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March 27, 2018
Meeting topics: 
CW on Supply (Health) - Legislative Chamber (2330)















2:57 P.M.



Ms. Suzanne Lohnes-Croft


MADAM CHAIRMAN: The Committee of the Whole on Supply will come to order.


The honourable Deputy Government House Leader.


            MR. KEITH IRVING: Madam Chairman, would you please call the continuation of the estimates for the Minister of Health and Wellness.


            MADAM CHAIRMAN: We’ll turn it over to the member from the NDP, who has 43 minutes remaining in her time.


The honourable member for Halifax Needham.


            MS. LISA ROBERTS: I wanted to follow up just a little bit more around the use of continuing care assistants, those employed by for-profit providers versus non-profit providers. There were some concerns I referred to yesterday in the last Auditor General’s Report in November 2017. You said yesterday that 80 per cent of home care in the province is provided by non-profit agencies and 20 per cent by for-profits. I wonder if you could comment on the different geographies. Is the 20 per cent of for-profit coverage for home care concentrated in the central region, or is it spread evenly across the province?


            HON. RANDY DELOREY: I did have to consult for some information, so I apologize for the delay. The information we do have on the breakdown is, of course, that health care services are distributed across the province. I believe there are four or five agencies that provide for-profit care as part of the home care services being provided, and they are all geographically located in the Halifax region.


[3:00 p.m.]


            MS. ROBERTS: I wonder if the minister would comment on any concerns of mine that he might share regarding the working conditions of CCAs working in for-profit firms. Simply put, those for-profit providers don’t provide travel expenses. They don’t provide guaranteed hours. They don’t provide benefits. They don’t provide pensions. I am concerned both that the government is relying on a precarious, casualized workforce to provide very essential care that really, our whole province is relying on as our population ages, and also that the nature of that casualized and precarious work has an impact on patient care as a result of frequent turnover in staffing of those CCAs.


            I would just welcome hearing from the minister if those are concerns that he has heard, and what plans, if any, the department has to address them.


            MR. DELOREY: Indeed, I can advise the member that the workplace and the working conditions, of course, particularly with respect to safety - I know that’s not exactly where the member is going with the questions, but indeed, those aspects we are certainly very much concerned with, as we would with all workplaces across the province, especially in those workplaces where they’re providing services either directly or indirectly on behalf of the people of Nova Scotia - the Government of Nova Scotia or through some of our partners like the Health Authority, or with home care providers in this case.


            As far as the nature of the specific contractual relationship between employees and their employers in the home care sector - as would be the case in other sectors, those relationships and contracts - and thus the nature of those work employment characteristics that might be covered by collective agreements in some cases, or just the working environment that is established, would vary. I don’t think that necessarily has to be stipulated on the basis of profit versus non-profit.


            To my knowledge, I’m not aware that there is a unanimous contract. I don’t think the contracts are the same, even amongst the non-profit care providers. I think the nature of the question seemed to be going down a path suggesting that there were differences in the employee contracts or employment - whether it’s rates of pay or benefits - in non-profit versus profit. I just propose that there would, indeed, be differences even amongst the non-profit organizations as well. I don’t think the variable would be just profit versus non-profit. I think it’s a situation, as you would see in other employment situations, where the employers enter into agreements with their employees to provide services for a particular remuneration and benefit package.


            MS. ROBERTS: I think I’ll follow up with the minister on some of the specifics of my concerns, perhaps in another forum. I will note that when the government announced some investment in lifts, for example, directed at addressing safety concerns just before the budget, as part of that windfall that the province benefited from, my first thought was that the issue I have heard from workers in a nursing home in my constituency is that lifts are not used because staffing levels are so low, and lifts require more than one staff person to operate them. There are so few staff on a given floor, that one staff member is over here taking care of this hallway, someone else is over here taking care of that hallway. When the moment comes to actually use a lift, there are not adequate human resources available to actually make use of equipment that might reduce workplace injuries.


            I’m going to turn over the time to my colleague.


            MADAM CHAIRMAN: The honourable member for Cape Breton Centre.


            MS. TAMMY MARTIN: To be brief, if it’s acceptable to the minister, because my colleagues were kind enough to relieve me yesterday evening, I still have two items that I would like to touch on before I continue with my colleague’s line of questioning.


            Yesterday we talked about mental health grants. I’m wondering (1) if the minister is considering having these programs streamlined into their operational funding system, and (2) if the minister could table what grants are given out to whom and for how much.


            MR. DELOREY: I’m trying to recall back to yesterday. Just to reiterate, I think we had spoken specifically around investments here towards mental health types of initiatives. I think it’s somewhere over $700,000 towards these types of grants.


            To the member’s question, in terms of knowing where all of them are, these grants are often application-based. They would be approved as they come through, and throughout the fiscal year as we work with groups and partners.


            As far as operationalizing, indeed, there would be some organizations that often apply and may receive grant funding on a frequent renewal basis. But others may truly be one-off funding. I don’t think, carte blanche, saying that we establish or fold our grant programs into core operational funding is necessarily a good thing.


            Madam Chairman, we do invest significant core funding to invest in providing mental health services. But there are times when we want to try something new. We need to be flexible and nimble in trying new things with community partners. That’s where grant programs really come out and shine. We can evaluate and identify where opportunities are, and then we can have conversations about where and when and whether the nature of what we learned from those experiences results in a particular organization, or perhaps lessons are learned, and we take it in-house and say this is a great program.


            I’ll use the example of CaperBase in Cape Breton. I’m sure the member opposite would be quite familiar with the success of that organization. It was one of the highlights at a time of great challenge in the community, when Dr. Kutcher went to Cape Breton to talk to family and community members about circumstances last June. When the Minister of Education and Early Childhood Development and I met with Dr. Kutcher to hear from him and his recommendations, his praise for what he had heard, and the pride and the recognition of the positive outcomes provided by a youth-based service connected with the school communities outreach that is done by that organization and that’s something we’ve learned. It’s not something we’re rolling out in kind of that traditional grants, we’re building it up and baking it in to expand services like that to other parts of the province.


I hope that explains why I don’t think that necessarily rolling grant funding into operational carte blanche is an appropriate thing but to recognize that at times we do learn from these programs and initiatives and we do create operationalized delivery of maybe not the exact same but similar services that we learn from these types of grant programs.


            MS. MARTIN: Now I’d like to talk about mental health and young people across this province but especially we’ll touch base on what’s happening in Cape Breton, as I’m sure the minister is aware that mental health is in crisis. I’ve said before that when you have a phone call from a parent and the parent is worried that the daughter or son is going to commit suicide and it’s after the hours when crisis is closed and with the lack of psychiatrists, especially child psychiatrists, we have nowhere to turn.


            I’d like to tell the minister a little story and look for some feedback at the end. I was contacted by a member of another constituency elsewhere in the province, as the NDP Health Care Critic, that their son, who was not 18 at the time, was going to commit suicide, was mentally unstable and addicted to drugs and they had absolutely nowhere for this young man to go. When they looked at what was available at the IWK - it is called CHOICES Addictions. It is up to 18, it’s an eight-week program and it’s kind of like a one-size-fits-all program.


            It was over the Christmas holidays so the young man had been there for a couple of weeks, then it closed for Christmas. He had to go home and hopefully come back and start all over again, which is not conducive to good therapy.


            In our neighbouring Province of New Brunswick, they have something called Portage, and it’s an adolescent program that runs six to nine months. It’s an intensive, exhaustive treatment that deals with multi-faceted issues, not just a cookie-cutter approach. I will stand and say again that mental health, especially for youth in Nova Scotia, is in crisis. I did look to have this person sent to New Brunswick in the hope that this province would cover the fee, as does Newfoundland, I believe, and P.E.I.


            My question, we talk here about being proactive, why are we not investing in these types of delivery programs that can help these young people before it’s too late? Again, in my own constituency there’s a group called A Town That Cares. They are begging for government funding to open this centre, they have a doctor to work in it. The doctor is on the board. Why are we not answering the cries of parents and residents of Nova Scotia? I know we have priorities but why are we not being proactive?


            This program, from what I understand in New Brunswick, deals with everything, it’s not just a one-off. Why are we not, or is this something we can look at, or is it something that the province would fund going forward?


            MR. DELOREY: I thank the member in particular for her commitment to bringing forward questions around mental health and addictions, very clearly an important area of health care delivery and an area I acknowledge that governments across the country and much of the world for too long failed - and not just governments and perhaps governments as a reflection of society - to realize or recognize mental health and addiction as health conditions. Someone with depression - I’m sure the stats are out there. About 20 per cent of the population is being touched by mental illness, so I’m sure, if not everybody in this Legislature, if not themselves, certainly have a loved one that they know - and if not, certainly a constituent that has been touched by or affected by mental illness and/or addiction.


[3:15 p.m.]


            For too long, society’s response to that has been - let’s use depression - the example that comes to mind is: get up, because you’re lazy. How many times do you hear that from people, where their colleagues or family members, that was the response when they’re unable to get out of bed?


            Our commitment and recognition of the need to improve mental health services is genuine. We tout and highlight the financial contributions and investments in clinicians, our commitments to partner and work with our education department. The member’s specific question was targeted around youth.


            As I said, we very much take to heart the need to work with and provide these services to our youth. That’s why we’re investing. Perhaps it’s a different model or a different approach that we’re really seeing take place here. Our focus and our investments, really, it’s to catch - and by catch, I mean to identify - mental health conditions, which are often co-morbidities, co-exist with addictions, depending on the circumstances. In some cases, you may find someone with an addiction and the addiction has developed because they’ve had a mental health condition and they’re self-medicating or treating themselves. In other cases, someone has an addiction and in that addiction, they begin to self-loathe and it leads to mental health conditions.


            Clinically, I’m not really sure the distinction as to which causes which or which came first, but practically speaking those cases do often exist and co-exist. For us the approach - and there are differences of opinion - we rely on recommendations and input from clinicians and from people in the field. I will be the first to acknowledge that there are differences of clinical opinion as to what approach should be used, and whether it’s in mental health or in other areas of our health care system.


            Every time as government, as a department, or I as a minister, roll out either directly an announcement, or with our partners a particular initiative, it’s because based on the information and the recommendations we’ve received, we believe - we truly do - that it’s the right approach to bringing the best value and the best supports to our citizens.


            That doesn’t prevent others who may have presented an alternative path from standing up and saying, we would have preferred this - and so they may be critical. That’s the unfortunate reality of our political climate and our society these days - that we don’t stand up and recognize the good work that governments do. We’re in a situation where often people with - and I really do have to believe that it comes from a good place, in instances where people come up and criticize very good investments and good programs because they truly believe that their model or their approach is the right one or the best one. Unfortunately, we have to take the information we have, take the evidence and try to make the best decisions.


            I assure the member, and all members of the Legislature, that’s exactly what we do. We work with our staff and get that advice and make decisions. As minister, I work with my colleagues to make the case to get the funding to deliver.


            As I said, we do make youth a priority. That’s why many of our clinicians have been targeted towards youth - the investments and our education system to bring down those silos are targeted there because we want to identify - we want to make sure that those youth have those supports so that they will have the coping mechanisms to move forward, have productive lives, so they don’t find themselves in a situation where they need perhaps other types of treatment services.


            I don’t want to take a whole lot of time - as important as the topic is - but I do want to touch a little bit, too, on the specific example the member raised about a program that’s, I think, six-to-nine-months intensive. There are models and there are individuals who subscribe that an intensive, in-patient type of treatment - particularly around addictions, but in mental health conditions as well – is often the right model.


What I can advise the member is, in my engagement with front-line care providers in the mental health and addictions space, the information and the recommendations and the feedback that comes up to me is that we are transitioning. The evidence is showing and suggesting community-based programs.


            It may seem counterintuitive. I’ll just focus on the addictions side. Historically, we’re used to detox centres. I’ll focus on what people may be most familiar with by volume, but I think the principle applies.


            Think detox from alcohol. As they say, you go drop so-and-so off at the detox for a week to sober up. They sober up, they get back to their old selves, and then they get returned to their family and their community outside. While they’re in that detox centre, they’re receiving counselling. They’re receiving supports. They are in a protected environment without access. There’s really literally no choice but to sober up - again, whether that’s alcohol or other drugs - and have the counselling. Of course, we see good outcomes from when they entered to when they came out. But the advice and information that I have been provided is that we don’t necessarily see great outcomes in the fact that we see a lot of relapse based upon those types of treatments.


            What I have been advised, Madam Chairman, is that one of the reasons for the relapse is because you’re in a protected space in those detox centres. When you get out into the community, then you’re out there trying to fend for yourself. The recommendations are to create a space where you work with those citizens, those people, in need of support.


            It’s a similar theme that has been advised to me around mental health conditions as well, that putting people in a real-world environment, helping them while they’re there, coping in their community, is actually seeing better long-term results in preventing relapse because people are learning coping mechanisms and skills, whether it’s for their mental health considerations or their addictions. That’s why we see the focus and investments to try to get out there, have more supports in the communities, to make those supports available to people who are in need. It’s not necessarily the intensive kind of interventions you would see in these detox-type of intensive longer-term programs; it’s less intensive but supportive throughout in the community so you get people to develop those skills.


            All that is to say that we look at all options when things come through. Very clearly, we have focused, and a lot of our investments are for youth, first of all, as the member has expressed her concern. We are there. We are investing. We believe in that as well. Intensive programs like the member has mentioned haven’t been a priority part of the model because we want to get those services out where youth can access them, where they can be in their natural environment, where they are most often, so that they can learn the coping skills and have those supports, when they need to lean on them, so that they can then cope better throughout their life in a more real-world scenario.


            That’s what I’m being advised is really the clinical approach. I recognize the member can probably find clinicians out there who disagree with that approach and would be willing to stand up and vocalize something different.


            Madam Chairman, unfortunately, we have to take advice, we have to assess, and we have to make some decisions. That’s what has been taking place here.


            MS. MARTIN: I’ll move on, back to where my colleague had started, under long-term care. Under the standard hours of care, in a nursing home or a residential care facility in Nova Scotia, are there prescribed standard hours of care? Would you be able to table the information to describe how you get there and how it is followed?


            MR. DELOREY: I believe there are some, when looking at the care and long-term care facilities, as I believe that’s where the member is questioning - so to verify, the member is looking for the hours-of-care-per-patient standard. I think in that situation, it may vary on the basis of the conditions of the level of care required by the patients.


            As far as what the range would be at the different - I’m just trying to think what the name is of the assessment criteria that we use - the MAPLe scores, which identifies the care levels needed, or the abilities of the individuals, which then influences or informs the level of care they would need, based on their capacity, which is evaluated using a standard approach called the MAPLe scores. That would identify the care level required and then hours would be associated with that. I’ll have to reach out to get the actual mapping that we have for what ranges result in what hours. I don’t have that information at my fingertips.


            MS. MARTIN: To be clear, I would expect there is a standard level in order to provide the appropriate staffing levels for these facilities. Whether the minimum is three hours per patient or five hours, I would think there is a bare minimum that you would have to adhere to.


            From that, are the nursing homes accounting for the actual hours that are provided? If so, how are they recording or tracking that information?


There must be, or I would think there is a standard level for staffing purposes, whether the average, or standard per person or per patient is three hours or five hours, I would expect there is something, because you need to be able to staff the facilities, as well as - are nursing homes currently accounting for their actual number of hours of care provided? If they are, how is that information tracked?


            MR. DELOREY: There are guidelines the department uses through the licensing process that certainly evaluates, on a facility basis. There are a number of variables that do come into play, certainly the level of care needs for patients, the staffing based upon the beds in place in a particular facility. I’m aware that in some circumstances staffing may be adjusted upwards, depending on the facility configuration; that is, if there are needs.


            There are some guidelines that are general guidelines used when establishing some funding for facilities. Many of these funding agreements, based upon positions, are long established, because many of the care providers have been providing care for a long time. What or why or how they established those times when they entered into those agreements and contracts, I don’t necessarily have, and they may be a little different. When contracts came into play with different providers and facilities, it may be a little bit different in one facility versus another. For reasons like that, because our care has really evolved over time, but certainly, as a department, we work to establish some of those guidelines, taking into consideration what level of care is needed, based upon the scores that we’d expect of residents within these facilities, as well as the nature of the facilities themselves.


            As far as accounting for and how we assess, as part of the licensing requirements, we do both announced and unannounced visits throughout the year with inspectors to evaluate, to ensure that staffing complements, which, depending on the nature of the facility, if it’s an RCF or a long-term care facility, their nursing complements, their CCAs, that those staffing levels are adhered to, that other licensing conditions are adhered to, which include things like policies being posted, privacy management, the food criteria. There are requirements around having resident advisory committees and so on.


[3:30 p.m.]


            When the inspectors go in, they evaluate these things. They identify if they’re being adhered to by the facility and the facility operators. When they find that there’s some non-compliance, they step up, take corrective action, and give directives to have those areas that have been lacking to be addressed and move forward and work with the facilities to make sure that they address whatever area where they may have shortcomings.


            I have spoken about more than just about staffing, but the process would apply, whether it’s how they manage medications, or other areas of documentation and information shared with residents and others.


            MS. MARTIN: As the minister alluded to, the care is evolving. The requirements of those in long-term care facilities are increasing. The long-term care facilities that I have visited where CCAs, for example, could be in place and have one LPN or one RN, with the level of care that’s coming into long-term care facilities, they see the need for CCAs decreasing in some scenarios and increasing, because they’re presenting and living there with more acute conditions. The care is evolving, the level of care is increasing, staffing is increasing.


            While we appreciate the government’s attempt to keep seniors in their homes as long as possible, sometimes that is just not possible. Sometimes people can stay in their homes but need to be in a long-term care facility, and as I said, we’re seeing that in many nursing homes, where the level of acuity has increased significantly.


            Could the minister table the guidelines that they follow within the facilities?


            On the need for long-term care, we agree to disagree, but in my opinion, the need for new long-term care beds is significant. With the huge investment of the QEII redevelopment, why was long-term care not considered as part of this? In order to keep the patient flow and those things moving forward, why not consider long-term care as part of this redevelopment?


            MR. DELOREY: With respect to the QEII redevelopment project, that project is ongoing. We have rolled out some stages of that work. We felt it was important, as a government, when we launched the QEII redevelopment a couple of years ago - I think it might be close to two years now, when we had the official launch and let Nova Scotians know that this was going to be a different approach.


            The complexity and the size of this project - to decommission a hospital while continuing to provide care and services, and building up new infrastructure to replace that infrastructure - was going to be a task that had never been pursued. Doing such a thing is very different than in the early days, when we just built new infrastructure, and it didn’t need to replace something else and transition. It is a far more complex approach that we’re going under. When we did our due diligence, what we identified was that we don’t have to continue to do things the way we did them for the last 50 years. The approach and the flows and where services are provided doesn’t have to be every service in the current site being provided in the same way in the same site.


            That’s why we have seen significant announcement of investments over at Dartmouth General, a lot of work being done there, additional ORs, surgeries, and other investments, and work being done over at Dartmouth General and Hants and at the clinic in Bayers Lake. All this work is to help ease some of the pressure off. But we do know that the major portion of the QEII redevelopment project is yet to be announced - that would be for the work at the site. When that comes, there will be more details.


            With respect to why the member brought up the question of the QEII redevelopment is in the long-term care context, so why or how, could or would long-term care and the bed flows - I think is what she was referring to - the patient flow through beds. I think that ties into alternative level care beds and others, that we could free up beds to be made available.


            A couple of points to be made there. Number one, we do have over 160 alternative level care beds that are allocated as such throughout the province. I believe it’s somewhere in the vicinity of 150 to 170 alternative level care beds throughout the province. Those beds are not acute care beds, but they would be the locations for people who don’t necessarily require medical supports or services that you would see in an acute or ambulatory part of the hospital. They don’t need that medicinal or medical treatment and care. They may need care, and they receive care in those beds, but they also can’t necessarily be discharged. These may be individuals - some may be palliative, some may be waiting for home care services or some renovations in their homes to go back home, based on their condition. Some may be waiting for home care supports to be started. So, it’s just a matter of getting that cycle so that they get into the next scheduling of home care in their community. Others may be waiting for a long-term care facility - that the assessment would indicate that they could not return home even with home care supports.


            What I can tell the member is, we have been working and we do recognize opportunities to improve our processes and flow. That’s why the steps are being taken and have been taken over the last number of years. We’ve seen a reduction in the number of people waiting in hospitals for long-term care beds. I believe the reduction is somewhere over 30 per cent in the number of people waiting in beds for long-term care placements or continuing care placements.


            For those who are waiting in hospitals, they are also waiting about 30 per cent less time than they had been previously. So, independent of the QEII redevelopment, but broadly as part of what we’re trying to do, we recognize the need to do better. We want to be able to work towards getting people placed as soon as possible; get them the care, whether it’s in their home - that’s why we’re investing so heavily in home care - or when they get to the point where they need that long-term care facility, we want to make sure that the facility and the bed are available in a reasonable amount of time.


            MS. MARTIN: To the one part of that question maybe you didn’t hear - I asked if the minister would be able to table the guidelines that you referenced in the other question.


            MR. DELOREY: I’ll have to double-check with those to verify. As I mentioned, many of the approaches that are used relate to the contracts that got put in place, so I have to cross-reference to verify with some of the contracts. Again, many of these contracts have been in place for many years and may have conditions that may limit what I can put out, but I’ll take a look to see what we’re able to provide to the member, and we’ll get that information out as part of it. I’ve made note of it, but again, I just have to verify what is contractual, what fits within the guideline’s space that would be relevant, and we’ll get the information we can. I understand the nature of the question.


            MS. MARTIN: A good segue into the next section about alternative level of care - and we don’t have a lot of time left. Are they charged for the number of days that they’re staying in the ALC beds?


            MR. DELOREY: I know there are some circumstances where individuals may be charged for a stay in the hospital if they’ve been medically discharged from the hospital. The process for identifying what the rates would be takes into account people’s ability to pay and so on, so there would be aspects there.


            I’ll have to double-check whether that’s blanket for ALC because again, depending on the circumstances and the nature - as I mentioned earlier, ALC - alternative level of care - results in different reasons for being there, so I don’t want to make a blanket statement that says, if you are in an alternative level of care bed, that there is a charge associated with it.


            I do know, as an MLA, of situations when individuals have been medically discharged and there may be some fees charged for care. So, if an individual is in ALC, for this example, waiting for long-term care placement, there would be a charge associated because they are receiving care in the hospital, and they would be required to pay for the long-term care bed as well.


            MADAM CHAIRMAN: Order, time has elapsed for the NDP. We will turn it over to the PC caucus.


The honourable member for Sackville-Beaver Bank.


            MR. BRAD JOHNS: Mr. Minister, when we last went through this process not that long ago, I was of course, somewhat fixated more on Cobequid than I was on many of the other questions. I did listen to some of the comments when the member for Sackville- Cobequid brought up some points, which I think echoed some of the points I brought up last time.


            I just wanted to ask a couple of other questions. Obviously, I did hear you say that there were no plans in this current budget to look at doing any significant service changes at Cobequid. I do want you to be very well aware - I think you are, but I want you to be very well aware that there are issues currently going on at Cobequid. I’ve raised some of these indirectly during Question Period, but I do want to bring these up while we are talking here.


            I do think that - and a number of members in your caucus probably received the exact same correspondence that I did from a doctor who is employed there, who was expressing some concerns in regard to the operations and the overall effect the backlog is having. It was suggested there are people who are staying there all night, that people are staying there as late as they possibly can, in some cases, and then being shipped out to other locations and coming back in the morning.


            In that correspondence, she raised some concerns in regard to inadequate facilities, which I’ve raised in Question Period to you. I’m concerned that in that correspondence - and, as I said, I know that a number of your members had been copied on that as well - there were suggestions that it’s having a toll on staffing at Cobequid, that we have nursing and doctor staff who are working double shifts with no breaks and a number of other things like that, to try to accommodate what is going on right now.


            Where I’m really disappointed is when I reached out to this doctor and I said look, because I fundamentally believe that in order - criticism sometimes is not always a bad thing, if you don’t know that there’s an issue going on or if criticisms aren’t made, you can’t resolve them. I think when we come to issues like health care, I think we all want the best health care we can get.


            I did reach out to this doctor and wanted to meet. The Nova Scotia Health Authority basically shut her down from meeting with me, which really bothered me. I felt that was a sense of, we’re trying to hide the problem, and I mean I’m hesitant to even bring it here and talk about it, but I do think that when a doctor, knowing what - and I don’t know, but I’m assuming that the culture out there, if this doctor feels frustrated enough that they’ve reached out to me, I know they reached out to the member for Sackville-Cobequid, I believe I saw the member for Waverley-Fall River-Beaver Bank on that correspondence, so I’m assuming some of your colleagues may have brought this forward.


[3:45 p.m.]


When that doctor finally had the courage and the frustration to reach out to people and then was shut down by the NSHA, I don’t think that’s the kind of culture that we should be fostering if there are legitimate complaints. I’m confused about the process. I think that our employees should feel that there is a culture where they can reach out and bring forward legitimate concerns without that feeling of being shut down.


            This is more of a comment than it is a question, I guess. I brought some suggestions forward when we were here last time. I do realize, and recognize, that this is a very short span between when we were last here and when we’re here now. But I do feel there are opportunities, and I know the member for Sackville-Cobequid raised a number of them, many missed opportunities at Cobequid that we can be looking at that would service that community. That facility services at least six different communities.


            As far as I know, and I wrote this down, I don’t see that there is currently a mental health clinic there. Based on comments - my assumption from the comments that I heard you give the member for Sackville-Cobequid - is that there are no intentions in this current fiscal year to look at putting a mental health clinic there. It’s those missed opportunities that are really starting to concern me as well. I don’t know if you can comment on this overcrowding, people staying in the nights. You did say it’s not a hospital, and we know it’s not a hospital - just some comments on that.


            MR. DELOREY: I do remember our conversation last time. The conversation indeed continues after estimates, because the member represents his constituency and has raised questions during Question Period since then. I’ll acknowledge up front the member, and I’m surprised the member has been so gracious to the other member for Sackville-Cobequid for that member bringing up a similar line of questioning yesterday evening. Notwithstanding that, both serve the same community, and this site serves their communities.


            What I would say to the member’s concerns for the capacity that they have identified, and the desire to leverage that infrastructure investment even further, is that we really have been focused on our efforts, not necessarily picking an individual community. We know that the needs, particularly the primary health care needs, of Nova Scotians exist throughout the entire province to provide that care and those services.


            Our partners at the NSHA had established what they thought was an appropriate policy early on in their mandate, in their existence, to require physicians to work at particular locations. They were looking at the parts of the province where there was the most acute need, and required those family physicians to go there. That was their objective, to try to get physicians for the communities with the highest level of need. We heard very loud and clear that that was not indeed achieving the desired outcomes that physicians wanted. We and our partners at the Health Authority said we need to relook at that.


            That’s why we’re being more flexible, so that physicians can choose which communities, where they want to go, particularly in that primary care family practice space. Broader than that, we’re saying, if there’s that flexibility, we don’t want to be going out there necessarily and saying, proactively, this is where we’re going to be making the investment with the physicians and so on. What we want to say is, we know where there are needs across the province.


            As long as there are needs, if there’s a family physician or a practice that wants to provide that care and that service, we’ll work with them. Our partners at the Health Authority are doing the recruitment. We’ll work with them to get them situated within those communities.


            The other big policy approach that we take is around collaborative practices, trying to get those established. Those that are established, if there are opportunities to expand because of demand and need in those communities, we will do that. These initiatives rely on physicians, but they also rely on nurses, family practice and nurse practitioners, and other health care professionals and partners.


            That is to say, we are looking to move the needle - not just in the Cobequid region and that part of HRM, but across the province. We do have strategies. We do have investments. We do have commitments. I’m advised that there is a mental health clinic, I understand, at Cobequid. So, there are mental health services being provided there.


            To the member’s question about the culture - certainly I’ve spoken to this before. I hope that in my outreach and engagement with physicians and other health care professionals, that they do recognize that. I certainly operate in an environment that is open - try to engage and be accessible, be responsive to requests that come in. It doesn’t always mean I can have meetings, but I’ll certainly make sure key members of my staff and the team - I’m always up to date.


            There has been a bit of a lovefest by members opposite for my executive assistant, Mary. I know this sounds a bit cliché, but if you tell Mary something, I can guarantee you, it’s the same as if you’ve told me. We stay in regular contact, and that’s the way we can be the most efficient to reach out and connect with the most people possible - to get the most feedback and take that information into consideration as we’re making our broader decisions.


            I know the member used a specific example of a physician who had indicated that the Health Authority had shut down engagement. I know during Question Period earlier this session a member - I can’t remember if it’s the member for Cumberland North on the members of the Opposition, or if it was a member from the NDP caucus - but a member made a statement in Question Period that I remember well, because it caught me by surprise, and I didn’t think it was accurate. They made a statement along the lines of, how are we supposed to make progress and get engaged if we can’t talk to anybody except for a PR person in the Nova Scotia Health Authority? So, I stepped back. I take that information and go off and investigate.


            What was interesting is that wasn’t necessarily the case. I can’t remember exactly which member it was, but I do remember shortly after that, being in Question Period and the member actually acknowledged themselves in conversation with so-and-so with the Health Authority, so a few days later they actually highlighted - it wasn’t something that I noted at the time, because I didn’t want to point out the contradiction.


Just to that point, there may be times when a particular individual intervenes and doesn’t work or respond the way that I would expect or hope, but I do try to operate in an open and engaged way with the people I meet throughout the health care system and I hope others do the same. Certainly, within my office, that’s the way we operate. We hope our partners do the same - be accessible, listen to the feedback, and respond accordingly. Let me assure you, though, unfortunately it doesn’t always mean that we’re going to give you what you want. It means we’ll listen and take it under advisement.


I said this during the public forums across the province - in Sydney, Halifax, and Yarmouth - when having this conversation about engagement. I made the comment that I know a lot of physicians at the time were frustrated and making claims - and other health care providers as well - that we weren’t listening. What I had to articulate was, I guarantee you - we’re listening. I am listening as the minister. But listening does not mean we’ll necessarily be making the decisions that align with what you are bringing forward. It means we’ve listened, considered, and we’ve made decisions.


In an earlier question today talking about mental health, I highlighted how there are different - even at the clinical expertise level - clinical recommendations and opinions out there. So, I can assure you, more often than not, when I in government make a decision or our partners at the Health Authority to go down a particular policy route or path, that is based upon recommendations. It is based upon listening. We’re more than likely still going to get criticized for it because although we listen to people, and we may have heard all recommendations and made a decision, I assure you we very seldom run into a situation where there is unanimous consent amongst all of the stakeholders, because health care is a very diverse group with a lot of stakeholders, and even with the same body of stakeholders there are people with different opinions. We try to be open, we try to be connected, and we certainly do try to listen and incorporate what we hear into our decisions we make.


            Again, it doesn’t help the member for his specific - that’s on the engagement piece and on the question around the Cobequid centre again.


            I’ve certainly heard both the member, and the member for Sackville-Cobequid, making the case that there is more capacity at the Cobequid site. As we continue our discussions and looking at how services are put out there, I’ll bring it up again and see if there is opportunity and if we see it, certainly as we go forward the members would be aware of that, and would make those public announcements. To date, there is nothing that has been lined up to expand in that way.


            MR. JOHNS: Once again, as I said this time last year, I appreciate the minister’s straightforward answers, and although it’s not the answer I want to hear right now, at least it is an answer.


            What I will say is I am patient, I do understand the budget process, having been over in City Hall. I raised this last time that I really start looking at now, not as much as this budget, but as planning for next year’s budget, I do recognize that when I raised these concerns last time around that it has been a short period this time and here we are now. So, I would certainly ask that staff review and come forward with some kind of upgrades, if possible, and look particularly around, as I suggested in the past, looking at trying to get that emergency department open 24 hours, on the weekends at least, I think residents would really like that.


            As I’ve said, based on the correspondence that I have had with this doctor, I am wondering if it’s not happening anyhow. I’m sure the minister will look into that and confirm whether or not that’s happening.


            Further, I do want to say in regard to the NSHA thing, I do fundamentally think that the minister’s office probably is open and is listening to what’s being said. I want to ensure that what is being conveyed to me, from this doctor, is that the NSHA has shut her down. I do not want to share this, to put it on public record, I certainly don’t have a problem later on meeting with you, and having you review the correspondence. As I suggested, I know there are a number of people in your caucus who have had that as well.


            What I would say to this, in closing, is I do fundamentally think you can’t have your cake and eat it too. So, if we are not going to do upgrades, and we are not going to turn Cobequid into a 24-hour emergency centre, or even as a first step on the weekends, if we’re not going to do that, that’s okay, but at the same time, if it’s not being done, you can’t have your cake and eat it too, and bring people in.


            I will share with the minister, I did drive up numerous times on my own to see whether or not - what kind of carload - and drove around the building to see what was going on there, at about one-thirty or two o’clock. I’m sure people thought I was stalking, but I did want to see what was going on, because once this doctor shut down, it was hard to continue to get correspondence.


            I do thank you for that, and hopefully next year I’ll have something good to say. To continue my time, the member for Cole Harbour-Eastern Passage. Thank you.


            MADAM CHAIRMAN: The honourable member for Cole Harbour-Eastern Passage.


            MS. BARBARA ADAMS: I’m happy to have another opportunity to talk to the Minister of Health and Wellness. The last time I did I gave him a compliment and it took him 15 minutes to answer my next question, so I’m not going to start with a compliment this time. I’ll reserve that for later on, depending on how this goes.


            There are a couple of major issues I want to focus on with my time. They are seniors, those living with chronic pain, and the resources in allied health professionals that we really don’t talk about enough.


            One of the things I always hear from the Premier and the government Party is that people want to stay in their homes - seniors want to stay in their home. It is a quote, and it’s true.


[4:00 p.m.]


            There is an article here - and I’ll table it - from December 12th, where it says: “Wait times for long-term care in Lunenburg County better than the provincial average.” In Lunenburg, they’re only waiting 81 days, and the provincial average is 181 days - I know in my area it’s way longer than 181 days.


            What he does quote is saying he doesn’t think we need more long-term care beds, because in his area they’re not waiting very long - they’re not complaining - but he does say that it depends on the support systems that you have in place. I would be the first one to stand up and say we don’t need any more long-term care beds if everybody got a long-term care bed within a reasonable amount of time, but they’re not.


            Then we have to say, what are the support systems that are supposed to be in place? The myth we have is that some seniors only need their pills and help with a little bit of meal prep and a little bit of bathing, but that’s not what most seniors need once they reach a certain point. There really isn’t enough home care you can put in place at a certain point. We have determined that that is when you reach a certain financial cost. Once it’s costing us more to keep you in the home than it is to put you in a long-term care bed, that is when people, for the most part, are getting placed on the long-term care list.


            I just want to go back to a comment I made to the Premier the other day: if there is no one on the wait-list, then it is true that everybody wants to stay home. But if I’ve put my mother on the wait-list - I haven’t, Mom - but if I put my mother on the wait-list, she doesn’t want to stay home anymore. She and the family have given everything they’ve got to keep her home, and with all the supports that were available, it wasn’t enough.


            When we talk about the support systems in place, the first support system we all think about is the continuing care assistant. I have worked with them for many years, and I know that the number one complaint we get is that they cancelled and didn’t stay the length of time that they were supposed to. I already referred to that in a question during Question Period the other day.


            When you look at Nova Scotia Community College’s fees for going to the CCA program, it is an eight-month program. The tuition and college fees sound pretty reasonable at $3,220, but by the time you add on an entire page full of fees - student health and dental benefits, $242; the U-Pass required for the Metro campus students, $173; you add in the administration fee for CCAs, and it’s $300; the uniform is $250; mandatory immunization shot, $400; placement travel, $400 - that tuition fee that sounds not too bad at $3,220 ends up being over $6,300. That’s to get a job that often pays minimum wage or slightly above.


            If you’re in private and you’re one of the private agencies, they were charging somebody - if they just called them - about $25 an hour, and they would pay the CCA around $12 an hour. It’s my understanding that we’re paying around $48 an hour for that same service.


            My question for the minister is two parts. We have 12 of 13 campuses at the Nova Scotia Community Colleges providing CCA care, and $6,300 is prohibitive for an awful lot of people who have just graduated from high school and don’t have a lot of income.


            Given that it is the number one care provider in the home - and we want people to stay at home - would the minister be willing to make all campus registration fees either free or reduced in order to cut the shortage in CCA providers in this province?


            MR. DELOREY: I thank the member for the question. I know the member wanted a shorter response. I’ll do my best here.


            The programming and the funding, as well as rates with funding and around tuition, by the providers - NSCC, although an offshoot of government, does fall under the purview of the Minister of Labour and Advanced Education. The fees for all of the programming would really fall under there, more so than the Department of Health and Wellness.


            MS. ADAMS: That’s great. I’ve now put a bug in his ear as to where we need to go with that.


            The second question I have for the Minister of Health and Wellness is, other care providers that go into the home are VON. I believe we pay them $85 for the visit.


            I referred to a case the other day where a constituent on income assistance was living with his sister. She was no longer able to care for him because there weren’t sufficient funds for her to do that, so he was moved into independent living in his own apartment. Now he has VON going in every day because he’s visually impaired. If he opens up a blister pack and the pills fall on the floor, he can’t find them.


            We’re paying $85 a day every day. She opens up the blister pack the first time, and then she puts the evening pills in a plastic cup. That’s an enormous amount of money to go toward giving somebody a handful of pills.


            For some reason, we have determined that the CCA who’s in there is not able to do that, yet there’s a CCA in there twice a week. There is a medication dispenser that you can get. You put the pills in the thing, and it swivels around. You can only take the pills out that day, so nobody can steal your pills, which is always an issue.


            When we look at VON going in, are we confident that a very expensive service could not be provided by somebody less expensive?


            MR. DELOREY: I think the question was disguised as a suggestion, or a suggestion disguised as a question. I’m not sure which way it was.


            In seriousness, as a rule of thumb, our desire, whether it’s in home care or any other aspect - I wouldn’t even say it’s limited to the Department of Health and Wellness - where there are opportunities to operate more efficiently and effectively and more cost- effectively, so that we can provide more services to more Nova Scotians or better services to those Nova Scotians we’re serving, that is the path we want to pursue. I’ll parallel it with that’s exactly why we’re looking at expanding scopes of practice and providing services throughout our health care system.


            It is a bit of a transition. The member, having worked in the health care field - I’m going to make an assumption. She can correct me if I’m wrong. I assume the member would be cognizant that in times of transition, when stakeholders within professions see an evolution and see changes afoot, they don’t always embrace those changes. But there’s no disputing that we are at a time of transition in our health care system. We must change. We must improve. It is the only way.


            We have seen over the decades that simply throwing money is not solving the problems. Delivering care differently, delivering care in new ways, is the only way, and looking for opportunities for savings not on the backs of others but by ensuring we get the right care providers providing the care. So yes, that’s what I take the suggestion to be.


            The member used one very specific example. I’m not familiar with that particular device, but if that’s an opportunity, we’ll be looking at opportunities.


            We do have some contracts, so for some things we may be tied in contractually. But we continue to look for opportunities, Madam Chairman. We continue to see where there are opportunities. In the home care space in particular, part of that is around working with our providers.


            I spent some time with my predecessor the last couple of years working to develop some performance indicators with our partners in the home care sector. We’ve been working to begin rolling out and learn. The first time you’re doing it, to roll it out as standards to start assessing and evaluating on a standardized basis. When you’re starting, organizations are at different levels at that point. We’re learning from that.


            In some cases, I believe we see opportunities to improve and maybe need to tweak some of the performance indicators. Maybe we aren’t necessarily measuring what we thought we wanted to measure. We’re still working to tweak that.


            Some of the previous members, I think perhaps from the NDP, asked about home care and the AG’s Report. This is just one of those examples. We are working in that area to get better metrics to know exactly how well things are lining up.


            I definitely take the suggestion to heart. I didn’t need it recommended, but it never hurts to have a reminder.


            MS. ADAMS: Continuing on with home care services: we never talk about home care physiotherapy or occupational therapy. Having managed a home care physiotherapy and occupational therapy company for 10 years, I can tell you that the services they provide can be life-altering. We can go into the home. We can assess the barriers, the dangers, and the risks. In one visit, we can make suggestions to a family that can make the difference between them staying home or having to go into long-term care. Sometimes the barrier is cost, because some of the renovations are very expensive. I’ll save that for another day for the Minister of Community Services, because I think we need to improve that as well.


            I’ll use an example. I had a patient at the time who had a severe neurological disorder that was undiagnosed. She was a new mother with a three-month-old baby. She was staggering around and falling. She got to see the neurologist. She was seeing me as an outpatient physiotherapist for her back pain. I got her sent to the neurologist, and they diagnosed her with a neurological condition. Because she was going to need ongoing care, I needed somebody to go out to her home to assess it.


            I put in the referral to home care through the Nova Scotia Health Authority, and it was a three-month wait for an urgent. She waited the three months. I gave her as many details as I could, because she couldn’t afford private services for me to come out to her home. They came out and saw her once, gave her some ideas, listed a whole slew of pieces of equipment that might make her able to hold onto her baby while she walked, and said they’d be back out in three months’ time. Meanwhile, she fell down the stairs and was no longer able to look after her child.


            The wait time for home care, home care occupational therapy, and physiotherapy is around three to six months. It is not treatment. It is what I call crisis care. You go out to the home, you look to see what you can do, and you make recommendations that they probably can’t afford, but you’re not coming back for treatment.


            Having been in both systems, where I worked for the Health Authority, I’d go out to the home and I’d say, this is what you need. I’d tell the family everything I could and I’d stay for twice the length of time, trying desperately to help them.


            There’s a huge gap there. What we are ending up - for me, it’s the equivalent of going to see the dentist and he says, you have a cavity so we’re going to send somebody out every day to brush your teeth, but we’re not going to fix the cavity.


            We’ve moved towards paying for CCA coverage funding through the department, but we haven’t moved to increase home care physiotherapy and occupational therapy around the province, so we are not paying to help people get better. We’re just paying to help people cope at the level that they are at. I’m asking the minister, has he given any thought to increasing the funds for the treatment by these two health professions?


            MR. DELOREY: I thank the member for the question. Specifically, in the context of home care, I haven’t delved in. In this budget, there isn’t a program to see expansion there, as the member would know. However - again, as I mentioned earlier in my response - we are in the time of transition. As a government, we certainly recognize the opportunity, where we can, to expand scopes of practice.


            We’re working hard in a lot of different areas. Unfortunately, moving the lever on every area where we can to expand scopes of practice and get that work done is a challenge. We invest in the OT/PT community-based rehabilitation program, I think somewhere in the vicinity of $3.5 million provincially in that program to provide the services to people who need it.


            As I said, I don’t believe any increased investment there, but that is a program and that’s the dollar amount we put towards those services.


            Do we recognize the opportunity for expansion? Yes, again, to go back to our collaborative care practices, primary care in communities and in the most recent round that I believe I announced earlier this month - on the 5th or the 8th, I can’t remember the exact date. One of the sites - I know it’s only one, but I hope the member and some of her former colleagues would see it as a positive thing, because I believe one of those sites did have an occupational therapist. I think they were only a half-time resource, but it just goes to show our commitment when we say, with our partners, that we’re open to getting care in our communities in these collaborative teams with other professionals. We were serious about it. But it’s early stages of that transition, which is a transition of a health care system.


[4:15 p.m.]


            We can always point to that individual scenario of, wouldn’t it be simple to just do this in this case? Yes, but as the government and as the department and with our partners in the Health Authority, we’re not able to be effective if we continue to develop a health care system on one-offs. We do need to take the time to consider and to evaluate and make sure we have thought out how we’re going to roll it out and how we’re going to implement it so that we can get it out. It may take a little longer to get up to speed and momentum, but we get those services, and when we do, we see better results in the long run.


            MS. ADAMS: I appreciate that response. I do know that things take time, but we can’t have it both ways, as the previous member said. If we openly acknowledge that we don’t have the supports in place and that we have to be careful how we roll things out, then we can’t at the same time say we don’t need people to be in long-term care beds. If we’re not ready to have them all at home, then we do need those long-term care beds. I will always say, having worked with them my whole career, there are people who, when they reach frailty levels 7, 8, and 9, just cannot stay at home.


            I’m fully aware of that $3.5 million program. I worked with it, and I know the staff who do it. They are amazing. The one thing members may not know is that there is an enormous amount of money that goes into care the first week somebody goes home from hospital or doesn’t stay in emergency. It’s deliberately designed so that somebody doesn’t go from emergency to the hospital bed. They go from emergency back home with a lot of supports in place for that first week. It’s wonderful. The problem is, it’s like I’ve given you a feast, and then I’m hardly going to give you anything at all. It works in a lot of cases, but there are those cases where it doesn’t.


            I agree with the minister that we need to keep moving forward on that one. There’s an awful lot of things that physiotherapists and occupational therapists can do to take the strain off our physicians, especially.


            The second thing I want to talk about, we haven’t talked about in the two sessions of the Legislature. Given that this is my area of expertise, I don’t want to miss out on this opportunity. That’s chronic pain patients. We talk about cancer, and we referred to that earlier today, and people who are surviving that. Of course, anything that’s life-threatening has a high priority - we have a high priority on certain things like heart attacks and things that could take your life.


            But when we talk about conditions that are related to chronic pain, we have put them down at the bottom of the list. When you look at the Nova Scotia Health Authority’s wait times, you will see the longest wait times are for things like hip and knee surgeries. I know that the government has put a greater emphasis on that, and I’ll talk about that in a minute.


            When we look at things like back surgeries, the wait time just for a consult is 439 days, and then it’s another 189 days for surgery. For hip surgeries, it was 382 days just for a consult, and then 567 days more for surgery; knees, 440 days for a consult and 584 days for surgery. That’s straight off the Nova Scotia Health Authority website. There are things like cardiovascular surgery that are 77 days for a consult and another 62 days for surgery. Even for something like foot surgery - I don’t know about the rest of you, but if your foot hurts, the rest of you is affected as well. It’s 155 days just for a consult and 314 days for foot surgery.


            With all of those chronic pain conditions, regardless of where the pain is, if one part of you is in pain, the rest of you weakens, and your ability to work goes downhill. This most commonly affects those who are working, and we rely on their tax dollars to fund our health care services.


            I want to ask a specific question about that. When I went to the Dartmouth General to talk about the fact that they were expanding the orthopaedic surgery wait times, I asked, given that you’re going to be doing more surgeries, how much have you increased the funds for the rehabilitation side of it? The doctor only does the first part. It’s the important part, but he only does the first part. I asked the Dartmouth General, how much increase is going to the physiotherapy department to help rehabilitate?


            I’ll give you an example, and I have used it before. When I was in Ontario as a supervisor there, when a new orthopaedic surgeon came on staff, he would not agree to come unless he got three outpatient physiotherapists to specifically see his rehab patients. He knew that the operation was only 5 per cent of their recovery and that 95 per cent came from being put through the rehab program.


            When I asked the Dartmouth General how much the department has increased their physio and OT budgets, there was no response.


            We can’t just increase the number of surgeries without increasing the number of support staff. I’m wondering if the minister knows how much the department has increased the budget specifically for those two professions.


            MR. DELOREY: I’ll just make one quick comment on the ending comments of the last one around care in the home and so on, and the member’s reference about acknowledging that people do want to stay - at times are not able to stay at home because they may need the long-term care. We do recognize that. We have over 7,800 long-term care beds across the province, and we have seen some improvements in both the duration of wait times as well as the wait-list in absolute terms.


            Just so the member knows, we are aware and working to improve things on that side of the equation as well. We acknowledge that some of those improvements can’t come from the home care side of the equation.


            To the question around orthopaedic services, we work with the orthopaedic surgeons within the NSHA. The NSHA more so works together with the surgeons to come up with a recommended plan to move forward on our orthopaedic announcement. That announcement was made in October 2017, I believe. That was to move forward.


What we saw between October and now - the end of fiscal 2017-18 - was predominantly based upon changes to when services are offered. Procedural process-wise, I believe there were plans to use Saturdays for ortho surgeries, which hadn’t been done before. That’s where they built up some of that capacity in the surgeries.


Within the funding increase that we allocated for the last fiscal year, as well as part of the ongoing commitment this year, which will see additional surgeons and anaesthetists or anaesthesiologists this coming year, we do have allocation in the formula that they use to make the budget submission commitments around pre-habilitation, and it also notes other supports that the surgeons are needed.


My understanding is that the collection of the staffing part of the formula was for all the supports they needed for the surgeries and the work. We at the department don’t necessarily give the NSHA the budget at that level of detail. We provide them a global budget. They came forward with a proposal and a plan.


I do pull out - because this was a bit of a new thing in October when we announced it - pre-habilitation services. Historically that wasn’t a key part of the orthopaedic program, but as part of the recommendation that came forward to us, it was a key element. We don’t want to go and do more surgeries just to have people come back in six or nine months - I don’t know if that would be an accurate duration - but to have them not stay as effective and come back in to - to say that the surgery only lasted a short period of time.


We want to increase the success rate of those surgeries so that when someone gets in and gets the care - they have to wait a while to get there. We’re trying to shorten the amount of time they have to wait, and we want to lengthen the amount of time that the surgery provides comfort and relief and allows these Nova Scotians to be vibrant and active, as we know they want to be, whether that’s in work or care.


We did engage in the pre-habilitation program as well. That ensures people take care of themselves, take steps to increase the positive outcomes of the surgery when that time comes.


MS. ADAMS: I just want to go to long-term care for a minute. I know that the last couple of years saw cuts to long-term care. I’m wondering if the minister could comment on what the budget holds for the long-term care facilities now, over the next year, if there’s not really a significant increase in the funding. What else have they done to try to help those nursing homes cope with the current budget?


            MR. DELOREY: The member may recall that it wasn’t that long ago when we were in Estimates Debates with the 2017-18 budget. That was the time when one of the announcements we made was actually an increased investment in our home care services targeted towards food and recreation programs within our long-term facilities. These were areas we wanted to make sure - when we were giving the funding, these were critical areas that we heard from Nova Scotians they wanted to see addressed.


            If I recall correctly, it was somewhere in the vicinity of $1.8 million or $1.9 million the last fiscal, in that area, to increase and provide those supports. We’re continuing that in this budget. We haven’t re-announced it. We want to continue to provide those services as part of the budget.


            In addition to that, there is an increase in the budget for long-term care services of about $3.3 million. The bulk of that would relate to inflationary pressures, I believe - WCB salary increments and so on. That’s what you would see in that line item and the information around long-term care.


            But in addition to that, I want to make sure you are aware that we also have a workplace safety action plan initiative that’s under way. We’ve announced that in year one we’ll be investing about $2.35 million around that plan. We’re seeing that in new initiatives throughout our long-term care facilities to help in workplace safety. We’ve talked a little bit.


            As a therapist, the member would know that CCAs, in particular in our homes and in long-term care facilities, are at the high end for injury. If you follow the Workers’ Compensation Board, I believe they’ve become one of, if not the, highest number of incidents. We want to address that and that’s where part of this investment is.


            We’ve seen how improvements can be made through other industries. I think fishing would be a great example of where, with focused investment, training, equipment, and so on, we’re able to turn those injuries around. That’s what we’re working towards here, in partnership with facilities, as well as the organizations and staff. We do have those investments, so we are seeing increased investments in those long-term carers, not just for the clients but also for the employees.


            MS. ADAMS: I’d now like to go back to another profession, which would be the pharmacists. Pharmacists are the ones who have the greatest training in looking after medications and what is appropriate and what is dangerous. They are the only health profession right now where you can call them up and get free advice. You can’t call up physiotherapists or social workers or dentists or psychiatrists or anybody else, and you certainly can’t call up a doctor and say, can I have some free advice? But they do that. I can imagine - well, actually, I’ve heard from several that when they found out that a doctor was going to be able to charge for being able to make phone calls, they’re wondering now why they, as a profession, are not going to have a similar thing at their disposal.


            When they charge a dispensing fee, that $4 or $12, whatever it amounts to for that particular person, sort of gives that person the right to call them up any time they want and ask them a whole lot of questions.


[4:30 p.m.]


            I guess what we’re thinking about here is equal pay for equal work. If a family doctor is giving a flu shot, he gets one amount of money. If the pharmacist gives that same flu shot, they don’t get the same amount of money. We have an opportunity to have pharmacists take off a significant portion of the load that is on family doctors, but with the cuts to the fees for generic drugs, the pharmacist in my area, who owns a number of pharmacies, estimates that he’s going to lose $450,000 a year once those cuts are made. They have been doing the ugly tasks of telling the pharmacists who work for them that they’re laid off or cut back, or that they’re going to be cutting back on benefits and other items. At a time when they could be somebody we use to take the load off our physicians by giving them a greater scope of practice, we have cut their benefits, their funding, and their profit line, but we’re going to demand more of them.


            My question to the minister is, what else could his department be doing to have a greater scope of practice for pharmacists? Has his department considered also allowing them to be paid to take phone calls on medications that were prescribed by a physician, especially in those cases where somebody doesn’t have a family doctor and they don’t have a doctor to ask?


            MR. DELOREY: It may not have been picked up on the microphone, but I have inquired how long the member would like me to go on for this. I actually have a bit of information in this regard. I won’t delve in - I know the member has some more questions.


            In fact, I’m pleased to advise the member that I had a meeting earlier today with the Pharmacy Association of Nova Scotia. This was a meeting I had booked. This isn’t the first time I have met with them. We have met numerous times.


            I’m trying to find a word that adequately reflects my respect and gratitude for the pharmacists of Nova Scotia and the Pharmacy Association of Nova Scotia as health care professionals who have stepped up time and time again to work with the province.


            I’ll give a few examples just since I have been in government. The naloxone kit program - we announced our Opioid Action Plan shortly after I came into office in August 2017. Within a couple of months, we had many - most - of the 305 community pharmacies across the province delivering these free naloxone kits to Nova Scotians.


            I believe I saw some data recently that indicated that since 2006 - I believe that was the date; I don’t think it was 2016, so unless there was a typo - but since either 2006 or 2016, there were about 3,000 naloxone kits delivered throughout Nova Scotia. Since the Fall, just through the pharmacy program, they have distributed over 900. We know that naloxone kits can save lives. We know that they’re distributing, and their effectiveness in doing that and reaching out in their location to the community is important.


            There’s a program that they’re working on with physicians and others. I forget the exact name of it, but it’s for patients who are on Warfarin. They have been working on allowing them to get their testing - Warfarin requires them to get a blood test testing their levels, up to every week. They’re delivering these programs through pharmacies. It’s on a pilot basis for 12 months for those Nova Scotians who signed up for the program. It was community pharmacists who were partnering with others in our health care system to pilot this program to see if the outcomes will improve.


            The information that was provided to me this morning by PANS, the Pharmacy Association of Nova Scotia, was how amazing it was. In the early stage, people just weren’t taking care of themselves. They weren’t getting the testing that they needed to ensure that they were getting the right dosage of treatment, of the Warfarin medication. That can have health impacts. The expectation is that we’ll see better health outcomes when the program is done because people are adhering to the proper prescriptions.


            We have the Bloom Program, which shows pharmacists stepping up because of their location in communities for mental health and addictions types of support and education. We’re seeing pharmacists step up.


            I use those as examples to let the member know that I’m well aware of and very pleased with the work that they’ve done in collaboration with government.


            To some of the key points the member made, though, I believe one is reference along the lines of government cutting pharmacists’ revenue or what have you. That’s a little bit inaccurate, so I just want to, for the benefit of the House, clarify what has transpired.


            We approve medications within the provincial government programs for our Pharmacare programs - we do nationally - and had seen in our health care system that one of the most dramatic challenges over the years, in the last decade or so, was the rising cost of drugs. So, governments, including the previous government in Nova Scotia, with their counterparts across the country, stepped up to take a new approach to negotiating with big international pharmaceutical companies, particularly around the area of generic drugs in the province.


            That’s what I think the member was referencing, that the national negotiations resulted in the lowering of those prices. That is in relationship with our negotiations with the pharmaceutical companies, not with pharmacists themselves. As independents, I think that where some of the revenue comes in, margins and so on, may have a trickle-down impact on them. That’s certainly not the goal or the target. We’re not trying to go out and hit pharmacists, but we do recognize that to be affordable and get the drugs that people need in our country, we need to ensure we negotiate the best prices we can for our citizens.


            The other thing about what we can do or why it is that pharmacists are not paid by government, for the most part, and physicians are - that really stems back to the 1960s. I wasn’t around when the Canada Health Act was established for payment. I’m not going to theorize as to which members here were around at that time. But the Act did stipulate that what the universal coverage would include is physician services and hospital services, so pharmacy - and we talked about other allied health professionals. That’s the reason those services don’t tend to automatically fall within the scope of provincially-funded programs and why you may see differences in some professions being covered to different degrees in different provinces. They are not part of the universal aspect of the Canada Health Act. I think a lot of Nova Scotians, a lot of Canadians, don’t realize that. That’s why we’re in the situation we are in.


            But back to some earlier comments, we are at a point of transition. I had a great discussion with the Pharmacy Association of Nova Scotia. I had some preliminary thoughts myself, but I wanted to hear directly from them where they thought they could have the biggest bang for the bucks and low-hanging fruit.


            I look forward to continuing the discussion. I think we are both very optimistic. I don’t want to put words in their mouths, but I’m optimistic that our relationship is going to continue and we’re going to see some good outcomes that we can incorporate.


            MS. ADAMS: I appreciate the response. I’ll just go on record as saying I was a baby back when that came in.


            I’m going to qualify the statement that the minister made about appreciating that the other professions are stepping up. They have been stepping up a long time. What I’m hearing is that you are opening the door, so this is a good place for all of us to be.


            The final question I have for you - my biggest heartache is when somebody doesn’t have a family doctor. I’m wondering two things.


            Would the minister consider - and this is a band-aid on a big gaping wound - I mentioned the other day that one of my constituents found out that his family doctor had retired two days after he had just been in to get a requisition for bloodwork. He went to the Dartmouth General Hospital only to find out, oh, my doctor has retired, from the clerk who was taking his blood requisition.


            Something that seems very simple to me is, would the minister consider that anybody who loses their family doctor automatically, without having to ask, gets a free copy of their medical record? I have people who call me up who say they were referred to a specialist but they don’t know where that referral went. They now have to go to a walk-in clinic but don’t know what drugs they were on.


            To me, something very simple is, let’s require - because this guy wasn’t even told that his doctor was retiring two days before he left. I just find it outrageous that he did that. The question is, would the minister consider giving them a free copy of their chart without them having to request it? Would he also consider some open referrals to some specialists, like back pain specialists or chronic pain specialists, who the member may not have been referred to but that they may need?


            MR. DELOREY: There’s certainly a bit of a challenge around records. As the member mentioned, it might be a bit of a band-aid for a wound, but I think the wound she was referring to was primary care access. I’m not going to reiterate all the work we’re doing to try to improve primary care access.


            I think perhaps there’s actually a different solution than going down the path the member has suggested. It really relates to technology, the digital record access. We have the MyHealthNS system that we’re trying to get doctors to adopt. As we get that adoption ramped up - the investment that we made with physicians the other week includes new incentive programs to try to encourage them to adopt the technology, to use the technology to interact with patients - patients will have more of their information. Right now, lab work would be part of that.


            If this individual’s physician had been on MyHealthNS, they would automatically get routed directly to the patient for the blood tests and other tests they can take. We’re seeing that as an opportunity.


            That’s where my focus has been. I want to see this stuff rolled out successfully for all Nova Scotians to get those test results.


            MADAM CHAIRMAN: Order. The time has elapsed for the PC Party. We’ll transfer over to the NDP.


            The honourable member for Cape Breton Centre.


            MS. TAMMY MARTIN: Thank you, Madam Chairman. Picking up where we left off with the minister, we were talking about alternative level of care beds. The number was 160 ALC beds within the system, and they are billed accordingly depending on if they’re waiting for discharge to home or for long-term care.


            I’m wondering if the minister is able to present or to provide us with a document for the total amount of invoices for 2017-18 from the ALC beds.


            MR. DELOREY: That level of detail would be within the Nova Scotia Health Authority’s budget line items. The way the Health Authority budgets for revenues and expenses, they have their detailed budget, and then it rolls up into the provincial budget. We get the total bottom line of what the Health Authority does. It’s called consolidations into the provincial budget. I don’t have that specific line detail of the NSHA’s budget here with me. We can try to pull that information from the NSHA.


            MS. MARTIN: I appreciate that. Thank you, minister.


            Aside from the amounts of invoices, I’m wondering if the minister is able to provide us with the numbers of ALC patients who are discharged and where they are discharged to, whether that be long-term care, an RCF, home with home care, or home with no home care. We’re looking for the specifics of the discharges of ALC patients.


            MR. DELOREY: I’m just going to have to read off the page. The data is not quite presented exactly the way the member has requested, but I think it’s the essence of some of what the member is asking. It doesn’t go to the detail of home with home care or not. The level of detail I have is home or long-term care.


            This would be data of people being discharged home from hospital - this is a little bit different. This is more about the long-term care data, so where people are going into long-term care from. Historically, the majority were coming from hospital: 52 per cent back in 2003-04 were being discharged from hospital to long-term care, and then 48 per cent of people were at home or in community and being placed. Then in 2016-17, 58 per cent were coming from home, and 42 per cent were coming from hospital. So, you see the data actually more than flipped.


[4:45 p.m.]


            If I say that again, perhaps it will be a little bit clearer. In 2003-04, or even if you go to 2008-09, people waiting for long-term care - I’m focused on the long-term care list, not the ALC beds, just a different metric, but in the same vein - 50 per cent of the people being placed in long-term care were coming from home and 50 per cent were coming from hospital in 2008-09.


            As we’ve been continuing our investments in home care, we’re seeing that actually, 58 per cent are coming from home and going into long-term care, which means that 42 per cent were coming from hospitals. We are seeing that there is a shift in the patterns, we’re not getting the actual data level, but we are seeing the trend line that is showing, that more people are going from - we can conclude from this that more people from hospital, when they are waiting, are actually getting home with the supports they need, rather than just going directly to long-term care. That’s why we’re seeing that shift that more people are getting the care they need in their homes before they transition. Again, it has shifted to 48 per cent - 42 per cent. That trend is ongoing since 2003-04, but we really saw it pick up between 2008-09 and 2016-17.


            It’s not exactly what the member was asking for, but I hope it at least provides something in the same vein or area around long-term care and home.


            MS. MARTIN: To be clear, we’re trying to ascertain when an ALC patient is discharged - are they discharged to palliative care, to home, or to a long-term care facility? If you have that data available.


            MR. DELOREY: Again, it’s not the way that I have the data laid out here. The starting point for the member’s question is the ALC bed, where you go from there. Trying to anticipate, as we do when we’re preparing for estimates, I was trying to anticipate what the questions from the member and other members were going to be, so how are they getting on that list and where are people coming from to go to long-term care?


That’s the approach that I took when preparing the data here, and as I’ve said, the two are related when we’re talking about hospitals versus home, so although I don’t have the explicit data about the ALC and who is going home versus who’s going to long-term care, the data that I had cited in my previous response does show the clear trend that going into long-term care has seen a significant shift from 50/50 in 2008-09 to 58/42 coming from home into long-term care.


I believe we can - because the data would show this if we teased it apart differently, the underlining data shows the clear trending that we are providing the supports at home, which means if someone’s waiting in a hospital, in an ALC, for discharge to get home, we’re seeing more of those patients going home because more patients are receiving the care they need at home before they go to long-term care. If the patients weren’t receiving the care at home, then we would see the hospital continue to maintain and possibly even grow that there are more people going from hospital to long-term care. What we’re actually seeing is a percentage of our long-term care residents are actually coming from home rather than hospitals.


Again, it’s a little bit of a jump because I don’t have the raw data that allows me to flip around to the specific direction, but I would leave the member - I believe the data that we do have shows that we are seeing the trends moving in a direction that sees more people going from hospital to home, and home is where they’re able to stay longer, because more of them are getting on the wait-list through home rather than through hospital.


            MS. MARTIN: To be clear, the minister mentioned that there are 160 ALC beds. Are they not counted in the acute care beds across the province?


MR. DELOREY: There are different levels, three levels of different categories of beds. There are acute care beds for those services. There are ambulatory care beds and of course, ALC is a different category of beds in the province. The acute and ambulatory would be staffed according to the needs of patients receiving medical services.


In the ALC space, there are less medical services required. The cost of maintaining those beds is less than with acute because of the depth of care. I want to reiterate and stress for all Nova Scotians that there is care provided, that individuals in an ALC bed - it is a bed, there is staff there to provide care and oversight for these individuals staying there.


            MS. MARTIN: Specifically, what I’m trying to get at here is that for example, we have instances where there are patients that are in an acute care bed, paying ALC rates because they can’t get to long-term care, and as I said, we can agree to disagree on the number and the need of long-term care beds. That’s not the issue. The issue is that they are taking up an acute care bed. I wonder if the minister can - because I definitely know one that I just helped to work with was in an acute care bed for nine months. How many instances, how often, and to how many in the province does this happen?


            MR. DELOREY: Thank you to the member for the clarification. As the member would know, data varies over time with people in beds. It is a fluctuation, so when we talk about some of this, other than what we fund as ALC beds, that would be a static amount.

To the member’s point, at times there are more individuals designated as alternative level care needs than we have alternative level care beds. That means there are sometimes individuals staying in an acute bed receiving alternative level care. So, that is correct, what the member said.


For example, I believe there are 166 - I’ll provide a bit of data here that may be helpful to members. If they want to get their pens out, I’m going to actually break the data down by zone. The total number of ALC beds for fiscal 2016-17 was 55 in the western zone, 10 in the northern zone, 59 in the eastern zone, and 42 in the central zone. If my math is correct, that should add up to a total of 166 across the province.


            As of March 14, 2018, we had 210 individuals waiting for the long-term placement beds. That would be obviously individuals in an alternative level of care. The breakdown here was 51 individuals in western, 28 in northern, 66 in eastern, and 65 in central. When you compare the number of ALC beds to the number of people who would be waiting for long-term care, you can see that in the western zone, there would still be some capacity in the ALC beds. There would be some individuals in the northern zone that would be in the situation that the member referenced. There would be about six or seven people across the eastern zone, which runs from Antigonish up to the member’s area in Sydney.


Across that whole area, there would be about seven people in an acute bed and in the central zone, again, you’re looking at about 20 people or so within the overall system. There are those changes, and I hope that helps clarify for the member how, particularly, people waiting for long-term care are in beds.


            MS. MARTIN: Sadly, these are some of the issues that we’re dealing with, trying to resolve the overcrowding of inpatients in emergency rooms and this dear, little old lady that I was dealing with, who spent nine months in an acute care bed, when we had inpatients admitted into the emergency room. My other big concern with this is not financial. It’s mental, because when these seniors are in an ALC and in an acute care setting, they’re missing out on the activities of the long-term care facility that they should get to participate in, the activities and the outings and the socialization, as opposed to just being a patient in an acute care setting. I’ll flag that as my other major concern with this ALC versus long-term care, and admissions in emergency, because I do believe that their lifestyle is compromised.


            Having said that, though, I will move on to home care. I would like to ask the minister if he can talk about the assessment tool, the interRAI, and exactly, in a description or a definition, of how this works.


            MR. DELOREY: In brief, the interRAI system is a standard and a tool for assessing individuals for their capacity. That information is then used to help identify the needs of the individual; it helps identify what supports may be needed for the individual. Obviously, individuals may have cognitive and/or physical conditions, and their capacity may vary. When we assess, that helps feed into when a care coordinator is identifying the needs that an individual looking for home care may require. That’s the system and the technology that’s used for documenting and recording and assessing, and that helps feed through to what programs or services they would be signed up and eligible for.


            MS. MARTIN: To be clear, is this computer-assisted assessment?


            MR. DELOREY: There is a technological component to the system. It is conducted and used and the standard, and the approach is an international standard-validated approach to this work. It’s been developed, tested, and validated from a clinical perspective, and then the staff who use the system have to have training. There is a technological standard to it, but there is also, behind that technology and the assessment work, both in the development of the system, international validation research that went into building it, and there are people on the ground who are involved in the assessments and reviewing, and those are individuals who would be trained with the system as well.


            MS. MARTIN: When continuing care does an assessment, they inform the individual of what their assessment - or how much home care that they will be receiving, the limits around home care, what could increase it or decrease it, the funding limits. I would have to hope that all of these parameters are somewhat negotiable. I understand for budgetary purposes that there have to be guidelines, but there are specific, certain one-offs that I’m sure I will talk to the minister about in the not-too-distant future. However, if you could give us some parameters around guidelines for qualifying for home care, what is the highest amount somebody may get, what is the least amount?


[5:00 p.m.]


            MR. DELOREY: There would be two responses to the question. The first one is around the tool and having a standardized approach. In part, there are reasons for having standardized approaches. That’s to ensure consistency and fairness and equity to all Nova Scotians, that they’re receiving the care they need. It’s an important reason the tools and the methodologies are used in the assessments. That would be similar in hospital and clinical settings with physicians. Physicians would use clinical judgment based upon the research and the evidence that shows when they’re assessing a particular condition. In this case, you’re assessing mental cognition and physical capacity for individuals, based upon assessment methodologies that have been validated through research. Just in terms of why you would have some standardization there is to ensure that an individual in Sydney, Cape Breton, would be treated equitably with an individual in Halifax or Yarmouth, so that if they have common or similar needs and circumstances, they have the care they need.


            To the second question about how much money someone gets for home care or not, that’s much more complicated. I don’t know that that’s necessarily something to be easily provided to the member. The reason is that there is a wide variety of options and supports available to Nova Scotians for their home care. We have programs like the Caregiver Benefit program, which has been around for a while, which we expanded. The way we expanded that program about a month ago or so, was to allow more people, particularly based on cognitive abilities. That is a wider range of people, so we have expanded that scope based upon those standards, to ensure that someone with a certain level of cognitive ability who a year ago was not eligible would be eligible today.


We have expanded that kind of scope. In particular, the biggest expansion is around cognitive abilities, recognizing the growing prevalence of conditions like dementia, loved ones wanting them to be able to stay at home, and also knowing the changes and the impact. That provides some money available for these individuals to provide to other caregivers.


            In other situations, the care may not be through a dollar program, although there are some of those. We spoke about one the other day, the IADL program, which would provide funding for some people who may have care. For others, it’s providing actual staff to go out and provide that care and support. It’s not necessarily a direct dollar value. That dollar value may be different, depending on who’s providing the service, and the contracts that have been put in place for those care providers. It’s for that reason - we’re providing a service, not necessarily dollars - that the range of dollars would not necessarily, I don’t think, answer the question that the member is really trying to delve into there. It’s not about dollars; it’s about the care and making sure that these home care clients get the care that they need to be safely able to reside in their homes as long as they want.


            MS. MARTIN: My apologies to the minister. I wasn’t trying to get at money. I was trying to get at the most amount of home care that a person could receive versus the least.


            MR. DELOREY: Thank you to the member for the clarification. When we’re talking about that, just for clarification, in this context, we’ll be focused on home care support services, which we would be measuring in hours as opposed to money. There is no minimum, necessarily, that I’m aware of. Again, if someone just needs a little support, we want to try to make those supports available. But we do have a maximum of 150 hours per month of support for home care services. When you get up to requiring 150 hours or more of support in this context, then the nature of those needs is considered much higher, and we

need to look at other options.


            MS. MARTIN: Continuing along that line, is there an appeal process that can take place? More specifically, how would it work if a constituent was receiving home care and needed those services as well as VON? Does one take away from the other? If so, is it hour for hour?


            MR. DELOREY: To the member’s question about an appeal process, I don’t believe there’s a formalized appeal process that I’m aware of.


            The system certainly recognizes that individuals’ care requirements may change over time. In such cases, certainly individuals can be reassessed and can always work and engage with their care coordinators if they believe that their situation has changed, and they require additional care or a different level of care. They could be reassessed as time progresses. Circumstances change, and certainly the care levels can change as well.


            That could be in two ways. You could have a situation where someone had an incident, say a fall. For a period of time, they may require a higher level of care. They may request a reassessment because they require less care as their body heals, and so they may not require as much care afterwards. There are other variables. As they continue over time, they may have cognitive or other physical conditions that may impede them. Thus, they may need to request another reassessment, and their care needs may go up again.


            It is designed to try to be a fluid system. That doesn’t mean it’s instant or immediate change because these things are gradual. It’s like our children. You see them grow, and you don’t notice the changes immediately. Then after a period of time, you notice these big changes and leaps as they continue to mature. The same thing happens for care requirements as we age.


            As far as VON versus the home care support hours, I’m going to double-check that with staff. I don’t want to misspeak on the record. Hopefully, I’ll have a response, and I’ll be able to incorporate it in a future answer.


            MS. MARTIN: I appreciate the minister saying that, because that is an actual example as well.


            We learned this month through an FOI that reconciliation of care received and approved is not currently done. Can the minister speak as to why the reconciliation of care is not being done? Will it be completed going forward? (Interruption) He didn’t hear.


            We had an FOI that reconciliation of care received and approved is not currently being done. Can you explain why it’s not and if it will be?


            MR. DELOREY: I thank the member for the opportunity to highlight some of the work that has been ongoing for a couple of years now working with our home care providers. It did start under my predecessor, the member for Kings West, the current Minister of Communities, Culture and Heritage and Minister for Seniors.


            It’s important to understand as a foundation point, because I think it is relevant as to why the member would have that information, that home care evolved into our system in different ways and on a kind of ad hoc basis throughout the province. Having different health authorities, it rolled out differently with different types of agreements and different providers in different parts of the province. Expectations established in communities differently. There really was then - I may be going a little too far, but if you look at what we are doing right now through a provincial lens, it does certainly give the appearance of quite an ad hoc approach because there are so many different approaches across the province. Recognizing that and recognizing that one of the key reasons for amalgamating our health authorities was to standardize, to ensure that there are consistency and best practices deployed across the province, a lot of work went in under the previous minister.


            Last year, we rolled out something known as key performance indicators or KPIs. This is an area, to the member’s note, about identifying how things are working. I don’t have the list of the KPIs that we have been working with to evaluate, but it is a pilot. It’s working through to try to standardize.


            Not having had this type of standardized approach and methodology to assess home care, we worked with care providers to identify what makes sense. We rolled them out last year to baseline and see how organizations were doing in the communities providing the care. We have had a lot of feedback.


            In some cases, we may not have been getting the data that we thought we needed, or it might be that there’s other data that might be better situated or suited to achieving the outcomes of identifying exactly how we ensure that we are getting the best value and the best services. That’s ultimately what we are looking for, to ensure that Nova Scotians get the care and service levels that they deserve.


            It is an ongoing piece of work because, although home care has been around in the province for many years, this level of attention and focus to try to improve the programming and also the consistency of that programming across the province is actually relatively new. But it is under way.


            I believe the member’s colleague yesterday started out by referencing the Auditor General’s Report and some of these aspect areas. That’s exactly what we’re doing with these key performance indicators. It has been under way for a couple of years to identify.


            It has been recently rolled out to try to get some baseline data. We need to work around that a little bit to make sure that we have the right ones. We might need to tweak some of what we thought were the right KPIs. We might want to tweak them a little bit before it’s fully finalized as to what we’re going to use on a consistent go-forward basis, but the spirit and the efforts are already under way.


            MS. MARTIN: I’ll ask one last question before I pass it off to my colleague for a few important questions that we feel need to get in before I continue or not. Recognizing that KPIs are so vital to the study and the process for home care services, why would the care providers not have their contracts renewed with the service providers then? From what I understand, they have not been renewed with home care providers for quite some time now because of the KPIs being reviewed.


            MR. DELOREY: It took me a second to connect the dots as to where I think the member was going with that question. The nature of contract with service providers, as I mentioned in the previous question, evolved differently over a period of time, and we are working to try to standardize much of that. Many care providers automatically roll over their contracts, just have a kind of automatic renewal with them. It’s not necessarily a formal process for it.


            I know there are some concerns because the goal of the KPI initiative is that our contracts have them imbedded within the contract so that, much like our EHS system, you meet the standards of the service levels, or you don’t. If you don’t, there may be penalties applied, but to earn your payment, that’s what we’re looking for. It’s to incent people to operate and achieve the level of care that we’re expecting.


            But we’re not at that point. We know we have KPIs in the contract, but we also know that we’re still learning from them. We have a bit of a transitional state that we’re in because they did just roll them out for the first time last year, and we are working with our providers. We recognize that we didn’t know where everyone was going to be on those KPIs as a starting point, so we were trying to baseline. We’re going to continue to work with them to make sure (a) that they are able to continue to provide that care and those services and (b) that we continue to improve those programs and services. I think everybody shares that objective, that the care to our loved ones in our community through our home care providers is important.


[5:15 p.m.]


            In some communities, these are smaller organizations, particularly in some of our rural parts of the province. It’s volunteers often on these boards outside of the metro area. They have said that having those skill sets, they need a little bit more support to make sure that they’re tracking and reporting appropriately and adopting practices. But we’re working with them to try to achieve those. Efforts are under way, and contracts are being renewed. That work is ongoing.


            MADAM CHAIRMAN: The honourable member for Dartmouth North.


            MS. SUSAN LEBLANC: I just have a couple of questions around sexual assault services. As you may know, the restructuring and reductions in government services have had a significant impact on women’s centres in rural Nova Scotia in particular. Government services have been cut, and others have been reduced or redefined. Women are not able to access services, so they’re turning more to women’s centres for assistance.


            One of the big challenges of this, of course, is around the changes to the mental health and addictions program, which categorizes assessment on a tiered system. All women’s centres work with women who experience mental health challenges and have pressures to provide services to more women than before. Because of the developments in central intake for mental health and addictions services, women’s centres across the province are seeing a significant increase in referrals from mental health and addictions.


            I’m wondering - the big question is - is there money in the budget to address this increased demand on women’s centres?


            MR. DELOREY: If the member will indulge me for one second, I do have a response to the previous member that I promised to try to get to. I apologize, but it’s very quick.


            The member for Cape Breton Centre had asked earlier whether or not, if someone was being assessed for VON or nursing support services, there would be a reduction of home care services. Two things - VON is providing nursing support, medical support services, versus the continuing care providing home support services. Those are assessed separately for the conditions, and thus, the hours are separate. There’s no connection between the two. If someone’s having VON, that should be for their medical needs, and continuing care is for care needs.


            A member from the PC caucus earlier asked a question kind of about this. An individual was assessed needing help for medication because they had a visual impairment and weren’t able to get into their blister pack for their medications. She raised concerns about whether or not using the nursing services was the best scope of practice to go in there for that versus continuing care. There may be some opportunities to improve.


            That just goes to show that that didn’t reduce the continuing care services they were receiving, but they did receive VON. There may be opportunities where maybe those resources, VON nurses, could have been better utilized somewhere else, if the continuing care person could have helped. Those are areas where we look for continuous improvement. That was brought up earlier this evening by one of the PC members. I hope that answers the member’s question.


            The question that has been raised by the member for Dartmouth North - I apologize for the aside - was around an important topic area, sexual assault. It’s a challenge a little bit in the conversation because it gets complicated when you have a service being provided across multiple departments.


            We’re talking about budgets and our role as a government and as a province to support individuals - women, children, and others - in the area of domestic or sexual assault, sexual violence. It is an area we have taken a keen interest in as a government. That is why, as the member knows, there has been a lot of work over the past three years with the sexual violence strategy. I believe it was dedicated funding through that program for three years through the Department of Community Services. That resulted in some programming and sexual assault trauma therapists being added into the system in some communities.


What has transpired and why this conversation is over with the Department of Health and Wellness is, we had conversations with the Department of Community Services discussing the nature of the care being provided for those by therapists in response to victims of sexual assault. That would be the role of sexual assault trauma therapists. We do know that there is some funding that was flowing from the Department of Community Services, providing those therapeutic services, that made its way through the Nova Scotia Health Authority in the past. I can’t say for certain because I wasn’t the Minister of Community Services, but I believe some of that funding may have come from the sexual violence strategy and came over to fund therapists in a couple of parts of the province.


            At the Department of Health and Wellness, there has been a shift of that funding to the Department of Health and Wellness to continue those services on an ongoing basis. Avalon and the Antigonish Women’s Resource Centre are continuing to provide those services in this funding. It looks like an increase in funding for the Department of Health and Wellness, but the reality is it’s a shift provincially from DCS over to pay for it so that the programming will be funded through us on a go-forward basis, through our partners at the Health Authority. It’s an increase, but I don’t want to mislead the member to think that it’s a new investment increase. This is an increase in our budget, but it has been transferred from the Department of Community Services to provide these services.


            I’m not going to go down this path too much, but at the high level, it’s well known that the sexual assault strategy program, the three-year commitment, has run its course. It is important to note - and I’m sure when the Department of Community Services is up for Estimates Debate there will be more conversation about this - they have adopted a new approach, a new focus, around domestic violence. Sexual assault, sexual violence, is certainly recognized to occur in a domestic context as well.


            This is part of our ongoing commitment as a government to be responsive to the needs of women and families in this province. Let me be absolutely clear that sexual assault, domestic violence, is absolutely unacceptable in this province - not just in this day and age, as people sometimes like to say, but at any point in history it has been unacceptable. We want to continue to make strides to make improvements there.


            We do rely on partners, and in this case, there’s funding, but I didn’t want to mislead the member that this is an increase. It looks like an increase in our budget, but it’s really a continuation of commitment to those services.


            MS. LEBLANC: I may have misled you when I introduced my question, talking about sexual assault particularly. In fact, what you have said actually addresses my second question, but I’m going to clarify my first question. It’s around mental health and addictions. Because of the changes and the shifts to services for women, many of them are presenting and being referred to women’s centres for mental health and addictions help. I’m wondering if there’s money in the budget to address the increased demand on women’s centres for mental health and addictions treatments in particular. Did you get that?


            MR. DELOREY: What I can advise the member is that certainly as a government and through the Department Health and Wellness, we continue our commitment around mental health. I have spoken a bit earlier about it. I won’t restate those because I know there are only a few minutes left.


            We continue to increase our investments, and we increase upon the increases we’ve made in previous years, predominantly with a focus on youth. There is a disproportionate focus on youth. But for example, we’re making investments this year to announce 10 new clinicians, five for youth and five for adults. Those are investments we have made available to work with the NSHA. In the rollouts, we haven’t identified where those supports are going to be, but we recognize that we need to get them out into communities and provide supports and services. Where they will land and how the NSHA will allocate - we do recognize the needs within the province and indeed, across many areas as we identify them. The demands on services will often outstrip the capacity to provide the services. What we’re committed to is continuing to march forward and try to make improvements. That’s why we’re continuing to increase our investments.


            There will be more supports out there and available for Nova Scotians, regardless of their gender and gender-identification. There will be supports. In what facility or structure - I won’t say at this point that it will be delivered in women’s centres. That hasn’t been allocated.


            That’s not the level of detail we have broken it up at. We have identified funding for some positions, the NSHA on the operational side and the IWK, to provide services. They have a number of partners to help move services out into the community.


            MS. LEBLANC: Getting back to the other question, on top of the money needed to help women’s centres across the province continue to provide mental health care and support, the Sexual Assault Services Network of Nova Scotia has been calling for the expansion of what you just mentioned, specialized sexual violence trauma therapeutic counselling services. Given the sexual violence prevention strategy and all the good work that that has done, it seems there are more people coming forward, and therefore, the need for counselling for these people is now increased.


            The network has costed what it believes is the amount that is needed to address the issues at $2.25 million to expand the trauma therapeutic counselling services. I’m wondering, can you point out where these investments appear in the budget?


            MR. DELOREY: As I have indicated, that wasn’t a program investment. We didn’t increase investments. The member cited some analysis and a Budget Estimate of $2.2 million for the expansion of sexual trauma therapists. As I indicated, there wasn’t an expansion. I was attempting to be very clear that the funding that came over to the Department of Health and Wellness was funding for the Antigonish centre and the Avalon. That’s new funding to continue those services. There weren’t new services. Those sites were providing, as I understand, the sexual assault trauma therapy.


            As the member would know, the funding through the sexual assault strategy was $2 million a year. If you’re going up with a program proposing for one - that provided supports and services to a wide range of stakeholders and services and programs, some on campuses and in other places. Clearly, it wouldn’t have ramped up to $2.2 million.


            What I think the member might be referring to is, throughout government and with the Department of Community Services, there are a wide range of supports and programs that do provide supports for people in the case of sexual and/or domestic violence. I think there is something in the millions of dollars range that would accumulate, but the majority of that comes through the Department of Justice with Victim Services and DCS through various programs and supports that they provide.


            Then we do have some of these programs, the sexual assault trauma therapists, and we also have the SANE program. The SANE program is over $1 million but less than $2 million. Then the funding for the sexual trauma therapist would be the total amount of funding that we would have in the Department of Health and Wellness, but that’s incorporating SANE and the sexual trauma therapists.


            MS. LEBLANC: What is that amount then, the total amount for those services, whether or not it’s moved over from the Department of Community Services?


[5:30 p.m.]


            MR. DELOREY: I apologize. I had actually pulled some of that data. If the member would look at my desk - I don’t work well with paper. I’m more of a digital person. I don’t think I have had the rules clarified if I’m allowed to use electronics to look my stuff up. That’s the way I tend to work, so I struggle to pull the data on paper.


            I did have an interview earlier this week where I did have that information broken out at that level of detail, so I know it’s available. I can’t find it on my desk right now, so I will get it back to the member. Sorry.


            MS. MARTIN: I apologize for any confusion, but my colleague had some very important questions that we were just trying to get in. Much to the minister’s disappointment, when these 10 minutes are up, we will be done. I know the minister will be sad, but we have to attend a meeting, so we’re going to let you off the hook for the remaining time after the PC Party. I’m softening in my old age.


            First of all, I would like to thank the Minister of Health and Wellness, his staff, and once again, Mary, his EA, for all of their assistance through this estimates process, the answers that they have provided and the continuing answers that I look forward to in the upcoming months.


            In this last little bit of time, I would ask if the minister could describe and explain to us about the $400 caregiver allowance, how it has come to be, what the requirements are, why there is a limit increase, who is eligible, and who is not. With that limit increase, are the recipients primarily women?


            MR. DELOREY: The caregiver benefit, the expansion of the benefit - the benefit has been around for a number of years. I don’t have full insight as to the evolution. When you come in as a minister, it’s great to get ramped up. Many days I’m just comfortable that I actually am able to process all the different programs that we have available to go through and understand the history because again, health care has been evolving over decades. I don’t have the full history of where it came from, but the dollar amount has been $400 for a number of years. That’s what has been available.


            When we talked about the expansion of the program that we committed to, we did increase that funding. It’s in 2018-19, and it includes almost $3 million, I think, for payments to caregivers in 2018-19. The way we came up with expansion - we made a platform commitment to make an expansion. We then had discussions about how we were going to expand. We knew the dollar amount that we were going to make available within our budget to invest. Then we had to say, how do we want to see that expansion? There’s usually two variables that you can use. You can either make it available to more people, or you can make more money available to the people who are receiving that benefit.


            We made the decision to say that there are many Nova Scotians who could be eligible. This is a program that is income tested, so it is targeted for lower income Nova Scotians, who we believe would be the ones who need it the most. We felt that there were still many low-income Nova Scotians who, based upon their assessed level of care needs, were not eligible. But particularly cognitive capacity, with the growing prevalence of dementia in our aging population, was the variable that we wanted to move on in this round of enhancement to the Caregiver Benefit program.


            I don’t have the technical breakdown. When I worked with staff, they would come forward with proposals as to how they could move the assessment criteria threshold based upon the standards that they use in assessment. What they did is, they just expanded so that they incorporate more people based upon their needs. We weren’t changing the income thresholds, and we weren’t changing the dollar amount. We were changing the level of assessment. Someone who, last year, didn’t meet the assessment threshold - that is, their needs were not high enough - may fall into this.


            We believe, through the changes we made, there would be about 600 additional Nova Scotians who would become eligible. These are Nova Scotians who, historically, would not have been eligible. Because we have changed the criteria to be more encompassing, more inclusive, they are now eligible. That’s how we made the change, primarily on the cognitive, some on the physical, but the biggest change was on the cognitive assessment range.


            MS. MARTIN: I expected the minister to be a bit longer, but I’m sure I can come up with another question.


            Was the eligibility different before around - the minister has said that it’s expanded around cognitive, but it has always been the same amount, and the limits have been the same? Who may not have been eligible before?


            MR. DELOREY: It would be based upon the level. Just for simplicity, think of mild, medium, and high levels of cognitive capacity. Someone with a low cognitive capacity would be higher needs. For example, historically only people with high cognitive impairment would be eligible. We have moved that, I believe, to a moderate level of assessment. We have encompassed more people. It’s not a change in them. It’s a change in the standards to allow more people to be considered eligible.


            I know there’s only a couple of minutes left. The member, in the preamble to her previous question, made some references to thanking me for the time. She had indicated that her Party’s time was wrapping up with estimates. I would like to take the last couple of minutes to acknowledge the member, who I believe has spent almost as much time as I have in these estimates, asking questions on behalf of her caucus and, of course, the Nova Scotians who have reached out, her constituents and also Nova Scotians who would have reached out to her colleagues and her caucus as well. It was a great mix of questions, I think, coming from the member and her colleagues opposite, to represent the Nova Scotians who have chosen to reach out to her and her colleagues. I appreciate that.


            I think the level of dialogue and opportunity to share information is fantastic. The member is becoming a pro here. About six months ago she was a rookie going through the estimates process. I don’t know if she heard the same thing that I did, but I remember going into my first Estimates Debates as a minister around this time in 2014.


            Colleagues who had been around the block, so to speak, indicated how the estimates process is very different from Question Period. A few members opposite have noted it in their comments earlier as well. I think the extended time of this debate, these discussions, allows us that opportunity. When you’re trying to get a very serious point across in a 45-second question - ditto for members on the government side to respond in 45 seconds - it’s hard to have an extensive conversation and clarify some of the nuances behind decisions and/or outcomes that may seem irrational or hard to understand.


I think that’s what the estimates process allows us to do. It ensures that we’re accountable for our commitments on programs and policy as well as financially, because it is part of our budget process.


            As a minister, particularly a minister responsible for about 40 per cent of the budget, I have the distinct pleasure of probably spending the most amount of time in most Estimates Debates on my feet responding and speaking. That is the responsibility that I’m afforded, but I think that dialogue and my ability to continue and have the stamina to do that relates very much to the quality and the nature of the questions that come my way. I don’t know if I would go as to say I enjoyed the process, but I appreciate the process and respect the colleagues opposite for their work and their commitment to their constituents and, indeed, all of their supporters who have reached out to provide insight and the nature of the questions.


            As said, I have my green sheets for some outstanding questions and will be working with staff to get that information back to the members for those items that remain outstanding. Again, I thank the members opposite. I believe we have about 10 seconds. I will sit down very slowly as we transition over to the last few minutes, or is there no one else coming up on the side? (Interruptions) Okay.


            MADAM CHAIRMAN: Order. Time has elapsed. We will now switch over to the PC caucus.


The honourable member for Cole Harbour-Eastern Passage.


            MS. BARBARA ADAMS: I didn’t get a chance to issue a compliment last time, so I’ll start off this time. I know when the passions flow in this Legislature, it looks like we’re not getting along. What it really means is that we all care a whole lot about what our constituents are going through. We’re all trying our best to speak up for them, so I will acknowledge the Minister of Health and Wellness for keeping an open mind when the Opposition Parties are bringing ideas forward.


            We’re going to go back to where we finished off last time, which was looking at the various allied health professionals. We had been talking about pharmacists and some of the things that they bring to the table.


            I want to talk about social workers for a minute, and I know it crosses over into Community Services a bit in terms of the types of care that they provide. I had an opportunity to go to New Start Counselling, which is a unique program that offers treatment for men who are abusers. (Interruptions)


            MADAM CHAIRMAN: Order. Can we keep the chatter down in the Chamber? It’s getting a little loud, and I’m having difficulty hearing the member.


            The honourable member for Cole Harbour-Eastern Passage has the floor.


            MS. ADAMS: One of the things we talk about - not enough but all the time - is about women who have been sexually assaulted. I had an opportunity to go over to New Start Counselling to ask just how many men who become abusers have actually been sexually abused themselves. It’s quite a high percentage.


            I know that New Start Counselling advised me that their budget had not been increased, yet they were expanding their programs to try to treat the children of the parent who was in for counselling. I’m wondering if the minister is aware that the percentage of men who have been sexually assaulted is much greater than we really knew and if they are looking at increasing the programs and services to men who have been victims of sexual assault.


            MR. DELOREY: I thank the member for the important question. It’s interesting - you would almost think the two Opposition Parties work together. I don’t believe they do, but the timing and the flow of the questions seems to be connected because we were just talking about this area.


            As I had indicated, a lot of the work and focus historically has been through the Department of Community Services. It is actually fairly new that, as part of this, we have taken some of those services, but existing services. It hasn’t been an expanded mandate. But we’re recognizing the operationalization of existing services that we wanted to keep and maintain, recognize them as therapeutic and the treatment side of it from a therapy perspective. That’s why we continue with the programs that we have here.


            There’s New Start Counselling, and I think there are some others. Man talk or man speak - I forget the exact name of it - would be similar. There has been some engagement with Community Services as well. That work has been ongoing and a bit historic, but outside of our department.


[5:45 p.m.]


            What we have been doing as a department and as a government in other areas - actually, I’m almost getting tired of continuing to reference my predecessor. But in his capacity as Minister of Seniors, I think he illustrates something that people talk about not just in government, but in the corporate and private sector as well. That is taking down silos and building bridges instead of silos.


            I think the SHIFT strategy that he developed really builds upon work that the former Minister of Communities, Culture and Heritage had done with the Culture Action Plan. What I’m getting at is that they worked on big initiatives, big projects, but they recognized the supports needed either for seniors or culture. There are departments doing good work in different departments throughout the government. Rather than re-inventing the wheel or investing a whole bunch of new money, it’s about how we build the - I’m loathe to use this term - synergies between those investments that we’re already making so that we get better outcomes and go further with the money we have. Part of the way to do that is actually talking to each other across departmental lines. That’s what I mean about taking down those siloed barriers.


            I use those two programs because I think they’re the two biggest and best examples in a very long time of government taking down those silos and building bridges between departments so that we recognize our citizens as individuals and look at how we deliver the programs, the services. The SHIFT strategy through the Department of Seniors is a great example, and the Cultural Action Plan through Communities, Culture and Heritage is another great example of that. That seems like I’m avoiding or extending, but I use that to say that as government, we are working to do that.


            Here we are without relying on a strategy now, and this is where the benefit is coming from. The Department of Health and Wellness and the Department of Community Services are having those conversations and not relying on a big strategy initiative to say, let’s talk. Let’s figure out how we have overlap and share common citizens in the services we’re delivering.


            That’s why I make reference to those programs. As a government, we are doing a better job of taking them down. In this area, as part of the budget process, we were having the conversations. It just didn’t result in us bringing everything across. I look forward to continuing to work with my colleague, the Minister of Community Services, to see where we end up with these types of programs at a future date. The conversations and the connections are being made, and we see the value in taking down silos and building bridges to treat the whole of the person in Nova Scotia.


            MS. ADAMS: My next question is about massage therapists. They’re an unregulated profession, so they have to charge HST for their services and so that cost gets passed on to their clients. I’m just wondering if there’s an opportunity there to change that.


            MR. DELOREY: I think there’s two ways to look at that question. If you strictly just look at it as a financial and HST rebate or reduction - the HST is harmonized. On the one hand, any credits or rebates for the whole of the HST would require federal participation because there’s a federal and a provincial component to it. Any changes around taxes certainly would fall to the Department of Finance not the Department of Health and Wellness, when it gets into that sphere and space.


            The other one though, I think is where the member started, with the fact that it’s an unregulated profession. In fact, while I was the Minister of Finance and Treasury Board, one of the things I moved forward with was kind of a standard approach to self-regulated professions to establish a mechanism, and that applies to anyone coming forward looking for that type of legislation now, so we have some standards in place. In the past, these self-regulated entities were often done on a bit of an ad-hoc basis. If a group stepped forward and found a willing member to move a Private Member’s Bill or a member of the government to implement it, they would often get established.


            The principle behind self-regulation is about protecting the public interest, and the public good is the underlying theme there. That exists in different parts of the system, in particular in the health care system. There are many regulated professions here. When I was in the Department of Finance and Treasury Board, there were a few professions there, most notably accountants. There is a process in place for health care professionals.


            It gets complicated for some. It depends on if they have a critical mass, enough people to make the self-regulation appropriate because there are administrative costs. There have been some discussions about looking at kind of an umbrella process so that the administrative costs could be shared among some smaller - that is, smaller by the number of members - groups to manage and keep the costs minimal and shared services that way. We’re looking at it and evaluating. There are frequently groups that have discussions about self-regulation, and we continue in those conversations when it makes sense. Again, the main driver is the public interest because that’s what the purpose behind these entities is.


            MS. ADAMS: There are other provinces that have already done this. I’m wondering, are you saying, just so I’m clear, that if the massage therapists wanted to be self-regulated here, the government would support that and assist them in that effort?


            MR. DELOREY: What I was getting at is, certainly any time a group is interested or believes that they are prepared and have a case to be made, we have some guidelines to work with them. We have a group within the Department of Health and Wellness to connect and engage with if representatives there want to reach out to have the conversation.


            But as far as whether the government is willing to go specifically with the massage therapists, I’m talking generally. We would have to see what the proposal and the case being made for that would be - not saying yes, not saying no. I’m saying we’re always open to people coming in and having the conversation to be assessed and considered.


            Again, the fundamental underpinning premise, in most cases, is the public interest. Part of maintaining public interest is that there needs to be a readiness within the profession to step up to that level. If you’re going to be self-regulated, there are going to be increased costs associated to pay for the dues and licensing costs and so on.


            The last one I remember coming into effect was actually paramedics as a self-regulated health care profession, not too long ago. I think, by and large, they came in fairly ready. They have been engaged working with other self-regulated professionals. I think they’re seeing some benefits of it. Maybe it’s some growing pains in some areas but, on the whole, a positive outcome.


            MS. ADAMS: I’m going to move on now to non-profit organizations. I know that some are given grants each year, and some are completely unfunded by the government.


I want to start with the Alzheimer Society and the dementia strategy. I believe that their grant was $300,000, and I just want the minister to confirm if that has been continued on or if it has been increased.


            MR. DELOREY: I can’t recall what the member had cited for the amount for the Alzheimer Society. We actually have the Alzheimer Society of Nova Scotia budget - I’m just going to double-check. Can I just take a quick second here? I think I’m being given two different pieces of data, so I just want to cross-reference to make sure I have the right one.


            The total amount is correct but, again, it doesn’t all flow from the same pot necessarily. Since the question is about the Alzheimer Society of Nova Scotia, it’s the total amount.

            I mentioned that I had two different pieces of data. One was just looking at one piece of funding. The other was looking at the total funding. That’s why I just wanted to verify that. The total amount in 2017-18 that flowed to the Alzheimer Society of Nova Scotia is $480,000 and will continue at that level this year for 2018-19 as well.


            MS. ADAMS: Just so I can clarify, it was $300,000 last year, for one year, and this year, it’s $480,000?


            MR. DELOREY: I think last year, the $300,000 was specifically for the dementia strategy. That’s where I was saying there’s different numbers. I was just verifying that. There would be other programs and supports - grants and so on - that would be applied for.


            The data in front of me was $480,000. That’s what we expect to flow to the Alzheimer Society of Nova Scotia again this year, and that’s what flowed last year as well. It’s the same - no growth but no reduction. That is for a combination of work. There’s work and grants that they do and come to us.


            The big amount of $300,000 is around the dementia strategy, and they’re doing a number of initiatives for us within that space. That’s where the big chunk of the $300,000 comes from, for driving that last year. That’s what we were highlighting - again, the work that they have been doing around public awareness, education, information, working to enhance supports, working with dementia protocols as part of the 811 service to help build that capacity in so that people can call 811 and have some level of the protocol, and the nurses and the staff there can walk through and support people.


            They also did a really interesting initiative around cultural assessments. They developed some tool kits, and they created culturally appropriate tool kits. I believe they did one in French and one in Mi’kmaq as well to work with community members in those areas - very well received. They do some great work. They’re a small but mighty group doing fantastic work in an important area of health care.


            MS. ADAMS: I am enormously relieved that that funding is being continued. As always, they wish it were more, and that’s always the preference. I’m wondering if that funding is permanent funding or if it’s just a one-year grant.


            MR. DELOREY: From a budgeting perspective, it is a one-year grant program. We don’t provide the organization core funding. But we have been funding them for a couple of years. We know that we’re working hard to have a number of outcomes we want to get across the line around the dementia strategy, and they’re an important partner in helping us achieve those outcomes and objectives.


            MS. ADAMS: I appreciate that information. This really refers to all the non-profits that are unfunded, but I’m going to start with the Arthritis Society. One of the things I know all too well is that it is the chronic conditions that cost the health care system the most amount of dollars. I don’t know the exact percentage but it’s somewhere along the line that it is the 10 per cent of the sickest of us that cost 90 per cent of our health care dollars. Certainly, those with arthritis would be in that group.


[6:00 p.m.]


I want to ask the minister, why is the Arthritis Society not receiving any funding from the government directly?


            MR. DELOREY: Really, we have a number of different grant programs and services that are funded by the province. We make funding available in those programs as organizations apply and meet the eligible criteria. Grants that do flow out, I can’t say with certainty right now if this is a situation where they’ve applied and haven’t received funding for existing, and whether it was a situation where if they had applied that they didn’t meet criteria. I can’t say for certainty there, but we do have a number of grants and programs that are available within the health system, either through the department or through our partners at the Health Authority and the IWK. I can’t say specifically why they wouldn’t be receiving any at this point.


            MS. ADAMS: I was at the Arthritis Celebrity Roast last week and there were over 450 people there, and one of the efforts they have is to send children to Camp Brigadoon for the Join Together Camp. I don’t know the exact total by the end of the night, but I think we were up to somewhere around $60,000 from just those people in that room, which sends 60 kids to camp.


            The number of programs that the Arthritis Society produces every year is quite extraordinary, but they recently lost their program coordinator to the Department of Labour and Advanced Education, so it’s a big loss for the Arthritis Society. I am aware of approximately what that person was getting paid and it wasn’t anywhere close to what somebody with that responsibility should have. I will encourage the government to take a look at that individual department, because we have a dementia strategy that we’re working on and we have a home care strategy, but as I mentioned earlier, we do not have a chronic pain strategy here and yet one in three of us is going to be living with chronic pain at some point in our lives.


            I want to go back to the chronic pain piece for a minute. Quite suddenly, I forget which month, the Dartmouth Pain Clinic shut down and they already had a very, very long wait, and I don’t know exactly where those doctors went, there were rumours, but I do know that all the patients I knew who were on that wait-list were distraught, and the people who were on the Halifax chronic pain wait-list were not happy to have another group of people thrown on top of them. I don’t want us to forget that this is a very large group of Nova Scotians, primarily those between the ages of 30 and 60, and if they’re not getting treatment they’re often - not often, sometimes the ones who end up addicted to drugs and then we have to treat their addictions.


            I feel like in this particular patient population we are treating them long after they have suffered. They wait months if not years to get a consult. The treatment they have is often provided by private health care companies like the ones that I worked at, and there’s an awful lot of people in this province who cannot afford it.


            I’m wondering if the minister can share with us - I know that you’re trying to get us doctors - but I’m wondering, what particular efforts are we making to get a chronic pain specialist back for the Dartmouth side?


            MR. DELOREY: I do appreciate the question. I do remember when that situation took place in Dartmouth. I received a lot of information about why challenges within the pain space have come to play and one of the contributing challenges that we’re faced with - again, not limited or restricted to the Province of Nova Scotia - but certainly we know that a lot of physicians in their treatment of pain particularly though medications, there have been a lot of challenges identified with what had been in recent history a more standard treatment practice. I know there are a number of different practices, not all are medically associated but that’s the area that gets a lot of the tension, using particular opioid-related medications for pain. That draws a lot of attention and has also resulted in a lot of criticism throughout society as a result of some negative consequences. The member made reference to people becoming addicted and many of the unintended consequences.


We recognize learning from provinces in the western part of the country, seeing the opioid challenges coming East, so we’re trying to get ahead of it and we’re investing in those treatment options, but of course having services that prevent those types of problems from occurring in the first place is obviously a desired piece. You want to prevent the incidents. As far as specifically the Dartmouth pain supports, there’s work ongoing, again trying to make sure that we match people as fast as possible to the care providers. I believe the NSHA stepped up and worked with existing providers and where new physicians were willing to take on patients to provide the care that they required, so the work was ongoing.


I don’t have the latest update as to who might be waiting versus people who have been picked up by other clinicians from that initial site. It has been a little while since I got that last update, but certainly part of the expectations of the NSHA in delivering these services is to continue to work with communities and health care professionals to make sure that the care is available.


MS. ADAMS: Having worked in this area my whole career, one of the things that we know is that the doctors are the gatekeepers to all the other services that a patient might want to access, including referrals to specialists.


I’m wondering if the minister has entertained the possibility that other allied health professionals would be able to refer directly to orthopaedic specialists, to chronic pain specialists? I know what happens in my circumstance is I’ll do the assessment on somebody who has chronic pain, I’ll write a letter to the doctor and ask him to turn around and write the referral to the specialist, and the doctor will refer the person to the specialist and they’ll say see physiotherapy report. We’ve added a step in there that we might not necessarily need and for the 100,000 Nova Scotians without a family doctor it’s incredibly frustrating for me and every other health professional who wants to refer somebody on for further care, but that missing step is the family doctor.


I’m wondering, how much effort is the department making in trying to alleviate that roadblock by allowing other allied health professionals to refer directly to specialists?


MR. DELOREY: I thank the member not just for the question but the commitment to recognizing the diversity of the scope of health care professionals out there. Indeed, often the focus is on one or two health care professions when, again, the health care needs of Nova Scotians are being served by a wide range of health care professionals based upon their needs.


As far as - you know, kind of that really getting to the point where we can really establish the full scope of practice, in this case talking about specific referrals, as I’ve noted - actually I shouldn’t say how “I” noted, I think the member herself, in a previous round of questioning did it best, made a reference to making progress, but in fact, no, that the allied professionals have been stepping up to the plate and what she did indicate is that we’re opening the door. And that is what we’re doing - we’re opening the door, we’re working with professionals.


I spoke specifically in detail about physiotherapists, where I think we’re seeing the most progress around here, certainly with our collaborative practices around nurses, particularly family practice and nurse practitioners, so we’ve really been focused a lot in, and for probably the longest period of time, now we’re starting to see that roll out, we’re getting that established and society is accepting it, people are seeing it. We’re seeing that now, bringing social workers in. We saw for the first time, to my knowledge, an occupational therapist as one of those teams in the one we announced - it’s only part time but it’s a start.


            We are seeing it and I’ve said we’re continuing to engage with pharmacists, so I don’t have a specific timing around referrals, but the conversations with our various providers are ongoing. We collectively, the team, are working to find a big bang for the buck and work with care providers and, as I’ve said before, unfortunately one of the natures of having so many stakeholders is that everyone wants to be first in line, and we’re just working our way through.


Just because someone is not at the front of the bus, so to speak, it doesn’t mean we’re not interested, it just means we need to prioritize, we need to try to get items off the bus, established and rolled out. Sometimes it takes, as we get new ones because this is, as I’ve said before, we’re in the early stages in a historical context, fairly early stages in this transition, so we need to make sure in the ones we’re rolling out first, we’re learning from them, and we learn from those and we do better and we go faster in the next one, and the next one. Over time, I think we’ll see better effectiveness.

            I do want to go back to a previous question on pain. I have a little bit of additional information, which is - I actually forgot about this because I didn’t learn about it, we did establish a Provincial Pain Network as part of the province, so this is just to tie into that notion the NSHA has stood up the pain network, and they’re going to be reviewing that status of what’s going on in the area of pain across pain services. They’re looking at challenges, they’re looking at opportunities throughout, and looking at the current but also projected needs to help inform where they’re going. As far as the gap, the challenge at Dartmouth General, they are continuing to work as I’d stated before, but I think that Pain Network really contributes to that piece that the member has referenced.


What are we doing? Do we see a need? We do, those conversations are ongoing and, again, we’re going to keep that work under way.


            MS. ADAMS: I’m wondering, are you referring to the Atlantic Pain Mentorship Network?


            MR. DELOREY: My understanding is the NSHA has established one internally, provincially, so I shouldn’t say internally, but provincially for a pain network to establish and work within the provincial context. That’s not to say that they don’t have members or participants on an Atlantic network as well, but just the information that was provided, the NSHA has indicated they’ve established a Provincial Pain Network recently that they’ve been working to establish.


MS. ADAMS: I’m not sure if we’re talking about two different things, so perhaps we can get some clarification because I’ve been a member of the Atlantic Pain Mentorship Network for quite a number of years and I spoke at their provincial conference just about a week and a half ago myself.


            One of the things that I’m wondering, when we have vacancies with a couple of physicians who’ve left, depending on how much they earned in that year, we’re underspending our budget and so I’m wondering, given that there’s that space at the Dartmouth General, could we not have turned that space and brought in a psychologist, a physiotherapist, and occupational therapist to match what we offer at the Halifax Pain Clinic?


We’ve got savings because there are doctors missing, yet I know people from Chezzetcook who have to drive from Chezzetcook all the way over to Halifax to go to a chronic pain program, and by the time they do that hour drive to sit through a two-and-a-half-hour chronic pain program is difficult. I’m wondering, when we have vacancies where physicians are not there, why could we not temporarily use those funds to support the pain clinic, just without the physician there?


            MR. DELOREY: Again, I think this is a question that falls into that category of what sometimes may look like simple solutions to complex problems. While there may be some vacancies, if we want to be in a position to be able to fund replacing those physicians, then we need to be in a position to have the funds ready and available to fund the positions when they’re recruited. For example, we don’t know if it’s going to take, other than from historical data is the best that we can do, but depending on what the labour market supply is like, to do that recruitment.


[6:15 p.m.]


Is it going to be three months, six months, or a year? It would be very difficult. Imagine if you were one of those other positions where we wanted to direct the funds, we wouldn’t know how long to establish that contract - would it be three months, six months, or a year? It’s difficult to establish a contract with those individuals saying well, you’ll have a contract until a physician is hired to come back to the original position that that money was allocated for.


            It does seem like the necessary thing or that there’d be an under-spend. The other piece, when you move this up from the very specific, one position for one position, you look at the health care system as a whole, there are obviously puts and takes, so within the overall health care budget we do know that demand is up and parts of the budget in some cases for circumstances or vacancies, or sometimes demand is down, there’s under- spending in parts of the budget but, rest assured, as a system we are, as are our Health Authority partners and we are as government, spending money to deliver care for Nova Scotians, especially those who need it. I think this year, emergency rooms in particular saw increased utilization and, thus, increased cost pressures.


            MS. ADAMS: Thank you, Madam Chairman, and I just have time for one more question, so I’m going to bring it right back to home.


            MR. DELOREY: Do I have time for the answer?


            MS. ADAMS: Probably, because it’s just a yes, that’s all you have to say. So, of course, I’m going to get a T-shirt, I keep saying that, you know my constituency is the only one without a family doctor and I know we’re working on trying to get a collaborative health centre out there, that’s what everybody wants. As I mentioned, in the previous election it was promised by the previous member serving there that we were getting one. I know that’s what was said on the doorstep.


There is a rumour still going around by a developer in my community that it’s coming and people are still talking about it - the people who know this developer are saying yes, it’s coming, and if it does it will be a surprise to me. I don’t know if it would be a surprise to you, but I’m just wanting to know. I know there have been collaborative health centres set up around the rest of the province, I don’t personally understand why anybody else but us got one, because we don’t have any and everybody else has at least four doctors or more. In a couple of minutes, before I pass it on to my colleague, I’m not sure what the barrier is to have one there, but I’m wondering, like if you were doing a school and you were prioritizing areas, when do we get to be at the top of the list?


MR. DELOREY: Madam Chairman, we’ve had this conversation, indeed I think at estimates in the Fall we had this conversation, and one day at QP, I believe the member did ask particularly about a nurse practitioner and we continue to work there too. We’re looking at both in-term, short-term, and longer- term things. We continue to work within the community and with partners to try to address the primary care needs, and to enhance and get some service providers in the community as a step one.


When we’re talking about the collaborative care practice, as the member noted, in these other communities there are often multiple physicians already there. Many of these collaborative care centres getting established aren’t always new physicians necessarily coming, but rather physicians coming together to collectively work and commit to working as a team along with bringing in other health care professionals as part of that team which, as announcements would go, would be different - often seeing family practice nurses and nurse practitioners as part of the team, but we’re now starting to see social workers more adopted, which are great to help people navigate the systems, help support mental health, and also social determinants of health, and as I’ve mentioned a couple of times, an occupational therapist - I think for the first time a 0.4 or 0.6 occupational therapist.


One of the barriers isn’t necessarily a willingness to look at or consider or support work there, but what it takes to establish a collaborative practice. We need to have people willing to establish and set up. I think the member may recall, particularly in the Fall, late summer and into the Fall, there was a lot of attention in the public and the media amongst physicians and, indeed, members of the Opposition Parties highlighting how this government and myself, as the Health and Wellness Minister, need to listen to physicians, need to listen to health care professionals. One of the key messages we heard through the election through the Spring and summer was it’s not effective to tell physicians and health care workers where and how to practise, particularly in the primary care setting.


We’re not in a situation where we can tell physicians they have to go to the member’s community. Obviously, for a long time, there haven’t been physicians serving that area. While it is an area we have to work with physicians, the physicians have to identify the community. We’ve referenced some of the successes other communities have had by coming together collectively.


I would encourage the member to actually reach out to one of my colleagues, the member for Clare-Digby, to have a conversation about the work that he’s done. He and his community have come together, he’s established a working group with representatives from the municipality. Actually, he has a couple of municipal units, so from municipal units, from other community stakeholders - also, I think a representative from the NSHA actually meets with them on a fairly regular basis to provide updates. They work to make sure they’re all going in the same direction for the needs within their community and they’ve really had some success in both physician as well as nurse practitioner recruitment initiatives.


I think it has now become known now as really a very successful model and they’re able to do that and become nimble and respond collectively, and they’re all looking for the same thing instead of working against each other, which often happens in some of our communities because everyone wants everything for themselves rather than coming together as a region and working together.


I know the member for Clare-Digby is more than happy to share his experiences and what he has learned from that process and encourages all MLAs to get engaged with their communities. That might be something that could help to spread the tide as we get more interested physicians wanting to set up there, we would certainly, I believe, the NSHA, work with them to get that care out there. In the meantime, we are continuing our work with that nurse practitioner and a couple of sites that the member brought forward as potential, so that work is ongoing.


MS. ADAMS: Madam Chairman, I just do actually have one more question. I just want to be clear when we start talking to potential physicians who might want to come - if somebody does not currently have a practice and they’re moving here from another province and they come out to my community and they take 2,000 people off the wait-list, do they get $150 per person?


MR. DELOREY: We’re looking at individuals who are setting up a new practice. There is an expectation that someone has a new practice that they’re just getting set up. There is a threshold as part of that agreement with Doctors Nova Scotia - I forget the exact number for what their practice size would expect it to be. Above that amount is where the $150 piece would then come into play but, again, that was part of the agreement worked out with Doctors Nova Scotia. They recognize that if someone is a new physician setting up, that’s just part of doing business. They would be expected to get physicians. It’s not the bonus for just doing your job; the bonus is to encourage people, exactly.


MS. ADAMS: Madam Chairman, I thank the minister for all of his responses, and I’d like to turn over my remaining time to the member for Inverness.


MADAM CHAIRMAN: The honourable member for Inverness.


MR. ALLAN MACMASTER: Madam Chairman, I think the minister has requested a recess, so I’m happy to comply with that. He may want to switch his staff because I’ll be asking questions pertaining to Gaelic Affairs.


MADAM CHAIRMAN: That is correct. We will take a short recess while we change ministries.


[6:24 p.m. The committee recessed.]


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


MADAM CHAIRMAN: Order, please.


            The honourable member for Inverness.


            MR. MACMASTER: Thank you, Madam Chairman, and ciamar a tha a h-uile duine an-nochd, ministear.


            It’s good to be with you to ask some questions in Gaelic, and one comment I will make at the start - a couple of people said, Allan, our member for Inverness, will you be asking any questions in Gaelic tonight? I think it highlights for somebody like me who is a Gaelic learner, you have to really work at it, you have to prepare, you have to plan, and I should maybe make a commitment that next seachdain I’ll ask all questions in Gaelic and English, just to show my effort.


            To keep a language alive, you have to put an effort into it. The investment that the government is making by way of creating programs which I’ll be asking about tonight, they make a difference especially for young people who are trying to learn Gaelic to fluency and they are an important investment, I believe.


I have a number of short snappers here and the first one is, do we know how many young people, how many people are learning Gaelic in Nova Scotia right now?


            MR. DELOREY: Madam Chairman, first of all, tapadh leat, Allan - not allowed to say the name - tapadh leat to the member for Inverness for his commitment as a Gaelic learner. On behalf of the community, perhaps we can - and I recognize because I’ve made some efforts with the executive director, when I’m in the community speaking, to try to incorporate some Gaelic particularly in my introductory and closing remarks from time to time. I know exactly what the member for Inverness was referencing in terms of how it takes time to learn and focus, but what the member didn’t know was how much the community appreciates that time and energy when we focus it in and make that effort.


I was always a bit self-conscious doing that but the community is very welcoming and I think it’s important for all members of this Legislature to know how welcoming the Gaelic community has been. It was one of my concerns when I was appointed because, as an Acadian Dutchman, to the best of my knowledge, there’s no Scottish Gaelic - I think I have one Irish relative and I’m not sure if there’s any Gaelic Irish in there but, to the extent of my knowledge, I don’t have any direct Gael heritage. The community has been very welcoming to me and I want to thank them. I know the member knows many of the people in the community across the province, so he knows what I’m talking about for that warmth.


            To answer the member’s question, I think the rest of them will be a little bit snappier. We have a number of programs and services. There are school programs, bursary programs, in-community programs, so it’s hard to get the exact amount. But I think we’re looking at approximately 4,000 people in the province who are involved in language and/or cultural programs across the province related to Gaelic.


            MR. MACMASTER: Madam Chairman, I thank you, minister. Next question - I’ll just roll a couple into one. How many would be enrolled in immersion programs, and it sounds like we’re tracking these numbers because I know the minister does have that 4,000 number, so how many would be enrolled in immersion programs - and perhaps you could also identify what programs of Gaelic Affairs are working best?


            MR. DELOREY: We’re still working through some of our paperwork here to get the exact breakdown, if we can pull it together what that breakdown is. I do want to clarify that that number in the data that we’re looking at here is probably 2015 data, I believe, so it’s not necessarily up to date current. While we do some tracking, there is some time lag between the day that we have as we’re collecting. We based that 4,000 on 2015 data.


I don’t have the breakdown with me off the top of my head. If I do get it throughout the evening, I’ll come back to the member to respond. I think the number is about 150 in immersion programming and, again, there are a number of different immersion program initiatives in the community. As far as what program or programs are, I believed the member asked, working best, I think there’s a bit of a subjectivity to a question like that and I wouldn’t want to unintentionally insult others for the work that they’re doing in their programming.


What I will perhaps qualify, my decision - one of the programs that I personally think is so amazing is actually the Bun is Bàrr program. It’s an incredible program. Bun is Bàrr - root and branch is a rough translation. It’s designed to connect our elders in the Gaelic community who are native speakers with non-native speakers who are going to learn and they immerse themselves not just in the language but the culture as well. They learn and that’s why it’s root and branch. The root, where the nutrition and the strength and the foundation of a tree or a plant comes from, would be considered the Gaelic native speaker, the elder of the community. Then the branch would be where the new growth takes place and where you see the strength and the fullness of the plant and the tree.


            That’s why it’s a very creative name. I think it’s fantastic, and I think it does a fantastic job of illustrating exactly how the program works in communities. I know it’s well received. I’ve met a number of people - and people who are not necessarily even Gaelic speakers - who have gotten involved and have learned a lot of the culture. They’re learning the language while they’re learning the culture, and vice versa: they’re learning the culture as they’re learning the language. That’s the nature. It’s in a natural environment. These are volunteers who work out with some stipends.


            There are a number of other programs, mentorship programs, that take place. We have partnerships with the Scottish Government to provide bursaries for immersion programs. There are a wide range of programs and then, of course, our school program.


One quick aside for the member: in Antigonish - as the MLA for Antigonish, not as the Minister of Gaelic Affairs - one day I had a sign up in my office, I don’t know if it was the poster for Gaelic Awareness Month or what it was. A constituent had come in. We had finished our meeting and come out, and he noticed the sign. He said, oh this Gaelic Affairs, Gaelic thing. Unfortunately, often there are Nova Scotians who say that’s not a great program, why do we continue to support that; there are so few Nova Scotians; or, alternatively, if we’re doing it for the Gaels why aren’t we doing it for other communities?


            These are the two criticisms that I most frequently hear from Nova Scotians not connected with the community, and that’s what I was expecting from this individual, who I don’t think had, believe it or not, a Scottish name in Antigonish. But, actually, that’s not where the individual went. The individual said, my daughter enrolled in Gaelic in school last year. Those negative comments that I said you hear from some people in the community? At first, that’s the way I responded to my daughter, my child, who enrolled in the program. I said, why would you do that? You have the opportunity for French. Why would you be taking Gaelic instead of French as your language? I forget why the daughter indicated, but that’s not the important part of the story. The important part of the story is that the father, the parent, said the daughter then started talking at dinnertime at the dinner table about her experience with the Gaelic program and what she was learning about the history, the culture, and the language.


That actually converted not just the child, who went into the program I think because some friends were doing it. She actually became immersed and engaged even though, again, I don’t believe that family had any direct, immediate connection to the Gaelic community. Here the daughter got engaged, got involved. And as a branch actually spins out, the father - although not studying - had a newfound respect for the Gaelic culture and Gaelic language.


            I apologize for the lengthy response, but I hope the member appreciates that I’m using this to help draw attention to the supports and the values. If the member would prefer shorter answers rather than these details, please just let me know.


            MR. MACMASTER: Thank you, I appreciate you elaborating on that. I think that’s a good example of how education helps people understand, and we’re all better for that. I understand that too. There are all kinds of people out there who I’m sure don’t think the government should be investing in Gaelic, but I have a different opinion. Knowing the history behind it all, I can honestly understand why they feel that way because, in a lot of cases, they’ve been told that for many, many, many years, maybe grew up hearing that.


            I want to go back to education. I know this may be a question for the Department of Education, but the Department of Education is such an important part of the future of Gaelic. I know that Gaelic has been left out of a couple of reports. Sometimes it’s been referenced, but when it comes time to make recommendations, it’s been left out. That concerns me. I would like to ask the minister about that. What is the relationship between Gaelic Affairs and, say, the Department of Education or the culture division? I believe there should be a role to advocate within those two organizations to ensure that they do include Gaelic, and if the government is committed to this, that they include it in their recommendations with the purpose of helping Gaelic.


[6:45 p.m.]


            MR. DELOREY: I thank the member for the question. The member is right. Again, my own example - and we didn’t set that up, that I would use an example about the language program in our school system, which is available in some parts of the province, through some regions, including down home in what would be the Strait region, which covers both my personal riding and the riding of the member for Inverness as well.


            There’s a great working relationship, I believe, a good working relationship between the department, the Office of Gaelic Affairs, and the Department of Education. That’s how and why we established a program, not just with the Department of Education but with the public service sector. Their programming brings education and information to public servants as well, the opportunity for public servants to sign up and learn.


I think the member made reference to the larger department that, obviously, does a lot of work in collaboration with Communities, Culture and Heritage. Again, that work is together. In fact, the Office of Gaelic Affairs is co-located with Communities, Culture and Heritage and works very closely there. They have some shared staff support resources. Indeed often, although the budget for Gaelic Affairs is not one of the larger budgets in the government’s overall budget, it is not the only source of support for programming within the Gaelic community. Gaelic Affairs often works with our partners, with the broader Communities, Culture and Heritage, which has a larger budget amount, to support all cultures. We have some dedicated funding within the Gaelic Affairs Office and then we work with our partners within Communities, Culture and Heritage to advocate and work on behalf of our stakeholders to ensure that some of the broader cultural funding and supports are made available.


We do the same in education. That’s how we developed the Gaelic Language Program in some of our schools, particularly those that have a higher density of people with Gaelic heritage.


            MR. MACMASTER: I won’t belabour the point, because I know the minister understands. The reason I bring this up is because, when the Gaelic community is left out of recommendations or reports or not acknowledged, it causes people in the Gaelic community to question how seriously the government is taking them and whether or not people care about their culture. I know some people would say it’s insulting when they’re trying to help keep Gaelic alive and the government forgets to include them in a report or they, maybe, make decisions to help other groups but not the Gaelic community. I think I’ve made my point, and I don’t want to belabour it.


I think it’s very important that people in the leadership of all those entities acknowledge that and make sure that, if it’s the will of government to leave the Gaelic community out of a report, then that’s a decision for the government. I think the leadership of those entities should at least make the government aware before they release a report. Be aware that the Gaelic community is watching, and they’re watching because they just want what’s best for the Gaelic community, and that is support for exactly what you’re doing with your office.


The reason I started out with questions around how many people are learning Gaelic is because we do want to see results. As a learner, I and other people my age are starting to see now that some of the last remaining Gaelic speakers are dying. We think, well, now this lands in our lap; we are the last ones to try to keep this going. Some people have learned fluency, and it’s a wonderful thing they have, but it makes us even more cognizant of the responsibility to try to keep native Gaelic language alive. That’s why I belabour the point a little bit tonight.


I know there’s going to be a break here in about a minute. I’ll let the minister comment on that since there’s just about a minute left there.


            MR. DELOREY: Madam Chairman, I want to highlight that working with our departments, we do work to ensure they get covered. One of the biggest reports that we had come out in the province, particularly focused around culture, is the Culture Action Plan. It came out about a year ago, almost exactly a year ago - maybe a little more. That does explicitly draw attention. Through that it also included how it was going to work out with other departments, which includes the Department of Education and Early Childhood Development. We’re seeing Gaelic included alongside some other important cultures - like Mi’kmaq, African Nova Scotian, Acadian, and so on - to have Gaelic culture recognized, through the work with the Department of Education and Early Childhood Development, to build some aspect of the history and information so that Nova Scotians become aware of the Gael history.


There is work within education, with the curriculum, to include and incorporate some of that Gael history. That stems not from the Department of Education and Early Childhood Development directly, but through the Culture Action Plan. It does show how we are taking down those silos and we are working together.


            I think the member is referring to a more recent report about some positions within the Department of Education and Early Childhood Development, which I don’t think I have time to delve into.


            MADAM CHAIRMAN: Order. Time has elapsed for the Progressive Conservative Party. We’ll turn it over to the New Democratic Party. You forfeit? Okay, we will again go to the Progressive Conservative caucus.


            Minister, would you like to continue?


            MR. DELOREY: Thank you, Madam Chairman. I appreciate and would like to thank the member for Sackville-Cobequid for deferring the last couple of minutes here to continue our conversation about Gaelic Affairs and Gaels in Nova Scotia. We’re just waiting for that clock to start ticking if Hansard wants. Okay, just trying to watch the clock. I know, for operational purposes, we need to stay close. It does make a difference, as the member and Madam Chairman would know.


            To pick up, I think the member was referring to a recent report around education, some of the education changes and the fact that there were indeed representatives from two of the cultural groups, African Nova Scotian and Mi’kmaq being clearly pointed out for positions on the council with the minister within the Department of Education and Early Childhood Development. What I want to clarify for the community and for the member is if you look closely at the Department of Education and Early Childhood Development, a lot of the work they’re doing is really focused at the educational outcomes. I think that’s a little bit different than what we’ve talking about, the importance of getting the message out about the culture, the people, and the language.


It is no secret that within the African Nova Scotian and the Mi’kmaq communities, First Nations communities in Nova Scotia, the children have challenges relative to the outcomes compared, on the whole, to the rest of the population. I don’t think we’ve seen data that would suggest the same applies to the Gaels in the province. That’s my understanding of the Department of Education and Early Childhood Development and the recommendations in the report for those positions.


I just want to encourage and assure the member opposite and other Gaels across the province that I think the purpose and the objective of having those positions for those communities is more about the educational attainment of students and ensuring that the appropriate supports are in place for broad educational outcomes more so than about the cultural aspect of improving, communicating, and engaging.


As I said, if you want to look at their Culture Action Plan, our commitments, the fact that working with the Department of Education and Early Childhood Development we did get Gaelic language as an option in some of our communities across the province. Where they don’t have to take French, these students can choose to take Gaelic language as an opportunity. We’re seeing, at least in my community and I assume the same would be true in the member’s community in Inverness, even people who don’t have Gaelic speakers at home are choosing to study Gaelic in the school system. In addition to that, for the broader culture, not everyone is going to take that step because it is a language. Learning languages can be a challenge for some people.


The member for Inverness made reference to understanding the history - if you understand the history of the Gaels, and not just the history from Scotland and how that contributed to the migration to Nova Scotia, but indeed even within the Nova Scotia context some of the more recent history that might be relevant, it’s important that in our education system we are identifying in the curriculum review that some of those comments are being shared as well.


[6:45 p.m.]


MR. MACMASTER: Madam Chairman, it’s interesting. There was something in, I think it was in the Culture Action Plan and it said that traditionally our museums have been telling stories predominantly through the lens of Anglo-Scottish culture, and to reflect Nova Scotia’s diversity and ensure museums remain relevant, especially for younger Nova Scotians, we need to refocus the system.


What’s interesting about that is that many people in Nova Scotia can trace their lineage to the Gaels, but very few are active in the culture as a result of all those things I talked about in my speech the other day. What I think is unfortunate about that comment in the Culture Action Plan is it would almost suggest that here’s a culture that’s been maligned, kept down and now, all of a sudden, it’s being blamed as sort of the dominant culture of the province that’s telling the stories through our museums, when it’s not the case. Whoever wrote that, I don’t think they understand what it means to be a Gael when you look at your history and see all those things that I talked about. We talked about Tartan Day coming up - well, the reason we don’t wear kilts at home in Inverness County very frequently is because when our ancestors came from Scotland they weren’t allowed to wear tartan for about 50 years.


            That might seem very strange for somebody not to be patriotic about tartan, but you have to dig a little deeper to understand why. It’s strange when you go through almost like an ethnic cleansing. You wonder, why don’t we wear kilts? Why don’t we have tartan? Then later on in life you find out why, that it was actually outlawed. You find out that other groups then made an industry out of it and it became romanticized. It’s up on Citadel Hill and other places, which adds further confusion to somebody who sees their ancestors fighting against the redcoats at the Battle of Culloden, which is their immigration story.


My intent is not to go on and on about that, but that is a comment that was in the Culture Action Plan, and I think it’s something that was unfortunate. Perhaps me putting on the record here tonight will carry that message back that that shows a misunderstanding. I don’t say that to be harsh or too critical, but I just note it as something that should be acknowledged. My goal is not to make everybody super sensitive and afraid they’re going to offend the Gaels, my goal is to try to show that all is not well in terms of the Gaels in the sense that we have so many people in the province tracing their roots to Gaelic, because many of us don’t even realize it and know.


            It is really a minority. I will be bringing forward some positive suggestions to the Minister of Education and Early Childhood Development, things that may be helpful. Hopefully, they don’t cost a lot of money, but might make a difference for the thousands of young Nova Scotians who want to learn Gaelic.


We don’t have a lot of time left here. I will ask the minister - I want to leave him time to provide some closing comments - what is the vision for Gaelic in Nova Scotia in five years from now and in 10 years from now?


            MR. DELOREY: Just a couple of things. To a large extent, I agree with the member. I think he highlighted, in particular, it is with respect to the Gaels - and I think many of the cultures that we work for in the province - to reset the awareness of the average Nova Scotian to the history and that often, history that’s been written does have different perspectives of that history.


[7:00 p.m.]


I’ll use an example that’s out of context for Gaels, but just to illustrate the point as to how viewpoints and perspectives that are often overlooked or ignored, or I think as the member used “pushed aside or pushed down.” I think many Canadians recall the recent find up North of the Franklin ship and I remember reading about when that was found. I had a bit of interest in it and one of the stories I had read - I can’t remember the source, if it was Maclean’s, but there are a number of agencies doing lengthy articles about the expedition. They spent many, many years trying to find that ship with a lot of history behind it. It wasn’t really about the ship that this one particular article drew my attention in on.


It was actually the reference that in the Arctic community in the general vicinity of where the ship was found, there was oral history being provided that came down through the centuries, through the years that identified, and I’d read that they’d done some modelling once they found the ship that indicated the location where the oral history of the people in the area that had been passed down through the ages, through the years, if you factored in how the currents over the time shifted the ship, they basically had where that ship was actually ice jammed and stopped.


Again, it’s not a context of the Gaels, but really ties in to the fact that many of our cultures have histories and those histories have not received the elevation and the awareness and I think that’s what, through the leadership of Communities, Culture and Heritage, through the Culture Action Plan, the overall intent and objective of that work has been to then bring that across government and I use the examples of through Gaelic Affairs how that’s being done. We’re bringing more awareness to public service through public servants and the Public Service Commission to bring attention and opportunities.


We work with the Department of Education and Early Childhood Development to bring enhancements to their curriculum, to recognize the contributions and stories, and it is unfortunate that there are some members of the community who felt, who are impacted by the comment that the member for Inverness read from the Culture Action Plan, but I want to assure the member and others in the community that that was not the intention.


What it was really just trying to get at is there are the particular lands that people get known for and the Scottish reference was not a Gaelic reference. It’s that traditional Scottish lens that people look at. I think some people referred to it almost as a tourism Scottishness when you talk about the tartan, some people don’t feel that goes deep enough to get to the heart of what the Gaels’ history and the culture is, it’s not deep enough to really appreciate and understand. I think that’s where that Anglo-Scottish reference comes from, is more people are aware of that Scottish history, New Scotland, even in the name. I think that’s what it was getting at, not towards the Gaels, themselves, and the plight and the history of the Gaels. It was more that tradition and what we’re known for.


To the member’s question about our vision and our plan, a number of things - in the short term we continue to do what we’re doing. We continue to work with community groups, the Gaelic Council, and our partners at the Gaelic College were fantastic, as well, who bring together community members. These programs of Bun is Bàrr and other programs that are in our communities, a number of smaller programs within different communities that received grants sometimes as little as $5,000 upwards into $10,000 or $15,000 for programming and supports - these things are going out the door but they’re being supported by community members who really want to work. These aren’t their day jobs, these are often volunteer and supports to communities.


That work is ongoing and we want to see that happen. We want to focus on this training and language, and culture through language. We want to continue to do that because we’ve had success and we want to continue to see these successes, but at the same time we want to see how the evolution with our work with the Department of Education and Early Childhood Development will also see that support and get that awareness and knowledge out to the broader population as well - maybe not the language and the culture, but at least an exposure to it.


It’s amazing the amount of early social studies that I remember. I can still visualize some of the photos in my early social studies textbook from Grade 5 or Grade 6, images that part of it is how much learning I’ve had since then to understand how biased some of those photographs were and the stories being told in those textbooks at that point in time, and that was a couple decades, a few decades ago now, I guess, but just recognizing that.


We will see over the longer term how these changes we’re making today, not just for Gaels but for other communities as well, will pay dividends, I think, to make a stronger, more vibrant, more inclusive, and more welcoming province for all cultures.


I think that pretty much wraps up this side, Madam Chairman. I do want to thank all my colleagues on both sides of the House for their support, for the questions that came from both members of the NDP and the PC caucus.


MADAM CHAIRMAN: Shall Resolution E11 stand?


Resolution E11 stands.


The time is allotted for the day. We will recess for a few minutes.


[7:06 p.m. The committee recessed.]


            [7:10 p.m. The committee reconvened.]


            MADAM CHAIRMAN: Order, please.


The honourable Deputy Government House Leader.


            MR. KEITH IRVING: Madam Chairman, I move that the committee do now rise and that you report progress and beg leave to sit again.


            MADAM CHAIRMAN: The motion is carried.


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


            [The committee adjourned at 7:11 p.m.]