HALIFAX, TUESDAY, MARCH 19, 2024

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

3:42 P.M.

 

CHAIR

Nolan Young

 

 

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

 

The honourable Government House Leader.

 

HON. KIM MASLAND: Chair, would you please call the Estimates for the Premier, Resolutions No. E19, E23, and E35.

 

Resolution E19 - Resolved that a sum not exceeding $11,371,000 be granted to the Lieutenant Governor to defray expenses in respect of the Executive Council, pursuant to the Estimate.

 

Resolution E23 - Resolved that a sum not exceeding $5,744,000 be granted to the Lieutenant Governor to defray expenses in respect of Intergovernmental Affairs, pursuant to the Estimate.

 

Resolution E35 - Resolved that a sum not exceeding $2,637,000 be granted to the Lieutenant Governor to defray expenses in respect of Regulatory Affairs and Service Effectiveness, pursuant to the Estimate.

 

THE CHAIR: The honourable Premier.

 

HON. TIM HOUSTON (The Premier): I understand the Opposition has no further questions. I’m happy to continue taking questions. I’m seeing no further questions from the Opposition. I have enjoyed my time in Estimates and look forward to doing it next time as well.

 

THE CHAIR: Shall Resolution E19 stand?

 

Resolution E19 stands.

 

Resolution E19 - Resolved that a sum not exceeding $11,371,000 be granted to the Lieutenant Governor to defray expenses in respect of the Executive Council, pursuant to the Estimate.

 

Resolution E23 - Resolved that a sum not exceeding $5,744,000 be granted to the Lieutenant Governor to defray expenses in respect of Intergovernmental Affairs, pursuant to the Estimate.

 

Resolution E35 - Resolved that a sum not exceeding $2,637,000 be granted to the Lieutenant Governor to defray expenses in respect of Regulatory Affairs and Service Effectiveness, pursuant to the Estimate.

 

THE CHAIR: Shall the resolutions carry?

 

The resolutions are carried.

 

The honourable Government House Leader.

 

KIM MASLAND: Chair, would you please call Resolution E12.

 

Resolution E12 - Resolved that a sum not exceeding $5,536,898,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.

 

THE CHAIR: We’ll continue debate with our Liberal colleagues. The honourable member for Bedford Basin.

 

HON. KELLY REGAN: I think when last we met, we were discussing surgeries - additional numbers of surgeries, et cetera - and I was wondering if the minister could just outline for us what the dollar amount increase is in money being spent this year to increase the number of surgeries over last year.

 

HON. MICHELLE THOMPSON: If we look specifically at actual surgical services, there would be an increase this year of $11.3 million. I would just say that some of the work that’s happening around increasing surgery - there’s the surgical-specific work, but also the work that’s happening around access and flow, around the mobility teams, the SAFER-f bundle. What that does is it allows us to discharge people more quickly and keep that surgical flow going so that we have beds that are available for people who need to be admitted post-operatively. There are surgical-specific values, which is $11.3 million, and then I would also say that there are a number of places through the budget where the other initiatives will also contribute to surgical wait-list improvement.

 

[3:45 p.m.]

 

KELLY REGAN: Thank you to the minister for her concise answer. It’s so nice to have that kind of thing.

 

When we were last talking, we were looking at the number of surgeries being done. Since we last spoke, I went in and took a look, and on the government’s own dashboard it compares the number of surgeries being done in a period versus 2019. I went and looked at the first 10 weeks that we’ve just been through, because that’s all that was up there, and in the first 10 weeks of 2024 there were 17,489 surgeries done in Nova Scotia. My issue with that is that in the same period in 2019, there were 17,450 surgeries done. This is only 39 more surgeries done in that 10-week period, compared to 2019.

 

We’re spending an awful lot of money to not get a huge increase: 39 surgeries over 10 weeks is 3.9 surgeries a week - not a lot when you look across the system and the need; the increase in the population, for example. I’m just wondering if the minister can explain why we aren’t seeing a much greater number of surgeries. This is concerning to me when I look at it.

MICHELLE THOMPSON: Back to the original question that we answered: When we look back at the numbers through the department, it should be noted that for the first two months - eight weeks - there were 155 more surgeries compared to the same period in 2019, and 432 more in the same time period in 2020. We are doing more surgeries month over month. What’s important to also celebrate in the work of the health care workers is the fact that we’re over capacity in the hospitals, because we’re underbedded to a degree we haven’t seen. There’s no peak and valley anymore, it’s just peak - consistently over capacity.

 

There was some disruption because of the major weather event that we had, the major Winter event that resulted in the loss of services because many facilities were closed and, of course, staff had difficulty coming to work. Despite these pressures, we actually continue to do a number of surgeries well over the baseline.

 

KELLY REGAN: Of that $11.3 million that the minister mentioned, as well as the money that’s disbursed throughout the system in a variety of other different ways, are there any new programs to increase surgeries and reduce the backlog?

 

I want to note my great restraint at not referring to the PR event as “the PR event.” I just want to note that.

 

MICHELLE THOMPSON: There are a number of things that are under way. As an example, we’re looking at cataracts. There is an extension of the existing contract with Halifax Vision Surgical Centre to do an additional 1,500 cataract surgeries through the next fiscal year. I think what’s really important to know is that there have really been some strong changes in terms of our ability to have cataract surgeries done over the past year. There is also a urological robot that we are investing money in. I really can’t tell you what that robot does, but I’m looking forward to going and seeing it and understanding how it works.

 

I would also like to say about the diagnostic imaging and access - making sure that the electronic requisition work that has happened with surgical referrals is actually being expanded to our diagnostic imaging access, so helping people access that, trying to get rid of the fax. Not only axe the tax - but we also want to axe the fax as well. We want to look at both of those things.

 

Scotia Surgery: There will be an investment as well to support the IWK and shortening their list. Improving access to surgical spine consultation as well, and I think the members know - I’ve talked about it before - we really do have the leading Canadian robotics program in the country. I think there are four Mako robots, three of them are here, and we are now a site for people to come and learn and train on those robots - which is incredible, to have all of the access to those surgeons across the country and see the dynamic work environment that we’ve created here. Then reduction to utilization, surgical access and quality improvement strategy, really helping move the ORs along.

I would also like to just talk a little bit - as an example, in the recent physician contract, there is an incentive for physicians to do surgeries after hours and on weekends. Certainly we’ve also negotiated a competitive nursing collective agreement as well because there are other people who work in the OR with physicians.

 

There have been a number of things that have happened. I go back to making sure that individuals have access to beds. One of the reasons that we saw in the past was that we didn’t have people moving through, and lower-acuity patients were in high-acuity beds, so the frailty and the SAFER-f bundle as well will support the surgical wait-list.

 

KELLY REGAN: In the Central Zone, we saw a sharp fall in the number of surgeries as well. In the first eight weeks - I haven’t done the math now for the first 10 weeks - but in the first eight weeks of 2019 it was 5,439 surgeries to 5,022 in the first eight weeks of this year. That’s a decrease of about 7.6 per cent.

 

I guess I can see why we would have had that big drop in Cape Breton or in rural areas that were heavily impacted by the snowfall, but it does seem to me that the central region rebounded quite quickly from that snowfall. That’s quite a decrease, so I’m wondering if the minister could speak to what’s going on there.

 

[4:00 p.m.]

 

MICHELLE THOMPSON: Again, I think our numbers are a bit different. What I do want to speak about - and we can clarify the numbers if we go back and look at the video - I do want to take note that there has been a 27 per cent reduction in the surgical wait-list since 2021. There have also been great strides made towards meeting benchmarks.

 

If we look at October to December 2023, 57 per cent of endoscopic surgical services were completed, or wait times were within benchmark. The target is 90, but that has been a significant increase. The performance is continuing to trend toward positive.

 

There have been 55 per cent of non-endoscopic surgical services completed. We also are seeing that there has been a 40 per cent reduction from 2020 to February 1^st, 2024, for ophthalmology services; 28 per cent reduction in orthopaedic surgeries and general surgery; and there has been a 14 per cent reduction in oral-maxillofacial surgeries of 27 per cent. We are getting there. It is incremental change. It depends on hours, it depends on staffing, all those things, but we certainly are pleased with the work that’s happened in the Nova Scotia Health Authority, in terms of improving wait times.

 

KELLY REGAN: In the month of February, according to the NSHA website, there were well over 800 vacancies in just the NSHA. Can the minister comment on why there are so many vacancies?

 

MICHELLE THOMPSON: There are obviously a number of vacancies throughout the Nova Scotia Health Authority. I can confirm the number of 800, but that would be across the province in various areas and across disciplines, I’m suggesting - was there a particular discipline that the member had noticed are 800 in total?

 

We do know that there is a shortage of health human resources across our health professionals. We’ve done a lot of work around supporting not only recruitment but retention, of course, and also the training. We’ve certainly increased the number of seats in a variety of different health professional fields in order for us to meet the growing demand for health care services.

 

Th other thing that’s happened is that as we expand these programs, as we create new pathways for patients, new opportunities - as an example, the mobility teams - we actually need more staff. In terms of the vacancies, we are expanding programs besides. There are a couple of reasons why for those numbers, but we are pleased with them. We’re working very, very hard to support staff in staying, but also seeing positive effect from recruitment efforts, and we will continue.

 

KELLY REGAN: Could the minister speak to which budget lines are attached to doctor recruitment incentives? Are there any new incentives in the budget? I think since the budget came out, we’ve heard of one new incentive, so maybe the minister could speak about that. I just wanted a little more information around that.

 

MICHELLE THOMPSON: In terms of incentive allocation, there is about $9.7 million allocated for incentives. I would like to note that for the new physician contract and academic funding plan, there’s actually an investment in this year’s budget of over $125 million for the salaries and the benefits related to physicians - a pretty significant investment in our physician community.

 

KELLY REGAN: In terms of the new physician recruitment incentive for the Central Zone - we’ve had some conversations about this already, but I’m just wondering how that is going to work. If a doctor wants to locate here, what is the incentive? How do they find out about it? How do we make sure they get it and locate in areas that actually have a great deal of need?

 

With this most recent report, when we look at the numbers in my particular area, the doctor wait-list has climbed 400 per cent since the Fall of 2021. It’s a huge increase in a lot of the Central Zone’s networks. We’ve just seen a huge number of people come on the wait-list, and some of that certainly is due to new people coming into the province. That’s about 35 per cent, roughly.

 

Another 55 per cent of people are on those lists because their doctor has either retired, is retiring, or has closed their practice. I just want some information on how these work because I want to understand it. If I hear about doctors who want to come to my area or a nearby area, I want to make sure that I know about it and I want to make sure that my colleagues know about it too.

 

MICHELLE THOMPSON: When a physician is interested in primary care practice, obviously they would work with local recruiters, either through Nova Scotia Health or the IWK specifically. They also work with physician services.

 

The incentives start with a one-time sign-on, and then at the end of every year following there would be additional funding allocated, provided they meet their targets on all of those things. When they sign their contract, information would be given to them about those incentives. It will happen as they are onboarded through Nova Scotia Health, once they sign their longitudinal family medicine contract with the department.

 

It’s $25,000 when they sign the agreement, and $10,000 per year for the next five years for a full-time physician. The initial sign-on, of course, happens upfront, and then the other will happen at the end of their year. That is how they can access it.

 

In regard to the loss of physicians: Since April 2022, there have been 43 new family physicians in the Central Zone, and there were 42 physicians who left, to the point that we really are seeing retirements. Unfortunately, that hasn’t been planned for adequately, throughout a variety of different governments and a variety of different reasons.

 

There has been some good work. The Atlantic physician’s licence is helpful. I have the number somewhere, in terms of how many people have signed up for that. Looking at the Patient Access to Care Act, if you have a licence anywhere in Canada you can come and work here. We’ll have you registered really quickly, and we actually will waive your first-year registration fees because they can be prohibitive.

 

There’s a variety of different things. We’re looking at red tape reduction. We are really leading the country in terms of red tape reduction. Over 200,000 hours have been reduced from time with a commitment to reach 450,000 hours in red tape reduction by the end of this year.

 

There are a number of things happening. One Person One Record certainly was very welcome news for the physicians who are coming and settling. The contract is a very good contract. We say it’s good for doctors and great for patients because it incents not only attachment but also access.

 

KELLY REGAN: In terms of One Patient One Record, we don’t really have that in Halifax Metro yet, do we? I was at the announcement but I think I might have missed one. I just want to make sure that I am clear on that. We don’t have that in Halifax Metro yet. It was still a pilot with the app - or am I conflating two separate programs? I think we’ve heard about it. I am not clear that it has actually been implemented and that there is One Patient One Record across HRM now.

MICHELLE THOMPSON: We did announce in February 2023 that we have a 10-year agreement with Oracle around One Patient One Record. It is a single, electronic health record that will allow all 26,000 health care professionals at the Nova Scotia Health Authority and the IWK to speak to one another.

 

The first sites to start using OPOR are Dartmouth General Hospital, Cobequid Community Health Centre and Bayers Lake Community Outpatient Centre. That will happen in early 2025.

 

There’s a lot of work that’s happening now. One of the things that One Patient One Record will do is standardize our approach to many things. Different facilities do different things, even though we are under one Nova Scotia Health Authority. This will help standardize it.

 

I am very grateful for the people who like tedious things because this is tedious, I am sure. Working with clinicians - it’s very much clinician-informed - getting this background, getting this foundation, so that when we roll it out, all these sites will come up and then we will look at expanding it across the province.

 

KELLY REGAN: We did hear a lot this morning at the Health Committee about the conditions that nurses are currently facing, in terms of violence, in terms of forced overtime. Now I’ve run out of time.

 

THE CHAIR: Order. That would conclude our round of questioning for Liberal colleagues. We’ll now pass it over for an hour to our NDP colleagues.

 

The honourable member for Dartmouth North.

 

SUSAN LEBLANC: Nice to be back. I’m wondering if we can talk a little bit about the app. I now find myself the parent of an 11-year-old child, which means I have to listen to commercial radio and there’s a lot of ads for the app, I’ve got to tell you.

 

I’m wondering if the minister can walk me through how the app was developed and procured. When did the work on the app begin? What third parties were involved? What roles did they play?

 

MICHELLE THOMPSON: In regard to the app, YourHealthNS, I think we’re confirming that’s what we’re talking about - the five-year contract with Think Research is to support YourHealthNS in the virtual urgent care. YourHealthNS will help Nova Scotians better navigate the health care system. It is a one-stop shop to book services, navigate care options and find information more quickly, and it’s right from the mobile device you have or your computer, whether that be an iPad or a tablet or your phone. It is the first of its kind in Nova Scotia. The 1.0 really allowed a chat bot to kind of help us with AI, to work through what some of the options may be required, based on the person’s self-reported symptoms. It also allows people - like a health services finder. We were able to do location services and help people understand, able to book blood work, tests, X-rays, immunizations, et cetera.

 

This next part of the app - we are now looking at a test-and-try environment where people actually have access to some of their records - their visits, when and where they saw somebody, some of their diagnostic reporting - those types of things. You can expect that over time, the iterations of these apps will change. We did see an app in Denmark - at 16 years of age everybody has an app. Their record is on the app. It talks about their health status. It’s been in place - well, they said they’ve been collecting and utilizing health data since 1968.

 

This app is incredible. It allows us, essentially, to take the health card number and attach it to the patient’s record - what they call democratizing their health. It was a very interesting project for us to see, certainly well established - 1968. We will continue to iterate this app as we move forward. We also are getting regular feedback from Nova Scotians after they use the app, and the satisfaction is quite high, in terms of their experience.

 

[4:15 p.m.]

 

SUSAN LEBLANC: I’m sure that the app didn’t start getting developed in 1968, but the data was beginning to be collected in 1968. As far as I can tell - I remember when we didn’t have computers, or not publicly available.

 

The third parties that we know are involved in the development of the app are EY and Think Research. Were there any other third parties involved in the development of the app?

 

We know that there was $8 million directed to EY as the principal contractor for the development of the app. Is EY’s work ongoing? That’s my first question. What other contracts are there, and how long are the contracts for?

 

MICHELLE THOMPSON: In regard to EY, they do have a contract with Nova Scotia Health. That’s who is the administrator and holds that contract. They continue to support the app.

 

SUSAN LEBLANC: There must be a contract for EY. They continue to support the app, but is there an end time to the contract where you might then go back out and look for a different provider? Or is it just in perpetuity?

 

MICHELLE THOMPSON: As far as we understand it, there is a contract that goes until March 31^st of this calendar year - the school year - and there would be an option in that contract to extend, if it’s required.

 

SUSAN LEBLANC: The Nova Scotia Health Authority also reported to the media that they contracted a firm named Think Research for work on the app. What is the work that Think Research is providing and how much is that contract worth, i.e., how much are they being paid for that work?

 

MICHELLE THOMPSON: Essentially, in a nutshell, the work that’s happening through Think Research is the patient navigation feature and also the chat tools. It really is around the development and management of clinical services workflow. If you go on the app and you get to the chatbot, that modality - for lack of another word - is what Think Research is supporting, and also the patient navigation portion of the app.

 

SUSAN LEBLANC: Can the minister tell me how much Think Research is getting paid for that work?

 

MICHELLE THOMPSON: There is $4.5 million allocated in the 2024-2025 budget.

 

SUSAN LEBLANC: According to the government’s own procurement database, Think Research was awarded $49.6 million through an untendered contract in February 2023. Obviously, $4.5 million of that is going to that aspect - the patient navigation feature and chatbot of the app - but what is the rest of the amount for and why didn’t it go to tender?

 

MICHELLE THOMPSON: As we mentioned, about 50 per cent is the YourHealthNS modality that we have, which we just talked about. The second project is the virtual urgent care that’s available to folks - the clinicians, the nurses, nurse practitioners, etc. - and the platform that it’s used. That’s where the $49.5 million comes from - the virtual urgent care and the digital front door and navigation services in the app.

 

SUSAN LEBLANC: Just to be clear, there’s the app stuff, which is $4.5 million, and then there’s the virtual urgent care, which makes up the rest of the $49.6 million?

 

MICHELLE THOMPSON: The total of that contract is $49 million, but it is actually over subsequent years. It’s not a one-year contract. In terms of the digital front door, it would be $3 million a year for five years; navigation services, $1.4 million per year. In terms of the virtual care, it is a subscription of $800,000 per year. Non-physician services are $1.1 million a year. On-call acute emergency-trained physicians is $1.2 million per year. There are various incidentals that could add up over time, with travel and things like that. That is the whole duration of the contract over five years.

 

SUSAN LEBLANC: That’s very helpful. Thank you for that breakdown. I guess the other part that’s unanswered is why was the contract untendered?

 

MICHELLE THOMPSON: The services were contracted through an ALTP process, which is under the Trade Act as a health services exemption. It’s a commonly used and accepted practice across Canada in terms of how health services are accessed. It was validly and legally negotiated through historically used processes in Nova Scotia. It is a valid procurement process available to Nova Scotia Health Authority and other health care organizations.

 

Really, when we look at access to care, when we look back over the last two years, we have to move fast. We can’t talk about not having access to care or bringing everybody - I mean, virtual care and urgent treatment centres are great, but if we have to bring people all the time to a place where it’s congested, we need to empower patients to be able to access this care on their own. Virtual urgent care - virtual access - has proven, for many people, to be a great way to access care. We have to move quickly. This has contributed to the 60,000 appointments that we have every month as a result of that. While it’s not for people who have more acute illness, it actually creates a different pathway, so that people of lower acuity don’t have to go to places like the emergency room. It really is important.

 

If we wait all the time - more, faster - I’ll tell you, I hear that in my sleep. We have to move. I will tell you that health care workers and patients appreciate it. They need us to get moving so that they have access to health care in a variety of different ways. I think the work that happened during COVID showed us that we can move quickly when we need to. Certainly, when we formed government, we knew we had to act very, very quickly in order to make sure that patients had access to care.

 

[4:30 p.m.]

 

This is a very valid process used regularly in health care fields. It’s within acceptable channels, acceptable procurement processes, and it’s an alternative procurement process that was used.

 

SUSAN LEBLANC: I want to turn now to travel nurses. I don’t know if you watched or if anyone was watching the Health Committee this morning, but there was quite a discussion on travel nurses. Janet Hazelton from the NSNU prefers the words “agency nurses” and I kind of agree with her because travel nursing sounds too glamorous.

 

First of all, I want to make sure I’ve got my head around exactly what happens with travel nursing. Permit me this - and please, honestly, I want to make sure I understand exactly what’s happening. We have a shortage of nurses in Nova Scotia, so we go elsewhere, to a temp agency for nurses, out of the province. We say we need five nurses for two weeks, or whatever. Then that temp agency charges the province money and then pays for those five nurses to come in for the two weeks, and presumably pays them slightly less than we’re paying for them because then there would be no profit margin.

 

Or is it that we just pay for the salaries of the nurses and then that company pays for the other things, in some other way, or gets their profit in some other way? I just want to make sure I understand the relationship between what we pay and what those nurses are paid. That’s my first question about that. Then we’ll go from there to make sure that we’re starting from the right spot.

 

MICHELLE THOMPSON: I don’t know off the top of my head, and we can check - there would be travel nurse companies where Nova Scotia Health would negotiate with these travel companies around what the costs would be. I don’t know if, in a proprietary world, they’d tell us what their margin is. It’s a private company so I don’t really think I’ll be able to tell you that. We do know there are things negotiated through that contract.

 

It probably does feel glamorous to be able to travel. We know, and certainly the premiers across the country recognize, that it is an issue. We do recognize that it’s a double-edged sword. While we need these travel nurses to help us keep organizations open, we also know that in many ways we are cannibalizing our workforce and each other’s workforces as a result.

 

I won’t be able to tell you what the margins are for the company but obviously, it was a competitive market, and the hope is that as we continue to reduce the reliance on travel nurses. There was a ministerial directive in December 2023, by both the Minister of Seniors and Long-term Care and me, to call on our providers to really reduce and change the way in which we utilize travel nurses in the province. We need that to happen across the country.

 

We know there is interest in that. We’re seeing across different provinces that they’re wondering what we’re up to, how it’s going. They also recognize that we need to really look at the workforce.

 

We’re grateful to those travel nurses because they assist us in keeping facilities open and providing care to Nova Scotians. We also know that it’s really difficult for Nova Scotia-employed registered nurses to be working next to a colleague who perhaps doesn’t know the facility or perhaps has a different background and is actually making more.

 

We are trying to work through that. It’s a difficult nut to crack, but we are committed to cracking it. Certainly, there will be more to say in terms of the effectiveness of our ministerial directive and how we support our own facilities in getting off the reliance on travel nurses.

 

SUSAN LEBLANC: I don’t think we need to know the margins. I just wanted to make sure that I understood the relationship. It’s like a temp agency for nursing.

 

The fact is that we are, as you say, cannibalizing our workforce and the workforces of other places. We’re also paying public money into private health care companies that are making a profit in some way. That always concerns me. I want to talk about this some more, but I do have a couple of specific questions about travel nurses, or agency nurses, in Nova Scotia before I get to the bigger nut, as it were.

 

Maybe this is part of the ministerial directive that the minister was just talking about, but on December 15^th, the change was made that travel nurses could be hired for a maximum of 180 days. Then the news release stated that travel nurses may choose to take permanent assignment in Nova Scotia or continue to work as a travel nurse in another province after the 180 days.

 

First of all, is that part of the directive that the minister was just talking about? How many travel nurses worked in Nova Scotia last year?

 

MICHELLE THOMPSON: I’ll just go through the bullet points in the ministerial directive if you’d like kind of an outline. “Once a travel nurse has been assigned by any agency to work for one or both health authorities or the long-term care sector for a total of 180 days, no agency may assign the travel nurse to work for either health authority.” They have a 180-day window to work:

 

The health authority must not be prevented from offering permanent employment to any travel nurse at any time.

 

The agency must not assign work to a health authority a travel nurse who has been employed by a health authority or any person operating in the long-term care sector at any time within one year prior to entering into a contract with the agency until one year has elapsed.

 

The agency must not assign work for a health authority a travel nurse who has graduated from a Nova Scotia nursing program within one year.

 

No expenses shall be required to be paid by the health authority in respect of pets, including accommodation for pets.

 

There were some individuals who were receiving money for boarding pets: “The health authorities shall, subject to the terms and conditions of any,” et cetera. We can offer them work if they want to come and if we want them to come and work with us full-time. Those were the top lines of the ministerial order.

 

There were roughly 350 travel nurses working in Nova Scotia at any given time as of January 1^st is what I would say. The IWK Health Centre does not currently use travel nurses.

 

SUSAN LEBLANC: We heard today at the committee that there was something like $70 million spent on travel nursing last year. If the minister can confirm that that’s the right number, that would be great. How much does the province anticipate it will spend on travel nurses this year?

 

MICHELLE THOMPSON: As of January 1^st, we’ve spent $76.1 million in the current fiscal year on travel nurses.

 

SUSAN LEBLANC: What’s the budget line for the budget that we’re currently debating for the coming fiscal?

 

MICHELLE THOMPSON: We budgeted $80 million this year.

 

SUSAN LEBLANC: Since the announcement in December, have we seen a shift in the number of travel nurses working in the province? Have we seen any evidence that some of those nurses are coming and staying and taking permanent jobs?

 

MICHELLE THOMPSON: It’s really only been two months since we put the ministerial directive in. We have 180 days in order to be able to see, so I can’t really tell you about the impact.

 

What I can tell you, just as an example, is when we offered the bonus to have nurses come back into the system, we know that there were a number of people - we have Nova Scotia nurses who are also working for travel companies, so we were able to attract about 148 people back into the system. Perhaps not all travel nurses, because we don’t know where everybody works, but what that allowed us to do specifically - out of those 148 about 35 of those were for really hard-to-employ areas, so we would look at critical care areas, places like that - ORs, ICUs, emergency, et cetera.

 

There’s a number of things that are happening, and we’re really pleased with the contract that was settled with nurses. We feel that that also will be a good benefit when we’re recruiting folks back or recruiting people from travel companies.

 

SUSAN LEBLANC: I guess we get to the big nut then, in travel nursing. The minister has said that she and the department acknowledge that this is a real issue. Other health ministers acknowledge that it’s an issue. The nurses’ union acknowledges this is an issue. Several times the nurses’ union has suggested, and we talked about it again today, this idea of a provincial locum system, where provincially paid and contracted nurses are able to work in other parts of the province with their expenses paid and that kind of thing.

 

For people who enjoy the lifestyle of travelling and doing some time here and some time there, the idea would be that nurses who live in Parrsboro could go down to Yarmouth to work for a couple of weeks, if there was need in Yarmouth, or whatever.

 

We know this is happening in Labrador, it’s expanding to all of Newfoundland and Labrador. We know that Manitoba is looking at this. What is happening in Nova Scotia when it comes to this idea? I guess the best way to describe it would be a provincial nurse locum program.

 

MICHELLE THOMPSON: I would say that the discussions in regard to travel nursing within the province - whatever it is, an agency - would be limited to date. We really have looked at the workforce overall. We have the Office of Health Care Professionals Recruitment. There has been no workforce planning done, really, for the whole entirety of my career. I graduated from nursing school in 1992 and we knew then that there was going to be a nursing shortage, and everyone assured us that would never happen.

 

There are a couple of things about that. I know that in certain zones, as an example, sometimes we would have a float pool position, where nurses would be hired into a float position where they would work. There’s a regional site and then there are several more rural sites in the zone.

 

I wouldn’t say that’s been hugely successful to date. We really are looking at increasing the supply. We have increased the number of nursing seats significantly. We’ve added a nursing program with designated seats to improve representation across the health care system. A lot of the seats have earmarked - at Acadia University specifically - that a good portion of the seats will be for underrepresented communities because we really do need to make a significant change as well in terms of representation.

 

[4:45 p.m.]

 

We looked at the LPN seats, broadening LPN seats. We have looked at the Patient Access to Care Act, making sure that if you’re registered in another part of the country - particularly if you have gone away to work - that it’s really easy for you to transition home and come back and work in Nova Scotia.

 

Also, the college has done an incredible amount of work looking at seven different countries - making sure that the education is equivalent and then allowing people to come with their credentials and then be socialized and trained in our system. We really are looking at increasing the number of individuals - that’s recruitment and training - but also looking at retention, so really working very hard around nurses’ quality of life. There were some negotiations where we’re looking at nurse wellness. We are looking also at nurses’ security issues - all of those types of things around work-life balance to make it a very attractive place to work.

 

Also, Nova Scotia Health in particular has started, probably about a year ago, doing stay interviews. Rather than waiting for someone to leave and doing exit interviews to find out why they left, we want to talk to the staff - not just nurses, a number of people - to understand: Why do they stay? What makes them stay? What else can we do? That’s obviously sometimes very site-specific, but there are things that are general for the entire system.

 

SUSAN LEBLANC: I appreciate all of that around the increase in supply. There are a couple of things I want to say in response to that. One of them is that we are doing a lot of things. I totally agree with you and acknowledge that we’re doing a bunch of things, as you have just listed, to increase supply. While we’re waiting for those new nursing grads to get through school or to get the folks who are coming from international places, we’re still paying travel nurses.

 

I wonder if there has been any kind of analysis on the amount being paid out to agency nurses or travel nurses versus what it would take to make staying in Nova Scotia more attractive, like the $10,000 bonus, or just a better hourly wage or whatever - more vacation days? I know that’s all collective bargaining stuff, but is there thought to that? If we can save this much money from travel nursing, we could put it into the collective bargaining process and make life better for nurses all across Nova Scotia. Has that analysis been done? Is that in the thinking of how we retain our workforce once we get them?

 

MICHELLE THOMPSON: That’s really always happening. In terms of analysis, there’s a broader analysis. Workforce development happens in the Office of Healthcare Professionals Recruitment in collaboration not only with the college and the colleges but also with the employers. The travel nurses bring net new nurses. While there are some Nova Scotia nurses who travel with those companies, it also brings net new nurses from other places to come and work in the province. That’s really what we need. We need net new on top of the nurses and other health care professionals whom we already have. While we want to phase them out and attract people, we also have to increase recruitment, because if we don’t, we’re just moving people around in the same space. We’re not actually fixing the problem, which is not enough people.

 

Right now, we do know that - we don’t know the percentage. We know that there are some people who are Nova Scotia nurses, who live here and work for travel companies. We really do need to increase the supply of nurses. That’s why it’s so important for us to look at immigration, in-migration, and training, and really pushing our university partners to understand what is the most important aspect of getting a nursing degree, looking at the LPN program, looking at CCA programs where people have propensity for care and how do we also bridge people.

 

If they have come into the workforce as a CCA, and that person wants to bridge to LPN, how do we support that in happening? Again, we need net new people all the time. As a CCA transitions to LPN, we need more CCAs to come in behind that individual. It is a constant supply and flow.

 

The nursing program changed in the 1990s, and it certainly had an impact - not right away, but if you graduate nursing at 20, and you work for 40 years, you’re 60 years old, and you’re able to retire with a full pension because of the work that you have given, the care that you have provided for the course of your life. We knew that was coming. There was no work in the 1990s, if you can believe it. I have two classmates who live in Nova Scotia. From my class, everybody went to Maine, Texas, and everywhere else and worked further afield.

 

It really is about increasing supply. It’s important from an economic development perspective. When we go out and speak in community, I tell people everywhere we go, there’s a hospital, a pharmacy, or health care services of some description in almost every single community in Nova Scotia, so we want young people to work here. If you live in rural Nova Scotia, particularly, what a great opportunity for you to be able to live and work in your community. A health care worker is now data analysis and industrial engineering. It’s so broad because of the complexity of the system that we work in. We’re really trying to promote it as a viable and important income across the province for students, so people don’t have to go away anymore to work.

 

SUSAN LEBLANC: I feel your pain, because when I graduated from acting school, there were only two people who stayed here. That’s a whole different story, but I was one of them.

 

Seriously, when we’re looking at retention, at making bridging attractive, and that kind of thing, we know that, in some cases, CCAs are having their tuition and books paid for. What about people who want to transition from LPN to RN? I’ve heard from people I know in Dartmouth who are doing this and really putting their lives on hold to pay for that extra training or that bridging training. Why aren’t we financing them? If we need more RNs - which we do, we need more everything - we do need more RNs, and we do need more LPNs, why are we not financing the training for people who are already working in the system?

 

MICHELLE THOMPSON: There is some work that’s happening. There is a $5,000 incentive through Nova Scotia Health for LPNs who are transitioning from LPN to RN.

 

I will tell you that I graduated from a diploma nursing program. I had to do my entire degree. I got zero credit for my years of experience as a registered nurse. I spent $20,000, and I was a registered nurse when I started. One of the things that’s been important is that they now give people credit for the time they’ve worked. Now when you go into registered nursing programs as an LPN, you have time taken off, but it is a bridging program. The fact that people are being recognized for their knowledge and their experience is an important part around shortening that.

 

There is some work that’s under way. For registered nurses in some cases, there are programs for individuals in hard-to-employ areas, where registered nurses will be supported through the nursing strategy to become nurse practitioners, but it does come with a return-to-service agreement. It is important that people go into that knowing that the expectation is that once the nurse practitioner program is completed, you will work in a rural community, as an example, or a community that needs primary care for a period for that return to service.

 

There are several things - these are some of the things the Office of Healthcare Professionals Recruitment is looking at. When we look at pay scales, it’s also important to consider the investment, people’s ability to make a wage afterward, and what that wage is. As a result, we’re pleased with the contract we’ve settled with LPNs, RNs, and nurse practitioners to support them. There are also some debt relief programs through the federal government. Trying to leverage all those things in order to help people attain education.

 

SUSAN LEBLANC: Do you know how much it costs? If you are an LPN and you want to go and become an RN, do you know how much that costs? That’s a genuine question - $20,000?

 

MICHELLE THOMPSON: I really don’t. I guess it would depend. I think that’s one for the Minister of Advanced Education. There’s the tuition, whether you live at home or you live at school – there are just a million factors, whether or not, so I really don’t have a number for that.

 

SUSAN LEBLANC: Anyway, my point is that $5,000 is not that much when you think about it. It’s better than nothing, but is there any consideration, given that, if you are a primary care nurse, family practice nurse - we know there are 150,000 people on the wait-list and we know that all across the province needs support in primary care clinics, health homes, et cetera. If that’s goal, which I think it is, then what if there was a return-to-service agreement? What if people could get financed to become RNs if they’re going to work in family practice?

 

I do believe that the office and you, as the minister, are looking at all angles, so can we look at that one?

 

MICHELLE THOMPSON: I would say that work is happening all the time and is under way. There has been a lot of action that has been taken. There is a provincial nursing strategy that helps recruit and retain nurses through orientation. We have mentorship programs. It’s not that there’s no investment. There’s been significant investment in the nursing profession.

 

Also, some of that professional development is covered. There’s a lot of support for nurses in the system. If you’re going into a specialty area, as an example, very often the program you require in order to work and maintain your specialty or to receive your specialty is actually covered by the employer. Family practice nursing isn’t just nurses going into that: It is experienced nurses. Several years ago - I can’t say for sure today that there’s still a program, but there was a program around family practice nursing.

 

Some of this professional development is already covered. I don’t think it’s just one thing. We do have entry-level nurses who are coming in and there is an investment and a long career ahead of them, of course, for that return on investment. We also have to look at how we support our mid-career and end-of-career nurses.

 

What I would say is that when we look at some of the data nationally, from when I was teaching nursing, we know that a lot of people leave the profession in the first five years. There’s a significant investment in our novice nurses, in terms of making sure that they have senior nurse support, at-the-elbow support, whether that’s by phone or in person, to make sure that their transition into practice is really well-supported, which it wasn’t always.

 

Sometimes when people graduate there’s a period of time, an extended orientation program, because perhaps they’ve been able to work in simulation labs and they’ve learned about things but haven’t been able to put all those skills together in a clinical environment.

 

I would say that across the work span of a registered nurse or an LPN or a nurse practitioner, a number of real-time and in-time supports are created in order to support the workforce. We get lots of feedback. There is a provincial nursing network where universities sit, the Department of Health and Wellness, the Nova Scotia Health Authority, the IWK - all of these leaders in nursing sit together and talk about ways in which they can support the profession and things that we can do better. Believe me, there’s lots of discussion ongoing all the time around how best to support, recruit, and retain the workforce.

 

[5:00 p.m.]

 

SUSAN LEBLANC: I want to go back quickly to the retention bonus. When we were in Estimates sessions before March Break, I asked you about - I think I did, anyway - why, for instance, the health care workers at the North End Community Health Centre wouldn’t be getting the nursing bonus because their funding largely comes from Nova Scotia. However, for the department, I believe your answer was that there has to be a cut-off and they are not technically employed - the employer is not the Nova Scotia Health Authority, et cetera. I just wanted to come back to that for a minute.

 

Since then I’ve had another constituent contact me who is a Nova Scotia Health Authority employee who is fairly new to the nursing profession but has worked casually for the first year and now is working full-time but is not eligible for the two-year I-promise-to-work-for-two-years $10,000 bonus. Again, it is this discrepancy where it feels like colleagues working together are not being treated the same way. That is the Part A.

Part B is that I came across an article yesterday - now I can’t find it, but I am pretty sure I can - that said that long-term care nurses were getting the $10,000 bonus. And they don’t work - they are employed by Shannex, so they are not employed by the Nova Scotia Health Authority. So how come they, as non-employees of Nova Scotia Health Authority, are able to get the bonus and someone like a nurse at the North End Community Health Centre wouldn’t be able to?

 

MICHELLE THOMPSON: I will give you a bit of information on who was eligible. In order to be eligible this year, you had to receive the recognition bonus last year; you remained employed in a knowledgeable position, working more than casually. So it had to be an FTE. Whether it was a 1.0 FTE or a 0.4 or 0.2, you would be compensated based on the complement that you held for a permanent full-time position. You had to be employed by an eligible employer in an eligible position and be willing to sign a two-year return-of-service agreement for March 29, 2024.

 

That really is the broad swath of people who are working in Nova Scotia health. In terms of the question, I think I know why nursing homes are included, but I really would rather have the Minister of Seniors and Long-term Care answer that because it does sit under her department, and I don’t want to misspeak on her behalf.

 

SUSAN LEBLANC: Respectfully, it does not make sense to me that the eligibility for this year would be that you were eligible last year because this is exactly why the person I am talking about - the person who contacted me - is not eligible. Because last year she was casual, this year she is working full-time, and she’s planning on staying. It seems bananas to me that the eligibility for one year would depend on eligibility for the year before. Is it not the point that we are trying to convince people to become full-time employees and sign on for lots of years? Thoughts?

 

MICHELLE THOMPSON: It’s preferable that individuals speak to their employer directly about their eligibility. It’s really hard, when you don’t have all of the information, to speak directly about a situation. You don’t want to offend anybody, but there have to be criteria - inclusionary and exclusionary. I know that there are a number of people who are not eligible based on last year, if they’re newly signed employees. We’re trying to extend to people and ensure that there’s stability over the next couple of years.

 

There are also sign-on bonuses in some places. There’s a number of different incentives that are happening. I appreciate that it’s always difficult for the outliers who don’t meet the criteria. It’s hard to have lines, but we have to have lines. The eligibility criteria were listed, and there’s no movement afoot to change that.

 

SUSAN LEBLANC: I only have seven or eight minutes in this round, so I would like to ask a couple of loose questions from various topics.

 

Diabetes Canada finds that Nova Scotia has high rates of individual-level modifiable risk factors. One of the factors they highlight is that 75.8 per cent of adults in Nova Scotia - including this one right here - are not eating enough fruits and vegetables. Is the department working on a strategy to reduce the occurrence of diabetes, in particular in terms of healthy diets and that kind of thing?

 

MICHELLE THOMPSON: There’s a number of things that are happening. Solution Six is really important. It is around the determinants of health, and it looks at what are the things that affect health. We know, through work that was recently done within a partnership with Novo Nordisk, which I’ll tell you about in a minute, that 67 per cent of Nova Scotians 12 years of age and older have one or more chronic diseases. We know that 37 per cent of children and youth in Nova Scotia are overweight or obese.

 

We really need to look across sectors at how we’re going to tackle this. It doesn’t just sit in health; it sits in the education system, in the municipalities around active transportation and the work that happens with MPALs. It sits in the Department of Seniors and Long-term Care.

 

We do have a program with Novo Nordisk, a foundation that has a subsidiary drug company from Denmark. They were involved with developing insulin. They worked with our own Canadian physicians to develop insulin. Their primary goal is to eradicate diabetes. When we were in Denmark, we learned a lot about that work. Novo Nordisk is partnering to help. They have a program called Lighthouse Consortium on Obesity Management that’s over there marrying health and wealth. We have just entered an agreement with them.

 

We will be going out to RFP - not just for government but for private industry and municipalities to come and work with us on projects out of a $3 million pot to positively impact obesity in children. We need to look at how we marry that. There has to be an economic driver behind it in order for us to really have an impact across the community but looking at a variety of different things. We have to work across government, looking at best practices in some organizations. The school food and nutrition program will be really important. We have a school Food and Nutrition Policy for Nova Scotia Public Schools which mandates what can be best served to students in our school system.

 

We know there are guidelines around physical activity. We want to start to have conversations with Nova Scotians that, yes, there is a genetic predisposition. Of course, we now know about epigenetics. There are opportunities through behavioural interventions that support people, but we need to enable them. We can’t blame people, right? We have to be really careful, but we need to make sure that we create environments where we enable people so that the healthy choice is the easy choice.

 

It’s very top of mind, I want to assure you. We’re working across government in a variety of different departments in order to address it. It’s going to be a generational improvement, for sure, but we absolutely are committed to starting at pre-school and right across that childhood span to support health and well-being.

 

SUSAN LEBLANC: With my last little bit of time for this section I’ll just do my tirade on sugary drinks. It just makes me crazy when I see in municipal recreation facilities pop machines or, if there’s no pop, they’re filled with juice or power drinks, or whatever those are called - like Gatorade, or whatever that’s called - thirst-quenching drinks. They’re packed with sugar.

 

I will tell you that as a person who has tried and feeds my kids pretty healthy food, the battle against Gatorade after a hockey game is a real thing. I know everyone needs to have choices and all that stuff, but to ban that stuff from schools or public buildings or whatever - we’re putting period products in public buildings; why can’t we take Coke out of them? You know what I mean? It just seems like low-hanging fruit for the health and well-being of our society.

If people want to buy them, great. I buy pop for my kids and we have it at home - but it’s like a public battle. It’s everywhere. It’s at every grocery store aisle, it’s in every pop machine. It’s really bad for the health and wellness and the economy of this province. With that little tirade I will take my seat, and I look forward to asking another hour of questions in an hour.

 

[5:15 p.m.]

 

THE CHAIR: Order. That concludes our time for the NDP. We’ll now move into the Liberal round of questioning.

 

The honourable member for Bedford Basin.

 

HON. KELLY REGAN: I think we’ll probably move on now. Earlier today at the Health Committee we did hear about physicians leaving. I think it was 31 who had left so far this year. It was a lot when you compare it with last year. I was just wondering if the minister had any insight into why we had so many leave in that short period of time. I think it was the first two months. What’s being done to ensure that doctors are staying and what are we preparing for in the upcoming slew of retirements? The baby boomers are retiring.

 

MICHELLE THOMPSON: From April 1, 2023, to January 31, 2024, there were 44 family physician starts and 31 family physician departures, 20 of which were due to retirements, across the province. That was a net gain of 13 family physicians province-wide. You can break it down in different ways, but from January 19, 2023, to January 18, 2024, there were 595 family physicians whose primary billing location was Central Zone, and that number has remained consistent since 2021. We have had a net gain of 47 nurse practitioners in the last two years.

 

There have been other investments, though. Since May of 2023, we have actually prevented more than 28,000 patients from going on the Need a Family Practice Registry because we were able to invest in practices. Part of that is through the hotline. There have been some changes, too, at the college. We know there are around 20 American physicians licensed since making the American Board-certified physicians eligible for full licensure in Canada. Licensure is the first step to moving. You need to make sure that you can work here before you come here. That work has happened with the college. The folks who are on the list - not all are static. We know that there have been almost 46,000 people who have been removed from the list and placed with a provider from the Need a Family Practice Registry in 2023-2024.

 

In terms of what we are doing, there is a new contract with better pay and new compensation models for physicians. That was developed through interspace negotiations, which were very successful and positive. We’ve increased the physician incentive budget. We expanded the incentive program to include Central Zone, reduced red tape for physicians. We are extending virtual care options. We added new positions like physician assistants, as an example, to care teams. We’ve created the Atlantic Physician Registry. We’ve increased the number of medical school and residency seats, supporting new graduates and doctors to establish their practices through incubator clinics like we see at Dalhousie Family Medicine and like the model that we are always so proud to talk about in Clare.

 

We have faster licensure for internationally educated physicians. Our Patient Access to Care Act allows physicians who are registered in other parts of the country to come and work here. We are also looking at how we utilize our physicians. We are expanding scope of practice for other professions.

 

As an example, we are piloting family practice anaesthetists in Yarmouth just to see how we can create and keep a more novel practice for physicians. If they have a special interest, we want to keep them in family practice, but maybe you can do a bit of obstetrics, maybe you can do a bit of palliative care, et cetera, so that we can give people some options. Also, investing in health homes because our new physicians want to work in a different environment than perhaps some of our more senior physicians.

 

KELLY REGAN: Keeping the same number of family doctors doesn’t work when your population is growing and when family doctors are not taking the numbers of patients they used to. It ends up being that although we may have roughly the same number of family doctors, we need more family doctors because the ones who are in the system now are not taking as many patients as they used to, and we have had an influx of people into the province. We need to make sure that we actually have the services that our current population has, but also the newcomers, because we want to set people up for success.

 

I appreciate everything that the minister had to say. I would just like to say those incubator clinics sound terrific and it sounds to me like we need more of them throughout the province. What we hear is that new doctors come in and they don’t want to go through setting up a practice and dealing with all the billing and all of that stuff. It would be really great if we could have some more like that outside of just Halifax.

 

The other thing I will say, too, is that the weekend clinic at Cobequid Community Health Centre - and I think I touched on this last time, but I just really want to make sure I mention that - having that available Saturdays and Sundays for a population that has experienced a 400 per cent increase in the number of people without a doctor, having that available to people on the weekends is huge, not only for people who don’t have a doctor, but for people whose doctors don’t practice on the weekend. There are a lot of people like that, and a lot of the walk-in clinics have closed down, so having that service is really valuable. I feel like if we had some more of those during the week, life would be better.

 

It would be better still if patients could be attached to doctors at those clinics because there are still too many people throughout Halifax Metro who just simply do not have a family physician or a nurse practitioner. I think that’s probably the last thing I’m going to say on that because I’ve probably talked about that a fair bit since we began Estimates two weeks ago.

 

I thought maybe I would move on now to the issue of rural emergency rooms. This past December, the Annual Accountability Report on Emergency Departments came out for fiscal 2022-23. It reported that emergency departments across the province were scheduled to be closed for 37,890 hours that year. In fact, Nova Scotia ERs were unexpectedly closed for 41,923 hours that year. All told, that was over 3,000 days of closures. The unexpected closures increased substantially from the year before. I’m just wondering: What was the cause of the increase?

 

MICHELLE THOMPSON: Nova Scotia Health operates 30 emergency departments and eight urgent treatment centres across the province. We also have St. Anne Community and Nursing Care Centre, which is a long-term care facility and operates as an urgent treatment centre as well. What we’ve seen is a decrease in the scheduled closures. It’s been very important, particularly in our rural communities, that we work with the available clinicians to schedule hours. The primary reason that we see emergency department closures is a couple of things, but always staffing, predominantly physician staffing.

 

We also see in some rural communities that we have some are more senior physicians who want more predictable hours, so that develops into more predictable scheduling of emergency departments, appreciating that emergencies are not schedulable. Where we can, we have urgent treatment centres as well. We know that the majority of things that come to our sites are very often able to be addressed through urgent treatment. We even look at things like lacerations that need suturing. We may have very simple fractures, et cetera.

 

We do also have some nursing shortages. It’s a very daunting environment to work in. Nurses have many skills, but I will say that working in an emergency department - particularly in a rural emergency department - is very different. The work that I did in Guysborough and the worry that I experienced when I worked at Guysborough Memorial Hospital emergency versus when I was able to work at St. Martha's Regional Hospital was a very different environment because of the supports that are available, obviously.

 

Our emergency system has changed as well. There are things that historically went to our emergency departments in rural communities that no longer need to go there. It’s not best practice. I use the example all the time of stroke. If you have stroke symptoms, we actually want you at the most immediate regional hospital in order for you to have diagnostic imaging to make sure that you get the care you require and go to an intensive care unit or a stroke unit. Similarly with trauma, there are different levels of trauma emergency departments. The bigger the trauma, we actually want you to bypass our smaller sites because we want you to have access to a trauma team and ultimately to the tertiary and quaternary services in the city. That allows us to do that diagnostic imaging lab, resources, and all those things.

 

Physician availability is the single most difficult resource we have. In days gone by, our more senior physicians were trained in a different way. They ran the emergency room, they did a little bit of everything - but our new emergency room physicians require a different type of training. We are working across the province to support physicians who have that skill set and, where we can, train them in a regional environment and support them in those community clusters.

 

We do see an increase in the unplanned closures. That generally is related to an illness or something that comes up - occasionally nurses, but often physicians. The urgent treatment centres have been an excellent option. I will say the emergency services - we are looking at that continuum. What is our ability to support different modalities in different places?

 

In Canso, for example, they have a model where extensive training is done with the nurses through the Medical Communications Centre in that week when the physicians are not in community at all, in addition to the support that is available to them through Guysborough Hospital and St. Martha’s.

 

We have to work in community. It starts with recruitment. It really is around supporting a practice and making sure, when people come to work in rural environments particularly, they understand the complexity of doing Level 3 emergency room type of care.

 

The last thing I’ll say - I’m sure there’ll be other questions - is one of the things Nova Scotia Health Authority and health care workers in this province should be very proud of is that we’re one of the only jurisdictions that has never had a disruption in our regional hospital emergency rooms. When we look at colleagues in other jurisdictions across the country, they’ve had disruption in their regional hospitals. I will say that there are times when there are resources in smaller emergency rooms that are reallocated to our regional hospital sites for just that reason - access to diagnostic imaging, lab testing, ICUs, and specialty services like internal medicine and surgery. There have been times when we have had to reallocate resources to different areas in order to support the regional site in maintaining the care they provide.

 

KELLY REGAN: To be clear, what the minister said was there are times when we must take from the smaller centres and bring them into the regional centre. Otherwise, we’re going to have a regional centre shut down. I’m assuming that serves more people and higher acuity. Okay, so we need to do that first. It’s like putting on your mask on the airplane when it drops down before you help somebody else. Thank you for the clarity on that.

 

Do we have any idea what the emergency room closure numbers are looking like for this year? Can we expect the planned ones to come down? I realize it’s hard for you to know whether the unplanned ones will come down. We’ll get those numbers at the end of the year, but the planned ones - are those coming down?

 

MICHELLE THOMPSON: I can tell you that in 2022-23 the total hours of closure were 79,813. Year to date, at the end of January in 2023-24, our closures were 53,424. It appears to me that it is trending to be fewer hours. However, I don’t have this quarter, so I don’t want to tell you something that is not accurate, and I don’t have quarter over quarter. I’m hopeful that it’s going to either hold or be a little bit lower. That would be what I would expect. Again, until the last quarter information is in, I really can’t guarantee.

 

[5:30 p.m.]

 

KELLY REGAN: Could the minister point to some specific investments that are being made to keep emergency rooms open?

 

MICHELLE THOMPSON: In emergency care initiatives overall, there’s $8 million that will be invested this year additionally in the budget. We would look at a couple of things that I would point to specifically. There is a bundle to support emergency care, which would include new positions, looking at different service planning and care delivery models.

 

Last year we made a number of investments in the emergency room, looking at physician assistants, looking at nurse practitioners, waiting room advocates, and care providers. All of those things will continue. We have the off-load teams, the FLOAT MD, et cetera. Those things will continue, but we are looking at the different models.

 

We’re also looking at virtual emergency care for individuals with less urgent needs in order to support folks. We also are investing in a trauma consult service, as well. Again, I don’t think there is just one thing. I go back to the contract. We are working with emergency room physicians as the contract continues to be around an accountability framework, supporting them in their practices, particularly in our rural communities. So there are a number of things under way.

 

What I would say as well is some of it is very site-specific. There are things happening at our bigger sites that maybe are not appropriate in our smaller sites, so we really do have to look at the environment we are in and the capacity and the skills and abilities of the workforce that is there.

 

I will tell you there is a mobile simulation unit, as an example, that travels around in the Eastern Zone particularly, that supports. Sometimes we have really high acuity but low frequency interventions in these rural sites, and it actually can be a deterrent for physicians, who maybe don’t insert chest tubes, as an example, or intubate on a regular basis. We do have an investment in mobile simulation that allows physicians and emergency room nurses to keep their skills.

 

It’s a high-acuity environment but the pressure is low, of course, because we are using a simulation environment and - I don’t think they are called mannequins anymore, but you know what I mean.

 

KELLY REGAN: Musquodoboit Valley Memorial Hospital’s emergency department was only open 39 per cent of its scheduled hours. That would be according to that particular report that came out in December. What will this budget do specifically to help keep that ER open longer?

 

MICHELLE THOMPSON: Musquodoboit Valley Memorial Hospital is an urgent treatment centre. It has been transitioned to an urgent treatment centre.

 

KELLY REGAN: It is an urgent treatment centre, so it is not an emergency department - it is just an urgent treatment centre. According to this report, it was only open 39 per cent of the time. What are we going to see in this budget that helps to keep that urgent treatment centre open?

 

MICHELLE THOMPSON: I will get back to you about that. I feel that there have been changes around stabilizing workforce in that area, and I don’t have that in front of me, but I will get back to you about the work that has been done there. In terms of urgent treatment, there is a virtual urgent care there as well, but I just realized I don’t have that exact document. I am trying to remember where I put it.

 

KELLY REGAN: I have a few other questions about specific ERs. I just looked the next one up to make sure it is still an ER so that I am not asking about something that doesn’t exist anymore. For example, the Strait Richmond Hospital - its ER was only open 42 per cent of its scheduled hours. I am looking to see what investments have been made there so that it can remain open more often.

 

MICHELLE THOMPSON: Again, we go back to staffing levels in some of these spots. We have introduced a rural specialist incentive bonus, up to $16,000 a year, for those practicing in rural Nova Scotia for three years-plus. So there are recruitment efforts underway.

 

And in Strait Richmond Hospital, they’re in progress. We are developing a virtual urgent care model there as well. There have been some changes there to support the staff in terms of offering urgent treatment when they are able. But again, we continue to look at how best to recruit to some of our more rural sites.

 

KELLY REGAN: Again, on the same theme, the emergency department at Soldiers Memorial Hospital was open during only 42 per cent of its scheduled hours. Is there anything in particular that’s being done for that ER to keep it open more often or longer?

 

MICHELLE THOMPSON: In regard to Soldiers Memorial Hospital, there has been work done there at the hospital overall. There is a new emergency room physician, who started at Valley Regional Hospital in January, who will start to cover shifts at Soldiers Memorial Hospital one day a week, hopefully to increase. There’s a new ambulatory care unit there that’s also helping patients to access care.

 

Working with the Mid Valley Region Physician Recruitment & Retention Committee and the Annapolis Valley Chamber of Commerce, we’ve invested in those community groups in order to support their recruitment efforts. They have a really robust and interested group in terms of supporting. There are primary care options there as well.

 

There are a number of things under way. We know that there have been emergency department closures, but again we go back to the availability of physician services and making sure that there are opportunities for people to access mobile care units, as an example, and also primary care services, when available.

 

KELLY REGAN: Staying focused on the Valley, this government closed the emergency department at the Annapolis Community Health Centre. Will the minister commit to investing in this emergency room so people can access the emergency care that they need? Or is there something in this budget that we don’t know about that will actually do that?

 

MICHELLE THOMPSON: In regard to the Annapolis Community Health Centre, in October 2022, it was actually converted to an urgent treatment centre. That was done in collaboration with the physicians. The physicians have been there a long time. They are much-loved. Working with them in order to stabilize access to urgent treatment centres, Nova Scotia Health Authority was able to find an urgent treatment model. It’s currently open Monday, Wednesday, and Friday from 9:00 a.m. to 4:00 p.m. And these are very consistent hours. Prior to that, there was an inconsistent pattern there.

 

Wherever we can, we want to improve or increase that. So at their community centre, they were about 1,608 visits in six months, and 83 per cent of the CTAS patients were Level 4 or 5. We continue to work with the clinicians there and continue to support attracting new health care professionals.

 

KELLY REGAN: So we have ambulances being turned away from Soldiers Memorial Hospital because there are no doctors, and the emergency room is closed. The Annapolis Community Health Centre no longer has an emergency room. Across the Valley the situation is rough. What is this budget doing to ensure that residents in Annapolis can get emergency care and aren’t stuck in ambulances - if they can get one - being driven around the province?

 

MICHELLE THOMPSON: I’ll talk a bit about emergency services. Some will be Valley-Western Zone specific, and others will be a bit broader. There have been significant investments over the past two and a half years, not only addressing deferred maintenance but trying to increase the workforce and trying to modernize the system. Overall, call volumes at EHS are up about 5.5 per cent over the past five years, which is significant. Of the calls that EHS receives, 30 per cent would be high-acuity calls, and 70 per cent would be considered lower-acuity calls.

 

[5:45 p.m.]

 

We’ve done a couple of things. I want to talk a bit about off-loads. The staffing access and flow work that has happened - looking also at supporting patients who are alternative level care, waiting for long-term care or community supports - there have been several investments.

 

A good story: Yarmouth emergency department had off-loads of about 60 minutes this time last year, but through the work and the investments of the SAFER-f bundle that I talked to you about and access and flow initiatives, we have reduced those. In January, that team in Yarmouth had their off-load times down to 37 minutes, which is impressive.

 

In February, that off-load time went down to 27 minutes - 10 minutes in a month, based on some of the new things that are happening there. That happens because we provide resources, but the team implements that and sees what works in their environment, so I want to give Yarmouth emergency department staff a shout-out. We are excited to see it. Of course, they are going to get a new emergency department, so that is going to be even more helpful to them.

 

We have talked about the clinical transport operators. I do think it is important to talk about the doctor in a box. We now have emergency room physicians working 24/7 in the Medical Communication Centre with EHS. We have supported them with a registered nurse, as you know, and there has been a senior paramedic working in that environment. That program has been so successful that we will be adding a second senior paramedic in that environment as well.

 

The RNs are experienced. They are wanting to utilize more of their skills, so you can anticipate that, over time, those nurses will expand their scope of employment. The RNs in the Medical Communications Centre answered 8,500 calls and were able to redirect a good portion of them away from - find different care pathways for them. The other thing that we’ve recently implemented is called the GoodSAM camera. The GoodSAM camera is a video link that can be sent to medical first responders and paramedics on the scene so the Medical Communications Centre physician can visualize. It’s like a video call, and it allows a physician in the Medical Communications Centre to see what’s happening in the area. It is a huge support, and we’re also supporting medical first responders in the rural areas.

 

About three weeks ago - three Saturdays ago - there was a medical first responder conference province-wide, which roughly 170 people attended. Dr. Andrew Travers and Jeff Fraser were working with those folks about how we can support them in the field, because we know they respond early in communities. There are new first responder packs that have been offered to them. There is wi-fi now on many of the fire trucks throughout the province to enable them. When we worked with Halifax Mutual Aid across the province and the Fire Service Association of Nova Scotia, we knew there were gaps in cellular service, so enabling the trucks with wi-fi has been an important communication tool.

We also have SPEAR units that are supporting the more densely populated areas. It is a single paramedic unit that allows one paramedic to go into questionable calls - not those where 30 per cent are those high-acuity calls. As a result of that, between four and six out of ten individuals have been diverted from being transferred. When we look at the quality of that program, less than 5 per cent bounce back to hospital because of that, and there have been no adverse events. That has been a really positive program in terms of supporting.

 

We will see that emergency medical responders - our first class of emergency medical responders is currently being trained. They’re going to work in off-load areas, where they would support patients and get our paramedics out on the road more quickly. They would also work together at times doing low-acuity calls. If the spare unit comes and treats a patient, and they need to be transferred, but they don’t actually need an ambulance, the emergency medical responders would be able to transfer these individuals. They’ll also work with paramedics on the trucks. We’re investing in equipment and spare unit supervisor trucks and a video link to support.

 

Recruitment: We have settled a good contract with our paramedics, and we’re pleased to have been able to do that. Recruitment is a top priority. The company and some members from the department recently had a mission to Australia, where there’s an equivalent program. That has been very successful in other provinces. They have some really good leads. The new chief operating officer of EHS is really pleased with that trip and had around 25 - I think - “bites” on paramedics. We’re training more paramedics. We have expanded the program. There’s one in Yarmouth, with a tuition rebate.

 

There are a few more things that I could go on about. I just want to reassure folks that we really are investing in pre-hospital emergency care and also in the clinical transport operators.

 

The other thing we have done as supports, I’ll just say, is the plane. We have a fixed wing now that will support patients who need to come into the city from Yarmouth and Sydney and come in for tests or procedures or whatever it is. That actually has put over 5,000 hours of ground ambulance back into the system.

 

We really do have to focus on our regional hospitals. When our regional hospitals get tied up, the impacts are felt rurally. So, that starts with the mothership, the QEII Health Sciences Centre. There’s a lot of work happening around off-load and access and flow there which inevitably will support the rest of the province, and then if we vote to form a hub and spoke, similarly, different interventions in our regional sites across the province.

 

KELLY REGAN: We have been hearing about people who have been taken from, say, Sydney to Halifax for tests, and they’re released there, and they’re told to find their own way home. They’re in a johnny shirt. They’re not dressed appropriately. They don’t have anyone who lives here. They’re just kind of left there. All of what you have just told me sounds great, but we also have to think about the human side of this, which is that you can’t just take somebody four hours from home and say, Goodbye, get your own way back. If they were sick enough to be flown in a plane, they probably shouldn’t be going home in a johnny shirt, sticking their thumb out trying to get home. I do want to leave that with the minister. We have heard of cases like this here in Halifax, where people are just left.

 

MICHELLE THOMPSON: I think that speaks to the work that’s happening in Nova Scotia Health Authority around our access-and-flow teams, really looking at discharge planning. Part of SAFER-f is not about how long a patient is in hospital, which is what we have talked about through my entire career, but it’s actually about how long a patient is away from home. I think the key to that sits in discharge planning and the expectations of families’ ability to pick folks up. We have heard that. I have heard that throughout the course of my career.

 

Patients go for a diagnostic procedure in the city and they’re discharged from the city. How do we make sure that families understand what the potential outcome is before people leave? In the event that people don’t have family, what are the alternative ways in which they can be transferred home? We do have transfer units now, but we also need to make sure that we’re communicating really clearly with families about what the expectation is and what the potential issues are around discharge.

 

If you have a stress test and you pass it, you may be discharged directly from Halifax. It’s perhaps a communication issue. That has happened historically over a number of years in my career. That does start with discharge planning, making sure that we have good supports in place for patients as they go outside of their regular hospital.

 

Similarly, there are people who are discharged home from local community hospitals, and for a variety of different reasons, transportation is an issue. It really is about knowing the patient and making sure that we work with them and their loved ones in order to support them in having a dignified discharge and transfer back home.

 

KELLY REGAN: I like what the minister said about a dignified discharge, because I think there’s nothing particularly dignified about being ushered out the door and told to find your way home. I am sure it happened under duress, and we are hearing it’s happening now. Now, with the fixed wing, it’s an even greater distance because it used to be it was your community hospital that was closing for the night, et cetera, and they were saying, You can’t stay here, and that kind of issue. Now it is literally people being flown great distances and with no way home, no money, no clothes, and they have to get home.

 

I think that is something we need to ensure isn’t happening to Nova Scotians, because needing a test so desperately that you have to be flown to Halifax for that and then being discharged like that must be a deep concern. There’s money involved and quite frankly, not all Nova Scotians can afford a trip home, whether it’s on a bus or via taxi or whatever. If they have to buy clothes on top of that, it would be very expensive. I am just hoping that people will be very sensitive to that particular concern.

 

We are also hearing from residents in Baddeck and they are calling for the Victoria County Memorial Hospital’s emergency room to be reopened. Is there any commitment in this particular budget to actually do that so that folks in Victoria County can access the emergency care they need?

 

MICHELLE THOMPSON: I would say Baddeck is in a very unique situation. There are a number of physicians who work in Baddeck. Currently they are operating under an urgent treatment model.

 

The reason they have moved to that model is that the physicians currently feel that they are not able to work in that emergency department, so we do really need to look at a resource plan. There is a community liaison committee that is working in Baddeck with Eastern Zone leadership, local leaders in the community, and certainly some local community members, problem-solving. There is significant access to primary care in that area.

 

Again, there are some part-time physicians there, et cetera. The commitment is to - we’ve heard from them, I have connections in Baddeck so I hear on a regular basis, as I do through my colleague from Victoria-The Lakes. I want to assure the folks in Baddeck and surrounding areas that there is a commitment to reopen that emergency room and we’ll continue to work in community with them and with the physicians in order to find a solution.

 

KELLY REGAN: During the 2022-2023 fiscal year, more than 10 per cent of patients left emergency rooms throughout this province without being seen. This is up quite a bit from the year before, even though overall emergency room visits were apparently steady. Does the minister find that concerning - that 10 per cent, and the increase?

 

MICHELLE THOMPSON: The left-without-being-seen percentage has stayed relatively the same. The number of patients who left without being seen in 2022-2023 was around 10.4 per cent, and it was the same in 2023-2024 year to date.

 

We are seeing a reduction in the patient visits from the previous fiscal year to our emergency departments. I think that’s a testament to the 60,000 primary care appointments in different pathways that people can take. I can’t cross-reference the numbers in my head, but I wonder if half those are strep throat tests, to be perfectly honest, because our pharmacists are able to do that now.

 

[6:00 p.m.]

 

We are seeing a reduction in utilization in our emergency rooms, which is really encouraging, because there are different pathways to access for episodic care, as an example. Obviously, whenever anybody leaves, we do worry about that, and - wherever possible through the triage process - if someone is triaged at a low acuity, we want to be able to provide them with an alternative. Sometimes that’s urgent care or virtual emergency room care in the emergency department, but there are other times when people could be seen in community or perhaps the next day, depending on the presenting concern they come with. We do encourage people to stay.

 

I would also say that the impact our patient waiting room advocates have - I hear positive things about the care people receive from those folks, making sure folks are comfortable as they wait, and from the care providers, who are able to perform some lower-acuity care in and around the waiting areas.

 

Again, we do worry about that - we watch it closely - but we are pleased that it’s not increasing the percentage and that we are seeing a reduction in ER visits overall throughout the province.

 

KELLY REGAN: Are there specific investments being made in this budget to ensure that Nova Scotians who enter an emergency room get treated - if they are there and need an emergency room versus could go to another kind of care centre?

 

MICHELLE THOMPSON: There will be a continuation of the investments we made in the prior year in regard to emergency room supports. There are 10 sites, as an example, that have the flow lead and off-load assessment team - we call them FLOATs.

 

There are several sites that have a waiting room care provider and patient advocates. We do now have four sites with physician assistants, and training our own physician assistants will help us maintain that supply. Eight sites have nurse practitioners who are working in the emergency room, and virtual urgent care is in six sites.

 

When we look at investments in optimization for emergency rooms, one of the things that has been successful, particularly in our busiest ER environments, including the IWK, has been the rapid assessment zone - particularly during peak times - so you are separating your senses of patients, and there are opportunities for folks to be seen.

 

I’ll give an example. Colchester East Hants Health Centre in Truro has seen positive results, as has the IWK, especially when we’re in those peak respiratory seasons. It allows them to see people on a quicker basis - a complaint-specific or condition-specific environment - which has been helpful.

 

The greatest thing we can do to support the emergency room congestion starts at our outflow. The work that is happening in Seniors and Long-term Care around building the facilities - our transition-to-care facility, which will open this year - is an essential part of making sure patients who are lower acuity and ready to be medically discharged, while recognizing they may have some frailty, can move to a different care environment, which will open beds. C3 has also been effective in terms of helping us manage the system, integration with our EHS partners.

 

As an example: In the city, when we know what’s going on in our emergency rooms, how do we then share the care load across Dartmouth General Hospital, QEII, Cobequid Community Health Centre, et cetera, to support different opportunities, so not everybody is coming to the same place, and respectfully divert people to different access points to care? Not everybody knows about that.

 

Of course, we also have the app, giving people the opportunity. We know people on the Need a Family Practice Registry have access to virtual care, but in fact all of us in Nova Scotia do. We can get two appointments a year, which has also proven to be effective in terms of diversion. Diversion around the primary care pieces is essential, but also the outflow, in terms of making sure there are spots for people to go so we have beds to bring people into.

 

KELLY REGAN: I do want to thank the Minister for mentioning the two virtual appointments, because it is one of those things I must remind myself to tell people when they are talking about the health care system. Twice a year you can use this particular service. I probably wouldn’t normally go to the ER twice a year. I might not need to use them for quite a while, but there’s lots of people who do, and having that is good. I do believe we should give props where they are due. Although my job is not to be your cheerleader - just to be clear.

 

One of the things we have been looking at is One Patient One Record. We did discuss that earlier today - I think it was today - and the minister did indicate it was supposed to come onstream in 2025. Is there any money being spent on One Patient One Record this particular year, and if so, how much?

 

MICHELLE THOMPSON: One Patient One Record is a huge project - humungous. This year, we will be investing $62.1 million in One Patient One Record, and $27.2 million of that is around the compensation associated with it: administrative, at-the-elbow support, change management, et cetera. Operating is around $15 million. Then we have some contingency built in as well. It is a significant investment. Obviously, there would be some infrastructure work around space, gear, equipment - whatever it is. It’s a total of about $62.1 million.

 

KELLY REGAN: In the few minutes I have left, I’m going to briefly touch on off-load times for ambulances. In January of this year, the average ambulance off-load time at Cape Breton Regional Hospital was 201 minutes, and that’s 73 minutes longer than the month before. I wonder if the minister could speak to that. Perhaps I’ll ask my last question as well. Then she can answer both. Will the minister commit to releasing monthly off-load time data for all hospitals across the province?

 

MICHELLE THOMPSON: We do know that off-load times - there are a variety of things that impact those, and I did share some early successes. We are seeing some success in the Truro hospital and in the Yarmouth hospital, as another example. That off-load time - because it is at the top of my head - went from 60 minutes down to 37 in January and is now down to 27.

 

We are seeing in some areas - when we look at the off-load times in our bigger centres, we know there are some challenges there around off-loading. Again, that speaks to throughput. Some of the things we are going to be looking at - perhaps it won’t change the time the individual may be on the stretcher, but what we are trying to effect by introducing emergency medical responders is the time paramedics are in the hallways, making sure individuals are triaged. Those FLOATs are available so we can put paramedics back out onto the trucks, because that is going to change response times. It all works together.

 

In the department we have moved from more of a contract manager to a regulator and are developing our own data systems. I can assure the member opposite that we - the regulatory branch of the Department of Health and Wellness who are managing EHS are creating their own data sets to watch that. There a couple places in the province that regularly meet their off-load times, and I would be remiss if I didn’t give a shout-out to the Aberdeen Hospital and to St. Martha’s Hospital for their regular attainment of their off-load times. Average offload times are updated weekly on the Action for Health website.

 

KELLY REGAN: There are a lot of little tabs on that particular one, so thank you very much for that. The minister has talked about folks who don’t have doctors, and they can get referred so they do have someone following them. We have discussed that before here in the House - sorry, they’re readers, so I couldn’t read your lips there - and I’m not sure all the people who need a doctor are getting referred on to that new service that is available. I wanted to draw the minister’s attention to that, because I really feel there are some people who are slipping through the cracks. As MLAs, we often hear about them and try to bring them to the department’s attention. My concern would be that, with some potential solutions in hand, if we don’t know how to get access to that new service - maybe some information about that dropped at our desks would be helpful so we have that.

 

THE CHAIR: Order. As we are reaching approximately the 2.5-hour mark - we are going to 7:42 p.m. - would you like a quick recess?

 

We are going to take a quick five-minute recess and then be back. We’re now in recess.

 

[6:13 p.m. The committee recessed.]

 

[6:21 p.m. The committee reconvened.]

 

THE CHAIR: Order. The Committee of the Whole House on Supply will resume. It’s now time for the NDP’s round of questioning. The honourable member for Halifax Citadel-Sable Island.

 

LISA LACHANCE: I wanted to turn to some issues around gender-affirming care. It’s been a slow road to having Nova Scotia follow the WPATH Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. As far as I know, we are still not at that place. There are procedures under the Standards of Care Version 8 that are not currently covered automatically by MSI.

 

Last year we learned that, despite that, there had in fact been at least one surgery of one of the procedures contained in WPATH Standards of Care Version 8 that was completed in Nova Scotia and was funded by MSI but was also subject to an NDA around that experience.

 

I’m wondering if the minister can let us know how many voice feminization surgeries have been approved and completed for Nova Scotians over the past fiscal year and how many facial feminization or masculinization surgeries have been approved and completed for Nova Scotians over the past fiscal year.

 

MICHELLE THOMPSON: We will get some of that information for the member opposite, but I do have to say I’m proud of the work that’s happened in this province around gender-affirming care. We have a new gender-affirming care policy that was implemented in July 2023 which is actually the first of its kind in Canada.

 

It was created with the department and through fulsome consultation with the community members - with several people who represented the Pride community and with the trans community - across this province, both rural and urban. It provides equitable and culturally appropriate care. It outlines the standards of care, coverage, eligibility criteria, and the process for access gender-affirming care.

 

I know one of the problems with implementing WPATH standards - I think they were supposed to be out in July, and they didn’t come until September - but we have been committed to working with community and working within the department to improve gender-affirming care. We’ve also ensured that there are fee codes, as a result, where physicians can take their time. We make sure physicians and nurse practitioners who are offering primary care are trained and make sure they follow WPATH.

 

Many people in the province want to offer excellent gender-affirming care. It’s going to take some time to ensure those individuals have, first of all, the education they require to make sure they’re standard-compliant, they’re getting the appropriate information, and they gain some experience and confidence. We are going to continue to work with clinicians across this province. We need to continue to work with people in community and organizations that support people accessing gender-affirming care.

 

I believe we, as a province, have made great strides in the last two years. I don’t believe it’s perfect - I couldn’t tell you that any part of the health care system - but I can tell you there’s a commitment from the department and from government to continue this work to expand and to support and help individuals seeking gender-affirming care and across the Pride community. There have been investments, as well, throughout the Nova Scotia Health Authority and the IWK to that end. While I appreciate it’s not perfect, I do believe that the individuals involved, both in community and in the Department of Health and Wellness, and with the care providers, should be celebrated for the work they’ve accomplished in the past two years.

 

THE CHAIR: Just before I recognize the honourable member, there are periodic bits of chatter here and there, and with the fans and stuff. I just ask, maybe take it down a touch.

 

The honourable member for Halifax Citadel-Sable Island.

 

LISA LACHANCE: Just to clarify, the minister will be able to follow up with the number of voice feminization, facial feminization, and facial masculinization surgeries that were completed in the past fiscal year, and whether there were NDAs used in that. Can I just confirm that the minister will follow up with that information?

 

MICHELLE THOMPSON: I will confirm the numbers, but if there’s an NDA associated with any of those, I will not disclose that.

 

LISA LACHANCE: In 2023, the department committed an additional $1.7 million to increase access to gender-affirming surgeries. The Canadian census says that about 1.17 per cent of the Nova Scotia population is trans or non-binary. Did the addition of the $1.7 million result in increased surgeries or increased types of surgeries? Could the minister speak to how that money was disbursed?

 

MICHELLE THOMPSON: In terms of individuals receiving out-of-province gender-affirming surgery: In 2021-22, there were 65 individuals; 2022-23, there were 118 individuals; and year-to-date 2023-24 there have been 109 individuals. I don’t have the last probably six to eight weeks.

 

LISA LACHANCE: We can probably assume that this fiscal year will end up around the same number as it was last year, so I’m wondering what the budgetary allocation of $1.7 million - how was it used to increase access?

 

MICHELLE THOMPSON: Obviously the utilization has increased in terms of gender-affirming surgeries that have been completed, but in terms of gender-affirming care - in terms of the investment - not all of it would sit necessarily in a singular budget line. There are new and expanded fee codes, as an example. There’s increased funding to the Halifax Sexual Health Centre and prideHealth. There’s health care provider work that is happening that they can declare. There’s education and modules to make sure that they have the credentials to ensure quality and safety for the patients accessing gender-affirming care.

 

There is also an in-province travel support program and an out-of-province travel support program. There’s also been ongoing consultation with the trans and gender-diverse community in order to make sure that we’re removing barriers in a timely fashion. I don’t know that it’s totally captured in just that $1.7 million. There have been other areas in which we’ve been supporting, ensuring that there is increased access.

 

LISA LACHANCE: I will go back to last year’s budget because I’m quite sure that that amount was specifically about increasing access to surgeries. I’m just wondering about that. There was also, last year, an additional investment to prideHealth announced. Again, I apologize, I don’t have the exact number right in front of me, but I think it was around $700,000 to $800,000 for the year, and that was to engage more navigators across the province. As of January 2024, no new navigator positions have been created, advertised, or filled.

 

The money was allocated towards prideHealth, and more importantly, increased access to support and services. The folks from prideHealth are the folks who can be on the ground in the regions, supporting folks who want to access gender-affirming care, supporting physicians and other health care professionals who have questions, and doing the general awareness-raising that prideHealth has done amazingly well with one person in place for many years. My question is: What is the plan to get navigators in place for prideHealth?

 

MICHELLE THOMPSON: In the 2023-2024 budget, there was $368,000 in new funding. According to my notes, there was a prideHealth navigator hired in October 2023.

 

LISA LACHANCE: In discussions with the leader of prideHealth in January, he said he had not seen any of the money and no one new had been hired. Perhaps the minister can clarify. For the $368,000, I thought the intention was to hire four navigators - one for each zone. Is the intention still to fill those positions?

 

MICHELLE THOMPSON: That money would have gone to the Nova Scotia Health Authority. I would have to check with them to see whether there were people who applied, if they met the criteria, et cetera, but there has certainly been no change in the funding because of that. We will have to check with Nova Scotia Health Authority around their recruitment efforts.

 

[6:30 p.m.]

 

LISA LACHANCE: The two months we are talking about from 2023 - have they been made permanent funding lines in 2024, or is there additional funding allocated to gender-affirming care and to prideHealth for this budget that we are currently discussing?

 

MICHELLE THOMPSON: Yes, that funding is permanent.

 

LISA LACHANCE: During the past year, the Premier led a contest to find health care ideas that didn’t cost money which brought in over 2,000 ideas. When the initial voting list was published publicly, it included the idea that health care providers use appropriate pronouns when working with members of the public. I believe that was removed from the list because we don’t have a habit of voting on human rights in public contests. I am wondering if the minister can talk about the process by which those ideas were selected and whether the minister had a chance to review the list before it was published.

 

MICHELLE THOMPSON: I did not review it before it was published. I think the team worked hard to discern amongst themselves what the best approach would be. It was recognized by an individual whom we don’t know, and it was submitted. We don’t know the reasons why it was submitted or if it was by someone who is part of the Pride or trans community. We didn’t know the genesis of that. We’re trying to balance the importance of recognizing that it was submitted as an idea and seen as a gap in the system, and recognizing, as well, with the feedback from the community, that it was hurtful to some individuals.

 

There was no ill intention around that. Whoever that individual was and however they identified, it was important enough for them that they felt it needed to be brought to the attention of folks. I don’t think it was meant in the spirit of a contest. I think it was a pure and considerate way for that individual to express the concerns that they had. It’s very, very helpful for them to bring that forward.

 

It is a balance. Perhaps there would have been an outcry if we hadn’t been able to go back, and if we had left it off. It really is a learning. We’re not going to get things right all the time. We wanted to respect the individual who brought that forward. We heard directly from community members that it was hurtful, and so we removed it, but it doesn’t change the commitment. We know that there needs to be increased education throughout our health care system. We know that the health care system has historically been and felt unsafe for a variety of individuals throughout our province for equity-seeking communities, so it is a balance and it is a learning.

 

I don’t want to discourage people from coming forward when they see a gap if they have a concern. I also appreciate the fact that it was probably not the most sensitive way to bring that forward. It is a balance. I think the care in which we managed that was a learning for the individuals involved, and I want to thank the person for bringing it forward. I want to acknowledge that we could have done something differently, and I want to thank the community for bringing forward their concerns.

 

We will continue to do what we can. We will make mistakes, and we will correct them when we know that there’s been an issue, and we’ll continue to learn as a community. That’s really all I can offer - that deep apology for the people we hurt and a deep appreciation for the individual who brought that forward. It was important to them, and they wanted that to be on our radar. We will continue to work through this with humility and with respect to do the right thing whenever we possibly can.

 

LISA LACHANCE: Certainly, in no way was I commenting on the person or the idea being brought forward in that context. What I was concerned about was that with 2,000 ideas, there hadn’t been a professional level of rigour that allowed departmental or governmental staff to identify that this was problematic. I just really want to make it clear that I was absolutely not in any way disrespecting the person’s experience who brought that forward.

 

In terms of departmental capacity around 2SLGBTQIA+ issues, I think last year we determined that, at that time, there was no one in the department for whom these issues formed part of their work package that they were evaluated on in terms of their expertise in this area. I know that you have a health equity team, but my understanding is that there wasn’t anybody on there specifically tasked. I’m just wondering if I could have an update on how the department is building its own capacity around 2SLGBTQIA+ issues.

 

MICHELLE THOMPSON: We do have a Health Equity Framework, of course, but we also work across government. My understanding is that the Office of Equity and Anti-Racism Initiatives is looking specifically at 2SLGBTQIA+ policy across government. What I do want to point out is that the Health Equity Framework team works very closely with a number of individuals throughout Nova Scotia, and so we work very closely with individuals from the Pride community in order to inform our decisions.

 

I can’t really speak to the lived experience or the particular specialty related to the 2SLGBTQIA+ community. However, I can say that relationships with some leaders within the community have been built, and we continue to consult and understand. Lived experience is present in the department, whether it’s from within the department or from relationships that the department staff have built throughout the province. That first voice is present in the department in regard to issues around Pride health, gender-affirming care, et cetera.

 

LISA LACHANCE: I’m wondering if the minister could identify the groups with which she has met in the past fiscal year.

 

MICHELLE THOMPSON: I would have to get some information from the department about some of the consultations that they have undergone. Certainly I have not had any formal meetings in particular with any groups in the province. I don’t know. I’d have to check to see if I had requests. That’s not to say that I don’t work really hard at maintaining my own competency around health equity issues, and I’ve been very fortunate in the past to attend, particularly when I worked on the school board, a number of educational issues so that I can be a better health care provider and representative.

 

There may be individuals who have come into my life whom I have met with, and I’m not privy to whether or not they’re trans, or to their sexual orientation, et cetera. That is not something that I would have met with someone specifically about.

 

LISA LACHANCE: One of the things that I proposed is actually a standing ministerial committee, an advisory committee on gender-affirming care. One of the reasons for this is the concerns about community engagement to be really valuable, and to build the type of trust that you need, particularly to talk about health issues - private health issues. Having an ongoing standing body that has terms of reference to guide its work to whom the minister can turn to on a regular basis, and they themselves - the members of a standing committee who are accountable to their community organizations and to their communities - I think it is really important, and with all respect, I think has been sorely lacking in terms of engagement with the 2SLGBTQIA+ community across government.

 

When government wants to think about Indigenous health, there are clear community organizations and organizations with which the government has partnered, has regular relationships with, and can go out and meet with. The same is true for the African Nova Scotian community. There are clear community partners that the minister and departmental staff would have ongoing relationships with.

 

As we expand our concept of health to include gender-affirming care, what I would suggest is that we need to be building that capacity as well. We’ve supported it with other diverse groups; even for the Acadian community, there’s a health organization.

 

One valuable thing the government and the minister could do would be to support that type of capacity-building and organization within the community by establishing a ministerial advisory committee. At this point, some of the people I love the most in this world have been on the other end of the phone - random ad hoc issues and ways they’ve been contacted. I don’t think it’s ongoing. I don’t think it’s respectful.

 

Would the minister consider establishing a permanent ongoing advisory group with which she could build a relationship and which would also be accountable for working hard and providing their input into the government’s actions?

 

MICHELLE THOMPSON: Through the consultations and the work that’s been done, particularly around the new gender-affirming care policy, there has been work that has been started through the department with some of the individuals who have worked with the department.

 

[6:45 p.m.]

 

There is no standing committee presently, but the clinical branch is looking at developing a more formal avenue to hear concerns from community and lived experience. That work is preliminary but is well under way in terms of relationship-building and understanding who some of the individuals and organizations are that could support the work in the department. That’s already been started.

 

LISA LACHANCE: The minister spoke about the importance of working with health care professionals to ensure they have the competency and capacity to engage with members of the 2SLGBTQIA+ community and to offer gender-affirming care in all its forms. I’m wondering how the department is identifying health care professionals who have competency and are interested in gaining competency. Is there an estimate, in terms of - I know there’s training - a percentage of different health care groups that have taken the training that’s available?

 

MICHELLE THOMPSON: To support a safe, appropriate, and quality care environment, there have been a few things that have been undertaken. First, to use the gender-affirming care fee code, there is a declaration and a requirement that physicians would take a certain number of courses. There’s work that’s happening with the colleges, particularly the nursing college and the physician college, to ensure folks are getting good WPATH-compliant information.

 

We’ve also been working with universities and community colleges around curriculum to make sure there’s a foundational entry-level understanding and education. Through employers, there’s an expectation through Nova Scotia Health Authority and IWK that there is ongoing professional education regarding several health equity initiatives and gender-affirming care as well as creating a safe inclusive environment for the 2SLGBTQIA+ community.

 

It’s got to be across sectors. We know it needs to start in foundational education, and we’re working with curriculum in universities and community colleges. We know employers have a responsibility, and we know the colleges have an opportunity. Through physician services, there is education that needs to be taken for physicians to use the gender-affirming care fee code.

 

LISA LACHANCE: I’m wondering if I could ask the minister how many health care professionals are certified to use the gender-affirming fee code in Nova Scotia and, for my own information, if the minister could explain what that fee code includes. When I think about gender-affirming care, it’s a spectrum of things - it’s not a straightforward pathway. It’s everything from that first conversation someone has about feeling gender dysphoria or feeling body dysphoria and can range from physician counselling to formal therapy and assisting with social transition, and it obviously can include surgery.

 

I’m wondering if I could understand what’s in that code and how many people are able to provide whatever is in that code in Nova Scotia.

 

MICHELLE THOMPSON: I’ll start. We’re waiting for some more information from the department. I think there’s a variety of different things that are happening. I would say that making sure primary care providers have good knowledge, that they understand the pathway to more specialist care, if required, I think is very important. Certainly the care that is offered for children and youth at IWK is essential because, to the member’s point, there is a variety of age-appropriate ways in which we intervene and support children and youth throughout a variety of reasons they access the health care system, and this specifically is very important and specialized care.

 

I think we’re in the early stages of it. We’ll look for the numbers. It’s been a year that we’ve had these, and so I would say from a primary care provider, I think part of the things that we’ll be looking at in the future is making sure that people with more specialized training have the opportunity to support pharmacare physicians, particularly for those primary care providers who are in rural communities. We know, because of the density of the population, that there are different resources available in a more urban environment, and perhaps in some cases it may be a little bit easier for some folks who can use public transit, et cetera, to access care, whereas we do know that there are different challenges in our rural communities.

 

We can get the number about how many providers. I expect that it will be low but increasing, and that folks are committed to taking the training that’s required in order to use the fee code. I think it’s also important that we continue to build a network throughout the province so that primary care providers don’t feel alone and aren’t going to avoid an issue that perhaps they’re uncomfortable with. It is going to be a gradual improvement and increase in the level of service available, but certainly for children and youth in particular we will lean on our IWK clinicians. It is very important that - again, the spectrum of seeking care, support, knowledge, and understanding, it’s really important that we have specialty physicians like we do at the IWK who can discuss and talk to people in an age-appropriate way about what they’re feeling and what they’re experiencing.

 

The gender-affirming fee code includes gender-affirming readiness assessment and post-op follow-up as two examples of what would be included in that. This is a work in progress. We are committed to working in community, making sure that we are improving services, and that they are safe and accessible to all Nova Scotians.

 

LISA LACHANCE: One of the things that I’ve heard from sexual health providers and community organizations like the AIDS Coalition of Nova Scotia, as well as from individuals, is concerns about the access to PrEP in Nova Scotia. Treatment for HIV and AIDS, or PrEP, is of course, of enormous use to all of us, but particularly in the 2SLGBTQIA+ communities, to prevent virus transmission and to treat infection to a safe and manageable level. It’s currently listed as an exception status drug in the MSI Formulary, and so it requires extensive physician notes. It can be difficult to obtain if someone doesn’t have access to a regular family physician, which we know many Nova Scotians don’t, or don’t have a primary care provider.

 

Similarly, I believe it could be covered under pharmacare, but because of the exception status, individuals - and I know they’ve been in contact with the minister and have written letters - have experienced the inability to actually access PrEP because they just don’t have access to a regular primary care provider and thus cannot meet the requirement. I’m wondering if the minister will consider how to increase access to PrEP in Nova Scotia in the coming year.

 

MICHELLE THOMPSON: The member is correct. In 2018, PrEP medications were added as a benefit under the provincial Pharmacare program. The other thing I’ll just let the member know is that, in partnership with Nova Scotia Health, starting in February of 2023, the Nova Scotia College of Pharmacists has been leading a first-of-its-kind project in Canada consisting of ten pharmacy sites prescribing PrEP and monitoring patients alongside the Halifax Sexual Health Centre.

 

The results at the end of this study - which will probably be very soon - the team will then share those, and we’ll better understand what the next step is, based on that pilot test and trial. We are looking at how to improve access.

 

Additionally, there is free HIV testing available through Pharmacare providers, including family physicians, nurse practitioners, and walk-ins. There is some access through Virtual Care Nova Scotia.

 

THE CHAIR: The honourable member for Dartmouth North.

 

SUSAN LEBLANC: I am going to switch over to ask some questions about midwifery care. The expansion of midwives in Nova Scotia has been stalled for years. The Association of Nova Scotia Midwives is currently running a public engagement campaign right now which, as of Monday, had seen about 1,000 signatures from Nova Scotians asking the government to expand care.

 

Considering this is a priority to so many Nova Scotians, as well as a priority area for the Reproductive Care Program of Nova Scotia, why has midwifery care not been targeted for expansion this year?

 

MICHELLE THOMPSON: There is a bit of a midwife program. There are 16 midwives registered in Nova Scotia, and they deliver approximately 5 per cent of births - they are attended by midwives. That is lower than the national average, which is about 13 per cent. Currently, there are four midwives between Fishermen’s Memorial Hospital and Bridgewater, with one vacancy; in Antigonish, at St. Martha’s Hospital, there are four FTEs, with one vacancy; and IWK has eight FTE positions, with two new midwives recently hired in January 2024.

 

[7:00 p.m.]

 

One of the challenges we have had repeatedly is filling the vacancies. This is a small workforce, as the member opposite will know. There is some work happening through the Atlantic provinces to understand the impact of a potential midwifery program, and that is being led by Newfoundland and Labrador. We are also working with midwives throughout the province and with Tajikeimɨk to understand what the model could look like in First Nations communities with midwives, so it’s not that there is nothing happening.

 

I would also say that with midwifery care, because it is not widely used in Canada, we need to make sure midwives are nestled in a continuum of a team. While many births are natural, they also can be quite high-risk, and things can happen very quickly. We see, particularly in our rural regional hospitals, where we have primary care physicians who are doing obstetrics; we also have obstetrics and gynecology physicians who are working throughout the province. It is important that mom and baby are the centre and that we make sure there is a continuum of health care providers, if and when complications occur, that midwives are well-supported and that there is backup for them.

 

It has been a program that has been difficult to expand. We have a variety of providers in the system who are providing pre-natal as well as obstetrical care, and the midwives are part of that. It has been difficult to stabilize the workforce and fill the positions we have, let alone expand.

 

SUSAN LEBLANC: I want to dig into this a little, because this is a conversation the minister and I have had several times now at Estimates, and I want to challenge what I am hearing. The program is difficult to expand because it is small - I know that doesn’t make any sense - but if someone is coming from another province to work as a midwife, it is not going to be attractive to go to a rural area where there are only two other midwives practicing because they are going to be on call every third night, for instance. I don’t know exactly how those things work, but you know what I mean.

 

Does it not make more sense to actually invest in the program? The Association of Nova Scotia Midwives is asking for a $5 million expansion, and that would double the number of midwives, taking it up from 16 to 32. It would make a huge difference, and I guarantee you - well, I can’t guarantee anything, actually, except for death and taxes - but I would be willing to bet a lot of money that a doubling of the midwife program would actually make a huge difference.

 

The other thing that I want to pick apart for a second is the minister’s assertion that - it’s not an assertion, it’s true - what she’s saying about how midwives need to have a backup, there needs to be a nest for them, there needs to be a continuum of care for people who are having babies. If we go with that logic, then that suggests that we don’t have that now for people who are having babies. People are having babies every day in Nova Scotia - some, very few, 5 per cent, with midwife care, but 95 per cent without midwife care.

 

Presumably, those babies are being born and cared for, and we have very good maternal outcomes and birth outcomes in Nova Scotia, so presumably those services exist. What midwives would do would take the pressure off our system, because even if - I don’t know what’s happening over there, but it’s distracting - even if every birth with a midwife needed backup care, we have that care in place. Because if we didn’t have midwives, it would be happening that way anyway.

 

I just want to challenge the minister’s assertion, and I don’t know how else to ask this, but is there another reason why Nova Scotia is not prioritizing midwifery care?

 

MICHELLE THOMPSON: What I would say is that we have a very well-established clinical pathway for maternal child care in the province. It involves primary care providers, nurse practitioners and physicians. There are maternal child nurses in our regional sites where they deliver babies, and certainly specialty care throughout the IWK, generalist nurses as well as specialty nurses.

 

Midwives are a part of the team. They are not available everywhere, as the member has said. These programs have existed for a long period of time, and even when there are permanent full-time positions, they are very difficult to recruit to. What we need to do always is ensure the mom and baby’s safety. The current model that we have now is heavily dependent on primary care providers. We have specialized nurses who work in our obstetrical and gynecological units across this province, whether that be at a regional site or whether that be at IWK, and we have obstetrics and gynecology.

 

The system that we have does not mirror systems in other parts of the world, which are predominantly staffed by midwives. We do not have the capacity to train a whole bunch of midwives, and the work that happens in our own nursing programs enables registered nurses to become more specialized in terms of obstetrical care. We are grateful for the midwives that we have. We appreciate that there are individuals who would prefer that, and at this time there’s no current movement to expand the program. We need to stabilize the complement we have. Even when there are permanent full-time positions, it’s very, very difficult to recruit to those.

 

I appreciate the member’s comments. I think the midwives are an important part of the team and the continuum of obstetrical care, but there is no movement to expand that program.

 

SUSAN LEBLANC: Again, I’ll just say, yes, these positions are very difficult to recruit to, because they are positions with tiny little teams in rural Nova Scotia. It’s very difficult to do midwifery when you don’t have a ton of support from other midwives. If we doubled with a $5 million investment, we could double the amount of midwives here. I implore the minister to just try it and see how it would be.

 

I know lots of midwives who have expressed interest in working in Nova Scotia, but it’s very difficult to come when the positions that are being advertised are not permanent or when they’re with small practices. So let’s just try it. We are trying to take the pressure off primary care. Midwifery is a way to do that.

 

We are trying to make sure that people have a continuum of care in a family practice or in a family health home. Midwives should be part of those models. It befuddling to me that we’re not planning on an expansion of the midwife program. I’m deeply disappointed in it.

 

The current model of midwifery care is expensive, because we do need all of the backup care, but the model of midwifery does not require a parallel increase in nurses and specialists in order for them to practice. In fact, it alleviates the demand on those and leaves time for the OBs to work on more complex cases.

 

I am a perfect example of this, as I’ve said before. I was labeled a “geriatric mother,” of course, because I was 38 when I had my first baby. My family doctor at the time was nearing retirement and didn’t want to deliver babies anymore, so I was sent to the perinatal centre. I got excellent care, but it was really expensive for the people of Nova Scotia, for me and my pretty healthy pregnancies - basically totally healthy pregnancies, which I am very grateful for, just for the record.

 

I wonder if more midwives being hired could help with the existing demand. The province has strategies to recruit and retain primary care providers, doctors, and nurse practitioners, but midwives are the third type of primary care provider that are also practicing in Nova Scotia. Why are there not resources devoted to a similar strategy of attraction and retention for midwives?

 

MICHELLE THOMPSON: We will check. They’re hired by NSHA, so I’ll have to look at whether or not, as an example, they’re hired to fill positions in rural communities, whether there are sign-on bonuses, et cetera, as other nurses are available to other nurses.

I’ll have to just check and see how those individuals keep up their competencies, and what type of investment - I don’t think it’s fair to say that there’s no investment at all until we really find out about professional development and some of the supports that are in place for midwives from the employer, and also in terms of the support that they get from their primary care and obstetrical colleagues.

 

As I’ve mentioned before, we are working with Tajikeimɨk, with the midwives, to understand if there’s a new, different, or expanded role where they can support First Nation communities. Currently in this budget, there is no expansion of midwifery services.

 

SUSAN LEBLANC: With the short amount of time I have left tonight, I wanted to ask about some drug policies. I just have to find the question, sorry.

 

I wanted to ask first about the COVID drug Paxlovid. Some of our constituents have noted a great deal of difficulty in obtaining a Paxlovid prescription when it’s needed. Does the department or Nova Scotia Health Authority have set criteria for Paxlovid to be prescribed? Do these criteria vary based on patient demographic? How does it compare to criteria and access in other provinces?

 

MICHELLE THOMPSON: Through infectious diseases, there is a table of individuals who support - individuals who are accessing Paxlovid. There are a couple of ways in which you can access it. There is a report and a support form available online, but there’s also a 1-800 number you can use to call and report. Of course, the sooner you have access to that medication, the better it is. Those ID physicians who work across the province then will work with local pharmacies to support access to Paxlovid.

 

SUSAN LEBLANC: How does that compare with other provinces? The minister may have answered that, but I didn’t catch that part.

 

MICHELLE THOMPSON: There’s a variety of different ways in which other provinces administer that medication through the expert table of Public Health and ID. This was the model that was chosen here, but there are a variety of models across - as we move further out from the pandemic response, it may be that we will change the model. I believe there are discussions under way now about changing the way in which there is access. Obviously, if you are in hospital, there is an IV version that is readily available for those with severe illness. We will be looking at more of a community-based model moving forward.

 

SUSAN LEBLANC: While I am on COVID response, I saw the announcement yesterday that the booster vaccine is available now for the most vulnerable people - people over a certain age, people with - all those groups. Will we be looking at a booster again available for the public later this year? When can we expect that?

 

MICHELLE THOMPSON: We continue to move away from that critical period, at the peak of the pandemic. We listen closely to public health experts. We have a pan-Canadian table that is advising us, in terms of how and where we provide immunization. There was a Fall campaign. It coincided with our influenza vaccine campaign. I expect, but don’t have confirmation right now, that it will continue.

 

We are obviously looking at those at highest risk - those most vulnerable individuals - having access to the vaccine on an ongoing basis. I think this is something that is going to continue to evolve as the COVID virus becomes more ubiquitous in our society.

 

[7:15 p.m.]

 

I can’t really tell you. I know this is out right now. I expect there will be a Fall vaccination campaign again, but we lean on the experts and the public health doctors, like Dr. Strang and Dr. Deeks, and the Public Health team to give us the next steps. This is the step we are at right now. We are going to provide high-risk individuals with another booster. Following that, we’ll take our direction from Public Health. I can’t confirm anything right now.

 

SUSAN LEBLANC: Over the past 18 months, the Canadian Agency for Drugs and Technologies in Health has positively recommended several new biologic treatments for Crohn’s and colitis, including - and pardon my pronunciation - Rinvoq, Omvoh, and Skyrizi. Does the department plan to allow coverage for these new options under MSI?

 

MICHELLE THOMPSON: I’ll have more to say the next time we meet, but generally after CADTH, if it’s going to be considered by provinces, there’s a pCPA, which is a pan-Canadian pricing exercise that is undertaken. I don’t know if those drugs are in there. I will have to check to see where we are.

 

SUSAN LEBLANC: I’m just going to slowly say thank you for this excellent question and answer period. I look forward to the next one.

 

THE CHAIR: Order. That will conclude time allotted for our NDP caucus. We’ll move on to our Liberal caucus. Before I do that, just a gentle reminder everybody about chatter in here: Keep it down.

 

The honourable member for Annapolis.

 

CARMAN KERR: I want to thank the minister and staff for being here. I’ve been sitting through tonight, and I think I have around 28 minutes? My first question is around parking revenues at Nova Scotia facilities. I’m continually asked a number of questions around this, and I said I would ask the minister to get more clarification.

 

I know that these monies are reinvested in health care and used to fund equipment purchases. I know that they’re to support operations, but what I really want to know is: In Annapolis Community Health Centre and Middleton Soldier's Memorial Hospital, how much of those revenues are kept on site for those practices?

 

HON. MICHELLE THOMPSON: That is through operations at Nova Scotia Health Authority, so I’ll have to confirm. What I have here is that all parking fees are reinvested into health care and are used to maintain the parking lots, fund new equipment, support operations, and support patient care. From that note, it sounds to me that it would be kept at the facility where the fees are collected, but I will have to confirm that with Nova Scotia Health.

 

CARMAN KERR: I appreciate that answer. I would appreciate just knowing if that - a lot of questions are: Is the money collected kept at the site that we use? That would go a long way with residents that I’m representing. I’m interested in how much is collected at each site, both at Annapolis and at Soldier’s. If the minister doesn’t have that information, if she could follow up or the department could follow up.

 

MICHELLE THOMPSON: We will have to check. We don’t have the revenues from that by site. I do know that overall, in 2022-23, there were 18 out of 41 hospitals that offered either daily or hourly rates, and the total collected was $7.3 million in the province. I will also say that it’s very important for individuals to know that you can also get, in many of the hospitals - people should check at the business office when they go into the hospital, because there’s also monthly parking if you have someone that’s there for extended periods of time. If it is a burden for families, there are chits that are available, and parking passes. Business offices are very discreet. They deal with all kinds of delicate issues related to money for patients and their families. It’s not a hard-and-fast rule. If there are individuals who require some support or some assistance, they should really go to the business office and talk to the individuals there. They will be able to assist them.

 

CARMAN KERR: I’ll certainly encourage people to visit their local business office. When I look at the fees that the minister just mentioned, there’s a number here where in Neils Harbour, it’s free; in Inverness, it’s free; in Baddeck, it’s free; in Windsor, it’s free. I could go on and on. In Annapolis, we pay $3, at least, at a site. I think in Digby they pay upwards of $4. I’m just wondering if the minister would consider lowering that amount or having the department lower the amount. It’s hard for people to understand why they pay $3 when so many sites are free of charge.

 

MICHELLE THOMPSON: I don’t set the parking fees across the province or decide where they are. There are 18 out of 41 sites that have paid parking, and it is through the operations of the Nova Scotia Health Authority. I can’t really speak for the operator in terms of that policy. We can certainly let them know that the question was asked on the floor today, but that’s not something that I’m able to really commit to or tell the member any more about. It is an operational decision of the Nova Scotia Health Authority.

CARMAN KERR: I do have correspondence back from leadership at Nova Scotia Health - not on that particular question - but I’m wondering: Does the minister not have oversight on those decisions at Nova Scotia Health to make that decision?

 

MICHELLE THOMPSON: Again, I can certainly pass on to Nova Scotia Health that the question was asked on the floor, but respectfully, I can’t get into the operational level. That’s why we have those administrative teams in hospitals. There are a number across the province.

 

I appreciate that it’s not a standard policy, and I can give that feedback to the Nova Scotia Health Authority and the executive leadership team, but respectfully, for me to get into the minutiae of all those operational decisions, I would really never be able to get anything accomplished. I do appreciate that it’s a hardship for some, and I do think that there is an opportunity for people to work around it in their community at their local hospital with the business office.

 

CARMAN KERR: Just switching topics, housing for health care workers is certainly a challenge. It’s a gap throughout Annapolis - it’s a gap throughout the province, I imagine. I know there are certain projects being looked at, or maybe they’re already under way, for housing for health care workers. Are there any plans under way in Annapolis, either through Soldiers or Annapolis or even Digby for looking at housing funding? Anything in this budget for funding for housing for health care workers?

 

MICHELLE THOMPSON: To the member’s point, we are seeing housing and child care as two of the biggest challenges that many communities are facing. In 2023 we did commit $20 million to the Housing Trust of Nova Scotia to look at modular housing and to uncover other housing solutions for health care workers. There has been some work in the Western Zone - in Lunenburg and in Bridgewater. There’s also been some work that’s happened in Guysborough County. There’s also been some investment working with community-based organizations. We need to work with municipalities.

 

The Mid-Valley Region Physician Recruitment and Retention Committee and the Lawrencetown Village Commission have also received funding. Those would have been on a grant application based on what they feel they need to enable them to look at some of the solutions locally. I know that this year’s round of funding will also be coming out.

 

We want to enable, but we do need local solutions. I know that, as an example in my area, folks are looking at surplus properties, what is the opportunity for additional housing units, working with developers, as well, to create spaces, especially for locums.

 

When I visited Digby, as an example, I met a person who basically took all of his furniture and furnished an apartment, working with the Digby & Area Health Service Charitable Foundation so that when those individuals aren’t there to pay rent, the rent is covered so there is a designated space. The Yarmouth Hospital Foundation has built housing, as well. We want to enable and we want to support, so if there are some solutions locally, we want to hear about them. I can’t speak directly for the Minister of Municipal Affairs and Housing, but those local solutions - working with the Nova Scotia Health Authority, municipalities, recruitments, all of that stuff - and ourselves to try to find solutions. It may be a family home. It may be a single apartment. It just really depends on who has the barrier that we’re trying to address.

 

[7:30 p.m.]

 

CARMAN KERR: I’m always looking for ways to support our health care workers. I recognize those two groups the minister mentioned. I have taken steps to reach out to leadership in the zone about housing - this was months ago. There was an indication that there was conceptual support to proceed in turning a building on Soldiers Memorial Hospital property into housing for health care workers, but I haven’t heard anything since. I’m not sure if anyone here tonight can speak on that, but there is a building that’s been identified. The community has come to my office, dozens of people asking what’s going on with that building. I elevated it to leadership, and again, back in the Fall, I was told that there’s support for the idea of that housing, but I would just like to have some kind of update on that, if I could.

 

MICHELLE THOMPSON: I think we would have to reach out to Nova Scotia Health, but also to the Department of Municipal Affairs and Housing. That would be a joint venture between them and the Department of Municipal Affairs and Housing. I don’t have an update for you, but we can look into that to see if there is something that we can find.

 

CARMAN KERR: I appreciate that from the minister and I’m excited if there are more housing options for health care workers in my riding. Just to switch over to paramedics: You certainly have shown support here in the House and locally for the paramedic schools in Yarmouth and, I believe, Pictou. What I am interested in is, beyond the pay raise for paramedics, what kind of retention efforts is the department taking with the MCI to retain the paramedics we have on the ground now?

 

MICHELLE THOMPSON: I fully expect that I will be back tomorrow, so I am not going to rush through this answer because there’s lots to say.

 

I am pleased with the new collective agreement that we settled with paramedics. There was an 8.5 per cent cost of living increase with 16.5 per cent classification adjustment for paramedics to signal to them it was important. There’s a retention allowance of up to $5,000 per year of the contract for paramedics employed in a permanent or term position.

 

There were improved extended benefits, including enhanced mental health coverage of $2,500 and increased things like orthotics and hearing aid coverage for them; resources to support the clinical transport operators to return to school and become trained as a primary care paramedic, if they choose. That’s an entry level position, so it’s important in that workforce to have a ladder. Now we have the emergency medical responders, whose first three months will mirror the first three months of paramedicine, so it’s an opportunity there, as well; and salary increases in recognition of the training required for clinical transport operators and aligning the classifications for various roles in the system.

 

There is also a lot of work that happens in the western zone in Yarmouth, in fact, around fleet - the ambulances themselves at Tri-Star Industries Limited. Any changes are really built on feedback from our paramedics throughout the province to make sure they have the type of truck and vehicle they need, whether that be for emergency transfers or transportation.

 

Looking at different roles for paramedics, it’s important that, over a career, there’s an opportunity for some novelty. The single paramedic units - prior to the fixed wing purchase and implementation, primary care paramedics didn’t have as many options. Primary care paramedics can work on the fixed wing if they are in the Western Zone or Cape Breton, which I think is quite novel as well. That certainly was exciting. We’re always looking at ways in which we can give them support to try to do new things, is what I would say.

 

We’re also looking at evolving the role around extended care paramedics and community paramedics to the point of giving different work environments, as well as supporting long-term care facilities in the province and what the opportunity is to do that. It gives folks a break. We know 30 per cent of those calls are high-risk, and 70 per cent are lower-acuity calls.

 

I don’t think any of us fully understand, except for paramedics, their colleagues, and their families, some of the experiences they have when they are on the truck. Sometimes it’s the actual experience, and sometimes it’s the anticipation of what could happen. Providing novel opportunities for people to work in a different environment and get a bit of a break, mentally and physically, is an important retention tool that you will see us evolve over time, based on their feedback.

 

I also think the support we now offer in the Medical Communications Centre is important in making sure paramedics in the field are well-supported by a multi-disciplinary team, which includes an emergency room physician, a registered nurse, and two senior and skilled paramedics, to support them in the field and allow them to divert and use their scope, as well as respond to emergencies.

 

We’ve invested in equipment to prevent injury. I’m really looking at the health and safety of paramedics. It’s a really difficult job, so there is an introduction of power loaders, power stretchers, lighter medical kits, devices, stairs - getting somebody from downstairs always amazed me. We’re really looking at how we get better equipment in order to support paramedics, and ergonomic adjustments to the trucks. Short-term disability premiums have been covered now.

 

There has just been a variety of ways in which we’re supporting paramedics. We want people to come into this profession. It is an amazing profession. I have worked with incredible colleagues over my career.

 

In Yarmouth, Dartmouth, Stellarton, and Sydney, there’s an $11,000 tuition bursary available to individuals going into that with a three-year return to service. Also a very successful recent trip to recruit in Australia. I am really encouraged by the feedback that EMCI, EHS, and the Office of Health Care Professionals Recruitment have gotten. I talked about the GoodSAM. Also working with medical first responders, building that relationship. We know we rely heavily on MFRs as an EHS system and as a department over the last number of months. Things were really disrupted during COVID, so we’re really leaning in and working to build that relationship and that collaboration between the first responders in community, the MFRs, and paramedics.

 

CARMAN KERR: Thank you to the minister for that detail. I appreciate it. It’s easier for me to promote that, as well, and be positive about it when I have more information.

 

I think a couple of hours ago, the minister mentioned the fixed wing out of Yarmouth, and I think the quote was “5,000 hours saved in ground transport.” Could I find out how many hours were saved on ground units in Annapolis, between the catchment of - if not tonight, could I have some kind of information on that, please?

 

MICHELLE THOMPSON: I will check for the member, but I think the short answer is probably not, the reason being that it’s not a static system. When you hear that people are responding and you maybe have people who live in a certain area of the province, it actually is very difficult - I mean, I will check, but because the system is so fluid and it’s always responding to what’s in front of it, there isn’t really a way that we can say this is from here and this is from there. That model of a base filled with trucks with people who we know from our community is not really the system we have anymore.

 

Our EHS system is a provincial resource. It flexes. It moves based on patient care, on emergencies, on transfers, on significant events throughout the province. It is a very dynamic system - always in real time. You might get a crew down in Lawrencetown that’s originally from Antigonish. That truck and crew could be redeployed from a transfer to Halifax but there is a recognition that the Western Zone needs coverage.

 

I know that folks are watching, but I do believe that it will be very difficult for us to isolate it. It’s really the whole ground ambulance system. To put 5,000 hours - 5,200 actually - back into the system means that we have paramedics on the ground who are responding in real time - full shift complements.

 

In addition to the paramedics themselves, the fatigue of driving that amount is significant - the wear and tear on the trucks, but also the patients. I don’t know if anyone has ever been transported in the back of an ambulance. We’ve come a long way over the years. It can be very, very uncomfortable for patients. The support that patients get when they have a shorter flight, in terms of skin integrity and pain control and comfort - it is absolutely superior to some of the ground transport.

 

CARMAN KERR: I imagine and can appreciate that it’s a difficult thing to answer, but I would appreciate any feedback. Maybe I will ask the same question in a different way. Not to be tricky, but in September, Middleton M140 - that’s a truck - was fully staffed 50 per cent of the time; Middleton M142 was staffed 53 per cent of the time; Bridgetown M144 - 16 per cent of the time; and M146 was fully staffed 18 per cent of the time. That’s September 2023. Could I have the updated numbers since that time of how fully staffed and the percentages of those trucks at those bases in Annapolis, Bridgetown, and Middleton?

 

MICHELLE THOMPSON: I will check on that as well, but to my earlier point, there will be time that those trucks are off the road, those particular truck numbers, because they’re in service. There will be times that they are redeployed to a different area. When we look at the system status plan, we actually look at the number of trucks. We do know that there is some allocation based on provincial coverage, but what the regulator and the company can tell is when people get pulled in close to the city or pulled out far to some of those more extensive sites. The truck numbers themselves are probably not helpful.

 

What we regularly look at is the number of trucks we’re down in the system at any given time, and what the mitigation strategy is for that. There are times it’s really busy in a certain place, maybe the Valley Regional, as an example, so the system is always moving toward that. We know with C3 and with the work that’s happening around integration with Nova Scotia Health Authority and EHS, if we know we have a lot of trucks at Valley Regional Hospital, there will be a response within the hospital to clear the trucks to help with access and flow. There will also be a response from the EHS system around coverage. If there’s a big event, the system moves toward the big event.

 

It actually is the system we want. It’s dynamic, it moves, it always has flexibility in it. There are times where we are down paramedics. We’ve seen some really good - with the classes, I think they hired 39 people or 35 people in January. It really is about bringing the number of paramedics in the system up so that the system itself is staffed, as opposed to a particular area. If the Western Zone ambulances are deployed to do transfers to Halifax, you want the ability for other trucks to go and cover the area. I don’t think it will be as straightforward and as simple as just “This is the truck, and this is the team.”

 

CARMAN KERR: I’m trying to be the MLA of positivity around health care, and I’ve spent hours and hours here each year on health and asked to spend as much time on health. I’m just looking for ways to sell the positive stories at home. So a fixed wing aircraft, 5,000 hours pulled out - Carman, what does that mean for us in Annapolis? I don’t know, let me find out. I hope the minister can appreciate that.

 

I’ve only got two minutes, but the minister mentioned the graduates in Yarmouth. Could she comment on the budgets for maybe the Yarmouth paramedic program for this year, and maybe how many will graduate or have graduated in the past year?

 

MICHELLE THOMPSON: Before I do that, I just want to tell the member opposite that there are good news stories in his area. I just want him to know that. The Annapolis Urgent Treatment Centre is open three days a week and providing care. There’s a new community pharmacy clinic in Lawrencetown that’s been launched. We are looking at, in Soldiers Memorial Hospital, doing cataracts in that surgery.

 

[7:45 p.m.]

 

There’s a number of things that have happened. We have an expanded practical nurse program at the Annapolis Valley campus in Middleton. There are community wellness initiatives that have happened. The Middleton Recovery Support Centre provides in-person assessment. The Centre of Rural Aging and Health is at NSCC Annapolis Valley in Middleton. The Primary care was strengthened at Kings & Annapolis Primary Care Clinic in 2023. In 2022, a medical day services program was relocated from the Valley Regional Hospital to Soldiers Memorial Hospital, which increased day surgery capacity for endoscopies and cystoscopies.

 

I just want to encourage the member that there are investments in the community. We’re looking at the Western Zone. You have a lot of hospitals in a small, reasonably close proximity, and how do we create centres of excellence in that area so that we can divert lower-acuity cases or services to different areas in order to build up services overall? I want you to know that there are good things happening, that we are looking at Soldiers Memorial Hospital, we are looking at Annapolis, we’re looking at where the resources are and how we find the things that raise all boats. I just want to encourage him, and I can give him that list if he’s interested.

 

CARMAN KERR: I think I’m out of time. I’m certainly aware of most of those initiatives. At home, I’ve promoted a lot of those with Lawrencetown, Annapolis, and beyond.

 

I’m thankful to the minister for giving that overview. I’ll save some time for tomorrow.

 

THE CHAIR: Order. The time allotted for consideration of Supply has elapsed. The honourable Government House Leader.

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

 

THE CHAIR: The motion is carried.

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

 

[The committee adjourned at 7:50 p.m.]