HALIFAX, TUESDAY, OCTOBER 3, 2017
COMMITTEE OF THE WHOLE ON SUPPLY
Mr. Chuck Porter
MR. CHAIRMAN: I now call the Committee of the Whole on Supply to order. We will continue with the Estimates of the Department of Health and Wellness.
The honourable member for Cape Breton Centre with 33 minutes left in her time.
MS. TAMMY MARTIN: I’d like to talk a bit today about what’s going on with the allegations from Doctors Nova Scotia that there has been a breach of their Master Agreement of their collective agreement. I’d like to ask the Minister of Health and Wellness, through you, Mr. Chairman, is it appropriate, as I’ve stated in the House many times, I’ve bargained collective agreements for years, and when both parties sign on to a collective agreement they are both, in fact, signing on to the document in its entirety - good, bad or ugly.
How does the Minister of Health and Wellness, Mr. Chairman, think they can cherry-pick the articles out of that collective agreement that they want to apply to them and disregard the ones that don’t apply to them?
HON. RANDY DELOREY: I thank the member for the question. Indeed, again I disagree with the premise being put forward by the member. There’s no cherry-picking going on here, Mr. Chairman. Indeed, we continue - and I’ve been advised by those with the legal expertise in this case, that we are in accordance with the articles and the terms of that Master Agreement that’s in place, the contract that’s in place and that that has been the case all along.
Mr. Chairman, if the member or any members of the Legislature, or indeed any Nova Scotians, question the commitment of the Nova Scotia Government, the Department of Health and Wellness, to ensure the payments of benefits for physicians, a process we agreed to, I’d like to highlight a couple of key points. First of all, to recognize that during the negotiating process, under the former collective agreement that expired back in at least 2015, I believe, or thereabouts, when that expired, there were no provisions to require continued payments or contributions towards benefits of physicians. But, indeed, Mr. Chairman, rather than adhering to that particular obligation, the government recognized the importance and the significance of continuing in good faith to provide funding for those benefits to physicians, extending on multiple occasions the extension of benefit payments to Doctors Nova Scotia, to ensure that those benefit payments continued.
So again, if anyone is questioning the sincerity and the commitment of this government to ensure benefits are paid to physicians, again I point to that as an exhibit that demonstrates that we’re not even obliged and there’s no question that there is no obligation to do so, the government stepped up to fulfill that service.
When it comes to the situation before us today that has had concerns raised and brought forward by Doctors Nova Scotia as to the amount of a surplus fund that Doctors Nova Scotia can hold, that would be a surplus fund of pre-payments for benefits. There is a process, of course, that the Master Agreement, the contract, does provide for auditors to get together to work through. The auditors have met a couple of times. There has been some information passed back and forth. My latest update was that at some point in late August Doctors Nova Scotia’s auditors provided some additional updated proposal to the government and the internal auditors within the Government of Nova Scotia followed up with some questions about the information provided and to date have not had answers to the questions put forward.
As part of the process, any time you’re working through and, again, that provision is, in terms of having the auditors review what if any surplus position would be granted to have taxpayers’ money held in reserve in a surplus fund of a third party. Really, that is something that the auditors would review and assess and come back with a recommendation. I look forward to getting that recommendation but, to date, the auditors representing Doctors Nova Scotia and the government have yet to come forward with a recommendation. When they do, we’ll continue to recognize and respect those provisions as per the Master Agreement.
I would also like to highlight and remind members here again about our commitments to physician benefit payments. At no point does the payment of benefits to physicians, the benefits they deserve that are outlined in the Master Agreement, that they’ve gone unfunded. So, again, we remain up-to-date with the payments. As the invoices come in, we’ll continue to pay those invoices. Really, the only outstanding question in that regard has to do with what size any surplus fund may require, but, again, that process was outlined in the Master Agreement and that’s to have the auditors representing Doctors Nova Scotia and auditors representing the Government of Nova Scotia review, to determine what, if any, provisions may be required.
MS. MARTIN: Thank you, Mr. Chairman. Thanks to the minister for that answer. However, as I said, I have been bargaining collective agreements for years and when a collective agreement expires, let’s say on March 31st, I want to say 99 times out of 100 those articles and benefits that fall under that collective agreement continue through until such time that there is a strike or impasse or a new collective agreement is negotiated. So, unfortunately, I’m not going to pat this government on the back for continuing those benefits because that’s typically what happens when negotiating collective agreements.
As well as the current crisis which this government refuses to admit that we are in, with more than 100,000 Nova Scotians without a family doctor, what a way to retain them and attract them. Come to Nova Scotia. You pay 35 per cent of your money to go into this surplus should there ever be a problem, and we’re not going to make any more payments from September 2016.
In the collective agreement and, if memory serves from today’s briefing, it was Section 2 and I haven’t read the agreement so I apologize if I’m incorrect but in Section 2 it says that there are two parts that must happen before you draw down the fund. One, the auditors must consult with each other and, two, then agree to the amount to which it was drawn down. In an article from Doctors Nova Scotia, they explained the concerns to Minister Delorey on August 16th telling him that at that time, if these issues weren’t resolved and agreed to then they would be proceeding to court.
So, clearly, again we have come to a point in the conversation where there’s a piece of the pie that’s not fitting in. Somebody is not being forthright when Doctors Nova Scotia say they’ve asked you on August 16th and you’re saying that the Doctors Nova Scotia auditors won’t commit to something. Regardless, at the end of the day, the government doesn’t have that power to draw that down to a certain amount of money without an agreement. So, can you explain that?
MR. DELOREY: I’m happy to explain the situation. The Master Agreement makes it very clear indeed that the balance that was currently held in the surplus account, based upon the new Master Agreement that’s in place, that that balance will be drawn down. So that provision is explicit in the Master Agreement that that process is in place.
It provides also in the Master Agreement that the parties would have auditors review and make recommendations as to what, if any, surplus amount would be appropriate on an ongoing basis.
I think it’s also worth noting some other changes that took place in the Master Agreement with respect to these benefits, Mr. Chairman. The concerns that seem to be being raised again by Doctors Nova Scotia, not the physicians themselves, because again I’ll reiterate that the benefits going out, payments to physicians, continue to go out the door, they continue to receive their benefits and we continue to pay the provincial portion of those benefit payments and we will continue to do so.
Again, as I said before, there was no provision in the previous collective agreement that required government to continue payments at the point of the expiration of a Master Agreement. Again, one of the articles that we brought forward to the new Master Agreement, having heard from Doctors Nova Scotia their concerns that the government may at some point, i.e. during a bargaining process, after the expiration of an agreement, no longer cover the cost. That seems to be the concern that Doctors Nova Scotia has been advancing as to the need for holding taxpayer money in a surplus account, is out of concern that in between negotiations the government may not be paying for benefits.
Indeed, what the Government of Nova Scotia brought forward and was accepted in the current Master Agreement is a provision, it is referred to, I guess in technical terms, as an ever-greening provision. What that means is that there is a recognition that these benefit payments will continue at the expiration of this. So it is very clearly now laid out in the agreement, even upon expiration, the government’s commitment and obligation to continue payments. We did that, Mr. Chairman, and we brought that to the table again, being very clear about our commitment and addressing the perceived risks and concerns brought forward by Doctors Nova Scotia.
We certainly believe that as a result of that provision, that the degree to which a surplus account of taxpayers’ money being held by Doctors Nova Scotia, based upon the rationale being put forward by Doctors Nova Scotia, as to why a reserve account would be needed, really limits what we think. But again, I wouldn’t say that’s a conclusion as to what the amount would be because that work is ongoing, that the auditors representing Doctors Nova Scotia and the province would be continuing to meet.
As I mentioned earlier, I believe, Mr. Chairman, the last update that I received was that the update that was provided by the auditors on behalf of Doctors Nova Scotia left some questions for the internal auditors, which I would like to highlight are not employees of the Department of Health and Wellness, they are internal government auditors. I think that’s an important distinction to be made, that through this process it is not my will as the Minister of the Department of Health and Wellness, that is doing that assessment. I remain committed to seeing the recommendation the auditors representing Doctors Nova Scotia and the province come forward with, and we will fulfill that obligation as per the Master Agreement. Thank you.
MS. MARTIN: So to speak to that survey that my colleague talked about before, from Doctors Nova Scotia, it says, and I may quote, a recent survey concluded that many instances of burnout are caused by physicians’ challenging relationship with the NSHA and propose that the most effective way to addressing it is to improve the relationships.
Does the minister believe that this lawsuit is going to improve the relationship between Doctors Nova Scotia and this government?
MR. DELOREY: I thank the member for the question. I think I’d like to draw your attention to the language used in the question put forward. The question cited information from Doctors Nova Scotia reflecting the views and concerns of physicians on the front line for primary health care providers, but then followed up to ask a question about the relationship with Doctors Nova Scotia, an organization representing physicians, and not necessarily the physicians themselves.
I think there’s a very important distinction to be made there because it’s the physicians who are on the front line who deliver primary health care services to Nova Scotians. It’s a very important service, and we certainly respect and value those services provided by physicians from one end of the province to the other.
The concerns being raised in the notice of an action being taken that’s before us today - that is an action based upon the organization that represents those physicians in financial compensation negotiations as the bargaining agent, and not the front-line physicians themselves. I think that’s a very important distinction to be made.
As I have said, our commitment to the physicians, in particular this area around benefits and benefit payments, I have stated several times, and I’ll continue to restate it each time the member asks the question, we have gone above and beyond in the last round of bargaining to continue to make payments when we’re not contractually obliged to do so. I know the member opposite previously indicated that she wasn’t about to pat the government on its back for going outside of the obligations of the Master Agreement and contract that was in place. Yet at the same time, she is willing to challenge the government when we believe we are living up to our obligations under the current Master Agreement.
I think it is important for the people of Nova Scotia, indeed for the members of this Legislature, to recognize that we have demonstrated how seriously we take the importance of benefit payments to physicians. We have demonstrated that through the previous round of negotiations. We continue to demonstrate it. The benefit payments have not ever gone unpaid. The taxpayers of Nova Scotia ultimately are paying for these benefits through their tax dollars to the Government of Nova Scotia, to Doctors Nova Scotia, to provide the benefits.
We wait for the auditors of the two organizations, government and Doctors Nova Scotia, to get together. I would certainly encourage them to continue moving forward on that and look forward to those results. It would certainly be ideal if we could get that review completed, but it does require the participation of both parties. I know that the internal audit team has indicated to me that they remain committed - ready, willing, and able - to move forward with the auditors from Doctors Nova Scotia. Again, the last time there was interaction, I believe there were some outstanding questions from the internal auditors. It’s hard to move forward until those questions are responded to.
But when the auditors for Doctors Nova Scotia have the answers to those questions, I think the process can certainly continue to move forward. I have no doubt that that will take place. Again, I remain confident.
The member mentioned the meeting in August. All of the concerns brought forward by Doctors Nova Scotia are able to be addressed, but it does require the work on the ground. I know on our side, we remain committed to sitting at those tables and dealing with those outstanding questions.
MS. MARTIN: I guess I’m not understanding from the minister what the distinction is between Doctors Nova Scotia and doctors. Drawing on my experience, when I bargained collective agreements - I may not be a nurse, I may not be a teacher, and I may not be a snow plow driver, but I bargained provincial agreements for those groups. Those groups take their concerns to me. That’s part of the process. With the members who do that work, we compile the concerns and the issues that are to be brought forward to a table.
You’re making a distinction, but I would think that Doctors Nova Scotia meets regularly with doctors, talks to them, hears what their complaints and concerns are, and as their bargaining agent, takes those issues forward. Can the minister explain to me and these representatives why you are making a distinction? They are one and the same. They are there to represent those doctors that they are representing.
MR. DELOREY: I appreciate the member’s question. The reason for the clarification was the context in which the member raised the last question. The context was about the interactions with the Health Authority and the delivery of front-line health care services, not with the compensation discussion. So, there’s very clearly a distinction to be made there. I think the report that was referenced from Doctors Nova Scotia and the survey that was conducted of their membership of the front-line physicians, health care providers, that noted the desire for improved relationships and communications within their work environment with the Nova Scotia Health Authority, is something that is being worked on and is relevant. It’s consistent with the feedback that I received when I went around and visited physicians across the province, from Sydney down to Yarmouth, and points in between.
One thing I can assure you, Mr. Chairman, this aspect of the Master Agreement never came up in those discussions with physicians. They had concerns, certainly, within the health care and the work environments. They thought feedback was generally consistent with the feedback that the Doctors Nova Scotia report highlighted but, indeed, not these specific issues.
So, whether or not these issues are being brought forward by the members, I certainly haven’t seen any evidence of that. So, again, I think that’s certainly relevant for the distinction between the front-line health care providers, the physicians, and the organization that represents them in bringing this concern forward but at the end of the day, I remain committed, as I’ve said before, that although the concerns were brought forward at a meeting in August that I had with Doctors Nova Scotia representatives, we have recognized those concerns. We had discussions about where the gaps between the two parties were, felt very confident that in this regard the audit team’s first step was a need to meet and carry forward the work that they’re doing. That can only happen if the two sides are responding and providing information in a timely manner.
As I’ve said previously, the last update I’ve received from the internal audit team representing the interests of the people of Nova Scotia through the government, is that they had some outstanding questions with the proposal that has been brought forward by the auditors of Doctors Nova Scotia. Again, I think it’s difficult to move forward in addressing the fundamental question that’s put forward in the Master Agreement which is, what size, to what extent, if any, the surplus fund of taxpayers’ money should be held by Doctors Nova Scotia for benefit payments in light of the new Master Agreement which, again, I state provides provisions to address the fundamental concerns. I believe that this addresses the fundamental concerns that have been put forward by Doctors Nova Scotia as to why such a fund should exist in the first place.
So, again, until those two groups, the two auditors get together, have those questions answered - and again I would encourage both parties to do so in as timely a manner as possible - questions outstanding, as I understand it, fall into the Doctors Nova Scotia’s court to respond to some questions. If we can have an open and frank discussion, I think that’s the nature of the collaboration that Doctors Nova Scotia cited in their report. That has certainly been the message that I’ve received from the President of Doctors Nova Scotia, reiterated by the chairman and the president-elect, that they want to build a relationship of trust and collaboration and openness with the government.
I’ve certainly been ready and available to the president at every step of the way. You know, in this case, they’re interpreting the language differently than the legal counsel providing advice to the department is. That’s a situation that unfolds from time to time but if we want to get down to the nuts and bolts of it, there are some very specific concerns that are being raised. I remain confident that the process can unfold if the two parties at the staff level are sitting down at the table and responding in a timely manner and I encourage both parties, the auditors, to continue to do that. Thank you.
MS. MARTIN: Thank you, Mr. Chairman. I would think August 16th to October 2nd or October 3rd is not a timely fashion. Doctors Nova Scotia says that they brought these concerns to you on August 16th and they’ve not been addressed.
As well, you keep referring to a distinction between Doctors Nova Scotia and those whom they represent. If, in this report from Doctors Nova Scotia, comments are made about the disconnect and the challenges that doctors who work for the NSHA have, this information has come from the doctors who work front-line care and report back to Doctors Nova Scotia. There should be no disconnect. They should be taking, I would expect, all of the concerns and questions back to Doctors Nova Scotia for that body to go forward.
I don’t believe the government should be patted on the back for not stopping payments for health benefits. How does the government explain the 35 per cent that the doctors put in themselves? Where is that in this overpayment?
A number of years ago - I want to say about 2006 - the government of that day tried to take a contribution holiday from our pension plan, from the NSAHO’s pension plan. We were at a bargaining table until 4:00 o’clock in the morning and about to go to court, and the government of the day recognized the error of their ways.
Although the pension fund had had in excess of millions of dollars, that doesn’t exempt the government from paying their share. At some point, anything could happen in the pension world, and that is beyond my expertise for sure. The government of the day realized that, no, just because you’re on the plus side of the balance, doesn’t allow you to stop making payments that you are obligated to make. From that, this government is doing the same thing.
It is common practice that you continue benefits. You don’t stop benefits just because you’re in a negotiation. You don’t stop talking or cancel benefits, drug coverage, and parental benefits just because you’re in negotiations. That’s standard procedure. So no, the government doesn’t deserve a pat on the back for that.
Does the government deserve a pat on the back for not responding to Doctors Nova Scotia time and time and time and time again, with all of these questions and concerns - the doctor shortage, the 20 fewer doctors in Nova Scotia since this government took power? In 2013, the election promise was that every Nova Scotian would have a doctor.
Again, I will say during this election period, never in my experience have I ever seen physicians take to the media to try to get their concerns and their issues out there before people went to the polls. Unfortunately, it fell on some deaf ears, but never have I ever heard a physician complain about the current government and the way that it’s governing. I would dare say that nobody else here can remember such a time either.
Then how can this government defend coming to an arbitrary decision, because that’s what they did. They asked you for help on August 16th, and the government hasn’t responded and said we’re in this crisis. How did this government come to a tune of $200,000 to issue a cheque back to Doctors Nova Scotia? Where did that number come from?
MR. DELOREY: There are a couple of things. Again, the member continues to question where the distinction comes from and continues to refer back to the report from Doctors Nova Scotia and the concerns there. I believe I made it very clear in my previous response, Mr. Chairman, and I will restate it in case I wasn’t absolutely clear. I do recognize those concerns that were brought forward by physicians through the surveys and consultations conducted by Doctors Nova Scotia. I appreciate the fact that they shared that with us. As I have already stated previously when the report was released and again earlier today, that feedback is consistent in general with feedback that I heard from physicians and front-line health care providers across the province. There is no dispute there. I’m not sure if I wasn’t clear on that, but I have restated it - absolutely clear about those concerns they were bringing forward.
Where I drew the distinction was in the case of the questions coming forward about today’s announcement from Doctors Nova Scotia. In that instance, what I am saying is I have not heard that concern being raised by physicians and front-line health care professionals anywhere along the line. What I do know is that the benefits are being paid. They continue to be paid. The question was through the government, that goes all the way back to when the previous collective agreement expired. Those benefits were paid and I believe extended a couple of times through that process.
Again, those benefits and the concerns of physicians are important to us. What we have here is the bargaining agent for the Master Agreement on behalf of physicians and their concerns in the dispute over the language and the application and interpretation of the language there. Again, what I highlight is an outstanding item which is very clear, the Master Agreement that is to take place, which is to have the auditors representing the government and the auditors representing Doctors Nova Scotia come together to review the situation, the benefit requirements.
That’s what this discussion around a surplus account, which ultimately would be a surplus account of taxpayers’ money, prepayments for benefits to be held by Doctors Nova Scotia in advance of the payments being accrued to be paid. We remain committed, as we did in the negotiation process and in the Master Agreement, to make those payments. Those payments are proceeding. The member asked about the dollar amount. I believe it was a payment of $200,000 or $207,000. It relates to actual invoicing for benefits, Mr. Chairman.
The member continues to reference the meeting that took place in August with staff and elected representatives of Doctors Nova Scotia, myself and some staff from the Department of Health and Wellness, from government, to have the discussions. It was an opportunity for them to provide directly to me their concerns, in particular, with this issue that came up. As I indicated at that time, I thought it was important to move forward.
Actually, on behalf of the department and government, I raised the concern on August 16th, the fact that there was a long-standing outstanding response from Doctors Nova Scotia. With all due respect to Doctors Nova Scotia and to the staff, it was not my intention to delve into this level of detail of the conversations and discussions. But the member continues to want more information in this regard, so I’m disclosing it in that regard. I certainly would not have chosen to do so because I do respect the need to maintain trust in the meetings and the conversations that we have. But we have it in the situation presented before us here.
In that meeting, I raised the concerns that for an extended period of time there had been no follow-up in this regard from Doctors Nova Scotia, their auditors representing them. One of the staff members of Doctors Nova Scotia literally sitting across the table from me looked me in the eye and said, well, you should have it in your department. Staff looked at each other. We delved into that a little bit further. They said, well, we delivered it this morning.
Knowing full well that we were having a meeting, they delivered the information that morning. Obviously, there was not time for me to have had an opportunity to review or consider the information they were bringing forward to have a meaningful conversation, yet sufficient for the staff of Doctors Nova Scotia to sit at that table, a table at which there was much conversation about the need to build trust with a new minister coming into the department, an opportunity for new beginnings. I was certainly looking forward to that, Mr. Chairman, and I continue to be committed to it as well. But to have a situation where the concerns being raised and being told that the information was delivered by Doctors Nova Scotia literally the day that they were coming in for a meeting to have this discussion - I don’t know if the member opposite thinks that that’s helpful in advancing and moving forward in these discussions in that regard when bringing their concerns forward.
In fact, I accepted the fact that that was the timing that their auditors had the information available and came forward. But clearly, we concluded the meeting saying that until we have an opportunity to review it, there wasn’t much opportunity for further discussion in that regard. We certainly committed that the internal auditors would review and respond back.
The member made reference to having a long period of time before responding to the concerns raised on August 16th. What I have to highlight to you, Mr. Chairman, and the member opposite is that, in fact, I found out that the information that the staff from Doctors Nova Scotia assured me was delivered that morning did not arrive, in fact, at the department until a week later. So even though they told me on the day I was there that it was delivered to the department, it was still a week later before that information actually arrived - not on my desk but in the department at all.
With respect to the reference to the delays and the time, the member mentioned October. In fact, there was engagement throughout September. In fact, on September 7th, the internal auditors met with the auditors for Doctors Nova Scotia.
MR. CHAIRMAN: The time allocated for the NDP caucus has expired.
The honourable member for Pictou Centre.
HON. PAT DUNN: I’m going to go back to dialysis again, minister. They’re not exactly questions. I’m just making you aware of a couple of issues that you may be able to help out with in the near future.
Patients receiving dialysis in Truro, Antigonish, and Pictou usually have to travel to Halifax once a month. During that time in their dialysis treatments, which are three days a week in Truro, Antigonish, and Pictou, they have the opportunity to Skype to speak to a doctor, ask some questions and get some answers - a little dialogue. That works out okay in Truro and Antigonish, but apparently in Pictou they’re only allowed to do it once. I’m not sure why, but I just wanted to make you aware of that. I’m not sure if you want to make a comment about that, other than being aware.
MR. DELOREY: I appreciate the member bringing that concern on behalf of his constituents to my attention. I’m not aware of that concern that he brought up about a differing level of service with respect to the ability to consult via telemedicine or videoconference.
Just for clarity, Mr. Chairman, I don’t think it’s simply a Skype session. I believe they have secured sessions within the health environment. I just want to assure Nova Scotians, from a basic perspective, it’s like a Skype session, but it is a secure connection between the health care sites to professionals in other parts of the province. It’s a very important part of ensuring that we provide services and limit the amount of travel time necessary for patients across the province, particularly in the rural parts.
Again, I’m not aware of the fact that there’s a different level. I will certainly endeavour to look into that and get back to the member to see if there’s something that can be dealt with there.
MR. DUNN: Thank you to the minister for that answer. Another issue, minister, that’s very bothersome is, I have a couple of constituents who travel to Halifax once a month. It’s a brother and sister combo. Of course, it’s very convenient for them to travel to Halifax together to have their treatment and dialogue and so on.
In a recent appointment they were asking some questions of someone there, a nurse or someone involved with the dialysis. They felt the response they were getting to their questions more or less could have been considered maybe a little on the rude side or whatever. When they went to ask for their next appointments, they found out that now they were given two separate appointments, maybe even as far as a month apart, I’m not sure. They were very dismayed. They didn’t say anything. They took their appointment cards, left, and went home.
That really bothers me, minister, because it’s just not right. I don’t know why it’s occurring like that, but if we can’t at least arrange for appointments for the brother and sister combo travelling from New Glasgow to Halifax, what else can we do? Again, I want you to bring that in. I’m willing to talk to you privately another time outside of this session here to let you know who they are and so on.
MR. DELOREY: I thank the member again for bringing these concerns of his constituents to my attention directly. As I’m sure, Mr. Chairman, you and the member can appreciate - when you get into such specifics, in particular in the health files, there’s sensitivities of personal and private information, so I appreciate the member’s willingness to perhaps take this offline. I’m sure you would have one of the privacy waivers signed by the constituents involved to ensure we adhere to the appropriate privacy concerns and, then, we can certainly take a look into that specific situation.
I would like to add that, my gut feeling on the situation - I certainly respect the health care providers providing front-line services and dialysis and in all other areas of our health care system. I certainly would not want the member or, certainly, his constituents to think that that was the reason - I would be very surprised if it was some type of response to questions being raised. Rather, I would suspect at this point in time without having further information, that it really was a timing issue with the appointments that would be available because, again, I think our front-line health care professionals throughout the system are consummate professionals. I certainly hope that’s the case and is what my expectation would be.
MR. DUNN: Thank you, Mr. Chairman, and thank you, minister. My expectation, of course, is that they can travel together. It just makes common sense and, at this moment, I’d like to pass it over to the member for Victoria-The Lakes.
MR. CHAIRMAN: The honourable member for Victoria-The Lakes.
MR. KEITH BAIN: Thank you, Mr. Chairman. I just have a couple of questions for the minister and I, too, will be turning it over to the member for Pictou West.
Through you to the minister, frequent ER closures happen, especially at the Northside General Hospital as you are well aware. Sometimes, they’re due to the unavailability of doctors and other times it’s announced because it’s a nurse shortage. Now, yesterday or the day before, the member for Northside-Westmount mentioned about 11 ER nurses who were taken from the Northside General Hospital and moved over to the Cape Breton Regional Hospital for the summer months and it actually wasn’t just the Northside General Hospital it was all hospitals in the outlying area. I think it is our understanding that the summer is over, but those nurses are still in the ER at the Cape Breton Regional Hospital. So, I guess my question is, do you feel that some of the frequent ER closures that are taking place are the result of a management decision to move those nurses to the Cape Breton Regional Hospital.
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. He is correct. I believe the question has come up in the past but in the process, I think, in terms of there being an element of a management decision, of course, management, when they’re assessing the needs within the communities for the services and the scheduling of those staff, so, in this case I believe you’re asking about nurses. To that extent, there would be a management decision process there but when you delve into what they’re assessing is where the staff who are available to provide services within the communities are able to provide the most service to ensure the system is providing the best services possible to keep our population safe.
Again, we’ve not shied away from the fact that there is work to be done with our recruiting. In this case, we’re talking about nurses as opposed to the more frequent conversation about physician recruitment and I assure the member, you know, I recognize the valuable role that nurses play in our health care system, particularly in the area of primary care. That’s one of the reasons why, when I did tour the province, I did ensure and made it part of my criteria in groups that I was going to meet with, to meet with nursing students in particular, those would be the next generation of nurses who will be coming out - to hear from them about what opportunities they were looking for as they were going through their studies and nearing completion, so that it can help inform what services and about the recruitment efforts that may be ongoing to fill those positions when those nurses complete their studies which, again, usually is in the Fall in around the November-December time frame and perhaps, to a greater extent, in the Spring when the students graduate.
MR. BAIN: Thank you, Mr. Chairman. The minister remarked that the management makes a decision that movements are made as to where the needs might be. Well, the needs exist in all those hospitals whether it’s Glace Bay, New Waterford, or Northside General Hospital. They exist 24 hours a day. So I guess my question after referencing those 11 nurses, can the minister assure us that those 11 nurses will be returned to their respective hospital ERs?
MR. DELOREY: Thank you, Mr. Chairman, and, as I had mentioned previously, those decisions and the work that they’re doing with the staff whom they have available to them is what I was referring to about ensuring that, when they allocate, they’re allocating in terms of the - again, recognizing the diverse health care needs and how they can ensure that the use of the staff who are available to provide services, that they are being utilized in the best manner possible, to ensure the best delivery of health care services throughout the province. In this case, of course, we are talking more specifically in the Cape Breton region. So, I do assure the member opposite, Mr. Chairman, and you in response to the question that the Health Authority will continue to do its best both with recruitments to ensure that they have the staffing levels they need to continue to provide care throughout the province, whether that be for physicians or nurses, nurse practitioners, other primary care providers, and indeed, in the Cape Breton situation, they’ll continue to manage that staff to ensure they provide the best health care coverage they can in light of the staff available at that time.
MR. BAIN: Thank you, Mr. Chairman, and I thank the minister for that. The only thing I have to say before I move on is that the understanding was that when these nurses were moved to the Cape Breton Regional Hospital, the understanding was that it was going to be for the summer months and, as I say, summer is gone and the nurses are still there.
Just moving along to another question, last week during Question Period I mentioned about the doctor shortage in the two hospitals of Victoria County and I want to mention specifically today if I could, Buchanan Memorial Hospital in Neil’s Harbour. They have lost a doctor. They have one full-time doctor and two 50 per cent doctors there now. I think it has already been recognized that there should be a complement of four full-time physicians in Buchanan Memorial Hospital. So, they’re down basically to two and the doctor shortage, especially with one person full time, helps contribute to doctor burnout, something that we’ve been talking about before.
I guess my question would be, if this burnout continues and this doctor doesn’t want to work as much as he can and realizing that the other two doctors can retire at any time they wish, the people of Neil’s Harbour don’t have the luxury of going to their nearest hospital. The nearest hospital could be two-and-a-half to three hours away if there is an emergency. So, I think that shows the necessity of the department, the Health Authority, and the community to attract doctors and I’m just wondering if the minister will give assurance to those people in Neil’s Harbour that everything will be done, especially through your department, to ensure that the doctor shortage is looked after in that area.
MR. DELOREY: Thank you, Mr. Chairman, and, again, I thank the member for raising the question, particularly as it is clearly one of significant importance to his constituents. I’d like to assure the member and yourself, Mr. Chairman, that it is a concern shared by government as well, not just the circumstances within that particular facility in Neil’s Harbour, but in facilities like it across the province. As the member correctly noted, or perhaps alluded to, government doesn’t have the option to direct physicians. I think there have been a lot of discussions even in this Legislature about the prospects of ensuring we direct physicians to communities or where they can operate. We continue with our efforts. We have heard loud and clear from physicians that that is not a means of successfully securing physicians throughout the province in communities that need their support and services. We do continue to recognize that feedback to provide the flexibility.
That’s where, as the member referenced, the community can play a role in assisting the recruitment efforts for physicians and primary care providers to their communities. In industrial Cape Breton, I think there’s a fantastic example where the community, particularly under the leadership of some business members, recognized that they could support the recruitment efforts. They created a video and website that really helps perspective recruits in the health care sector, in particular physicians, see how beautiful and how welcoming Cape Breton is as a community.
I would like to assure all members who may not have spent much time in Cape Breton that it’s not just industrial Cape Breton that’s a welcoming community. Indeed, all parts of Cape Breton are. I live in the Strait. We’re right next door. I spend enough time down in the Strait region of Cape Breton to recognize that level of hospitality. Many of those communities are great places to work and to raise a family.
Those recruitment efforts for primary care providers, in particular physicians, nurses, nurse practitioners, and family practice nurses are continuing throughout the province. In this budget, we have programs that we have changed to try to encourage physicians to get opportunities to practice in Nova Scotia, which we’ll see through the resident program.
We have demonstrated a high propensity of retaining physicians who go through a resident program in the province, that they have a tendency to stay here. By expanding the number of seats available, not only do we get medical professionals who have completed their studies and are completing their residence program, which is the practical training portion of their work before they become fully licensed, but given the level of expertise our residents have, they are providing service. So even while they are residents - whether it’s a two-year family medicine or general practitioner program or an extended four- or five-year program for a specialty area - those residents are providing health care services to the people of Nova Scotia at that time. Then we have the higher probability that they will stay in our communities.
In addition to that, with a particular eye to Cape Breton, we are trying another program to encourage, particularly students at the Dalhousie medical program, to prioritize and look for resident placements within Nova Scotia. We’re rolling this program out first in Cape Breton in a couple of communities to have third-year medical students complete their training in the community, before they even get to the resident stage, to increase the probability that these individuals will want to do their residency in some of our communities in the province and that they will choose to stay afterwards.
We are taking steps at every opportunity we get to recruit whether it’s the facility in Neil’s Harbour or communities right across the province.
MR. BAIN: I want to thank the minister for that. Regardless of who is involved in the recruitment, the need for primary care exists everywhere.
I think one of the important things that has to be taken into consideration, especially in the area of Neil’s Harbour, is geography. Geography seems to be overlooked in a lot of these cases. As I say, it’s three and a half hours if you have to go to the Cape Breton Regional Hospital in Sydney.
I guess my question would be, has the department ever considered setting up a collaborative care centre in the Neil’s Harbour area?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. Certainly, the government has put forward a commitment to resources to pursue and support physicians and primary care providers who are interested in establishing collaborative care teams in the province. So, you know, there are opportunities if there are primary care providers who are interested in moving forward with practices that are designed to support collaborative teams. Again, we have funding and investments targeted there. As far as, if we’re talking about, kind of the more infrastructure-building side of the network, beyond just the team environment itself - as we know, we’ve had discussions previously here even during Estimates.
There are a couple of locations including New Waterford and Roseway down in Shelburne that are currently the primary two sites that we’re focused on getting that infrastructure in place and up and running. Again, I want to assure the member while there are aspects of infrastructure that are important, indeed, we’re focused on the collaborative teams, the primary care providers, getting those people up and running. We do have supports and, certainly, if you are aware, if your community is aware of primary care providers, nurse practitioners, physicians, family practice nurses who are interested in coming to the province, if they have any questions, by all means, if you want to point them in my direction over to the recruitment team, if you need support to identify the recruitment team for the Eastern Zone from the Nova Scotia Health Authority, we’ll certainly help get the member that contact information to help within his community to ensure, again, those recruitment needs are being met. Thank you.
MR. BAIN: Thank you, Mr. Chairman, and thank the minister for that. I just wonder if there are incentives for doctors to come to an area to establish a collaborative care centre. Are there incentives within the department?
MR. DELOREY: I thank the member for the question. Certainly, from a broad sense, there are incentive programs and opportunities in a variety of areas through the Master Agreement and the fee structures that are available through the negotiated contract. In addition to that, there are programs and initiatives that the government and the NSHA have in place, within the NSHA budget, things to help prospective Pharmacare providers to do site visits, relocation fees, and so on, to encourage them to move within these communities to practise.
I think the nature of many collaborative practices, although it’s not exclusive, many of them do have a tendency to pursue an APP contract rather than the more traditional fee-for-service contract type. That’s again something that’s governed under the Master Agreement with Doctors Nova Scotia. It’s available but does lend itself in that compensation framework, to be more attractive. Certainly, as a province, we’ve had success. I believe there has been information cited about the CIHI survey report. In the CIHI report we hear about the number of positions. It also indicates that the ratio of physicians on an Alternative Payment Program is higher in Nova Scotia than in most other jurisdictions.
Again, it goes to show that we do create with our compensation framework - although not the highest area of compensation - we do provide attractive compensation through that program relative to other jurisdictions and that supports collaborative type practices.
MR. BAIN: I thank the minister for his response and for your time. I would like to turn over the rest of my time to the honourable member for Pictou West
MR. CHAIRMAN: The honourable member for Pictou West.
MS. KARLA MACFARLANE: I am pleased to be here. I will only take a few moments. First of all, I want to congratulate the member on this portfolio. I can’t even imagine how difficult it is. I know my colleague to the left here can but I know I will never have to worry about being in that position. I do want to say - and I don’t want to belabour this or speak of it ad nauseum – but until every Nova Scotian has a doctor, we have to continue speaking about this. You know that many of us have hundreds of people in our constituencies without doctors. I feel we have all been very patient within the last four years, thinking that we would have enough doctors to serve all our constituents.
So my question is, really, I want to be part of the solution and I know that the minister must feel these questions come to him time and time again, the same questions and the same answers, but is there a potential to perhaps start some PR campaign? I noticed about a month ago when I was waiting in a waiting room and I saw this ad for the Northwest Territories. It was with regard to their health care system. They were looking for all different types of professionals in the health care field.
So I am wondering, is there an opportunity or maybe you’ve already done this but, obviously, whatever the plan was in 2012 that you campaigned on a doctor for every Nova Scotian, something is not working. So I am wondering if perhaps we can hire a marketing firm and go out. Is there some potential for something like that?
MR. DELOREY: Let me first, through you, thank the member for the kind congratulations at the front end of her remarks. I would like to assure the member that I certainly respect the member and all members in the Legislature bringing their concerns, whether in the health care space or whatever aspect of government, particularly when raising those concerns on behalf of their constituents and the people of Nova Scotia.
Again, I reaffirm my personal commitment and the commitment of the government to make every effort to continue moving forward and to improving our primary care coverage for all Nova Scotians, that that work is ongoing. I don’t think I’ve ever shied away from recognizing that task before me. The member came forward with a couple of suggestions or recommendations around marketing and recruitment and advertising. What I can say, I think one of the reasons you would see an advertisement from another jurisdiction in a Nova Scotia context, is they are trying to recruit our professionals from here.
I think you would see similar types of recruitment materials in publications, that would be targeted to health care professionals outside our jurisdictions, as the Health Authorities are attempting to recruit, obviously from those jurisdictions, into Nova Scotia. So you wouldn’t expect to see, necessarily, those same ads in a Nova Scotia context because we need the physicians who are in our communities where they are. We are not trying to create an environment in our recruitment efforts where we are attempting to recruit from one part of the province to fill another part of the province, but rather recognize that we have a need in many parts of our province.
So our premise is to get new physicians, new graduates, residents to practice here and then also where there are opportunities to recruit and advertise and promote in other jurisdictions, more experienced health care providers to come to Nova Scotia. So, again, to that point, I believe part of the recruitment process would include advertisements.
I would note - and I don’t know how to articulate this effectively, in such a way that it won’t be presented by some in a political context because, indeed, that’s not my point but given that the member’s concern and suggestions face around the recruitment on the marketing side, I think, in many cases, individuals when they’re looking, yes, they would be looking at publications and periodicals that would be targeted to the medical profession or the health care profession, but they also Google and they search the web for areas in which to operate.
I think the Leader of the Official Opposition in Question Period today made reference to a recent CBC, I think Mary Jane Webber, I believe was the - sorry, I apologize and I stand corrected - it was Mary Jane Hampton who did a recent interview on CBC and she acknowledged the challenges but through that interview, if you listened to it, also highlighted that, I think the way she framed it was a self-fulfilling prophecy almost. I don’t know if those were the exact words that she used but the essence of what she was getting at and what she meant was, the more we focus on the negativity and the challenges, the more that is the first thing that people looking at our jurisdiction see. Again, I’m not trying to articulate that to dissuade in my opening remark.
I acknowledge the member’s comments and concerns and I don’t tire of the member asking the questions and bringing forward concerns of Nova Scotians and the constituents. That, of course, is the job of the members of the Legislature to do that but, again, to the extent that we want to create an environment and attract people, if you’re looking strictly from a marketing lens, we need to see - it would certainly be helpful having more of our positive stories, and there are many positive stories as well. So, while it is in part the role of the members of the Legislature to raise concerns and opportunities for the government to do more, I think, again, when we recognize that part of the challenge before us is recruitment and marketing, that, if we want to work on that solution, part of it is to also share some of the positive stories and experiences in our health care system that do exist as well. Thank you.
MS. MACFARLANE: With regard to the marketing, Mr. Chairman, I just would like the minister to maybe give me a ballpark figure of the financial investment that’s put into that as well as if, perhaps, he can elaborate. Is there an actual - I was thinking, like, is there a marketing team or a collaborative team working together who would go, perhaps, to all the universities across Canada, trying to recruit young health professionals?
MR. DELOREY: Thank you, Mr. Chairman. I thank the member for the question. The first thing is, again, the work that recruitment has performed is led by the Nova Scotia Health Authority, so again, when asking a question in the budgets that are before us here, we’re tabling the provincial budget which does provide an allocation to the IWK Health Authority and the Nova Scotia Health Authority. They would prepare their detailed budget from their allocations. So, if the member is asking explicitly what the line item is or the dollar amount, that would come out through the Health Authority’s budget.
I can assure the member that, certainly, the recruitment within the Health Authority is active and ongoing. The member asked about attracting and engaging and putting a team out to recruit across the country. I can assure the member that efforts are made to recruit people, including an initiative to recruit physicians internationally.
I was talking to my colleague, the Minister of Immigration, about this. For the first time that either of our departments are aware of, there are efforts tapping into the support of our Immigration Department so that they can support us as we try to make the process as easy as possible and find physicians who may have an interest in coming to Nova Scotia, to go through. I think the Minister of Immigration and her team have demonstrated throughout the past number of years the success that they have in establishing new approaches to recruiting. Just for one example, I believe the NSHA has budgeted about $30,000 for a trip to the U.K. that’s taking place later in October, to recruit physicians in the U.K. market to come to Nova Scotia.
MS. MACFARLANE: I’m sure there are a lot of good people working towards promoting Nova Scotia and recruiting. Then, of course, we have the issue of trying to retain them. I think that leads into my next question. Nova Scotia is beautiful. There are all kinds of reasons why we live here. Everyone in this Chamber I’m sure would have the choice to leave if they wanted to. But we choose to live here because our roots are here. It’s hard, though, to justify. It’s hard when someone comes to you and says, I want to start a business, or I want to come here because I have family here. But we’re looking at the highest corporate rates, the highest income tax, the highest power rates and HST. There are a lot of negatives against us.
I think the medical field and the professionals within the medical field are looking at us - they see all that and their operating costs, overhead costs, and they’re thinking, in Nova Scotia we’re paid the lowest. At the end of the day, it’s just a simple question - does the minister believe that, perhaps if we paid our doctors more, would we be able to recruit more?
MR. DELOREY: I do believe that the decision of where individuals, whatever their profession, choose to locate and practice their craft or their profession - whether they be, as the member made reference to, entrepreneurs and business people or, in this case more specifically, health care professionals - I think the variables that are considered by individuals when making those types of decisions, are complex. If we were to try to boil this down and look at what the data, information, and evidence show, I don’t think that physicians necessarily are solely motivated - as there is research that also shows that compensation is not actually the primary motivator in many professional areas, despite it being an easy area to point to. It certainly is the one that often becomes the centre and flashpoint through bargaining processes in unionized environments. But there is lots of research out there, management research, that does clearly indicate that there are other motivating factors that have a higher influence rate on individuals’ decisions. Not all individuals - you can always point to an individual where money will be the number one factor or perhaps the deciding factor.
If we do look at Nova Scotia, where we rank nationally in terms of compensation and yet you look at our ability to have the physicians and you look at the numbers out of the CIHI report, which is the report that shows our ranking on compensation, it also shows that we do have, on a per capita basis, more physicians here. There are a variety of reasons. Those are the reasons that would be attracting and retaining. Whether that is the medical school and the research opportunities that are presented in Nova Scotia and the fact that we have a phenomenal children’s hospital in the IWK and the opportunities to provide such amazing services there. Or if it is the natural beauty and the friendly nature of our constituents, the people of Nova Scotia, that make living here and serving a population so attractive. I don’t have explicitly the answers to the question. To the specific question that the member asked, I don’t think compensation is certainly the only or the deciding factor that will solve the challenges faced with the delivery of primary care services in Nova Scotia.
MS. MACFARLANE: I thank the minister for his answer. I do believe that if there was a little bit more financial incentive, we would see a little bit of an increase in recruiting. Sadly, money sometimes is the motivator in any profession. However, I want to move to the hospital in Pictou, the Sutherland Harris Memorial Hospital, as well as the addiction centre in Pictou. I grew up in a home where Remembrance Day was the most important day of the year, before our birthdays. We used to have cake for Remembrance Day, but we had birthdays when we didn’t have cake. I have always been very fond of veterans. I am fortunate that we have a veterans unit in the Sutherland Harris Memorial Hospital in Pictou. I love this job. But I think I could spend every single day out there with those male and female veterans. I just absolutely love it. I learn so much through them.
One of the things I see though is, and I know it is a federal issue, however, we have done a wonderful job of looking after our World War II veterans, but in my opinion we are not doing such a great job looking after our veterans who are fighting a really different war today. They are coming back home with a lot of different diseases and issues, PTSD obviously, mental health issues. So, one of my big goals or dreams, is thinking outside the box in order to sustain the hospital in Pictou. In order to sustain the addictions centre in Pictou which, obviously, long before this government has been in, there has been threat after threat, year after year, that it is going to close, downsizing. I would like to see them morph together.
I would like to see us open something that could accommodate the newer veterans, and have everything sort of morph together. I know that it is a big thought, a big question. I have had the opportunity to discuss it with my MP Sean Fraser. He says, wow, you are really thinking. But it’s really not that far off. It is a vision that I know can happen. It is a great location. My question to the minister is, how would I begin that dialogue with the minister’s department? I know that it has to start out as baby steps. I would like some advice on how I can start that dialogue on behalf of the Sutherland Harris Memorial Foundation, as I have spoken with them, and we do want to start making steps and progress to this endeavour.
MR. DELOREY: I would like to highlight - I believe that the member was speaking to our MP. Actually, no, correction, Sean Fraser is not my MP, although we both serve Antigonish. I live down east and it’s another member of government who represents me.
To the question about how an idea like this – again, I think you have probably put in far more thought and details than you’ve had time to present here. I would propose that the member for Pictou West reach out, and we will schedule some time to sit down together and I’ll hear more details of what is being proposed. That will help me determine, as I have more of those details, where to point in the appropriate direction and to manage what might be possible, based on current situation, the big idea and ideas that the member has, because I do think it is appropriate to hear those details.
MS. MACFARLANE: I do want to thank the minister before I turn it over to my colleague for Queens-Shelburne. I just want to thank you for that. I will follow up and set up a meeting as soon as possible because I do believe it’s a worthy endeavour. I realize that these things sometimes that five, 10 years, and that’s why I really hope that we can start working towards something that we can lay claim to being the ones who started it. Okay. Thank you.
MR. CHAIRMAN: The honourable member for Queens-Shelburne.
MS. KIM MASLAND: Mr. Chairman, I can tell the minister my short time being in this House, I never want to be the Minister of Health and Wellness, but I do have a few questions for you. (Applause) (Interruption) Oh no, no. I know that.
In my area and what I’ve noticed in the last year of being a senior safety coordinator, I noticed that we have very few specialists in the geriatrics field. We are blessed to have a great geriatrician, Dr. Diyana Docheva, who works out of Queens General, but I was saddened to learn that she has only one administrative support one day a week, and, sadly, I do believe that there are health professionals who could be seeing seniors but that administration of getting them booked, getting the referrals, the phone calls, the faxing, with only having administrative support one day a week, is not getting them there. So, my question is what do you feel that the department could do to change things?
Right now, we have eight months to a year for many seniors in my area, waiting to see a geriatrician. Sadly, you know, that was where I was involved, with seniors’ safety, because many of these seniors who are undiagnosed with dementia and Alzheimer’s are frightened, they’re fearful. They’re calling the RCMP in the middle of the night because they have a disease that has not been diagnosed and is not being treated. So my question is, what are the plans to address, making sure that we have access to a geriatrician and we’re not waiting eight months to a year, and what can we do about that administrative support one day a week?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the, what was a compliment or what that was at the top, but I’ll take it as a compliment, or condolences perhaps. I assure her, despite the many challenges of the role, it is certainly an honour to represent such an important portfolio on behalf of the people of Nova Scotia. So, while the task before the Minister of Health and Wellness at any point in time is daunting, I assure you it is also very rewarding to have the opportunity to work with the dedicated health care professionals and the Nova Scotians who are really working in communities from one end of the province to the other, to ensure we provide the best health care possible. So, never say never, I guess, to the member.
With respect to your specific question, I think there are a number of variables. The member used a specific example of a particular physician providing a particular service and the nature of that contract. It is difficult to go and delve in, again, to the specifics, in part for privacy and the nature of their relationships but, in a general sense, things do get complicated a little bit in the compensation framework and structure for health care professionals, particularly the medical professionals, because there are in the Master Agreement, about which there has been much discussion today, which really governs the compensation framework for physicians across the province, it does provide for really two main means of compensation. The one would be what we would think of as the traditional payment model for physicians, and that would be called fee for service, which is where there is a negotiated fee schedule. A patient comes in for a flu shot, there’s a certain allocation of funds to pay for the flu shot service and, through those fees that are received by the physicians, they cover their overhead costs, which would include their administration and operating expenses for their practice.
The other model, which is the alternative payment plan or APP model, would be more akin to a salary-based model, which may provide some other administrative or overhead support. So, really, on specific situations, it really varies. Certainly, these types of situations, what we have been focused on for the health care services, geriatrics - and I think the model applies and is seen to actually provide better services for all Nova Scotians or for all people who go through the process - is true collaborative practices because that’s a situation where the administration of a practice can be shared amongst multiple health care providers providing the primary care.
In the discussions I’ve had at various collaborative facilities or teams across the province, again, although all are structured a little differently, one common theme that was noted by those health care providers, the nurse practitioners, family practice nurses, and the physicians, was that in some cases individual primary care providers have a greater degree of interest or training in a particular area. For example, you’ve mentioned, geriatrics, so in the collaborative context a service can be provided and if there’s an individual, whether it’s the nurse practitioner or the physician who has that expertise and skills and interest, they work their relationships and may redirect for consults or, if they know that they have a certain number, in this case geriatric type of patients, that perhaps that individual would take the main roster, but with shared administrative support.
So, the whole notion we’re talking about encouraging our practitioners and the notion of collaborative practices, this isn’t just an initiative and a focus, although infrastructure is what gets the attention. It is about encouraging but not forcing or requiring physicians and health care providers to look at opportunities to collaborate with their colleagues to make the best use of their resources possible, to ensure we provide the best services to all Nova Scotians.
MS. MASLAND: Thank you. My next question is concerning long-term care. Despite what looks to be better numbers, those working in the system are still seeing little change. Hospitals are still blocked with seniors who are awaiting placement and those who - I guess I’ll just cut to the chase with an example. I had a constituent whose wife was diagnosed with dementia and he placed her on a list, to be placed. When the time came, she wasn’t ready to go. So, he continued to keep her. So, of course, when she turned down the first placement, he then had to wait three months.
Unfortunately, before those three months came, she desperately needed to be placed because of the downturn and the aggressiveness of the disease but when that time came, he couldn't get her placed. So, it seems like the system is set up to really penalize those who are trying to look after those whom they love at home as long as they can. I guess my question to you is, you know, where can we - where is this government prepared to go in possibly reviewing that rule, so that if you are on the list and you do turn down that first placement, why do you have to wait again for another three months before you can be put back on?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question, again, very important and I think not just for the member’s community but for communities across the province. A couple of things; one, because you spoke about the specific case and I want to assure the member, certainly, the case of Alzheimer’s and dementia in a broader context is an important area. It’s why there was work done on the dementia strategy, and I believe in this year’s budget we have almost half a million dollars dedicated to work with Alzheimer’s Nova Scotia, to continue advancing that work within that space. So, I want to assure the member and her constituents that that might fall in that space, we’re continuing to make strides there.
With respect to the member’s concern about a situation where an individual was on the wait-list. I’m sure, not just in the situation where they might have been put back on the wait-list with a three-month waiting period, but indeed, even if they hadn’t gotten to the top of the wait-list, there are provisions and capacity to be reassessed in terms of the acuity of an individual’s situation. So while the default, or the standard process, would be that if you’re not ready and you don’t think you’re ready then the assumption is, another three months shouldn’t be, it should be mental, that if the need wasn’t that great to require the placement, that’s the reason for the deferral in the case where you’ve turned down a location. Yet, the flexibility in the system does exist, to allow for reassessments.
I would encourage the member, for your constituents, whether in that case, or in other cases - I apologize for saying “you”. What I was getting at was, for any member who has constituents who might be in a situation like that, if there has been a dramatic change in the acuity or the severity of the condition, whether that’s dementia or other circumstances that may face the individuals on a wait-list for long-term care, to reach out to the care coordinator, to see if a reassessment would be appropriate. That may influence then, the ranking on the list, but again, it is based upon a clinical assessment.
MS. MASLAND: My next question, is concerning the two ERs that are in my constituency. I have one ER that’s never closed, it has never closed its doors. And I have one that constituents drive by, because they assume it’s never open, and that’s Roseway.
I’d like to know if the minister has spoken with the ER physicians at Queens General Hospital, to learn about the successes, and to understand the supports that they need to provide the additional care required, to ensure that influx that we’re getting, also from Lunenburg County too, and from Shelburne County. They’re already working in an overwhelming environment. Have you reached out to them? Have you discussed with them, how we can go about making sure that we are able to meet that demand that’s coming into Queens General ER?
The second part of the question, which I assume will be part of your answer, is, what is the status of the collaborative care centre in Shelburne? When do we expect those doors to be open?
MR. DELOREY: So, to the first question, I don’t recall having met with the Queens site, but, I certainly have met with ED representatives in other facilities across the province. Unfortunately, I’m not able to get to every facility, as I’ve gone around. I did, though, meet with a physician at Roseway, providing services, and spoke to him about the challenges that they face there, and certainly received that information.
One of the things that was a surprising take-away for me was the fact that they had indicated that there are more general practitioners, physicians, than there have been for quite a long time in the community, but just not necessarily with an interest or a willingness to work in an emergency department, and that’s a challenge, I think, for other communities as well.
With respect to the question about the Roseway collaborative practice, that work is still ongoing. I think, as you would know, the site has been demolished. The crews are on the ground there, doing the work. So, we’re expecting it should take about a year of work to get the facility constructed, again, recognizing the importance of the medical set-up of a facility like that. So, about a year from now.
MR. CHAIRMAN: Order, please. Time for the Progressive Conservative caucus has expired.
The honourable member for Sackville-Cobequid.
HON. DAVID WILSON: Thank you, Mr. Chairman. I want to pick up, I think, an area where I was trying to dive into a little bit the last time I had a chance to question the minister, and that’s around the mental health and addictions strategy. For those who might not know, it was in May 2012 that that strategy, the first in our province, was introduced in Nova Scotia and a lot of work went into consulting with a wide range of service providers, consumers, people who were affected by mental health and addiction in our province and this Together We Can Strategy was a roadmap for government, not only government of the day but future governments.
I know we’ve had a number of progress reports over the years and I had indicated I was a bit concerned that we didn’t hear much about the mental health and addictions strategy in the Throne Speech. Knowing that the five-year strategy is coming to an end, I’d like to maybe give the minister an opportunity to inform us if there is a phase two to that strategy. Is there continuation of the strategy? What is the government’s plan on the mental health and addictions strategy that was introduced in May of 2012?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for raising this important question. I believe, if I’m not mistaken, in 2012 the Health Minister of the day - oh, the Health Minister of the day was a former Antigonish resident, despite not representing the area at the time. I guess it just goes to show how important, again, I don’t think just people from Antigonish take mental health but, indeed, all Nova Scotians. I know the member opposite certainly is concerned around mental health, undoubtedly as a member of that caucus when that change went through, but also in his advocacy around PTSD supports, particularly for emergency responders. It’s clearly evident, his personal interest in this area.
So, the work on the Together We Can strategy, the mental health strategy as the member referenced, was initiated back in 2012. We continue to provide significant financial supports in the various areas that were identified through that program, to provide supports and programs for people requiring mental health services and supports. In addition to that, we have and continue to engage with professionals throughout the province, as I’d noted previously. The previous minister, I believe, and perhaps it predates him, I’m not sure, but, certainly there was a panel in place to provide advice and direction and suggestions to the minister in the area of mental health. That’s a panel co-chaired by Dr. Stan Kutcher and Starr Dobson and the work that they perform is ongoing and continues. They’ve made some recommendations that really align and are very similar with the recommendations that came from Dr. Kutcher and his visit to Cape Breton back in June, so, we’re really focused and investments in our budget demonstrate that we’re really trying to focus while we’re continuing our commitments in these areas identified in the strategy.
We are very concerned about access to primary care services and supports so we are really working hard to ensure that there are more clinicians available, that there are more access points, particularly for our youth, which means we partner and work with our education system there. It’s for that reason that not all investments that are being made by the government are seen necessarily in the Health budget, but also through our Education budget. You would see initiatives like that. Just a couple of those things, on top of the investment in 2017-18 for continuing the many programs for the Together We Can initiative, which I think comes up to the tune of over $6 million, we continue to expand. We have highlighted our investments in things like kids help phone, expanding SchoolsPlus sites, and hiring additional clinicians in mental health, including in our First Nations communities.
Again, we do continue the work and recognition of the importance of the work that was started under the previous government on behalf of Nova Scotians, to improve mental health access and supports throughout the province.
MR. DAVID WILSON: I won’t argue that there is work being done by the current government to try to address mental health and the services that Nova Scotians need, but in the strategy that was released in 2012, there was a lot of work, a lot of important initiatives in that document, but one of the things that was just as important is the fact that there was a document. There was a roadmap and accountability to Nova Scotians. That’s why I asked if there is going to be another strategy. Not only was it created to hold my government at the time accountable, but future governments.
Yes, each budget year we’ll hear from the current Minister of Health and Wellness and the future Minister of Health of investments in health care. We spend $4 billion plus, so there is investment. There are positive initiatives going on but by having it in a strategy, by having it in a report, by having progress updates or progress reports that come to the floor of the Legislature, it holds government to account. It is not at the whim of, is there money here this year - we will add a new program. So that is why I ask, again, is there going to be a phase two, or is the current government going to come forward with a mental health and addictions strategy to not only hold the current government to account, but future governments to account?
MR. DELOREY: Yes, our efforts to continue the planning process with the strategy initiatives for mental health in the province continues. The member is right, that is an important part of the process, especially when it comes to accountability. The reason I wanted to highlight in the previous response that it is not just about the planning process and so on, but indeed that - because governments sometimes get too often criticized for spending too much time in that process in establishing strategies and documents and so on - and that’s why I felt it was important to highlight and stress the investments and the commitments that we have as a government, in acting as well. I don’t want Nova Scotians to think that it is simply the one or the other. But we will continue working. Whether the name stays or changes may be up for discussion but the principle of planning and continuing forward with a strategy addressing mental health and addictions in the province, is certainly an important one for the province.
MR. DAVID WILSON: I would agree that, yes, there is criticism at times on consulting or what might be perceived as delaying, you know, making changes or initiating initiatives that hopefully will change services. I don’t believe that even the Liberals at the time criticized the fact that the province didn’t have a mental health and addictions strategy. People were on board with it. They knew that the groups who were brought together and the individuals brought together, worked hard. I just want to make sure that the minister and the government know that this is an area where we will continue to make sure that we move forward and that there’s an accountability process in place.
I know my colleague who has taken over the reins as the Health and Wellness Critic in our caucus, is very passionate (Interruption) Enough from the member for Pictou Centre over there (Interruption) Pictou East, sorry.
She had mentioned to me, some of the work that Starr Dobson and Dr. Kutcher did more recently, but a concern of hers, coming from Cape Breton, was that the report was done about Cape Breton but yet was released here in Halifax. Government needs to be sensitive to that. If there’s anything I have learned over the last number of years, it’s that people do recognize, especially Cape Bretoners, how important it is to be there face-to-face when dealing with issues. I would be remiss not to mention that for well over 400 days now, some in Cape Breton are waiting for mental health services.
I want to move on to another area which holds government to account. That was behind the reason for the progress reports of the mental health strategy and also the annual accountability report of the emergency departments and the emergency department closures. In that piece of legislation, it requires the government, no matter who they are, to report annually to this House what’s going on with our emergency departments across the province. I know when I first walked through these doors some 14 years ago, ER closures were top of mind and were brought up on the floor if not every day, every other day in Question Period, in resolutions, in notices of motion, in debate. That’s why we brought forward the emergency department annual accountability report.
I know that in there, it indicates that we weren’t that specific on exactly when that report was supposed to be tabled, but I think last year it was December 21st when that report was given, I believe to the Clerk, if we’re not in session. Then it is put into - I don’t know the term - but it’s tabled in the House and it’s per se.
I’m just wondering if the minister can give us a date. Is that going to be the timeline when we’ll see the Accountability Report on Emergency Departments again? If so, would they consider changing that date? December 21st, I have to admit, I try to unplug a bit, especially that close to Christmas. I don’t know if that’s the intention of why it’s being delivered then. I’ll give the minister an opportunity to respond when we might see that report this year.
MR. DELOREY: I thank the member for the question. I don’t have a specific date for it, but I do certainly appreciate the member’s concern with the date. I’m thinking about where I was and what I was doing on December 21st last year. I wish I was given the opportunity to unplug that close to the holidays. Unfortunately, duties required me to stay engaged on other initiatives. I do appreciate the concerns around how close to the holidays. I will certainly endeavour to get it out at least a bit earlier from the holiday season.
MR. DAVID WILSON: Continuing on with mental health - I know this is an area I tried to get into last time I was up, but I think we ran out of time. It’s around federal funding for mental health initiatives that was announced in the most recent federal budget. I know that they’re putting emphasis on mental health throughout the country. I’m wondering if the minister could indicate how much additional funding we’re receiving for that - what I would call targeted money, I believe - from the federal government in the most recent federal budget. I’m wondering if he could provide us with a figure on that.
MR. DELOREY: I think the member opposite set me up. The activity I was busy with around that time last December was, indeed, working towards establishing updates in my previous role, for this funding. So, for 2017 and 2018, the figures are, I believe, $5.2 million towards home and community care, so that would be under the continuing care space; and $2.6 million in the mental health and addictions space.
As previously mentioned, in responses to some questions, I don’t recall if it was from the member the last time he was raising questions, or another member, but I think it might have been the Leader of the New Democratic Party who asked the question about whether it was a linear, that is, a flat rate, or an escalating one. At that time, I did indicate that it’s not a flat rate. We are expecting increased payments over the 10-year time period, in these areas.
MR. DAVID WILSON: I will dive into that for a few moments. The $2.6 million for mental health - what parameters are on that? Are there parameters in place? Is it specific, targeted funding to a certain program, and if so, or if not, what reporting mechanism do we have with the federal government? I would assume, from what I heard, and I know, governments, Ministers of Health, have been reluctant over the last number of years, and I weigh on that side of the argument, I think, for the most part, of allowing the provinces to address the needs of the health issues in that province. But, from what I understood, it is a targeted amount of money, targeted for specific things. So, I’m wondering if you could maybe elaborate on the mental health component of the $2.6 million. What is it going for? Or, what is it to be used for, and, what kind of reporting is required back to the federal government, to show that that money was spent on that specific program or initiative?
MR. DELOREY: The member is correct in the understanding or the awareness, the notion of the targeted funding being of interest for our federal partners to be going towards programs and initiatives within our provincial jurisdictions. Again, targeted primarily in two areas, that is, the continuing care stream, and the mental health stream.
Beneath that, certainly there have been lots of discussions, and, really, a broad level framework of what areas. So, for example, in particular on the mental health and addictions, which I think is the primary area of discussions here, we’re looking at areas in investments and expanding access to community-based mental health and addictions services, particularly for children and youth. That’s because we recognize the effectiveness of early interventions to treat mild to moderate mental health disorders.
Spreading evidence-based models of community mental health care and culturally appropriate interventions that are integrated in our primary health care services, and expanding availability of integrated community-based mental health and addictions services for people with complex health needs. I think in that broad sense, under mental health and addictions, it’s aware that there is flexibility, again, as the member referenced, recognizing the constitutional responsibilities of provinces to the health care delivery jurisdictions across the country. Provinces and territories certainly recognize their obligations and responsibilities to their citizens to invest appropriately, so there’s sufficient coverage in the target parameters of the framework that allows jurisdictions to, again, meet shared objectives with a particular focus on community-based supports in mental health and youth.
I think that’s definitely an area that there is broad consensus on. I think we’d likely see broad consensus on those, as priority areas throughout the Legislature and across the province. Thank you.
MR. DAVID WILSON: Thank you, Mr. Chairman. Is there a requirement to show the federal government that the provincial government hasn’t reduced their commitments to mental health funding? So, if it’s $2.6 million, do you have to prove or show to the federal government that you didn’t replace provincial funding with federal funding? I think it is an important question, so that, it is additional funding. So, I guess there are two questions there. Did the province reduce anywhere any of the programs that the federal government is targeting, and are you required to show the federal government that you haven’t done that?
MR. DELOREY: Thank you, Mr. Chairman, and I appreciate the question from the member. Off the top of my head, I honestly don’t recall a provision that requires that, but I assure the member and all members of the House that in the Province of Nova Scotia our commitment and our investments, particularly in the area of mental health and addictions, far exceeds the federal contributions here. I believe if you look at the bottom line of our investments going towards mental health and addictions throughout the province, you’re seeing an increase of almost $6.6 million that, again, as I’ve mentioned earlier, I believe it was $2.5 million for mental health coming from the federal government this year and, in addition to those investments that fall under the Department of Health and Wellness, let’s not forget the additional funds going towards our Department of Education and Early Childhood Development to support SchoolsPlus expansion, clinicians and so forth, to support our youth in those areas which, although it’s being delivered through our education system, it does support aspects of our health care.
MR. DAVID WILSON: Thank you, Mr. Chairman. I just want to be clear. I initially wrote $2.6 million, but it’s $2.5 million from the federal government? Or is it $2.6 million? And of the $6.6 million in our budget, does that include the $2.5 or $2.6 million? Clarification on both, if the minister could.
MR. DELOREY: Sorry, I apologize to the member for my rounding of the 2.6 to the 2.5 but I trust the member would appreciate that it’s a situation where I rounded mathematically accurately if not the way one would expect a political Party or representative to round. That is, I rounded more conservatively than - so, to that anyway, $2.6 million was the correct figure. I apologize for my previous statement.
The second question about the $6.6 million and whether we reduced?
MR. DAVID WILSON: No, was that $2.6 million included in that figure?
MR. DELOREY: Oh, yes, so the total investments, the revenue that would come in would be considered in the total contribution of delivery of services collectively between the services and, again, recognizing the additional, on top of the $6.6 million, is the money in education. I believe, off the top of my head, it’s somewhere in the vicinity of $1.8 million. I’ll defer to the Minister of Education and Early Childhood Development to confirm that figure, though, but I believe it’s in the $1.8 million range there, as well.
MR. DAVID WILSON: Thank you for that. Is there a requirement by the federal government - and I know the previous federal government was infamous for this - is there a requirement that a federal representative has a chance to speak at maybe a new initiative? You know, is there anything like that? I mean, the last Conservative Government had signs everywhere, was at everything. So, I’m just wondering if the new federal government is going to do the same. Is there any requirement on your behalf or on the province’s behalf, to make sure that they’re included in ultimately what is a photo op when it comes to - and maybe announcing some of these initiatives that we’ll see in the next year?
MR. DELOREY: I think that it is interesting that the member seems to poke a little bit of fun about signs going everywhere for investments that were made.
I may remind members of the House that back in 2013 really there was an absence of signs when the government changed back at that time, and they were not replaced. They made the announcements but not certainly going out to leave signs up around the province of where, really, taxpayers’ money was going.
From a provincial perspective, that certainly has been our approach in government. With respect to the specific question and whether or not the federal government in regard to the investments towards these health care initiatives, require a federal participation announcement, again, not to my recollection of the agreement in place for these funding models. Does that mean a federal representative wouldn’t be - or does it preclude the possibility that if or when announcements are made that there may be federal representatives? That does happen from time to time, but again, it is not a pre-condition on the funds flowing through, to my knowledge.
MR. DAVID WILSON: I would like to turn to an area also that was top of mind when I entered this Chamber, and it hasn’t really gone away. That is, the access to long-term care facilities and long-term care beds across the province.
I know when I was first elected, there was an initiative - well there was kind of a halt on any new beds for many, many years. I want to recognize that the Progressive Conservative Government after a number of years finally came to their senses and realized that we needed to create and build new long-term care facilities, and not only build new long-term care facilities, but increase the number of beds in this province.
I would be the first to support the initiatives of continuing care in home care. I have advocated for that; I have increased budgets when I had the opportunity to be in that position. So it is important, but definitely knowing the situation in communities across the province, the situation in some of our hospitals with people who would be better served in a long-term care facility, I truly still believe that we need to move as a province with increasing the number of beds in the province right now, along with increasing support for continuing care in the home care aspect of things.
I know that there has been no increase in the number of beds in Nova Scotia. So I want to ask very simply, with the budget when it is implemented, will there be any increase to the number of long-term care beds in this province after this budget is passed?
MR. DELOREY: I thank the member for this important question. You know that there are a number of things that have changed over time in regard to continuing care services provided to the people of Nova Scotia, including a recognition and a focus on providing home care services, recognizing the growing interest, desire and indeed the opportunity for many people in the population who may have previously entered nursing care services, or long-term facilities, at a much earlier stage in life than may have otherwise been required.
So if you look at the investments we have made as a government and the moves to continue to increase investments, particularly to provide the supports needed for Nova Scotians who are able and desire to stay in their home through home care initiatives and supports, Mr. Chairman, and increased investments there. I believe that’s an important variable to consider as well.
The member asked around the specifics of long-term care facilities and actual, again, provincially-funded, long-term care beds. In addition to new infrastructure which the member talked about, there are areas within the province where there is obviously an interest in even maintaining or refreshing the infrastructure that’s currently in place. So, there are many - as I’m sure the member is aware - many, many significant variables at play when we’re looking at continuing care and establishing the right balance between, again, home care and long-term care and acute care services for the people of Nova Scotia, and that work continues.
There certainly have been, even in my short time, some proposals coming forward for situations of expanding or renovating existing infrastructure and, also, some interest and proposals on expanding infrastructure. So, we’re looking through those many applications and proposals to see, but recognizing the length of time that it does take that infrastructure to be built or moved forward, there isn’t in this budget explicitly new long-term care beds, but there is work in some communities with refurbishment of sites and new sites that are replacing beds that are in the system, ensuring the services and the safety, in some cases, of the residents in those facilities. So, again, investments being targeted as best we can to the supports that are needed.
MR. DAVID WILSON: Thank you, Mr. Chairman. That was a lengthy answer to say no. I would have thought the minister, after all the hours, would take the opportunity to just say no, and we’ll go on to the next question. I appreciate what he’s saying, but it’s no secret the demographic shift that is going on in our province. I know for my riding, for example, for many years, there was no long-term care facility in Lower Sackville. People who were from that community had to leave the community - not super far, but that was the big push and initiative and the fight for many years and now we do have a facility. But, saying that, now, there’s a two- to three-year wait to get into the facility, if you go through those channels. So, I am concerned that that’s not going to change over the next year and we’ll continue to push the government to make sure that they do the right thing and address the issues.
A number of years ago, the federal government put, I think, all jurisdictions across the country on notice around Veterans Affairs beds that are funded through the federal government. There are long-term care facilities across the province that have one, two, five, six dedicated Veterans Affairs beds in there, that the federal government funds. I haven’t heard much over the last little while, which may be no news is good news. This may be that situation, but I know there’s a lot of talk around the federal government to change how they support veterans and, especially, the definition of a veteran and who gains access to those long-term care beds.
I know, often Camp Hill is at the forefront around access to those beds, but we have, as I said, long-term care beds that are funded through Veterans Affairs Canada across our province. So, I wonder if the minister has heard anything from the federal government on any reduction in the federal government’s commitment to pay for these beds because, of course, as soon as they pull the plug, if they go that route, it means the province is going to have to pick up that funding and offset it, I would assume, to some degree. So, I wonder if the minister could give us an update, if there is an update, on what the federal government is doing with those long-term care beds that are designated for Veterans Affairs Canada.
MR. DELOREY: Thank you, Mr. Chairman. I appreciate the member’s question. I think, in terms of the specifics with the federal government, it’s best directed to them in terms of their intentions and so forth. What I can advise to the member through you and to all the members of the Legislature is, I’m not aware of any intentions or outstanding or pending reductions. It certainly hasn’t come to my attention in my time in this role.
MR. DAVID WILSON: Thank you, Mr. Chairman, and I encourage the minister and the deputy to keep on top of it because I know at my time in the department, it was often the deputy who would have those talks in the hallways and in other places than when the ministers are face to face and when the Ministers of Health meet with the federal minister across the country. So, I don’t think we should wait until they make a decision. I think we need to continue to say, listen, you need to fund those beds and we can play a role, I think, especially with our history of military service in Nova Scotia. I think we can be a champion for Canada when it comes to the federal government and some of the changes that need to happen on their level, especially if changing their criteria of a post-Korean veteran, compared to current-day veterans, and I think there’s a lot of talk there.
Camp Hill, I mentioned a few minutes ago. We know that it has been underutilized over the last number of years. The number of beds there have opened up. There’s still a challenge on the federal side and I’ll continue to advocate for the federal government to do the right thing and allow veterans to use that, but the province has used a number of those beds over the last number of years, especially with the renovation of the Dartmouth General Hospital. I’m wondering if the minister could remind us, or indicate how many beds the province is using now. They’re paying for those beds, and just an update on that situation at Camp Hill.
MR. DELOREY: Thank you, Mr. Chairman. I would have to dig into the specifics of that but we’ll get the questions about, specifically the Camp Hill facility, we’ll get that information and bring it back. But, related to the overall discussion that the member brought up, my understanding is that we have no long-term care veterans’ vacancies in the Province of Nova Scotia. So, again, those beds, as the member may be aware, are being used because we do have a veteran population and I would assure the member, in my experience working certainly with the MPs that support my community, I’ve seen nothing but advocacy on behalf of veterans, when needed in my community. So, I think our federal representatives do advocate as well as we do on behalf of our veterans in the Province of Nova Scotia.
MR. DAVID WILSON: Thank you to the minister. I look forward to that information because I know, like I said, when the redevelopment of the Dartmouth General Hospital is underway, we are using some of those beds.
I know it’s probably not on the government’s radar, but it was something that I had been talking with a few military personnel in the province and it was interesting, one of my colleagues from the Progressive Conservatives mentioned this, I think, in response to the Throne Speech and it’s around access to medical care for the families of military personnel. Often, or what happens now, is that military personnel’s medical coverage is covered. They seek treatment usually down at Stadacona, but their families are required to seek that support and services in the provincial public system. I’m wondering if the minister has had any discussion or, if not, would the minister be willing to look at, and ask of the federal government that they should be required to support the families of military personnel, especially if they’re transferred, especially in the environment that we’re in right now in Nova Scotia with a doctor shortage. I know of one family that has three boys, and the spouse has no doctor, but the service person has a doctor. To me, that’s just unfair. I know it’s not ultimately the government’s responsibility, but if we could get the government to support that, that’s a pressure off the provincial program.
MR. DELOREY: I thank the member for the suggestion. As the member noted, at the service level anyway, the level of the details that have been presented, if we were to have success in having discussions like that with the federal government - I haven’t to date had that conversation. Perhaps it’s my location as the MLA for Antigonish, we certainly do have service men and women, but not the resources that you would see up here in the HRM part of the province, where you would have active service personnel and where, perhaps, that concern is more acute.
Again, if the opportunity arises to have the conversation and raise it with my federal counterpart, I would certainly bring it up there, but I couldn’t hazard a guess as to how the federal government would respond or where they’re moving in this regard. But to bring the suggestion forward to them for consideration, I would be happy to do so.
MR. DAVID WILSON: I appreciate that. Whatever help or assistance I can give, I would be more than happy to lend it to the government, to the department.
As I said before, I do want to get into some of the numbers in the budget. I know often we talk around the numbers. I’ll be referring to pages in the Estimates and Supplementary Detail. Right on Page 13.1, when you look at the budget - I respect the fact that it’s a $14.1 billion budget. But when I went through it, I noticed the estimate was $4.132 billion, and the actual at the end of the year last year was $4.104 billion. That’s a reduction of about $27 million. I’m just wondering if the minister is okay with leaving money on the table.
In reference to how much money is there, it may be minimal, but when we were just talking about programs like mental health and community-based mental health and targeting funding, when you look at $2.6 million from the federal government, yet $27 million was left on the table, there’s a lot of potential there. I’m just wondering if the minister has any comments on that $27.5 million, I believe, that was left on the table.
MR. DELOREY: It is important to recognize that it is over a $4 billion budget. What we have to remember here is that budgets are forward-looking documents, where we expect to spend our resources. In this case, we’re talking specifically about the money that we expect to have the priorities of government and to spend that money moving those priorities forward. Again, it is forward-looking. There are circumstances and things that do change throughout the year that do impact budgets and sometimes, I think probably more often than not, those changes are where the management, underestimating perhaps, at budget time, the demands or the needs and the investments needed from government. That perhaps paints a rosy picture on Budget Day, but at Public Accounts when you’re closing the books for the fiscal year, you see that the investments end up having to be perhaps higher.
In the context that was just cited over the 2016-17 fiscal year, we’re looking at about 0.5 of 1 per cent variance in the actual spend of the $4.1 billion. The largest amount or contributing factor to that $27 million is almost $16 million underspent in the capital area. It is a conversation we’ve had. Indeed, in my role prior to becoming Health Minister, when I was in Finance, this was a common point of discussion when providing a fiscal update, seeing that capital project allocations to the Health Authority, to health projects that were delayed.
It is important for the members and others to recognize the complexities of timing. I think I used, for example, the member for Queens-Shelburne previously, when talking about the Roseway facility and how that is a project that had been announced several years ago, indeed predating our government, and yet we were very clear in our commitment. We are ready and we’re starting to move forward on that project.
The project was a renovation of the facility, all of the budgeting and the planning in that case, for that capital project, that would be capital expenditures, when the engineers and the staff that would be planning and preparing that work went into the site and did a more detailed assessment, they determined some challenges that you wouldn’t have known as you are planning and preparing for it, until you got a little bit closer to the ground. It was realized that the specifics of that specific site and the condition of the facility and some of the challenges, that it would actually be more cost-beneficial for the province, and that is the taxpayers of the province, to take the time, to step back and actually do a complete decommissioning; that is, taking down the building and putting a new facility up from scratch.
That is one example that I can highlight for the member for Queens-Shelburne - that situations like that do happen. The health care community there, although the people are anxious to have access to the new infrastructure and new facility, can respect the rationale for why in particular this delay would come into play. How that manifests itself on the books, though, is that indeed we had intended to spend more money in a given year. You come to new information, and to spend a little less. You would see stuff like that happening on various projects throughout the year.
MR. DAVID WILSON: I just want to know how the minister knew I was going to go from Page 13.1 to 13.14 - from the first page of his estimates to the last because, as the minister said, one of the areas that is reported on often is hospital infrastructure and the minister mentioned $16.5 million. So, last year’s estimate was around $34 million and the actual was around $17.5 million.
There is a reduction of about $16.5 million. I was just wondering, I’ll give the minister an opportunity to say, is there a specific project that is the bulk of that $16.5 million and, if not, could he elaborate a little bit on why under Hospital Infrastructure that reduction was seen between the estimate and actual?
MR. DELOREY: I thank the member for the question. So, when looking at the amount, it is important to note that what we are looking at is the net amount. I think one of the concerns, as I have mentioned - this has come up even in my term as Minister of Finance and Treasury Board - this is a concern I shared that I wanted to become more efficient and effective at planning and managing, in particular, our capital investments. Even within that, we have invested and were able to in those projects that were slowed down – that is, we anticipated to spend more money. Then we didn’t.
Part of that was offset by a project over at Dartmouth General Hospital, as part of the QEII redevelopment, where we were able to expedite some work there because of the anticipated underspend, and we were able to put almost $6 million towards projects there. If you get into more detailed specifics, that is to say, again, the interest and the concern that we have as a government to do a better job, that if we see areas where the plans aren’t advancing as quickly as we anticipated in our budgeting process, Mr. Chairman, that we look for those opportunities and plan a little bit better. I think this is a new way of looking at things within our health care system. Certainly, I believe the Department of Transportation and Infrastructure Renewal has far more experience at managing their capital projects, you know, looking and seeing all of the projects together, and that’s work that I’m hoping to bring forward within our health system as well.
I wouldn’t say that there is any individual one that takes up - from a percentage perspective - but the single largest would be the South Shore Regional expansion, so that would be the Roseway project which I actually used as my example. So, that would be the single largest portion of the underspend in that fiscal year. I think that was about $4 million and I’ve already provided the details as to why and how that manifested itself.
MR. DAVID WILSON: Thank you, Mr. Chairman, and that’s why, you know, going through the budget - even though I know that Health is such a large number when you look at it in total. I mean, the budget is line by line and, as we were just discussing the hospital infrastructure and the underspend of about $16.5 million, it brings me to Page 13.2, around Capital Grants and Healthcare Capital Amortization. We saw a reduction there of about $15.6 million. So, between the two, you’re pushing into over $30 million, right. So, just for some clarification, maybe a little bit on that line item, on Page 13.2, it was budgeted or estimated, the estimate was $72.4 million. Actual was $56.7 million, so, a reduction of about $15.6 million. I’m wondering if the minister could just elaborate a little bit on that, just so that we’re clear, because there are a number of areas in the budget that show some underspent money and we just want to make sure that there’s a reason why.
MR. DELOREY: Thank you, Mr. Chairman. I believe that variance works out to the same as, I would think, of approximately $16 million. It’s actually referring to the same capital projects. It’s listed as Capital Grants and Healthcare Capital Amortization I think in part because the infrastructure that belongs to the NSHA, it just gets into some accounting details with respect to - from the Department of Health and Wellness, it’s a grant to the Nova Scotia Health Authority. Within the Nova Scotia Health Authority, it’s a capital asset and would follow through and flow through. The net effect, it flows back up and rolls back up onto our bottom line, but it does get recognized both in Health and Wellness as a grant to the Health Authority and then the Health Authority’s expense, but it’s really just the way that the accounting within the organizations have to recognize it.
MR. DAVID WILSON: Thank you, Mr. Chairman. So, we notice under the estimate for 2017-18, it has gone back up, an increase from the estimate of the previous year by about $24 million. Is the minister confident that that’s where the budget will be, around the $81 million, $81.6 million and is he confident that next year when we’re doing this all over again, when I’m talking about the actual of 2017-18, we may be closer? Those two figures may be aligned a little bit better?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. Indeed, the estimates that we put forward are certainly our best estimates as to what we think, based upon the information of government priorities, the operational needs of government, in this case focusing in on the Department of Health and Wellness.
Again, the priorities that we have are part of the reason you see a bit of a more significant increase. Even estimate over estimate, is because we are endeavouring to continue moving forward on our QEII redevelopment project, the expansion work at the Dartmouth General, which the member may be aware of, is well under way. Ground has been broken. So, again, once you get to that stage, we expect to see that project continue. Again, it’s my intention to continue to work to the best of our ability to ensure that the capital money that we’ve budgeted, we’re able to expend and deliver on those capital expenditures in our health care infrastructure.
MR. DAVID WILSON: I’m going to stick to some of the figures on Page 13.2, Strategic Direction and Accountability; under Chief Medical Officer of Health there’s probably about $800,000 between estimate and actual, but from estimate to estimate there’s a reduction of about $700,000, I believe, from 2016-17 to the estimate for 2017-18. Just wonder if the minister could give us a bit more detail on why that change in budget is required?
MR. DELOREY: I believe that particular impact there relates to an allocation that was originally in the last fiscal year, allocated to that office, so this is correcting that. That’s why you see the reduction, on the year over year, it was an allocation that was never intended for that office.
MR. DAVID WILSON: If we were to turn to Page 13.4, under Programs and Services, we see another reduction under the Chief Medical Officer of Health from $2.3 million, if I’m reading this correctly, to $1.4 million. I would think that that’s a reduction of about $800,000, and we also saw the reduction in the estimate, the actual, of about $600,000. Just wondering if we can get some clarification on that line item, under the Chief Medical Officer of Health?
MR. DELOREY: Again, a significant portion of that was, as I mentioned, an operating cost that had, incorrectly, originally been allocated there. It was, I believe, services being provided out of the Health Authority as part of that restructuring piece, in the roles. There was a piece of that work that had moved over, but the funds still maintained themselves in last year’s budget, so this is a correction to that piece.
The other, probably major piece, is savings related to bulk printing costs within that department. As you’d know, the work of the Public Health Office and the Chief Medical Officer of Health, much of it is about promotion, and getting material and information out there to health care providers and the community at large. They do have a significant amount of printing and there’s a fairly significant decrease in transfer of the funding. Again, there’s work being done, but we’ve transferred the actual printing out of that department, into the Nova Scotia Health Authority that’s doing some of that work.
MR. DAVID WILSON: I know I only have a few minutes left. On Page 13.4, the Office of the Deputy Minister. The estimate to actual was reduced by about $158,000 but then, pretty much is restored this year. I was wondering why a reduction between estimate to actual?
MR. DELOREY: I believe what we had there was a shift, just a movement of resources between the minister’s office, and the deputy minister’s office. If you look, there’s an allocation there that transferred, and I believe it was just an individual personnel member.
MR. CHAIRMAN: Order, please. The time for the NDP caucus has expired.
We’re going to take a short recess to give the minister and his staff a chance for a break. We’ll be back shortly.
[5:30 p.m. The committee recessed.]
[5:34 pm The committee reconvened.]
MR. CHAIRMAN: Order, please. We will now call the Committee of the Whole on Supply to order.
The honourable member for Queens-Shelburne.
MS. KIM MASLAND: I have a question around the secrecy surrounding the Nova Scotia Health Authority board. All regular board meetings are essentially completely secret. To clarify, before the boards were amalgamated the present Queens County Health Board ran public meetings, properly announced with open agendas, and the minutes were published. The NSHA does not publish agendas, persons attending, and the purpose of their attendance and input is unknown. I’m sure we can all agree that open government and fiscal management is a requisite for a democracy. Why then are regular meetings of the NSHA held in camera and minutes not published?
MR. DELOREY: I thank the member for the question and concern being raised. Certainly that is something that in terms of the extent to which communication and accessibility of the board and the work that they do, that is certainly a concern that is shared. We would certainly hope to see more engagement, more exposure within our communities. It is one of the reasons why we have the Health Authority to get out to our communities, to have access.
Since coming into office, I know that in discussions with the chairman, when I have gone down this path to have some discussions about how engagement and the communication channels can be improved, not just within our communities but also, in particular, our health care stakeholders at the front lines. In one of the last conversations I had with the chairman, he had indicated his efforts to get around himself to hear some feedback. So I am consolidating all of that information to come through and kind of putting together my action plan as to how to move forward and address some of the concerns that have been brought forward to me through that process of engagement out in the front lines.
Again, we will certainly be looking at how we go forward with the Health Authority and its engagement. Much of the conversation is with front-line health care professionals, the staff and the service providers. But you raise an important consideration for the broader community access as well.
MS. MASLAND: I have one further question concerning the nurse practitioner for Queens General Hospital. Last year, we lost one of our doctors who worked in our collaborative care centre and when the Nova Scotia Health Authority was approached asking for a nurse practitioner, the family physicians were told no. So the hospital foundation stepped up to the plate to keep those patients out of the ER - which would cost the government much more - and paid with foundation money, which is donations of the community, and payed for health practitioners for six months. It is my understanding that the government has now stepped up to the plate and is paying for the following six months.
My question is, is that now considered a permanent position at Queens General, and will that funding remain in place for that nurse practitioner?
MR. DELOREY: I would have to check in to get the very specifics of that particular position, to answer more completely for the member. But notwithstanding that, I hope that the member and her community do see, most importantly, the shift - again notwithstanding the circumstances that led to the situation, as those circumstances are consistent with some concerns that were brought forward - notwithstanding the concerns we have heard before about forcing individuals as to where they practise and so on, I think what you see here with that shift, is consistent with the direction and the shift in direction to be a bit more flexible, that the focus is on ensuring that we get the care out to our communities when those opportunities present themselves. That’s where I believe the situation is, but I’ll get the specific answer. I don’t want to set the member’s expectation unnecessarily. So I will certainly reach out to the NSHA to find out what that specific position is and get back to you.
MS. MASLAND: Just to wrap up, it is not a question, but it is very important for me to say to you today because I would like a commitment from you. As you may have heard in my maiden speech, I referenced the amazing doctors in Queens County who work shoulder to shoulder with the Opioid Replacement Therapy clinic. This is extremely important because we have a serious opioid crisis in Nova Scotia, and specifically in Queens-Shelburne.
I think it was mentioned that, on travels, maybe the opportunity wasn’t there to stop at Queens General, but I really believe that it’s important - and I think we share some of the same emotion when it comes to mental health and opioid replacement therapy and the opioid crisis that we face. It’s really important for me as a member, that that stop is made and that you do visit with these people at this clinic, so that there is an understanding of the challenges that are faced there. So I would like to have a commitment from the minister that a visit will be made to Queens General to stop and visit this clinic.
MR. DELOREY: I appreciate the member’s interest, not just in mental health and addictions generally, but very specifically on the opioid situation facing not just her community, not just the Province of Nova Scotia, but indeed the country and really much of the western world, and particularly here in North America. This is a situation facing our country that for those who have paid attention - although the member is obviously well aware of the situation - I just want to take a moment because I don’t think all Nova Scotians are aware of the circumstances that do exist in our communities with individuals who are maybe our neighbours or, indeed in some cases, our family members.
Although I didn’t get to visit the clinic there, probably one of the most memorable stops on the tour of many was actually in Amherst where the meeting was with a coalition group of individuals. It wasn’t really a formal government program or initiative, but rather a group of people who happen to provide government services. You saw some nurses and other health care providers, but you also had community members, you had representatives from the RCMP and the Department of Justice who came together. They’ve been working together for several years - long before the notion of the challenges in opioids even made the headlines, certainly in the eastern part of the country, other than the odd national headline that would be made from what was happening in the western parts of the country. So they saw it really in their community, the border community, in Amherst and surrounding areas.
That was a really memorable meeting with those stakeholders who live it and see it and work with community members, advocating on their behalf. I think that’s why the work with our opioid framework that we released in August - the commitment with a five-pronged approach to move forward to address the situation - is a big shift in the public health approach to dealing with addictions, especially such serious addictions as the opioid situation, which can be the situation starting with, or related to prescription-based opioids, but also in situations where other illicit products in communities may have opioid-related or products laced with opioid derivatives and so on, that people become addicted to. It can occur in different ways.
This framework is a shift from the notion of strictly focusing on criminal and so on, but recognizing the challenges faced by people with these addictions - in many cases through no fault of their own. It focuses of course on education and the desire in an optimal world, abstinence and avoiding these situations, which would be an ideal world. What we’re realizing now is that we don’t live in an ideal perfect world, that indeed, harm reduction needs to be part of the solution and the approach we take. That’s why we’re investing in the Naloxone kits - to save lives.
In addition to that, we are also investing significantly in our budget to go towards expansions of clinic spaces, to ensure that the wait-list that is currently there in our communities across the province is addressed. But also the funding we have allocated actually anticipates continued demand and growth in demand. While we prefer not to have growth in demand, we think it is far more prudent on behalf of the people of Nova Scotia, not just those seeking treatment but also their families and the community members who care for these people.
You know, far too often those individuals suffering with addictions are relegated to the sidelines and their value from a broad societal perspective is often overlooked, but we have to recognize those individuals are, in some cases, parents themselves. They have sons and daughters, or they are sons and daughters of other Nova Scotians. So we are investing to have about 250 additional spaces across the province, on top of addressing the actual outstanding wait-list.
As far as the specific question, I will certainly do my best to get down there to your community to visit that site.
MS. MASLAND: I will now share my time with the member for Argyle- Barrington.
MR. CHAIRMAN: The honourable member for Argyle-Barrington.
HON. CHRISTOPHER D’ENTREMONT: Pleasure to be back for a few moments to discuss Health and Wellness issues. There are a couple of things that I do want to bring up. First all I want to start off with something that is important to my neck of the woods. I think we talked about it a little bit already. The second one is a process issue that frustrates me to no end, as a member of the Legislature.
First of all I want to talk about cancer treatment, and cancer treatment especially in southwest Nova Scotia. I know that there have been a number of meetings that have been held. I know that the minister is fully aware of the request from Yarmouth to have a radiation oncology system, to be able to get that service without having to drive here to Halifax.
Like I said before, one of the dirty little secrets of health care in Canada is, it is great, you can get the service - if you can get there. Because, of course, travelling in a lot of cases is not covered on behalf of our residents. They have to live outside of their communities in order to receive that service. So maybe a few moments, if the minister could bring me up-to-date, and of course bring the constituents of southwest Nova Scotia, as to where we are in the process of looking at the possibility of having a radiation oncology centre in Yarmouth.
MR. DELOREY: Thank you to the member for raising this question. Indeed, I often start my comments recognizing their interest on behalf of their constituents, but clearly the interest in this particular topic expands across Party lines and constituencies.
The status is yes, as part of my tour a few weeks back around the province, I did have an opportunity to stop in Yarmouth. One of the meetings I was able to organize was with advocates in the community, representing some community members, foundation members, as well as a council member who was in attendance. Again a broad range of individuals who have an interest. They certainly made their case for why this should be considered by government.
What has transpired - I wouldn’t say necessarily since then - it was information I was able to bring and share with the constituents at that time, that we have had conversations with Dr. Bethune, who is obviously a leading expert in the province around oncology services, cancer services. He has initiated a review that is taking place starting this Fall. He had indicated at that time - which would have been later in August - that at that time the work was underway for the design of the review that he was going to be leading, with the intention to actually get the formal review itself started this Fall. Again, I have every confidence that the commitments Dr. Bethune made to ensure that it’s a proper review and that it gives all due consideration to the services and cancer care within the province, that that will be taking place. I look forward to getting those results back from him and we can consider what steps once we see those reports.
MR. D’ENTREMONT: I appreciate that. I know that the community is ready, willing and able to partner with that. I know the foundation is more than ready to do its part, even though they know it’s one hell of a mountain to climb. I would also suggest that a number of years ago we were able to access wait-time funding from the federal government to help pay for the new machines here in Halifax. That was a replacement one or an upgrade to the one in Sydney. We need to be able to take all of that basket together and see if there’s a realm of possibility of how to pull that off.
I thank the minister for that input and look forward to the discussions that will probably happen over the next number of months on it.
The second issue that I want to bring up quickly is a little off of this one. It revolves around long-term care. I could stand here and talk about the inadequacies of long-term care in southwest Nova Scotia - the availability of beds and all that stuff. We know there’s a challenge. We’ve got to build some more beds. It’s going to take some time to get that all figured out.
We as MLAs are probably the - I don’t know how to say it. When people go to your department to try to get some kind of information out of the continuing care coordinator to find out where their loved one might be placed or how they’re going to be placed, the challenge that I have is that if they don’t get the right answer over here, or if the flow of information is lacking, they’re going to come to their MLA to try to find out what they can. Where is my mom on the list - probably all of us have gotten that as MLAs - where is my dad on the list, where is my loved one on the list?
So we try calling into your department to get that answer, and then we’re confronted with a number of challenges. One, do we have a confidentiality agreement signed, and if we do have one signed, sometimes it’s accepted and sometimes it’s not. Sometimes the staff member is different - their interpretation of their rules is different from what the previous person’s was. So you can understand the frustration that I can never find out where mom is on the list. I don’t know if I want to know exactly where that person is on the list, but we keep running into this wall trying to advocate on behalf of our constituents and our patients.
I’m just wondering if maybe the minister has some thoughts on how we can streamline this - I would say, mess - so that we as MLAs can actually advocate on behalf of our communities?
MR. DELOREY: As an MLA representing constituents myself, I’ll assure the member that concerns with respect to the processes to fulfill our duties as MLAs - I think it’s equally shared across the roles that we fill.
Recognizing that we would want to do better, especially in the area - in particular, consistencies - with the services being delivered and offered across the province, indeed we want to make sure that we do have consistencies. This is one of the objectives of actually having a single health authority and the department work that we’re trying to do. Certainly that’s part of the ongoing operations. We’ll do what we can to improve that.
With regard to the specific example, although the example was with respect to wait-lists and long-term care, I suspect the concern could be applied in a broader context, so we’ll certainly take a look at that to see what can be done in terms of improving the consistency and the efficiency of the processes.
With respect to the specific concern around long-term care times, I know we’ve had some other questions earlier this evening about long-term care and the wait-list process. I think, recognizing that it’s a dynamic list and it shifts, people can get reassessed. I think it’s a challenge sometimes to set people’s expectations by saying, this is where someone exists on the lists. I think that might be the reason why care coordinators are often hesitant to provide that level of information to individuals, because you may find yourself in a situation where constituents start counting the entries and exits of facilities in our communities and wonder why someone may have made it through, again recognizing, as I’ve mentioned earlier, there are clinical assessments that can be reassessed, and an individual on the list may change their acuity and thus the priority placement. So it is hard to ensure the list. It is not a static thing.
MR. D’ENTREMONT: No, I never expect it to be a static list, because I understand the challenges of patient safety and somebody comes in and is assessed at a higher level than someone else. There is always a challenge to that. I know it is probably not on the full priority of what the department should be working on but I think we should be an asset to the community. We are not the bad guys. We are just trying to clean that up, in order to make sure that they have the best information that they possibly can, because we know the waits can be very long.
With all due respect, they are counting people going into those homes. They know exactly everybody who is there. They question everybody who goes into them. Why did that person’s sister get in over and above my husband or wife? So there is a tremendous challenge there. I would never want to be a care coordinator because I don’t think there is anything that you could ever do that would be right.
It is a tremendous challenge. I thank you for that. That is my questioning and I appreciate the minister for his time here, and I will be sharing my time with the member for Kings North.
MR. CHAIRMAN: The honourable member for Kings North.
MR. JOHN LOHR: I appreciate the opportunity to ask a few questions on some things specific to Kings North. Saying that, I do recognize that many of the same issues my colleagues have already asked about are certainly at play in Kings North and in the Valley with the doctor shortage, access to drugs, access to specialists. We have a lot of different issues.
I realize that this is a bit of a marathon, and we’ve gone a long time already on many of those subjects, so I just want to ask about an issue very particular to the Valley, which would be if you could update me on where we are with dialysis going into Valley Reginal Hospital and when will we see that program there. I know that I have had friends on dialysis. It is a life-altering thing to have to go into Halifax for dialysis. My particular friend did get on the waiting list and did get in for dialysis. There was a bit of an improvement. I know that you are committed to dialysis in the Valley.
I am just wondering if you can give me any idea of the timeline and when we will see that go in place.
MR. DELOREY: So this is one of the dialysis projects at the Valley Regional in Kentville that we are certainly committed to. It is work that does have a significant budget contribution, I believe. Just to illustrate, you know, again several million dollars allocated, somewhere in the vicinity of $3 million for this project in this fiscal year that we expect to expend. But it is a contract right now. The work is being done, the meetings bi-weekly for progress and status updates on this work. So right now a lot of that work is underway, with the design and implementation. Once the final sign-off comes on the designs that are in place, I think, the next phase would be actually - it is not quite breaking ground because of renovation inside the facility - but I think you get my point that once those designs are done, the work can commence.
MR. LOHR: I would like to thank the minister for that answer. What would you say would be an expected completion date for the project to be installed, approximately?
MR. DELOREY: To the member, I am often loath to provide estimates on projects because we know that capital projects do often - we were talking about the financial side a few moments ago - but I will, for the member indeed for his constituents and residents in and around who may make use - right now we would be expecting completion at some point in Spring 2019. It will take some time to get all of the work completed, but the latest information I have would be an estimate of Spring 2019, again recognizing that large capital projects, particularly in the health care environment and particularly in an active health care setting, there are a lot of challenges for the workers and that delays do happen. We have to keep in mind the continuity of service delivery and that maintaining a healthy environment when this work is ongoing is top priority as well.
MR. LOHR: I’m not a medical professional, but if I think about a project like that, I think there are probably three elements. One would be the physical building, the second would be the actual equipment and the third would be the staffing. I know when they speak of dialysis, they speak of chairs. Do you have any ballpark figure of how many chairs or how many people this unit would service at one time?
MR. DELOREY: I believe the number of chairs - again recognizing that dialysis patients are literally sitting in a chair attached to the machine that treats the blood, so I don’t want to say “confined” but by nature of the treatment they are restricted in their movements because of the attachment for the blood to be cleaned and rotated back into them, for an extensive period of time. I believe it’s 12 chairs within the Valley-Kentville site.
MR. LOHR: I guess the last question on dialysis - would you anticipate that this would involve a new physical building, whether it be an addition to the hospital or will it be incorporated into the existing hospital?
MR. DELOREY: I’m going to double check to verify for the member, but I believe this is requiring some additional space being built with a connection to the facility. It’s not simply an internal renovation, but a construction, an attachment to the existing site; but I will verify that for 100 per cent accuracy and get back to the member.
MR. LOHR: I guess to the minister’s comment, that would be my guess too. I don’t know if there is exactly a lot of empty space in that hospital - it’s pretty full. In fact, so much so that at some point in the past they moved the administration offsite and utilized some of the administration space from what it was originally built.
This is the last line of questioning. Can you update me on the hospice, when ground will break? I know a site has been picked. I believe the design work is done. Is the design work done and when can we expect the ground to break on that?
MR. DELOREY: I appreciate the patience as I was just trying to collect the most recent information or update that I have. I don’t have exactly an estimate for breaking ground in the information I have with me. Again, I will go to grab that information and follow up with the member.
Just to give the member an indication of how quickly we work, I did get confirmation on the previous question, that indeed it will be an attachment with a link to the facility for the dialysis. I had indicated in my previous answer that I was going to verify that. I have verified that that would be construction attached with a link for the dialysis.
I will have to get back to the member as to when ground is expected to be broken on the Kentville hospice work.
MR. LOHR: I guess at that point, I would like to thank the minister for those answers. I would like to turn it over to my colleague for Northside-Westmount.
MR. CHAIRMAN: The honourable member for Northside-Westmount.
MR. EDDIE ORRELL: I want to start back where I left off. I had a couple of minutes earlier in the week. There are a couple of other little questions I want to ask.
The first one is, there’s money in the budget to increase the caregiver allowance that people are going to receive. I know the caregiver allowance as it sits is not a true caregiver allowance because it’s only for people who have dementia or have other problems. It’s not for a person who has their loved one at home, and they need a little bit of respite to go out and do the grocery shopping or so on and so forth. If you’re going to improve that caregiver allowance, has the criteria lessened so that people who need it can access it? Is the money different, or is it the same?
MR. DELOREY: I thank the member for raising the question. Our focus here on that investment of almost $2 million, I think about $1.9 million, that has been allocated, is designed to be targeted to expand the number of people who are eligible to receive this benefit. The focus is on ensuring that more people are eligible to receive those supports, taking into account things like the income threshold and the various criteria. That is the goal, and we’re working to make sure that we can have the criteria to ensure that the people who need it, particularly those who need it the most, are going to be covered with the updates to the program.
MR. ORRELL: But the criteria of the patient as it sits right now limits the amount of people who can access that fund. If the person doesn’t have dementia or they’re not screaming and hollering - I had a gentleman whose wife had a stroke. He took her home, and her head was completely clear, but physically she wasn’t going to be able to care for herself. He couldn’t access that caregiver allowance because she didn’t meet the mental criteria for that.
If we’re going to expand that money and that program to get more people, the actual criteria of the patient and the parent or the caregiver has to change and expand. Is that happening with this?
MR. DELOREY: Yes, there will be changes to the criteria, as I said. There are still going to be criteria and an assessment necessary - not of the caregiver, but the citizen, the patient, the client would still require an assessment. Again, to ensure that we can get those additional investments, the additional money rolled over to cover more caregivers, the way to do that is by expanding - or loosening, I guess - the criteria to ensure that more patients or clients are covered. Again, that’s the role of the program change.
MR. ORRELL: Thank you. That was the thing I was looking for. People who were trying to access that program couldn’t, because the criteria were too stringent. So that’s great.
The previous minister, when he was down to visit us a year or two ago, gave us his word that the emergency room and the lab and the Northside General Hospital in general would not be closing - that there may be some changes, but they would not be closing. Now we have an emergency room that’s open from 8:00 a.m. to 3:00 p.m. every day. The nurses have now been transferred over to the Cape Breton Regional Hospital, and there’s no indication that they’re going to be coming back, that the positions at the Regional are going to be filled.
Can the minister give me the same assurance that the Northside General Hospital will not close and that lab and emergency services will still be available?
MR. DELOREY: I’m not aware of any changes, and I have certainly not initiated any changes from that position that the previous minister had. I’m not aware of any changes or thoughts about that site that would have changed the position from the previous minister at this point in time.
MR. ORRELL: That’s great. Thank you, sir. My question is, does the Health Authority have any plans to change that? Could you find that out for me, and could you convey that to me one way or another so that the people on the Northside will have something that they can either look forward to, or realize that’s not going to change?
If you could do that, I would appreciate it, as would my constituents. They’re starting to rally around the Northside General and some of the changes that are going on, and there’s real concern amongst the elders in the community and the people who have children, especially, who maybe don’t drive, to get to an emergency room or a hospital for care. It could be life and death for some people, so if you could check that out for me, that would be great.
The other thing - I guess the biggest question I have - is, back in June 2015, there was an announcement that a CEC was going to be in Sydney. That announcement was made before a meeting that was held in public with people at the Joan Harriss Cruise Pavilion. There were 1,000 people at that meeting who were told that that CEC was going to open in January.
January has come and gone, and we’re now into a second year. I don’t know if there’s any sign of that happening. Can the minister give us an update on when that will open and how many doctors and health care professionals will be working in that centre?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. I’d have to dig back - I think you said June 2015? That predates both myself and the deputy who’s here supporting me. We’d have to dig back to see what exactly the commitment was in terms of specifics for the Sydney community.
I know in the New Waterford space, which would be in proximity to Sydney proper, we’ve spoken for collaborative centres and the work that we do. That work is ongoing. We’re focused on that site, for sure, within that general - again, I recognize the distinction between those communities, but again, that is a priority area that we’ve been focusing on more recently. I’d have to go back, as I said, to check what exactly was the nature of that 2015 meeting that the member referenced, Mr. Chairman.
MR. ORRELL: Thank you, Mr. Chairman. I guess basically I have one or two more questions left to the minister. I’ve heard, and I’m very happy to hear about the option and the opportunity for internationally-trained students to come into the area, that they’re going to open up some more residency programs. My understanding of that was that the international student program is going to be as much for our Canadian Nova Scotian students who are internationally trained than it was for actual internationally trained students. I could be wrong, and correct me if I am, but my thing is if we have a shortage of doctors like we have now and we open that up to our Canadian students as well as international students, our Canadian students, our Nova Scotia students, the Nova Scotia Government hasn’t paid a nickel, not one nickel for an international student to be trained to come here as a doctor.
They can come here to do their residency, and nine times out of ten they stay. If we open that up to them, we’re getting doctors for free. So, an incentive is great. Most of them don’t worry about the incentive as long as they can get their residency here and a billing number. Is the minister aware that’s what the plan is for this, in opening these international students up and/or the residencies for the students who are at Dalhousie University?
MR. DELOREY: Thank you, Mr. Chairman. A couple of things to note. So, yes, on the specific residence seats that we’ve focused on which cover both family practice, primary care seats, and specialist seats, those would be as per our traditional residence seats for residency spaces. So, that is part of a national program for residents. So even though the seats are allocated or assigned under the Dalhousie Medical School program and they manage those resident positions and the training that takes place under the residency program, the way that resident seats are filled, and this, I believe, is practised right across the country, is that they are part of a national - there’s a name for the program, I don’t recall off the top of my head the name of that national program - but, essentially, it’s a program where all of the provinces and territories that have resident positions available, those positions are documented in the system. It’s electronic. There’s obviously some human oversight, but it’s entered into the computer system.
So, that’s the residents and the seats the provinces and territories have available. Then, on the other side of the equation is the medical students, residents who are looking to be placed and it’s almost, you know, I think when it was being described to me in a meeting with residents - because I was having to understand how, broadly speaking, the residents program worked - I think it was referred to, in part, as almost a matchmaking or a dating service between residents and those positions because the residents identified their preferences, be it by location or type of service or opportunity in the area and then, of course, the jurisdictions that have resident seats obviously describe the characteristics of the residencies to be filled. So, for those family and specialist positions that are identified as residencies, it would still flow through the same, general process. So, it’s really open to all Canadian students to fill those seats and it’s just a matter of the fact that Nova Scotia has more seats available.
For the international lens that the member was talking about, what that is called is the practice-ready assessment program. That’s a little different than what we’d see as a traditional residency program. So this would be a situation for already-qualified international medical providers, physicians who are already qualified. So not moving them in, necessarily, for residency, but rather a process by which they can come into the province, be properly assessed and vetted, and hit the ground running in the province. That work is ongoing to get that program designed and implemented.
MR. ORRELL: So these international students who were, supposedly 10 extras, are not going to be actually international students. They are going to be international graduates. They are going to be vetted. I guess I don’t understand the answer I got there.
They are not going to get a residency? They are going to go into the same pool. This is not going to benefit Nova Scotia any if 10 kids from Quebec want to come here and do their residency and head back to Quebec. This is not going to benefit the Nova Scotia students at all. Can you explain that a little better?
MR. DELOREY: As I mentioned, it could, I guess, if Nova Scotia students are working elsewhere or have their qualifications from other jurisdictions, that opportunity to come in and be assessed, there can be the opportunity for them there. This is about the practice ready for those placements for internationally-trained physicians, qualified individuals, to come into the province. Again, a little different than just explicit residency seats. So, we know that we have additional residency seats that are being allocated, but we also have tuition reimbursements, bursaries, debt assistance and other educational incentives provided to students studying and available here.
Again, there is a lot of work for the recruitment initiatives to bring in physicians, primary health care providers across the province. I am quite confident that the combination of these various initiatives and programs from the additional residency seats that are committed, the practice-ready assessment program as well as, again, the incentives going out to new graduates, are all programs and initiatives that are going to, on top of the clerkship program being rolled out to third-year medical students, are all going to pay dividends in our efforts to improve primary care service for Nova Scotians by providing a wide variety of options to ensure that we get primary care providers delivering services here in Nova Scotia and including in Cape Breton. We know that some of those residency seats are allocated to ensure that we get more positions up in Cape Breton as well.
MR. ORRELL: So I guess the answer is, that residency program is not actually a residency program for international students. I guess I will finish by asking, can I get that description in writing of what that is, before the end of this session happens? My daughter is one of those international students who’s excited to hear that she was going to be able to apply for residency here in the province over and above what they already provide. She is trying to make a career decision of where she would like to go to work. She would love to return home, but if that residency program is not an actual residency program, the chances of her getting one of them are still in the thousands. I’d wish the minister could provide me in writing what that new program is going to actually entitle, in writing, before the end of this session, so that I can convey to them exactly what the residency program he is talking about is.
MR. DELOREY: Sorry, I think where some of the confusion comes in is perhaps the way some recruitment programs and initiatives can interplay. So, again, I want to go back to specifically the residency positions. They will allocate or work in the same general fashion, I believe, as a residency program, but we do have as part of our educational incentives, we do have funding available of, I think about 1.3 per cent or $1.4 million available to help incent those medical graduates and physicians coming back in and getting into a residency program.
Again, we are restricted based on the total number of residency positions that we do have in the province. We do have incentives. We are certainly interested in Nova Scotia students recognizing the opportunity. They already know about the community. They don’t have to be sold on what opportunities there are here, but it would be kind of through a combination. They would still have to apply and get matched through the residency program to fill a seat, but we do have incentives and supports through our educational side to support situations like that.
MR. ORRELL: So, the province really has no say in it as long as - if they go into the match program. It’s through the Canadian matching program or Dalhousie University. It’s got nothing to do with the big pomp and circumstance that 10 more residencies for international graduates are going to be available. So, it still has to go through the same channels it goes through now. It just allows 10 more to happen. I’d like to get that in writing if I could, just so I can explain it to whoever is talking to me, because I’ve been talking to people who have left here, who have trained abroad, have qualified, but couldn’t get a residency here. So, they’re gone and they’re never coming back. There are five kids whom I know in the last year, whom I’ve spoken to personally who would have done a residency here. If they go and get their qualifications because their residency is going on somewhere else, they don’t come back. So, if I could get that in writing to explain to them, because to me it sounds like that announcement is for 10 new residency positions but it’s going to go through the same process it went through before. So, it’s not going to benefit anybody that way.
MR. DELOREY: Thank you, Mr. Chairman, and certainly as part of the follow-up, we’ll provide the additional information requested by the member. Thank you.
MR. ORRELL: I’m going to pass it on now.
MR. CHAIRMAN: The honourable member for Sydney River-Mira-Louisbourg.
HON. ALFIE MACLEOD: Thank you very much, Mr. Chairman, and minister, I’ve got a couple of questions for you. You should be all done in two or three days. My first question though is, it’s a very serious issue and the issue is that of prosthetics.
There are a number of people who have to travel from Cape Breton, which is a four-, four-and-a-half-, five-hour drive to come here for a 10- or 15-minute tweak. I’ve spoken in the past to the former Minister of Health and Wellness on several occasions and as recently as just before the last election, to talk about the opportunity to have a clinic in the Northside General Hospital. The facility is already there. They used to be able to - not to get legs made or arms made - but to actually get the tweaking done to save people - I know of one couple who are making three and four trips in a month to come to Halifax for, like I said earlier, a 10- or a 15-minute meeting. So, in the practice of serving those people and giving them an opportunity of not having to do the travel with all the other challenges that go with that, I would like you to be able to give me an idea if your department, one, is looking at the intention of doing this - such as, a satellite clinic - because, in the past, I’ve talked to the director here and I’ve talked to several clinicians who were willing to travel to Cape Breton to do that work and, two, can you provide some assurance one way or the other if such a program will ever take place because, again, there’s a lot of hardship on a lot of people because of it.
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for raising this issue with me, as he’s mentioned having raised it with my predecessor. I don’t know offhand what the status of the work is that would have commenced under my predecessor but what I’ll do is guarantee the member I’ll dig in and see what work may have already started and we’ll definitely pick up where my predecessor left off to see. I’ll get back to him with the details and whether it has been assessed as to the feasibility and the opportunity. Certainly the member makes a case on behalf of constituents, not just his constituents, but from a broader Cape Breton area. That is something worth looking at. Again, I just can’t comment on where that work has gone and the extent to which it’s been assessed but when I get that information, I’ll get back to him.
MR. MACLEOD: I want to thank the minister for that answer and I appreciate the fact that, of course, he wouldn’t have that information but it is an undertaking and I thank him for that because I do hear about it on a regular basis. As the minister knows, I have that little challenge myself, but I’m here on a regular basis, so it’s not as big a deal for me, but there are a lot of people for whom it is a major financial hardship, as well as everything else.
I wonder if I could ask the minister quickly if he could tell me where we stand with the recommendations that were made with the Kutcher report regarding the challenges with mental health on Cape Breton Island.
MR. DELOREY: I thank the member for this very important question about probably one of the first and certainly more substantive tasks that faced me when I came into this position. A couple of the Cape Breton-specific recommendations that came out of those recommendations were, the funding to the Cape Breton-Victoria Regional School Board to ensure that the guidance positions were available and the additional investment for the CaperBase programming so they can continue and expand some of their services. I believe those monies were ready to flow to provide those supports.
Some of those recommendations went beyond Cape Breton but certainly apply and support Cape Bretoners as well as other Nova Scotians, like the recommendation to ensure that additional resources were provided to the crisis line. I believe that was something that was moved on right away by the NSHA to ensure that there were additional staff, initially on a temporary basis, and then moved to make those positions permanently filled.
Some of the other items do fall over into the Education and Early Childhood Development Department, recommendations around some curriculum and evidence-based consideration of best practices in the curriculum surrounding mental health initiatives and so on. Those recommendations were all accepted, and we’re working towards them. Those again covered the specific Cape Breton ones. The work and the action are ongoing with the commitments and the expanded investments in mental health, to ensure we get our clinicians to get expansion of SchoolsPlus into our communities right across the province.
These all, if not explicitly referenced in the recommendations, certainly serve the spirit and will serve to benefit particularly our youth when it comes to mental health services across the province.
MR. MACLEOD: I’m sure that the minister is aware, but I will remind him, that the funding that was given to the Cape Breton-Victoria Regional School Board was money to maintain positions that were already in place. There were no new positions. Those positions were in place when the tragedies happened with those three families. There weren’t enough resources then, and there are not enough resources now.
Is there a plan to take forward more resources for the people in that school board and for families in general right across this province? As the minister knows, this is a problem that is not maintained in one specific geographical area of the province; it’s across the province. People are concerned and worried, and they’re losing their loved ones. You say that there was funding given to the Victoria school board, but that was only to maintain what was already there. It did not add any new resources.
MR. CHAIRMAN: Order please. The time for the PC caucus has expired.
The honourable member for Cape Breton Centre with 27 minutes remaining.
MS. TAMMY MARTIN: I’m just referring to my notes here. I’m referring to an announcement that was made in July of this year. The Department of Health and Wellness and the NSHA told home support employers that the agency contracts will only be extended for six more months rather than being renewed on August 1st. The agencies will be required to conform to the DHW and NSHA requirements for addressing indirect service costs, and if an agency cannot meet the requirements, the contract will be cancelled.
Having said that, Mr. Chairman, my question to the minister is, why would the contracts not be extended, and what is the government’s plan if and when they don’t meet these requirements put on by the Department of Health and Wellness, as well as the NSHA?
MR. DELOREY: Thank you, Mr. Chairman. Just a quick clarification to make sure I heard the question and the context correctly, if the member can clarify or verify - it was home care processes that she was referring to?
MS. MARTIN: Yes. Home support services.
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. I’d be curious - if the member makes reference to that announcement, if she could - just to make sure we’re talking about the same thing - if she has a copy, she could table it so I could take a look to see the specific details that she’s referencing? I certainly don’t recall doing an announcement in July of this year in that regard.
What I do know, with respect to ongoing work with home care service providers, is that working with the service providers, the organizations that provide these valuable services to the people of Nova Scotia, to bring together a more formalized - I think over many years, the relationships have established, in a more informal way, the desire and the efforts as a province to move forward and formalize relationships and contracts and so on with our service providers would be in line with the expectations of the government and the Health Authority, in particular the Auditor General, to ensure that there can be some transparency and accountability in terms of where and how the resources are being spent.
That would be kind of an underlying rationale for moving forward in working with our service providers to develop - I think I made reference in some previous questions with the member to the work to develop key performance indicators and so on that would form part of the expectations of the outcomes within that space. But in terms of reference to, as the member put it, the cancellation of contracts, I’m not aware of that.
Again, if I could see the specific announcement to have that context, it might be helpful to further our discussion.
MS. MARTIN: Thank you, Mr. Chairman. I don’t know that it was a specific announcement, but the employers were being made aware. As you mentioned, minister, these key performance indicators would be part of the baseline, I guess, for contracts to be cancelled.
My fear is, and the fear of many home support workers and many people across Nova Scotia, is this is a way for the government to get out of contracts that have proven to look after our seniors and keep residents in their homes and change the way that the service is provided and/or funded, along with remuneration for workers?
MR. DELOREY: Thank you, Mr. Chairman. I appreciate the member, through you, clarifying the context, that it wasn’t an announcement, per se, but rather some form of information that was passed on. Again, I think we’re on the same page in acknowledging and recognizing that there are efforts under way to work with our home care providers, around identifying and establishing baselines around key performance indicators.
As I’d mentioned in my previous response, those efforts really stem from a broad recognition that the expectation of government, providing services to Nova Scotians, if they want a means to understand what services, what the expectations are, and so on, I assure the member and the members of this House, that the efforts there, about ensuring that those receiving care, those Nova Scotians today and into the future who rely on the services provided by our home care service providers, that, when the Auditor General assesses that, we’re able to say and show clearly that we do have mechanisms to ensure the quality and the value of the services being provided.
We can say anecdotally and go talk to clients all we want, but that generally doesn’t leave us in good stead when we do get reviewed of the types of programs and services. To the member’s fear or concern being raised that this exercise is somehow an effort to get out of the service delivery, that’s not the case at all.
I do hope the member and all members of the House do recognize and share our interest in ensuring, again, quality services, in a way that is measurable, that we can, for the services and the contracts that we put in place - it’s not an initiative limited to home care - we want to see improvements in this regard. I think many of the questions coming from the Official Opposition Party, through Estimates, actually did centre around this very point, and I credit the member for Cumberland North. Here’s an example I didn’t use in our discussions in Estimates, of exactly a means by which we’re making efforts, but I assure the member for Cape Breton Centre, I do want to make sure that the representative for Cape Breton Centre is aware that we are working, and our goal and our effort and our motivation is to work with our service providers. Not to disrupt the system, but to work with them to ensure that we move forward to, again, get those baselines around key performance indicators, that are evidence-based. I think that’s good for the care of the clients but also for the accountability that taxpayers expect, that we can show that accountability.
MS. MARTIN: I beg to disagree with the honourable minister. I don’t believe we’re on the same side with the opinion of KPIs for home care. Although I do believe, and can assure the minister that the standard to which they are measured now, those support workers are providing excellent care. More than, as I stated, just washing dishes. I would defend those workers, and think that they are already held to account, to care for our seniors.
I would like to move on, because we do have limited time. There was a comment today, going back to the Doctors Nova Scotia issue, that this is the first time since the 1990s that Doctors Nova Scotia has challenged the government of the day to a court challenge. It’s also the first time, under this government, that teachers went on strike, in over 100 years. So, I just want to bring that record forward, because I don’t think it’s necessarily a record to be proud of. Having said that, I am wondering, where in the budget does it show the surplus of the amount of money that’s sitting, regarding the benefits, the $4 million that we heard of today? Where does that reflect in the budget?
MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. Before addressing this one, I do what to clarify just for the member, when I made reference to us being on the same page with the KPIs, I didn’t mean to insinuate that the member was necessarily supportive or on the same side of the movement. What I’d intended in my comment there was in terms of the broad discussion, in terms of the concerns being raised around the notion of the KPIs. That’s what I meant when I referenced being on the same page with the specifics of the concerns being raised.
With respect to the allocation and the establishment of, I believe, it’s about $4.4 million in money that was being held in a surplus account with the Doctors Nova Scotia organization. That’s where those funds would be recognized. As that fund surplus amount was being developed and established, that occurred over multiple years under a previous Master Agreement with Doctors Nova Scotia. That process saw the government, through that period of time, making benefit payments based upon information provided by Doctors Nova Scotia to the government, which was essentially their estimate of what benefit costs would be rather than the benefits. So, that’s how that fund came into being and to be held within Doctors Nova Scotia because, essentially, the amount of money contributed to go towards benefits exceeded the actual costs of the benefits.
That’s something that government became aware of, I think, going into the negotiations for the agreement that expired in 2015 and was ultimately ratified and signed back in 2016, known as the new Master Agreement, the one that’s really in question here now. Recognizing that the process - and we believe that taxpayers and the Auditor General of Nova Scotia would expect more consistency in the direction of resources, taxpayers’ money being put towards a program. In this case the benefit payments would be shown to actually go towards that which it was intended to go towards and, again, in this case, is benefits.
That’s why in the new Master Agreement, the one ratified and signed in 2016, that the structure of how and where payments get made, I think Nova Scotians will be pleased to know that we now get billed and invoiced with actual benefit costs, so that our share as a province on behalf of the people of Nova Scotia reflects the actual costs of the benefits being incurred by physicians across the province.
So, the resources and the investments are really from an historical - the new Master Agreement does take into account the fact that it would be drawn down based upon the payments, and work is ongoing between the auditors with the Province of Nova Scotia, the internal auditors, and the auditors on behalf of Doctors Nova Scotia to identify exactly what, if any, surplus or contingency amount should be held by Doctors Nova Scotia for benefit payments for physicians across the province. That work is ongoing and, as I’ve mentioned earlier today, internal auditors last met earlier in September with representatives from the auditors representing Doctors Nova Scotia. The Doctors Nova Scotia position was brought forward. The internal auditors on behalf of the province had additional questions. To my understanding, those questions remain unanswered and by that I mean I don’t believe any correspondence or information has been provided to actually answer the questions that were brought forward. Indeed it will be difficult to come to a resolution and recommendation from these auditors at this point if the parties - that is the auditors - respecting the two parties at play aren’t providing the answers to the questions being raised by each other.
So again, just to reiterate, the surplus amount was taxpayer money that went to Doctors Nova Scotia and it was held in a surplus account on their books.
MS. MARTIN: So to be clear, the government was holding this money - $4.4 million - and didn’t have record of it in the budget that you presented, and realizing that it has been growing, regardless of how that came to be. My question was pretty simple, I thought. Where does it show in the budget because I would think you would have to be accountable for any money that is in your possession? Where does it show that money?
MR. DELOREY: I’m not sure if we’re perhaps talking in circles a little bit about where and what and how those funds existed or materialized. We would have seen in an historical context as payments were being made to Doctors Nova Scotia for benefits based upon the old Master Agreement that expired in 2015, that those payments would have been recognized as an expense line item in the books of the province. So that’s where the funds were allocated, so it would have been recognized in past budgets as we made contributions to Doctors Nova Scotia for the benefits.
As I explained in my first response, the process by which we, under the old Master Agreement that expired in 2015, were establishing benefit payments, it was based upon estimates provided by Doctors Nova Scotia to the province. That was essentially a pre-payment of the benefits. What we came to realize over time was recognizing that those estimates that were being provided to the Province of Nova Scotia on behalf of Doctors Nova Scotia, those estimates tended to be almost consistently - if not always – overstated, as to the actual cost of those benefits being provided.
So through the period of time, the provincial books - you would have seen those contributions being recognized as an expense on behalf of the Province of Nova Scotia, payment made to Doctors Nova Scotia for benefit payments for physicians.
What happened from there though, was that Doctors Nova Scotia’s actually-incurred costs for distribution of the actual benefit program on behalf of the physicians did not require all of the funds that the province had previously disbursed. So again, to the member’s position and question, the dollar amount would have been showing up on the income statements of the financial reports of the Province of Nova Scotia as an expense paid out under the Physicians Services budget, I believe.
MS. MARTIN: I’m curious if the Minister of Health and Wellness could provide this side of the House with proof that these payments have been made since January. From my understanding, Doctors Nova Scotia have invoiced the government four times for benefits and have not received payment to date. This has been agreed in the Master Agreement and we would be curious to see that these have been paid going forward, and paid accordingly as the minister has suggested.
MR. DELOREY: As I talked about how the surplus account of taxpayer money targeted towards benefits for physicians in the Province of Nova Scotia came to be, now I believe the question is about what happens under the new Master Agreement. The process by which the benefits - again, I want to reassure all members of this House and indeed all Nova Scotians and especially physicians across the province, that their benefit payments have been made consistently, that they have not gone without benefit coverage since the Master Agreement was signed.
What is clear in the Master Agreement is that it does make provision that the surplus account being held by Doctors Nova Scotia would be drawn down to cover benefit payments for physicians, recognizing as well that efforts would be made between auditors representing Doctors Nova Scotia and the internal audit team representing the Province of Nova Scotia. They would get together to establish what, if any, surplus would be necessary to address concerns about the benefit program being expressed by the Doctors Nova Scotia organization.
Again, much of the concern that came up from Doctors Nova Scotia representatives through the negotiation process for the 2016 agreement was around continuity of benefit delivery of payments to their membership. That is, in part, why the Government of Nova Scotia brought to the table what is referred to as an evergreening process. That is the commitment within the contract that benefits would continue to be paid even in the event of a contract expiration and so on. That seems to be where the concerns of Doctors Nova Scotia’s rationale for the perceived need for a surplus account rested.
Again, we remain committed to work with the auditors from Doctors Nova Scotia. I believe the last time they met was earlier in September. As I have said before, there are some outstanding questions based upon the information provided by the auditors of Doctors Nova Scotia that the internal auditors have. I respect the work and the role of those internal auditors on behalf of the Province of Nova Scotia to make sure that whatever recommendation they work to come up with is in the best interest of the taxpayers of Nova Scotia, but also consistent with our obligations under the Master Agreement.
MS. MARTIN: Although I could go on for days, I realize that possibly the time has come to wrap up these discussions. My concerns are just as heavy now as when I first came into this House. As a health care worker and a labour leader, I think we’re spending our money in all the wrong places, and I think we’re more worried about having a surplus budget than we are about the health care of Nova Scotians. As I said earlier, I don’t think I would want to stand on a record that put the teachers out on the street for the first time in the history of this province as well as taking the doctors to court for the first time since 1990.
I do appreciate that you deserve time to wrap up. I will now give the minister that opportunity.
MR. CHAIRMAN: The honourable Minister of Health and Wellness to provide closing comments, with about two and a half minutes left, and to move your motion.
MR. DELOREY: I do want to recognize for the record that I think much of the discussion through Supply has actually been managed on the other side of the House by a number of rookie representatives, including the member for Cape Breton Centre and the member for Cumberland North, both Health Critics on behalf of the NDP caucus and the Official Opposition, the PC caucus. Again, I would like to recognize their work and obviously due diligence, not just on behalf of their constituents but on behalf of Nova Scotians, to question the efforts and the work and the Budget Estimates that are brought forward to the floor of this Legislature. Recognizing that these two Health Critics are both rookies in the Legislature, I think they did a fantastic job in fulfilling their duties. Although we may not land on the same page at the end of the process, we can respect each other and the work that we do.
In my last minute before moving forward with the resolution, I would also like to recognize all of the staff within the Department of Health and Wellness, within the Department of Finance and Treasury Board and throughout government who have worked diligently in preparing the budget and Budget Estimates, in particular my deputy, Denise Perret, and CFO, Kevin Elliott, for the work that they and their teams have put forward to prepare our work. They worked diligently throughout the year, often don’t get recognized, but Kevin and Denise did support me here over the past 16 hours or so and I would be remiss if I didn’t recognize them and the team of people behind them.
So, with that, I would move Resolution E11.
MR. CHAIRMAN: Shall Resolution E11 stand?
Resolution E11 stands.
Order, please. Time for the Estimates today has expired.
The honourable Deputy Government House Leader.
MR. KEITH IRVING: Mr. Chairman, I move that the committee do now rise and report progress to the House and beg leave to sit again.
MR. CHAIRMAN: The motion is carried.
[The committee adjourned at 7:01 p.m.]