - instead of being shocked by the number, we’re going to prepare that the number is going to be “this”. The number of doctors is going to decline to “this” number and the number of patients is going to rise to “this” number, so that you can get ahead of it as opposed to reacting to it when it actually happens.

MICHELLE THOMPSON: We do know that there are approximately 189 physicians who are over the age of 65 in the province. They have various-sized practices. We also know that when we have physicians who perhaps are of that age group their practice may look a little bit different than their younger counterparts or their newly minted physician counterparts - so looking at the fee-for-service model versus when we have them on alternative payment plans.

We do know that will actually increase the number of physicians that we require in the province. Our fee-for-service physicians tend to have a higher caseload. Again, we are anticipating these, but we can’t ask people when they’re going to retire, so we continue to recruit. We need to fill the vacancies that we have and attach the patients on the Need a Family Practice Registry now.

While people are on that list, we are increasing access to care. We have increased virtual care. We have set up urgent treatment centres in two locations in the province. We have started an innovative nurse practitioner- and pharmacy-led clinic as a proof of concept and hopefully we’ll expand that.

While we do know that we need practitioners, what’s important is that people have access in their communities when and where they need it so that they aren’t always defaulting to the emergency room. They are getting care in a timely fashion.

Those are some of the actions that we’re taking of offload the system and make sure patients have access while they sit on the Need a Family Practice Registry.

[8:15 p.m.]

PATRICIA ARAB: Again, I thank the minister for that answer, but somewhere what’s getting lost is the preventive model. I’m going to frame it from another department.

When schools are being built and the capital plan is put out, they do a projection of growth in an area. They say yes to a school here or it’s going to be this many students because there are a lot of unknown variables, but there’s enough data that they can put together to say this is going to be my best estimate.

It doesn’t always work out. It’s not always the right estimate, but there is a formula in place that can take unknown variables to still project so that you’re trying to get ahead of the game - you’re not playing from behind.

I respect the answer that the minister and the department are trying to alleviate the current lists and trying to find ways to overcome the vacancies with our family doctors. My question really is: Is there a formula or any sort of process where the unknown data or variables can be put in to say we know that we’re going to have 10,000 people on the list in five years - so we’re going to start looking for those doctors because the doctors are different.

The fee for service, as the minister mentioned, is accurate but a doctor who has had a family practice for 40 years might want to take on 1,200 patients, and a doctor who’s just coming out right now might only want to take on a fraction of that. Do you need two doctors for that one practice?

Again, this is just trying to understand if there is any preventive work that’s going on or if it’s just - this is where we’re at right now, we’re focused on this, we’re not focusing on what could happen next.

MICHELLE THOMPSON: There is a physician workforce plan that has not been updated since 2016 that looks at the things that you’re talking about. We also need to consider immigration - bringing people into our community and migrating people home. We need to factor our estimates and our hopes for what that can look like and where we hope people will settle.

The work is now with a data scientist. It is in process. It’s tedious work and it requires some modelling. It is under way currently.

PATRICIA ARAB: A little inside baseball - do the staff at the Department of Health and Wellness tell all ministers to use the process? We had a game with Minister Delorey. Maybe it’s only inside baseball for this side of the room. (Laughter)

Thank you. I appreciate that. Staffing at the Office of Healthcare Professionals Recruitment - this will focus on your staffing of this current office. Right now, you are set to increase your staff complement from 4.6 full-time employees to 33. Is that correct?

MICHELLE THOMPSON: It is correct.

PATRICIA ARAB: Are the staff from the Department of Health and Wellness physician services team being integrated or are these net new positions?

MICHELLE THOMPSON: These are net new positions.

PATRICIA ARAB: Does the minister have this information or can she get it for me? Is this in addition to the FTEs and the Physician Recruitment team at the NSHA?

MICHELLE THOMPSON: It does include the transfers of people from the Nova Scotia Health Authority, yes.

PATRICIA ARAB: How many recruiters are in each of the health zones, and can you tell me, what are the gaps?

MICHELLE THOMPSON: There is a total team of 13. I’m hoping my math adds up. There are eight recruiters, two in each zone; there’s one Dal resident recruiter; and there’s a manager recruitment position. They report to Dr. Nicole Boutilier.

PATRICIA ARAB: I would like to ask the minister: How many physicians was the department able to recruit this year - both domestically and internationally?

MICHELLE THOMPSON: Since September 1^st, which are the numbers I have, there have been 56 physicians recruited to the province.

PATRICIA ARAB: Is the minister able to break that down domestically and internationally?

MICHELLE THOMPSON: Dr. Orrell will get that. He doesn’t have it off the top of his head.

PATRICIA ARAB: I’m curious - how many of these recruited doctors are family physicians and specialists?

MICHELLE THOMPSON: [Inaudible]

PATRICIA ARAB: Then I will ask the minister: How many of those numbers that are recruited are actually here in the province?

MICHELLE THOMPSON: In 2021-22, there were 30 GPs and 33 specialists in Central. This is the total here. Eight GPs and 18 specialists in Eastern; 12 GPs and 14 specialists in Northern; 16 GPs and 22 specialists in Western - for a total of 153. Based on NSH reporting, there are currently, as we said, 170 physician vacancies - 86 family medicine, and 84 specialists.

PATRICIA ARAB: Again, and not to go too far down this rabbit hole, but of the 153, how many of those were new practices, not just a replacement or filling a vacancy - or were they all just filling?

MICHELLE THOMPSON: They were filling gaps. I would say for the next period of time until that list is gone, really all of the next physician recruits that we have - particularly in family practice - will be filling those gaps until that list is exhausted. Of course, with our specialists, for the most part we don’t tend to go above core, so we need there to be a vacancy in order for us to recruit to that vacancy. We don’t tend to have slack or surplus in the system.

PATRICIA ARAB: I am wondering if the minister can give me the targets per health zone for 2022-23.

MICHELLE THOMPSON: Right now, it would be a similar expectation that we would continue to recruit the same number on a ballpark for the next couple of years. If we can get more, we certainly are nowhere near our saturation point, is what I would say. So we will continue to, at a minimum, recruit at the speed and at the numbers that we have in order to address the Family Practice Registry but, of course, with increased efforts we’re hopeful that we’ll be able to fill those gaps.

We do some negotiation as well. As you can imagine, when we bring physicians into our province, we tend to bring them around. While we know where the greatest needs are, we also have to work with physicians around where they are willing to settle and what best meets the needs of their families, their children and what have you.

There is an art and a science. The science is the numbers, and the art is really encouraging them to come and stay and love the place. We have great recruitment teams in communities that have done a lot of work.

PATRICIA ARAB: It is all about the finesse. I love this province so I cannot imagine anybody coming here and not wanting to stay.

If the minister would indulge me, could she actually just tell me the numbers again, so it’s just the numbers that would be the target, which I understand you are saying is what we have done. What are those numbers again as a target?

MICHELLE THOMPSON: Currently, that part of that work is with the physician resource plan that the department is working on. At a minimum, I think we would continue to recruit to this degree now. We need to look at the vacancies in certain areas, particularly Central. We would continue to look at a pace of 153 physicians a year, making sure that those vacancies are filled. Again, it is a moving target so sometimes we have specialists, as an example, who need to move or decide to move on. It is a bit of a moving target, but we would continue to have at least 150 a year - hopefully more.

PATRICIA ARAB: The new Primary Care Physician Incentive Program is set to encourage doctors to establish a family practice outside of Central. These are doctors who qualify currently earn up to $125,000 in incentives - $25,000 when they sign the agreement, and $20,000 per year for the next five years. These payments are made at the end of each year after their key targets are met.

I am curious - could the minister tell me which program, or programs, did this new incentive replace and what was the rationale behind that?

MICHELLE THOMPSON: The new physician incentive program replaces the tuition relief program that we had previously, and the debt relief. The reason was that there was poor uptake in terms of those programs. We felt that this was a better option to recruit and so that is why the incentives. There was a great deal of confusion as well amongst folks in terms of how they accessed it and how they used it.

PATRICIA ARAB: Who qualifies for this package and are these doctors on APP or a fee for service?

[8:30 p.m.]

MICHELLE THOMPSON: The physicians that this would apply to would be physicians who were recruited to communities outside of HRM with a few exceptions around the Eastern Shore. They have to be within 10 years of graduation in order to access the incentive. They get to choose for the most part. They can choose which source of income they would prefer. It would probably depend on the type of practice that they have.

PATRICIA ARAB: Part of this is that the payments are made at the end of the year after key targets are met. I would like the minister to let us know what the key targets are.

MICHELLE THOMPSON: Those conditions are outlined in their contract, so it may include, or will include, the size of their panel as an example - what the expectations are for them. It may include the number of hours that they work. It would really be dependent to a degree on the contract that they negotiated.

PATRICIA ARAB: Just so that I’m understanding, the key targets would be dependent on the individual, not on the program itself. Is that correct?

MICHELLE THOMPSON: Each practice is different. There would be key targets like the size of the panel. It would be different for specialists, and it would be different for family practice physicians. It would also depend on, in an APP, how many hours we expected them to work. There would be a variety of different contracts based on the needs in the community. It isn’t always one size fits all. We may ask that they provide some after hours or evening hours, as an example.

We have to look at the needs of the community. There would be a minimum around panel size, and there would be minimum expectations around how much they would work. Their pay would reflect that, particularly in an APP. You’re going to work half-time or you’re going to work three-quarters-time - it would outline the hours that were associated with that amount of money.

Then fee-for-service could have a different approach. It would also look at complementing the practice that they were going into as well as community needs. There are minimum standards. Again, to the art and science, it isn’t just one size fits all. There is some leeway in terms of the negotiations with physicians when they come in.

PATRICIA ARAB: I do apologize. As I said, I’m new to this department. I’m just a little bit unclear as to how a person could have key targets that - there’s no key targets. There’s a key target meant for each individual. How do you know that they have met their key targets if you don’t have a set of key targets that are meant to be met?

MICHELLE THOMPSON: There are targets, as an example with the panel size. If you’re in an APP and you need to have a certain panel size, you have to shadow bill 80 per cent of the panel size that is in your contract. That would be audited through a variety of different ways. The fee-for-service, because you are billing for each of the visits you have, there’s also capacity for us to audit that as well through the department when you do your billings.

What we would do is compare the performance and the panel size and the work that’s happening. So 80 per cent of shadow billing is required under the current contract to make sure that people are seeing the panel that they are supposed to. The number of contacts they have is an example. That is audited on a regular basis in order for us to monitor it.

The incentives are there. When you come in, you qualify for that regardless of what the process is. Over the years, we do monitor that your APP and the funding that you receive is actually patient-facing hours.

PATRICIA ARAB: I know that the minister referred to minimums that have to be met. Maybe we could have what those minimums are. That would be great.

MICHELLE THOMPSON: A full panel for a physician currently coming into the province is 1,350 patients. We may have some physicians as an example, when we’re doing the resource plan, who have carried a patient assignment of 3,000 patients. It’s not one-for-one in terms of the resource planning but the minimum expectation is that a physician would have 1,350 patients.

PATRICIA ARAB: I’m curious, Madam Chair, what the estimated cost for this incentive program in 2022-23 will be and what’s the return on investment?

MICHELLE THOMPSON: The cost would be around $3 million and that assumes 100 physicians per year, based on physician recruitment figures.

PATRICIA ARAB: Can the minister tell me how many physicians have been recruited through this program?

MICHELLE THOMPSON: This is a hot-off-the-press incentive program. It has been in place for only several weeks. There is one person who has been recruited since that time who has been able to sign their contracts. While there are many who are talking with the department, there has been one person in the last several weeks.

PATRICIA ARAB: Thanks to the minister for that answer. The new Specialist Physician Incentive Program offers the same incentives to specialists who establish a practice outside of Central Zone. I’m curious if the minister could tell me who qualifies for this particular package and if we could get key targets for this particular incentive program.

MICHELLE THOMPSON: In order to qualify for the incentive as a specialist, you must be office-based, you have to have completed your residency within the past 10 years and it would be your first practice and you would be responsible to shadow bill the people that you receive. (Interruption) No? Oh, for the APPs, yes.

PATRICIA ARAB: Just again, in order for this incentive program to be actualized, for a specialist to receive their incentives, what would be the minimum key targets if this is something like the other program where it would be less of a one size fits all?

MICHELLE THOMPSON: These are incentives like recruitment bonuses, you get them because you came. You get the first amount of money because you took the job and then at the end of every year of service you get the bonus of the $20,000. It’s not tied to performance. Your salary would be tied to the performance, not the incentive.

PATRICIA ARAB: That makes sense, thanks. What’s the estimated cost for this program and return of investment?

MICHELLE THOMPSON: The total cost of the incentive packages for specialists and family practice physicians is $3 million. It’s half and half.

PATRICIA ARAB: How many doctors so far have been recruited through this incentive program?

MICHELLE THOMPSON: There are none yet.

PATRICIA ARAB: They’re coming. They’re coming.

With these two programs - they’re new - what is their projected uptake? We hope that they’re going to do better than former incentive programs. That’s the decision that the minister has said, why they were brought in. What’s the projected rate of growth that research has shown that these types of programs will be able to entice specialists and family practices?

MICHELLE THOMPSON: Again, it’s not a very straightforward answer, I guess is what I would say. These incentives were put in place on the recommendations of physicians and things that we felt would help from the feedback that we got. We’ve put them in place to recruit to the number of physicians that we need. We want to move that list and finish that up, and to your point, as that workforce planning document, what are our future needs going to be around physicians.

The reason it was changed is we felt that it would be more applicable to physicians, and it would be more of an enticement. Certainly, with the new website that has been launched, in terms of bringing physicians in, that’s one of the first questions that they ask. We feel that it’s generous. We feel that because they’re asking about it, it will be a good incentive tool, but we don’t fully know yet. We know that we want to recruit to fill that list, obviously. I think it’s kind of a wait and see. We’re going to see how it does, and we will absolutely tweak it as necessary. We want that list to go away.

PATRICIA ARAB: Are these incentive programs used anywhere else? Is there any sort of a benchmark that could be given in terms of success rates for them, if they’re in another jurisdiction, or something similar?

MICHELLE THOMPSON: What you’ll see, if you look across the jurisdictions provincially, is that a number of provinces have implemented signing bonuses and similar programs. We are competitive with all of those programs. They’ve shown benefit, of course, in other places.

Aside from the financial pieces, we have worked really hard along the recruitment piece to sell what Nova Scotia has to offer. I know it feels like it’s always about the money, but it isn’t actually all about the money. We, in a number of communities, have community-based navigation teams, so we often say that we’re responsible in the Department of Health and Wellness to recruit the physician, and these community navigators, often employed by the municipalities, are there to recruit the families and show them what Nova Scotia has to offer.

[8:45 p.m.]

Even though they are competitive, they are not the top, but that’s okay, because what we hear from physicians who come and see Nova Scotia is they like the lifestyle. They see that there’s innovation in health care, and they’re interested in coming and working. It’s not just all about the money.

PATRICIA ARAB: I remember saying in 2013, when I was first elected, that if you create a world-renowned education system, that will bring people to this province. That will recruit. That’s enough. If you’re giving people’s children the best education they possibly can have, they will come. It’s not just about the money, it’s the quality of life and it’s the future that you’re giving to their next generation.

Keeping that in mind - and I don’t know if it’s a shared philosophy within the Department of Health and Wellness - is there any talk with other departments about how to create this whole package when you’re recruiting? What are the selling points? Are you talking to the Minister of Public Works about infrastructure in certain towns or in certain municipalities? Are you talking to the Minister of Education and Early Childhood Development as to what is being offered?

Is there any collaboration in making it about more than just the money when you’re trying to talk to physicians and specialists and sell them on why they need to come here?

MICHELLE THOMPSON: That’s a great question. Of course, we do work across departments. I have said it’s similar to the determinants of health. I often say I’m the minister of health care and all the other ministers around me are actually the ministers of health. To your point - when we look at a strong education system, when we talk to the families, and we talk to the physicians, and we understand what their interests are, how do we then align them with communities that are the best fit for them?

We do continue to do that. I would say that we are learning to do that more. We’ve only been in government for seven months. I will tell you that - I don’t know if everybody knows this yet, but anyway - there’s a nurse practitioner from Newfoundland and Labrador who was interested. She had an offer in New Brunswick with Gagetown, and she had an offer at Digby. We were very fortunate. I was able to reach out to the MLA in Digby. She phoned her, and we now have a new nurse practitioner who will be starting in July.

We are working to support practitioners coming here. I think there’s more for us to do, but we certainly are very focused. I feel the support of my Cabinet colleagues and my caucus colleagues in order for me to be successful, because we’re all successful when we recruit.

PATRICIA ARAB: Medical students who train in Nova Scotia are more likely to practice here. In 2019, Nova Scotia was one of the only provinces to increase the number of spots available for entry-level medical students attending Dalhousie University for a total number of 94 seats.

The province also invested in more residency training sites, adding a program to train family medicine residents in northern Nova Scotia, an internal medicine site in Yarmouth, and family medicine residents are now training in southwestern Nova Scotia, the Annapolis Valley, Cape Breton, Halifax, and in northern Nova Scotia.

There are 25 residency training seats. I’m curious if the minister the numbers has the numbers on how many of those doctors who have completed residencies in Nova Scotia have stayed and signed agreements?

MICHELLE THOMPSON: I’m going to answer a previous question that you had for me around current leaves of absences. At NSH, there are 1,619 staff; the IWK there are 175. In terms of COVID absences to date - IWK had 113 as of Monday, and the Nova Scotia Health Authority had 735.

PATRICIA ARAB: Thank you for that. I’m just looking on how many of the doctors who completed their residencies have stayed and signed agreements.

MICHELLE THOMPSON: We’re just getting it.

PATRICIA ARAB: I’ll ask my next question. It’s still around this. Is there anywhere in the budget that I might have missed or any talks of expanding seats in residencies through Dalhousie?

MICHELLE THOMPSON: We are in discussion with Dalhousie University to see what the capacity is to potentially expand.

PATRICIA ARAB: Since I don’t want to waste my last 10 minutes, for now I’ll move on to nurse recruitment and retention while the deputy minister is getting me the information.

How many nurses has the department been able to recruit this year? What is the breakdown per health zone? What are the targets per health zone for 2022-23?

MICHELLE THOMPSON: We will actually reach out to the health authorities. They manage it. The Office of Health Care Professionals Recruitment would be more at a strategic level in regard to the nurses because they are employed directly by the Nova Scotia Health Authority or the institutions where they work, and they are in a contractual unionized agreement. We would actually have to get those numbers from the Nova Scotia Health Authority - and we will.

PATRICIA ARAB: That was for the doctors, not the nurses? (Interruption) That’s the nurses. Okay.

The government is adding 200 more new nursing seats across the province and 120 more practical nursing seats at NSCC. I’m curious if the department knows how many of these seats are anticipated to be filled by Nova Scotians.

MICHELLE THOMPSON: I don’t actually know. The universities would hold the lists. In a way - of course, we want to train Nova Scotians. The wait-lists for the nursing programs are significant, particularly in the LPN program. If there are people who are attending university from outside the province, our work is to make sure that they stay, to the best of our ability.

Again, that would sit with the university. They know who the applicants are. We would not not take somebody. There would be a certain percentage, I’m sure, that are required to be Nova Scotian. The key will be that in their second year, they are offered a job. They know that if they want to stay in Nova Scotia, there is work here available to them. We want them to stay. There’s no shortage of work.

PATRICIA ARAB: I’m curious: apart from the offer of a job, are there any other incentives that will be given to new nurses who choose to stay in the province?

MICHELLE THOMPSON: Currently, the Nova Scotia Health Authority does offer sign-on bonuses, not so much the IWK. We are working to better understand what the needs of folks are and what would actually be the best approach to retain them. Those hard-to-recruit-to areas specifically, I know that there are sign-on bonuses available to the nurses and sometimes relocation bonuses as well.

There was a woman on CTV news not that long ago. She bumped into one of the reporters when she was walking. She had actually come from Ontario. She was mid-career, closer to the end, and decided that she wanted to get out of Ontario, and her last 10 years would be spent here. She was going around different areas of the province that did offer recruitment and sign-on bonuses to see what would best fit her lifestyle. She wanted a little slower pace outside of work. They are having an impact.

PATRICIA ARAB: The Nurse Practitioner Education Incentive Program was first announced in July 2018 to increase the provincial supply of nurse practitioners, particularly in areas of great need within primary health care. The incentive covers the salaries of registered nurses while they attend the Dalhousie University Nurse Practitioner Program on a full-time basis. In return, recipients will commit to work in a designated geographical area for up to five years.

I’m curious if the minister can tell me how many nurses are currently participating in this program, and if there are any plans for the program to be expanded so that more RNs can become nurse practitioners? Is there a plan and what is it?

MICHELLE THOMPSON: We will get the numbers in terms of who is enrolled. One of the things, in terms of the program that we need to be really mindful of, we want to always allow people to progress in their careers. We also need to be mindful sometimes we’re pulling from the same pool. We want to work in communities, as you said, find the most difficult to recruit to places for both primary care access as well as nurses. We want to make sure that while we give people the opportunity to advance in their careers, we are also mindful that we need to protect those basic services in those communities.

We can get the numbers for you. It has been a good program. It has been well received and I know that it has helped recruit to difficult areas, particularly in rural Nova Scotia.

PATRICIA ARAB: Maybe if the minister can expand on that a little bit. I understand that the balance - we have shortages in registered nurses, we have shortages in GPs. We need to raise everybody up. We need to make sure that we still have registered nurses. I understand that.

Is there a dedicated plan on how you’ll proceed with this to make sure that you are allowing people to get professional development and move on to where they want to be without then doing a disservice? We need nurses, we need LPNs, we need GPs, we need all these things. How do we make sure that taking from one pile to help the other isn’t going to just deplete that pile?

MICHELLE THOMPSON: That is the work of the resource plan - for us to understand what the needs are, particularly in different communities, which communities are difficult to recruit to, in areas where it is difficult to recruit to, how do we bring people through a community? Are there people already in health care who we can move forward? Are there people, as an example, working with education, are there people in community that we can train in those hard-to-reach areas, and move them through a trajectory of professional care? The work of the resource plan is simply to understand what is the best use of services, and how do we plan for the population and the expected population growth?

PATRICIA ARAB: A number of questions - for the nurse practitioner education program, is there a current cost for that program?

MICHELLE THOMPSON: We’ll have a look for that to see what the number is.

PATRICIA ARAB: I’ll try and get one last question in - maybe two. The office was charged with developing a nursing mentorship program. I’m curious if this program is administered through Dalhousie or through the department.

[9:00 p.m.]

MICHELLE THOMPSON: Actually, this is a very exciting program for me. It is going to be co-administered. It’s joint with the Department of Health and Wellness and the Nova Scotia Health Authority. It’s such an important part for us to take new graduates who are transitioning from student to practice and provide an opportunity for them to have mentors.

In a dream world, while we want to have nurses available, we think that there’s a really great opportunity here, particularly for our retired nurses in the province to come back, who maybe don’t want to work on a full-time basis but have so much to offer. Certainly, in my career, they have been the nurses who have pulled me up. They teach you to think differently. They teach you how to time-manage.

It’s really exciting. It is a joint effort between Nova Scotia Health as well as the office and Department of Health and Wellness to see how we can best support these new nurses. We know, particularly during the pandemic, that a number of nurses were considering leaving the profession because they felt overwhelmed.

PATRICIA ARAB: I will have a couple more of these questions for my next hour, but maybe if you have it off-hand, before the time elapses, do you know the cost for this mentorship program?

THE CHAIR: Order. It is now time for the NDP’s turn.

The honourable member for Dartmouth North.

SUSAN LEBLANC: Thank you very much, Madam Chair. Thank you to the minister and to all of you for being here. I’ve been listening for the last hour, and I have all kinds of questions that are related to what you have all just been talking about.

I’m going to try to stick with my script a little bit, but I have a couple of initial comments. The first one is that I wanted to echo the support and the thanks of the health care workers in Nova Scotia, particularly in - well, forever, but the last couple of years. As you’ve pointed out, it’s just been unprecedented stress and commitment.

I think about all of the workers at the Dartmouth General, of course, which serves my community, but also the pharmacists who vaccinated my kids up in the Lawtons at Primrose, that kind of thing. Everyone who’s been on guard, basically, through this whole thing. At the beginning of the pandemic, the Dartmouth General Hospital Foundation had a thing where at seven o’clock folks were encouraged to go out onto their doorsteps and cheer for the health care workers. It was a really meaningful and big, important thing.

Then even just recently, my colleague and I - the member for Dartmouth East - went over to the hospital to hand out Lysol wipes to the workers on behalf of the foundation, and just to have a chance to actually be like, thanks for everything, here’s some wipes. It just seemed so inadequate, but also meaningful to have that time to say thank you.

I also just want to say that I appreciate the minister’s experience as a nurse. I’ll try not to say that I think she’s passionate, because I already complained about being called “passionate” earlier myself, but the fact that she has real-life experience in the health care system - it counts for something. I just wanted to start with that.

You were talking about retired nurses coming out to mentor. I’ve heard from a friend, who is an emergency room nurse, that this is particularly needed in emergencies, where it is such a high-stress environment. There was a time when there were a lot of nurses in emergency departments who had a lot of experience, and then they sort of left - not en masse but in the course of a couple of years - and there’s been very little ability for new nurses to be mentored.

I think of my own mom, who she trained as a nurse when she was probably 18, and then stopped nursing when she had her first child, which was 60 years ago. But she’s still a nurse. I really do think that nurses are in it for life. She did end up doing other hospital-related work later, but I think it’s a really special and important profession. I’m deeply grateful for nurses.

I want to start by asking about the health care tour - the tour across the province. Whose idea was that? Was it the minister’s idea? Was it the Premier’s idea? Whose idea was it? It’s pretty good. I’m just curious.

MICHELLE THOMPSON: Thank you very much. I will say that it was the Premier’s idea. I have to tell you, in regard to the tour, it was a terrific idea. It was so meaningful for me particularly. It helped me transition from being in health care to this role. It was interesting - we went to different places on the tour, and often they would have to pull me out. I would sit down at the desk in the nurses’ station, and you could just see the camaraderie of nurses, which Minister Comer can probably attest to as well. There is just something about that. I’m sure it’s the same in all professions.

The other thing that I would say is that you really get to know your colleagues when you’re in a car with them with really good snacks for 2,500 kilometres across the province. We went from Neils Harbour, which is a beautiful place to start, down to Yarmouth, and then we circled back. Deputy Lagassé and CEO Oldfield and one of the comms folks and I were in this van for four days. That was also a really good opportunity for us to gel and talk about ideas and process what we’d heard and brainstorm. It was a really good idea, but the people made it what it was. That was the best.

SUSAN LEBLANC: I’ve done a lot of touring - of a different type, but I totally get it. I’ve been in a van for hours and hours with my colleagues going all over the place, and that is a really important time.

I’m curious about the Sisterhood program. I’m going to jump all over the place. I apologize. The Brotherhood Initiative, I’m really familiar with, because their office used to be next door to my office in Dartmouth North. We’d often be referring folks over to the Brotherhood office and hanging out with them when things were quiet. For a long time, they’ve been talking about this, the rumour that there was going to be an expansion.

I’m just wondering what that will look like. I admit that I don’t know how far the Brotherhood reaches outside of HRM or the Central Zone. I’m curious to know about its reach outside the Central Zone, but also, what will the Sisterhood look like? How many people are going to be employed? How many people are expected to be served by it?

I will say that when I was canvassing in the election, one day I knocked on the door of an African Nova Scotian woman and asked her what her issues were. She immediately said, my son doesn’t have a doctor, and I was like, I have an idea for you. I gave her the Brotherhood information. That is such an amazing program, that I can just say, here, you can go and see this family practice, this primary care physician, and all kinds of other folks.

If you could tell us exactly what an expansion means, that would be great.

MICHELLE THOMPSON: There’s a whole lot in that. Since I’ve come into this role, I’ve had the good fortune to have a few interactions with Duane Winter and Mario Rolle with the Brotherhood. Certainly, on the tour we were able to stop and visit with them and talk about what they felt the communities that they serve needed.

I can’t actually tell you exactly what it’s going to look like, because that really is for that group to decide. I know that Sharon has been a huge proponent of this program. The important part is that the community, that the Brotherhood gets the money and works with the Health Association of African Nova Scotians and they work within community to understand what the community needs are.

I did hear a couple of times when I did speak to Duane that there are people travelling from as far away as Cape Breton to access the services that the Brotherhood offers, particularly the services of Dr. Ron Milne, who is an absolute champion for the community and just a wonderful practitioner.

I think what the money does is enable them to expand their reach, to work with community in a different way. The Sisterhood has been - Sharon Davis-Murdoch has wanted the Sisterhood for a long time to offer parallel programs, and I suspect they will work together. So that really is a question for them. What we want to do is enable them to do whatever work they feel they need in community. We trust them to do that.

SUSAN LEBLANC: Like I said, I’m going to jump around. Getting back to the infamous health care plan, the plan to fix health care. When will it be released?

MICHELLE THOMPSON: Not tomorrow, but imminently.

SUSAN LEBLANC: Thank you. I just want to talk about the backlog of surgeries for a second, or a few minutes. We talked about this at - I guess at Public Accounts Committee, I can’t remember. Was it Public Accounts last week? We had the FOIPOP that showed that there were 27,000 people on the surgery wait-list. We know, especially for folks who are diagnosed with cancer, that quicker surgeries obviously result in better outcomes.

You did talk earlier a little bit about the plan for surgery backlogs, but can you be more specific and outline the steps that you’re taking? I guess a B part to that is, will there be a plan that’s released to the public, or at least some communication about what to expect?

MICHELLE THOMPSON: I know that’s top of mind. It’s top of mind with us, and certainly at Public Accounts Committee you heard first-hand that it is such an important objective for us to achieve.

There is planning. The health leadership team meets on a weekly basis, and I know that there are discussions happening now. There will be a plan that we will talk about. We’re currently looking at every resource available to us, internally and externally, to see how we can move surgeries forward. They talked about the beds at Dartmouth General. We talked about increasing capacity in Cape Breton. We need to see what capacity is in the system - not just OR theatres but also staffing available to do these procedures. As well, how are we going to tackle the different types of procedures?

Surgeries that require admission, as an example, are a little bit more precarious, particularly when we have staffing shortages, whereas outpatient or day surgery procedures are a little bit easier. We’re also looking at a centralized registry so that we can see, and we can make sure that folks are getting quickest access. Sometimes we’re referred to the closest specialist, as an example, where there may be a specialist in a different area of the province whose wait time is shorter. So when we centralize these referrals, it will allow us to be more efficient and effective and make sure that people are getting service in a timely manner and we’re meeting those timelines.

SUSAN LEBLANC: Is there a budget line attached to addressing the issue? Where can we find the attention to the issue in the budget?

[9:15 p.m.]

MICHELLE THOMPSON: The total investment is $14.25 million, and $10.4 million is for enhancing capacity. Increase for GI, endoscopy, and cystoscopy is $2.7 million. Increased capacity at Cape Breton Regional Hospital is almost $600,000. Those are some of the things. Increased training costs for perioperative services, $198,000. There is a budget line specifically dedicated to that.

Additionally, we did receive funding from the federal government. We don’t have the details yet around what it encompasses, but we did have a funding announcement late Friday to support surgical backtime from the federal government. It was on the news.

SUSAN LEBLANC: Do you have targets in place for addressing the backlog? So 27,000 people - the way you were talking about a hundred doctors a year - is there a way to tell if we’re making progress, or how quickly we’re making progress?

MICHELLE THOMPSON: Again, surgical wait times are a priority. The money that we talked about in the Central Zone will achieve 2,500 surgeries, but we will be able to scale up. As we centralize our list, triage the list, see what’s happening and what resources are available to us, we do expect that as time goes on, we will become more efficient.

I can assure you that we are hyper focused on that list. From an orthopaedic perspective alone, we know the impact that has on people’s quality of life, particularly their ability to stay in their own home. For some folks, it’s their ability to work. We will be very hyper focused on that list. As we get the plan solidified, we will be reporting publicly on how we’re doing.

SUSAN LEBLANC: You mentioned orthopaedics, and we talked last week about the pre-habilitation programs. Obviously, Dr. Orrell will be very familiar with this. In terms of the anxiety and the stress around waiting for surgery, that type of program can be very useful, not only for the actual pre-habilitation - which is important for preparation and recovery - but in terms of individuals hitting benchmarks or having something to do, frankly, while they’re waiting for their surgery.

I’m wondering if there’s any money allocated to expanding the idea or that kind of program to other types of surgeries while folks are waiting.

MICHELLE THOMPSON: I couldn’t agree more. My husband is actually a physiotherapist in one of the OACs in the province. Certainly, he can speak to the benefit of having those folks come in early, pre-surgery. There are some efforts in Cape Breton specifically around a clinic that would address some of the personal health factors, particularly around obesity, that could help offset some of the discomfort and strengthen folks until they’re able to get their surgery. That would be an example.

We will watch that program and see, in addition to our current OACs, how they’re doing, and then look at the program again.

SUSAN LEBLANC: Thank you, Madam Chair. We were told that there’s really no way in the province to know how many people are waiting for consultation with a specialist. I’m just wondering if you can offer any estimate about how many folks in the province are waiting for consultations with specialists.

MICHELLE THOMPSON: To that point, as you said, there’s a time to intake and time to surgery. We don’t have clear numbers about those just yet, which is why that central intake process is so important for us to be able to manage that list. It really is an essential component for us to be able to manage people’s care in an effective and efficient way. There is dedicated resource to that central intake program for just that reason.

SUSAN LEBLANC: Just to clarify, there’s money set aside for when that program gets up and running - that central intake or central engine around surgeries? There will be money set aside to process the information of how many people are waiting for consultation? The list of people waiting for surgery will start from waiting for your consult to your surgery?

MICHELLE THOMPSON: There is money set aside simply for that planning process, to make sure that it has got the technological support that it needs. The planning piece is in place, so that we can look specifically at those two benchmarks. Once we get them up and running, that is something that we would probably be reporting, so that people understood whether or not we were meeting national benchmarks.

SUSAN LEBLANC: The other thing that we talked about around waiting for surgeries the other day at Public Accounts was just general communication. Even if there’s not a pre-habilitation portion of someone’s journey in the system, a call every once in a while, to say, “Just wanted to check in with you and remind you that your appointment’s coming up in 18 months,” or whatever.

I’m being facetious. It’s kind of true. Is there money available or designated to that kind of work happening to ease the anxiety of folks waiting for surgery?

MICHELLE THOMPSON: The point was well taken, actually, the other day in the Public Accounts Committee, and certainly well taken by CEO Oldfield, as well as Deputy Minister Lagassé. My feeling is that under that planning, that would be an important component of that - for people to be able to check in and talk to people about where they are.

To your point, it really is important. You have to figure out how much longer you can hang on, and what you’re facing. That would be something that we could build into that planning piece in the program.

SUSAN LEBLANC: This is just something I’ve come up with, so it might be a tricky thing to know about. Are there any data or statistics in Nova Scotia about any correlation between surgery wait times and opioid dependency? If people are in pain and waiting for surgery and being prescribed opioids, do we know if there’s any correlation to dependency?

MICHELLE THOMPSON: Currently we don’t have that capacity in Nova Scotia. We aren’t tracking that. (Interruption) No, we’re not.

SUSAN LEBLANC: But would you agree that there could be a correlation?

The budget commits $2.1 million to address the surgery backlogs due to COVID-19 at the IWK Health Centre and to fund more cataract surgeries. That’s a quote from the budget documents. I’m wondering, are these private contracts with Scotia Surgery and the vision clinic? In the case of the IWK, is this budget line in addition to the announcement about paediatric surgeries at Scotia Surgery in December?

MICHELLE THOMPSON: The line item you talked about is actually with Scotia Surgery, similar to the announcement before. In saying that, I want to assure the member that we have maximized internal resources. The wait-list is to a place that we felt people would wait for a protracted period of time. We do have a contract with Scotia Surgery while we continue to run and use our internal services for more complex and complicated cases.

SUSAN LEBLANC: Okay. Sorry, that cataract surgery - is that also with Scotia Surgery? And just to clarify, this is in addition to the announcement made in December, so this is a new crop of surgeries, as it were?

MICHELLE THOMPSON: It’s a continuation of our contract with Scotia Surgery, but the cataracts are actually done at Halifax Vision Centre.

SUSAN LEBLANC: Great. I don’t think I got an answer to my question, which is: In December, there was an announcement about paediatric surgeries at Scotia Surgery. Is this budget line, the $2.1 million, connected to that announcement or is this another crop of surgeries? Is this more surgeries besides the ones in December?

MICHELLE THOMPSON: The total contract is the $2.1 million: $800,000 goes to Scotia Surgery and $1.3 million goes to the Halifax Vision Centre in this budget. There was money before, and this is in this . . .

SUSAN LEBLANC: This is new money.

MICHELLE THOMPSON: New money. Yes.

SUSAN LEBLANC: Thank you. Again, at Public Accounts Committee last week, the CEO of Nova Scotia Health, Karen Oldfield, left the door open for further privatization of health services. When we asked about the expansion of using private services, she said that all options are on the table. At the time, I expressed my concern with that, and I know that lots of Nova Scotians are concerned about the sort of a looming privatization, or a continued privatization, of our public services.

I know you’ve just said that using Scotia Surgery for the IWK situation is because there really is no other option. I’m just wondering if the minister can explain, with examples, what other private partnerships are being considered for health care. Like the virtual care situation with Maple, that kind of thing? Are there other contracts being considered for other types of care in the health system?

MICHELLE THOMPSON: What I want to reassure is that it isn’t a privatization. These are all insured services. Once we maximize capacity within our internal systems - and we have too many patients - ethically, we have to look outside of our system in order to support people in being well, reducing their pain, making sure they can see, have access to a primary care providers until we find a primary care provider for them through virtual care - doing all of those things. These are all publicly funded, so access is equal. We want people to be able to access that care and reduce wait times.

[9:30 p.m.]

We will continue to look at what our options are, always, knowing that we have excellent health care workers, excellent facilities. We’re in the midst of redevelopments now. It may impact our capacity for a period of time. We have to look at everything. We can’t leave a stone unturned until we get out of this crisis. Then we can readjust and see what options are available to us.

The folks that we work with provide quality, ethical care, and it is funded, through the Department of Health and Wellness. It isn’t privatized. It is available to the public as an insured service.

SUSAN LEBLANC: I guess that’s the question I’m really asking. I understand the ethics of it, and we’re at capacity. We have an overflow of needs, have an overflow of patients, and people are waiting too long, especially children.

I guess my question is: When the crisis is over, when the 100 doctors a year get recruited and the surgery backlog list is gone, can you commit to us, can you commit to Nova Scotia, that the next step - or I guess, sister step - is a massive investment in the public system so that we don’t ever have to use private surgeries again, so that people can access public health care, insured services in public institutions with people who are public servants?

MICHELLE THOMPSON: What I will say is that as we move forward with our redevelopment, there has been - and there will continue to be - massive investment in health care. We have significant staffing shortages and we’re not going to solve those all internally. We need a really strong immigration stream, as an example, and that’s going to take some time to set up. We are going to invest in technology, in modern facilities, in modern equipment - all of those things.

If the capacity remains for us, when we get there, and we’re able to do that, yes. I think we will always keep our options open to see if there’s expertise that sits in a different area, that allows us to ensure services and provide expertise in a different area. We’re always going to look at the best options, the most cost-efficient options, and the highest quality of care for Nova Scotians. All of our options need to be on the table to do that.

SUSAN LEBLANC: I’m going to jump around again. The Progressive Conservatives, your party, ran on a promise to meet national benchmarks for wait times for surgeries and procedures within 18 months of being elected. The benchmark to complete knee and hip replacements is 180 days but patients in some parts of Nova Scotia are currently waiting an average of 685 days for knee replacement. I guess I’m not really jumping around - this is still about surgery - for hip replacement and 673 days.

In 2020, only 47 per cent of procedures took place within the national benchmark. Only 31 per cent of knee replacements were performed within the benchmark in 2020. Eighteen months, i.e., the amount of time the platform said this would be looked at in, or the national benchmarks would be met in, is about a year away now, so February 2023. I just want to know if we’re on track to meet that target.

MICHELLE THOMPSON: What I will say is that the work is under way, and we would love to meet that benchmark target. We are going to do everything we can in our power to meet that mandate item and make sure that we are within benchmark.

It really is a priority for us because we know that people are uncomfortable that the wait times are too long. We know that there have been interruptions because of the pandemic, particularly the staffing disruptions. I will tell you, certainly in my mandate and the direction that I have from the Premier, the expectation is that we will move every mountain in order to meet that target and time frame that we have promised Nova Scotians.

SUSAN LEBLANC: Another election platform promise as part of this, was to open operating rooms and allow them to run longer hours as a way to adjust the backlog. You probably know this by now, because I’ve said it a few times, our office has filed several FOIs at the department, Nova Scotia Health, and at the Premier’s Office to understand what work is underway with that idea. There were no records of any detailed planning or work.

I am wondering if you could explain to us what work is under way on the commitment to open operating rooms for longer, and when do you anticipate that program being in place?

MICHELLE THOMPSON: There is a line item that indicates that there be $5 million to address surgical wait times and increase efficiencies in the ORs beyond banking hours, so there is money allocated to it. I can assure you that as a leadership team, we are in close contact with one another on a regular basis. I know that the planning is under way, and I am confident in our ability to make a meaningful impact on that list in a timely fashion.

I just want to assure the member that there is money allocated to it. I can assure you that it is top of mind for the leadership team.

SUSAN LEBLANC: I suppose we can’t FOIPOP the conversations that happened on the tour across Nova Scotia from Neils Harbour to Yarmouth. I wish we could. Maybe that’s when it all went down.

All joking aside, the national goal for cancer care is a ten-day wait. Records from last year describe the following waits for various types of surgeries: 36 days for breast cancer, 46 days for lung cancer, 55 days for colorectal cancer, 84 days for bladder cancer, and 112 days for prostate cancer.

The medical director for Cancer Care in Nova Scotia has warned that delays can lead to more aggressive illnesses. The Canadian Cancer Society has called on the government to create a public plan for clearing the backlog. Will the government be creating a public plan - this is specific to cancer care - and can the minister please explain what the cancer-specific plan is to clear the backlog in tests, procedures, and surgeries?

MICHELLE THOMPSON: Urgent, emergency, and time-sensitive cancer surgeries and procedures continued during all waves of COVID-19. There were some delays for patients needing some cancer-related surgeries, but patients were prioritized. There is an expansion of hours currently in the diagnostic imaging in Central Zone to support getting cleared up some of the backlog around diagnostic imaging. There is $2.7 million allocated for gastrointestinal scoping as well as cystoscopes. Also, the money that’s allocated for surgeries will also address some of those surgeries.

Again, in that surgical wait-time list, we are top of mind and continue to work very, very hard to meet those timelines for those time-sensitive surgeries.

SUSAN LEBLANC: Thank you, Madam Chair. I want to talk a little bit about recruitment. The first thing I wanted to ask is about the comment the minister made just a few minutes ago about the immigration stream.

I just met a gal the other day who was a nurse in India and who has moved to Canada with her two kids. She’s waiting to be licensed as a nurse in Canada. In the meantime, she’s applied for a couple of CCA jobs, and then in the meantime, ended up getting a job as an EPA in a school because she needs work.

What is the process for someone like her to practice nursing, in Nova Scotia, which is what she is educated to do, and how long is that taking right now? I know that Dr. Orrell was talking about - never mind, I’ll ask that next.

MICHELLE THOMPSON: It is complicated, is what I will say. If you’re coming over specifically to work, you do need a work permit and you need a job offer. This is where the federal and provincial intertwines. It is a bit complicated.

Most people, almost everyone who comes in internationally trained, other than maybe our U.S. counterparts. They come in at a level that’s different than where they trained. Registered nurses and LPNs will often have to come in and work for a period of time as continuing care assistants.

There are some language proficiency requirements as well. There are also some educational requirements. They need to assess their training and make sure that it meets those criteria. Often there is a requirement that they take more education.

I taught as a nursing instructor in the distance nursing program at one of the universities. Last June was the first time in the 10 years that I’ve been teaching nursing in the distance program, that I actually had all internationally trained students in my distance class. It was really different. I hadn’t had that before.

What I will tell you is that immigration is going to be a key component of us addressing our workforce issues. We are working on a process. We’re trying to understand how we can streamline it and support people from coming in. We simply cannot train and grow the workforce that we require in Nova Scotia in time, so immigration is a key strategy for us.

We continue to look at the barriers in order for us to see whatever way we can navigate it with and for people, in order to bring them in in a timelier fashion. We recognize that it is a deterrent for people, so we want to make it as easy as possible for nurses, in particular, to come and work here.

SUSAN LEBLANC: Thank you, that’s helpful. I only met this person the other day, but my sense is that she didn’t come on a work permit. She must’ve come in some other way. If you’re not attached to a job when you get here, what is the process there? How do you get connected?

MICHELLE THOMPSON: This is my understanding: If you don’t have a work permit, then you need to be a permanent resident in order to apply for work. Those are federal immigration requirements. As a permanent resident, that person would come - if you’re going to work as a continuing care assistant, as an example, that is also a designated career that has credentials.

[9:45 p.m.]

Let’s say this person was going to work in a long-term care facility. That long-term care facility would then work with the CCA division of the Health Association Nova Scotia to look at the requirements for Prior Learning Assessment and Recognition (PLAR).

Then comparing their training that they have before they come to Canada with the requirements for continuing care assistants, there would then be a PLAR program. Even to become a CCA, the credentials have to be recognized, and they have to work for a period of time in order to meet that credential. Then as they work as a CCA, once they’ve kind of achieved that, then they would work with their employer, probably, to look at whether or not they could scale up to become a licensed practical nurse, if they were a registered nurse, and then hopefully be able to continue their education.

They can go right to registered nurse, but often a number will come in and look at the LPN program. Again, there are some English requirements in order for them to do that.

SUSAN LEBLANC: Speaking of LPNs and RNs, I’ve heard from folks who are LPNs who, acknowledging that we need to recruit - I think we need to recruit LPNs and RNs, but we definitely need to recruit RNs. There are a number of LPNs who would like to - what do you say?

AN HON. MEMBER: Upgrade.

SUSAN LEBLANC: Upgrade their qualifications to become an RN. Thank you. I was going to say “re-up,” but that’s a little bit different.

My understanding is that there are only two places in Canada you can do that. One is Athabasca University and one’s at StFX University. For LPNs who are in the Central Zone, it’s quite difficult for them to take the training at StFX University. It’s costly. It’s out of the city. If they have jobs, if they have families in the Central Zone, it makes it really hard and it’s a real barrier.

I’m just wondering if there’s any thought or plan to expand that type of education upgrading at Dalhousie, for instance, or some location - even to accredit the Nova Scotia Community College, for instance, to do that upgrading so that folks in the Central Zone would be able to do that training.

MICHELLE THOMPSON: There are discussions about how we would be able to do that. Again, we always want people to be able to progress in their career. Regarding that workforce plan we’re in the midst of developing, if people are going to be on a career trajectory, which is terrific - we see it very often, where people continue to upgrade - we want to make sure that we have a steady stream of individuals backfilling the people who are moving along. That is part of the workforce planning that we are doing.

I didn’t realize that StFX University was as unique as it was in terms of the program that they offer. I do know that there have been some conversations about how we can enable people to move through that career path.

SUSAN LEBLANC: I just wanted to ask some questions about doctor recruitment, or primary care recruitment, that are kind of based on your conversation with my colleague, the member for Fairview-Clayton Park.

We in Dartmouth North are advocating for primary care in Dartmouth North, so I know a little bit about this. I’m wondering, when you talk about the panel size - let’s just say a 40-hour or 35-hour full time equivalency primary care family physician who’s on a full time APP at, say, a Nova Scotia Health home. You mentioned a minimum amount for their panel, but what would be the best practice for a panel size for someone like that?

MICHELLE THOMPSON: So 1,350 is the ideal for that person. It was chosen so that people wouldn’t have to wait for protracted or extended periods of time.

We all have different skill sets, time management, office management, and all those things, so if a physician wanted to take on more than that we would be thrilled, of course. Also, not all practices are the same. How often I currently visit my family physician may be very different from somebody who has comorbid conditions. We want a practice that’s diverse in terms of the needs so they may be able to increase their numbers. If they have young families, as an example, their practice may grow a little bit. But 1,350 is kind of that sweet spot that we would like them at a minimum to reach, as an APP working full time in their office.

SUSAN LEBLANC: Is there a number that is too many for something like that? I get that we would love them to take on more, but then how do you work out those metrics? All of a sudden, it’s 4,000 and people are waiting six weeks to see their doctor.

MICHELLE THOMPSON: That is complicated. Of course, we know there are a number of physicians who ethically feel that they want to take on more. What we have seen historically is that fee-for-service physicians tend to be later in their career, and they tend to have higher panels. I think that’s an accumulation of family members and friends over time.

There are several GPs who I know of who do carry panels of 3,000 and 4,000, but again, it’s a good mix of individuals. In terms of access, people generally have good access, but it is a very different model and certainly a very different work/life balance than we perhaps see our current younger, newer entry physicians.

I don’t want to generalize too much, but we are in a bit of a different place in terms of how people want to practise medicine. There is no ideal number. What we want always is access. We want people to get the care they require when they need it, and some practices manage that in different ways than others. There are physicians who have 3,500 patients who manage that work very, very well. It really is in some way around some of the physician management practises as well.

SUSAN LEBLANC: Would you say that currently, with the physician or the family primary care recruitment - I’m not going to differentiate between physicians and nurse practitioners in this case - are you actively encouraging APPs, or are you just saying we want you and you could do whatever you want?

MICHELLE THOMPSON: Both. We really want to work with people around what suits their best work/life balance. So, again, if people want to come in and work for fee-for-service, we’re happy to do that. If people want to come in and work as a full-time patient-facing practitioner, we want to do that.

There are also a number of family physicians in particular who want to work a certain percentage in their office and perhaps have a sub-specialty that they want to use as well. That could be palliative care, medical oncology, it could be emergency room, it could be hospice. We really do work hard to support the physician choice in terms of where and how they practise, in order to keep them here, and give them the work/life balance that they’re looking for.

SUSAN LEBLANC: I had a question based on that, but maybe it will come back to me. Is there any money in the budget or do you have any plans to expand the residency programs? I ask this because I understand that it’s obviously the same with the nursing - to expand nursing programs and hire people from those programs.

I remember a couple of years ago, either in the Health Committee or Public Accounts Committee, we talked to folks at Dalhousie who were in charge of training doctors. I understood at the time that they were expanding residency programs in rural areas, which was great.

I guess my question has two parts. One is: How is that all going? Are there plans to expand those kinds of programs in rural areas? Also, are there any plans to expand into deeply urban areas? Whereas rural physicians have particular situation challenges and what it is to be a rural doctor. Similarly, I think that there must be something about what it’s like to serve very marginalized inner-city communities.

I’m wondering if that has been given any thought. I think that in my community, for instance, it’s a challenge to attract doctors because the needs are so high.

MICHELLE THOMPSON: I’m going to give you the lowdown here. The clinical clerkship programs happen with third-year students. Those are programs that help address some of the things that you discussed. Then we have traditional residency programs in the Central Zone. We are under discussion about how and where we expand those programs, to your point, around the highest needs of Nova Scotians. We just haven’t made any finite decisions about that yet.

SUSAN LEBLANC: Is there any money allocated to expanding the programs in this budget?

MICHELLE THOMPSON: We’re adding another 15 this year. It kind of increases. It’s a $2 million budget item and it adds 15 on an annual basis. There’s 15 from last year and 15 from this year. That continues every year to include the 15.

[10:00 p.m.]

SUSAN LEBLANC: Thanks for that. I wanted to go back to the recruitment trip to Dubai and Singapore, I think someone said. I’m curious to know if that was for physicians or nurses or CCAs or who.

Also, what is the pitch? This is my question, actually. Obviously, for whatever position it is there’s going to be the money and the incentives and that kind of thing. What is the pitch to pick up and move from Dubai or Singapore and come to Nova Scotia? Aside from the lobster and the surfing, seriously, what does one tell folks? Why is it better here?

MICHELLE THOMPSON: The Singapore-Dubai trip was for RNs, LPNs, and CCAs, and then the Britain trip was for physicians.

It’s a couple of things. When we go on these trips, often a number of people are interested in coming to Canada already, for a variety of different reasons, so we recognize that. When we talk to them, we talk about the innovation that’s happening here. We talk to them about the work/life balance. We talk to them about the communities that they will settle in and what Nova Scotia has to offer. Already, there are people who want to come here, they want to immigrate to Canada.

Our job is to really engage, build a relationship and a connection with them, and talk to them about what we have to offer here. We do have the finest health care workers. I think you would really enjoy the Nova Scotia Health Innovation Showcase that we had. I’ve been working in health care for 30 years and even I didn’t realize the wonderful people we have and the innovation that’s happening here.

We will have state-of-the-art facilities. We’re open for business, we’re sending . . .

THE CHAIR: Order. It is now time for the Official Opposition’s turn.

The honourable member for Fairview-Clayton Park.

PATRICIA ARAB: Thank you, Madam Chair. Just for clarification, how much time will I actually have, since the House is set to rise at 11:00 p.m., just so I know how much time I get.

THE CHAIR: We’ll stop between 10:45 p.m. and 10:50 p.m.

PATRICIA ARAB: Okay, thanks. Before I move on to my next section of questioning, I’d like to go back to the nurse mentorship program. There were a couple of questions that we didn’t get to at the end of my last hour. What are the program’s desired outcomes? What is the cost? The last question I have that I didn’t get a chance to ask is if it’s a requirement for a nursing education program or if it’s considered an elective.

MICHELLE THOMPSON: The nurse mentorship program continues to be under development. The desired outcome really is around knowledge translation and support for new graduates.

When I think back to my early years as a nurse, I learned so much from very seasoned registered nurses. That’s what we want. When you have a lot of vacancies and you hire, you suddenly have a lot of very junior nurses. It’s important that they feel supported because you can get in over your head fairly quickly.

With that mentorship program, we have people with experience and expertise, and it allows them to mentor. It allows them to work alongside the nurses who are newly trained.

There’s been a lot of work done in research about the transition to practice for nurses. Research will show that the first five years when you transition into nursing are really important times. If you’re in a position where you’re in over your head - and it can happen really easily - it can cause people to underestimate their abilities or feel fearful. We want to put those experienced nurses in situ with our less experienced nurses in order to support them.

The program is under development, so I don’t have a cost for you, but I really am hopeful and confident that this program will encourage and strengthen our nursing workforce as they transition to practice.

PATRICIA ARAB: Thanks, Madam Chair. Just one last question, through you. Is it a requirement of the nursing education program or an elective?

MICHELLE THOMPSON: It’s actually neither of those. It would be post-graduation. Once they’ve graduated and they’re employed, we would actually have somebody in the organization who would mentor these folks. They are going to have their clinical placements, their consolidation, all of those things. They’ll come out and they’ll graduate.

This is an additional resource that would be available to nurses in the work environment when they are working as graduate or registered nurses to support their practice, and get the skills that perhaps they weren’t able to get in the consolidation - and also just around time management and critical thinking. There’s a lot to understand.

PATRICIA ARAB: I’m going to shift my questioning to virtual care and telehealth. We know that $14.5 million has been invested to make virtual care available to everyone, especially those who are on the family practice registry. There is a desire to expand the different types of care that will be available through virtual care.

We have 60,000 Nova Scotians who have accessed virtual care already - 10,000 appointments since the service launched. This allowed primary care walk-in clinics to offer virtual care and continue virtual care to include primary consultations and more types of specialists, and to develop a multi-year virtual care strategy to guide the expansion and integration work with Nova Scotia Digital Services to increase the speed and innovation toward a One Person One Record - which we will refer to as OPOR moving forward - solution.

The purpose of OPOR is to transform Nova Scotia’s health care system by replacing three aging hospital information systems that exist in the NSHA and the IWK with a modern, high-functioning, data-driven clinical information system, ensuring that the right information is available at the right time and place when and where care is needed.

OPOR is something that I’m very familiar with. My first question off the bat is: Where do we stand with One Patient One Record, and when will this service be implemented?

MICHELLE THOMPSON: Since the member opposite has been involved in the past, you’ll understand when I say we are in an active procurement process. That’s really all I can say about that at this time.

PATRICIA ARAB: I do indeed understand the holding pattern. I’m curious if there is an alternative or a plan that can either transition into a different system or make access go a little bit faster. This is basically a system that was needed yesterday. With most technologies, they become redundant as they age, so where do we even stand with the technology that we’re currently talking about? Is this going to just come in and already be an aged technology? What is your IT section of the Department of Health and Wellness working on to try to overcome the barriers to implementing this type of program?

MICHELLE THOMPSON: Again, I am a bit limited in what I can talk about, but what I want to assure you is that it’s very future-facing. One of the things that we heard, surprisingly - I was in the trenches when MEDITECH came in. Eastern Zone, my Health Authority district, adopted MEDITECH. Computers were really new then, almost, and it was a huge shift for us. I remember the strife and the angst that was associated as we learned this system, and we went from pen to MEDITECH, particularly.

On the tour, when we started to talk about OPOR, I anticipated some of that angst - again, the generations, I’m starting to date myself. I was pleasantly surprised at how eager the frontline health care professionals are to have that modality installed, and have it available to them, not only to streamline the efficiency of their work, but also felt very strongly that our system was so antiquated that it was actually a barrier to recruitment. I was really pleasantly surprised. So in terms of the adoption, when we get it, I think it will be very eagerly met by health care professionals - not all, but certainly many.

To your point, that is one of the things that we have looked at. We know that technology is changing very, very quickly, and the last thing we want to do is invest in something that is going to be outdated when we get it. Again, we are in an active procurement, and the points that you raised are important points that have been taken under consideration in the process.

PATRICIA ARAB: When we’re talking about the cost of it, the previous government spent approximately $7.4 million on OPOR, including $4.8 million on the procurement process itself - fairness, monitoring, consultants, legal, et cetera. They spent $2.6 million on readiness within the NSHA and the IWK. I’m curious if the costs have increased, and how much in this fiscal year is being committed to OPOR.

MICHELLE THOMPSON: There is a team that’s doing readiness now, in terms of how we will be able to adopt it. The budget has actually been transferred to Nova Scotia Digital Services.

PATRICIA ARAB: I don’t know if the minister will be able to answer this or if this is going to need to be saved for when the Department of Service Nova Scotia and Internal Services gets up. Does the minister know how much the federal government is contributing through the federal virtual care bilateral and Canada Health Infoway funding? Has there been a commitment from the federal government for this?

MICHELLE THOMPSON: There are two things here. In 2021-22, we received $6.9 million from the feds for virtual care. Some of that money has carried over into 2022-23, but it is not designated for OPOR. That would be done within provincial resources at this time.

PATRICIA ARAB: So none of the federal contribution is going towards One Person One Record. Okay, thank you.

I’m curious, how many physicians, specialists, and nurse practitioners from Nova Scotia are partnered to deliver VirtualCareNS?

[10:15 p.m.]

MICHELLE THOMPSON: I probably will have to find out a little bit more about that. I can tell you a little bit about the usage, if you want, for the general practitioners, if that’s helpful. The proportion of virtual care among GPs shifted from less than 1 per cent in 2019-20, obviously pre-pandemic, to at least 35 per cent in 2021. More than 485,000 patients attached to a family physician had one or more virtual interactions in 2021. Certainly, a big increase, if you are attached. Is that the question around the attachment?

PATRICIA ARAB: My question isn’t about the usage from the patient’s side, but how many physicians, specialists, and nurse practitioners are connected to the program who are offering their services virtually. If you can get that for me, that’s great.

Something else is, do these doctors and nurses have practices elsewhere in the province? Are they retired? Are they actively practicing and are there any doctors or nurse practitioners outside of the province who are delivering virtual care to Nova Scotians?

MICHELLE THOMPSON: I am going to package all of that for you in just a minute.

PATRICIA ARAB: I would like to talk about the platform that is used to deliver this service. I am curious if the minister can confirm that it is Maple. Is she aware if telephone and Zoom appointments are being completed - that are being done by doctors - are included in the VirtualCareNS program?

MICHELLE THOMPSON: There are just a couple of nuances there that we want to clarify. There is VirtualCareNS, which is for unattached patients. We can get the numbers around the practitioners which is what I think you asked - who is involved with that, whether internal or external to the province. Then there is virtual care for attached patients - and there are fee codes that are associated with that.

Any practitioner in the province has a billing code. So even if you are an APP, you would still shadow bill for your virtual care if you had an attached patient. Fee for service as well - you would have a billing code. Then there is the VirtualCareNS piece where unattached patients can access. I am thinking that your question is around the unattached patients?

PATRICIA ARAB: Yes, my questions are for the unattached patients - so using Maple as the technology. Then this brings up a question of - in the uptake, what is the data that’s being looked at? Just those unattached patients who are accessing VirtualCareNS? Or is the inclusion of attached patients who have seen their family practitioner virtually - either using Zoom appointments or phone appointments - included in that number?

MICHELLE THOMPSON: Those statistics are kept separate. We would look at the unattached patients who are accessing virtual care through that platform. Then we would also be looking at understanding attached patients and how they access their primary care provider. The ideal is that it is always a patient’s choice - as an attached patient, whether they are able to see their physician in person or whether they get to speak to them virtually. For the majority of attached patients, their virtual care is happening over the telephone.

PATRICIA ARAB: Just looking at VirtualCareNS, which is the unattached patients receiving virtual service. What is the cost for this delivery?

MICHELLE THOMPSON: In the upcoming budget, there’s $6.25 million attached to VirtualCareNS, so that people can access the Need a Family Practice Registry. That’s the allocated funding that’s available in this fiscal year.

PATRICIA ARAB: This might seem redundant, but is that the cost of the service or is that the anticipated cost of the service? That’s the budget that you’re giving it, but how much is the cost for the service?

MICHELLE THOMPSON: That is the estimated cost going forward. We don’t have the actual cost with us. We have to consult with the Nova Scotia Health Authority, but we can look at that.

PATRICIA ARAB: How are the physicians and nurse practitioners compensated for this? Is it billing codes? Are there fees? Maybe you’ve already answered this, but just to clarify: What are the anticipated billing fee costs to the province?

MICHELLE THOMPSON: The physicians and nurse practitioners associated with VirtualCareNS are paid a sessional fee for the hours that they work.

PATRICIA ARAB: Can the minister break that down for me? Is it per 10-minute segment? Is it per patient? Do I get the same if I have somebody with complex issues that is going to take maybe an hour to sit with them to dissect, as I would with somebody who just needs a prescription refill or something? What is the breakdown of that cost?

MICHELL THOMPSON: When you get a sessional fee, it is an hourly rate. Sometimes you’ll work more and sometimes you’ll work less, but essentially you get an hourly fee for the expertise and for your availability. That’s how they do it so the costs, in some ways, are fixed. It’s not on a fee-for-service basis.

PATRICIA ARAB: Maybe the minister can clarify for me if the cost is lower for virtual care as opposed to in-person delivery.

MICHELL THOMPSON: For attached patients, whether you are seen in person or you are seen virtually, it is the same. You don’t get paid less or more. It’s absolutely the same.

For patients on VirtualCareNS, they’re only seen virtually. It’s an hourly session. There is only a virtual option. There’s no in-person option for those patients.

PATRICIA ARAB: I do understand that, but the question still is: Which is the more expensive - whether you’re attached or unattached? If I’m unattached and I’m using VirtualCareNS, and then I get attached to a practitioner, what’s going to be the better savings for the province - VirtualCareNS or having them attached to a GP - just from a dollars and cents perspective?

MICHELLE THOMPSON: It is a bit of an apples and oranges thing. I don’t know that. If you’re attached and you have a physician who’s on an APP versus a fee-for-service, it may be a little bit different, versus if you’re getting essentially a sessional fee, which is an hourly wage for physicians and nurses. The nurse practitioner is probably neutral because there would be a pay scale as unionized employees, and that’s what they work.

I think it depends a little bit on the physician. They would be comparable, but I don’t have that ability to tell you exactly what that would be right now.

PATRICIA ARAB: Maybe we’ll get back to that. We’ll leave that for a little bit.

I’m wondering - if you’ve already answered this, just repeat the number - how much is the federal government contributing to VirtualCareNS?

MICHELLE THOMPSON: The VirtualCareNS program is funded provincially. The money that was received from the federal government in 2021-22 went towards IT initiatives. They are two separate things.

PATRICIA ARAB: Just to be clear, the $14.5 million is the total cost, and it is completely Nova Scotia’s cost.

MICHELLE THOMPSON: Yes, that’s correct.

PATRICIA ARAB: Of the 10,000 appointments completed so far, what metrics does the department have to understand its utilization?

MICHELLE THOMPSON: There is actually an evaluation being conducted by the Nova Scotia Health Authority right now.

PATRICIA ARAB: Will this evaluation look at how many were prescription renewals, and how many were pre-existing condition follow-ups? Is that what it will be looking at?

MICHELLE THOMPSON: I don’t have the exact metrics in front of me, but certainly, if we think about accreditation principles, it’s going to make sure that it’s effective, that’s its timely.

In addition to quantitative, I’m sure there will be some qualitative data around people’s experience and things like that. I don’t have the exact metrics, but I do know that there is a fulsome evaluation that’s happening right now. Certainly, it will be a way to expand and make sure that it is responsive to the needs of Nova Scotians.

[10:30 p.m.]

PATRICIA ARAB: I wonder if the minister would be willing to allow the House to see what that evaluation is and get more specifics on that.

MICHELLE THOMPSON: Once that evaluation is done by the Nova Scotia Health Authority, we can discuss with them how we would best distribute that and what parts of it. I’m not sure about confidentiality and privacy and things like that, so that would be something I would have to discuss with Nova Scotia Health since they’re the ones who are conducting the review in terms of how much we are able to share publicly.

PATRICIA ARAB: I think in terms of confidentiality, no personal information, it would be the data sets of why people were using virtual - like what were the issues. Anyway, that’s okay. We’ll wait and see.

Another service near and dear to my heart is 811. I’m curious with the introduction of virtual care, what impacts have there been to 811?

MICHELLE THOMPSON: What we know is that over the course of the pandemic, 811 became an important tool for people to access advice over a broad range of issues - particularly around even restrictions or what to do if and all those things. We do know there was a significant increase in the utilization of 811 over the course of the pandemic.

PATRICIA ARAB: I guess specifically with VirtualCareNS - and I know you can’t put the pandemic aside, but looking at it from a utilization - has the service been a help to offset some of the typical stressors that would have been on 811? I don’t even know if you can answer that because we are in a pandemic, but has this been a benefit to 811?

MICHELLE THOMPSON: What I would say around VirtualCareNS is that I think it’s been a very valuable service, period, to Nova Scotians. There may have been some folks directed there through 811, through the Need a Family Practise Registry registering process. I think over the course of the pandemic, Nova Scotians, the Department of Health and Wellness, and Nova Scotia Health, have had to be really innovative in terms of how they responded to the needs of Nova Scotians.

What I can tell you anecdotally from people who used virtual care is that they really appreciate the opportunity. We know it’s not for everybody, but they really do like the process. They find it efficient. I don’t know that it correlates, but I think it complements. Certainly, it must be great for 811 to have another option, obviously, to refer someone to.

Of course, there are other things now with urgent treatment centres and walk-in clinics and things like that. I think it has helped provide another access point to Nova Scotians through that 811. I think they would be complementary to one another.

PATRICIA ARAB: What’s the process for Nova Scotians who are on the Need a Family Practice wait-list who require in-person care for consultation?

MICHELLE THOMPSON: If you are on the Need a Family Practise Registry and you need in-person care, there are urgent treatment centres that would provide that. There are walk-in clinics in some communities. In some communities, you do need to go to the Emergency Room to access in-patient care. It just depends, one, on the acuity of the presenting concern, and then the other issue would be who is the best practitioner. If it is a prescription refill, or if it is for an assessment for Lyme disease, as an example, you can access your pharmacist in certain places as well.

I think 811, for example, would be able to help triage you if you were not in need of emergency care, to help you find the practitioner and the resource in your community that would best suit the need that you had. Episodic complaints are always best seen in a walk-in clinic or urgent treatment centre, and potentially, in a pharmacy. Certainly, we would want any urgent or emergent things to go to the emergency room if they need emergency care.

PATRICIA ARAB: Who is being consulted in the development of the multi-year virtual care strategy?

MICHELLE THOMPSON: We are working with our stakeholders, which would include the Nova Scotia Health Authority, IWK, and Doctors Nova Scotia. We would get some patient feedback as well, to understand their experience. Also, the staff who are delivering services - because they would intimately understand what could be improved, or what was working and what wasn’t. Those would be the people. Of course, there are experts as well in virtual care. Internally to us, in terms of making sure that it’s a unique program for us, that’s who we would be consulting.

PATRICIA ARAB: Can the minister tell me the timeline to have this strategy completed?

MICHELLE THOMPSON: That evaluation will be completed within this fiscal year.

PATRICIA ARAB: What bilateral agreement or dependencies are attached to this strategy?

MICHELLE THOMPSON: There are no particular requirements around the bilateral agreement in relation to this project.

PATRICIA ARAB: Does the minister think that this will put a hinderance to it at all? I’ll try to reword: Does the minister think that this will hinder the project at all?

MICHELLE THOMPSON: No, I don’t anticipate. It is provincially funded now. The program has been successful. The evaluation will help us understand how best to move forward. I don’t anticipate there being any issues related to bilateral funding.

PATRICIA ARAB: The NSHA and the IWK have started their readiness assessment work, which involves taking an inventory of current processes and workflows, building standards for these workflows, which they have done through consultation with physicians and clinicians. I’m curious if the minister can update us on the status of that work and its outcomes.

MICHELLE THOMPSON: In regard to the pre-readiness work, to your point, clinical standards work is happening, and a strategy will promote a consistent approach to care provision. I know that work is under way. The development of a project management plan for implementation is under way as well. I don’t really have a specific update, but certainly that work is happening in order to be as ready as possible when the procurement process concludes.

PATRICIA ARAB: I know we’re going to run out of time, but can the minister start to talk about funding within this budget for IT infrastructure and what is being looked at specifically? Are we fixing aging infrastructure, or is anything in this budget being used to move forward for IT?

MICHELLE THOMPSON: I’m going to let you ask that question of my esteemed colleague when you speak with him, because it will be under Nova Scotia Digital Services.

THE CHAIR: Order. It is now 10:41 p.m. and the House is set to adjourn at 11:00 p.m.

The honourable Government House Leader.

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

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

The motion is carried.

The committee will now rise and report to the House.

[10:42 p.m. The committee adjourned.]