Leonard Preyra - MLA for Halifax Citadel - Sable Island

Wednesday, November 18, 2009

LEGISLATIVE CHAMBER

Pandemic Preparedness

Printed and Published by Nova Scotia Hansard Reporting Services

PUBLIC ACCOUNTS COMMITTEE

Ms. Diana Whalen (Chairman)

Mr. Leonard Preyra (Vice-Chairman)

Mr. Clarrie MacKinnon

Ms. Becky Kent

Mr. Mat Whynott

Ms. Lenore Zann

Hon. Keith Colwell

Hon. Cecil Clarke

Mr. Chuck Porter

[Mr. Howard Epstein replaced Ms. Lenore Zann]

WITNESSES

Pictou County District Health Authority

Mr. Patrick Lee, Chief Executive Officer

Ms. Janice Kaffer, Vice President, Clinic Services

Mr. Brian White, Chief Financial Officer

Capital District Health Authority

Mr. Chris Power, President and Chief Executive Officer

Ms. Kathy MacNeil, Vice President, People

In Attendance:

Mrs. Darlene Henry

Legislative Committee Clerk

Ms. Kim Leadley

Legislative Committees Office

Mr. Jacques Lapointe

Auditor General

Ms. Evangeline Colman-Sadd

Assistant Auditor General

HALIFAX, WEDNESDAY, NOVEMBER 18, 2009

STANDING COMMITTEE ON PUBLIC ACCOUNTS

9:00 A.M.

CHAIRMAN

Ms. Diana Whalen

VICE-CHAIRMAN

Mr. Leonard Preyra

MADAM CHAIRMAN: I’ll call the meeting to order. I know we have a couple of members who are on their way, but we have a quorum here and it is 9:02 a.m., so it is important that we get started today.

I’d like to welcome our guests who are with us today from the Pictou County District Health Authority and the Capital District Health Authority. We’re here continuing the discussion on the pandemic planning for the H1N1 pandemic. We’ve had two previous meetings, one with the Emergency Measures Organization and one with Dr. Strang and our Deputy Ministers of Health and Health Promotion and Protection.

It was suggested that we also have a meeting with the district health authorities so that we could get a feeling of what’s happening on the ground, on the operational side. I believe that was suggested by Mr. MacKinnon at one of our earlier meetings.

So in keeping with our usual pattern, we’ll begin by introducing ourselves, starting with Mr. Epstein.

[The committee members and witnesses introduced themselves.]

MADAM CHAIRMAN: Thank you very much. Just a couple of housekeeping things before we go to the opening statements. First of all, because we have two different health bodies here today, it will be important when you are asking the questions that we make sure to go through the Chair. It will be alternating Chairs - Mr. Preyra and I will be taking the Chair today. Just so that Legislative Television understands who is going to be answering the questions, as we go back and forth between the two boards, if you could just let me know or let Mr. Preyra know who you were hoping to speak to, because I’m sure the questions will be a bit parallel there.

If we could, perhaps I’ll turn it over to Ms. Power to start with the opening statement. I know we have statements from both boards. Thank you.

[9:04 a.m. Mr. Leonard Preyra took the Chair.]

MS. CHRIS POWER: Good morning and thank you, Madam Chairman and standing committee members, for the invitation and opportunity to answer questions regarding Capital Health’s pandemic preparedness. Joining me today is Kathy MacNeil, who is our Vice President of People. Her portfolio has responsibilities for emergency preparedness, among other things.

It is also a pleasure to appear before this committee alongside my colleague, Pat Lee, CEO of Pictou County Health Authority, who is joined by members of his executive team.

By way of introduction, I’d like to remind committee members of the geography and jurisdiction of the Capital District Health Authority. Capital Health serves the citizens of West Hants and Halifax Regional Municipality. Providing health care services to the people of this district are the hospitals and programs operated by Capital Health and the IWK. Capital Health includes hospital sites and programs such as the QE II Health Sciences Centre, Dartmouth General Hospital, the Nova Scotia Hospital, Cobequid Community Health Centre, East Coast Forensics Hospital, the Tri-Facilities, Public Health Services, addiction prevention and treatment services and community health, and the list goes on.

Although the IWK has its own board of directors and management team, it is important to note that all of our pandemic planning has been done jointly. We recognized early on that a pandemic situation would involve our communities as a whole, so in addition to the IWK, HRM’s Emergency Preparedness Team have also been integral to our planning efforts from day one. At the outset, I would like to acknowledge the quality and thoroughness of the Auditor General and his office and their review - almost a year ago now - of our pandemic plan. The audit was truly helpful to us in stepping back from our work that we had been focusing on for over six years, seeing it from the perspective of a third party. It was an opportunity to test drive our planning before the plans actually had to be implemented.

As you are all aware now, in April of this year our plan had to be implemented with virtually no advance notice when an outbreak of H1N1 was discovered in Windsor. Almost overnight Nova Scotia, and more specifically Capital Health, found itself in the middle of the Canadian epicentre of the first wave of H1N1. After six years of planning for an influenza pandemic, none of our plans had anticipated that it would show up here first. Even though some of our planning assumptions were wrong, we were still prepared. In fact, I’m really proud to say that as a district, we responded quickly and effectively. There is a saying at the Canadian Red Cross that in times of crisis, it is important to get big fast. That’s exactly what we did.

Our plans and teams have been in place since April, being guided by over 35 plans and 1,400 pages of material that make up a district pandemic response. By the time the AG tabled his report in July, we were already revising and updating these plans based on what we had learned from the first wave of the outbreak.

It is important to note here that it has been the months and years of planning that went into the actual pandemic plan, rather than the plan itself, that is serving us so well now. Our planning has been a district priority since 2005. In that time we’ve honed our ability to develop scenarios, identify resource requirements, establish agreements, order equipment, consider alternatives and simulate emergency responses.

The plan continues to provide overall direction, but it is the agility, collaboration and responsiveness of our health care leaders and providers that is serving our district and province in a confident and cohesive manner.

Our response and decisions are coordinated by our district emergency operations centre, which has been functioning at different levels of activity since April. We ramped up to full emergency operation with a dedicated team of up to 50 people operating on an around-the-clock basis since October 30^th. I would like to note that the IWK Health Centre also has an emergency operations centre.

If you have looked at our plans you will see that we have two broad objectives. The first is to prevent the spread of disease in our community, so as to protect the public from becoming ill; and the second is to ensure the continuity of health care services and the provision of specialized care for those who become very ill. Every day we closely monitor specific data and activities which serve as triggers within our pandemic plan.

They include, the number of confirmed influenza cases; any changes in volume of patients arriving at our emergency departments across the district; the number of patients presenting with flu-like symptoms at our emergency departments; staff sick calls, especially those self-reporting with flu-like symptoms; activity in family physician offices; the number of patients admitted to hospital, ICU and ventilator utilization; and severity of illness and mortality.

This real-time, up-to-date data has allowed us to make timely, informed decisions guided by our plans; when and where to open primary flu assessment centres or PACs; when and where to deploy key staff to priority areas; when to begin to reduce surgical activity to free up in-patient beds for medicine patients; and what is required for just-in-time training support for deployed staff.

I would like to share with you some of these facts that illustrate a day in the life of a health system in the midst of a global pandemic. Within a matter of hours, we implemented a key component of our pandemic plan, the opening of primary assessment centres, which has proven to be an enormous benefit in our management of this pandemic situation. Each day, we are able to divert between 200 and 400 people away from our emergency departments and family physician offices, which are already at full capacity, to central community locations in Halifax, Dartmouth and Windsor, which are designed to assess and treat flu-like symptoms.

That so many physicians and nurses rose to the challenge of staffing these centres is testimony to the spirit of good will with this public health threat that has been generated in our community. While other centres across Canada deal with emergency departments that are experiencing overcrowding from increasing flu activity, our emergency departments are running smoothly and our system is working in a sound, safe and collaborative way.

Other highlights include close to 5,000 citizens visiting primary assessment centres to date, and over 100 staff redeployed from their normal places of work. We’ve disbursed 93,000 doses of vaccine in our health care facilities, we vaccinated over 10,000 of our staff, we estimate that approximately 20 per cent of our district has been vaccinated. All non-H1N1 business and administrative activity has been suspended while we focus on the issues at hand. We have reduced surgeries by approximately 55 per cent. On any given day, we have been 20 and 30 beds occupied by patients with flu-like illness and we currently have seven ventilated patients.

When it comes to protecting the public’s health and preventing the spread of illness, this responsibility falls to our Public Health Services. In times of Public Health emergencies such as pandemic, Public Health’s resources are redirected towards its protection mandate. They have been involved in the planning and delivery of the biggest vaccination program in our province and country’s history. I know there continues to be a lot of interest regarding the decisions related to site selection and operations of vaccine clinics and I’ll be happy to respond to any of your questions surrounding that.

Our focus has not been limited to our work as a district. Our staff and experts have been fully engaged, not only with partners across the districts such as school boards and municipalities but provincially as well as nationally, providing leadership, advice and support to a broad range of pandemic related activities. As CEOs we meet twice a week by teleconference with our provincial partners to review the pandemic response from a system perspective. Without question, an endeavour of this size, complexity and duration has and will continue to present challenges. I understand and I empathize with the concern, fear and confusion that you’re feeling. We’re not immune to this. At Capital Health we are a community of over 11,000 people and we are also part of broader communities. So we are experiencing the same stresses.

In addition to providing care, we also have a role in assisting the public in understanding what’s happening around them and how to make informed decisions about their health and well-being. In any emergency we are challenged with walking that fine line between panic and apathy. How do we prepare the public to take appropriate action in the face of real risk without creating anxiety and fear? This becomes even more challenging as we operate in a crowded information environment - news stories from across the country and around the world providing us with changing information of what is happening and what we know. It underscores the critical importance of coordination during times of crisis.

This is why I welcome the opportunity to answer your questions today because we share a responsibility to assist our citizens in understanding what’s happening around them. I also hope this will demonstrate to our citizens that they have reason to trust us and feel confident in our ability and agility to lead through this and to continue to provide them with the care they need.

I understand the importance of making our thinking, decisions and actions as transparent as possible. This is absolutely necessary, not only to ensure our accountability but also because as citizens it’s essential that we continue to learn and broaden our understanding of the health system and our rights and responsibilities within it. We take these responsibilities seriously. We work hard to ensure that we’re prepared. We act with confidence based on the best available information and we do not make these decisions lightly because we understand, as do our partners, that our decisions have consequences.

I believe that our pandemic response to date is in keeping with how we have responded to emergencies and crises in the past. In fact, we have a lot of experience in this area with Swissair, Hurricane Juan, White Juan and, more recently, with Porters Lake and Herring Cove fires. We have shown that we have the capacity to put the interests of our community ahead of our own, to treat others as we would wish to be treated in stressful times, and to do what’s necessary regardless of title to minimize the threats to our community.

At the same time we believe we can always do better. As legislators, you should be concerned with these questions. Yes, understanding the specific decisions is important but just as important is looking at whether we have robust systems and structures in place, the right people identified, the resources to support this work, clear lines of communication and effective decision-making tools. Thank you once again for your invitation and I look forward to your questions.

MR. CHAIRMAN: Thank you, Ms. Power. We’ll move directly to Mr. Lee, CEO for the Pictou County Health Authority, and then questions after. Mr. Lee.

MR. PATRICK LEE: Good morning, Mr. Chairman, and members of the standing committee. Thank you for inviting us here today to respond to the Auditor General’s Report on Pandemic Preparedness in general and specifically to the recommendations contained within the report concerning the Pictou County Health Authority.

I would like to take a moment to introduce the two members of my senior leadership team who are joining me this morning. On my left is Janice Kaffer. Janice is the Vice-President of Clinical Services at our health authority. On my right is Brian White. Brian is our Chief Financial Officer.

Simply speaking, we planned the work over the last two years and as of October 28^th we began working the plan. I would like to provide you with an overview of that plan but before doing so I would like to acknowledge Chris Power, CEO, and our colleagues from Capital Health, who are also part of this morning’s proceedings, and certainly to acknowledge the work of the Auditor General who, doing comprehensive field testing in February, provided us with a foundation and basis upon which to focus, prioritize, and complete our pandemic plan. I’m pleased to report that the one recommendation from the Auditor General pertaining to the Pictou County Health Authority regarding finalization of essential services was completed in June.

I realize I only have a few minutes to provide a brief overview of our pandemic plan and, really, to talk about the reality of today. I’d like to provide you with an executive summary of the pandemic plan and to share with you our experience in implementing the plan over the last three weeks, highlighting some of the successes and some of the challenges.

The plan’s objectives are to minimize the severity of illness and lessen death rates within the district, slow the spread of pandemic illness within the district and province, ensure central services are maintained, and address business recovery post-pandemic. We grouped our planning into the following broad seven categories:

One, surveillance of trigger points. These methods include surveillance reports from our community physicians, our presentations of citizens with influenza-like illness in our emergency department, our primary assessment centre, and also looking at staff absenteeism. We’ve been monitoring these trigger points for the last several months on a daily basis so that we’d have a baseline upon which to draw comparative analysis. I’ve included a copy of our Situation Assessment and Response Committee report for your information. It gives you a sense of what we’re looking at each and every day.

The second strategy is immunization. The plan was to immunize residents at immunization centres throughout the county. To date, we’ve offered 19 clinics in various locations in the county and have immunized approximately 9,000 residents, or 20 per cent of our residents at this point. We’ve offered almost daily immunization clinics to staff, and to date have vaccinated 65 per cent of our staff.

The third component of our plan is antiviral medications. The plan was to dispense Tamiflu as a treatment option at both the primary assessment centre and the emergency department. To date, we’ve dispensed 182 doses of Tamiflu, which represents approximately 2.5 per cent of our population.

Surge capacity is very important in a pandemic, and we’ve worked hard in identifying six areas of surge capacity, of which to date we’ve used two. The six areas of surge capacity include a primary assessment centre, which provides surge capacity to our emergency department by providing screening, Tamiflu treatment, and education to those with influenza-like illness. We opened our PAC - primary assessment centre - on October 31^st in a central county location, and to date we’ve served almost 1,000 clients.

The second area, surge capacity, is around secondary assessment centres. We’ve planned these centres to provide additional surge capacity for the emergency department and medical in-patient units by providing assessment and up to 24-hour treatment, such as IV hydration therapy.

The third component is to provide surge capacity for the medical in-patient units. We’ve planned an additional 10-bed short-term medical unit at the Aberdeen Hospital acute site, and to date we’ve used this for approximately a week to decant admitted patients from the emergency department, some of whom had ILI symptoms.

The fourth component of surge capacity deals with planning for critical care demand as a result of a pandemic. We’ve worked hard with our provincial partners to enhance and maximize capacity across the province. At Pictou County Health Authority we purchased four new invasive ventilators, which have increased our critical care capacity by 40 per cent.

Recognizing respiratory therapy may be a limiting factor during a pandemic, we have expanded the scope of our current critical care nurse practice by training our critical care nurses in functions that were formerly performed by respiratory therapists, such as arterial blood gases. To date we’ve had approximately two H1N1 patients per day in our ICU.

The other surge capacity strategy, palliative care and funeral home capacity, has not been needed at this point, although plans are in place.

The fifth strategy of our plan deals with essential health services. Our services have been identified into three areas - high, medium, and low. Essential or high priority services are those health services which cannot be deferred and are viewed as threats to life or limb. Medium priority services are those services that can be deferred up to two weeks during a pandemic - for example, Holter monitoring and echocardiograms. Low priority services are those services which can be deferred for up to six to eight weeks; an example of such a service would be our Well Women’s Clinic.

To date, in the course of the pandemic, we’ve moved to essential services in Public Health to focus all of our activity on immunization centres and have made some deferrals of activities such as enhanced vision screening in our schools. We’ve also had to defer a minimum number of elective surgical cases for the week of November 16^th to redeploy some of our OR nursing staff to our primary assessment centre. We have a process to capture deferred work and will be addressing the deferred work in post-recovery pandemic planning which we are now developing.

The final component of our plan is integrated command, control and communications. Our integrated command, control and communications centre has been operating weekly since June 30^th and daily since November 2^nd. The centre has the overall responsibility for directing all aspects of the pandemic plan while concurrently maintaining the designated level of priority services. Like Capital Health, our focus has been on implementation evaluation of the plan, and non-H1N1 administrative activities have been suspended at this point.

Our integrated command, control and communications centre is connected to the provincial pandemic and CEO leads through biweekly teleconferences. We are also connected with the regional emergency response organization - in fact the director of that organization has been a member of our standing committee.

We are committed to timely and relevant communication updates with our staff and key stakeholders. To date we have had 26 staff updates, numerous CEO town hall meetings for staff, and a stakeholder engagement strategy for managers was developed and implemented.

Some of the challenges we’ve experienced to date - in spite of all of our planning and best efforts, we were overwhelmed on the first two days of our public H1N1 immunization clinics due to the size of the crowds; not withstanding our ability to set up 14 immunization stations and immunize 1,000 people per day, in the first two days we still had crowds of hundreds waiting outside, some of whom had to wait four to six hours to receive the vaccination. Certainly, from that experience, we learned that we had to do better logistical management.

We implemented, after reviewing the first-come, first-served experience, an appointment time ticket system which scheduled demand to capacity and reduced the lengthy waits. This change brought positive feedback from our communities.

The second challenge I would draw your attention to was the unanticipated vaccine shortage announced on October 29^th, which caused concern not only for the public but for our staff who had to turn away individuals because they did not meet the criteria for immunization at this time. The shortage of vaccine, which is temporary, and the rationalization of priority groups contradicted our mass immunization promotion strategies that we had developed based on Harris/Decima polling in mid-October, which suggested two-thirds of Canadians were not going to get the H1N1 shot.

We were also challenged to rationalize vaccine to our staff and to reserve our immunization to direct care staff only. All of our staff are equally valuable members of our team, but the severe vaccine shortage made us critically select which of our staff could receive it.

We’ve had considerable successes as well in terms of our program to date. Despite challenges regarding vaccine availability, I can tell you that our vaccination clinic that took place at the Pictou Landing First Nations community had the highest vaccination rate of First Nation communities, as we were told by Chief Anne Muise.

Another success - and I think we should celebrate it - is the overall county immunization rate, which like Capital Health is 20 per cent, which is among the highest in Canada. I’m very pleased to report that our vaccine wastage rate is 0.2 per cent compared to vaccination wastage rates, which are in the 1 to 5 per cent range.

So, Mr. Chairman, on behalf of the Pictou County Health Authority, we’re very pleased to be here this morning and we’d be pleased to answer any questions that the committee members may have and share our experience to date. Thank you.

MR. CHAIRMAN: Thank you, Mr. Lee, and before we move to questions from the Liberal caucus I’d like to welcome Mr. Cecil Clarke, the MLA for Cape Breton North, and Keith Colwell, the member for Preston. Welcome.

Ms. Whalen, you have the floor, and the time is 9:27 a.m.

MS. DIANA WHALEN: Okay, we have just 20 minutes and I will be moving my questions back and forth between the two health authorities, so I will try and be quick about that so we don’t waste a lot of time as we go.

I want to start, if I could, with Ms. Power for the Capital Health Authority to talk a little bit about the priority lists and the people that we have identified. First of all, you mentioned a lot of statistics about the number of people who have been immunized and how it has been going, and I know you are monitoring that every day - can you tell me who is responsible for sending vaccine to doctors’ offices?

MS. POWER: Our Public Health, which is an arm of Capital Health, is responsible for packaging and sending the vaccine to physicians’ offices. We also have a biologics depot, so Capital Health actually does it for the whole province - we disburse to the whole province for that. If you are specifically speaking about Capital Health, our Public Health Department would receive orders from family physicians’ offices and we package and ship to them.

MS. WHALEN: And you did that for doctors across the province?

MS. POWER: Yes.

MS. WHALEN: But also for Capital Health District, which is my first question.

MS. POWER: Yes.

MS. WHALEN: Okay. How is it determined which offices would get how much in the way of vaccine for individual family physicians?

MS. POWER: Family physicians place orders with our Public Health Departments for how many vaccines they feel they need for the patients they are caring for. When we first went down this road, some family physicians’ offices didn’t order, but many did, and a number was disbursed based on the amount of vaccine that we had. Then, when there was rationing, the list came out of the priority groups and family physicians were asked if they would please respect that particular list.

So now what we are doing, as more vaccine comes into the province, is doses are being packaged for family physicians’ offices based on how many have requested it and trying to equally disburse it to our family physicians, and we’ll continue to do that.

MS. WHALEN: I understand there’s quite a limited shelf life when the vaccine is opened and ready to give - it’s a 24-hour one, from what we read in the press. My concern there is that it’s not as efficient administering it at doctors’ offices as it is through your public health clinics - can you respond to that in terms of the decision made to send any significant number to doctors?

MS. POWER: Well I think in speaking with a number of our family physicians, many of them were booking in people specifically for that vaccine, so they were arranging their schedules based on having a number of people come so that they wouldn’t be wasting. I can’t really speak specifically to what they’re doing in their particular offices, but if you look at any of our vaccination processes in our regular flu season it is an effective way to get flu vaccine to the community, by doing it through family physicians’ offices.

MS. WHALEN: Just one question around the cost of having it administered at a doctor’s office - is there not a cost for each person who is going to receive the vaccine? Normally a doctor will charge for each procedure or each test that they provide, so would we be paying a lot of extra by having the individual doctors providing the vaccine?

MS. POWER: I’m not aware that doctors are charging patients for having the vaccine. They may be, the family physicians are not under Capital Health so what they do in their offices is up to them, but I wasn’t aware that they were charging people for vaccine.

MS. WHALEN: I wonder if anybody else with the guests today has an answer to that question.

MR. LEE: It is my understanding that physicians are charging what is called the tray fee, which is under medical services, so it is an accepted cost . . .

MS. WHALEN: Per dose? So it would be per dose, though, there would be a cost?

MR. LEE: That’s correct.

MS. WHALEN: I believe there is for the regular seasonal flu. Yes, Ms. Power?

MS. POWER: So are you saying that the cost is incurred by the patient or that the physician is billing?

MS. WHALEN: No, that the physician is billing our system.

MS. POWER: Oh yes, sorry, I misunderstood your question. I thought that the cost was being incurred by the patient.

MS. WHALEN: No, but if you go to a public health clinic you have one overall cost - where you’re administering, as you mentioned, thousands were done in the first couple of days at the public health clinics, so it seems to be a lot more economical to the province to do it that way.

My other concern in asking these questions is the control over whether or not we’ve abided by the priority groups. That’s been a big issue for us as MLAs. We’ve received a lot of calls, and I’m sure you have in your capacities, from individuals who feel they’re at risk, that they have underlying health conditions, respiratory problems, asthma, it might be that they are new mothers and they weren’t in the priority groups and there’s a lot of pressure, yet there are other stories of other people receiving the vaccine who simply asked their family doctor and got it - so what control do we have on maintaining this strict idea of the priority groups? I don’t know if you can answer that in your role, Ms. Power, as the head of Capital Health.

MS. POWER: Well, there’s no question that it’s difficult once it leaves Public Health and I think that was part of the concern when we went to developing priority groups, why we had it quite centralized. We do work with our physicians, they are our colleagues, and we ask them to abide by the priority groups. We don’t have specific control, we just trust that that will be the case.

MS. WHALEN: In this morning’s paper there is an article which you may have had a chance to look at that said that people on Agricola Street who were at Gus’ Pub were offered the shot, I believe it was last night - no Saturday, it said “on Saturday.” You may have seen that article, it said that there was a vaccination clinic where they had extra vaccine left and so they just went and offered it to people who were at the pub that night. It’s good not to throw it out but I’m wondering, what assurance do we have that the people they offered it to would have been in the priority groups, or was it just whoever wants it? Were you aware of this story?

MS. POWER: I was aware of this story this morning when I looked at that. I think all of our staff who are working, and volunteers, are really trying to encourage people to get the vaccine if they fit within the priority groups. My understanding was that it was offered in various communities, but to people who were in the priority groups so we wouldn’t be wasting it.

MS. WHALEN: So your assumption would be they would go through the bar and ask if any of them are new moms, or dads, or falling into one of the other groups?

MS. POWER: I can’t speculate.

MS. WHALEN: I’m hearing too many stories about people who are not in the priority groups and that certainly at times it’s who you know and not whether or not indeed you have underlying health issues or you should be on that list, and that’s a concern to people. I think it’s important that we shine a spotlight on it and look at that and try to control it because we still have only inoculated 20 per cent of the population at best. My concern is that we not allow that to happen because it undermines your messaging, the messaging that’s coming from Dr. Strang, and the national messaging around priority groups.

It really is a concern to me when I see letters coming to me from people who really are in distress because they have conditions and then I hear of other people with no conditions whatsoever - can you assure me whether or not in the hospital where you’ve had immunization that there has been strict control over the vaccines there?

MS. POWER: Yes, there has been. We have followed the priority groupings that have come out from Dr. Strang’s office based on the advisory group that he has who advises him on that - we have followed those directions.

MS. WHALEN: Okay. When the crisis period has passed - and I will say we’re in a crisis, I don’t think we’ve hit the peak just yet from recent reports - I would hope that we will review the records of who was immunized when and have a look at that. I think that’s important, that people in the system understand it will be reviewed, because I think that might be a help in ensuring that people do follow an honour code. I think I’m hearing that pretty much a lot of it is on an honour basis with doctors and with others in the system.

MS. POWER: Yes.

MS. WHALEN: Maybe you could take that as a suggestion for after the system is through because, as we understand it, there is paperwork with each and every one of the inoculations.

I just want to ask about the percentage of people immunized. You gave us some figures as we began, Ms. Power, but one-third of the health staff in the province, roughly, are here in Capital Health, so the rollout of immunization was different in Capital Health than in the other districts, which began with a more open clinic at least for the first few days until we realized the shortage of vaccine was going to overtake us. You indicated about 20 per cent have been inoculated - 20 per cent of the population?

MS. POWER: Yes.

MS. WHALEN: Can you tell me how many doses you’ve actually had up to this point in time?

MS. POWER: Within Capital Health?

MS. WHALEN: Yes, how many doses of vaccine have been allotted to us?

MS. POWER: As of November 17^th we’ve had around 93,000 doses that have been disbursed from our Public Health for Capital Health. We’ve vaccinated about 16,000 in our public clinics and over 10,000 within our staff, physicians, students within Capital Health, and the rest would have gone out to other occupational health clinics, family physician offices at the outset and continue to be disbursed.

MS. WHALEN: Well 93,000 would be close to - what are we in your area, about 400,000?

MS. POWER: Yes, 400,000.

MS. WHALEN: So almost approaching 25 per cent. Do you have a great deal of stockpile that has not yet been used?

MS. POWER: No, we don’t have a great deal, and we don’t really have any way of knowing what has been used in the family physicians’ offices at this point in time. Many of these doses would have been disbursed to occupational health departments around HRM and when we did go to a priority grouping they were asked to stay with those, so we’re not exactly sure of how many doses are left in any of these particular places. We have the records that we have within Capital Health.

MS. WHALEN: How many public clinics do you have open right now in Capital Health?

MS. POWER: We’ve run 53 clinics so far in Capital Health, over the duration of the last few days, so . . .

MS. WHALEN: Is that counting each day and time?

MR. CHAIRMAN: Hang on a second. Ms. Whalen, would you give her a chance to respond to those questions.

MS. POWER: Six a day, six clinics a day we’re running as public health clinics.

MS. WHALEN: And they’re open still today?

MS. POWER: They are, yes.

MS. WHALEN: Yes, okay. So do you have any idea how many doses are left at the clinics?

MS. POWER: At the end of each day? I can get that information for you.

MS. WHALEN: Well, I guess my question is, you’ve got a certain number of doses now and you will get more on Monday presumably?

MS. POWER: Right, yes.

MS. WHALEN: Do you have enough to continue without any interruption?

MS. POWER: We do at this point in time for the number of patients that we’re vaccinating on a daily basis, with the priority groups that have been identified.

MS. WHALEN: Do you have enough to expand the priority groups yet?

MS. POWER: That’s looked at on a daily basis and we work in conjunction with Dr. Strang and all the Public Health Departments. So every single day we’re looking at the amount of dosage that’s there and are there opportunities to start to expand. Those decisions will be made collectively and Dr. Strang takes the lead; we work with him on that.

MS. WHALEN: Can you tell me the uptake with your health workers, you know, I know initially it was said that usually not that high a percentage take the annual flu shot?

MS. POWER: Yes, we typically have a very low uptake from health care workers on the annual flu shot. We have vaccinated almost 11,000 staff, physicians and students who are there. So we’re exceedingly pleased with the uptake from health care workers at this time around.

MS. WHALEN: That’s great. Mr. Lee, I wonder if you could tell me how many of the Pictou County Health Authority’s staff have been inoculated, roughly percentage-wise?

MR. LEE: Sixty-five per cent as of yesterday.

MS. WHALEN: Sixty-five per cent. So you still have a way to go in terms of urging them to take the shot. Is there a reluctance?

MR. LEE: There is a reluctance among some, but not near what we anticipated. The seasonal flu experience is generally around 40 per cent for our health authority so we’re up to 65 per cent. Based on what we’re seeing, we believe that we’ve basically saturated the direct care staff and now we’re waiting for the criteria to expand to include the indirect care staff and we do believe that a number of those staff will step forward and take the immunization as well.

MS. WHALEN: Could I just ask, perhaps Ms. Power, did we look at all staff - indirect and direct health staff - when you did the 11,000 or your aim was 11,000 workers in Capital Health?

MS. POWER: Yes, 11,000 includes everybody who works in Capital Health but we have been following the criteria around our direct care providers - those involved with pandemic planning and those that we need for business continuity as per our plan. So we still have a number to go.

MS. WHALEN: Very good, thank you, and again I’ll go to Ms. Power, if I could. I would like to know about how many surgical procedures have been cancelled to date?

MS. POWER: We moved last week to about 25 per cent of our surgeries in order to free up some of our staff to work in critical areas and some of our beds. So last Friday we went to a little bit of a deep dive where we cancelled 37 surgeries on Friday, 34 were cancelled on Monday. We have a little bit more capacity within the organization now so yesterday we were able to do more surgeries than we were and today, again, we’ve cancelled about 10 surgeries at each of our sites in Halifax.

MS. WHALEN: How do you determine, when you say a little more capacity, would it be the number of H1N1 patients in ICU?

MS. POWER: That’s right. So we look at a number of things. It’s our patients in ICU, it’s our patients coming into emergency and filling our beds. It’s also our staff capacity so how many staff are calling in sick, do we have the staff with the right expertise to care for our patients in intensive care? Many of our staff who work in our operating rooms and in our recovery room or PACU have those special intensive care skills, so that’s why we were reducing in order to draw from that staff capacity.

MS. WHALEN: It sounds like you definitely have a finger on the pulse, you know, day-to-day on that one and we appreciate why you have to cancel those surgeries. Certainly this takes precedence, there’s no question that all of us here understand that.

I wonder if we could look a little bit at staff illness and see what impact it’s playing right now. Although a lot of people have been inoculated, it takes a number of days for that to become effective. So have you seen a marked absenteeism or illness rate?

MS. POWER: I’m going to ask my colleague, Kathy, to speak to that.

MS. KATHY MACNEIL: Thanks for the question. We are seeing a slight increase in our ill time. So we’ve looked at the time frame from November 1^st to November 15^th and on average, on any given day, we have a little over 110 employees who are not able to work because of illness.

We are tracking our illness, again, on an honour system. As an employer we really can’t ask people why they can’t work. But we have asked people who are suffering influenza-like illness to call in to our occupational health. So it’s a self-reporting system that we’ve put in place. We’re tracking about 4 per cent per day calling because of influenza-like illness.

So, on any given day, 100 people would be out because of sickness and we could say four of those people might be suffering from the flu. We also know that that is likely highly under-represented in terms of numbers.

MS. WHALEN: That’s quite a bit lower than we’re seeing in the education area, certainly with teachers out sick, so it seems that you’re not hit quite as hard as some of the other sectors right now, which I hope will continue.

Can you let me know how you did on the call for extra nurses and doctors to come and help? There were the ads that ran just a week or two before we were hit with this wave.

MS. KATHY MACNEIL: I think our public has responded very well to our call for help. Within a two-week period we hired over 100 casual nurses, so these would be nurses who have not worked in Capital Health before or who have recently retired. We’ve been very pleased with the response. Those nurses, for the most part, are working within our primary assessment clinics and within the vaccine clinics that have been set up.

MS. WHALEN: It certainly freed up staff for other things. So that’s good. I mean, certainly our district should have the most number of those nurses available, I would hope, but that’s important.

I wondered, in the overall view of what’s happened so far, recognizing that your pandemic plan has to be fairly fluid and the information we’ve received has changed quite a bit from day to day, what has been the major challenge that you have experienced, Ms. Power?

MS. POWER: I think probably the major challenge was how early on we were managing the numbers of people who were coming to our emergency departments. So because of our pandemic plan we were seeing an overwhelming number of people coming, and we’re busy on any given day in our emergency departments, so we knew we very quickly needed to move that. So we were able to, by opening our flu assessment centres, which have been a godsend and have really made a huge difference. So just a little bit of a challenge getting them up and running, getting people to staff them, getting the public to understand to go there, but I think within 24 hours they were a success story for us. So that was a challenge for us.

I think there is no question the vaccination issue was a challenge in trying to help our public understand, with all the changing information. So great information coming, but at a pace that is difficult for people to sift through. So those have been challenges for us.

MS. WHALEN: The idea of moving people offsite and trying to - I think you were using the word “triage” or “decant” - take people out of the system. Have you looked at moving people out of hospital beds if you need more hospital beds as this continues to mount? There had been a story earlier on, I think it was in the Cape Breton district, where they talked about having a plan that might move people into hotels or into other locations.

MS. POWER: We didn’t have to go the hotel route, but we did work very closely with our long-term care facilities. Because we are a provincial resource, many of our patients come from all over the province, so we worked really closely with our colleagues in the other districts about moving people back to their home hospitals, and the collaboration and co-operation has been phenomenal. So we have really been able to keep the number of beds open for any of our community that would need it.

MS. WHALEN: That’s very good. So you have no plan to move them, other than to other medical facilities?

MS. POWER: No, not at this point in time, for sure.

MS. WHALEN: I actually had a number of questions around reciprocal agreements. Do you have any official reciprocal agreements with other health authorities that would say that if we’re over-capacity, we could move some of our patients?

MS. POWER: We work as a system. In Nova Scotia, we work very well together, all of the CEOs. We are on teleconference twice a week with each other, so we understand what’s happening in each of our districts. Without question we would help each other, and the other districts have responded amazingly for us because we seem to have been hit harder than most, in Halifax. We don’t have formal agreements. We don’t need them, because we work as a system.

MS. WHALEN: I would just like to ask, with the coming holiday season, whether you have made any additional plans around staffing issues? Because it’s always a difficult time around Christmastime and people wanting time off. I had the experience of breaking an ankle on Christmas Eve once, about 10 years ago, and it is a difficult time staffing-wise to get people through emergency and care for them. Have you made any special plans for the holidays?

MR. CHAIRMAN: Ms. Whalen, your Party’s time has expired. We will move to the Progressive Conservative Party, starting with Mr. Porter.

[9:47 a.m. Ms. Diana Whalen resumed the Chair.]

MR. CHUCK PORTER: Thank you, Mr. Chairman, and welcome to the members of the committee this morning and our guests, thank you for being with us. It’s been an interesting time as we work through some of these things. I represent the area of Hants West, which also includes King’s-Edgehill School in Windsor. As a matter of fact, it is right across the street from where I live so we worked our way through what was an interesting time back in the Spring, unfortunately.

As I said before in this committee and in other times probably in this House and publicly, that was managed fairly well overall. I think people in the area were somewhat comfortable with how things were done and it didn’t seem to be that big a deal. I know that the media had joined us in Windsor and were asking people on the street, almost expecting some sort of panic mode but that wasn’t there. Reasonable people do reasonable things, we like to think.

People took everything in stride but at that time, I could say that it seemed to be a very short-lived thing. I don’t think people were thinking about the coming Fall, the next wave of this thing and how widespread it would become, maybe, or even that it would become a pandemic around the world. So they’re seeing it a little differently today and the comments are a little different today - not that they’re in a panic mode but there’s a concerned mode and there has been for the last number of weeks, especially around how things change daily; sometimes hourly, it seems like there are changes to this plan.

I want to start around the plan itself. Ms. Power, in your opening comments you talked about April and this whole plan coming together, the AG’s recommendations, numerous pages and such like that. It appeared as though you were quite confident in April, where you had a plan - many, many pages - but there are a lot of people who would say the plan is not working very well. The perception on the street is this has been a horrible mess and that for these specific groups there are not enough vaccinations. They can blame whoever they want, going all the way to Ottawa for that and how this whole thing is being done. Certainly locally, here in this province, they are saying this is unbelievable.

I’m not just talking about the average Joe in the street. There are doctors who aren’t happy about not being able to get the numbers that they’ve procured and asked for, right down to here we are reading about 80 doses or something being tossed out the other night, when there are all kinds of people waiting in lineups who would have loved to have had that dose. So I’m just kind of curious as to how much this plan is really changing and how effective that plan that you talked about in April really was or is.

MS. POWER: I believe that our plan is still very effective. We are following it. Where we make changes on a daily basis is based on new information that’s coming, so for every plan that you have in place, you need to respond to what’s happening around you in the environment. So you plan with a given set of parameters and they can change on a daily basis.

Our plan, I believe, is sound and all of the major pieces of it remain sound. Where we make our changes is in how quickly we bring up primary assessment centres, how we staff them, the hours that we staff them; no question around the vaccination and the clinics because the original plan was to have family physicians, that many of us would do that. None of us anticipated that we would have the number of people demanding it or wanting to take it and none of us anticipated that we would have a shortfall of it. So from that perspective, we’ve had to be very agile and change.

I think our communication strategy - I think none of us anticipated that on a daily, sometimes hourly basis, that the information would change. So those are the kinds of things that are requiring us to be so agile in moving forward.

The plan, in terms of the plan itself, is sound, it absolutely is and from my perspective has been working well. Can we learn more? We can. Every single day we meet as a group within Capital Health and we tweak or we change course, if need be. So it’s been a great experience from that perspective and I think a success story, despite the concerns from the public. I understand that, I get it, I understand their frustration and why many of them are upset about that but we are working very hard to try to ensure and instill a sense of confidence that we know what we’re doing.

MR. PORTER: Thank you. You talked a bit about the communication piece. I know when we had Dr. Strang here a number of weeks back - I just forget the date but it was a month or so back - we talked a little bit, and I stressed at that time the importance of that educational communications piece, what would be done.

To me, that was probably one of the biggest pieces of the entire plan, was getting it out to people, and it’s a wonderful thing to put all this stuff on-line, the clinics on-line, but there are still many people in this province who don’t have the on-line ability. What are we doing? I mean, I haven’t seen any mail-outs that have landed - and I’ll just speak locally, in my area - to the households referencing a whole lot of anything. We do see the on-line clinic stuff set up, and even that’s changing. The hours of our local clinics have still been up in the air until they’ve actually been opened, as far as I can tell.

There are problems with - maybe problem is not the right word, I don’t want to use the word problem - but there were issues. People weren’t aware of the assessment clinic at Hants Community Hospital, for example. We had a lady whom I know specifically who came to me and said, I have two kids that are sick, now my other two kids are sick, and I was going to take them to Wolfville to be assessed and now I learn this morning at 6:00 a.m. that there’s a clinic open in Windsor. It doesn’t seem as though that’s getting communicated. So I’m wondering what it is specifically you’re doing to get that out? How is the message getting delivered to everybody? Because this is an everybody issue in the province - not just certain groups, it’s an everybody issue.

MS. POWER: Yes, it absolutely is, and we recognize that, and we recognize that there’s so much information coming that it’s hard for people to discern it. We are using traditional and non-traditional means of communication. So we’re using all local media. We use the local newspapers. We do put things on-line, but recognize that not everybody is on-line. In terms of mailing out, because the information is changing so rapidly, you know, that could be old information by the time it got there. So we’ve not chosen to go that route, and we are making decisions on such short notice that we may make a decision at 7:00 p.m. that the next day we’re going to open the assessment centre, for instance in Windsor, based on the numbers of people and, yes, would the whole community know? No, they wouldn’t, probably for a day or so, but all local newspapers, radio stations, we’re trying to reach as much of the media as we can to get to people, and recognizing that some still don’t know.

MR. PORTER: I appreciate that very much, and I think that people do as well. We see daily briefing notes coming out, Dr. Strang doing public awareness, communicating and trying to change the message, and it seems like it is changing a great deal - but it is the flu, and I think back to years past with the flu. Something like 4,000 Canadians a year die from the flu. What percentage of that 4,000 - do we know, as part of your plan, what percentage of the 4,000 flu-related deaths a year are in Nova Scotia? Any idea what the numbers in Nova Scotia would be?

MS. POWER: I don’t have that statistic, but we can get that for you.

MR. PORTER: All right, I was just kind of curious, given that Capital District Health is one of the biggest parts of the province. What about Mr. Lee from the Pictou County Health Authority? Any idea what your numbers are there that are flu-related at all?

MR. LEE: Not of the 4,000, no, but we could get that for you as well.

MR. PORTER: That’s fine, thanks very much. I was just kind of curious about that. Again, I think part of the reason that people sort of take this at a calmer level and put it into reality, you know, is that people do die of the flu, and a lot of that is related to the underlying conditions and such. I think people understand that it’s generally not the healthy people, but they get scared when they see these cases like in Ontario, where you see the 13-year-olds. Maybe there was an underlying hereditary issue. Who knows? I mean we really don’t know, but I’ve been impressed by the people and their ability to just stay calm about the whole thing and not - you know, you hear the word “pandemic” and everybody panics and you’re going - what does that mean? They stop and think pandemic, what does that mean, you know, and it’s the flu. It is serious, there’s no question. This is a serious issue and there are great concerns around the almost hourly, daily changing idea.

So I guess what I’m going to here is, in the beginning of this it was stay home for seven days. I’ll go back to the Spring, you know - at King’s-Edgehill we kept folks in there for a seven-day period, roughly. They recovered. They moved on. Life was normal, and it was a great way not to spread things around. Now we’ve changed things drastically. What happened to the message about - and I’m sure this must have been in your plan, and maybe it wasn’t, you can enlighten me, it must have been there - what happened to the very simple thing about staying home seven days recovering, staying away from people? It just seemed to be a very simple way of recovering from the flu.

MS. POWER: That still stands, and in every publication and every communication it is: if you’re sick, stay home. As employers, we send people home if they come to work and they’re sick.

The seven days has been slackened somewhat and so for health care workers, we still say seven days because we want to be sure that they’re healthy to come back, but I think that many of our public health officials and we, as employers, recognize that seven days was a huge hardship for many people, particularly if they weren’t paid when they were off. So I think that the message has been when you’re feeling better, you can go back but if you’re sick, stay home. It is still absolutely the gold standard for reducing the spread of this disease.

MR. PORTER: And again, this comes back to this whole communication, education piece. We’re not really hearing a whole lot about that right now. It’s more of the ever-changing rules around what we should do and who the groups are, again specific to a number of things, and we’re not hearing that message which is probably one of the most important pieces of this is to stay away from other people.

On that, has there been any thought to just closing things? I know locally, at our schools, Windsor Elementary where my children go, there have been days when seven or eight kids in the class and teachers have been out sick. Have there been any thoughts within the plan, again with the daily and weekly meetings, or discussion about closing certain facilities and saying, listen, everybody just go home, take that week, let’s get everybody well in order to prevent the spread of and maybe get rid of it much quicker, especially where the vaccine is not available in the numbers we would like and even when you do get the vaccine, knowing that you have to buy a couple of weeks to get this thing into the system and to react the way it should. Does part of your plan, Mr. Lee I’ll allow you to speak to it as well if you would, have to do with closing down some of these places?

We know with schools, if there’s something going around, it generally goes around and everybody gets their share and they take it home to their families, et cetera and then it just keeps on going. It’s one of those places and there are more, but I’ll just use that as an example.

MS. POWER: So, as part of Capital Health’s pandemic plan, it’s not contemplated that we would close schools. I think those are conversations that the school board would have based on what was happening within their particular area.

MADAM CHAIRMAN: Mr. Lee, did you want to have a comment there? I think you were asked as well.

MR. LEE: Our plan is similar. I would just add that we are looking at clusters each and every day. If, in fact, there was a cluster in the school or at some other facility, then we could offer Tamiflu, for example, as a treatment option. So we’re looking at that daily.

MR. PORTER: Thanks. The reason I asked that question, I know that school and health are separate, but yet they are one and the same and they do interact with numerous programs and things. These are places where hundreds actually do gather and the opportunity to spread the germ is there for obvious reasons. I just wondered within the plan if that’s something that was being considered, talked about at all, because they are a huge piece. When we talk about, it is a pandemic, it’s not level four anymore, it’s not just the regular flu, it’s a serious flu and when we talk about the prevention, I would think people are curious about that. I know I was as this goes on and on. I thank you for those answers.

I want to move on a little bit about the dollars and cents of this thing. Hopefully I’ll have time to get to a couple of other areas. In your opinion, I don’t know if there was a cost you could even project, maybe early on in April when you began the pandemic plan and you looked ahead, you knew what happened in April locally here in Nova Scotia. Are you adequately set up financially? I don’t know if it’s ever enough, but I’ll use adequate. I’ll ask both of you again to comment on that as far as your district health authorities go to manage this process.

MS. POWER: We don’t have any money specifically set aside for H1N1, but we know that things happen so we are working with the province around that. We have been tracking since day one what our costs are specific to H1N1 and again in conjunction with the province who has asked us to do that. We know what we’ve spent to date, we know what we would project year end if we continued along this line.

We haven’t been reimbursed for any of those dollars, but again, we’re working with the province around that to see at the end of the day what that would be and if there would be any resources to help us with that.

MR. LEE: We’ve been tracking daily as well. Although we didn’t budget specifically for H1N1, we have been tracking both the salary cost related to pandemic, the supply cost as well as from Capital. For example, the province purchased four new ventilators for us so we’ve been capturing that. We will be reporting it to the Department of Health. Actually, to date, we have a forecast based on, if planning parameters hold, what pandemic may cost our health authority.

MR. PORTER: Thank you, and to both again, I would ask this, you put together a pandemic plan, you must have had a line item, a figure, associated with this plan, are you even close to what your - and I would think not, but I’ll ask the question, and it being difficult as well - but there was a plan put in place based on the fact that we assumed there would be an issue with this second wave, or at least I would like to think people were concerned about a second wave coming this Fall, that it was going to be an issue, it was going to be costly, there would be people off sick, it would all fall into the plan. Are we anywhere near what would have been estimated at the time of building the plan or are we just blowing that right out of the water?

MS. POWER: We did not have any estimates around what it would cost us. H1N1 happened when we were into this fiscal year so we hadn’t put that as part of our business plan. We plan for any kind of disaster or pandemic, we have those and so we don’t set aside money particularly for those, understanding that when they happen they are things that are out of the ordinary and often we can work with government, either at a provincial or federal level around that. We did not have any money set aside for this but, as I said, we are tracking and we know what we’ve spent to date and we know what we’re projecting if we continue on this path for the year end.

MR. PORTER: Thank you. Mr. Lee.

MR. LEE: The only think I’d add to Ms. Power’s comments, the reality is, we won’t know until it’s over. For example, we purchased 30-day stockpiles of certain pieces of supplies, it’s sitting in inventory, it won’t be expensed out to H1N1 unless we need it. We’ll still need that equipment if it’s not used, or that supply is not used, post-pandemic. Again, we’ll have to work our way through it and then actually go back and calculate what the costs might be.

MR. PORTER: We hear a lot about the potential for a third wave. How long does this go on? What is your plan here? I mean, that’s a hard question, but with the plan and the recommendations from the Auditor General, obviously you’re into a lot of money, there’s no question about that. As you said, you may or may not use it. Are we expecting - and I’m assuming we are preparing for a third wave, and if so, do you think that will be different from how we’ve prepared for the second wave of this?

MS. POWER: We are preparing for a third wave, based on the epidemiology, what our Public Health Agency of Canada tells us and what we see around the world, because we track that too, it helps us to plan. We are planning for a third wave so we always plan for the worst and hope for the best. What we have seen with each of the waves, the first was very mild, the second was increasingly a little bit more severe, and we would anticipate, because this virus changes, it mutates as most viruses do, we would anticipate and plan that it gets even more severe as we go. However, the thing that we are trying to factor in now and have no experience around is that we have vaccinated, so what impact will that have? The pandemic, from those three waves, was based on the fact that it just continues to get worse, but as a province, I think we’ll be in pretty good shape before the third wave hits.

We don’t know, and this is probably a much better question for Rob Strang or infectious disease people to answer than me.

MR. PORTER: Mr. Lee?

MR. LEE: I have nothing further to add to Ms. Power’s answer.

MR. PORTER: It would be interesting, yes, with those vaccinated, it’s one of those things, I guess, and maybe Dr. Strang would comment the same as you, they may really not know how it would affect us. I would like to think that it will be less of an impact given that we have gone through the vaccination and such, so we’ll hope for the best, as you’ve said.

I know that we all hope for the best, but the flu is, I guess, each year - I’m not sure, we talk about these waves, I don’t know that I’ve ever heard the term second or third waves used in regular flu. Everybody, not everybody, but 400,000 or so get the regular flu shot and we go through the season and it’s almost a non-event, annually, for most people. They get the flu, yes, they’re sick, they stay home, they do their thing. This whole hype around the H1N1, how much different is it? Maybe it won’t be a whole lot different, at the end of the day, and we certainly would hope not.

With the procurement piece - and I know I’m running short on time there, so what I’ll do is save it until the next round, it’s about less than 30 seconds so I’ll give my time. Thanks very much.

MADAM CHAIRMAN: With that, the time has elapsed for the PC caucus and we’ll move to the NDP caucus.

Mr. MacKinnon, I believe you will be taking the questions or perhaps sharing your time.

MR. CLARRIE MACKINNON: I’ll be sharing my time. I want to welcome you all here this morning. I think this is a very important session for us.

All of my questions are going to be to the Pictou County Health Authority and it’s going to be very difficult to refer to Mr. Lee as Mr. Lee because we meet on a very regular basis. I think it is something that could be learned in other areas as well. We actually get together as MLAs over the last few years, every three months, and we have the next four meetings lined up in advance, so we know our schedule pretty well and I thank you for that communication. Often we have the mayors at those and the warden as well at those sessions.

I have one of the 13 First Nation communities in the province in my constituency. I left here on a Friday afternoon and went directly to the First Nation. I witnessed what took place there and I think it could be a learning experience for other jurisdictions across the country, perhaps, because I was so impressed with the First Nation response - opening the council band office at six o’clock in the morning, providing meals throughout the day and coffee throughout the day. The leadership taken by Chief Anne Francis-Muise and others was really commendable, and helping the RCMP with traffic and so on. I was very proud of the health authority as well because it really worked very nicely with the First Nation. Could you elaborate on the interactions that took place?

MR. LEE: Well, maybe I’ll start and then I’ll turn to my colleague, Janice, who actually was on-site most of that day. I think what we saw at Pictou Landing First Nation was really the result of several years of hard work and working with the chief and the band council there. We’ve been working hard on a number of different initiatives. I think on that particular day the success was around the immunization program which I described in my opening remarks. Ms. Kaffer was on-,site so, if I may, I’ll turn to Ms. Kaffer to more specifically talk about that particular day.

MS. JANICE KAFFER: Thank you, Pat. I think that from an elaboration, one of the things that helped us on that day and in preparation for the day was my colleague Ruby Knowles, who is the vice-president of community-based services. I had visited with Chief Anne and a couple of the councillors at the band office prior to the community clinic, to ask how we could work together to make sure that we got as much of the population out and found out from her what her goal was in getting her population, the members of the council, out to assist on the day.

We worked very closely with them in communicating with them on the day and in preparation for it and then followed up with them as well. We also had a good location and we had the good support of the RCMP as well, in providing support in traffic for that particular event.

I really do think that the success of that particular event was a combination of really good communication, good planning, a strong relationship with the band and really hard-working individuals who stood outside in the cold for most of that day, helping to make sure that the people who got into the clinic were the right folks.

MR. MACKINNON: I’d like to talk about the learning process, if I could. One of the first experiences, of course, was the Westville gymnasium and people outside and so on. I think there was a quick response to that learning experience, the ticketing process that took place and also moving to locations like the Museum of Industry - I fervently believe that the learning process was one that didn’t take too long. Can you talk about your learning experiences?

MR. LEE: I think maybe back to some earlier comments in terms of working the plan is that the plan is evolving and very, very responsive. I think the example of moving to the ticketing system illustrates that.

Maybe just a bit of background - we were, in the first two days of the immunization clinics, going on a first-come, first-served basis and, as a result, had lines four to six hours long. I think we all saw that in the media.

Towards the second day in, actually, we had a look at whether that was serving the public best and we felt it wasn’t serving the public best so we moved to a booked time. We knew that we could do approximately 100 immunizations per hour, so we started assigning - had 100 tickets, we gave 100 tickets out for 2:00 p.m., for example - 3:00 p.m., 4:00 p.m., 5:00 p.m. - so that people were not waiting in a line to be seen. They could come back at an assigned time, and we also gave them a choice; if 3:00 p.m. was more convenient than 5:00 p.m., we gave them that choice.

The museum, I think, was an ideal location for us, as you point out. Again, one of the things we learned, even after we implemented the ticketing system, was that, initially, we were providing those tickets inside the museum. What we observed were moms coming in with babies, for example, so we actually took the ticketing out and we screened individuals as they came in - they sat in their cars, we provided them tickets then. So they didn’t even have to get out of their car to get the ticket. They got an assigned time and then came back at their assigned time for the vaccination which, from most accounts, were done within an hour to an hour and fifteen minutes once we moved to the assigned time system.

MR. MACKINNON: I would like to talk for a moment about the assessment clinic and how it has actually worked, and whether there is a need for additional - it’s almost like planning for the unknown in relationship to what’s going to happen next in relation to the pandemic. Is there consideration for additional sites? When I think of the county and I look to River John and other places and so on, could you perhaps comment on that?

MR. LEE: Well, we’re reviewing the primary assessment centre function each and every day by looking at the volumes that are coming in, and consideration has been given to other primary assessment centres if need be. The challenge would be the staffing issue, in terms of staffing up the additional primary assessment centres. At this point I can’t tell you. I have the total number of stats by day, but I don’t know by address and the county. I couldn’t answer that question to tell if, for example, people in River John are not coming to New Glasgow PAC. I don’t know the answer to that.

MR. MACKINNON: How have the communities responded to pandemic planning at the district level?

MR. LEE: In my view, I think it’s really been one of the successes. There has been great teamwork province-wide in terms of the health care system, but also linking very well with our colleagues in Emergency Health Services, Emergency Measures organizations locally. I think it has just been an outstanding success and a fine example of teamwork. So in my view, at that level it has worked very well. I think the communities have responded well, as well, in terms of the leadership at the community level, the mayors and the wardens; for example, in Pictou County, the community in general, I think, has been very appreciative of the efforts, but I think appropriately critical by times in terms of some of the logistical issues related to immunization.

MR. MACKINNON: The AG has been with us this morning, and certainly from a pandemic planning perspective, we’ve pretty well covered things - hazards planning and business continuity planning. I’m just wondering if, rather than hitting all three of those, we could discuss your business continuity plans?

MR. LEE: Maybe just a bit of context, the response to pandemic is within the context of all hazards planning, which is a response we would have no matter what the crisis might be. In terms of our business continuity plans, when the Auditor General’s Office surveyed us in February, it was still a work in progress. Specifically, we had not finished our central services exercise at that point in time in February. As I mentioned in my opening remarks, we did finish it in June, and what we did, actually, was go through each and every one of the services that we offer as a health authority and then designate whether that would be high priority, which means it has to be maintained no matter what, i.e., threat to life or limb; medium priority could be deferred for a certain number of days, 10 days for example; or low priority, which could be deferred for up to 30 days; and of course the pandemic.

What we then did was to take the departmental plans and look across the health authority to make sure that, as we looked at the continuity of service, it flowed throughout the health authority. As an example, the emergency department would need support from the X-ray department. So we had to make sure, in order to maintain a central emergency service, that the necessary supports were there in the other departmental plans as well.

MR. MACKINNON: My 10 minutes has expired and I have a lot more questions, but I know where to get the answers. Thank you.

MADAM CHAIRMAN: Mr. Preyra.

MR. LEONARD PREYRA: Madam Chairman, I know we’re coming to the end of this series on pandemic preparedness and I want to use the occasion to thank the Office of the Auditor General for the work that it did in preparing us for this crisis. I know we were talking earlier, Ms. Power was talking about getting big very quickly, and I think the Office of the Auditor General did as well, it completely remade itself in the process of that examination and Capital District Health did as well. I shudder to think of where we would be if we hadn’t started those preparations. I know Capital District was well involved in those plans before that, but it certainly helped the process. So I wanted to thank Capital District Health and Pictou County for participating in that process, and to the Office of the Auditor General for sounding the alarm early in the process, so that we could be in a position to respond.

I do have a few questions about the response to the Office of the Auditor General’s recommendations. Most of my questions will be related to Capital District Health, as Mr.

MacKinnon’s were related to Pictou County, it’s what I know well, we’ve spent a lot of time together over the years and I’ve been very impressed with the facilities in my constituency.

I want to talk about Recommendation 23 which talks about the district health authorities and the status of union issues relating to dealing with the crisis. You were talking earlier about the spirit of goodwill and here we have a situation where the unions are in the middle of a collective bargaining situation, I see an announcement in the paper saying that they’re not going to let that interfere with addressing H1N1 issues. You’ve announced the good neighbour policy where the unions have allowed sections of the collective bargaining agreement to be held in abeyance while the crisis has been dealt with. How did you come up with that agreement and how is it working in practice?

MS. POWER: I’ll ask Kathy to address that.

MS. KATHY MACNEIL: The good neighbour agreement has been in progress for the six years that we’ve been doing the pandemic planning, in development, I should say. That agreement specifically speaks to the sharing of employees across our DHAs, our district health authorities, so it would speak to the movement of people across employers. Within Capital Health though we’ve been very fortunate in working with our labour partners. We meet with them on a regular basis, we speak to the whole deployment strategy that we have.

On any given day we have 100 employees who are moved to another job within our organization and our labour partners have been very supportive in seeing our need to do that. The elements of the collective agreement that we’ve asked for forgiveness, or put in abeyance, would be things like notice periods for shift changes or notice periods for changes in the location of work. Understanding that we’re all responding, we’re all coming to do what we need to do in real time, we’re very happy with the co-operation that we’ve received.

MR. PREYRA: Will this be something that will be carried over into the future?

MS. KATHY MACNEIL: We certainly hope so. We’ve enjoyed the relationship working together. I think we’re both proud of the results of that collaboration.

MR. PREYRA: It certainly is extraordinary because I look at what’s happening in other provinces and it seems to me that it has been used as a good opportunity to negotiate other, more preferential terms. Certainly as a former union person I would say, well that’s a lost opportunity, but it’s very impressive to see what’s happening on the union front in the health care sector.

I want to ask you, also, about the primary and secondary assessment issues, another issue coming out of the Auditor General’s Report, the thing that all district health authorities should ensure that there are appropriate primary and secondary assessment units. I believe that was first used in Windsor during the outbreak, or it was considered in Windsor. How is that working and what kinds of uptake have there been with that?

MS. POWER: The primary assessment centres have been a fabulous good news story for us, they truly have. So yes, we initiated our very first in Windsor, in April, and it proved to be tremendous to have people go to one area rather than to our already busy emergency departments, and have people who were specifically there to manage the symptoms of flu.

We opened our first assessment centre, very quickly, in Halifax, and two days later followed in Dartmouth and at the end of last week opened one in Windsor. We do this based on the - we track every single day, almost hourly, what’s happening in our emergency departments, so we see when our emergency departments start to get overwhelmed with people who are showing up with flu-like symptoms.

These centres have been phenomenal in Halifax and in Dartmouth. We’ve worked in conjunction with the IWK, so we have pediatricians and pediatric nurses who are working alongside people with adult expertise. We are seeing between 200 and 400 people going to these assessment centres. We’re seeing them in fairly short order when they get there. We’ve gotten really great reviews from our patients and families who are using them.

This has been a tremendous initiative for us. We have not had to open any secondary assessment centres because we’re sending the appropriate people to our emergency departments. They are very ill, the ones who are going there, and they are very appropriate, so we haven’t had to open that, but again, we track it on a daily basis.

MR. PREYRA: At our last meeting we were looking at emergency rooms. One of the continuing themes is that people are overusing emergency rooms for non-emergency purposes. Is there a potential to use this assessment principle to address those types of issues? Is there anything in the works for considering - given that you’re saying this is a phenomenal success, is there any possibility of using this in another setting, in another application?

MS. POWER: This is a great question and one that we’ve been putting a lot of time and energy around. I think for the first time in many years our emergency departments are functioning smoothly and doing what they’re intended to do, and that is treat people who are ill, coming through their doors, because of all the other initiatives we’ve put in place around H1N1.

We want this to be the new normal for us in using emergency departments in an appropriate fashion, certainly in the Halifax-Dartmouth area we have a pretty appropriate utilization, in terms of true emergent kinds of things coming through our doors. In some of our rural areas, perhaps, more people use emergency departments as doctors’ offices. We do have a team of people looking at this, saying what shape does this need to take in the future when pandemic is finished, so that we reduce some of the pressure off our emergency departments.

We don’t know what that shape will look like yet, but it certainly is something we’re considering very seriously.

MR. PREYRA: I wanted to ask you a question, as well, about Recommendation 25 in the Auditor General’s Report, about the temporary licensing of professional groups and broadening scope of practice. You had talked earlier about bringing back casuals, nurses who had retired and other health care professionals. How is that working out? Is that something that has worked well? Is that something, too, that can be considered as an option for the future?

MS. POWER: It has worked well. I’ll ask Kathy if she wants to speak to this.

MS. KATHY MACNEIL: We’re very grateful to the licensing bodies, in particular the Registered Nurses Association and our physicians, the College of Physicians and Surgeons. The College of Nurses had expedited their licensing procedure, specifically to bring people back into the workplace who have been retired five years or less. So they put in an expedited licensing procedure to fast track that. It has worked very well.

Also, they have done a pro-rated cost for the licensing. So I think they’ve shown great leadership in coming up with some creative solutions there. We are very fortunate at Capital Health whereby many of our recently retired employees do come back on a casual basis. We see about 30 per cent of people coming back to work with us, in some capacity, after they’re retired. So that is a model that is already in place but there could be lots of things that we could explore, in terms of possibilities.

MR. PREYRA: I read in the paper, either this morning or yesterday, about Capital District Health having greeters at the door to say hello, but also to talk with people about whether or not they really do need to be in the hospital and whether they’re feeling well. I know that it’s recent, but . . .

MADAM CHAIRMAN: Mr. Preyra, your time has elapsed, it’s 10:27 a.m., I’m sorry.

We’re sticking to our time because we’re a little short for our third round. We have 10 minute sessions for the third round for each caucus, beginning with Mr. Colwell for the Liberal Party. Mr. Colwell.

HON. KEITH COLWELL: Thank you, again, for coming today, this is a very important topic, as you are well aware, probably more so than anyone else in the province. Just a question for both of you, what are your views on the immunization within the schools? I know that school-aged children aren’t on the priority list yet, and my colleague for the PC caucus mentioned issues within the schools, there is a high infection rate with the H1N1. What are your views on that?

MADAM CHAIRMAN: Ms. Power.

MS. POWER: Thanks for that question. When we were initially working on how the vaccinations should roll out, there were conversations that took place with the Halifax Regional School Board on having clinics in schools for the general public, but also for school-aged children. A decision was made by the school board that that would not probably be the best use, primarily because it would be so disruptive to have it day after day in the school system, so we chose to do clinics outside of the school. They would not have been specific for school-aged children but they could have participated.

We are now looking at that, for when the criteria open up, that children generally will be able to be vaccinated, and are working with our Public Health colleagues - and they will be working with the school boards - to see if that is something we want to be considering, going into schools and having the vaccination given there. We’ve never had a general vaccination for a lot of years, where everybody in the school would have participated, and when we looked at getting it out to the largest numbers, it wasn’t feasible in the beginning, but it’s certainly something we’re looking at now.

MADAM CHAIRMAN: Mr. Lee.

MR. LEE: We looked at it initially, as well, and the concern, in addition to what Ms. Power has mentioned, was around the consent issue, particularly with the younger children. Having said that, based on the experience to date, we do feel there’s merit, actually, in maybe moving into the high schools, where consent is not an issue and reassessing whether, in fact, from an immunization point of view, we should be doing it in the other schools as well, but definitely in the high schools, I think there’s definite merit.

MR. COLWELL: I can remember when I was going to school - and that was a long time ago - this was commonplace in the schools for even Primary to Grade 6. Another question I have is around location of the sites of the clinics. I’m going through the scheduling here for November 16^th to November 21^st and I see, for instance, in the Captain William Spry Community Centre, five of the six days there will be a clinic held there. I note in my community - in which I represent the areas of not only East Preston and North Preston, but also Lake Echo, Porters Lake and Mineville - in the Preston area we have chronic disease rates that are 13 per cent to 43 per cent higher than other parts of Nova Scotia, yet we’ve had one clinic there, at the time in each community, and there are no clinics scheduled in the next five or six days that I see for this community. Could you comment on that, please?

MADAM CHAIRMAN: Ms. Power.

MS. POWER: So we’ve had two clinics in North and East Preston, in November. When Public Health is determining where to run the clinics, we look at the population base to be sure that we’re making the best use of peoples’ time to go there and that we’re reaching the greatest number of folks who are there. We also look, once we’re there, at what the experience is in terms of uptake, how many people are coming to have it. I know that because of the resource issue from Public Health, and the people that we have doing the vaccinations, we’re trying to go where we can reach the greatest number of people.

Every day they are looking at where we should be going in terms of doing the clinics and on a week-by-week basis we are doing that. I’m sure they will be looking at the Preston areas again. Cole Harbour is fairly close by, but for people who have difficulty in getting places I know that’s an issue for many.

MR. COLWELL: The other issue, too, is areas like Bedford and Clayton Park, which have huge populations, haven’t had clinics yet.

MS. POWER: Again, I think what Public Health is trying to do is really look at where they can get the greatest number of people coming in. The other issue for us is finding a place to do it that’s large enough in order to accommodate and has the parking that’s required. So these are all issues. I think Clayton Park has been raised a few times, and I think people are looking at possibilities of moving clinics in various locations.

MR. COLWELL: By going to similar places all the time, like the one I recognized here in Spryfield, after a while don’t you sort of reach a saturation level in those areas? Then your uptake is smaller because you’ve really serviced the priority list in that area, and it’s time you should move to someplace else.

MS. POWER: Yes, that would be true if the priority list stayed the same. What we’re seeing is, as the priority list changes on a fairly regular basis, as soon as that announcement is made we see another huge surge of people coming through. Our hope is that as we get more and more out to family physicians’ offices, that’s where more and more people will be going to get their vaccine. So we will be able to disburse it throughout the district in a much more equitable way.

MR. COLWELL: As we’re all aware, there was a real chaos created about the way the government rolled this out, and the general public feels - and I don’t disagree with them - it has been a real - I won’t call it a fiasco, on how this was all done. I understand why you do it after we talked to Dr. Strang and everything like that, but a lot of people don’t. They simply don’t understand. There were clinics in some areas, and I’ve heard personal stories of people, even in the health care system, who work in the back offices and come forward and say, we meet with the public. They don’t meet with any public, and got the vaccination. I’ve run into some constituents who were vaccinated because they just happened to be in the right place at the right time rather than being on the priority list - even after the priority list was in place.

So this is a really serious problem. How are you going to ensure that the rollout of this, as time goes on - that you really get to the people you should be getting to? I think that you’re getting to some of them. I feel everyone should have this, don’t get me wrong here, the sooner the better. I realize the restrictions you have, so how are you ensuring that the people on the priority list, whom you have on the list now, are really getting serviced instead of the people who shouldn’t be on that list?

MS. POWER: This is a major challenge for all of us. We have gone on an honour system. We haven’t required people to bring medical records with them or anything to determine that they are on the priority list. Some, like pregnant women, are easier to identify, but not everybody is, particularly as we move to those with chronic diseases. The only way we really can do it at this point in time is to appeal to people’s honesty. Have people slipped through and gotten it? I hear lots of anecdotal stories from you and others that that has been the case, but I know that our staff who are working on the front lines giving this are turning people away every day. It has been very difficult for them to do that. Are some people coming and telling a little fib in order to get it? Could be, but we’re learning lots from this experience, particularly if we were ever to go through this again. From the very beginning there was a priority list that was developed, but we didn’t anticipate, as I mentioned earlier, the numbers of people who would be wanting it, and we didn’t anticipate the shortage. So we’re learning lots of lessons this time around.

MR. COLWELL: That’s a very tough situation to be in, realizing you don’t have enough vaccine. If you had enough vaccine, there wouldn’t be an issue.

MS. POWER: Yes.

MR. COLWELL: I realize how it is. Every day you have to change what you’re doing, and it’s very difficult for people to understand. Another question I have is covering the cost of all the ads, the clinics, and all these sort of things - human resource costs, the cost of all the supplies and everything. Who’s responsible for that, and do you have a commitment from government to cover those costs after you’ve tabulated them all when this is all finished or as you go forward?

MS. POWER: Yes. We certainly have kept track of every single cost that we have incurred about this, and we are working with government; we are making known to them, at their request, what costs we have incurred. We don’t yet have a commitment but, as I said, it’s a work in progress. I think that government really needs to have an understanding of what the total costs are, and we’ll continue to work with them on that.

MR. COLWELL: If for some reason - I know the government is under a lot of financial stress, and it’s becoming more obvious every day - if for some reason you don’t get this totally covered, what kind of an impact is it going to have on your regular services when this is all finished?

MS. POWER: Well, it will have a significant impact for us. We’re projecting that this is going to be a significant cost if we hit wave three and we continue the way that we’re going. So we’ll need to work with government at year end, if there is no money to cover that, to determine how we move forward into the next year.

MR. COLWELL: I also see that the flu assessment centres, which I think is a fantastic idea, and I think there’s no argument about that from anybody, and I think that they should be commended for doing these things, but I also see that the hours have now been reduced in some of these. What’s the reason for this? Is it because there are fewer people coming forward or is it lack of staff now? What’s the story?

MS. POWER: It’s purely based on numbers. Every day we look at the numbers of people who are accessing it, and the hours during which they’re accessing it, and we’re seeing a decrease in the number of people. The amount of illness in the community isn’t as great as it was in the last couple of weeks. We want to be efficient in the use of our staff, and it is taking a significant amount of resource, so we have reduced the hours to see if that still meets the needs of the community. It’s a work in progress, every day will change and we’ll respond if more people need it and waiting lists get greater, but for now we think that cutting back the hours, as we have, will work for us.

MADAM CHAIRMAN: Mr. Colwell, your time has elapsed. I’ll now turn the floor over to Mr. Clarke for the Progressive Conservative caucus.

HON. CECIL CLARKE: Madam Chairman, like others, I want to welcome our guests here today. Just carrying on some of the financial aspects of this, I think with your business planning for this current year, maybe to both CEOs, Ms. Power, there was no budget allocation for pandemic, is that correct?

MS. POWER: That’s correct.

MR. CLARKE: Mr. Lee, that’s the same?

MR. LEE: That’s correct.

MR. CLARKE: As a result, as you’ve indicated and we won’t go over, you’ve been tracking the costs and the like. I would see at least five areas where there are going to be pressures - the human resource pressure; the supplies, which you’ve indicated; capital equipment; the actual impact on the existing infrastructure, and accommodating that; and then the operational aspects in terms of how it impacts other functioning within the health care delivery system.

Just to be clear, you both have been tracking them but there’s no indication, at this point, that the government is going to pay you for those additional costs.

MS. POWER: That’s right, we’re in discussion with them, so they recognize, they’ve asked us to track the costs, but we don’t know yet how that will be reconciled at year end.

MR. LEE: Yes, and in fact they’ve given us a template that we’re required to fill out so we are tracking the costs according to their template.

MR. CLARKE: Can you quickly say how that template look in terms of all of those other things you’ve said about supplies, HR, communication costs?

MR. LEE: It’s comprehensive in my view. It’s the salary-related costs; it’s the expense-related costs, whether it be advertising or the need for additional security, for example; or leasing a space; as well as the capital costs, so in my view it’s comprehensive.

MR. CLARKE: To Ms. Power first, then Mr. Lee, what would your contingency allocation be in your business plan for unexpected expenditures such as this?

MS. POWER: We budget for about a $3 million contingency on an $800 million budget.

MR. LEE: We do not budget contingency.

MR. CLARKE: So there’s no contingency there, and $3 million on an $800 million is a very small contingency, and I suggest you’ve probably used that up, and more, at this point.

MS. POWER: We have, yes.

MR. CLARKE: Yes, so one of the concerns that I would have, going forward, is both in cost recovery, but in out years, because we now have a government that’s coming forward indicating that they’re going to be doing expenditure control, by their own words, and the health sector has been identified as a major component of that. As a result, can you both, Ms. Power and then Mr. Lee, explain to me, or provide, the fact that expenditure control is going to be an issue, contingencies either don’t exist or they’re very small, how do you deal with those pressures or, more specifically, can you indicate areas that you think you can cut to find contingencies or extra room?

MS. POWER: In the health care system we have been cutting around the edges for a number of years, so is there low hanging fruit there we can just clip off? The answer is no, but what we have recognized for a long time is - and we’re supportive of the direction of this government and ones before it - that the current way the health care system is operating is not sustainable. We know that, we understand that, we know our health outcomes are not getting any - our health status is not improving. We know we need to do some major transformation in the health care system. This is not about tweaking around the edges or cutting the low hanging fruit. This is about fundamental change in the health care system and it is the direction we’ve been moving in Capital Health, so we’re continuing to move in that direction.

MR. LEE: I would agree with Ms. Power’s assessment. Again, just emphasize expenditure controls. It’s been an ongoing issue. We deal with expenditure controls and mitigation strategies each and every budget year.

MR. CLARKE: I appreciate the responses. The other thing we’ve heard is that the government, in finding new revenue sources, are looking at income tax increases, HST increases, other service fees that are required through the Province of Nova Scotia to find revenue streams. However, one of the things that was clear in the government’s statement is that it’s open season with collective bargaining. Again to Ms. Power and then Mr. Lee, can you can indicate to me how many bargaining units and/or numbers of people you have coming forth in the upcoming year, either this year or next year’s budget? Do you have an idea?

MS. POWER: We do. Kathy, do you want to do that?

MS. KATHY MACNEIL: We have four bargaining units that will be doing collective bargaining in the new year. All of our collective agreements expire the end of - they might be expired now, actually, the end of October. But we have agreement, as has been mentioned earlier, that the current crisis that we find ourselves in, we’re going to wait until the new year for collective bargaining.

We have about 6,500 employees within those four bargaining units, so of our almost 11,000 people at Capital Health, you can see there’s a large percentage of our people who are unionized.

MR. LEE: Yes. We have three unions that are all approaching collective bargaining or will be in collective bargaining post-pandemic - NSGEU, NSNU and CUPE. Of those three unions, I would estimate 750 staff would be involved in collective bargaining.

MR. CLARKE: Thank you. I guess when you look at that, you template that across all DHAs in the Province of Nova Scotia, what we’re going to see is a significant capital pressure added to that in being able to cope with those numbers and assuming that the government has indicated there will be many constraints on the rest of Nova Scotia and Nova Scotians, but the collective bargaining process is fully open. Do you anticipate the status quo, both Ms. Power and Mr. Lee, we’ll keep going in that order, how are you going to be in terms of, do you see yourself forecasting deficit this year given all these pressures?

MADAM CHAIRMAN: Yes, Mr. Epstein.

MR. HOWARD EPSTEIN: Thank you. At this point, I think we’ve crossed a line. The mandate of this committee is to look at efficiency of expenditures in the past. I think the first question was more or less marginally related to the topic that’s on the agenda for today, but to proceed with the second question and to now look forward into budget speculation is way beyond the mandate of this committee and, of course, beyond what it is that we’re talking about today.

I would ask you to instruct the member to confine himself to the topic. Thanks.

MADAM CHAIRMAN: Thank you Mr. Epstein. Mr. Clarke, did you have a comment?

MR. CLARKE: Yes. Well, my point is we’re talking about pandemic planning and we’re seeing cost estimates that are different now than when Dr. Strang and his colleagues were before this committee and we’re seeing the impact of the ability to respond to pandemic responses. I’m asking, quite clearly, if we’re talking about pandemic planning, if we don’t know the parameters where we are, if we don’t know what the government is or isn’t going to provide as a means of support, how can we properly respond to the Auditor General’s recommendations to deal with the pandemic planning?

I would say it’s a legitimate question because those districts either have a capacity or don’t have a capacity to deal with this matter, so I think it’s very legitimate for a district to try and deal with pandemic planning that are being given directions to track these. Those pressures are there. I don’t think I was going over any lines of what this committee should look at with regard to the reality of the current day impact.

Maybe, rather than going forward, I’ll redirect my question, as of today, rather than end of cycle, are both DHAs within their budget or over budget at this point in this fiscal cycle?

MS. POWER: At this point, we are projecting a small deficit, but we have a commitment that we will have a balanced budget at year end. We always do forecasting, we project that. That is outside of our H1N1 cost, so we have not factored that into our projected deficit, but our commitment is to have a balanced budget at year end, and we will.

MR. LEE: Our year-to-date actuals are balanced and we’re projecting a balanced budget at year end.

MR. CLARKE: Madam Chairman, part of this is recognizing that, as we go forward and as we deal with continuing monitoring with regard to pandemic preparedness, and as has been indicated, we have on many (Interruptions) Well, no, there was a point of order that I shouldn’t have to account for. So to my NDP colleagues, I’ll use up my time appropriately.

The point is the government has indicated that they are prepared to make massive cuts on the backs of other non-unionized Nova Scotians. They have an open-door policy with regard to collective bargaining, and at the same time we now have DHAs around the province that are dealing with operational pressures that are going to be difficult to respond to with bargaining unit matters coming forward, and at the same time a public that expects the pandemic preparedness and response to be delivered upon.

I think - not to the people that are here as witnesses today, Madam Chairman - what we’re going to find, back to our government colleagues, is that the government is putting undue pressure on the DHAs in this province to properly respond to pandemic preparedness.

What we’re also hearing from the government, especially around expenditure control, is that that is going to face a great deal of pressure, because while everyone says that they’re going to be in balance, there will be choices made, pressures added. I would just note for the committee’s benefit that we’re going to have to come back to this pandemic preparedness another day.

I do appreciate the limitations of our guests, but recognize the government is imposing - likely what we will see is either ongoing deficits or challenges for the DHAs that are going to be very difficult to manage within those regions, especially with upcoming pressures.

So as we go forward, I would assume we would have (Interruptions) I can take the time I’d like. Does the member want to say a point of order, Madam Chairman?

MADAM CHAIRMAN: I had allowed time for the interruption to Mr. Clarke, so you will have 10 minutes for the NDP caucus in due time. Would you like to take another minute?

MR. CLARKE: Well, I will. Specifically, to the point that we have presenters here today who I appreciate and thank for coming forward, who have done yeoman service with regard to responding an ever-changing environment. We recognize that, but at the same time, in terms of pandemic preparedness and the Auditor General’s Report, what we’re seeing is that we’re building in structured challenges and structural pressures that won’t be appropriately accommodated. With that, Madam Chairman, it may be noted for future response that we’re going to have to track the information that they have been asked to submit to the government, the government’s response and, more specifically, the resourcing back to the DHAs so they stay in budget this year. With that, I will conclude my comments.

MADAM CHAIRMAN: Thank you very much, Mr. Clarke. There are 10 minutes remaining for the NDP caucus. Mr. Whynott.

MR. MAT WHYNOTT: Madam Chairman, thank you to all the folks who joined us here today. I’ve certainly heard from the constituents that I represent, a real confidence in the way that the flu assessment clinics have been undertaken, the clinics in the community that I represent, anyway, and also the hard work of the health care workers. That’s certainly one thing that I’ve heard - the care, they always put the patients first, and I think that’s what Nova Scotians would want, but also have seen time and time again in every situation here in the province.

I know that there has been quite a lot of work going into informing people through communications, encouraging people to get advice as much as they can, especially through the 811 service and the various other assessment clinics, and people are - the majority of people, I would say - quite happy with what’s going on.

I’ll make a note that the clinic in the area that I represent, at the Sackville Sports Stadium, at Newbridge Academy, for instance, I’ve heard people - after each announcement of the new criteria for people to be able to get the flu shot, the wait times to get in and get your shot have been quite low. Even my own mother, who has a chronic illness, went in to get her shot last week, I believe, and she waited 20 minutes. So I think it’s getting out there that if you are in the category groups, you can go and get it and the wait times are quite reasonable. My colleague, the member for Cole Harbour-Eastern Passage, also notes the fact that a flu clinic in her constituency, at Tallahassee Community School, was quite a benefit to her community last night.

I do have some questions. I’m just wondering, Ms. Power, what have we learned from the first wave of H1N1 and what has Capital Health done to put in new processes?

MS. POWER: I think the greatest learning from phase one, or wave one, of H1N1 was around our primary assessment centre and how imperative it is to move on that quickly for the community. So that was one of our great lessons that we learned and we moved quickly on. The second one was around communication and how imperative that is, and with that, although it was a small community in Windsor and it was fairly contained, there was a lot of confusion. So we learned a lot about that, about how we have communications people working as part of that team right from the get-go, and so although it still remains confusing to some, it’s not because of lack of effort and we are pulling out all stops.

I think the other thing we’ve observed, which has been fabulous for us, is the amount of collegiality and collaboration that happens among care providers. We always knew we had wonderful people who worked within our system, but how they have stepped into a great space, how they have stepped up to this challenge and put patients first, completely - some of them are working incredibly long hours, seven days a week, just to make this work for our communities. So that has been wonderful for us, the versatility, how we tap into the talents that so many people have and that we sometimes don’t recognize on a daily basis.

I think we’ve learned a lot around vaccination clinics. We’ve learned a lot around how we need to engage our family physicians in a hugely meaningful way, that they are an incredible part of our team, and so we work with them in a very different way than we have. So we’ve learned lots of lessons along the way.

MR. WHYNOTT: In response to that, and going back to the assessment clinics, what are the things they’re doing today as part of a pandemic plan that are innovative and effective that you might consider doing after the pandemic?

MS. POWER: A great question. The assessment centres are one, so how can we take the pressure off family physicians’ offices and our emergency departments in a more round-the-clock way than we currently do in our community. Another area for us that has been really beneficial because we’re so large as a district, we didn’t have a centralized staffing pool, so each of our areas kind of did their own thing with staffing, and it worked to some extent, but because human resources are so critical at this particular point in time, we have centralized that and that has really paid off in spades for us and we are looking at how we continue that as we move forward.

We think we can be far more efficient in our staffing, human resources, use of overtime, by doing that. I think how we work with our family physicians will continue to develop. We had already gone down that path, but we’ll continue communicating with them in a much more robust way than we have in the past and seeing them as part of our team. The work that we’ve been doing with the IWK has been terrific. We had some projects with them before. We are separate entities but we have come together in a way that we never have before in our history. All of us think this is an absolute way to move forward and we’ll continue to do that. So those are just some.

MR. WHYNOTT: I guess, going back - and I think most members here have already talked about the collaboration of staff - you also mentioned, in your opening remarks, that your staff is feeling the stress and the anxiety similar to the broader public, what are you doing to support the staff?

MS. KATHY MACNEIL: Great question. In fact, we realize how difficult it is for our employees who may have sick family members at home and who are coming to work to care for sick members of the public, so we’ve put a number of supports in place.

One is we are working with our employee assistance providers and enhancing the offerings they may have around counselling; we put in place what we call stress support centres, drop-in centres, with counsellors on-site for people to drop in; we have conflict resolution expertise that we’ve brought into our organization this past year, and her role is really to help people deal with conflict and build capacity within their own interpersonal skills - she’s out with teams working, especially areas that may not have dealt with the public in the past and may not necessarily have that expertise of dealing with people who are afraid or stressed, so she has been a great assistance to us as well; and understanding that we’re a district that has multiple sites, we’ve put in a one-number phone call that is almost like a stress hotline, and then we can expedite access to different services.

We have been really proud - again, another example of how our internal resources have come together to provide this counselling support to their colleagues.

MR. WHYNOTT: Great, thank you. Ms. Power I have a final quick question - are you and the district health authority, do you feel and are you confident that the DHA has the capacity to deal with this pandemic if the situation gets worse and, also, are there enough medical supplies on hand right now to respond if it does get worse?

MS. POWER: I absolutely have full confidence that we can manage whatever comes our way. We are tremendously resilient, we are used to preparing for these things - not a pandemic, but certainly we’ve had experience with others. So we’re absolutely confident we can deal with what comes our way - it will have to be at reducing other things within the organization as per our pandemic plan, but we have planned well for an onslaught, and I hope we never have to go there.

Do we have enough medical supplies? Yes, we do, currently, for what we need. We have good relationships with our suppliers, we have a good provincial stockpile that we have been instrumental in helping the province to get there, so I have every confidence we can manage what comes our way within this province.

MR. WHYNOTT: Thank you, and thank you to all the members who came today.

MADAM CHAIRMAN: Mr. Whynott, your time has just elapsed. It is 11:00 a.m. and we don’t have much time for a closing statement - perhaps just a few words from each of our CEOs. We do thank you very much for joining us today.

Ms. Power, perhaps you’d like to close.

MS. POWER: I’d just like to thank everybody , they were very thoughtful questions. I hope we leave you with a sense of confidence in our system. We are blessed with tremendously talented people in Nova Scotia, and I thank God every day for the people that I have whom I work with. We’re in good stead to help take care of all of us.

MADAM CHAIRMAN: Mr. Lee, do you have a final comment?

MR. LEE: I do, thank you, Madam Chairman. I share Ms. Power’s confidence in terms of our ability to respond to a pandemic. I also want to acknowledge the superlative efforts of our staff, physicians, and volunteers, who work so hard with us, and all members of the team, both provincially as well as regionally in terms of addressing this pandemic. Thank you.

MADAM CHAIRMAN: Thank you, and I’d like to say, on behalf of the committee and the other members of the Legislature, we do appreciate the way your teams have risen to the challenge and are working your way through what is something really unprecedented in both the vaccination and the experience we’re having at the hospitals at the present time. We thank you, and we also thank you for taking time from your schedule to come before us today and let us know just how it’s going, because we realize it’s ongoing and I’m sure we’ll have a chance to talk again in the future about it - later, perhaps when the pressure’s off.

With that, we are finished with the business. We are going to have a subcommittee meeting on agenda setting and that is because the Auditor General’s Report, which we expected December 2^nd, and again the 16^th, has now been put back to January. So the members of the subcommittee could stay afterwards and we’ll have that in camera meeting. Thank you.

The meeting is adjourned.

[The committee adjourned at 11:01 a.m.]