HALIFAX, FRIDAY, MARCH 23, 2018
COMMITTEE OF THE WHOLE ON SUPPLY
Mr. Chuck Porter
MR. CHAIRMAN: Order please. Before we get started this morning with the debate on estimates, I just want to remind members, yesterday was a little bit loud at times, and I don’t want to be calling “Order” all the time with regard to the noise. So a reminder to members - if there’s a conversation that needs to happen at length, perhaps you could take it out of the Chamber and have it. I’d appreciate that.
I did mention yesterday for members, a reminder about the terminology of using the word “you.” I’m not going to call you every time you use the word, so I would just remind you to try to keep that in mind so we don’t have to interrupt the proceedings and we will carry on as I always like to - fairly laid back and allow things to work respectively.
We have 41 minutes left for the New Democratic Party caucus.
The honourable member for Cape Breton Centre.
MS. TAMMY MARTIN: I want to talk about collaborative practice teams. I know that the government has a keen interest on moving forward with collaborative practice teams for health care in Nova Scotia.
Last year’s budget contained $6 million to advance new collaborative care teams across the province. Can you please table how much was spent on what, what date, and in what communities of that $6 million that was in the budget?
MR. CHAIRMAN: Order, please. We’re just going to take a short recess to correct a slight technical problem.
[10:57 a.m. The House recessed.]
[10:58 a.m. The House reconvened.]
MR CHAIRMAN: The honourable member for Cape Breton Centre, and you can repeat your question.
MS. TAMMY MARTIN: Thank you, Mr. Chairman. In last year’s budget, regarding collaborative practice teams, there was $6 million to advance new collaborative care teams across the province. We are looking for information, if the minister can provide it today - or if you don’t have it today, you can provide it to us later - on where this money was spent, when it was spent, and in which communities in particular, for this $6 million to advance new collaborative care teams across the province?
HON. RANDY DELOREY: I’m happy to advise the member that at the end of the year I believe, we are forecasting to have spent $5.5 million towards collaborative practices for the province.
I had the opportunity just a couple of weeks ago to bring an update to the people of Nova Scotia with respect to collaborative practices in the province, noting that we were expanding and/or creating collaborative teams - 23 additional ones in 17 communities across the province. Some of the work had already been commenced, so it was really bringing an update at that time, as well as the work that was still ongoing - having identified communities and physicians that were going to receive physicians.
Just to restate, this information is public, released a couple of weeks ago - I believe on March 8th, I made that announcement.
I’ll just reiterate for the benefit of the House that we identified seven new collaborative teams that include two sites in Dartmouth, and they will be receiving, as part of that, two nurse practitioners and two family practice nurses; two sites in Kentville with two nurse practitioners and two family practice nurses; two sites in North Sydney with three family practice nurses and a social worker; and a new site in Glace Bay with a nurse practitioner, a family practice nurse, and a social worker. Those will be new teams being created.
There will be enhancements to teams that already exist, including Dartmouth with a family practice nurse and a nurse practitioner; Springhill with a family practice nurse; Sydney, at a couple of locations, with a social worker, and a family practice nurse. Also for that Sydney site, we also have another 1.5 FTE - full-time equivalent - for other health professionals that haven’t fully been identified, but we know that they want to work with, so we have allocated for that. In Westville, a nurse practitioner and a family practice nurse. Lunenburg is one FTE, but it is split between a .6 social worker and a .4 physiotherapist, I believe, at that site. In Windsor, there is the addition of a family practice nurse.
In addition to that work to establish these and expand those collaborative care teams, we also recognize that in certain parts of the province there are communities and teams that came forward with really acute - we know that there are many communities with needs that we identified the opportunity to provide, or we felt that the opportunity was present to provide additional health care professionals to teams.
In Chester, we made available a family practice nurse; in Liverpool, a nurse practitioner; in Kingston, a nurse practitioner and family practice nurse; and in Musquodoboit Valley, a 0.8 FTE family practice nurse. In Pictou, we provided two additional nurse practitioners; in Parrsboro, an additional nurse practitioner; in Hatchet Lake, a nurse practitioner; in New Glasgow, a family practice nurse; and another social worker in Sydney.
These are all steps that we’ve been taking, as we’ve heard from Nova Scotians, to strengthen primary care access.
We recognize that primary care access can be provided by a number of primary care providers, often referred to as allied health professionals. We know that it is not just about family physicians, but while we have spoken and continue to speak and support the collaborative team model, that is not to suggest at any point that family physicians and family practices are any less important and critical to the foundation of our primary care services. That is not the case.
The whole point in principle behind collaborative care teams is the collaboration of all our health care professionals. This just goes to show, specific to the question, that we’ve spent about $5.5 million toward collaborative teams and practices last year, and this was a list of the announcement on March 8th which brought an update as to the work that has been and is focused on being done.
MS. MARTIN: On top of the $6 million that was allocated in 2017-2018, that was on top of the $3.6 million that was previously announced for family practice nurses and nurse practitioners. Are you able to provide us with the information of how much of that $3.6 million has actually been spent and where?
MR. DELOREY: The $3.6 million would have been for the existing collaborative care teams that would have been in place at the start of last fiscal year - or I guess the current 2017-2018 fiscal year. Those collaborative teams would have been in place, based on the previous budget, so I don’t have that information for where those specific ones were, but that is where - that is the continuation when it was identified and implemented in 2016-2017. Those funds would have carried forward to continue providing those services, then the additionals are what we continue to add to that to continue to expand collaborative care practices throughout the province.
MS. MARTIN: Specifically, you don’t have that information here on the $3.6 million, but I’m wondering if you are able to get that information on how it was spent and where - basically the same type of question.
So in this year’s budget, there is $8 million to advance collaborative care teams. Have the decisions been made on how that money is going to be spent, and where and when and what will that include in this $8 million?
MR. DELOREY: We wouldn’t have that level of detail as to specifically where each and every site or resource would be allocated. What we do have is a recognition that the work for establishing and expanding access to primary care - that the collaborative care teams are a critical part of that. That’s the strategy we’ve been deploying for several years now and that brings together many different health care providers.
The other principle or foundation of our collaborative practice is recognizing that the needs in different communities may be different and that I believe, in my previous response, I highlighted that - that in some practices there were social workers, in some there were more nurse practitioners, some family practice nurses. One, I believe, had a physiotherapist allocated.
The point is that if we defined rigidly what a collaborative care team or practice looked like - saying every practice will have this many nurse practitioners, this many family practice nurses, this many of each of the other types of professionals - then we could very easily predict and say we are going to have these many practices because we would know exactly how many clinicians and care providers will be part of them.
What we’ve heard loud and clear from health care providers, as well as communities, is that the needs of the population many be different and the needs of each team may be different. We were told and we listened that they need to be flexible. That is why the approach we’ve taken - the Nova Scotia Health Authority approached communities with an expression of interest. They reached out and asked who is interested. We know that we are going to have funding to continue our expansion of collaborative practices in the province, so who is interested?
I’m pleased to report that the expression of interest closed in January and there were about 100 expressions of interest - that is, organizations or teams that have come together to say we would like to either build upon the practice we have, or expand or create a new collaborative team.
Within the submissions, I believe there were over 400 physicians identified within those 100 teams being put together. That is significant. We have about 1,200 family physicians across the province and over 400 of those 1,200 are part of teams that have expressed interest in establishing.
To the member’s specific question, we don’t have the exact locations at this point, but we do know that there is more than adequate interest and desire to be able to start rolling these out.
Our partner at the Nova Scotia Health Authority will be working with those communities and groups looking to establish or expand their practices, and to do the recruiting to get those positions filled in those communities as soon as possible. That work is ongoing.
As I said, the expression of interest information - they are working their way through that and following up with those various teams. Again, that was January when they received it, so that work is ongoing.
MS. MARTIN: I’m not looking for specific, rigid information. I guess what I’m trying to get at here is that $8 million has been allocated in the budget, so that number had to come from somewhere. If we don’t know what you are going to need or what your planning, where does the $8 million come from and when can we expect that money to be spent to see improvements in health care across this province?
MR. DELOREY: As I was saying, I don’t think there’s any secret within the Legislature - within the general public, for that matter, of the need for expanded access to primary care services in Nova Scotia. We know that the demand exceeds the access at this point in time and that is why we continue to move forward.
What we have is a budget. When we’ve looked at and established amongst all of the competing priorities through the Department of Finance and Treasury Board committees, looking at all the competing government interests and opportunities to invest money for Nova Scotians in priority areas, obviously health care was one of those significant priorities - over 40 per cent of the financial budget is allocated towards health care. But not just as an absolute amount but as an expression of our priorities for new investment - it was also receiving over $100 million new investment.
We recognize this is a priority area. Through all of those competing priorities and interests, we identified the $8 million that we had available to put towards collaborative practices. We know that we could spend even more than that if the money was available, but the demand would be there to consume more than $8 million. What we’ve said is we know we have $8 million to provide to the Nova Scotia Health Authority to continue supporting these collaborative practice teams out there.
The approach that we’ve taken to identify and roll these out is first to get the expression of interest because we know the demand exists from one end of the province to the other. We’ve got that expression of interest - we know now who we can work with because they’re getting ready. We’re going to look to roll that money out to support those teams that are most prepared and ready, so we can get these services out to Nova Scotians as fast as possible.
As I’ve said, we have over 100 expressions of interest so we know there are 100 teams that are interested and ready to go. We have $8 million, the Nova Scotia Health Authority is working with those teams to prioritize and then allocate the money. I believe 100 teams would more than outstrip the $8 million though. We have more than enough opportunity to put the $8 million to good use.
MS. MARTIN: I would expect then that should be rolled out as quickly as feasibly possible when these expressions of interest are fulfilled, so to speak.
Before I move on, going back to the $6 million that was allocated in the Fall budget, I’m going to go here again because I’m in the hot seat about this - the New Waterford practice or the health centre that this government has promised the residents of New Waterford. In the last budget it was listed that part of that $6 million spending was going to be for this new health centre. I’ve been told by doctors that the ground’s going to break in the Spring - well, the other day was Spring and I’ve heard nothing.
I’ve sent letters to the minister’s office asking about this and I’ve had public meetings about this. People are conflicted - they don’t believe me and they don’t believe the government; they believe me and they believe the government. I’ve asked and I will ask again - I’m here for an honest answer. I need to know, is this coming forward and if so, where are we getting the staff for it?
MR. DELOREY: I appreciate the member’s frustration, in particular on behalf of her constituents. You can hear it in the member’s voice. Clearly, this concern is sincere and genuine.
With respect to this project, I do know that there seems to be different messages being conveyed in and around the community, so I will attempt to clarify. The commitment and work with the community to establish a space - this is one of the differences, those practices that we’re talking about that have been established - in many of them there are spaces that were already identified. This isn’t about capital investment, these are teams that just putting the staff in place so the money is going towards the operational staff, hiring the nurse practitioners and the family practice nurses - not the capital projects.
So, teams and initiatives that require the capital work actually has two parts to it. One is getting the capital, as the member indicated, breaking ground. That means this initiative in New Waterford is looking for physical space to go along with the staff to provide the care. Those projects sometimes are complex when a site isn’t already identified.
That work and those conversations are continuing. I know that there are certain people in the community who have a preferred location and site. I believe what’s happening, as I understand it, is that some people feel very strongly that the site is already chosen and is going to happen at a particular site. I have not seen and I am not aware, and it hasn’t come across for approval within government, across the department’s desk to take to Treasury Board on the capital side of that particular project, so we know that the Nova Scotia Health Authority is continuing to work on the functional plan and the project options, meeting with the groups, and we’re expecting that that work should be completed soon so that we can get more clarity around what exactly, and how it would look, and then the project has to come forward for the capital approval.
That hasn’t happened yet so again, the odds of breaking ground this Spring for whomever set that expectation at that point, I will clarify that’s not likely to happen at this stage, because again it hasn’t made it through that far through government process on the capital side. Again, notwithstanding that, we do know that we have made commitments and expanded collaborative care practices in practices that do exist in the Sydney region, and in the Sydney area. We are committed to continuing this work with the New Waterford area but, again, when you do have capital projects it does sometimes get hung up on finding the locations, getting things identified.
I’ll use the example of a former member of the NDP caucus who often asked about Roseway, down in Shelburne County, quite frequently over a number of years, because that site took many, many years. There’s a physical building already there, again, in the community. It seemed like a very easy thing to say, well, it’s already there just move the people in and away you go. Unfortunately, to establish and bring these sites up to a standard as we are moving forward with something new, it’s not as easy as just saying there’s a 50-year-old building over there, let’s just throw some health care providers in to deliver the care. We want to make sure that when we do these things, we’re getting the appropriate infrastructure in place.
In that Roseway example, even when government did get through all of the project planning and we announced we were going in to renovate that existing building, TIR staff got in there and did the assessment on site, and they realized, wait a second, there’s a lot more complexity in here than we had planned in the preliminary stages. They said, we have to step back and decide, is a renovation actually going to be the most cost-effective and timely way to do this, or will it be more effective to take the building down and start from scratch? At the end of the day, the conclusion in that example was to take it down, and that added another year delay to the project. But had it been the renovations, the cost and the time frame would’ve been extended longer than that year.
So I understand the frustration in communities when they continue to hear the promises being made that the work is going to be done, but I assure you that work in Roseway, in Shelburne County, is well under way, expected to open in the Fall of this year, I believe. So, again, when we make the commitment, we’re good for it, it’s just that we need to trust the experts and the staff on the ground who are assessing the opportunities and the options of where to locate and how to move forward on those things. It hasn’t made it through the necessary processes though, so I wouldn’t want the member’s community to think that the ground is likely to be broken this Spring. I can’t imagine it at this stage of where the project is at.
MS. MARTIN: To paraphrase, then, what the minister is saying is that when you make a commitment, you’re good for it. So this government committed to the Town of New Waterford that a collaborative centre would be opened in the Spring of this year and I completely understand, and I am aware of the building the minister is referencing that has caused quite a bit of contention in the town. I’m here to represent all Nova Scotians in health care, but specifically this was one commitment made by this government to happen in the Spring of 2018 that has not happened.
If I could ask the minister then - in the Fall budget, there was capital money available for collaborative centres - was none of that for this centre in New Waterford? My other part of this question is that I would implore the minister to accept an invitation to come to New Waterford and explain this to this residents. It is a serious, serious issue and like I said, they believe that I’m lying, the minister is lying, or somebody doesn’t know anything. I really believe that they deserve to hear exactly what is going on.
MR. DELOREY: As I indicated, the meetings are ongoing within the community and with the stakeholders working on this project. The Nova Scotia Health Authority, on the operational side, has taken the lead on assessing and working through that.
They will have to bring a proposal forward requiring, when there is a specific technical project for capital, that those types of projects would come across for approvals because the Nova Scotia Health Authority does require approval from the department. That work also, when there is a capital project, is in collaboration with the Department of Transportation and Infrastructure Renewal at the technical side. It’s not the Department of Health and Wellness that really focuses and identifies what and how that work needs to be done.
For identifying locations and the state of buildings, really the way it works is, our Health Authority that represents the operational arm of our health care services has the clinical expertise to identify those clinical needs and components of proposals, what the needs may be, and how they respond. They bring that clinical view and lens and requirements forward. Transportation and Infrastructure Renewal have the technical engineering expertise to create the infrastructure around it.
As I said, the meetings and things, I believe, are ongoing with the stakeholders and the community groups. I will endeavour to get the latest update and information from the Health Authority. My understanding was that they are, again, feeling like they are making good progress and I’m sure, as the Spring progresses, we will have more information to share with the community, either through the Department of Health and Wellness or the Nova Scotia Health Authority.
MS. MARTIN: Last point on this, I swear. I did ask the minister if he would agree to come up to the Town of New Waterford and have this conversation at an open town hall forum, and I would hope that is something we could schedule.
My second point about this - and I don’t know if it’s more of a question or a comment - but I have to express my extreme disappointment to have to come to the floor of this House to find out about something that is happening in my constituency. I have no idea how other members find out about stuff, but I have no idea why I am not included in this process. This is my constituency, it’s something I have raised several times, and I’m trying to work with whomever to resolve this issue - good, bad, or ugly - as I’ve said several times.
I would ask the minister if he can bridge that gap to include me in this process so we don’t have to take up time on the floor of this House to get the answers that I think I deserve, as do my constituents.
MR. DELOREY: I believe the work on the New Waterford clinic option predates my time in the office as minister. I believe the teams and the community representatives - stakeholder group - was identified. There is a group within the community working on this. I would think that would be the venue where the community has really come forward to represent on this particular file. That is, I think, how the information on this one has been proceeding.
As is often the case on individual, specific organizations or groups that come forward to advocate for work, we are working directly with those organizations to move forward in the province. It’s not intended as a slight to anyone, it’s just that we can’t have everyone at the table at all times, and as updates come out we do make broad updates available to everybody in the community and the public at large, when we reach those significant milestones.
MS. MARTIN: So that’s a no to the public meeting, then?
Now we’ll move on to midwifery. I am looking for information specific to the budget on where I can find the funding for the two additional midwives.
MR. DELOREY: There is not a specific line item to identify at that level of detail. When we have line items in the budget allocated to the Nova Scotia Health Authority and the IWK, the midwifery services that we provide as a province are provided in Antigonish and the South Shore by the Nova Scotia Health Authority, and in the metro region, through the IWK. The funding is in the operating budgets of those two organizations to provide those services and those positions.
MS. MARTIN: I would expect that when the minister took over, the minister would have been briefed on the midwifery program and where it was in the province, and at that time there was an external review recommending expansion of the program.
At any time, did the minister reach out and have a conversation with the Coalition for Midwifery to talk about this expansion and just how important it is to the residents of Nova Scotia for those who don’t have family doctors or access to collaborative care? This is their only access, quite possibly, to prenatal care.
Would the minister not agree that this is a vital part of our health care system, that in order to reduce these wait times with doctors and ERs and those types of things, that investment in midwifery that the recommendation called for would be part of the solution?
MR. DELOREY: Actually, I’m sorry to advise the member opposite that it was not when I became Minister of Health and Wellness that I became aware of the report that the member is referencing. In fact, before that point in time when I was in a previous role as the MLA for Antigonish, I had meetings with local midwives to discuss that very thing. It was something in my capacity as MLA for Antigonish that I was aware of that.
Move forward, the other question I think that the member asked was whether I’d met with the Midwifery Coalition. I have not, but I have had productive conversations and dialogue with the Midwifery Association of Nova Scotia - with the president as well as a number of midwives - when I did my tour around the province. I know I stopped in my own community, in Antigonish, for a tour of the hospital facility and I made sure that as part of that visit, I was meeting with the local midwives, as well.
They took the opportunity to show me the birthing room that was recently opened in that hospital, and they were very proud of because it provides a different - I guess I’d say a little bit more customized, more home-like environment birthing room than the standard obstetrics birthing rooms, which is a space then for the midwives in Antigonish to deliver in hospital.
So with midwifery services, yes, some choose to have the at-home birth and some choose to go to the hospital. What they were learning was that people who were using midwifery services wanted to go to the hospital, maybe because there might have been a slightly higher risk factor - going into the hospital but would like a homier environment. The Nova Scotia Health Authority has been responding to those desires and needs and are still very much involved and working with the Association of Nova Scotia Midwives to continue advancing and working in this area.
I’m pleased that there has been expansion for the Antigonish and South Shore programs and, again, the work to establish future changes or enhancements to the program - that work will be ongoing with our partners and the Association of Nova Scotia Midwives.
MS. MARTIN: Sadly, a resident of Cape Breton had to go to Antigonish to seek the help of a midwife because they were unable to obtain prenatal care on the Island, and yes, not that long ago, when the midwives were crying out and looking for help because they basically had to take some time off because they were working 24/7. The government only implemented two new midwives that could help this situation but, as I’ve said, midwives are a vital part of the solution for the crisis in health care that we talk about. Midwives absolutely play a part in reducing ER wait times in family practice doctors, in their schedules, as well as those who don’t have access to primary care.
So, when will this government see the importance of midwives and implement the recommendations that were brought forward by the coalition of midwives?
MR. DELOREY: As I’ve indicated, I do recognize the role that midwives play. Certainly, for those members of the province, those parents - particularly mothers, but fathers as well - go through and have the experience with their prenatal care with the midwife speak very highly of their experience. Many, as I’ve said, really feel more comfortable in the home environment, the natural experience, feel closer and bond with their infant child at birth. So, for many reasons, they do play an important role in the services that they provide.
But, with respect to the proposal, the pros did include a number of items. The first phase and the first step in that was establishing those positions to strengthen in those communities that were understaffed at the starting point to get those employed. Those are the positions that we announced.
As I had mentioned in my last response, the work is ongoing to look at any further expansions of midwifery services throughout the province. They’re delivered by our partners at the IWK and the Nova Scotia Health Authority. So, that work with those partners is ongoing. We do agree and have communicated to them that we do believe that midwives do play a role with providing care for Nova Scotians with the services they deliver.
MS. MARTIN: See that - now, we agree. We agree at how important midwives are. Specifically, that there will be an expansion - or not an expansion because they don’t exist. Can we expect the program to expand to the Valley and to the residents of Cape Breton because, clearly, they’re seeing a huge need of lack of midwifery programs and, again, I’ll say, part of the solution to this health care crisis.
MR. DELOREY: As we’ve said, there was a proposal made that had a number of steps within it. The first step was stabilizing the programs that were originally put in place. That step was taken continuing to monitor the situation to ensure that the hires and staff are in place there. We did make it clear in communications with the partners that we do support work being done here, that they’re continuing to look as part of their overall care, as the member has mentioned this is one part of the needs and the demands and departures within our primary health care services. We do, and it is incumbent on our partners as well as the government to ensure we respond. We are responding to the primary care needs of Nova Scotians.
We’ve made that very clear. We continue to expand our investment to support our family doctors, which are a critical component. They, too, can provide supports for mothers in need during a pregnancy as well as nurse practitioners and family practice nurses can provide obstetric supports as well. So, all of our work together - and I don’t want the members of this House to be left with the impression that the only supports and care of the pregnancy - that the only primary care option is midwifery services.
We’ve recognized that that is one option and one care provider, but all of the many other supports and services we’re providing around primary care like expanding our collaborative practice teams, providing more nurse practitioners and more family practice nurses, supporting the recruitment and retention of family physicians - all of these steps are being done to support broadly, primary care access in Nova Scotia, and through those steps as well, we are supporting obstetric support services, prenatal care as well.
MS. MARTIN: The Minister of Health and Wellness talked about family practice nurses and nurse practitioners - from what I’m hearing from constituents across this province are that some nurse practitioners are taken out of their current positions to be put in as part of a collaborative care team, and leaving those communities behind with nothing.
Can the minister explain - what’s being done for those communities that are being left behind?
MR. DELOREY: Certainly I can advise the member, and the members here, about the process for filling positions when a collaborative care team is being expanded, or established.
The process would be that the department and the Nova Scotia Health Authority would be advertising, or the clinics posting to fill those positions. They get advertised as a job opening. What individuals apply for those job postings, as in any other field, people would apply. People make their decisions as to whether their level of satisfaction with the position they currently hold, or if a new position opens up in another location - they may wish to be moved geographically. That may be something because of someone else in their family may have an opportunity or they may already be living apart - that happens from time-to time, where an opportunity to move closer to their partner - or for other personal reasons.
So we can’t speculate or stipulate as to why people choose to apply for these positions. We do know that positions are posted - in some instances, people in one position apply for a new position that opens up. In that case, it does open up a vacancy in the position that they’ve left, and if those are vacancies, they would still be funded, and they would be posted and recruitment would be ongoing to fill those positions.
I’ll just use for one example, it was March 8th when I did the announcement in Dartmouth about the update around collaborative care practices. The site that we were at had a family practice nurse as part of that practice, she had been there for about five weeks with the clinic that had been in operation for about 30 years. The nurse spoke at that event and she had indicated this job as a family practice nurse was her dream job. It is the type of nursing, clinical supports that she had wanted to do for decades.
For the last 15 years or so, that nurse had been working in a correctional institution, although she indicated she appreciated the opportunity and recognized the value of her work provided in that environment, it was truly in a family practice collaborative environment that she wished to work. When the opportunity came up, she jumped at it, and for the five weeks she’s been there, it is meeting and exceeding her expectations. Her satisfaction in finding the work opportunity - yes, that opened up a vacancy at the correctional institution she had previously been working at. However the job posting we posted there - and for some it could be a new graduate, it could be someone working away - that’s a great opportunity, it might be right up the alley of someone else to pursue that job.
So, yes, vacancies come up when new positions are filled, but we continue to recruit, we continue to educate, we continue to hire nurses as they become available to fill these vacancies, just as we do with physicians and other health care providers throughout this province.
MR. CHAIRMAN: Order please. The time for the NDP caucus has expired for this hour.
The honourable member for Pictou East.
MR. TIM HOUSTON: Mr. Chairman, I thank the minister for the responses. I was surprised to see you left five seconds on the clock there.
I have some questions about staffing levels. I want to start with nurses. I know there are different elements to the nursing profession, but I’m wondering if the minister can provide some information as to how many nurses there are actively working in the province - then if we have any kind of demographic split on the age of those nurses in the profession. I do hear a lot of concern that a great number of nurses are nearing retirement age and I’m just wondering if the department has kind of looked at that type of demographic split.
So first, how many nurses do we have active in the province, and then, secondly, do we have a split-down of any type of demographic - is the department concerned about the number of nurses nearing retirement age?
MR. DELOREY: I thank the member for the question. I will say that this is an area as part of workforce management that, indeed, we’d be wanting to monitor and keep track of - the workforce profile. That’s really what I think the member is getting at, specifically to the workforce profile of nurses.
The data that we do have on that is from registered nurses profile for 2017. We see a distribution - actually, it’s an interesting chart where we do see just under 10,000 registered nurses who are registered in 2017, and 96.2 per cent of them - so 9,591 - were employed at the time of registration. Within that, the vast majority are working full-time positions; about 20 per cent are working part time positions in 2016.
As far as the age working in casual positions - this just the nature of the work, because the member is asking about the age profiles - of just those working in 2016 in casual positions, just under half of them are RNs 60 years and older working casually.
What I’m getting at here is if you look at the demographics, you actually see a high number of young nurses at about - and it’s roughly across the stream - between 20 and 35 years old. You see a pretty steady between 600 and 800 nurses in each of the age categories between early 20s and mid-30s. Then you see a dip between the mid-30s and 40s for nurses at that age range. I think that would be roughly Gen X, and demographically that would be consistent. Then you see the flow up a little bit higher back to the 800 in those 50- to 60-year-old nurses, and then obviously tailing off to nurses over 60 years old.
Again, what is interesting is that of those nurses 60 years and older, many of them are actually filling the casual positions, so it’s very clearly a situation where it would seem nurses are easing their way into retirement in that regard.
I do want to be clear that is only in reference to registered nurses. We also have data on nurse practitioners and licensed practical nurses, if the member would like me to go into more detail.
MR. HOUSTON: Thank you for that detailed answer. He was reading from something and I’m wondering if he could table that chart or document he has. Thank you for that. That is helpful.
I hear a statistic often. I don’t know if it’s folklore or if there is truth to it, but I wonder if maybe the minister can comment. The statistic is kind of like, 10 per cent of the people consume 90 per cent of the health care budget. In other words, the most unhealthy amongst us require a lot of care - I guess that’s the best way to put it.
I wonder if the department has their own statistic on that or if they kind of agree with that - about 10 per cent of the people consume 90 per cent of the health care budget. I wonder if that’s something the department looks at.
MR. DELOREY: I believe the member used an example of a 90/10 split. I think when the member hears statistics or data like that, it really falls into what we think often as the 80/20 rule - in many instances, 20 per cent of something takes up 80 per cent of the time in customer service; or in sales, 20 per cent of your customers account for 80 per cent of your revenue. I think people just simplify it to illustrate, and very quickly articulate, that people with more acute care needs in the health care system, the cost of delivering those higher acute services is significantly more than the cost allocation for lower acuity services; that is, less significant health care demands.
For example, there are individual drugs where treatments can cost in the hundreds of thousands of dollars for an individual person in a given year. That would be a scenario where one individual has a much larger impact because of the nature of the condition than an average person who may not require any drug coverage during a particular year. Again, the vast majority of the population, the amount of hospital visits and care that they would need - we don’t have specific data that would say exactly, it’s like 11.6 not 10. But the principle that higher acuity services within the health care system are the ones that cost the most, but they are also the most serious health conditions that people have - it’s understandable that the costs are higher, but they are less frequently in demand, yet it still consumes a portion of our budget.
MR. HOUSTON: I thank the minister for that answer; it makes sense. I wonder, does the department have kind of a list or some indication of the illnesses that are the most expensive to the province? So, diabetes is one I hear quite a bit, diabetes requires a lot of the health care budget; I hear obesity and there’s other kind of respiratory illnesses. I wonder if the department kind of has an indication of the top four or five diagnoses that are consuming most of the health care budget, maybe?
MR. DELOREY: Certainly, understanding the profiles both of our population, but also how those profiles and those conditions present themselves to the department and our partners at the Health Authorities - for allocating resources and so on - are important. As part of the budgeting process, I don’t have those specific data details that were questioned, so I will endeavour to pull that together - and I’ll make the note right now to ensure we get that.
So I’ll say the top five conditions - and I guess, just maybe, can I ask the member in the reference to the condition, because there’s two ways that it can be interpreted. I believe it was the top five conditions in terms of the cost of service delivered as opposed to the top five conditions by volume of patients, but it is actually on the dollar value of delivering the service, the cost. We’ll pull that data, and if not by Estimates - again, I’ve made the note and I’ll take that in.
MR. HOUSTON: I want to finish up my time with a question on the Murray Formula. I’m not sure if the minister is aware of the Murray Formula, but the Murray Formula is used to determine the funded hours - I think specifically for an emergency department, but it might be more extensive than that. I’m hearing that the Murray Formula calculation is done maybe a couple times a year - maybe once in the Spring, once in the Fall - and it impacts the number of hours of physician coverage in an emergency department.
The most recent Murray Formula calculation for the Aberdeen resulted in a reduction in the hours of coverage at the Aberdeen Emergency Department. It doesn’t seem intuitive to me that with what we have going on in primary health care and more people presenting at emergency rooms that there would be a formula that would be reducing the hours that are already there.
I think the Murray Formula is unique to Nova Scotia, so I guess what I would ask the minister is: It may be time to look at the Murray Formula, and would the minister have been surprised, like I was, to find out that the result of the Murray Formula was that there would be less physician coverage in a busy emergency room, given what we have?
Just his initial reaction - would that seem strange that we would be reducing hours based on a formula? Is the minister familiar with the Murray Formula, and is it time to look at the Murray Formula when we see results like? That would be my general question?
MR. DELOREY: I guess, yes, the member is correct, there is a formula that is used as part of the budget allocation to identify the resource allocations - in this case, it is for emergency rooms, that particular approach. That would have been developed after an extensive review for care provided there. It provides a means even to the earlier question the member was delving into, the importance of having good data to help inform, particularly at the planning stage for allocation of the resources that are needed.
As far as linking the emergency room pieces and coverage back to primary care, while the member would be aware we are investing heavily in primary care as well to reduce those demands which will also, we anticipate, be reducing demands within our emergency rooms. We are taking a multi-pronged approach to addressing the many challenges we have. I don’t think there’s a direct linear correlation in all of those pieces and that’s why these formulas, I think, are used often because they take into account numerous variables to make those decisions.
MR. HOUSTON: Thank you, minister. I just had those few questions for today and I appreciate his willingness to get back to me on the diagnoses and the nursing profiles. I’m going to pass the remainder of my time to my colleague. Thank you.
MR. CHAIRMAN: The honourable member for Argyle-Barrington.
HON. CHRISTOPHER D’ENTREMONT: Merci beaucoup M. le président, je voulais premièrement remercier le ministre pour ses efforts, ses efforts ont va dire ça en guillemets, pour répondre à une question en français.
I want to thank the member for his efforts to speak French in the House of Assembly and try and answer a question in French, and maybe I will ask a full question in French in the next few weeks and we’ll see how he does on those ones. Maybe I’ll give him a little heads-up as well.
I have about three items that I want to discuss that are important to constituents in my constituency. I’ll try to get them done in about 20 minutes if we can. The first question revolves around EHS and paramedics. There have been a lot of concerns especially from the West Pubnico community, where that service has been geared back from their community due to the ambulance being out of the area more frequently. We’re experiencing the same problem at the Woods Harbour base as it’s been closed a lot. I was wondering if the minister could give us an idea of what’s happening in southwestern Nova Scotia?
I know the system is made to react and move but I’m wondering what maybe is going to alleviate some of the lack of coverage that has been happening in the West Pubnico and Woods Harbour areas?
MR. DELOREY: I would like to acknowledge on the record the member’s advocacy. Particularly I’m familiar with, and the member has brought it forward on behalf of his constituents in the past - I believe in writing and I think possibly even in questions in the Legislature - with respect to the West Pubnico, and I believe the re-profiling of the station there is part of the EHS system.
What’s happening - the responsiveness design of the EHS system is part, but that would be more on your day-to-day basis, then you bring it up a level. I guess that’s where the ranking or the category of the stations and the bases are defined. What happens is that the EHS continuously monitors the nature of the calls, and they want to position those ambulances as frequently as possible so that they’re as close to where they see the volume of calls. Now you can never predict with 100 per cent of certainty where a call is going to come from, but past behaviour and profiles within communities allows for them to do that as efficiently as possible. So they continue to update.
The alternative would be that we would have certain stations and locations for the ambulances. If they were fixed there for historical purposes, as profiles and demographics, and the needs of communities’ change we may be over-servicing particular areas and other areas being under-serviced, even though the community profile has changed. That’s really what’s happening in these communities and others, but the whole goal and the purpose is to provide the best emergency care possible to each of these communities, so that they are there and able to respond as fast as possible.
MR. D’ENTREMONT: I would say some of the confusion that’s been happening in regard to this is when the transfer of service happened from the West Pubnico Ambulance Service to EHS, that there seems to be a belief that in the contract, when that takeover happened, that Pubnico would remain as a priority base - whatever the definition of priority base is, I’m not quite sure.
So people are finding it challenging that their ambulance is not available, and I do try to explain the system but I think the system right now is under stress. We can only extrapolate that from what we’re seeing on Twitter. I hate to use Twitter as a way to gather data, but we’ve had the Code Critical things tweeted at us quite a bit over the last number of weeks when it comes to the availability of ambulance services in the Northern, Central, and Western Zone regions, and we’ve seen it a lot that there is maybe one ambulance in a whole region because everything else is being caught up, probably mostly here, at the Infirmary site waiting for transfer of patients.
I was just wondering, maybe as a global answer, how are the department and EHS going to be able to try to alleviate some of these problems, as it seems not only to be just happening now, but it seems to be a trend that’s continuing to happen?
MR. DELOREY: A couple of things. Yes, we do obviously take these situations seriously, the concerns being raised. In fact, within the health care system actually in my experience, our partners with the EHS system from a data perspective - having data and being able to analyze that data and return information - they are very well established. They have a great repertoire and capacity to respond when I have questions to get the data back to understand how the system is responding, what the demand pressures are, and how they are responding to them.
One of the important things is knowing that as the service provider to the Province of Nova Scotia delivering those ambulance services, there are service-level agreements in place, the contractual requirements that stipulate that they have to meet response times to ensure the safety of our population. That was one of the things when concerns were being raised to me, when I first heard concerns being raised about coverage.
I can understand that concern within the population would present - we often hear about the world-class ambulance services we have here in the province, and the care provided by our medics, but also the way it’s designed to be responsive. When you start hearing concerns being raised, as they have been recently, I did want to understand that, and they are continuing to meet the service level standards.
So despite the presumed concerns that are coming from the social media campaigns, the data that I’ve seen most recently does show that they continue to meet their contractual requirements. I think it’s nine minutes or so within - actually I’m not sure, I’ll have to double-check with the specific time period. But, they have been meeting those standards within the province, so it is important to note that the system is working in that regard.
To the pressures that are also being reflected in referencing the ambulances when they’re waiting to the offload piece, people are seeing and connecting these two pieces together, seeing ambulance offloading, saying that means that’s an ambulance not in service. But keep in mind we are paying for the service to provide response to the emergencies of patients. That just means staffing up and making sure they have the ambulances even if they’re being held up at the ED site.
Notwithstanding, we certainly would rather have our highly trained paramedics with the ambulance out and available. As I’ve mentioned before in the House, I’ve asked for a report and my understanding is the team working on that, I did check in on the status of the report, they do have something well under way and has recently gone back to the committee that’s looking at it. They’re doing a final review of it and I’m expecting it in the not- too- distant future, at which time I’ll see what kind of proposals and recommendations they have for moving forward there.
MR. D’ENTREMONT: Data is always king when it comes to some of this information. I was hoping maybe - I know if I asked for the data on whether they’re meeting their contractual obligations, it will give me a pretty even “nicey” look at what they’re providing. But anecdotally, what I’m hearing from my community is that they waited 25 minutes for an ambulance, 35 minutes for an ambulance, those kinds of things. I don’t know what data set I can ask for that would provide me with that kind of information.
I’m hearing, anecdotal stuff that the ambulance that’s supposed to be in Pubnico is actually in Meteghan - and there’s no way that the ambulance is going to be able to respond to a cardiac arrest or some kind of emergency in 9 minutes if they’re sitting in Meteghan and the accident happens to happen on the wharf in Pubnico.
I’ll just sort of leave it with the minister to maybe find out, if the minister could provide me with some kind of data set that would show us they are meeting those contractual obligations, maybe giving us a little more depth of what is really transpiring.
I’ll move on to my next quick question and maybe he can answer as he goes along - when are you going to give me dialysis in Barrington Passage?
MR. DELOREY: I really do appreciate the question. The member has been a fierce advocate on behalf of his community for the dialysis. We do have a commitment announcement we’ve made for several dialysis expansions across the province. The result of these projects - two are currently under construction and three more are in the design phase. When all of these dialysis seats are added, we will have about a 30 per cent increase in dialysis across the province. That’s our first priority, to get those seats up and running.
What I do want to advise the member and other members here is while there is little comfort for those members who don’t have dialysis units in their communities, we are trying to reduce the travel time for all citizens who require the dialysis. I want to make sure they’re aware also of the potential home dialysis. It doesn’t work for everybody, but for those that it does work for it doesn’t just address the travel time to a dialysis unit, it also allows the patient to get the dialysis overnight which, on top of the travel reduction in time, has a profound impact on quality of life.
MR. D’ENTREMONT: I appreciate that there is a lot of work to be done on this but if I could get the minister to commit to maybe providing the renal dialysis plan showing where we see future growth for that service, or the potential growth. I know my community seems to be hit quite hard by renal failure, diabetes - those kinds of things that require this kind of service. The province is a difficult one to provide services to because of the distances between our communities. I know this community is thinking outside the box trying to find a solution to that distance. I know I do it with a number of patients in heart and I know a couple of them will never get to see a possibility of this kind of service.
I have one of them - and I don’t have his, I should have had the form before me - I have one of them who continually texts me every time I ask a question in the House of Assembly, basically saying he’s talking to his family now to stop getting dialysis. He has come to his end, he can’t deal with it any more - so time is of the essence.
I know we’ve been talking about this one for quite a long time but if the minister could provide us with some information on where they see the future growth is going to be and start thinking of those, I would say possibilities or what kind of guidelines communities could think of. I think a community-based dialysis unit would be a good place to think of a pilot, try it, those kinds of things.
I’ll do that before I move on to my final point.
MR. DELOREY: There is a dialysis report, Strategic Direction, around dialysis in the province. It is a report focused on 2016 to 2019 that is publicly available on the Nova Scotia Health Authority’s website. If you want to do a search for that or if anybody wants to do a search for that, search for: NSHA Renal Program Strategic Plan, and it’s 2016 to 2019. It was really that plan that laid the foundation for those announcements of the growth that we’ve already identified. Again, that’s a 30 per cent growth in the number of seats for renal dialysis.
MR. D’ENTREMONT: The final point that I’ll do for my area revolves around cancer treatment. I know there is an ongoing piece of work being done by Dr. Bethune and Cancer Care Nova Scotia. I’m just wondering maybe if the minister could give us a quick update on his timeline - when he plans on having a recommendation in his hands on how the department is going to be able to deal with this.
If it’s positive, that’s all wonderful; if it’s negative, we’ve got a fight on our hands. I’m just wondering, where are we in this process?
MR. DELOREY: I know this is a topic that is of significant interest to the member but also to my colleague, the member for Yarmouth. I’ve had the opportunity to meet with people in the communities, I think I’ve mentioned in the Legislature before, so I’ve heard first-hand directly from community members down there the importance of this to them. That’s why we committed, why I committed, to having that review done. Dr. Bethune is reviewing it.
I’ll just jump to the specific question which is, I think sometime in the late Spring/early summer time frame is when Dr. Bethune - I know that earlier, just about a month or so ago, he started going down and having some public meetings in the community so he’s getting that input. He has been doing a lot of the technical work with the team. I think the last update I had was he was expecting to have it to me in late Spring/early summer.
MR. D’ENTREMONT: To the minister, I appreciate that. I do acknowledge the work the community is doing together, the municipalities are working together, the foundations are working together. The member for Yarmouth, me, and the member for Clare-Digby are working together. This is an important piece, we believe, anyway. Hopefully the data and the information will show that, but we believe very important for individuals who require radiation cancer treatment in southwestern Nova Scotia.
Far too many people have to travel to Halifax to receive that service and, quite honestly, I know a number of people who have refused that service, that kind of treatment because they just can’t figure out how they can get here and afford to stay here, and being away from their families. Sometimes it’s not even a cost issue, it’s simply they can’t see them leaving home. There are people we know in our communities who don’t travel very far, and to get them to come to the big city and put up with that kind of service is just too much for them to bear.
Again, that’s an issue that I would believe is time-sensitive, one that we all need to work together and heavily on. I want to thank the minister for his dedication on this one, and of course the department as well because I know it’s going to take a big effort on behalf of everyone.
With that, that is my final question on Health and Wellness at this point. I don’t know if the minister wants to quickly answer, but when I’m done I know the member for Victoria-The Lakes will be taking over. Thank you.
MR. DELOREY: Merci à la député pour ces questions à moi monsieur le Président, c’est tout pour ce moment.
MR. CHAIRMAN : The honourable member for Victoria-The Lakes.
MR. KEITH BAIN: First of all, let me say thank you to the minister and staff for being here. I know that there are questions coming from all directions, and I can guarantee you that mine will probably be no different. My first question is going to be a combination of doctor shortage, doctor recruitment, and ERs, and I’m going to be combining them all together.
Just this week, we found out that several physicians no longer feel comfortable working in ERs, and are having difficulty balancing the ER work with their practice and their family life. We also found out that Cape Breton is losing one part-time physician, a family physician who works both in emergency and his family practice and is moving to Ontario; and another doctor, who is over 70, has decided to retire.
I guess what this does is leave the hospitals of Cape Breton with the possibility, and likelihood actually, that they’ll be unable to fully staff the ER at the regional hospital, let alone the Northside General, or the Glace Bay, or New Waterford hospitals. We know that the ERs, especially the satellite - can I call them that? - ERs in Glace Bay, New Waterford, and North Sydney are closed quite often, and a lot of times the three are closed at once. The emergency department at the Cape Breton Regional was never built to accommodate the number of patients that show up there, and when these three are closed at the same time it just exacerbates the problem.
So I’d just like to have the minister comment on what’s being done to recruit more doctors to Cape Breton. We heard numbers before that there are only 89 people in Sydney without doctors - I think if you looked at the broader Cape Breton picture, it’s a lot more than that. So, I’d like the minister to comment please.
MR. DELOREY: The member noted at the top about the gratitude and acknowledgement he extends to the staff being here with me. If you think of the amount of time they have to spend with me here, just imagine the time they spend with me in the department on a regular basis when we’re not here. I think they deserve a lot of gratitude for putting up with me.
There are a number of questions in there that I’ll try to address. On the first, the member is right. It’s something we’ve been talking about for a while, about the changing evolution in the area of how physicians are practising. The member indicated in some cases, individuals not feeling comfortable, or wanting to, for whatever reason, practice in an emergency room environment for example, that that is one of the sources of challenges of getting physicians to work in ERs.
I’ll use an example. When Question Period comes up, one of the areas that often gets highlighted for closures - even before my time as Minister of Health and Wellness - is the Roseway Hospital in Shelburne. Often, if you go back to Hansard, it’s probably one of the most frequent questions in QP since we’ve been in government.
When I did my tour of the province back in August and September and I was down at Roseway, what I was advised is that community had more physicians than they’d had in decades, but they just weren’t choosing to practise in the emergency space, which is confirmed - the member accepts that that’s what he’s hearing from the front lines as well.
So when we’re looking at the challenges of ER closures in some communities, in those communities where it is about not having physician availability, not just an issue with recruitment of physicians and primary care access in the communities, it’s actually because of - in part, not all, but in some situations - a change in the preferences and the practices of physicians themselves. It does compound the complexity of the problems we face. It’s not just as easy as saying recruit another doctor to provide care in our community.
Historically, yes, a family physician/general practitioner in a community would provide the coverage in a practice as well as in the emergency room, but with the changing practices and the evolution, we are seeing where that doesn’t happen all the time. Someone may come to practise in a family practice and may chose not to work in emergency room coverage, again for personal reasons. It isn’t as important as the fact that it’s a reality we must adapt to in our health care delivery services.
The other thing I’d like to note about emergency rooms in the provinces is that it is not strictly a physician challenge in all communities. In some communities, physicians are ready and available, but it is sometimes other staff that is needed, like nurses. I think this goes to highlight the fact that when we are talking about collaborative care teams, we do see collaboration.
We know our health care professionals work together and are critical in working together to provide care. I think that just goes to show that ERs don’t work without doctors - and ERs don’t work without nurses, either. Again, we try to recruit and ensure their availability, as well.
To the questions or the comments that the member made around news of physicians choosing to leave, relocate, or retire, obviously we are aware of those pressures coming. We know that we have a demand and we’ve established a physician resource plan.
There was a very extensive modelling done back under the previous government in 2012, and that model has served as the foundation over the last six years or so, being refreshed every two years to make sure that what we are seeing in the province is still accurate, and to help and form our recruitment efforts. We are expecting the resource plan to be updated later this Spring for 2018; the last time it was updated was 2016.
I can tell you, as Minister of Health and Wellness, I do not need that plan to tell me we need to recruit more. We need more primary care access. That’s why we didn’t wait for that plan to be updated to take steps to strengthen access to primary care physicians and collaborative teams across this province.
MR. BAIN: I thank the minister for that. When we talk about doctors not wanting or hesitating to work in ERs, we heard of instances - the member from Sydney River-Myra-Louisbourg mentioned the other day that there are only six actual emergency beds available in the region because the rest are being taken up for long-term care. I’m sure the doctors don’t feel that they can do their jobs, especially when there is an influx from the Northside-Glace Bay-New Waterford because those ERs are closed.
Does the minister feel that the overcrowding of ERs might play a part in whether or not doctors want to work in ERs, as well?
MR. DELOREY: I know that there’s been a lot of talk recently about the role of alternative level care beds in hospitals for people who may be waiting for a long-term care placement. First to clarify, a patient in an alternative level care or ALC bed is not automatically a patient waiting to go into a long-term care facility. The fact that there is an ALC patient in a particular bed, one cannot assume that they are waiting to go to long-term care - that’s one piece. What it actually means to have an ALC designation is that they don’t require specific medical interventions at that time.
In many cases they are waiting to move somewhere - it may be in their home, but their home may require some updates or upgrades, or they may need to get their home care plan in place so they can go home and not just into the hospital; and sometimes it’s palliative. So there are a variety of reasons why someone might be in an ALC-level bed.
What I can tell the member is over the past five years - and I know they’re tired of hearing that we’ve reduced the wait-list by over 50 per cent for long-term care placements. Specifically, how that equates and the impact in hospitals is that we’ve seen a reduction of about a 29 per cent decease in wait times for long-term care placements from hospital. That is, the number of people waiting in hospital to get placed in a long-term care facility or residential care facility, nursing home or residential care facility, in a hospital bed waiting has reduced by almost 30 per cent since we’ve come into office.
The pressures, although there - they’ve been there long-standing and the steps that we’ve been taking in providing care for our elderly has actually been improving the situation despite the challenges that still exist, and we’ll continue to work to improve the situation for our entire health care system.
MR. BAIN: The minister’s remarks brought up one word that was going to be my next set of questioning, when he mentioned palliative care. I don’t have a breakdown, but I’m assuming palliative care falls under continuing care in the budget? I’ll ask that question first and then we’ll go from there.
MR. DELOREY: Actually, just to clarify for the member, palliative care would fall under the primary care of the hospital budget. It’s not in the continuing care space.
MR. BAIN: The reason I ask that is because in Victoria County the palliative care nurse that we have is only a half-time person because of lack of funding, and Dr. John Ritter, who is the palliative care doctor, spends one day a week in Victoria County. I met with the hospice palliative care people in Baddeck just recently and that was their biggest concern.
What they’re looking for is the possibility of getting that half-time palliative care nurse increased to full time. She’s overworked because of her caseload - she has an equal number of cases as compared to four palliative care full time at the regional hospital in Sydney.
I’m just wondering if it is at all possible that the funding could be made available to make that palliative care nurse in Victoria County full time.
MR. DELOREY: Certainly funding is made available from the department to our partners in the health authorities to deliver the care and the services. They are tasked then to operationally identify the needs and respond to those needs within communities.
When it comes to palliative care, what I can advise the member and others is that not all palliative care takes place in the hospital. It’s important to know that there are community-based palliative care services that have a nurse or physician. We spoke earlier with the member for Argyle-Barrington about paramedics and the role they play - in Nova Scotia we have a paramedic palliative program as well where paramedics actually participate and provide palliative services, and that’s available across the province as well for individuals.
The solutions in some communities, it may seem like it’s adding to the existing complement or expanding in the traditional way, we may already have resources and programs and I’d encourage the members and the communities to engage with their local Nova Scotia Health Authority representatives and possibly if they’re not familiar with the paramedic palliative care program, they can reach out to my office and we’ll pass along those details to you as well.
MR. BAIN: I want to thank the minister, and I’m going to turn my time over now to the member for Dartmouth East.
MR. CHAIRMAN: The honourable member for Dartmouth East.
MR. TIM HALMAN: From Victoria-The Lakes to Dartmouth, minister. I want to thank the staff for all the work they do for Nova Scotians each and every day, and the minister as well. I have no doubt it’s a very, very challenging job.
These questions that I’m going to pose to you, minister - through you, Mr. Chairman - come from consultation as all MLAs do with their constituents. I’d like to first start off by asking about the investment in mental health which is, if I understand correctly, $2.9 million. Does that $2.9 million include putting emergency psychiatry service at the Dartmouth General Hospital or mental health supports at the Dartmouth General Hospital?
MR. DELOREY: I guess the first thing is although what we’ve identified in the $2.9 million - that’s new investment. I just want to clarify that so people in the House don’t think that’s all we’re investing in mental health - in fact, that’s an increase which is an increase on top of the increase we made in the last fiscal year as well. We’re continuing to invest more and we’re upwards in the $300 million range for investments in mental health through various initiatives.
As far as the programs and where we’re allocating these investments, what we have is a commitment to have ten additional mental health clinicians, five for adults and five for children and adolescents. We have $800,000 going towards IWK Telehealth Outreach - that’s to provide those expert services to other parts of the province so that people can consult, they don’t have to necessarily travel to the city, making the best use of those special experts; about $500,000 providing eight First Nations child and youth clinicians and an expansion of community-based youth initiative into the Northern and Western regions; and the Eastern Zone in Cape Breton has a program called CaperBase already in place.
Those are the programs and initiatives that are new, that we’re investing the $2.9 million. Specifically to the member’s question, it would not include the resources that he was enquiring about at Dartmouth General Hospital in that $2.9 million specifically.
MR. HALMAN: I hope with time that the government will develop a strategy for Dartmouth General Hospital specifically as it relates to mental health.
I’m sure the minister is aware of the statistic that - it’s often said in Dartmouth that 40 per cent of our primary care providers, our doctors, are going to retire over the next five years. While as an MLA I’m thankful that we have four new nurse practitioners for Dartmouth, could the minister give an overview or provide the strategic plan for Dartmouth? With a statistic like that, I know many of the residents of Dartmouth find it very concerning, so could the minister provide us with an overview as to the plan for Dartmouth over the next say five to eight years for doctor recruitment?
MR. DELOREY: A couple of things the member noted. On the one hand, like many parts of the province, we know Dartmouth has a need for expanded primary care access and, as the member acknowledged, we’ve been investing. We’ve provided several more nurse practitioners to provide that care, joining collaborative teams to help support more Nova Scotians, more people from Dartmouth to get the care that they need in these clinics. But that does not exclude the need to do more as physicians retire or are approaching retirement age; again, not a situation unique to the constituents of Dartmouth. So when we’re doing our planning, we are planning province-wide.
I’ve made reference to the fact that we do have an updated Physician Resource Plan. I’d be expecting to see more details through that plan and how it will influence then more broadly recruitment initiatives across the province. But as I’ve said before in this House, the fact of the matter is I don’t need the resource plan to know that we have a need in Dartmouth and in other parts of the province and that’s why we’ve taken a number of steps. One is recognizing that as important as traditional family practice models are - we continue to support physicians who want to work that way if they want to create new practices and work that way. But we also recognize that for many new physicians and other health care providers, that working as collaborative teams is the desired approach.
So it’s relatively new, we’re expanding and moving into that space because it will help us with our recruitment initiatives, especially with young physicians and other health care providers like nurse practitioners and family practice nurses to get into the space - and the people who are working there are excited. Whether they have 30 years of experience - when they actually experience it, the feedback I’ve had by and large is they are very supportive of working in these collaborative environments.
We also announced back in February, I believe, a new immigration stream for encouraging family physicians from other parts of the world to be able to immigrate here and work in Nova Scotia. Again, while that’s not a strategy specifically for Dartmouth, it is a provincial strategy to bring physicians into the province - the need is everywhere. Then it will be up to those physicians to choose where they want to practise - in that situation, Dartmouth. We’ve seen the successes in areas like Cape Breton. In August, the community in Cape Breton led by the business community and partnership with others around the foundation and volunteers working with the hospital - they actually developed a recruitment video to highlight and showcase what life in Cape Breton is like.
Far too often, we hear the depths of despair of industrial Cape Breton from the challenges back with Devco, and the decline of coal mining industries and the traditional industries that supported Cape Breton and served the people there so well for so long. When you see this video, you see the life in Cape Breton is anything but. It is a vibrant community in industrial Cape Breton, and throughout the rural regions as well, with amazing opportunity and fantastic family life.
We hear stories down in the Digby area and Kentville of how primary care providers come to the communities, and they say it’s not the money or what anyone in the government or the Health Authority has done - it’s been the welcome from the community. So again, for people in Dartmouth, I encourage them and the member for Dartmouth East opposite to think about that as well. Not just what government is going to do, but what the community themselves can do when they hear of people being potentially recruited, that they can make themselves available to introduce - if you hear there is a new physician or nurse practitioner in town, show them around the neighbourhood, bring them a cake, or something, right? Just show them Nova Scotia hospitality, that goes a long way for getting them to stay here in the province.
One thing though that probably more directly applies to Dartmouth, and I’ll wrap on this, is that we’ve made a change in recognizing the needs - again, not specifically to Dartmouth, but the metro region. Historically, the incentives that we have made available to particularly new physicians around tuition relief and so on, have been designed for areas in the greatest need. We wanted to incent physicians to go to the areas where we needed physicians the most, and it excluded the metro region, and for too long, the Physician Resource Plan didn’t take that into account. When we started the 811 list, which I know a lot of people like to criticize because the number is about 42,000 to 44,000 people waiting for a family physician, the importance and the significance of that list cannot be overlooked.
We quickly realized as people were registering, the depth of the need within the metro region, and that would be Dartmouth and the peninsula and the broader Halifax area. That would have been ignored, so with the pressures existing and forthcoming, we’ve expanded those programs now so it’s where there’s need. There’s need in metro, there’s need Dartmouth. So, those potential physicians are eligible for those as well, so that will be something to help recruit specifically to the Dartmouth region, on top of all the other things we are trying to do.
MR. HALMAN: Certainly, if we wish to take someone to Dartmouth East to a restaurant, it would probably be the Mic Mac Bar and Grill, which many members of this House are familiar with.
Minister, thank you for your response. My next question relates to those four new nurse practitioners in Dartmouth. I understand one is at the Pleasant Street Clinic. For the residents of Dartmouth, could the minister indicate where those three other practitioners will be practising, and how many patients will they be permitted to take on?
MR. DELOREY: Mr. Chairman, I know that we do have the clinics that have been existing and expanding include Woodlawn Medical Clinic, Albro Lake Medical Clinic in Dartmouth as well. I know we announced at the announcement the data that I had was in Dartmouth. I didn’t get it broken down to which specific ones. So, I know these clinics already exist in Dartmouth, I don’t know if these are allocated directly to those, or others in the community. It’s just the way that I had the data, I didn’t make that specific level of detail.
MR. HALMAN: Perhaps then, minister, we could get clarification of that at some point at a future date. That would be fantastic.
Switching topics a little bit, going from a regional constituent issue to provincial - I had a great conversation with some rugby coaches in Dartmouth the other day, they’re actually in the process of starting up a mini youth league to see that sport grow. Certainly, we had a great conversation about the importance of concussion education. They indicated to me, Mr. Chairman, that we have seen a huge shift in attitude toward concussions, and thank goodness. I know certainly, as a former high school teacher coaching football and rugby, to see those shifts in attitudes is critical.
It’s my understanding that a few years ago, there was work on a Concussion and Traumatic Brain Injury Strategy here in the Province of Nova Scotia. I understand a number of neuroscience nurses, nursing researchers were seconded, some investment was put in to having that strategy developed. I was hoping the minister could provide an update as to the status of the Concussion and Traumatic Brain Injury Strategy, and what the plan is moving forward to have a strategy here in the Province of Nova Scotia.
MR. DELOREY: I think for those working with rugby would know that. As the member for Antigonish, and the success of the women’s rugby team at St. FX University, I’d be remiss if I didn’t give them a shout-out (Interruption) the member for Pictou Centre knows all too well what I’m talking about here.
So, certainly well aware of the commitment that it takes, the importance, but also the risks at play for rugby, or football as well, and hockey - really any contact sports that are out there. I’m not familiar with a Nova Scotia version, certainly, I believe, Nova Scotia participated on a national program, but in Nova Scotia, what we did that would be in that same space specifically - actually, let me back up. That’s my understanding, I’ll have to double-check to see if we had a Nova Scotia-specific trauma concussion one, I’m aware of a national one, which Nova Scotia participated with. So, I’ll have to double- check to see if there was a Nova Scotia-specific one.
I do know, of course, that in Nova Scotia we did develop an acquired Brain Injury Strategy Initiative under the leadership of the former Minister of Health and Wellness - the current Minister of Communities, Culture, and Heritage. So that work has come forward - I looked at it in the Fall. We’ve been working with the Brain Injury Association of Nova Scotia to continue to advance that work inside of government, to identify the next steps, and we should have some further updates in the coming weeks or so on that particular one.
So, acquired brain injury, concussions would certainly fall under that category.
MR. CHAIRMAN: Order please. Time has elapsed for the PC Party. We will now move back to the NDP caucus.
The honourable member for Cape Breton Centre.
MS. TAMMY MARTIN: I’d like to start off by talking about dialysis and where exactly we can see dialysis figures and/or funding in the budget. Does this government, this minister, believe that dialysis is part of primary care?
MR. DELOREY: From a category perspective, to the member’s last point in the question, of whether or not dialysis is primary care, I believe it’s predominately considered acute care because of the nature of the equipment and the specialization around the renal treatment. It’s generally managed through our renal program. I think rather than primary, I think it does fall under the classification of acute care.
As far as the budget details, the operational budget details of the dialysis treatment are included in the global budget that goes out to the Health Authority, because it is the Health Authority that delivers the dialysis treatment. Within this budget specifically, what I can advise the member about our commitment to the growth of dialysis in the Province of Nova Scotia is that we do have a capital investment around dialysis. These expansions, when fully implemented, will see an increase of about 30 per cent in the number of seats or stations available to provide dialysis treatment to Nova Scotians.
I’ll just iterate what we have from a capital perspective to get new seats available so we can expand the access to dialysis across the province. These sites were announced previously, but the funding for the projects is in this budget.
Kentville dialysis is a project that has $5.7 million allocated in this year’s budget to go toward construction. Design was completed previously. They’re now in the construction phase. Digby dialysis is allocated $4.1 million to construction in this fiscal year. Again, design had previously been completed. The Halifax Infirmary and Dartmouth General are both in earlier stages, with some rework and reallocation being done. Both of those are in the design phase, and in this year’s budget we’ve allocated about $70,000 to each of those initiatives. The Glace Bay initiative, also in the design phase, has about $244,000 going toward that design.
We’ve committed over $10 million for construction and design. “Why these sites?” might be an obvious next question. We had a review in the renal program a few years ago. They came up with a strategic report for 2016 to 2019. It’s the Nova Scotia Health Authority Renal Program that conducted this. It’s called the Renal Program Strategic Plan 2016-19. That plan is publicly available, I understand, on the Nova Scotia Health Authority’s website. That provided some insight as to where need - part of that need is not just the need of the community but also the surrounding communities who are trying to reduce travel times. Many people in rural parts of the province do have to travel a significant amount of time.
I don’t know if you’re aware of people who require dialysis treatment. To be perfectly honest, I didn’t appreciate the significant impact on the lives of Nova Scotians who require this treatment until I became the Minister of Health and Wellness.
As I toured the province I visited some of the existing renal centres, dialysis centres, in the province, where I found out the reason we call them seats instead of chairs because the system is actually a chair that you sit in and you have your blood literally taken out. It goes through a system to be cleaned and comes back into your body. It can take upwards of eight to 12 hours of the day for a treatment, multiple times a week.
Just imagine that to receive this treatment you may be required to travel an hour or two, in some instances, to a community that has one of these dialysis units, and then sit in a chair for eight to 12 hours while the system cleans your blood, just so you can stay alive - a very significant impact on the lives of Nova Scotians requiring this treatment.
Again, that goes back to say that we do recognize that. That’s why we’ve expanded. It’s going to result in about a 30 per cent increase in communities around the province to hopefully reduce some of the travel time for some.
I will reiterate that in addition to this, we do have a home renal dialysis program. That is a situation where you can actually have renal dialysis conducted in your home. It isn’t for everybody - not all patients are able to take advantage of this program. But for those where the nature of their treatment works, or aligns with the program offering, the impacts on quality of life are immeasurable. Instead of having to spend your day receiving treatment sitting in a chair, my understanding is that in many cases these systems can be configured so that you are going through your treatment overnight. Imagine that, instead of being in a chair all day, you are able to get your dialysis overnight, freeing up your entire day throughout the week.
I do want to clarify one thing before I sit down. I misspoke at the beginning of my comment where I said that dialysis fell under acute care. In fact, it’s under ambulatory care. I would like to make that record clear to the member’s question of if it is primary care. I mistakenly suggested it was in acute care. It is actually ambulatory care. I’ve had it clarified. I hope that answers the member’s question.
MS. MARTIN: I think it’s a little disingenuous for this government to claim victory on the dialysis unit in Glace Bay. We’re very aware - I would say that 90 per cent of the funding for that dialysis unit in Glace Bay came from deceased family members. I recognize that the minister has said that some additional funding is going in, but the majority of those funds came from a deceased family member.
I’m glad to hear that you talked about travel, because that brings me to my next point, specifically about - and I have to look at the words - the Instrumental Activities of Daily Living Program. That is something that one of my constituents relied on. I’m wondering if this government can let me know what the funding has been for the past three years, and what the funding is for that program this year?
MR. DELOREY: Unfortunately, just a quick clarification on another point. I thought it was eight to 12 hours, but it’s more in the four to eight hours for dialysis treatment. I’d like to make that clarification as well. It’s still a significant impact on the quality of life, when you factor in the travel times. I think that collectively it might be up to 12 hours for some Nova Scotians. I think from home and return is where my 12 hours - not actually 12 hours in the chair. I just wanted to make that clarification as well.
I do not have the 2017-18 allocation at that level of detail for the IADL - it’s called the Instrumental Activities of Daily Living Program, for those members who aren’t familiar with it. In 2018-19, it’s about a $1-million budget. My understanding is that there has been no change, so I believe it was the same $1 million in 2017-18 and for 2018-19 as well.
MS. MARTIN: The constituent that I’m speaking of has been informed, actually, albeit the budget may remain the same that the funding has changed, the allocation has changed - I hopefully stand to be corrected.
This one particular member, who is a single elderly woman, has never been married, has no family in the area, and requires dialysis three times a week. She’s never driven, and she lives alone. She relied on the funding that came from the IADL to provide her with cab fare to get to and from her dialysis. I don’t know if this minister or the government are aware, but cab prices are rising and exactly what it costs to go in a cab from her home to the regional for dialysis, or from anywhere else in the province to the nearest hospital. Also, at the time that she needs to go for dialysis, the Handi-Trans doesn’t operate.
Now she’s being informed that this funding has been cut in half. She was allotted $500 per year and now it’s been cut in half. It used to be specific that you could have $500 say for transportation, $500 for lawn care - now it’s $500 together. So she has about $250 she’s working with to get to dialysis three times a week for 12 months.
When she called the NSHA and asked how she would get her treatment, she was told to sell her home. I think that’s disgraceful. When she called and had this conversation with me, she said, I either have to sell my home or I will die. That is the situation that she is in currently.
I don’t know if this government understands the issues that face rural communities in Nova Scotia, and how difficult it is to rely on public transportation. Not everybody has the privilege of owning a car or has family and friends around to provide that transportation, and we’re telling seniors on limited income - she didn’t work a lot in her life, she cared for her very sick mom and dad - to sell her family home of over 100 years or die.
MR. DELOREY: I’m not familiar with the particulars of the specific situation the member has raised. From a provincial perspective - from my perspective - the Department of Health and Wellness which funds the program did not make any changes to the program. I know we have it delivered through the Nova Scotia Health Authority. I’m not aware of any changes in those areas.
Perhaps what the member and I could do for the sake of the specific nature of that particular concern - maybe we’ll connect and we’ll work through my office. We’ll delve into that to get things clarified. That’s not the expectation of how the program would be operating.
Again, I’m not aware of changes globally across the program. If there have been some communications to that end, they certainly didn’t come from our office.
MS. MARTIN: As I indicated, this would be one of the situations where my office does rely on the help of your office and of Mary to assist with these one-off situations. Frankly speaking, I don’t think anybody should be told to sell their home. So I look forward to that, and I thank the member opposite for that.
In the member’s comments, you referenced public awareness of reports on the NSHA website. I’d just like to just briefly go there, because it was mentioned. When information is publicly made available, it causes a lot less opportunity for skepticism and discrepancy and doubt of those constituents and residents of Nova Scotia, who are wondering what is going on behind closed doors.
Does this member agree, and this government agree, that public information on the NSHA website for meetings and board meetings should be made public and available?
MR. DELOREY: Indeed, I’ve spoken to this in the past. I believe information, particularly in the public interest, should be made available. I had indicated that as has the Premier, when questioned as to the structure of the Nova Scotia Health Authority and the bylaws they have in place for meetings, which ensures the AGM is open to the public, at least.
Although they haven’t had the debate portions of the meetings open to the public, they do have those meetings across the province. We’ve made sure that that took place, if they’re in communities, having the opportunity to engage with the public to provide those additional details.
What happened in the early stages was people were getting familiar with the governance structure - of course, that’s the starting point. As an organization gets more mature, more established with the board members and so on, the opportunity then - as those bylaws and everyone’s sure of the roles and adherence to them, the opportunities to expand with that level of openness does present itself.
Again, I’ve previously publicly committed to continuing the dialogue with the chairman of the Nova Scotia Health Authority in engaging in opportunities to ensure that the openness of the organization meets the expectations of the people of Nova Scotia.
MS. MARTIN: I would hope we can agree - the former CEO of the Cape Breton District Health Authority, John Malcom, has said that transparency is utmost in the relations between the public and the Department of Health and Wellness and the district health authority. However, to continue on his thought process, he also believes that centralization is not the answer. Everywhere in this province has lost its autonomy, and that’s not a good thing in my opinion, especially when you’re from outside of HRM where everything seems to fall.
I’d like to now move to ER closures. We all know there are significant ER closures across this province every day. They have not gone down, we know that. As I said in Question Period on several occasions, every ER in CBRM has been closed at the same time for three, four, and five days. The same on the South Shore and the same across this province, except in HRM.
Aside from the ER closures that happen every weekend, or scheduled ER closures, I can tell you from personal experience that a surgical floor at the old Cape Breton District Health Authority is closed every summer and at Christmas. I can tell you that currently the regional hospital is running two overflows because of the 29 - or whatever the number was that was quoted here the other day - of the 33 beds in the ER were taken up by patients needing a bed. So there are two overflows.
I’m telling the minister that those two overflows are primarily staffed by RNs who are getting paid double time, costing this province and these taxpayers an astronomical amount of money. How can you justify closing floors for an extended period of time without ever looking for an answer to solve this problem? The floor is closed. You closed a surgical floor to allow people to take vacation, for example, which is one of the reasons that I’ve heard. Yet by closing that floor, you’re just staffing another floor at double time.
Does the minister, does the Department of Health and Wellness, not see how ridiculous that is in money? I mean, you know you’re going to have double overtime. You know you’re going to have at least one overflow or two or more. I’ve seen patients in recovery room because there are no beds in hospitals.
When are we going to wake up and realize and spend our money wisely and recruit and retain as many health care providers - nurses, doctors, whatever the case may be; primarily here are nurses - to solve this problem and leave those beds open?
MR. DELOREY: Indeed, the shortest response to the member’s specific question around why don’t we do more to recruit - we are. We are working to recruit. We are working to fill the positions that we can throughout our health care system at all levels of health care provisions. We are active and we know there is need in Cape Breton. We know there’s need in the Northern Zone and the Central Zone.
In the concluding comments on the previous topic, there was reference to the amalgamation of the health authority being a bad thing. That’s not the message I’ve heard across the province.
When it comes to the importance of ensuring clinical care across the province, being able to plan as a single organization - and that’s not to say it doesn’t come without criticisms - the concerns around the change and the change management, and going through a transitional period, and understanding the flow and the dynamics as the organization, changed through this process.
It’s not to say that there were not frustrations or challenges with that, and it’s not to say that it was unanimous in people’s support of the model, but when I went around the province and I sat down with front-line health care professionals and asked about that, obviously it was something very important for me to understand - what do you think about this? It’s been a couple of years. What do you think about the single health authority?
I would hear the frustrations with the process of restructuring, but by and large, the clinical response was to have the ability to plan as a provincial unit across the province, to bring consistency in the care being provided to Nova Scotians.
To have the flexibility and specialized services like orthopaedics, the program we launched in the Fall would not have been possible under nine different health authorities - or if it was, it would have been far more complex and time-consuming to develop and roll out. The model now allowed us to get the orthopaedic surgeons and others related to the surgeries to come together and develop a plan with one organization - the Nova Scotia Health Authority - to bring that plan forward to the government for funding. That is what happened and they were able to do it.
Had we been in the historical model that would have required bringing nine separate organizations together - with nine different, current practices of planning and delivering orthopaedic surgeries, with nine different groups and perspectives to establish them - it would require further coordination and collaboration to allow for referrals from one part of the province to another, because of the artificial lines that those former health authorities had.
Again, as a provincial entity - a single organization - the ability for someone in Yarmouth or Dartmouth who’s looking for surgery, if there is capacity - as the member from Pictou West I believe alluded to yesterday, at the Aberdeen with some capacity in the orthopaedics space - then someone from another part of the province could get referred and receive that service in New Glasgow at the Aberdeen, reducing the pressure in the other areas. There are many good things about this amalgamation of the health authorities, particularly, and most importantly, from a clinical perspective of planning and delivery of those health care services.
Again, I want to be very clear: I am not downplaying nor attempting to suggest there is unanimous support in that regard, but the long-term vision and rollout is what I have heard from clinicians on the front lines.
As far as the recruiting and delivery of services, we want to deliver health care in the most cost-effective way possible. Of course, we want to make sure that our services stay open and available to the people of Nova Scotia.
Again, I know that the member is a fierce advocate for the members of her constituency, as I am for mine, and all 51 members of the Legislature are for their own. I appreciate that as Minister of Health and Wellness, and I am here advocating on behalf of all Nova Scotians.
I am aware of the challenges in all provinces. The specific question was about Cape Breton, but I think it can roll up, because it’s not just Cape Breton with those challenges. We do have recruitment initiatives and we have recently announced for physicians on the primary care side to try to recruit and retain them with increased compensation.
In the Fall, one of the first things I did as the Minister of Health and Wellness, it got a little less coverage than the recent announcement, but it was targeting hospital lists - those physicians who would work in a hospital - to facilitate patient flow.
There were some issues around the compensation model there. I worked with Doctors Nova Scotia, the department, and the Health Authority to come up with appropriate changes there. Those changes were made, they were rolled out to improve the care, which will provide recruitment and retention and value in that area to help patients flow through our hospitals, to get people discharged, whether they have a family physician or not.
So, we are taking steps, we remain committed to those steps, and we’ll continue to strive with our partners to get the right combination of care providers - not just primary, but specialist as well - in Cape Breton, in the Sydney-New Waterford area, and throughout the province.
MS. MARTIN: What I’m hearing from the member is that centralization, that the merger of the health authorities was a good thing. I am here not only for Cape Breton Centre but for all of the members of the province too, and I have heard from too many to count - from staff and patients - I’ve not heard one good word about centralization, and I’m being quite honest. (Interruptions) Centralization, just like the school boards. What I’m hearing, and what I believe, is that it’s easier to convince one CEO than it is to convince nine CEOs to get on the same page.
Now, you talk about recruitment and retention, when you talk about scheduled closures, which happen - you can set your clock by them, set your calendar by them, scheduled closures. So, you are not trying to mitigate the closures when the department knows that there are scheduled closures in different areas - from one end of the province to the other, that happen once, twice, three times a year - they are scheduled closures. So, how can you defend that the department is trying to mitigate those closures?
MR. DELOREY: Because these challenges in the health care system are large and complex, and the solutions are not simple. Another Cape Breton member earlier in Estimates - the member for Victoria-The Lakes - raised similar questions around closures. The member made reference to the challenge that he’s hearing from physicians - which I conceded is a reality that we’re aware of - that there are practitioners who do not feel comfortable particularly in community-based emergency departments. The pressures on maintaining emergency rooms open - particularly the community-based emergency rooms - is not simply a question of the desire of the Health Authority, or the facility, but is also dependent on the care providers that are needed to operate and deliver.
When the approach was taken to identify scheduled closures, the reason for that was in response to a desire to minimize risk to the community so the community would know in advance. If the appropriate staffing complement was not available to deliver those services, they would know in advance where they would have to go for their emergency care needs - of course, always knowing that they could call 911, and the paramedic operators of the ambulance would know where to go.
The notion of having scheduled closures is about reducing the risk to community members in a scenario where there are chronic challenges of getting the appropriate staffing complement. Of course, safety and the delivery of these services are of the utmost importance to all members from the political at the top of the organization, right down to the front line, through the department and the Nova Scotia Health Authority.
Again, there are many complex challenges to this kind of generational transition and shift in the way health care providers are being trained and practising, and we are living through those challenges. We’re continuing to work to understand what it takes to help improve our recruitment and retention to deliver. That’s why I can stand here and say with confidence that we are working to get the recruitments to get the right complements, to mitigate those challenges. But, in the interim, we are still faced with those closures. We do the scheduled ones because we believe that doing so in advance is in the best interest and in the safety of the communities, to know that information as soon as they can.
MS. MARTIN: However, one would hope there would be an ambulance available at that time, but I’ll get there later.
Does the Department of Health and Wellness record closures anywhere within the province, either in emergency rooms or on other scheduled closure floors - for summer vacations, winter or Christmas vacations, that type of thing - whether it’s because of doctors or nurses? What is the percentage that would be tracked, and the hours that these facilities or areas may be closed, based on whether it’s doctors or nurses, because in fact, in this province, there’s a deficit in both areas, from what we’re being told?
MR. DELOREY: I’m going to apologize to the member - I might have missed part of the question there. But with respect to, do we track emergency departments and closures, what I can tell the member is yes, and we do table a report. We have the emergency department closure report tabled in December; it’s publicly available. I don’t have the web address off the top right now, but it’s publicly available, it has been reported on in the media from back in December. I think there might have been some subsequent stories early in January in the media. That report is publicly available, you have the past couple of years of data.
We’ve seen progress in some areas. For example, Roseway in Shelburne, I think the number of hours closed reduced from somewhere in the vicinity of 1,200 to about 400. Still, a lot of closures in the community, but a significant increase in the data from the last year reported to the one previous.
What I am able to advise the member and the House is that in the past year 96.4, almost 97 per cent of all scheduled hours were staffed for emergency departments in the province.
MS. MARTIN: I thank the minister for that answer. However, I’m looking specifically for the reason of the closures. Is it a shortage of doctors? Is it a shortage of nurses? To that end, what public consultation has been done, as outlined in the Emergency Department Accountability Act, before these closures take place?
MR. DELOREY: The last time I reviewed the report was in December. I don’t have it with me, so I’m racking my brain here to recall if the level of detail in that report breaks down to the specific source. I think it does, I believe it does indicate at a staffing level, but I’m not certain, and I cannot commit whether it’s at the level of what staff, whether it’s physician or nurse.
I don’t recall if the report is at that level of detail, but again, it is publicly available so the member could take a look to verify - again, the report is there and available. Consultation and engagement takes place with the Health Authority throughout the year. They work with the community health boards and others, as well as with staff. Part of the work is to identify the scheduling hours as far in advance to plan how they’re going to respond to these situations and try to staff them up, get locums in.
I know they work hard in the event of a vacation situation, to bring locums in. Those would be physicians who are willing to travel to work on a part-time basis or short-term period, to fill hours in an emergency room. So that work gets done. It’s only in the event that they’re not able to find others to come in and backfill that they do make those closures take place.
MS. MARTIN: Maybe I’m not being clear but I’m quite familiar with the closures because of doctors, and I would think that whether it be a surgical floor or a medical floor or an ER department - if there is a closure that takes place within the NSHA in this province at any time, the government should be required to track why they’re closed, whether it’s doctors or nurses.
What I believe I’m hearing from the minister is that it’s with locums and shortages and scheduled closures. But what I’m hoping to find out is why these closures are taking place. There has to be data associated with it, whether it’s a shortage of nurses or a shortage of doctors. I do know, 100 per cent, that it is sometimes because of both, maybe one, maybe the other.
To my other question about the Emergency Department Accountability Act, it says that the communities need to be consulted. Has that happened?
MR. DELOREY: Again, as I’ve said, the data is collected and reported on, particularly for emergency rooms, explicitly. Operationally, our partners at the Nova Scotia Health Authority - within the facilities and the work that they do - would be well aware in identifying and knowing on a day-to-day basis what the status of the facilities are.
What I was referring to was in the context of a formalized reporting system - that’s what I was referring to. That’s what exists in the emergency department, because as the member referenced, there is a requirement for that report to be produced in that format to be delivered and made available.
That’s not something that exists collectively for all aspects of the system, but that does not mean that work is not ongoing and part of the operations of the organization, for tracking and managing their staffing requirements and so on. That’s just part of regular management of facilities and the staff and the services being provided.
As far as the specific question around emergency departments and the public consultations, I believe if I recall that legislation off the top, that is around systemic closures that take place and the consultations around that. It’s my understanding those consultations are taking place as well to identify those criteria that are necessary per the legislation.
MS. MARTIN: I worked in health care for almost 17 years. I’m not aware of one of those meetings, not aware of any consultation. I live in a community where the emergency room is closed more than it’s open. I’m not aware of that ever taking place.
Specifically, the NSHA records the data, understands why a medical floor or an emergency room is closed. Does the Department of Health and Wellness have the numbers or the percentages of why these departments are closed? Is it nursing shortages? Or is it doctor shortages?
MR. DELOREY: As part of our commitment and the work we do as a department throughout the entire system, we work with our partners on an ongoing basis to collect and share information, to make sure it’s available on a wide range of services being provided, so we can understand, we can learn from them, we can identify where and when policy changes may be necessary or appropriate. I’m not aware of a formalized report coming from the NSHA to the department with that data.
But I want to assure the member that the Health Authorities Act is very clear that the data that we need to do our jobs, you can certainly request it, get that information. One of the things we’re working hard on recognizing that with the growth of technology and expansion of technology, the availability of data and the capacity for us to collect and slice and dice data, is growing at a very fast rate. One of the things I’m working on is getting some systems in place - software technology - to do a better job of actually pulling that data and slicing and dicing it, and reporting it in new and amazing ways through data analytics.
As the minister, in my time here, that’s work that I’m undertaking to pursue. While we may not have a specific report in the areas with the specific data that the member is referencing, it doesn’t mean the data doesn’t exist. It just means we may not have requested that specific report in that particular way, and what I’m working on is bringing together some technology and analytic solutions to be able to do even more proactively, and also be more responsive when there are ad hoc types of requests that come into play. These are early stages and these projects do take some time.
MS. MARTIN: Believe me, I am not trying to be facetious, but how could you recruit for vacancies if you don’t know where they exist or why there are closures? I would hope, from what I just heard the member say, that they may not have requested that information. So, today, I am requesting that information so at some point, maybe by the end of this session, you could provide me with that information of exactly what the numbers are - doctors, nurses, why there are closures.
To that end, I am familiar with a doctor who was on a locum in a local emergency room recently, who was leaving. He loved to work in this little community hospital. He was coming from out west and he couldn’t stay any longer. He couldn’t afford to stay any longer because in the terms of his locum, the NSHA only covered his lodging costs when he was actually working. So if he worked Friday, Saturday, Sunday, his lodging expenses would be covered, but if he was off Monday, Tuesday, Wednesday, he was on the hook for that expense. How is that beneficial in our attempt to recruit and retain doctors, as the minister described yesterday, from all parts of the world?
MR. DELOREY: I believe that the locum program is designed to support temporary closures - short-term, temporary shifts on a shift-based approach. That sometimes does run into multiple days at a time, which would be exactly why an option for providing travel accommodation expenses could be made part of that property or program.
If it gets to a situation where somebody is staying in a region or a particular area looking to be there for extended periods of time - I’m not familiar with the very specific situation brought forward, but I don’t believe that was the way the locum program was designed. That would be more of a situation of looking at whether or not there is an opportunity for a permanent position, if someone is looking to be established and set up in a community.
Perhaps rather than working on a locum basis, to be paid for periods where costs of accommodations can be covered for someone, I think that would present a situation where that person might be more interested in a permanent position, and as the member knows, we have lots of permanent positions around this province to set up and provide those services.
MS. MARTIN: I really do appreciate this process, because the information that we gain from members opposite is beneficial. However, I have to double back for a moment because there is something important I forgot to mention, and that is the MCT that we’ve talked about in New Waterford several times, and I know, 100 absolute per cent, that there was no public consultation done. Is that not a systemic closure?
MR. DELOREY: Sorry, can I just get the member to elaborate? Did you say MCT? Can you just elaborate on the terminology there?
MS. MARTIN: Again, I don’t mean to be facetious, but I guess that’s why it’s closed, if the minister doesn’t know what it is. It’s the mobile care team in New Waterford.
MR. DELOREY: Sorry, I’m just not familiar with that particular abbreviation. I believe, as the member would know, what happens in many cases with that program is staffing availability and pressures - in particular at the regional hospital, I believe that draws a lot of the pressure. I believe as part of the program, the nurse is allocated over to the Cape Breton Regional Hospital to address some of the nursing shortages there.
What I believe, when assessing the resource and allocation of the staff, as I’ve mentioned earlier, the NSHA, when they are reviewing, they do look at when there are going to be shortages, how they can ensure the best coverage and support is available for a region. In a case where there’s going to be shortages at a regional hospital, maintaining those services does take top priority, because that regional hospital does provide services to a wider range, a geographic footprint. My understanding, and I’ll double check this and clarify if I’m mistaken, but off the top of my head, I believe the amount of coverage, or visits, that were being seen by that team averaged one every two days.
So the utilization of it, for those resources - a nurse and a paramedic allocated to it, seeing, on average, half of a patient per day - having the nursing resource allocated to the regional hospital was far better use of those resources, to provide the care that’s needed for the entire region and the community. Obviously, it was not a major significant demand at that time, and it’s been trended that way. So, that would be the reason for that particular situation.
MS. MARTIN: While I don’t disagree with the member about utilization, it was of vital importance to that community. Secondly, there was no consultation done as per the legislation, and thirdly, the staff and myself, through continuous requests, keep being told that it’s going to reopen soon, it’s coming back soon. We need to know the truth. Like I said, I appreciate this process, but we need to know the truth. Yes or no, either way.
MR. DELOREY: As the member would know, the operational plan and the timing of work, and those front-line decisions are being made at the Nova Scotia Health Authority level. As far as this specific question there, on that specific resource, I believe the representatives from the Health Authority have previously stated that when the decision was made, it was temporary, but it was being reviewed. I haven’t seen a result of that review, so it’s not to my knowledge been finalized, which way it would go.
I can understand the desire within the community to get an answer sooner rather than later. I will follow up and we’ll move to see what the status of that is in the course of the many pieces of work being done by our partners at the Nova Scotia Health Authority. It will be one of those ones I’ll encourage them to make a final decision on, and move forward to get that information out to the community as soon as possible.
MS. MARTIN: I thank the member for that response. I’m not optimistic that I’m going to like the answer, but like I say, an answer is better than none.
Now, going back to locums. If I could ask the minister to describe the locum process. What defines a locum? How many locums do we have and in what areas are they - whether it’s medical, surgical, emergency rooms? Because I think it’s important to know how many locums we’re relying on in order to keep our health care functioning - albeit not very well.
MR. DELOREY: I know the member has stated a couple of times the appreciation for this process because of the opportunity to get a lot of information, a lot more detailed response than the 45 seconds we have in Question Period, which can seem rushed, especially for someone like me.
This is a particular question delving into some very specific data on the locum program, which is an operational aspect within the NSHA. We don’t have that level of detail broken down, specifically with the locums and how many the Health Authority has allocated, keeping in mind that the locums are there predominantly as a resource to backfill and fill gaps in the system. While we can recognize that short-term relief can be planned to some degree and built in, as I understand it, some physicians choose to almost make a career out of locum work, and not just locum within the province. They could be doing locum work across the country, going to different provinces for periods of time, based upon need. Also, there could be physicians working with a full-time clinic themselves. They could be working full-time, who may choose to put their free time towards locum services.
I think the data may be a little difficult to say specifically, that there are this many locums, because it’s not completely a designation, but rather an opportunity for people to come in and fill in. So, if the member is looking for how many individuals are classified as locum, I don’t think that will get to the data and the understanding that the member is really looking for.
Again, as I said, I don’t have the data, in part for that reason. It’s not something that I have at the table here.
MS. MARTIN: I wonder, in response to that, if the minister could agree to provide us again with that information. I would look to, let’s say for the end of the fiscal year, how many locums we’ve had - for Budget Year 2017, for example - just so we can know how heavily the Department of Health and Wellness is relying on doctors who are not necessarily here permanently.
Along with that, I hear from several doctors, from Glace Bay to Yarmouth, who receive different rates, different expenses, as I alluded to in another comment where some are covered for hotel stays, some are covered for travel, those types of things. I’m looking for the rhyme or reason that would differentiate between different locums. How do we get to that? How do we budget for that if we don’t know what we need?
MR. DELOREY: I believe you may have noticed that I was taking notes. Again, as I mentioned in my previous response, I don’t have the specific data, but I did write it down. I think I’m doing a much better job this year of being very explicit in taking my own notes, rather than relying on others for situations like this, where there are specific questions where I don’t have the data. I’ve got my list here for all of the members to date who have asked me for these types of things. I’ve got it written down, and I’ll certainly endeavour to get that data.
MS. MARTIN: Thank you to the member for that commitment.
I want to talk now about nurse vacancies. As I said earlier as well, when we talk about different floors in different hospitals that close periodically throughout the summer, over Christmas vacation, my information tells me that it’s because we have so many nurse vacancies across this province that the nurses would never get vacation if departments didn’t close.
Is there a way the minister can provide us with the information or the data that supports this, to say how many vacancies we have, in what departments, in what areas? Again, just to ensure that enough is being done to recruit and retain these nurses that we so desperately need.
MR. DELOREY: I certainly don’t have that level of detail with me. I do know that in a general sense, we know that there are challenges in many areas, including across the border in New Brunswick. Just recently, the reports were that the Moncton hospital emergency room was shut down. I used to live in Moncton. There are two major hospitals in the city: the Moncton hospital and the Dr. Georges-L.-Dumont University Hospital Centre - one with the English and one with the French. It was shut down, and I believe the news reports indicated it was shut down because of nursing shortages. So, as I’ve said before, it’s not just about doctors. We do need to work as teams not just in primary care but throughout our hospital system as well.
What I can advise the member about nurses in Nova Scotia is that we have about 14,000 nurses across the province, which is about 2,000 more than we had a decade ago. We know that we continue to recruit and fill positions. It’s been relatively stable the last number of years, even despite retirements. We’ve been recruiting and filling vacancies. In fact, again, the nursing force is made up of a variety of different certification levels - registered nurses as well as nurse practitioners, and LPNs as well. The numbers may shift a little bit, depending on which area. Overall, talking nursing and the nursing workforce, it’s been relatively stable, and up significantly from a decade ago.
MS. MARTIN: While I appreciate that it’s significantly higher than it was ten years ago, I respectfully disagree with the minister, because I know for 100 per cent certainty that floors need to close every summer to allow nurses to get their vacation. Then we start the process again: they come into ER, they go into overflow, and we’re pulling nurses back from vacation days off to work overtime. It just seems like a ridiculous cycle to me, and a huge waste of taxpayers’ money.
We also know that there are long-standing vacancies in certain areas of hospitals from Glace Bay to Yarmouth, in critical care areas. This information has to be readily available. I know as a prior employee of the NSHA, I had that readily available when you could see the postings on the NSHA website. I no longer have that access. However, I know continuing vacancies are a huge problem with nursing - specifically, I’m talking about registered nurses, although the LPN classification is drying up quickly as well.
Specifically, I’m looking to the minister to be able to provide my caucus and the residents of Nova Scotia with the numbers of how many nurses we’re short. How long are these vacancies going on? Is it acceptable to close an entire floor for the summer so that nurses will get vacation? A lot of times they don’t, because they’re called back to deal with the same patients on a different floor?
MR. DELOREY: I’ll try to tease apart the comments made and provide the general information that the member is looking for. On the one hand, talking about vacancies, I can advise the member with the latest data I have.
There are about 250-260 vacancies posted within the NSHA for nurses - not broken down by type, just nurses across the entire province. I want to be clear that there is a distinction. There is always a certain amount of vacancies, because it takes time to fill in the position when someone leaves than for a vacancy. The other thing is that the strategy the NSHA deploys is not just hiring for the positions posted - they have a general hiring process. They’ll take basically every nurse from our graduating programs in Cape Breton, St. Francis Xavier University, and Dalhousie University to fill positions.
MR. CHAIRMAN: Order, please. The time for the NDP Caucus has expired for this hour.
The honourable member for Dartmouth East.
MR. TIM HALMAN: Once again, minister, from Cape Breton back to Dartmouth. Let’s take some time and chat about specialist appointment and surgical wait times. Certainly, in my conversations with residents of Dartmouth, there is concern about those wait times.
I was wondering, minister, if you could provide to us the strategy that’s in place to reduce these wait times, not only for the residents of Dartmouth, but for Nova Scotians.
MR. DELOREY: A couple of things are taking place, and they happen in conjunction with each other. First, at the highest level there is the amalgamation of the Health Authority, which started in 2015. That is a move not just about surgical wait times, but it is one part of the process to respond to those challenges. By amalgamating, we took down those artificial barriers from one part of the province to another.
For example, being a resident of Antigonish, which is part of the former GASHA Health Authority - that regional hospital is only about a half hour to 40 minutes from the Aberdeen in New Glasgow, but that was part of a different health authority. As a resident of Antigonish looking for services, I wouldn’t necessarily have that access crossing that seemingly artificial boundary, because there were two separate organizations or entities. The ability to transfer required two organizations to collectively work to figure out whether they would do shared services and supports for surgery or other types of care.
By bringing them together as a single health authority, there is a single organization responsible for all the hospitals across the province. Bringing those artificial barriers of separate organizations, legal entities, out of the way, it allows for the organization to plan provincially, to look at the wait-list and distribute. The amazing thing is that you can see in some communities, there are very lengthy wait-lists for particular procedures or services, and in other communities that particular procedure or service may have had no wait time. Yet because they were operating in isolation, in nine separate pods across the province, those communities or regions that had no wait time, that is excess capacity going underutilized, they were not supporting or helping other parts of the province.
As a single entity, we have a single picture now to look within our Health Authority across the province to see where the capacity and the demands are. Again, I’ll just narrow in to the member’s question surrounding surgery, but it could apply to other services as well. Within surgeries, you’re waiting for the wait times, we post the data, it’s available to physicians as well as the public.
If you’re looking or waiting for a particular service, and you’re being referred, and you look at the wait-list and you’re being referred to someone geographically close, but the wait time is extra long for that particular service - whether it’s a surgery or some other specialized service - but you notice in another part of the province the wait time is much shorter. The individual could approach their care provider and say, rather than the referral here with a longer wait time, I may have the means, I may have a vehicle, or I may have family in that other part of the province that I could stay with and receive that care - can I get a referral to this other part of the province?
That allows us to smooth the demand and the capacity, because if someone from an area with a larger or longer wait period goes to an area with a shorter wait period, that’s one less person of pressure in the area with the most demand. That’s one of the paths through the amalgamation and distribution of work to better balance the utilization of existing resources.
When we narrow into surgeries, particularly around orthopaedics, it shows an area where we’ve made a conscious effort to really make an impact. We’ve taken that as an area within our surgeries to focus on, because historically they did have very long wait times and high demand for these services, particularly around hips and knees. Those surgeries make a really substantive and meaningful impact in the quality of life for those people in need.
What we did first through the amalgamation was take down those barriers; that was step one. Then, we asked our partners in the Nova Scotia Health Authority, and the surgeons and specialists, physicians who work in this area to come up with a proposal. They came to government with a proposal - we said we want to attack this, we’re going to plan to put some money towards it, you come and tell us what, operationally, we can do to get the most efficiency and do more surgeries and work our way towards that national benchmark for these orthopaedic surgeries.
In the Fall, I was pleased to join a physician who was part of the planning process, we accepted the recommendations, it’s a multi-year plan. That recommendation resulted in a plan that they had forecasted a desire, a plan, to reach about 500 additional surgeries by the end of fiscal year. Again, keep in mind we only released the plan in October, and they were expecting an additional 500 surgeries. I believe, the last I heard was around 415, so not quite to that mark, but that’s 415 more Nova Scotians today that have had orthopaedic surgeries done than would have if we didn’t take those steps.
Within that space, there are a number of things that were done during that time. Working with them, we took a different approach to making available operating room time. I believe, historically, there wasn’t work being done on Saturdays or in the evenings, necessarily. So, they expanded when they would be providing these orthopaedic surgeries at those locations that have the services. Working again with the teams they identified - if there was time available in non-traditional slots, they would make use of those times.
Without having to build additional capacity, we were making use of under-utilized capacity within our infrastructure, and that’s why, without actually building additional capacity - physical, capital capacity - we were able to move forward and address many more surgeries this year. That was even without additional staffing resourced for the orthopaedic surgeons and anesthesiologists.
However, the multi-year plan does say that in order to continue to do more, you need more surgeons. If you are going to have more surgeries with more surgeons, you are going to need more anaesthesiologists, and you need more support teams around those surgeries as well.
That’s why in this budget, we do have more money allocated to orthopaedic surgeries, and I believe we’re looking at hiring eight additional physicians around orthopaedics and anesthesiology as well as other health care partners that are needed to go through the surgical process.
It’s also investing in pre-habilitation, because we know taking the steps before you go into surgery - I’ll use an example of a former teacher of mine down home, who I bumped into. Seeing him walk around, struggling a bit with a cane, waiting for his surgery, he said he’s on the wait-list, but he’s not allowed to go in until he took care of himself and shed a few pounds.
I’m actually pleased to say that the last time I bumped into him, he was very close to having his surgery booked, and I was amazed, he looked in better shape than I had seen him - gosh, I think he’s probably in better shape than he was when he taught me in high school. That’s part of that pre-habilitation, getting people ready for the surgery so that they maximize the success of the surgery and the benefits it provides.
I hope that provided the information of a multi-pronged approach. Orthopaedics is an area where we really delved into it, but all of it, really, without the amalgamation, wouldn’t have gone as smoothly and as successfully as it’s gone to date, and we hope to tackle other areas as well.
MR. HALMAN: For the record, as the minister knows, there are certainly different points of view on that amalgamation - different perspectives as to how all that’s transpired - but I do appreciate the response.
Within the same topic of specialists, my conversation with specialists, they seem to indicate that they like to follow up with their patients using technology, by phone or by video. For rural Nova Scotians, this saves a drive, especially if you have to make it to Metro Halifax for a specialist appointment. I’m wondering if this form of patient follow-up is going to be pushed further by the Department of Health and Wellness? Will specialists be encouraged and supported to facilitate this type of follow-up with their patients?
MR. DELOREY: Before I answer that specific question, because I know the member is very concerned about the Dartmouth area - he’s a representative there - I was remiss in my response about surgeries to have not referred to the QEII redevelopment and the extensive construction and capital investments being made over at Dartmouth General, which includes additional surgical capacity as part of that work. Again, part of the solution is going to be Dartmouth General for us to do more in that surgery space.
With respect to this particular question around the use of technology by physicians - in this case specifically, specialists - we’re in the early stages of technology being used in the communications to patients. The use of technology of course is not new; we’ve seen massive advances in technology within the health care field over the years. Often the integration levels are between specialists and primary care physicians, and between physicians and physicians. We recently announced some incentive investments to encourage family practice physicians to leverage technology and non-face-to-face communications as part of our strategy to improve access to, and delivery of, primary health care.
I believe where the member’s question was going was, will those services and incentives be applied to encourage specialists to leverage that technology to communicate directly to their patients as well? At this stage, we’re in the early stages.
I believe I may have previously mentioned to another member that in 2016 - for the first time ever in Nova Scotia it is my understanding - the master agreement provided an option for physicians to receive payment for non-face-to-face engagement with their patient. That may seem strange in this day of Facebook, social media, instant connectivity, total communication in so many aspects of our lives, but in the medical field, the entire compensation model has been designed historically to be based upon providing a service directly to a patient. Thus, all of the compensation fee codes are based upon physical interaction with the patient in the delivery of health care.
The 2016 master agreement was the first time in Nova Scotia we recognized that there is opportunity to be more efficient not only for the patients but also for the physicians. That’s why the master fee code was changed. But after rolling it out, we’ve discovered and had the feedback that the processes and the controls put around the fee were too restrictive, and so it was not being adopted by very many physicians.
The technology exists but the compensation model appeared to be challenged. That’s why we just recently announced changes to that, in consultation with Doctors Nova Scotia. We learned from the first iteration in the master agreement to say we need to make changes. We’re going to just roll that out and see how it works. We believe it will increase the adoption of the technology by primary-care physicians, we believe it will result in better outcomes and more contact points with patients and increase their satisfaction and access to primary care in situations where it makes sense.
We need to learn from how it actually works in the delivery of care before we move to the next step. Do I think that in the future there will be some specialist opportunities for that type of technology to be leveraged? Personally, I believe there is opportunity. Do I have a timeline for that to take place? No, because, again, we learned a lot in the last year over the non-face-to-face program. We’ve changed it, we need to see if these changes, if the right model, the right approach, is that going to get the public to start adopting - we don’t know yet for sure, but we believe the public will adopt these technologies for the interface with physicians, but we have yet to see. Before we start jumping in all the way with all services, we want to make sure it works in the primary care setting first.
MR. HALMAN: This will be my final question, and then I will be handing this off to the honourable member for Pictou Centre. As you are probably aware, there is a feeling among a lot of our health care professionals that there’s a broken relationship between the government and health care providers. It was summarized to me by one health care professional that, for years they had been told there’s no money, don’t ask for it, take what we give you. Now we are seeing, from their perspective, money being thrown around at a lot of different things.
It’s been indicated to me, and probably many other MLAs, that it’s resulted in a feeling of - we’ve been here before in this House on a different file - a lack of trust and a feeling of being undervalued. My question to the minister is, how will the minister go about repairing that relationship between the government and our health care professionals? I recognize that’s a very broad term, health care professionals - it encompasses many professionals. I’m curious as to how you will go about regaining that trust?
MR. DELOREY: I thank the member for the question. I believe I had the privilege of being sworn in as Minister of Health and Wellness in mid-June of last year, so less than a year ago. All 51 of us campaigned a few months before that across the province, in each of our own communities, and we heard loud and clear from health care providers about their thoughts, their concerns, frustrations.
We responded as a government, individually and collectively. We responded and said we have heard and we are committed to investing in primary care, we are committed to investing in mental health care, continuing care services for Nova Scotians. We’ve made them priorities. We’ve seen renewed investments and commitments in our health care budget since I’ve had the fortune to serve, with the 2017-18 budget in the Fall, and this one.
The area of budget receiving significant increase in growth has been in the health care space. This budget is a matter of identifying and managing our priorities across the entire government. We’ve said that health care and education are our two primary focuses, so we’ve invested heavily to respond to the needs and the expectations of the people of Nova Scotia. Will there be more demand on services - will our investment solve all of the concerns and frustrations? No, I think there’s far more to it than just money.
What have I been doing to work on repairing relationships? I don’t want anyone to think that the relationship challenges are all about money. We’ve heard that many of the concerns and frustrations being voiced had to do with a feeling of frustration of not being heard or feeling that they haven’t been heard. In my short tenure thus far, I’ve been around the province a couple of times, meeting with front-line health care providers, participating in public forums to have those dialogues, to hear first-hand from the health care providers, from the public, and to learn from it.
The feedback I have received has been very positive. The ongoing engagement and dialogue with organizations that represent our health care professionals - with Doctors Nova Scotia, the Nova Scotia Nurses Union, the Pharmacy Association of Nova Scotia and others. Having those meetings, keeping those doors of communication open.
This is how I believe we repair and work towards improving the relationship with our health care providers, both in the public but also on the private side, partners looking for more opportunity to work with government, like the pharmacists in Nova Scotia. We keep that dialogue open and work with them because we know there’s a multi-pronged approach to addressing the health care challenges we have as a province. We know that all of these health care professionals have an interest, not just because of the health care and chosen profession, but also because they are Nova Scotians. They have families, they have neighbours, they want to make sure that the province is delivering the best quality care to their loved ones as well.
MR. CHAIRMAN: The honourable member for Pictou Centre.
HON. PAT DUNN: Minister, I have three questions to ask, all concerning Pictou County. One is on dialysis, the second on mental health, and the third deals with hip and knee replacements.
Prior to that, minister, we could talk a few hours on St. F.X. and kill all the rest of the Estimates very easily. (Laughter) That is a very nice ring you have on your right hand, by the way.
I want to mention something that the member for Cape Breton Centre mentioned yesterday when she stood up to begin - I thought for a minute she was reading my notes. I want to compliment your EA, Mary Chisholm. You replied back with Tracey Preeper and so on - and, of course, your great staff that’s with you today. I’d like to echo those comments. She has been extremely helpful with my constituency office in New Glasgow and has dealt with many, many issues, and I’m sure she will be dealing with many issues going forward. I know my CA thinks she can walk on water. I assume, she is probably owed a very large, substantial increase in pay sometime soon. She certainly deserves it, Minister.
Over to my first question dealing with dialysis and, of course, the quality of life with people that are facing three days a week with dialysis. You mentioned earlier to another member on this side about the increase of 30 seats in the operational budget, and you also mentioned the various places that are in various stages like Kentville, Digby, Halifax Infirmary, Dartmouth General, and Glace Bay.
In Pictou County, we have four chairs, as you are well aware. In Pictou there’s a waiting list, so that means some of our residents have to travel over Mount Thom, Kemptown to Truro, or to Antigonish through Marshy Hope, sometimes in weather when they probably shouldn’t be on the road. My question is, how far down the road realistically do you think that there will at least be an announcement for additional chairs in Pictou County?
MR. DELOREY: I thank the member for Pictou Centre - and I hope it’s not a point of order - for acknowledging the ring I wear on my right hand. I did not bring it in as a prop; I understand the rules of order would prevent me from doing so. But, indeed, we do know that this ring has significance for all of us who sport them, and I must compliment the member from Pictou Centre on his ring that he sports on the right hand as well.
I’d also very quickly like to advise the member and others in the House that Mary did reach out last night. She indicated she’s blushing and so on, so we’ll continue the conversation about Mary because I know she’s watching the proceedings, along with some other colleagues, and she loves getting the shout-outs. I’ll just reiterate the direct interaction that takes place because Mary is my executive assistant. In fact, she works with the team; she just happens to be that entry point. She’s a phenomenal team member, and I’m glad to have her along with the rest of the team throughout not just the Department of Health and Wellness but our partners as well.
Many times, when we’re trying to solve challenges that are brought forward by MLAs on behalf of their constituents, we do work with our partners at the Nova Scotia Health Authority, the IWK, sometimes with third-party organizations as well outside of that. So, again, I assure people that - even though at times you get frustrated with the results or the initial responses - everybody in the system from the top down are really working their best to provide the best care possible. There are many challenges longstanding within health care across the country, and the people in the system are doing the best they can. I want to make sure we acknowledge everyone from the top right down to the bottom.
To the member’s specific question about dialysis in the Pictou area, I never want to mislead or set anyone’s expectations unnecessarily. I wouldn’t see an announcement in the foreseeable short-term period about that.
As has been mentioned a little earlier, there has been a renal strategic plan put in place in 2016. It has been that plan that identified where the needs are and the travel times to establish additional clinics. We announced four or five different clinics that I have referenced previously: Kentville, Digby, Halifax Infirmary, Dartmouth General, Glace Bay, and Bridgewater. There are two under construction and three in the design phase. Just to clarify, I think the member mentioned 30 seats. What I said is that it will increase by 30 per cent, the number of seats we have in the province - not an absolute number of 30, but a 30 per cent increase.
At this time, our priority is getting these seats implemented in these communities, up and running, see how the system reacts to those changes, and then we will see what needs to be done on top of that.
I do want to note that it’s not just about health care that can help address some of the challenges. The member referenced some of the concerns that people in this community may have if they are travelling to Antigonish for that dialysis treatment. We are familiar with the challenges in the Sutherland’s River area and Marshy Hope area on the 104, Trans-Canada Highway. As a government, we’ve committed to have that section of highway twinned, improving the safety of that commute between Antigonish and New Glasgow, not just for those requiring dialysis services but for those who commute for work or education or even for recreation or other reasons - and not just from New Glasgow-Pictou to Antigonish, but Antigonish-Pictou-New Glasgow. It’s going to be a great addition to help support those people and improve the safety for all Nova Scotians.
MR. DUNN: Thank you, minister, for that answer. This is the second of three questions, this one dealing with mental health. As all members of the House know, our clinic was closed at the Aberdeen Hospital some time ago. Just recently we lost the only psychiatrist we had in Pictou County, and we have approximately 46,000 people in the county.
We have experienced constituents visiting our office, pleading for help. To be honest, our only answer is get yourself to the ER or we’ll get you there, or a family member will get you there to the hospital.
Again, it’s difficult when you have a constituent, either on the phone or in person, saying that they’re contemplating suicide and, depending on the day that they are there - one particular constituent talked to me on the phone the other day. He said: I have attacks and they can happen any time. You’re looking at Monday to Friday, 8:30 to 4:30, but things happen on the weekend. He feels that assistance, that help, is not there for him.
Another person mentioned the fact that when he finds himself in a crisis, he ends up at the ER. He is placed in a padded room with a security guard at the door, waiting until Monday when he can get some help. Perhaps, at that point, they either keep the person or send him off to another hospital in the province.
Again, with not having a psychiatrist in Pictou County, is there any move afoot to even have a locum or whatever other strategy we can use to take care of the burden that some of these residents are feeling and to help the people who are working at the hospital?
MR. DELOREY: I thank the member for the question. Mental health as an area of health care, for members of the Legislature who may not be aware - when we look at the Canada Health Act and what services are needed to be ensured, the historical evolution has been predominantly focused on physical health. It’s only been recently where we as a society have accepted and recognized that mental health and well-being is equally important.
Sometimes our mental wellness has a very direct impact on our physical wellness as well. If you are depressed, you are not taking care of yourself. You are not able to get out of bed and exercise, eat well, and so on, and you end up having a compounding impact on your health outcomes. Often your mental health relates to conditions tying into addiction conditions as well, again having detrimental impacts on the physical health of individuals.
We do recognize, as a society and as a government, that for too long mental health services and mental wellness have not been given its due recognition in the importance of overall health and wellness of individuals. That’s why, as a government, we recognize the importance, our society recognizes the importance. We continue to invest in this area. It continues to be one of the areas we expand. We continue to build our investments in the area year over year.
We are very much targeted at youth in providing those services, partnering and taking down silos between the Department of Health and Wellness and the Department of Education and Early Childhood Development to get those services and clinicians with the ability to identify and intervene, provide interventions, help provide the tools to our youth because we know mental health conditions often present themselves for the first time in adolescence. The earlier we can identify, the earlier we can intervene, the higher the probability of long-term success in the treatment and the more productive life these individuals can have. That’s why you’ll see we do invest heavily in our mental health with clinicians and with our school system to address, and that’s broadly for our provincial interests.
In terms of the challenges the member referenced, I’d like to acknowledge that, indeed, I suspect it’s not just the member for Pictou Centre. At my own office, we’ve received phone calls from individuals. They are tough calls to take.
One of the things we did in my constituency office was to recognize the challenges, particularly with my team. The member opened by referencing my executive assistant, who works with me in Halifax. My constituency assistant, who works in the office in Antigonish, we had her take a mental health first aid course, providing her with some training to understand how to respond when these calls come in or if someone presents physically in the office in a crisis situation of concern. That’s not a course that provides treatment, of course, but it does help understand how to identify and respond in a particular situation.
So, what do people do? Certainly, mental health represents a very broad spectrum of conditions and circumstances, all of them important to the well-being of individuals. We do need to recognize that at the acute stage of conditions, the crisis point - which I think the member was delving into in his specific examples - we do have programs, services, and responses.
We do have a crisis line. It’s not limited to times of day to call into that crisis line. These individuals are able to assess, through the phone line, what degree of condition is taking place, help work with the individual, identify, help walk through some processes to see if they can regain the control in the moment or whether resources need to be deployed to assess the individual. If the incident is taking place in their home, it could be deployed there.
We’re continuing to expand in this investment, putting into that crisis to expand services in Halifax, Sydney, Antigonish, New Glasgow, Truro, Annapolis Valley. We are taking steps to expand and provide services around that.
The challenge that the member has mentioned - the recent departure of a psychiatrist taking a bit of a well-deserved and needed leave in the community leaves them without an active psychiatrist for the hospital in the region right now. Within the Health Authority, the recruitment does continue to take place.
Efforts and investments - a previous question was asked by the member for Dartmouth East about technology and the use of technology. We’re investing in the IWK to provide access, to use technology, to facilitate. We may not have youth psychiatrists and clinical expertise in our communities around every single province, because these are very specialized skillsets these individuals have, but we do have them here in the IWK. Not always does a child need to move or travel up to Halifax to see them. By leveraging technology we’re able to use video conferencing, get assessments done, reducing the commuting but also expanding the reach of these very capable experts throughout the province.
We are looking to get the care that’s needed in all of our provinces. There’s a very high demand for these types of experts, clinicians - from psychiatry, psychologists, social workers, and others - not just within the province, but demand across the country.
As I said off the top, one of the issues is that mental health has for many years not been seen as an important or equal part of the health care system. As a society, not just in Nova Scotia but across the western world, we’re beginning to appreciate this. We just need to get people out there trained, fill these vacancies. We know there are lots of great careers out there in these areas - very difficult, challenging, but I believe rewarding - to help the people in need.
We’re working as hard as we can. This is an area of great importance.
MR. DUNN: Thank you, minister, for that answer. The next question is dealing with knee and hip replacements. You mentioned earlier about the infusion of dollars for additional knee and hip replacements. My direct question is, what does this really mean for the Aberdeen Hospital? I know you mentioned additional operations on Saturday and so on.
The second part of that question would be, does it mean additional responsibility for surgeons who already work there, or is it a combination of surgeons and locums at the Aberdeen?
MR. DELOREY: We’ve spoken a bit about the orthopaedic surgery initiatives - again, the program was announced in the Fall. The first phase of that was about rescheduling, as the member mentioned, and process and scheduling changes, working with the staff and the teams that were in place. There might have been some additional investment in some support staff through these surgeries and the pre-habilitation program.
This next phase, going into this fiscal year, we’ve identified eight hires within the space; I think three of them have already been placed or hired and filled. That work for recruitment will be ongoing. I don’t have the breakdown specifically of what staff or hires might be made, but we do know the second phase going in for this fiscal year, 2018-19, does include some additional hiring throughout those facilities that provide the orthopaedic hip and knee surgeries, of which Aberdeen is one. I believe some of that investment may be going there. I just don’t have the breakdown as to where the specific positions are going. But we do know that the Aberdeen is an important player in delivering orthopaedic services to the people of northeastern Nova Scotia, in particular.
MR. DUNN: I thank the minister for that answer. Before I turn it over to my colleague for Northside-Westmount, I want to thank the minister for his answers, and his staff to the left and right. I’m very pleased that the minister is going to carry on the tradition of taking his two staff members out to the Keg for a steak supper after Estimates are over.
Having said that, I’ll take my place.
MR. CHAIRMAN: The honourable member for Northside-Westmount.
MR. EDDIE ORRELL: I’m going to ask a few questions here this afternoon. I’m going to be pretty specific to my constituency and a few of the very important issues that are going on to the residents in my constituency, but also in Cape Breton.
The first question I’m going to ask is, we have three emergency departments on our Island other than just the Cape Breton Regional Hospital. We all know the Cape Breton Regional Hospital was designed to replace St. Rita’s Hospital and Sydney City Hospital. It was never designed to handle the capacity of the whole island, as far as emergency care goes, and just general practice care, of family practice doctors looking after patients in the hospital, and so on and so forth. It was designed to handle the amount of surgeries it needed to, but as it was built and developed, they finally realized that they couldn’t handle everything at the regional. They do urinary-type surgeries at the Northside General and they do day surgeries out of the other hospitals. So when these hospitals are closed it puts a real strain on the Cape Breton Regional Hospital and the fine staff who work there.
Having worked with some people and having had some surgery myself, I realize the difficulty that’s faced when these hospitals are closed. It’s scary. I just got a quick note earlier that this weekend the Northside General Hospital Emergency Room is closed on Saturday and Sunday, the New Waterford is closed Saturday to Tuesday, and Glace Bay is closed Friday to Monday. So we’ve got a whole weekend with one emergency room on Cape Breton Island - or industrial Cape Breton, I’ll say, because they still do have Strait Richmond and Inverness.
This weekend is also the Vince Ryan Memorial Hockey Tournament. It’s the biggest adult recreational hockey tournament in all of Canada. We’ll have another 400 or 500 or more recreational hockey players and their families coming to the Island and participating in a hockey tournament, so the risk of something happening is a lot greater.
We heard yesterday from the member for Sydney River-Myra-Louisbourg that 33 beds were available, 27 were people waiting to get admitted to the regular hospital, and it was because of an exceptional flu season. I hear this every weekend that when one is closed, they don’t have the staff, they don’t have the resources, and they don’t have the room to handle it.
I guess my question is, what is the plan for the Northside General? I know we’ve extended some hours - hasn’t been working the greatest. I had one lady who had an IV in place that they took out to send her home because they were closing. They told her to either come back tomorrow and get it done again to finish her IV, or go to the Regional and have it done. So it’s a huge waste of money, but also a huge waste of resources, and not very good patient care.
I’d like to know what the plan is for the Northside General - if there’s any plan to ever keep it open for 24 hours, or do we have to do something different to manage the need that’s going to happen because of that?
MR. DELOREY: I can appreciate the challenges that the member, and really all of the members around the industrial Cape Breton side, particularly those around New Waterford, the Northside, and Glace Bay areas. I believe members from all Parties in the Legislature represent those areas, so this is not a partisan question being asked, but one of genuine concern for the community and that region.
We recognize those challenges. The member referenced the closures taking place this weekend. We understand what some of the underlying challenges around staffing there are, to fulfill the hours - if the staff were available, that is, the physicians and the nursing staff to provide those services, they would’ve been provided. But we do know with the changes that have been taking place - and it’s not just here. There are other parts of the province and other parts of the country, communities having similar challenges. We are endeavouring to delve in to evaluate and take a fresh look at what the solutions are.
We all understand what the challenges are. We really need to delve in, roll up our sleeves, and start seeing what we’ve been doing, working on the locums. They work to an extent, but clearly are not solving all of the challenges. We’re taking a fresh look, rolling up our sleeves, and seeing what is the long term, not just in the short term. We continue to proceed with the status quo, but we have to come up with a plan for the medium and the long term as well, and that work is ongoing. When we come up with how we can address these concerns and these challenges, we’ll be out there to communicate that.
MR. ORRELL: I guess my question was, is the plan to keep the Northside General and the New Waterford and Glace Bay hospitals open? Is the plan to transfer everything over to the regional hospital? I don’t think the regional hospital can handle it without a major expansion and an influx of staff.
This weekend, I don’t know if the staff of the ones that are closed will be pulled in to help out with the massive amounts of people who are going to end up at the regional. A couple of weeks ago, we had seven or eight ambulances backed up there that couldn’t get into the regional. We had to bring in an ambulance from Antigonish.
People in my office complaining about this are comparing us to Third World countries, that we have to wait that long for emergency care. Our highly trained professionals aren’t getting the chance to do their job because they are either waiting or they are treating people who should be on a floor upstairs. There has to be a plan for these hospitals.
The other question I have - I could tell you right now there’s five doctors in Cape Breton who wanted to come back to Cape Breton but could never get a residency there who are gone now to work in other parts of the country or in the States. Now they won’t come back because they realize the grass is greener there - higher pay, more time off, better working conditions. We’re hearing in this Chamber every day that that’s the way doctors want to work.
My question is, what are we doing to reduce those barriers for the people who are from this area who might get recruited by a doctor in that area? For a time, we weren’t allowed to bring them in because we had too many in that area or - we didn’t do it. What is being done to make sure that we can bring our own kids back to the area? I’m not talking about unqualified kids. I’m talking about young adults who are qualified who want to be here who can’t get back here. What are we doing to change that?
MR. DELOREY: That’s a timely question focused not on recruitment broadly but indeed recruitment of new graduates. I think that’s what the member is focused on there when talking about residency. There’s a few things with respect to barriers. Number one, as far as the hiring process, what we have certainly heard loud and clear is that given the fact that there is a need right across the province, it’s far more efficient to take artificial barriers down and allow physicians, particularly family practice physicians - primary care being that focal point - to choose where they want to practice because the need essentially exists from one end of the province to the other. We have provided that flexibility for our family practice physicians as we continue to address our primary care challenges in that regard.
With respect to how someone gets to become a fully licensed physician in order to practise, it is a bit of a process. It starts by entering the medical school program. We have 80 or 90 medical student seats at Dalhousie for the educational piece of the program in Halifax. My understanding is that 67 or almost 70 of those seats are for Nova Scotia students, if I recall my last conversation with the dean of medicine. The vast majority of those medical seats, I know a lot of people talk about needing to have space allocated for Nova Scotia students, for the students who meet the entrance criteria. They are first grabbed by Nova Scotia students.
I have heard from people in communities saying so and so’s son or daughter had applied, they have a 99-per cent average, a very high academic skills, and they didn’t get into the medical school program. The fact of the matter is, these programs are very competitive. Many of the candidates applying have very high academic achievements. It’s one of the reasons why they tend to pursue a challenging career like medicine.
But there are other aspects that get assessed - it’s not just your GPA coming out of your high school or an undergraduate program. There are MCATs, the exams that are taken at the front-end assessing aptitude and probability for success going through the medical program. Part of it is your performance on those as well as the interview process.
One of the things that I remember as a high school student at a time when I thought my career path was going to be studying medicine was universities coming around recruiting high school students. One of the universities from Quebec that had a medical program talked about the changes at that time, in the mid-1990s, in recruitment using an example that, historically, it was only science students who pursued medical degrees, and then there was a change in culture and approach, saying you don’t necessarily need to have a science undergraduate degree. There’s a certain amount of capacity and a recognition of skill sets. You do have to have your science knowledge, but the specific medical training comes through the program.
Beyond that, if you do get into the program, then you have to get the final training. You’re a doctor because you graduate from medical school, but to become licensed, you have to finish your training, which is the residency. We have talked about this. Of course, we know the data that we have shows that someone who completes a residency in the Province of Nova Scotia, 75 per cent of them or thereabouts stay in the Province of Nova Scotia. We know, as the member said, that if those young medical students have the opportunity to do a residency in Nova Scotia, they’re much more likely to stay in Nova Scotia to practise. That’s one of the reasons why part of our strategy includes expanding our residency program, additional family practice seats and additional specialist seats in order to provide more opportunity for more physicians to get placed here.
It doesn’t answer the underlying question though, the very specific part of the question, which is around our own sons and daughters, our own community members, having the opportunity because we know they may want to stay in our communities. There are two answers to that. One is that residency seat placement - again, very, very competitive.
I believe the average allocation of residencies to medical student seats in Canada is about 106 residency spots per 100 medical students. I believe it was the Canadian Medical Association that recently wrote to me just within the last couple of weeks that they were recommending increasing that ratio to 120 residency seats per 100 medical student seats. I’m pleased to advise the Legislature our current number before the increase is, I think somewhere around 115 or 116 to 100 - well above the national average, but very close to the recommended average. When we add the additional seats that we’re bringing into the system, we will far exceed the recommendation, making Nova Scotia one of the only jurisdictions adding residency seats.
That will make it very well known to young medical students not just in Nova Scotia but across the country that we want them practising here. We want them training here. We want them to experience the lifestyle here. We want them to provide care here. We want them to stay here. So, we are doing those things.
But again, the process is a national process. We can’t guarantee that it’s going to be our son or daughter who is going to get that seat. We would certainly love to have it. I know the member has some people he knows who fit into that situation. They may have trained internationally and are looking for that opportunity to come back to do their residency placement. I have had many of those. I have reached out. Every time someone reaches out and lets us know that there’s a prospect, someone who may be doing a residency elsewhere as a potential recruit, I have done that.
I’m sorry to advise the member - sometimes it is the wish of family members and/or community members that the individual come back and we will reach out and the resident is very much interested in coming back to Nova Scotia to work in their community. However in some cases, while they’re very happy to come back to Nova Scotia, they don’t necessarily want to go back to their community, as much as their parents and community members hope they do. That’s another reality we face as well.
MR. ORRELL: Thanks for outlining how med school works, Mr. Minister. I knew that.
I asked a question about bringing people back here. I appreciate that we’re going to get 10 foreign-trained doctors, and I appreciate the 10 residency seats. But as a government here in the province, we have a shortage of doctors. We are going to put 10 new residency seats in and not going to guarantee that they are going to be Nova Scotia students, who may, or will - or maybe they won’t - come back here. I think that’s a waste of our good hard-earned taxpayers’ money. If it’s not guaranteed that they’re going to come back here, and it’s not guaranteed that they’re going to be provincial students, I think that that’s a waste of our money that we could be spending in other places and maybe getting them here. That’s my opinion, and my opinion only, not the opinion of the management and staff, as they used to say on the radio.
This will be my last question for the day. The big talk is collaborative care centres. I appreciate that new doctors want to work in collaborative care centres because of the time they get, the freedom they get. They have massive bills that they’re going to have to pay, but they want a lifestyle as well. I appreciate that we have to compensate them well, and we have to make sure that we have people who can work together to provide primary health care to the people in the Province of Nova Scotia.
I worked in a hospital for 25 years, not that that makes any difference today. We had collaborative practices then, but we didn’t operate under the same roof. If I had a doctor call me and say they needed to get somebody in for physio, we got them in for physio. If I called the dietitian and said this patient needs to see the dietician, we saw the dietician. We didn’t have to be under one roof. Collaborative practices that have to be under one roof, I get that.
My question is, if we’re going to bring a collaborative practice to an area like Northside, where we have a shortage of doctors now, and a doctor who goes in there with 3,000 patients wants to map right in the collaborative practice, and another doctor comes in with 2,000 patients, that’s 5,000 patients for two doctors. If we bring in a new doctor, are we going to bring in the other 1,300 or 1,200 that they’re saying that new doctors want?
The doctors who are going into a collaborative practice may want to reduce their case load to get time off, but if they have that many patients and now they’re bringing it in, how is that going to change how they get their time off or how they’re going to work in a collaborative practice? Is it going to be for new doctors, or is it going to be for old doctors? I don’t mean old.
MR. DELOREY: I think what the member was concluding with there was doctors of his vintage versus doctors of mine. The long and the short around the collaborative practices is that it’s not just about bringing collaborative teams of physicians together. The whole point of these teams is that they’re collaborative - not just physicians, but also other primary care providers.
In this example that the member used of physicians coming in and the scope that may be able to be sustained in a given practice, that would be based upon the work within the team that they would identify, and the extent to which they were practising. That team could bring in a brand-new nurse practitioner or a family practice nurse. Although they may have a certain patient loads, those other partners with different scopes of practice may be seeing patients who fall under a particular physician’s roster.
Using the analogy there, that physician who may have 2,000 patients and feels overworked and is looking to cut back a little bit may be able to continue to sustain the 2,000 patients because some of those patients may be seeing the family practice nurse when they come in and have symptoms that can be managed by the family practice nurse. As a physician, they wouldn’t necessarily be having to see all of their patients all of the time the way it works today in the traditional practice.
That’s an aspect of the remodeling of the system - to free up the capacity to for those physicians to provide more care and hire acuity care for patients and, if they are currently overworked, to be able to take some time off if that’s what they feel that they need at that point.
My last point is back to the previous question actually. The member referenced it not being a good investment potentially, in his opinion, if we don’t guarantee that they’re for students. At this point, we encourage them to come back. We of course would welcome and encourage all Nova Scotians to come back. We want that to happen.
But these seats, with the way that it’s integrated at the national level, if we were to start deviating and breaking things off from the nationally approved standard, we may start to find ourselves very isolated. Although we could get our Nova Scotia students back, we may not have access to the national pool that are also certified to work here in Nova Scotia. That would be very much an unintended consequence.
MR. CHAIRMAN: The time has expired for the Progressive Conservative caucus this afternoon.
For the New Democratic Party caucus, the honourable member for Cape Breton Centre.
MS. TAMMY MARTIN: Before we broke, we were talking about shortages and overcrowding and those types of issues. Now I would like to take up with the minister about ER overcrowding, and I know we’ve talked here several times about hallway medicine, about people being treated at water cooler number one or pot machine number two. This is actual reality for many ERs in Nova Scotia. It compromises doctors’ care, and it puts patients at risk.
As the minister alluded to before, there are many patients who are admitted without family doctors or without access to primary care. I’m wondering if the minister can provide us with information that actually details how many patients are admitted to emergency rooms under the hospitalist program, or under a hospitalist doctor now.
MR. DELOREY: I don’t believe I have that data here with me for that type of breakdown. I’m not sure if we have the specific breakdown because the data would change, as the member might imagine. It is a bit different in different parts of the province. The fact is, not all hospitals make use of the hospitalist program because in some communities they still practise much more in the traditional manner.
That traditional manner is, the general practitioners in a community, the family practice physicians, would do rounds and go up to the hospital. If any of their patients were in there, they would go in and see them, assess them, and discharge them if they were well enough to do so. That’s the traditional model of care, and that’s why we call them general practitioners. They would work in their practice, and as part of their day, they would go up to see their patients and treat them through the hospital as well.
What happened over time is, we found out that we had some vacancies. People were showing up without a family physician in the hospitals and needing care and discharge. General practitioners, family physicians, started taking on that load as well, saying, we’ll see, and we’ll do our rounds in shifts.
As time went on, certain family practice practitioners were saying, “You know what? I don’t really like that part of the practice” for whatever reason and were saying, “I don’t really want to go and work in the hospital and do those rounds. I’m happier practising in my clinic.” So they provided that service, which then opened up more patients who needed to be seen. As I understand it, that is - in a very simplistic way - the evolution of the hospitalist, because there are enough so-called orphan patients to receive that care.
Again, I don’t think I have specific numbers for it. There are certain hospitals within the province that do have dedicated hospitalists providing care throughout the day to patients. In other jurisdictions or other hospitals, the care might be a combination of hospitalists and community providers coming in. In other jurisdictions, they may not have any hospitalists allocated.
I believe there are currently seven sites - South Shore Regional Hospital, Colchester East Hants Health Centre, the Cape Breton Regional Hospital, QEII Health Sciences, Valley Regional, St. Martha’s Regional Hospital, and Dartmouth General Hospital - that all make use of hospitalists.
MS. MARTIN: I find it very strange to think that a lot of this information I have asked the minister to provide - he tells me that it’s not readily available, or it’s something that is not tracked. How can we run an emergency department and not know how many patients are admitted without a family doctor? I know in my constituency, I had one who was trying to be sent back to her home town and couldn’t go there because she didn’t have a doctor to accept her back in her own town.
I don’t know how we can fix a problem if we don’t ask the questions. Why are we not asking these questions? To that end, I am also looking for data, numbers, whatever you can provide to this side around triage to admission and the wait times. We all hear the complaints that constituents are waiting 10 or 12 hours. I know the facts. They take the most severe first. But I also know that there are severe wait times. We’re looking to have some statistics to share that information and to help us understand exactly what is going on in emergency rooms.
MR. DELOREY: Just to clarify for the benefit of the member opposite, when I indicate that I don’t have the information readily available, what I’m actually talking about is the binders in anticipation of the types and specific questions. We’re getting into some fairly specific items that we don’t have readily available, as I’m responding to the question. Data is available within the system, and certainly we do track information. We have information and data available. When I’m saying we don’t have it readily available, what I’m actually saying is I don’t have it readily available at my fingertips here today.
Of course, we track lots of data throughout the system, with our partners at the Health Authority. I made reference earlier that we would have data and that I recognize the importance of doing even more and doing better. We do have more technology within our health care system, so we are actually able to track data in different ways at a more finite level. That means we can do more slicing and dicing and look at it in even more creative ways. That can influence our policy decisions, our investment decisions and where we need to focus our efforts at a given point in time. That work is ongoing.
The member asked about the emergency department triage data in this question. The first one was specifically about hospitalists and kind of an average number of cases that these hospitalists carry. Again, I don’t have the data right here but we’ll endeavour to pull that. I have taken the note.
The second question about ED and the triage - as the member who has worked in the hospital environment would know, they do triage and identify I believe five priority levels of care. I know for a fact we have the data because I have asked about it before. I have seen some data. I don’t have it with me but again I have noted that request.
I would also like to note that, as far as managing data and information, Mr. Chairman, it’s not just data that we have and leverage ourselves internally for analysis. There are third parties like CIHI that take this data that we provide nationally as comparators. I know the members opposite are familiar with this report because they often use it to cite certain characteristics of our physician population and so on. CIHI does a lot of national data, and that’s all data that we are tracking provincially. We feed it in and get the reports back so that we don’t just know what we’re doing, but we also know how we’re comparing on a number of parameters against our sister provinces across the country.
MS. MARTIN: In reference to the current health care crisis in this province and particularly talking about emergency rooms, I would like to read you a comment that was sent to me from a doctor in Nova Scotia. It says, “The most soul destroying part of my job is saying to patients that I understand their frustration but there is nothing I can do to help you. It will take 6 months/12 months/3 or more years before you can have that service. It might help to recruit some more family doctors, which we so badly need, but they won’t stay” here because the resources are not in this province, and it is very difficult to work under these circumstances.
As I have said and I will continue to say, health care in this province is in a crisis. We are short nurses and doctors, and I know there’s vacancies in labs and x-ray. They are listed as ongoing vacancies under the NSHA. However, what we’re finding out from the minister and from the government is that you’re trying and you’re putting money in. But when doctors are faced with substandard conditions in many cases, how are they able to provide the best care and provide what these patients and constituents need?
Another disturbing fact is about elderly patients in the emergency rooms. This is something I’ll get into deeper under long-term care, but many times elderly patients - because of becoming combative, possibly with Alzheimer’s or dementia - are discharged from their long-term care facilities to an emergency room. There is nowhere for them to go, so they remain in the emergency room. There is not sufficient staff to monitor these patients. They are combative. They roam. They get out. All of these conditions are playing on and working against the people who are working in emergency rooms.
Do the Department of Health and Wellness and this province recognize the current conditions in which doctors and nurses are trying to help people? It seems like the department is just working against them.
MR. CHAIRMAN: Before I recognize the honourable minister, I would ask the honourable member to table the document that you read from as per the rules of the House, please.
MR. DELOREY: Just for the member’s clarification, I believe what the Chair is requesting to be tabled is the note from the doctor that you read from. I think it was an email or something. You read it at the beginning.
MR. CHAIRMAN: Thank you. That is correct. Yes, it would be that document.
MR. DELOREY: I have a couple of things. I know there is a lot packaged in the description when coming up to the question. I’ll delve into it on a couple of fronts. The recruitment and retention of physicians, we have talked about that extensively. I won’t delve into it a lot, but specifically in that piece that the member read from a physician made a comment - I’m paraphrasing, but roughly - that they may be able to recruit with those incentives, but why would they stay when it’s under-resourced?
Indeed, I’m pleased to remind the member that we recently announced a significant investment to support both recruitment and retention initiatives for physicians. That has increased compensation for them, for the very important primary care services they provide and also to encourage them to expand practices where appropriate and take more patients on their roster. That is, to take them into their practice - accept more patients. All of these are being done. It’s not just verbiage, that we’re saying that we’re working on it. I believe our words are followed up by action.
It’s not all about money, but we are putting money towards these initiatives. These are initiatives that we didn’t choose on our own accord. We worked with physicians through Doctors Nova Scotia, which is the bargaining agent on behalf of doctors within the province, to identify and come up with this package that we rolled out recently, which we have budgeted for.
These are all things that we have done. We have been criticized quite frequently by the members opposite suggesting we don’t listen, that we don’t collaborate. Indeed, these are exactly the things that we have been doing that have resulted in the package that was recently referenced.
The second big theme within the member’s comment related to the scenario of elderly - and they don’t necessarily have to be elderly - patients with dementia, particularly dementia types of conditions that may have behavioral challenges associated as well. I don’t want to be overly general here, but there are certainly circumstances where behavioral challenges also co-exist with dementia patients in some instances.
This is an issue that isn’t new to government or those who work in health care. I believe the member opposite, given her previous career, is likely very familiar with the Broken Homes report. That report that was developed did result in my predecessor - the former Minister of Health and Wellness, the member for Kings West - establishing the committee and agreeing to work to come up with some strategies. We have received that strategy. We have accepted the recommendations and are working towards them. I know there are many specific items in there.
I recently spoke with the president of the Nova Scotia Nurses’ Union. She certainly flagged the importance of all the items, but one in particular that she raised actually applies to this very scenario that the member raised. That being an individual who under normal circumstances would be a nursing home or long-term care resident, but was in a hospital setting because they were looking for a site that may be able to provide the care that was needed - not just the residential aspects of care but also the physical safety aspects for the individual resident and also safety for the employees.
So in the Broken Homes report - the member may know this, but others in the Legislature may not - I don’t remember the exact terminology but one of the recommendations related to providing units to support those exceptional or most acute cases that are really challenging. Again, this is not for the norm, but for the most challenging individuals with behavior that presents a potential safety challenge. Again, it’s about safety for the individual which is paramount, but also for our employees who would be working with the patient.
So that is a recommendation within the last week or two that I had conversations with the president of the Nurses’ Union about and her desire to see progress. I have certainly been looking into the status of work on that part of the report. We are working on a number of aspects, so I have delved in, collecting more information about where we are in that progress. We recognize it. There have already been reports and recommendations of how we can move forward with it. It does take time. It’s unfortunate.
The member read the doctor’s statement about the soul-sucking response of saying unfortunately there is nothing I can do - I’m paraphrasing, but something to that effect. It doesn’t give me pleasure to say it’s going to take time to deliver these results. But I hope the member and others in the Legislature take solace in the fact that we do recognize the challenges. We are identifying the path forward, and we are taking action in those areas. I just use that Broken Homes report as one example that relates specifically to the item that the member brought up in her question.
MR. CHAIRMAN: Order, please. The time for Estimates for this afternoon is concluded. We will take a short recess before we rise while we wait for the Red Chamber to conclude.
[The committee adjourned at 2:58 p.m.]