Healthcare salaries and employee benefits in Nova Scotia grew by $1.93 billion over five years, representing one of the largest expense increases across government, Auditor General Kim Adair said Monday in her 2025 Financial Report.
Nova Scotia’s annual healthcare operating expenses reached $7.7 billion in 2024-25, an increase of $2.4 billion over the last five years.
The province spent $123 million on travel nurses in 2024-25, part of a three-year total of $314 million as it works to address healthcare staffing shortages. The 2024-25 figure represents a decrease from an all-time high of $154 million in 2023-24.
Additional travel healthcare spending
Beyond travel nurses, the province spent an additional $13.2 million on other travel healthcare professionals in 2024-25, including $7 million for diagnostic imaging technicians, $6 million for personal support workers, and $158,000 for sonographers.
The province invested $16.4 million in nursing workforce initiatives including registered nurse prescribing, mentorship, simulation learning and transition to practice programs. Another $15 million went to the SPRINT program for recruiting and retaining internationally educated health professionals.
Long-term care sector obligations
The province has signed service agreements with long-term care providers totaling $15.7 billion for both operational and capital needs over at least the next 25 years. These agreements account for more than half of the province’s total contractual obligations.
Over the last five years, the province spent $4.1 billion on long-term care, including operating costs, staff compensation, capital expenditures and debt servicing.
An accounting adjustment in 2024-25 resulted in $879.9 million in loans to long-term care service providers being reclassified, with related facilities recognized as tangible capital assets worth $798.4 million.
Overall spending up 43%
Nova Scotia’s annual spending has climbed to $18 billion, up $5.4 billion or 43 per cent since 2020-21.
Despite a $265 million surplus in 2024-25, the province’s net debt increased $1.7 billion from the previous year to reach $20.8 billion at the end of the fiscal year.
“A trend of increased net debt weakens a government’s financial position because more of its future revenues will be needed to pay its past debts,” Adair said in the report. “That could negatively impact the ability to provide provincial services without resorting to additional borrowing.”
Capital investments drive debt increase
Capital investments in health facility projects were key to the $1.7 billion increase in net debt. The Halifax Infirmary Expansion received $361 million and the Cape Breton Healthcare Redevelopment got $146 million. The province also invested $325 million in long-term care facilities including nursing homes.
Over five years, total future spending commitments have grown from $9.8 billion in 2020-21 to $29.7 billion in 2024-25.
Debt servicing costs rise
The province’s unmatured debt now stands at $19.3 billion. Interest on debt for 2024-25 was $756 million, an increase of $207 million from the five-year low of $549 million in 2021-22.
Debt servicing costs currently stand at $810 per Nova Scotian, the highest of the past five years.
Revenue uncertainty and over-budget spending
Adair cautioned that significant uncertainty has impacted the province’s revenue estimates.
Over the last five years, the province has spent $6.7 billion in over-budget spending through additional appropriations, with $1.6 billion in 2024-25 alone.
“Although I noted accountability and transparency around over-budget spending improved slightly this year, I am concerned that important recommendations remain unaddressed,” Adair said.
Other significant findings
The province may receive up to $784.8 million over 20 years from Canadian tobacco companies to help offset healthcare costs related to smoking.
To ease rising electricity rates, the province spent $117 million to purchase receivables from Nova Scotia Power. As of March 31, 2025, $109.7 million was still owed from customers.
Annual toll revenue of roughly $25-37 million is no longer being collected following the elimination of Halifax Harbour bridge tolls. The province is now responsible for future capital and operating expenses for both bridges, which averaged $29 million a year for the past five years.
Clean audit opinion maintained
For the 25th year in a row, the Province of Nova Scotia received a clean audit opinion on its financial statements.
However, significant control weaknesses at two government departments and two government organizations need to be fixed, according to the report.
