Solution Two: Provide the care Nova Scotians need and deserve
Our healthcare delivery across the continuum of care will be very different, as we embrace modern tools and technology, data and metrics, and leverage staff expertise and experience in order to give people compassionate, equitable and effective care - in the right place, at the right time, from the right care team.
Our progress on what we will do
Work Ongoing: Started and continues through 2022-26
Complete: The action is complete
Work Underway: The action has been initiated
Not Started: The action has not been initiated yet
- Develop innovative primary healthcare models to deliver care when, where, and how it’s needed
Actions will include Progress Update Status - Strengthen local decision making by empowering leaders in each zone to develop clinical health services plans to realign services with the needs of communities
- Planning is underway with health system partners to understand community health needs and opportunities to improve access to primary health care.
- Give local leadership the supports they need to implement their plans, including the adoption of new technologies, integration with other areas of the system, and letting providers work to their full scope of practice
- Work is underway with Dalhousie Medical School’s Family Medicine Clinics to take 3,500 more people from the Need a Family Practice Registry.
- Four collaborative Nurse Practitioner and Pharmacist clinics have been implemented, with additional sites being explored.
- A new physician funding model pilot (called blended capitation) has been launched to encourage more team-based care, and to make it easier for patients to get the care they need, when and where they need it.
- The scope of practice is being expanded for other healthcare professionals to support team-based care and reduce the burden traditionally placed on physicians.
- Launch mobile primary healthcare clinics to help bridge the gap in primary care services
- Staffed by nurse practitioners, family physicians, and other health care providers, this service helps bridge the gap in primary care services.
- The mobile primary healthcare clinics are a partnership between EHS, IWK, and Nova Scotia Health’s Innovation Hub.
- Over 22 clinics offered to date with 2,500 patients seen across these clinics since the launch in September 2022. Current staff and patient experience scores are 4.9/5.
- Expand access to long-term and home care with investments in people, technology, and infrastructure
Actions will include Progress Update Status - Renovate and build more than 2,500 single-bed rooms over three years
- 27 projects identified province-wide will provide single rooms for 2,400 more seniors.
- Continuing to identify opportunities to increase capacity by an additional 300 beds through conversions of residential care beds, unused Veterans Affairs Canada beds, and assisted living units.
- An RFP for 500 new beds, plus an additional 300 new beds in Central Zone, was awarded, anticipated to be opening in 2025.
- Seek federal government funding for at least an additional 1,000 new private rooms on top of the 2,500 for a total of 3,500 new single-bed rooms
- Funding for long-term care infrastructure has been discussed in NS-Canada negotiations with the federal government.
- Work to increase staffing levels at long-term care homes to achieve a daily standard of 4.1 hours of one-on-one care per resident
- Nursing homes across the province are in the process of receiving additional funding for staffing once they are assessed and return signed agreements. Quarterly assessments of homes receiving funding will occur to ensure resident care hours are being met.
- Continual new Work and Learn CCA intakes will help facilities achieve the minimum of 4.1 hours of one-on-one care. Seniors and Long-term Care is available to meet with any LTC facilities struggling with hiring.
- Currently, 73.3% of facilities have been assessed ready and provided funding support to reach 4.1 hours of care. Another 7.7% have been assessed as close to ready, with 15.5% still working on a state of readiness.
- Increase culturally specific supports to ensure needs are met in a way that reflects the diversity of the residents of Nova Scotia
- Work is underway on policy improvements related to better access to home nursing in Mi’kmaq communities to improve access to care.
- Improving access to home care and community supports for equity-seeking communities has been added as a key criterion in grant funding.
- Priority focus in awarding Age-Friendly Community Grants will be given to projects that increase culturally specific or diverse community supports.
- Refocus efforts on Home First strategies to help more patients return home with increased levels of supports rather than wait in hospital for admission to long-term care
- Approximately 2,000 people are receiving expanded Home First funding to purchase home support services while they wait at home for admission to Long-Term Care, access home care services, and augment services in their homes for support. Approximately 125 more people are added each month. Many of these are removed or diverted from ALC and home support wait lists.
- Redesign the Home Support Program to better meet the needs of continuing-care clients and their caregivers
- Redesign of the Home Support Program is underway, including improved accountability in contracts and service agreements, home care workforce initiatives, and implementation of a province-wide technology platform.
- Technology platform upgrades are underway and have been implemented in 7 of 9 rural home care agencies this fiscal. A tenth agency will be added in 2023.
- Improve the coordination of care services for Nova Scotians with complex needs
Actions will include Progress Update Status - Expand the INSPIRED program beyond Halifax to provide home care for patients with advanced chronic obstructive pulmonary disease
- Funding has been identified and expansion planning has begun with recruitment underway.
- The proof of concept is starting with optimized processes and pathways for chronic obstructive pulmonary disease patients working with the INSPIRED program and will expand over the coming years.
- Develop new chronic disease management programs to provide supports for other chronic illnesses
- Chronic Disease Management (CDM) strategy has been completed. Communication efforts are underway for broader stakeholder engagement.
- Building on the strategy, The Department of Health and Wellness Primary Care will work with NS Health on developing a Policy Framework to support an Integrated Chronic Illness Treatment and Prevention Program across the province.
- Planning has begun to develop CDM Patient pathways and service blueprint for targeted patient population.
- Development of a conceptual model to provide enhanced care for Diabetes patients with complex or other chronic disease is underway.
- Building on learnings from INSPIRED, VirtualCareNS is being leveraged for patient-facing solutions with early COPD patients.
- Expand challenging behaviours supports for continuing care providers, clients, and their families
- Work is underway to develop a plan to update and strengthen the framework for managing responsive behaviours to better support the long-term care and home care sector. Four pilots in long-term care facilities are planned, with one currently in progress.
- Implement programming that better meets the needs of specialized populations such as individuals with complex behaviours and young adults
- A medically complex care unit has been implemented within a long-term care facility. Planning is underway to develop other innovative solutions to better meet the needs of specialized populations.
- Seniors and Long-Term Care, NS Health, and the Department of Community Services (DCS) Disability Support Program are working to transition clients from Long-Term Care (LTC) into apartments, receiving home care and other supports from both departments. The first four individuals in the shared services pilot have moved into their apartments. Work is underway to move 25 more people with complex care needs into community from LTC and hospital as a second phase to the shared services program.
- Implement innovative solutions to reduce surgical wait times, provide safe, quality care, and achieve benchmarks
Actions will include Progress Update Status - Reduce wait lists by completing 2,500 additional surgeries in the next 12 months
- Work continues across all zones to ensure all opportunities to expand surgical capacity are maximized.
- Establish a centralized booking system to manage waitlists for surgeries
- Centralized booking is in place at three hospitals across the province with further implementation planning to begin before March 31, 2023.
- Realize efficiencies by establishing a process for central intake and pooling of referrals
- Consultation with surgeons and primary care have occurred and remain ongoing. An electronic referral solution has been procured and implementation of all surgical specialties to begin before March 31, 2023.
- Continue to dedicate resources to expand operating room hours and capacity
- A new endoscopy room has opened at Dartmouth General Hospital. It is the third endoscopy room at the hospital and allows about 125 more people each month to have colonoscopies as part of Nova Scotia’s Colon Cancer Prevention Program.
- NS Health and IWK are working across all zones to ensure all opportunities to expand surgical capacity are maximized. This includes leveraging additional capacity created by the Dartmouth General Hospital expansion and increasing the volume of ophthalmology procedures completed at the Halifax Surgical Vision Centre. Under a new agreement with the Halifax Vision Surgical Centre, the centre will perform up to 6,000 cataract surgeries in 2023, an increase of about 3,700 from 2022. The surgeries will continue to be available to patients at no cost and will be performed by the same eye surgeons who perform surgeries through NS Health.
- Work is underway to stabilize the surgical workforce to ensure resources are in place over the longer term to enable and sustain access.
- Expand virtual care to strengthen the system and improve access to appropriate care
Actions will include Progress Update Status - Develop a multi-year virtual care strategy
- The development of strategic policy recommendations to guide the expansion and integration of virtual care is complete.
- The final policy will be released by end of fiscal.
- Expand virtual care to include some consultations with specialists so patients don’t have to travel for care
- NS Health’s Innovation Hub has launched a six-month pilot program with Virtual Hallway, a Nova Scotian company that connects primary care providers with specialists to improve patient access to specialist care.
- Integrate mental health services into the virtual care program for all Nova Scotians
- Expanded an agreement with Tranquility, an online program that helps people experiencing depression and anxiety better understand their emotions, thoughts, and behaviours, and build skills and coping strategies. Now anyone can access the cognitive behavioural therapy program 24 hours a day, seven days a week at https://www.tranquility.app/novascotia
- Virtual technology and online supports have been incorporated and made available to the public. The Clinical Virtual Care Team has been expanded by 20 employees and a Provincial Virtual Urgent Care project is being piloted with plans to expand to new areas.
- Access has been expanded to urgent mental health and addictions care in rural communities by allowing assessments to be conducted virtually, which reduces wait times, improves access, and eliminates travel to other regions.
- NS Health is working to expand access through a Peer Support Warm line.
- 230 Non-Urgent Virtual Care Appointments were provided through Nova Scotia Health’s Mental Health and Addictions Programming between April-July 2022.
- Introduce virtual care as another service option in emergency departments to lower wait times for patients without a primary care provider seeking non-urgent care
- Virtual Care Emergency NS (VENS) launched in May 2022 at the Colchester East Hants Health Centre in Truro, with comprehensive evaluation in place to engage patients and providers. Since then, VENS has been soft-launched in Strait Richmond and Yarmouth, with over 1,200 completed visits, over 1,000 requisitions issued, and over 1,000 prescriptions issued over three locations.
- Patients with less urgent needs can now see a doctor virtually, with a paramedic or nurse on-site, at more hospitals.
- NS Health and Emergency Health Services (EHS) are partnering to provide virtual physician support to some rural emergency departments.
- Allow walk-in clinics to offer virtual care
- This policy change was effective April 1, 2022.
Solution Two Results
We said we would expand access to long-term and home care.
We will monitor changes in the waitlist for home care, with a goal of returning this waitlist to where it was prior to the COVID-19 pandemic. We will also monitor changes in how many admissions to long-term care we are making from hospitals and community.
Volume of the home care waitlist
Number of admissions to long-term care (from hospital and community)
We said we would make it easier for Nova Scotians with complex needs to access care early.
We will monitor how many people are admitted to hospitals for complex conditions where a hospital visit could have been avoided with primary care.
Percentage of hospital admissions for people whose complex needs could have been addressed with primary healthcare
We said we would use innovative solutions to reduce surgical wait times
We will monitor how many surgeries or surgery wait times are within our benchmark for both diagnosis (endoscopic) and treatment (non-endoscopic) surgeries.
Percentage of endoscopic surgical services completed or wait times within benchmark
Percentage of non-endoscopic surgical services completed or wait times within benchmark
We said we would expand primary healthcare, in part through innovative new models
We will continue to report on how many people in Nova Scotia are seeking a primary care provider, as well as how frequently Emergency Department visits are by patients who do not have a primary care provider.