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3 mai 2016
Comités pléniers
Sujet(s) à aborder: 
CWH on Supply (Health & Wellness and Seniors) - Legislative Chamber (1920)












3:38 P.M.



Mr. Gordon Wilson


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


            The honourable Deputy Government House Leader.


            MR. TERRY FARRELL: Mr. Chairman, would you please call for the resumption of consideration of the estimates of the Departments of Health and Wellness, and Seniors.


            MR. CHAIRMAN: The NDP caucus has 26 minutes remaining in their time.


            The honourable member for Sackville-Cobequid.


            HON. DAVID WILSON: I thank the minister and his staff for being here.


            I'm going to pick up a little bit on some line item questions from the budget that I was asking last evening. I will be on Page 13.2 at this time. I know I finished off with some questioning around physician services. I'm going to drop down to Capital Grants and Healthcare Capital Amortization. I'm wondering if the minister could indicate to the House what really is found under that line item and what constitutes - last year's budget was about $79 million, and of course this year's budget is around $72 million. I'm wondering if the minister could give us a bit of a breakdown on what we would find that drives those costs under that Capital Grants and Healthcare Capital Amortization line in the budget.


            HON. LEO GLAVINE: I thank the member opposite for the question. I just want to take a moment to recognize in the gallery the Deputy Minister of Seniors, who's here today and available should support be needed from him. Also, Roy Jamieson from the department, who was very helpful in putting together the opening comments, is here for support throughout estimates.


            In the Capital Grants and Healthcare Capital Amortization, we have capital envelopes with the estimate and then the forecast. In the 2015-16 budget, that was at $21 million; hospital infrastructure, $42 million; health care capital amortization at $16 million - for a total of $79 million and the forecast at $55 million. That would include some IT projects in that health care capital piece.


            As the member opposite would know, we always deal with projects that get slowed down. Hospital work is always complex. I've been over to take a look at the work going on on the third and fourth floors at Dartmouth General. I've gone there and expected that we would definitely be much more ahead of schedule and able to predict an opening date, and all of a sudden, that is not realized. Maybe it's a piece of equipment that doesn't show up on time.


            Basically, these capital envelopes are the small projects that go on in our facilities right across the province. For example, work was required when the CAT scan was installed in Inverness and turned out to be probably a bigger project. The new linear accelerator in Cape Breton - these are examples of projects that are smaller but needed. We have a number right across the province that will get a delay from time to time. I believe it's somewhere in the vicinity of $24 million that didn't go out the door in the fiscal year.


            MR. DAVID WILSON: With that, would you not anticipate those costs being seen on this year's budget? The reason I ask that is that the budget for this line item went down by about $7.4 million. Is the minister saying that the $24 million, roughly, that was not spent last year - that's a significant decrease from almost $80 million when the province ended up spending about $55 million - would he anticipate the cost that was budgeted last year, the $24 million, would be captured in this year's budget? Or are some of those projects now off the table?


            MR. GLAVINE: We know that there can be a lot of different reasons why projects do get delayed. Some of that money can be used this year, or it can be out even further. We've had the Aberdeen refurbishing project of the pharmacy and the emergency going on for a number of years, and some of that money that may have been in 2015-16 will be this year and possibly beyond as well. We have the decrease in hospital infrastructure projects of $8.2 million, and due completion of existing projects such as Halifax Infirmary dialysis and a linear accelerator at Digby and Area Health Services Centre. Again, that's work that has ended. Other projects, however, are still in scope and in play for a period of time.


            MR. DAVID WILSON: There was a committee that made recommendations to the minister's office around some of these larger projects. I think it stemmed from some criticism from the Auditor General a number of years ago. I'm just wondering if that's still the case. Is there still a committee that looks at these ticket items, these larger projects, within the health care sector that the minister and deputy minister and his department look at on an annual basis?


            MR. GLAVINE: I do want to convey to the member that the TCA committee does remain in existence. While he's asking about Health and Wellness, obviously it goes across other departments as well. That committee really does that very deep analytical look at what this project will entail, how many years it's likely to be done over, and then on to the Treasury Board for approval. That's a process that continues to go on.


            We all know that it was the Auditor General and the member's government that got started on the Dartmouth project because the Auditor General had identified that infection control was not at the standard that was required. That was a project that goes back a number of years, it's still being worked through, and it's still a ways from completion.


            MR. DAVID WILSON: With the most recent announcement of the plan for the replacement of the Centennial building - as I say that, it doesn't mean that the replacement of that existing building will be the same. We know that, and that was never the intention, I don't think, in past governments to just build what was there. It was trying to find out what was needed when services were moved out of there. With that release and that news conference that happened a couple of weeks ago, there has been the question around funding. Would I be correct to say that any large project like this, funding should be reflected under this budget line item? The minister can indicate, if there's any for the planning, if it's found under here, and what the cost of that is. Am I correct to say that that type of project would be found in the cost under that line item in the budget?


            MR. GLAVINE: I'm sure the member opposite knows very well the kind of discussions that went on before we did take a look at the VG and Centennial replacement and how those services would be deployed in a distributive model of care. As the member rightly identifies, this thinking has been going on for some time. We didn't need a duplication of the current building. The model of care has changed very, very dramatically over that period of time. I guess without going through all of the proposal that we currently have - and I think there will be even some further addition as the clinical services review gets to that final state of making recommendations, and the goal of course is to have the right service in the right place and the right amount of a particular service being delivered.


            One good example is that we know we also need some additional human resources if we're going to be able to invest $8 million for hip and knees, if we're going to be able to capture that each and every year - human resources, some changes in the orthopaedic locations, and doing surgeries. I'm pleased to say that we'll be adding a foot and ankle specialist this summer to that group.


            Really, when we talk about facilities for our specialists and those who deliver care, we absolutely need to be looking with a lot of foresight at what the next 40 or 50 years will require. It's very important - the design work, the work that's currently in the budget for the third and fourth floors of the Dartmouth General, monies for the expansion; both the design and renovations that should get under way at the fifth floor of the Halifax Infirmary this year, where there will be three additional ORs, as well as money for the design of the addition to the Halifax Infirmary; and monies are also in the budget for refurbishing the OR at Hants Community Hospital.


            While there's not that big an envelope for the major build, renovation, and expansion at the Dickson Centre, we know it will be four or five years, maybe, but probably five or six years. We have, in fact, money for all of the design for Hants and the QEII. That will be a very important step this year in order to initiate that work. The work on the Halifax hospice, I think the final signing of that work gives us an opportunity for doing palliative care differently here as part of the array of services that are offered at the QEII.


            While it's early days, it is also wonderful to hear from the foundations that they are preparing for a capital campaign. We know that this is not just a provincial hospital, but it's also our Maritime regional hospital, with some services provided to Newfoundland and Labrador as well. I'm pleased to say that that model of the past, 75-25, will probably need some adjustment on the millions of dollars that will be required to bring all of the required facilities up to the standard, either expand or build new.


            I believe that's where the next budget, taking the one-time money, the $110 million this year, will allow us some capacity for borrowing. I believe in the next couple of years we'll start to see more significant amounts of money required for hospital construction here to replace the VG.


            MR. DAVID WILSON: Thank you for the comments because as the minister continues to talk, there's more and more questions. I think we heard today that not all of the $110 million went on the debt so that it can give some relief so that we can potentially borrow against that.


            What I had asked was, is there a dollar figure? If the minister can't provide it now, I'm more than happy to allow him to provide it. Is there a dollar figure within the department that we are going to spend next year? There's $25 million for the transition of moving services out of the Centennial building into other facilities around the province. I'm wondering if the minister could give us a dollar figure. I know he said there's monies, but this is the Budget Estimates, and I think Nova Scotians should know what the commitment is so that we can hold the government accountable and so that next year, when we look at the budget and look at line items especially under this line item, when see potentially $24 million underspent for whatever reason, we're prepared to do that.


            I'm wondering if the minister can give us a dollar figure of what the government's commitment is in this year's budget towards moving those services out of the Centennial building and moving them throughout different areas that the minister had referred to in the last answer.


            MR. GLAVINE: What is in the budget for this year is design dollars, slightly over $3 million - closer to $4 million, sorry - that will be available this year. We know the work continues, very important work, at Dartmouth General. It's critically important we make sure that what we do build and what we do refurbish is on the right scale for the future. While this year has a small amount, it will put us in a position for considerable dollars to be spent next year.


            The $110 million is indeed on the debt. That will allow us, in time, better borrowing capacity.


            MR. DAVID WILSON: I think I'm clear on that: $4 million is the commitment this year, in hopes of getting into a position where next year, there will be a larger investment, I would assume.


            But I have to question the minister - actually not the minister because the minister didn't make the announcement. It was the Premier who made the announcement on the movement of services out of the Centennial building, and that was going to happen this year. In 2016, some of those services are going to move out. I find it very difficult to understand that that's going to happen when all that has been allocated in the budget is $4 million for design.


            I want to back up, as I wrote some of the answers down, to a question I just asked the minister. That was around medical equipment and trying to figure out and prioritize what is important and what the priorities are as we move forward in the upcoming year. The Auditor General had indicated some concern around how that happened, how that happens within government and within the minister's office.


            The former government created a committee of staff from the Department of Health and Wellness and staff from the district health authorities to prioritize equipment, similar to what the school board does for their requests to the government on what projects are number 1, 2, 3, and 4. In the past, it was generators for IWK and things like that.


             The minister mentioned the TCA committee, which is the tangible capital asset committee. That's separate. That was a separate committee that the government had. Is the committee that was created within the Department of Health and Wellness with the district health authorities, which you could now associate to the Health Authority, still up and running? Are there recommendations from that committee to the minister? I'm not asking about the TCA committee; I'm asking about a dedicated committee about hospital equipment that was created a number of years ago. Is that still ongoing? Or is that gone in the restructuring that happened with the amalgamation and with the changes in the minister's office?


            MR. GLAVINE: As the member opposite knows, the provision of equipment for hospitals is obviously very expensive. We're certainly pretty vigilant about best-before dates after the sterilizers that we had to deal with this year. There is prioritization.


            That committee that the minister is very familiar with obviously would have taken the requests from the nine districts and given prioritization to that. That is now taking place by the NSHA, as the NSHA also develops what services will be provided where, getting the right number, the right amount, in different parts of the province, and making sure we have the equipment to provide the diagnostic work, also along with the diagnostic work, providing equipment for monitoring, the CAT scans, the ultrasounds, and so forth. We'll do this as well in conjunction with the IWK. The two health authorities will be constantly assessing what equipment needs replacing and what additional equipment.


            It's always a wonderful story for any Minister of Health when they're invited to a community, and there is the unveiling or ribbon-cutting - also the work of our foundations. The one area that when we went to the consolidation, the amalgamation, of the districts - I would have to say the foundations are in fact very often the first to come to the public's mind about who puts equipment in the hospital even though we spend millions each year in providing.


            We're just now getting three state-of-the-art linear accelerators. I'm told by the radiology oncologists and physicists that at this moment in time, we have the most advanced delivery of radiation in the country just because we were able to buy three of the next generation of linear accelerators. So that's a good day for Nova Scotians.


            One of the areas that is now part of the mandate of the Department of Health and Wellness is the establishment of standards, making sure that constant oversight of the system is in fact constantly being carried out. DHW oversight remains a significant part of the provision of the equipment and the technology advancements that we need in our health care system.


            The committee that the member and former minister is familiar with will now be the purview of the IWK and the Nova Scotia Health Authority.


            MR. CHAIRMAN: Time for the NDP has elapsed. We'll now rotate to the Progressive Conservative Party.


            The honourable Leader of the Official Opposition.


            HON. JAMIE BAILLIE: Last time we were here together, we were just turning to the Seniors' Pharmacare Program and looking at the changes that were proposed and then delayed. I was talking to the minister about whether seniors had been consulted truly about those changes. I'd like to just pick that line of questioning up now where we left off.


            I'd like to start by asking the minister, when was the consultation with the Group of IX, the representative seniors, on the changes that had been proposed by the government this winter?


            MR. GLAVINE: I don't have the dates in front of me here, but I know that there were a number of occasions when department officials presented to the Group of IX. Their reaction and their levels of support were indeed monitored and identified in terms of the proposed changes that we were making. I know that any time we've presented to the Group of IX - they represent significant numbers of retired Nova Scotians in particular since they represent nine significant groups, whether it's government employees or teachers who have retired or a number of other groups who have representation on that committee. I know that when I first started to meet with them, I was pretty impressed with the kind of ask they would have and also the kind of research that they had done in order to support the positions that they were presenting to the minister.


            I'm pleased to say now that we have a full-time Deputy Minister of Seniors. It's a small department and an unbelievably hard-working department. I certainly do reach out to that department to provide the best information.


            There were several occasions during the last year when this whole presentation of changes to the Pharmacare Program was made known to them. That included their advice where possible. I don't think they went out to their membership to glean some additional feedback from them. I know the Group of IX, having been in front of them to present and to hear their reactions, are truly well-represented by the leaders who come before the minister and the deputy minister and who speak publicly about issues that are of concern to seniors.


            MR. BAILLIE: So I hear the minister saying on a number of occasions prior to the changes being introduced. Who from the government side was in those meetings, and did that include the minister at any time himself?


            MR. GLAVINE: What I can tell the member opposite here is that I was not in attendance at those particular meetings. It would have been the role of the deputy minister to be present during those meetings. He has made a very strong connection to the current Group of IX, not only on the Pharmacare issue but on a wide range of seniors' issues. He has used the leaders of the Group of IX as a sounding board whether it's maintaining grants for age-friendly communities, those who provide greater security in our communities. He has had that dialogue back and forth. I've relied on the deputy minister, as I should, to get information to move a number of programs forward.


            MR. BAILLIE: As members might recall from last night, we were beginning to examine the five-year projections for Seniors' Pharmacare which the department produced at the time. They indicate a 5.4 per cent increase in the cost of the Seniors' Pharmacare Program starting in this year and going on each year. According to the Estimates Book, that turns out not to be the case. It's either 0.3 per cent, if you're measuring from the forecast, or 1.8 per cent when you measure estimate-to-estimate, far short of what the public was told and apparently what the Group of IX was told. I say that, because they now say that they believed the outcome of the consultation was that they would see an increase of around 5.4 per cent, in line with the cost increase of the program that was presented to them.


            I would just like to give the minister a chance to present his side of that story. Would the minister tell us what the department told the Group of IX in those consultations about the rate of increase in the upcoming year of the cost of the Seniors' Pharmacare Program? Was it presented to them as 5.4 per cent as has been alleged, was it the number in the Estimates Book, or was it some other number?


            MR. GLAVINE: With this particular area of Pharmacare or whether it's Family Pharmacare or Seniors' Pharmacare, we're fortunate to have just a couple of programs to monitor and deal with in our province, unlike our neighbour province which has about 15 different Pharmacare Programs. Projections in this particular program are really very difficult to be able to pin down exactly.


            A 5 per cent to 7 per cent range is not out of line whatsoever because we all of a sudden are no longer adding the generics to the formulary. We need to know that previous governments - and I would say the last year or two of the MacDonald Government and the years of the Dexter Government - were fortunate to see about 18 generics added to the formulary. This saved government and it saved seniors millions of dollars over that period of time because these were dramatic drops in brand-name drugs that we would now put in place of the very expensive drugs. That came to a halting end where we were not adding these. So projecting this 5 per cent a year up to 7 per cent was a very reasonable projection.


            One of the areas that the department benefits from is a system of rebates. This was very controversial because we know that for years, pharmacies were also able to benefit from rebates that came to them. Some years, this amounts to considerable millions of dollars, and during the period of time in formulating Pharmacare, that number was not available to us, coming into the department once a year. The rebates are variable, and they have provided more this year than we had anticipated.


            MR. BAILLIE: The rebates and generics may well have saved government, but there's no evidence that they saved seniors. Actually, that brings up an interesting point about the split, the cost sharing between seniors through their premiums and the government contribution itself. In fact, when the program was first devised, it was envisioned that it would be a 75-25 split. The government would pay 75 per cent of the cost, and seniors would pay 25 per cent. I believe the reason behind that was to make sure that medicines were affordable to as many seniors as possible and to get the medicines they need into seniors' hands.


            That split has been eroding over time, and that's why I wanted to ask the minister what makes him think that seniors have been benefiting from the savings because from the government's own Estimates Books, seniors were paying 30 per cent of the cost in 2014. In 2015, that had crept up to 31 per cent as the government scooped the savings from generics and did not share that with seniors. Then in 2016, the seniors' contribution rose to 32 per cent, clearly going in the wrong direction from seniors' point of view. Had the changes that the government proposed been enacted, that would have jumped all the way up to 37 per cent of the total cost, with the government down to 63 per cent. Now that has been halted, so we're back to the current estimates, which is a 69-31 split, but seniors are not getting any of the savings; the government is taking every dollar of those savings from generics and from rebates.


            I would like to just get the minister's confirmation: was this eroding change in cost share in favour of the government and added to the cost of seniors shared with them in the consultations that were held prior to the changes that were proposed this year?


            MR. GLAVINE: First of all, I want to convey to the member dates of meetings with the Group of IX: August 13th, September 24th, and December 21st.


            I would take a different perspective, I guess, than the member opposite because there's no question that without the generics, for every senior in this province who wasn't exempt because of their low income and receiving the GIS, we know there would have had to be a continuous escalation of the premium and probably the co-pay, realizing that we hear perhaps more from seniors who could not afford all of the medications that were prescribed. I've had that occasion with a constituent in front of me, where they were stretching a 30-day supply over 45 days.


            We need to remember that we have somewhere in the vicinity of 24,000 Nova Scotians who get only the OAS and the supplement as their income. We have an extraordinary number of seniors without pensions and without income to get the medications they need. The Group of IX were very cognizant of that movement of 25 per cent to 27 per cent to 28 per cent to 30 per cent to 31 per cent. There was a very strong realization that those who could pay more into a system that unfortunately many people saw as only an insurance program.


            But this is a true social/insurance program because we've always had people who paid no premium and somebody else had to pick up the premium. Obviously, with government putting in over $100 million every year and seniors also paying premiums and paying co-pay made this system work. They realized that we were running out of the high-volume generics that could bring some measure of stoppage of premium rise.


            If the member wants to take a look at what's happening across the country, he will see that we're in a very good place in Nova Scotia in terms of our Seniors' Pharmacare Program. We have a very good program, but its viability, its sustainability - if we're going to be able to add other drugs to that formulary, if we're going to be able to put biologics, if we're going to be able to put the new oral cancer drugs, then we will need a different formula than where we are today.


            What I think should never be forgotten in this discussion is that we moved to a place where 12,000 more Nova Scotians pay no premium for their medications and an additional 29,000 have a reduced premium. I don't think that should ever be forgotten in this discussion.


            I know that whether it's the Group of IX, when we go out to do further consulting, the overwhelming voice that I have had to me as minister is we all understand that we were going to move to a place and a day, once the generics benefit was gone, where we would be paying more to have a sustainable program, or government would have to continue to put considerable amounts more into the program. I think we can find a balance point in this. This is where our discussions with seniors and our consultations will go. Whether it's at the kitchen table or whether it's in church basements, we will get a real read from all of our seniors as to, knowing how valuable the program is, how do we absolutely make it sustainable? I can guarantee that this government will put in monies to work on that sustainability viability for the future.


            MR. BAILLIE: I know seniors were told the government wants to make the program sustainable. I know seniors were taken by surprise by the changes that were actually made. The Group of IX actually felt that they weren't given the whole story when they were in the consultations. This is very relevant because there's going to be consultations again sometime in the very near future, and we ought to know whether seniors will be given the whole picture this time or not.


            I'll give you an example. The minister talks about sustainability, how we want to be able to pay for new drugs that are coming on stream that can benefit seniors and we want to make sure that low-income seniors are able to access the drugs that they need. Those are all worthwhile objectives that we all share. But a government that meant that, wouldn't actually take $10 million out of the program, which is what they propose to do.


            I will again return to this chart that was produced by the Department of Health and Wellness itself which showed that member contributions, those premiums that are paid by seniors, would go from $54 million to $64 million in one year, a $10 million increase, which is actually almost a 27 per cent increase in their premiums across the board. At the same time, the government contribution was supposed to go from $120 million down to $110 million; the government was going to take $10 million out of the program. No one that wanted to make the program sustainable would actually take $10 million out of it.


            I know that this is already done and that the changes have been halted. But the Group of IX that are being consulted and the seniors who are going to be consulted again in the upcoming year want to know that they're given the straight goods when they're being consulted. I'm going to ask the minister very directly: did his department tell the Group of IX in those consultations, on those three days, that the government planned to take $10 million of its own out of the program?


            MR. GLAVINE: What I can tell the member opposite is that he knows very well that these are scenarios; these are not firm numbers. You can get statistics from the past when estimates were made on how much would be spent on the Pharmacare Program and where we ended up in a particular year. We've had to provide funding on occasion to make sure that the Family Pharmacare met their obligations and Seniors' Pharmacare met its obligations. What I know and what I can confirm for the member opposite is how pleased seniors were that we did a reconsideration and a re-look at this program.


            We know that it would be great to put on the formulary as many of the requirements that are asked for. There's not a month goes by that we're not being asked to take a look at new medications that are coming on the market. They are indeed very expensive. We will move from scenarios to giving the full picture of what we see ahead for Nova Scotians in terms of making sure that Seniors' Pharmacare is there for all seniors who join.


            Many areas were exposed about the program. Certainly, the one that I found most disconcerting was people of very high income who are able to manoeuvre their income so that they qualify for the GIS. I think our seniors will give us very strong information on many aspects. In fact, I've been able to gather some very good recommendations already without even going out to the public. I can say, as minister, that I'm pleased by where we are with the Pharmacare Program. We'll make it strong for the future, and it will be there for our seniors.


            MR. BAILLIE: I just want to point out: this is not some planning exercise. This is the exact document, the numbers, every single one of them, coming from the Department of Health and Wellness itself, with the conclusion in writing that net costs to the government are about $10 million lower and that no changes have been made, referring to the changes the government tried to make. Clearly, they intended to save, from the government's point of view, $10 million by charging seniors $10 million more plus whatever the inflation cost is. That's what happened.


            With a consultation about to start, I think it's important that seniors actually be given all the information this time instead of not all the information. I can't imagine - we've already had this confirmed: the Group of IX would not have endorsed any change that saw the government taking money off the table.


            Now we're moving forward, and there's going to be more changes after a new round of consultation. Can the minister assure seniors today that it will not again try to cut money, its own contribution, out of the Seniors' Pharmacare Program?


            MR. GLAVINE: What I can tell the member opposite and all Nova Scotians is that we will engage in the strongest of consultations. All of the information that Nova Scotians want as part of the information sessions certainly will be available to seniors and to all those who have an interest in working on strong solutions for this very important program.


            We know that our seniors have a number of insurance programs that may be available to them. Some purchase private insurance programs. Our military and RCMP continue with their programs; many don't join the provincial program because their program has a wider array of coverage compared to what we're able to provide. As I often say, it's a social/insurance program.


            One of the areas that we were cautioned on in terms of implementing a new program was that we couldn't go back every year to make adjustments to the program. So that's why a number of different scenarios were developed. I know that we'll find the right balance as we move across the province to get a formula for the future.


            MR. BAILLIE: The schedule that was produced at the time included a number of scenarios. The scenario we were discussing is the actual proposal that was made, but there were additional scenarios that projected what would happen if premiums went up for some people to the maximum of $1,200 if they went up from $400 by 100 per cent or 200 per cent. The department produced scenarios that made assumptions that some would drop out of the program. Those projections show anywhere from 8,000 seniors dropping out of the Pharmacare Program to as many as 15,000. I hope nobody would want that. I just want to be clear: is the department really okay with making changes to the Pharmacare that would see so many thousands of seniors drop out of this program that they need?


            MR. GLAVINE: We certainly don't want to see Nova Scotians drop out of the program, especially with the fact that that amount of money that seniors provide through the premium is actually what allows a number of Nova Scotians who have very low incomes to get the medications they need to improve their health. In fact, if we had 10 and some would say as many as 20 high-volume medications that were part of our national Pharmacare Program, our nation's health would be substantially improved. People go without medication.


            We're not fine in terms of having whether it be 5,000 or 8,000 or 10,000 drop out of the program. If everybody subscribed, we'd also be in a better spot. We have some who take a chance at 65 and don't join. That leads, of course, to another area where we have challenges. One of the areas that is very difficult to predict is how many of those thousand that turn 65 will join each month. Utilization rates - you get a drug like Harvoni, and we get enormous calls from seniors who suffer from hepatitis C, and they want to get a medication that's actually going to cure that.


            There are many, many variables involved in this program. You often put forth a worst case, a middle case, and other scenarios that you can take a look at through the process of deciding where we would go.


            MR. BAILLIE: I would certainly hope that there is no scenario the department would consider where so many people drop out of the Pharmacare Program. The minister has alluded to a very important point: if people go without the coverage they need, they will end up sick and in an emergency room. That's obviously not good for them, and it's not very good financial planning by the government, which ends up with that cost. That's why we support keeping the Pharmacare Program as affordable as possible for seniors: so they can get the medicines they need and stay active, stay at home, and stay healthy much later in life. There are some wonderful modern, miraculous drugs that help seniors do that.


            Looking to the future, it has been three months more or less since the government announced that there would be a new round of consultations before new changes were brought in. Have the new consultations been scheduled, and can the minister share with us where that stands?


            MR. GLAVINE: What I can convey to the member and all Nova Scotians is that rolling out a consultation plan is an important process. We've used it on a number of occasions, and we'll make an announcement when we have that finalized as to where meetings will be held.


            I think this is a good time for us to take a look at where this program needs to go. We know that by 2031, 31 per cent of us will be seniors in this province. With longevity also continuing to go up a little, we need to make sure that we will have a sustainable program and that we get the right balance. Is it 30-70 now? I remember when Medicare was 50-50. We've had a considerable change since that program was initiated. I believe it's a good time for us to make sure that we get this program right.


            MR. BAILLIE: I know seniors are patient, but when I asked when the consultations would be, and the minister talked about 2031, I thought he was asking them to be a little more patient than he should ask for. The last round of consultations was with the Group of IX, not all seniors. The first meeting was August 13th; that's just three months from now. I would encourage the government to get on with it. We'll soon be into another budget year. I know they know that even though we're still here in this budget year.


            Seniors are going to want to know what the next round of changes is going to be and if they're going to have a true consultation and, as was promised to seniors, if they're going to be consulted from one end of the province to the other. Better start booking those town halls, because they have a lot to say, I know, and would like a chance to say it before any new decisions get made.


            The last question on this topic: can the minister provide to us the exact budget effect of halting the changes to the Pharmacare Program? How much in this budget is a result of halting those changes?


            MR. GLAVINE: In terms of halting the program, it required an additional $3 million to be able to provide no premiums to an additional 12,000 Nova Scotians.


            MR. BAILLIE: I'd like to move on at this time to talk about another very important topic, which is mental health and the delivery of mental health services. I just want to do a check if we're okay to proceed on that topic now or if the minister requires any other officials. We're good to go? Okay, thank you.


            Just starting at a very high level, the budget supplementary publications indicated that $271 million is earmarked for mental health this year. Can the minister point in the Estimates Book to where that number is? In other words, what makes that up?


            MR. GLAVINE: I guess this is the real kind of time of estimates, when we take a look at dollars here.


            In terms of the mental health and addictions budget, the NSHA mental health and addictions is $116 million. That is the short-term psychiatric units, the psychiatrists, all of the personnel who are involved with mental health. We know that there are a whole number of community hospitals across the province that provide addiction services. Whether you're at Fishermen's Memorial, Soldiers' Memorial, or All Saints, these have addiction programs. The Abbie Lane and the Purdy Building - all of those add up into that category.


            The IWK mental health and addictions is a $30 million figure. This is what I would say is our central place for children who have a range of very serious early psychosis, where they go to a world-class - the Garron Centre, which I know the member is familiar with, is probably the best in North America. They've recruited clinicians for a number of specialty programs that will work in the Garron Centre. Also, they're now moving mental health services across the province to be able to have adolescent psychologists in areas across Nova Scotia so that those needing a higher level of clinical support can be supported.


            The department program budget is over $4 million, just a small amount on administration of $447,000. On the addictions side, the NSHA has budgeted $38 million; IWK, $3 million; and the DHWA program budget, almost $4 million. All of that comes in at a total of around $196 million. Then we add in physician services, psychiatry, and the pharmaceutical area - $48 million for physician services, that being psychiatry; and $30 million for pharmaceuticals. This is a full comprehensive $275 million that goes into mental health services across the province. Before we were probably looking primarily at what was coming out of the department in terms of providing for mental health. I'll stop there and give the member an opportunity to maybe drill down on some of those statistics.


            MR. BAILLIE: I appreciate that list. I know there are some really impressive things going on in mental health. The government in the budget publications pointed out that there was $271 million being spent in this area. The minister has listed it for us. How does that compare to the estimate and forecast for the previous year?


            MR. GLAVINE: This is a considerable amount of money that is spent. There's not a significant change in the total amount, this year at $275.3 million and last year at $274.1 million.


            However, if you start to break down what was spent on physician services and pharmaceuticals, we see some variation there because we have added over $3 million to EIBI in this particular budget year, which comes under the $275 million. This is a program that many families have certainly made a very strong statement to me, since becoming minister, that they want their child to get the EIBI program before going to school. When I arrived at the minister's desk, we had some children who are now six years of age who didn't have the EIBI program. Immediately, we put $1 million into the program to look after those who were in that school-age year.


            We've had now the opportunity for the IWK and the public school system to give us feedback on families who saw the chronological age of their child being at school age going to school without the program and those who receive the program and certainly the preparation for learning that would take place in the school was really impeded by those who didn't have the benefit of the EIBI program. This is why now to put over $3 million into EIBI will create about 60 more children's opportunities for EIBI in getting more people trained to deliver the program.


            Actually I think it was in Cape Breton that we really got behind because we had three go out on pregnancy leave all at the same time, and we had some children who should have had the program who didn't. It really tells us that we need more therapists trained and ready to support because the earlier we can get the program, but more importantly getting the program, either the full intensive program, or now they're actually developing at the IWK a strong assessment of what the nature of the program should be, I think, how long it will need to go on. They're also including the training of family members that can continue to reinforce what is being done through EIBI.


            I think we're at a much better place with this particular program, and I think we'll see those kinds of benefits for the children and obviously for families who have that challenge of a child at some place on the autism spectrum.


            MR. BAILLIE: I'm wondering if the minister has with him the current average wait times for youth mental health services and adult mental health services by zone in Nova Scotia.


            MR. GLAVINE: This gives me an opportunity here to let the member know that we will get that information for him with the latest updated statistics, but it also gives me an opportunity to let him know as well that I have a full picture of the wait-lists and vacancies and so on at the nursing homes that he had asked about last night. Also, we are getting a picture for Parrsboro in terms of doctors, doctor recruitment, and the CEC there. We'll have that information as well for the member.


            MR. BAILLIE: I appreciate that, and I look forward to receiving it as soon as it's practicable, hopefully very shortly; it's a very important topic. I am going to ask if the minister will include with that information the benchmarks that are in place for both youth wait times and for adult wait times. I think he's nodding, so I won't spend a lot of time on just a yes. I appreciate that as well.


            Nova Scotians have been watching with growing worry when they hear about their fellow citizens, particularly adolescents who are presenting themselves at emergency rooms with some signs of mental illness - whether it's depression, suicidal thoughts, great anxiety, or many other mental illnesses - who unfortunately all too often end up in the emergency rooms of the province, and sometimes they're turned away. We had the story just last week of Lianne Perry who took a friend to the emergency room, and they were both sent home. I'd like to give the minister an opportunity to tell us what the department is doing to ensure that our emergency rooms today are properly equipped both staff-wise and otherwise to handle the growing number of Nova Scotians with mental illness who are showing up at emergency rooms and need treatment there.


            MR. GLAVINE: The member raises a very, very important question for families and for Nova Scotians who have to access care. The first thing I would say is that I'm certainly not sure or convinced at this point that we have more mental health issues than in previous years. I believe the good story that we need to tell, and this is happening across our country and hopefully across other parts of the world as well, is the breaking down of that stigma of mental health has gone a tremendous ways in our country. We know there have been some outstanding champions.


            Many were touched by Clara Hughes and Let's Talk as she bicycled across the country. She was able to relate her story. Here you had one of our most prominent athletes in both summer and winter Olympics, yet she suffered for a very long time with mental illness. She's the kind of person that I believe has opened a door for many more people to talk about a whole range of what constitutes a mental illness. I believe that kind of making it known and speaking about it in no different terms than if you have a cardiac incident or a lifelong cardiac issue - people talk about having a pacemaker and how some get back to athletic performance and so on. We need to talk about our mental health issues in the same way. It's a long journey for some to be able to do that.


            In terms of those who come to our ERs because it is and will continue to be one of the access points, whether you're brought by an ambulance, a family member, or a friend, the training has begun for the doctors who are working in our ERs and outpatient clinics. I recently signed off on the 50 for this year who have taken part in a professional program to support those who come to their office and come to an emergency room who are suffering and dealing with mental illness. When we have an incident that becomes public, that's very, very unfortunate to have had happen. We know in some cases there's actually a nurse who's able to provide psychiatric nursing care to some of our outpatients and in some of our emergency rooms. That's a great ability to meet the crisis and deal with it as fully as possible on those kinds of occasions.


            While the Aberdeen has been in the news, what I see there is really one of those silver linings where we take a look at what was not the right service for that community in terms of making sure that people were getting the right service at the right time. Short-term psychiatric units are set up so that within five days, somebody is helped, and they're back home to their family or they go on for further help at one of our facilities here in the city, maybe a 30-day assessment - whatever is required. There are some who do still need long-term placement in a place such as - if there's a crime associated, it could be the East Coast Forensic Centre. It could be the Purdy Building. But we have those facilities that are available.


            What I like about where we're going at the Aberdeen - and we're talking about a population of roughly 40,000 people - is there will be two beds established and set aside for those who present in some kind of mental health trauma that they need care for. Those will be observational beds where we will be able to call in psychiatric care for those who are in that condition and then a decision can be made on what is needed to deal with those patients.


            Many here are familiar where a patient's mental illness is very well controlled by medication but sometimes they go off the medication and it's not a good day when that happens and it's a very difficult day for the individual and the family. Very often it can be a medication adjustment, or it can be continuous counselling and support and psychiatric interventions that may be required.


            A longer time in a bed is no guarantee if you aren't getting the right help. Unfortunately at the Aberdeen, psychiatrists, psychiatric services were very sporadic and were not meeting the current provincial and Canadian standards.


            What I see in the future of building capacity in that community and getting people in front of the right mental health provider at the right time will lead to much better outcomes for those citizens. I think you're going to see what's happening there actually replicated across the province.


            MR. BAILLIE: I know that some of my colleagues will take up the cause of the Aberdeen short-stay units so I do want to stay focused on those Nova Scotians who do present themselves in one way or another to our health system because of mental illness. The minister's last words are ringing in my ears, we want to make sure they get the help they need on time - the right professional at the right time. That's exactly why I'm asking for the information on wait times. It's why knowing that our ERs are set up for people is such a great question and an important question, because that's where people go when they can't wait.


            I know we would all agree that it's very important to de-stigmatize mental illness, to talk openly about it, to have those difficult conversations so people can then get to a point where they are able to come forward or even self-diagnose and come forward with confidence that they'll be looked after, and more work does need to be done on that.


            I'm not going to debate whether there's more mental illness now or whether there's just more people coming forward now, but the fact of the matter is that more people are presenting to our system and we need to help them.


            I know we're running short on time here. We've talked about ERs, we've talked about wait-lists for counselling services and other services - we're going to get those numbers. The important thing is to shorten the wait as much as possible, so what can the minister point to in the health budget? What new funds have been dedicated to shortening wait times for youth mental health services and adult mental health services?


            MR. GLAVINE: I guess starting with the 2012-13 budget of the former NDP Government, leading up to now, we've invested about $25 million in health care. The budget went from about $250 million to $275 million over that period of time.


            I believe as we advance the CAPA program of building community capacity across Nova Scotia, many more people who aren't psychiatrists, psychologists, and counselling therapists - there are many others who are taking mental health training. I believe that is very, very significant in terms of what will help reduce our wait-lists.


            In fact, we had a couple of districts that had really made the CAPA model work and work strongly and resourced properly. I believe that what we have to do now is take those examples and move them across the province. The South Shore, for example, is one of the health districts - in fact, it's where our deputy minister was located as the CEO. They worked in many of the communities in that health district with a just-in-time mental health service. We know it can be done and this is what I believe we have to do. Perhaps we've counted very strongly on the services of the IWK - the former minister, the member for Sackville-Cobequid, came into office after a phenomenal improvement was made in the assessment of adolescents. I think when their government started they had a wait-list of about 900, and made a dramatic change in getting youth assessed.


            I know that's critically important because we're finding out more and more that it is, in fact, the adolescent population where we need to make some of our strongest inroads and some of our best work; our dedicated resources need to be in those early years.


            The one area that I will comment on where we have to make improvement, and the start of it is under way, is transitioning an 18-year-old or a 19-year-old into the adult mental health system. Every Minister of Health spoke passionately about the need for this at our national conference recently, and we know that work is well under way. I've received a wonderful document that just came out of B.C. that I think will help us as we start to take a look at what is beyond the five-year Together We Can strategy.


            MR. CHAIRMAN: The time has elapsed for the Progressive Conservative Party. We will rotate to the New Democratic Party.


            The honourable member for Sackville-Cobequid.


            HON. DAVID WILSON: I want to continue on my last question just as we wrapped up. Where I wrapped up my last round of questioning was around the committee that was created within the Department of Health and Wellness to look at prioritizing equipment purchases. My understanding is that that no longer exists. That came out of a recommendation from the Auditor General, so it's my understanding now that the minister indicates that the Nova Scotia Health Authority will take on that role. I guess we'll have to wait and see if the Auditor General sees an issue with that and potentially will make comments around the fact that it's not held within the department.


            I was talking about the Capital Grants line item and the expansion, of course, or the replacement - I guess you could call it an expansion - of the Centennial building. A group of physicians that work closely not only with that facility but with our universities is the Academic Funding Plan physicians, AFP. They do a lot of work in research, and the proximity to the universities and the research labs and the QEII is very important.


            I wonder if the minister and his department have had discussions with those physicians who are captured under the AFP on ensuring that they're on board with some of the potential services in and around the area. We're talking some services will end up in Windsor and around HRM. Is there discussion with the department and those physicians on AFP to make sure that they're on board with whatever plan goes forward, to ensure they can continue on that close relationship between the academic research and providing care to Nova Scotians?


            MR. GLAVINE: The member poses a very, very important question here to estimates and myself as minister. I would say that our health hub is one of those gems that I have certainly discovered, and I'm sure the member opposite did as minister and probably knew from his prior life. As a paramedic, he had a lot of contact, interface, with the health care system. Our health hub is probably quite unique in terms of that small little geography of what actually takes place there. When we have what happens at Dal - the med school and the research that takes place - the IWK and the links there, and the QEII, it is certainly something that we don't want to lose in any kind of a distributive model.


            I know that the NSHA, the team that was responsible for the vast amount of the change, the distributive model that will go forward, made sure that clinical teams, those who do surgery, and those who are involved with research and teaching - certainly we didn't consult everyone, but there was a great deal of consulting. Really in many ways now as we really put our intensive work into the Halifax Infirmary - where the transplant surgeries, all of our major cardiac, oncology, trauma - the Halifax Infirmary now becomes that centre and site for teaching, for learning, and for innovation. I believe that's going to be pretty central to the great work we will do for Nova Scotia there as well as Maritime Canada. Sometimes we also have patients from Newfoundland and Labrador, in terms of transplants, who will go there. I think the integrity of the research and the work hub of medical diagnostic intervention and procedures will indeed be in a very good place there.


            We all know that specialists also go to some of our other health centres, in particular our regional hospitals, on occasion. Whether it's in that teaching or clinical mode, we do see that happening from time to time. But knowing what goes on at the IWK in terms of world-class research - and when I say that, they're actually linked to other sites around the world that are doing similar research. That certainly all stays in place, as well as what will be at the Halifax Infirmary.


            Probably what I'm very excited about is, the baby boom cohort certainly has a rising incidence of cancer just by the fact of longevity, and again, the disease associated with that age group and doing a refurbishment of the Dickson Centre, doing some expansion there, and continuing with both diagnostic and treatment work there. I think that's where we'll get a real chance, in my view, for some federal help around innovation and around research that can take place there. We know that our province is in that range of about $70 million of research work. We really do hit above our weight in terms of some wonderful discoveries. There's a few on the verge of some commercialization so I think we're well placed and we'll continue to be. I don't think our distributive model of care will impinge on that.


            The AFPs, as the member stated, are critically important. I'm not sure how advanced and how many of these we'd find in other jurisdictions but I know that here in the province it is something we have to safeguard.


            MR. DAVID WILSON: Thank you, minister, for that. I think we need to do everything we can to ensure we can continue to expand that. We have a great opportunity with the teaching hospitals that we have, but also the universities located in Halifax and in the province for that matter, to continue on that good work.


            A bit of a constituency question, I guess - with the release of the plan and the need to look at providing services in other areas of HRM and the central region, I guess we could say, the Cobequid Health Centre, which was built a number of years ago from the previous Progressive Conservative Government, was land owned by the province. It was the former home of the correctional centre, so significant cost savings when the decision was made to move the old Cobequid centre up to that site.


            At the time during construction there was a commitment and I think during the build to allow for future expansion - a huge parcel of land there that can be expanded. The building itself can be added onto. The one thing I didn't hear in the plan released the other day was the possibility of what we can do there to move services to Cobequid. I have to say not just because it's my riding, but we really are just at the corner of the avenues that come from the Valley, with Highway No. 101, and the more central and northern part of the province, with Highway No. 102, and you're not going downtown. There's ample parking, and a great opportunity to utilize an asset that would reduce the costs of building new facilities on land that we may not own. I wonder if the minister could give us a comment on that, to ensure that the minister, the government, and the Nova Scotia Health Authority are looking at that site for the possibility of an expansion.


            MR. GLAVINE: He doesn't need to make any kinds of apologies for bringing up the Cobequid Health Centre. In fact, he could probably elaborate on many of the services that are actually provided there.


            I have to say that without question, I've been in all of our regional hospitals, most of our major community hospitals across the province, and I've been out to the Cobequid Health Centre. My unreserved comment is that I was truly impressed with the number of services there and what takes place in a day roughly from 7:00 a.m. until 12:00 midnight, with a full ER during that period - diagnostic services, specialists who now come out.


            When we had the flood at the VG - and some caution me about continuing to bring that up, but I am a realist. To be able to move out there and do some of the ophthalmology work, take some of the Eye Care Centre work out there - and certainly it is a model that whether it's in Bedford or Clayton Park or where there's a high density of population, do we do something similar to a community facility like what's in Cobequid, or as the member has well pointed out, we need access and the arteries that flow into a community facility, which is critically important as well. A pretty significant part of what we will do in moving services out of the VG and the Centennial is now in place. That was certainly not the absolute finished expansion of services that may be needed, I guess.


            We know that in HRM the population is continuing to grow and when we hear from HRM that they'd like to see, I think they mentioned a figure of about 100,000 more within HRM - 50,000 to 100,000, the number eludes me now - but continuing to have growth in this area is very realistic to expect, I think, and whether or not Cobequid will be part of some of the other services that can be provided. I know it's a very strong-functioning facility serving the needs of well beyond Sackville. I thank the member for raising that.


While there's nothing definitive at the moment, it really is included now in health services planning. There is nothing more important - and I stated this today - in terms of strategic investment. I believe that for far too long we have simply thrown not just dollars but millions of dollars at health care approaches, hoping for the right outcomes. We know our outcomes are not the best in Canada; in fact, we are probably second from the bottom. Changing that, making that shift is a huge cultural shift in our province.


            I know there are many health care clinicians dedicated to bringing about a change. They themselves have become examples of healthy lifestyles, of having annual checkups, doing many things that are along the prevention lines. We know we will all get sick at some time, and having the right facilities in the right place and Nova Scotians being in front of the right provider has to be a much more dedicated effort than perhaps our past has been.


            I think if strategic investment is needed as part of the VG change, I would say Cobequid is in a very good position. Their performance and function currently is at a very strong level.


            MR. DAVID WILSON: Thank you to the minister for that. I'll continue to look towards the Nova Scotia Health Authority and the government and the department for future announcements. I have a shovel ready for him any time he needs a shovel. There's actually a few organizations or businesses that will make sure the backhoe is there also. Just right around the corner there's a trucking company in the Sackville business park; there's enough support in there.


            Anyway, I couldn't agree more with the minister around ensuring that we change models of care and ensure that health outcomes are a top priority. I believe that in the not-too-distant future we'll be able to look at communities like Parrsboro, for example, and I've mentioned this on a number of occasions, that with the change in model of care with the Collaborative Emergency Centres wasn't just to address the chronic closure of the emergency department, it was to address an issue and a problem that we've seen in many communities across Nova Scotia, and that's access to primary care. Patients, residents in the Parrsboro area would wait five, six, or seven weeks to see a primary care clinician because the family physicians were overworked. They were working not only in their family practice, but they were working in the hospital and they were doing rounds at the regional hospital.


            When that model was introduced with same-day/next-day appointments, people are being seen sooner who might have a chronic disease. The management of that disease, I believe, and I think if there's a study done on that community and those who have seen the change, that you'll see benefits in changing models of care. I think the Collaborative Emergency Centres are just one that we can look to.


            I want to turn to the transformation of the department itself. I know a lot of things have moved out and moved towards the Nova Scotia Health Authority. One segment and one area within the department's mandate that I don't agree with moving to the Health Authority is that of quality and infection control. It was within the department of the minister, the Department of Health and Wellness. That responsibility now, as we've heard from the minister, is being relegated to the Nova Scotia Health Authority. The question is, where is the minister's oversight if that's divested to the Health Authority? I feel it's extremely important that the minister and his department still have some oversight if something goes on at one of the hospitals around our province.


            A prime example is Cape Breton Regional Municipality. There was an outbreak - I think it was C. difficile or one of the superbugs - that happened. The health care team within the minister's department went down there and made sure that the quality control was improved upon. I wonder if the minister could give a little bit of information on why his department would give up that responsibility and divest it into the Health Authority when really I think there has to be some kind of oversight by the minister and the department itself across the way here.


            MR. GLAVINE: I really appreciate the member asking that question here during estimates. I haven't got around to responding to at least three significant articles in The Chronicle Herald that addressed the very thing that the member, a former minister, has brought to the floor here today. I know Robin McGee was the author of one of the articles. She's a lady very familiar with the health care system, and she wrote a book called Cancer Olympics. Dr. Raymond LeBlanc also wrote a very significant article in the Saturday edition. I believe it was a Hanson who had the third article. They were kind of putting forth the same kind of premise that we had now moved that quality assurance into that operational area.


            What I need to move on here is, yes, two moved from the department dealing with quality assurance into the Nova Scotia Health Authority. They're there, in many ways, to deal with those things - implementing guidelines and having a working team if we have something like C. difficile break out. What I'm pleased to be able to speak to today is that now we have an entire section in the health department, and their primary job is to look at system performance: what are the quality measures that are there for us to gauge how well the system is performing on a regular, ongoing basis? I don't think there's any better way of improving our system than to have that constant view. What is the standard? Are the standards being met? How do we raise the bar on quality improvement and outcomes for the system?


            We knew that we weren't doing as strong a job as what needed to be done by the department in this area. We had a very fragmented system, and that was really challenging to the department to improve when we sometimes had nine different ways of looking at system performance. That's essentially what was going on. There was a bit of oversight, and that was the role of the department, but CEOs and VPs and lead teams were really responsible for what was taking place in each of the nine districts, and we often had many variations of that going on.


            I've told the story before, but within a few weeks of arriving in the department, when I saw the same adverse medical incident being reported with a different narrative, different values presented, and different timelines, I knew we had to make a pretty substantial change, and it went well beyond a few people who were working on quality assurance. In fact, it needed an integrated collaborative approach to taking a look at how the system performs on an ongoing basis. I believe this section will be making strong statements by the Fall about system improvement.


            That really is what our health department and the mission of our department should constantly be: how do we improve quality of service delivery from Yarmouth to Sydney and from Bridgewater to Amherst? If we don't cover the province and support one million people's care with setting targets and raising the bar on health outcomes, I don't think we are really doing our job.


            What I'm very excited about is that we have other provinces starting to talk about how we can do a better job. We will learn from each other and we will bring to the department perhaps the best oversight since we began the Department of Health and Wellness.


            MR. DAVID WILSON: Mr. Chairman, I have to say, though, the issues that the minister brings to the forefront dealt with the nine district health authorities. There was a need within the department to have oversight, but those issues should have been resolved when they amalgamated the district health authorities. I have to say, every experience I have had with those working within the ministry and the department at the minister and deputy minister levels were amazing individuals who were very concerned when issues were coming out of areas of the province.


            There still needs, I believe, to be oversight over the district health authority. We didn't eliminate the district health authorities altogether; there's still two district health authorities. So what happens if they fall down, and they don't meet the expectation of policy or the direction of government? Who's overseeing that? That's the concern I have with the destruction, the elimination, of the quality and infection control wing of the department and the minister's office. We still need oversight, and I guess that's where we're going to have to disagree on the direction.


            I think a lot of the issues that the minister brought up, as I said, would have been dealt with by the amalgamation. If there were nine ways of doing things, there should be one way of doing things now. Who's going to oversee to make sure the one way now - or the two, with the IWK; I apologize - is what they're supposed to do? If government brings forward changes in policies, changes in direction, brings forward maybe even legislation to deal with infection control and quality control in our province, who's overseeing that now that all that responsibility is being divested to the districts?


            I think I'll leave it there. I think we have two different stances on that. I feel bad for those within the department who lost their jobs on that. Some may have found some employment within the district, but I think that by no means is it as strong as it was. I guess time will tell. I just hope that we don't see any issues arise because of that change.


            The other area within the minister's office was mental health and addiction services, very dedicated people who work within the minister's and deputy minister's offices overseeing the implementation of the mental health strategy and the direction that government brings to how we improve services in health, how we improve services in mental health.


            I have to say I'm a bit concerned with that going to the Health Authority, because as I said with quality control, if government decides a new direction is going to take place, I believe there's a role within the minister's office and the deputy minister's office to coordinate and to drive those policy changes. Who does the minister turn to now for policy - being a policy adviser potentially on maybe a different direction?


            The minister has indicated recently that the government is going to start looking at the mental health strategy where I think we're near five now of a five-year strategy. The minister gave some reassurance that there would be no gaps between what's going on now and the recommendations and the requirement by law to give updates about the work that's being done.


            Those positions being transferred out of the minister's office and into the Health Authority, the question is around accountability. I know that during Question Period often the minister said, well, the Nova Scotia Health Authority now looks after that. So where is the accountability when it comes to if there's an issue around mental health and the mental health strategy and the recommendations, and I bring it up myself or our caucus or the Official Opposition brings it up, where is the accountability within the minister's office? The minister is responsible for bringing forward policy of their government and their Party, so I'm wondering why the decision was made to move those jobs out of the minister's office and divest that into the Health Authority.


            MR. GLAVINE: This is a big issue, it's an important issue. In fact, we started about five years ago to take a look at unfinished business, which was moving to the two provincial health authorities in the province, and what it could do to have a much more integrated system but one that indeed was much more accountable. If we took a look at the nine districts, it was very difficult to have that full accountability of what was taking place.


            In fact, we had a wonderful development in the province and the minister may have been in on finalizing one of our nine provincial programs. Our nine provincial programs were designed because we didn't have a robust system in place to make sure that those programs were in place across the province, that we had working for the best standards and the best outcomes.


            Maybe the member remembers a day, probably about 20 years ago, when we had the worst outcomes for breast cancer in Canada, and today we're usually around number two in the country. The reason being is that we put a standard in place across Nova Scotia that said as soon as there's a test result that is suspicious, it would then come under a provincial navigator and move into the women's health centre for what should be the course of treatment and follow-up that could be available.


            The nine provincial programs have served us extremely well. Now we will have every function of the health care system under the accountability, under the scrutiny, of what the standard is: are the targets being met when an improvement plan is brought forward? That now becomes the signature role of the Department of Health and Wellness. It's fine to develop a policy, develop a program, but how is it performing across the province? There will be quarterly reports that will be provided to the minister on a wide variety of measurables in the health care system that can simply tell us how we're performing. How are we doing?


            One of the areas for example is in the orthopaedic world. Most people didn't think the orthopaedic surgeons would come together and function as a team of surgeons and provide expertise across the province. They happened to be one of the first under the perioperative, under the surgical plan for the province.


            One of the areas where they have set a new standard that we'll measure is in fact reducing the number of revisions. Revisions are costly. Revisions impact quality of patient care. What can we do in our five sites that will reduce the requirement for revisions? We don't have many, but we certainly have what Dr. Michael Dunbar would classify as greater vigilance and observation and a plan to improve in that area. That's where the Department of Health and Wellness now will take a look through an accountability structure that has many experts, a lot of analysis that will be constantly going on, quarterly reports that will come before the ministry, and a leadership team - a very strong foursome in the leadership team - that will take a look at what those next steps are on a plan for improvement.


            MR. DAVID WILSON: I know first-hand how dedicated many who work within the department are, who were recognized nationally. The reputation of Nova Scotia and those professionals who worked within the department on a national level is lost now, I think, with the termination of a number of those dedicated individuals.


            While I'm there, I'm quickly going to go back to the quality control because as I sat down, I remembered that not only does quality control and infection control deal with the district health authorities, but they also deal with the long-term care facilities. That was within the department. I would assume the Nova Scotia Health Authority - are they taking that role on now, or did the government create something new, an oversight mechanism, for long-term care? Then I'll get back to some more mental health questions.


            MR. GLAVINE: Again, the question of looking at nursing homes, the continuing care area, in terms of standards, accountability, looking at the performance in our nursing homes. The two people who went off to the Health Authority, unlike the past, we have a highly integrated model whereby the health authority and the Department of Health and Wellness are actually working in concert and integrated in terms of their performance.


            In the Department of Health and Wellness we were very siloed; we were siloed across the province with the nine districts. So by having this model whereby the people working in the Health Authority are in contact with people in continuing care because they also need physicians, of course, they need nurses, they interact with the acute care system, they interact with the paramedics. So we're taking a look at how this full functioning of the system is happening from day to day.


            I believe this is one of the real hallmarks of the Health Authority: they're just not a CEO and a team of eight VPs and those that work under them. They're not working in isolation; they are physically or virtually in touch with their zones each and every day. This was one of the organic pieces that we put in place as a result of the 30 work streams and looking at the past version, looking at what happened in other provinces that seemed to develop a disconnect. We've built this highly integrated system that will have oversight and accountability and be constantly working with the department.


            The day I went to visit the Health Authority site in Bayers Lake, who was at the table? Those who have been assigned to continuing care in the Health Authority and our people from the department, working together on the issues that are constant ones for nursing homes and home care in our province. I see no disconnect, I see a tremendous strengthening of connectivity throughout the system that will be monitored, that will be measured, new targets and standards set, and an accountability framework that will truly give us an improvement path to the future.


            MR. DAVID WILSON: I know that it's not just within the minister's office that we've lost dedicated professionals who have made a positive impact on services, especially mental health. One area of the province that had the shortest wait-list and quickest access to mental health services was South Shore Health. I know when the amalgamation happened, the lead there who worked with his staff to make sure that the people in that area gained access was terminated by the Health Authority. So it's not just in the minister's office; with this amalgamation we've lost a huge amount of individuals who have contributed in a positive way.


            Having nine district health authorities wasn't all negative. There were very positive things going on in regions all across this province. With the amalgamation we've lost, I think, an opportunity, especially when someone who was leading that charge for mental health in the South Shore, was terminated, not offered a position in the new Health Authority.


            The minister talked about the need to amalgamate so that we don't have a number of wait-lists and things are done in a better manner. One of the examples he used was some health services within the central region where a woman would be in the new Health Authority but would have to cross into another district for the IWK because the services are in both those districts. The same thing happens with a child who comes up through the IWK system and then would have to cross over to the new Health Authority.


            I'm wondering, does the minister realize there has been some loss with the amalgamation of some very talented, dedicated health care providers who have contributed in a positive way under the old system? I'm wondering if the minister has thought about that and what kind of input he had on potentially trying to make sure that these people remained in place with the new Health Authority.


            As I said, South Shore Health had one of the best statistics for mental health, access to mental health services, and I think it's a great loss with that health care. Is the minister concerned that we have lost, I think, a lot of dedicated people who brought a lot to the table with the amalgamation of the district health authorities?


            MR. GLAVINE: I'd like to go back and give at least the outline for the first chapter in my book on the health care system, and that is looking at the journey we started and how it was amazing to hear from so many people about what we were planning to do, but now what we have executed, which has reached its one-year birthday, if you wish, its one-year milestone.


            When I started down this road as minister, I met literally thousands of people who work in the health care system. While many didn't have the plan at their fingertips or on their lips, they knew that the system needed change. That was the one area that was the common theme that people spoke about: putting, whether it be 4 per cent or 5 per cent more into the health care system year over year and not seeing better outcomes and improved results. That was frustrating to thousands of people working in the health care system. I got that message loud and clear.


            People knew that when the change was made, their job could be one that was at risk. So we got through that first year and people understood where we were going, why the changes were being made, and we started to sketch out what some of the good results could be. Even after just one year we know that the Health Authority has many strengths. It has challenges, yes, but there is that plan that over the next four, five, or six years, the real health transformation will take place.


            I saw my role as getting the foundation in place for what really needs to be done. In fact, we'll have some direction even from the Auditor General on what needs to be done in our province around facilities. That report is coming soon.


            There is no question about the strengths being developed in the new provincial Health Authority and we can say the IWK is business as usual, but I would say anything but because they are also seeing the need for change. They will do some structural change. They are examining and reviewing their programs. I'm very fortunate to be able to sit down with Tracy Kitch and her team and look at how they are actually envisioning the future.


            The one area that was given in big letters to the minister, to the deputy, and to the people in our department was, don't wait very long to realign your health department with the new Health Authority or health authorities. New Brunswick went to two health authorities based on language. They were adamant that you do this early and make sure that you aren't duplicating, that you aren't having conflict of roles, that there are very clear mandates for the Health Authority on its operation side and for the Health Authority in terms of its policy, program development, oversight, and accountability of standards. That's what we've redesigned the part about.


            I did take time to meet as a group with those who were leaving and obviously thanked them for the outstanding work that they did. Many, as the member opposite, and former minister, pointed, out were national calibre people. Many were offered jobs elsewhere. Many were getting very close to retirement and decided to retire. I took the time to do about 10 exit interviews. It was a combination of people who moved to another department. It was people who received severance; their job was cut. It was people who were very close to natural retirement. It was 10 people that I sat down with, and I can say unequivocally everybody agreed with what we were doing; a time for change and to do things differently in the department was top of mind for all 10.


            I can say three were significantly impacted, and it was that tough moment when I'm looking at a person who is going home to tell their family. That is the toughest moment. I know the deputy and the associate deputy had a very tough January, February, and into March. We took this extremely seriously in terms of how it would impact on lives and people who had given so much to the department and made their contribution to improve the health care system in our province.


            But by the same token, they realized we could not see the department doing business as usual. Within the department, there is also now great opportunity for leadership that maybe in some ways was buried because of seniority who will now emerge on a new leadership team with a different approach in our department. I was fortunate during my teaching career to work in a school where, long before we voiced the word "collaboration," we worked as an extraordinarily strong team, especially our departments - the department of math, the department of English. I was in a rural high school big enough to have departments. In that kind of collaboration, we shared some good teaching methods, classroom practices, and evaluation methods. We shared those and collaborated.


            This department now is excited about a new way of working. That's what will take place. We will see results; in fact, Nova Scotians will see results relatively quickly. But what will go forward and go on, I think, is where perhaps other departments may even take a look at the model now that we are putting in place. I'm pretty excited about what has taken place, but it was not an easy process.


            The one area that you hear from people today in many different workplaces is that change is going on. Change seems to be a constant but they also say change is never easy. I think the further along we are in a career point, change is even more difficult.


            I, in fact, am very bullish on what we have done. I can't tell the full story here but when our deputy minister presented our model of a health care restructure and alluded at that point to what we would do in the department, when he went to Washington and presented before state government representatives what we were doing, he got many sidebar conversations and opportunities to present what we were doing in our province as a strong practice and perhaps a lead practice in having our four zones integrate with a leadership team at the Nova Scotia Health Authority and the IWK and work in an integrated way with the Department of Health and Wellness on a much more regular basis. I think we have set in motion an approach that I don't say lightly and I won't be the minister who takes a look in five years' time at our system, and across the country they will see perhaps the best health care system in the country.


            MR. DAVID WILSON: It's interesting to see the transformation of the minister's department and the loss of a number of positions within that department. I know that for Active Living, for example, that was moved over to Communities, Culture and Heritage, mental health services were kind of - and public health are moved out. The interesting thing is, other than Active Living, there's still a number of budget line items in the budget held within the minister's office.


            There may be a new leadership team emerging from the changes but I have to say that coming from and working with that department, I never felt at any time that we were long in the tooth when it came to FTEs who were there. They all worked extremely hard on critical issues that faced Nova Scotians. So you look at Mental Health and Addiction Services, for example, a reduction of about $5.2 million. I understand that's because it is moved out to the Nova Scotia Health Authority, but there's still an $8 million budget. So I notice that staff went from 13.5 to 4, so who in the minister's department now is overseeing that $8 million budget for Mental Health and Addiction Services?


            MR. GLAVINE: I'm pleased to say that the person is the Senior Executive Director of Strategy and Performance, and in this integrated model it will be providing oversight of mental health right across the continuum. Ruby Knowles is the person who is responsible for that team that will work in an integrated way. They will be dealing with health promotion all the way to palliation, monitoring of the system's strategy performance and with a team approach to mental health, and again the other services that I just mentioned.


            MR. DAVID WILSON: I do feel that seems like still a high budget line item in the department. Should that money not go to the Nova Scotia Health Authority so that we can improve direct front-line care when it comes to mental health services? I know the minister mentioned a few. I'm wondering if he could provide us a breakdown of how that $8.1 million is going to be allocated. He doesn't have to give it to us right now, but if he could provide that in the next few days or so.


            I know I only have two minutes, just a quick concern around the nursing exam. I think this year was the first year under the new electronic exam that is seeing an increase in the number of nurses who have failed multiple times. It's an American company. The concern is that sometimes there has been some confusion around empirical measurements. I wonder if the minister is aware of those concerns. What is he doing to ensure that our nurses have a fair chance of getting their licence during the exam that they have to take?


            MR. GLAVINE: I addressed this issue most recently at the Nova Scotia Nurses' Union annual meeting. The NCLEX exam was top of mind for Nova Scotia nurses. The national president, Linda Silas, was also there; this was an issue top of mind for her.


            We have been perhaps very fortunate in Nova Scotia to be able to have the college and have our universities work with those graduates who did not pass on the very first write. We are at about 90 per cent; 90 per cent is generally what has been the pass exam on the national exam, so we're in that area. But fortunately those who did rewrites and so forth on the pass exam, many did get their certification. We can write up to three times in the province on the national exam currently. They can also keep a temporary licence during that period. I'm pretty sure that in the past, if there wasn't a pass of the national exam, they would not be able to have a temporary licence.


            The exam is still posing a challenge across the country. We are having the Canadian Federation of Nurses Unions take a look at this exam, what is currently taking place. I know they're working for a consistent approach to the number of times they can rewrite the exam. I believe there were challenges around the number of provinces and representation in selecting this particular exam. That remains a difficult issue for everybody.


            Look, I had no problem saying at the NSNU AGM and here today that I don't understand personally, in a country with 35 million people, why we can't have our own nurses' exam. I absolutely believe that we have to take a strong second look, and that is taking place. We're moving to a time in Nova Scotia, with the new nursing strategy, where we will see the most time spent during training in the workplace. We will have one placement of 13 weeks at the end of the fourth year. We're going to allow for specialization as they move towards graduation. Maybe we need a portion of the exam to look at the nurses' performance, their skill level, and their competencies.


            I don't think the last chapter on the NCLEX exam is over but I believe in the short term, certainly providing consistency of rewrites, is very important. I can say that one of the areas that I am extraordinarily pleased about - and again, the former minister alluded to the expertise, the quality of people we have in the department, there's no question about it. When it came to the nursing strategy, the work of Sheri Roach and Cindy Cruickshank was extraordinary.


We have a nursing strategy now being looked at by other provinces. We will prepare the next generation of nurses, I believe, stronger than what we have been. We'll have a common curriculum across Nova Scotia. We will have an opportunity for LPNs to get their RNs in a shortened program. So I believe we're moving to a better place in the preparation of nurses, and that's what we have to speak to and that's what I want to speak to as minister, and knowing the work that goes on at our three university sites.


            The exam has some problematic elements to it. We're third in the country - we were third in the country even on this new exam so I believe that's an important statement to be able to make. What of the future of this exam? I believe the leadership of the Canadian Federation of Nurses Unions is very strong in wanting us to meet with the colleges. They're certainly going to make representation to the federal Minister of Health on this particular issue and I think we'll get to the right place.


            It was a huge jolt to the system when this came in because it is a very different format for examining nurses as they prepare to go into practice.


            MR. CHAIRMAN: Thank you. Time has elapsed for the NDP. We'll now move to the Progressive Conservative Party.


            I would ask the minister if he is interested in a short break, he has been over two and a half hours. It's up to him. (Interruptions) He's a trooper.


            The honourable member for Pictou West.


            MS. KARLA MACFARLANE: I just want to say that's quite impressive of the minister to continue on.


            I apologize in advance if I am asking any questions that may be repetitive. I've been trying to listen between multitasking so once again, I apologize in advance.


            I do hope to focus in on questions that are most related to Pictou County and the Town of Pictou. One of my first concerns I want to address is we've been here for two and a half years, and since that time I have reached out numerous times to the Addiction Services centre located right in the Town of Pictou.


            I simply reached out initially, just as a courtesy call, to have a tour of the facility, just learn more about the services and the functions that are provided there. But time and time again I kept hitting that proverbial brick wall and most recently been told not to open the door for me to come visit.


            I would like to ask the minister if he could shed some light on perhaps helping me get inside the door to learn more about this service that is happening in my community and, as well, to elaborate a little bit on that facility and what the future plans are for the Addiction Services centre in the Town of Pictou.


            MR. GLAVINE: I know that's a frustrating area for the member for Pictou West to speak to, in terms of getting some further insight into what is the nature of the program that is currently in Pictou. I know she's looking also to the future.


            What I will tell the member is that I will certainly find somebody in the clinical setting to provide some further insights and information on the nature of the program there. I will work to see that happens for the member.


            One of the areas that I know even going as minister to some of those areas, I have the highest regard for privacy and always, when asked if it's appropriate for me to be here and if patients are comfortable, usually there's a plan in place to deal with it. I know in many regards, just to walk in and see what's taking place in a counselling setting, not everybody is comfortable with that. But to know about the program, how it's delivered, I think it's important for us as MLAs to know what services we have.


            In an MLA's office, it's interesting the wide spectrum of questions we get - not just about health care but about many, many areas. I think we are a more effective MLA when somebody comes to our office and we know about and we can speak first-hand to a service that's available in our community. So we'll certainly work to help the member know a little bit more about that service.


            We know that while the mental health unit became a big story, one of the lessons that I have learned since becoming minister, looking at whether it's the public or private addiction services across the province, looking at mental health delivery, it is a very, very challenging area. We know that placing somebody in a hospital bed without perhaps the best psychiatric team to work with them, providing follow-up care in the community, without that full, comprehensive support to a patient, to a mental health consumer, we know there are limitations in that.


            One of the areas that I believe the public system is learning from some of the private addiction services is actually providing that follow-up care and checking in on people who have been in a program, whether it be detoxing, whether it be two weeks, three weeks, whatever the requirement is. This is one of the areas that I know our public sites are doing a much better job on. They're not just talking about a five-day detox stay, they are starting a program that is helping to develop coping skills, helping to build some of the decision-making ability, to be able to go back into a community. That's one of those realities that we now try to get into a program: you are going back to your family, you are going back to a community.


Having those kinds of connections and supports built into a program is critically important, and some long-term follow-up as well. I think that has been one of the weaknesses of our public system: we haven't done a strong enough follow-up or put in place connections to the community.


            I know that the addiction services that we have, all of those are needed. We are moving to just a central intake but with a distribution across the province of addiction services.


            I spoke recently with one of our provincial leads on the addiction services as a constituent of mine was working to get into a detox. I took a bit of extra time to take a look at what is taking place; they have shortened the wait-list, they are working towards getting a just-in-time service for Nova Scotians.


            I believe there will always be a combination of private and public addiction services in our province. There are and probably always will be different models of treatment. For some the harm reduction model works extremely well; for others the 28-day or 45-day program that we have in private facilities that's absolutely abstinence-free, is what will work and work extremely well for particular individuals.


            I'm pleased with the direction that we're going in the province with addiction services. When I hear a commitment to work to getting people in when they need the care, it's not an area where I like to see a wait-list - when people decide that they want to go for treatment, the research shows they're halfway there; they are 50 per cent on the way to a successful rehabilitation. So I think we're in a good place; again, we need to move to a full just-in-time service for Nova Scotians.


            MS. MACFARLANE: I want to thank the minister for his answers. There is a lot of great information that he just provided to me. I want to express that I, too, have great respect and understand privacy with regard to the Addiction Services centre in Pictou, and I have offered to meet offsite to learn of their services and was still turned down for a meeting. So I just want to express that I'm absolutely more than willing to respect those wishes of those individuals who would be there and to meet offsite to learn more.


            More specifically, I guess what I was looking for is to find out if there are ongoing discussions right now taking place to close the Addiction Services centre in the Town of Pictou and have those services move elsewhere. If so, where? To the Aberdeen Hospital? To Truro? I'd like to have that question answered.


            MR. GLAVINE: What I can tell the member at this stage, because I haven't had a full review of Dr. Linda Courey's work in terms of a review of Mental Health and Addiction Services and what we need across the province and what should be located where - that's still absolutely a work in progress.


            What I know is that when it comes to addiction services, I have constituents who will go to Lunenburg, who will come in here to Halifax. We've always looked at what's available across the province. So I know we will get the right amount and the right placing of those services.


            We also have people who will, from time to time, go out of province. So the goal here is to support Nova Scotians who may need a second or a third time. It's an area where unfortunately there is a rate of relapse that does take place. We all know, all of us here know and have wonderful accounts of people who have dramatically changed, what I call transformed their lives as a result of strong addiction and mental health programs. We want nothing less in our province than the availability, the access, and the people who are able to take from the research and apply to making our programs as strong as possible in our province and providing someone in Pictou first with an insight as to what takes place there, but also once the service review is done, to be able to provide her and members and really all Nova Scotians as to what the plan will be.


            MS. MACFARLANE: Mr. Chairman, I thank the minister for those answers. I did not realize that there was going to be a service review taking place, but I will certainly be looking forward to the results of that review. Perhaps he will be able to give some indication when that review will be completed and presented.


            One of my concerns of course, as we all know, is mental health. What I would like the minister to explain to me and try to help me understand and justify that Pictou County has a population of 46,000 people. We have 1.8 psychiatrists, so that's basically one and one-half or so. The Truro area has a population or servicing a population of approximately 67,000 people, and they have eight to nine psychiatrists. Can the minister please help me understand how this is fair?


            MR. GLAVINE: I firmly believe that what we were doing within the nine districts, I don't think we often had built the best teams that we could possibly have and sustain for the future. Even when trying to say we're going to recruit more for Pictou or other areas of the province, it isn't always possible. We have been able to build a strong team in Truro, and if we have those specialty health hubs across the province, I think we will be much better served.


            I don't know if this is a correct comparison or not, but when a particular surgery, a complicated surgery - and we have a hospital in Nova Scotia where the surgeon does eight or nine a year. I personally do not want to be in the queue. I want that volume of expertise available for operating the same way in terms of if we're going to have a person in what is truly a short-term psychiatric unit, one where psychiatrists do the admission, do the care plan, I think we need that strong level of expertise. But that does not in any way diminish the fact that we do need care in our regional sites.


            One of the areas that we know we're building greater capacity, we want our doctors to also get professional training, and some have now started with taking a mental health professional development unit. We need to build capacity in those areas that are on the front line, who see people on a regular basis, and to just point towards psychiatrists, I don't think is giving Nova Scotians the full picture. We have outstanding psychologists, counselling therapists, school counsellors - people in the workplace who now are taking the mental health tool kit to be able to support fellow workers in their workplace.


            I believe that yes, we have leadership in the community. I think the model that is being planned for the Aberdeen where we will have support for those who will come in in trauma, we'll have that availability to them. But in terms of treatment, getting people in centres, where we have in fact a specialist who can deal with an eating disorder, a specialist who works with patients with schizophrenia, another who works with bipolar, we cannot put those specialists in all of our regional sites and across the province. We have to build those strong health teams across our province.


            I believe in the collaborative model of care that we're actually going to see, like I have in one of my communities of Berwick, where we have a mental health provider who works side by side with the doctors and the nurses in that collaborative practice. When a patient comes in and it's a mental health problem, the doctor can pass that patient on. We are working towards a different model of care, one that I believe in, one that the research is showing can be supported at many different levels.


            MS. MACFARLANE: With regard to mental health, we all know in Pictou County we've been struggling with the issue of having a lack of psychiatrists. When you have only 1.8 servicing the 46,000 people, I believe that one of the reasons why our doctors end up coming and leaving is because they get burnt out. I want to express that we can't be looking to recruit one doctor at a time. We need to be looking to recruit at least four or five psychiatrists if we want to work the ratio out compared to what they're getting in Truro, and if we want to be able to maintain that service at the Aberdeen Hospital, we need to be recruiting four or five psychiatrists.


            Can the minister simply tell me, what is the recruiting plan specifically for the Aberdeen Hospital to recruit psychiatrists?


            MR. GLAVINE: I'll have to address that question with Dr. Linda Courey who oversees the plan for mental health services across the province and what that plan is.


            Again, I would go back to saying that there are a number of people involved with the provision of mental health services. We have a number in our clinicians now that are available for a family of schools. The SchoolsPlus program is showing strong results, it's a lead practice in Canada. I believe that our emphasis on the early years is the right approach, but we know that mental health issues are right across the - from children to seniors, especially seniors sometimes who move from home into a nursing home. They experience those adjustment issues: anxiety, depression, and they may not see family members as often as they did.


            Getting the right amount of services in the right place and really the right providers is critically important. As we build a hub model of strong providers in a particular area, I think that will serve us better than where we currently are. I'm sure that once the review is under way, it's a planned review and I didn't mention that in my earlier answer, but this will be part of getting the right complement of people in that particular area.


            MS. MACFARLANE: The minister has indicated getting the right hub model, which just reminded me that Truro is known as the "Hub of Nova Scotia." Sadly, Pictou County people are seeing all their services, a lot of them anyway, moving in that direction. It just actually put a red flag up for me to remind me that we lost our eight beds. Truro in their mental health unit went from 10 to 14 beds, taking financial resources that were supposed to be going to the Aberdeen to increase those beds.


At the beginning we were promised that those four beds were going to be for Pictou County residents but at a meeting that I had approximately three weeks ago at the Aberdeen Hospital we were told that yes, the finances are going because we have to have money to increase those beds from 10 to 14 but there's no promise that they're there for Pictou County residents; hence the reason why we sometimes end up in Sydney, sometimes we're in Yarmouth, or sometimes in Truro but there's no guarantee. It's very upsetting.


            Can the minister please tell me what the actual financial number is that has been taken away from the Aberdeen Hospital, to ensure that those four beds are paid for - and perhaps the model is changing - but why aren't we using those financial resources to get those psychiatrists that we need?


            MR. GLAVINE: I can say the member is being a good advocate for her community and a strong voice in that regard.


            One of the areas I can speak to is that we have had people move to different sites across the province for a very long time. In fact, the former health minister in your caucus is very aware that people have moved across the province for a very long time.


            Look, I want to see Nova Scotians in front of the right provider of a health service as much as our human resources will allow to happen. As Dr. Courey said, when we had our small districts - and our districts were extremely small - and now getting a centre in our zones to deliver stronger mental health, a stronger array of medical/clinical services is the model that we'll be able to sustain for the future.


            It is not just in the GP world that we're seeing collaborative practice, we're actually seeing specialists who also want to work in a team setting. So that is part of the recruitment challenges. If a psychiatrist can go to Truro and get full backup, if he takes a month for professional development, taking family holidays, there are many reasons why recruitment and attracting, whether it's a psychiatrist or a doctor, into a team is much easier. I believe that is absolutely how we're going to be able to provide the very best services to Nova Scotians.


            I think we will see those benefits as time goes on. As I said in the House earlier today, change in the medical system, the mental health system, in the Department of Health and Wellness - those are great challenges, to see that something that is not quite developed yet is going to be a better service for a particular community. I think we're in very early days of developing those teams and the services for particular communities, and that's a work in progress.


            MS. MACFARLANE: It just feels that we're losing medical services in Pictou County. Every other week we're losing something, whether it be your mental health, whether we're losing doctors, whether we're losing our pathology department now that has gone to Truro - it raises great concern. We continuously see this erosion happening, and we try to get ahead of the game to learn how we can stop that and maybe find a solution.


One of my greatest concerns right now with regard to the Sutherland Harris Memorial Hospital, as we have discussed in the last week or week and a half, is the after- hours outpatient clinic. We can speak about it forever; really, that whole hospital is the cornerstone of our community. One of the greatest units there that I love going to and spending hours upon hours is the veterans unit. There is much concern, because as we all know, sadly our veterans are dying, and we're very concerned about how that unit is going to look in the future. So could the minister please tell me if there are any plans or are they working on a long-term plan for that unit?


MR. GLAVINE: The member raises a great question, one that affects a number of sites across the province, one in my community, Soldiers' Memorial Hospital, which has a veterans unit. I believe Camp Hill is around 175 beds, and as the member said, the impact of the youngest veteran, now a Second World War veteran at about 89 years of age and a small number of those who took part in the Korean conflict, we're already seeing 25 beds at Camp Hill that are no longer necessary, and we're now going to see less requirement every year.


It is very early days for discussions with Veterans Affairs Canada and how the new federal government will look at those beds, but certainly utilization is on a downward trend and in some cases happening very, very quickly. What will take place for those beds, whether they will be an alternate level of care, will they be a transitional ward? I know Mr. Chairman has a ward in his hospital that probably at one time may have been a surgical ward because our local hospitals had general surgery and had services based on the fact that people were not as mobile, and we looked after people within their geography. Nobody would create districts as small as some of the ones that were created in the nine districts. We had one district with almost half the population of Nova Scotia; then we had Pictou with 45,000; and I think Cumberland had some 30,000 people - not even large-size cities. Again, the delivery model has to absolutely change.


As I was saying, the member has a phenomenal transitional ward in his hospital. I have been in there; in fact, this is a good point to make. Digby is exactly - if I go out the door, it's 100 kilometres, and I took many, many trips to Digby. It's 100 kilometres from where I live, and there are people from my community and further east who go to Digby to be on the transitional care ward. To see people there who have had a massive stroke or some other medical condition and have been told the likelihood of you going home is very remote, to see the work being done on that transitional care ward is extraordinary. So there can be repurposing, and maybe some of those beds, some of those rooms will take on a different purpose.


            That's where over the next number of months, and maybe even a year or two into the clinical services review, starting to make plans for when those beds do become available - and I'm certainly in no rush to see them go. I think it's a great moment when we all go and visit a vet, whether it's in their home or whether it's in one of those units. I've been very fortunate to see our vets as they age, go to a facility that really is second to none, in terms of the care that has been provided and is being provided for them.


            What is the future of those beds? That is a great question. I know the Health Authority will look at it with a provincial lens as to what kind of repurposing could go on.


            MS. MACFARLANE: In the Pictou clinic we have a doctor who will be leaving this summer. I've become good friends with them, adore them, a young family - just the two of them, both are doctors. We spoke about this in Question Period over the last two years, actually. He has been here for three years, his contract was for two years and the contract ended but he stayed on. Six months later he got a letter from the Health Authority thanking him for his time and best wishes for his future endeavours. They didn't even realize that he had stayed on. The reason he stayed on is because his wife is a doctor as well.


            We exhausted all levels of help out there to try to find her residency, just even to try to find her a job in the health care field of some sort, while she waited to win that lottery of finding a residency. They have to give up. They will be leaving in July. They will be heading for Ontario where he will be employed and where the Health Authority there has worked hard to find her a job as well.


            You look at these people who have committed to come here, want to hang their hats here, wanted to start a family in a little town by the seaside, they were willing to stay. We did everything in our office to try to help them and encourage them to stay. They say themselves they felt that the health department did everything to discourage them.


            I think we need a plan and I want to know what the plan is from the minister to recruit and retain. Unlike other provinces where doctors are coming in, there's a website for them to go on and learn about the province and the different things they can become involved in. There's actually a system in place to help them and help their spouses to move into that transition. Can the minister please stand and help us understand better what the plan is and how he can implement improvements so we can keep our doctors here?


            MR. GLAVINE: I thank the member opposite for raising what has not only been a significant frustration, I guess as minister, but also the same experience as an MLA. You're not relaying really a new situation. It's difficult for me to speak about an individual doctor and so forth in terms of why they are leaving.


            The IMG doctors who come to the province, we don't have the strongest retention with them, even though we've given them an opportunity. We've invested in them, a place to practice, but very often there's a larger cultural community that they will soon find out about in Canada or already knew about but saw the door open in our province as a way to get into Canada and to practise here for a period of time and move on. This has been one of the weaknesses that we have had around recruitment.


            The other area you allude to is if a partner here or anybody who was trained in another country - we have a lot of Nova Scotians now who go to the Caribbean. I have met with young doctors out of the Caribbean, met with their families, and if there is a frustrating area that I am bothered by is the fact that they can't get back here and get a residency. We have to get residencies for our Dalhousie students. We have upped the number of medical students at Dalhousie, and to get their residencies across the province into New Brunswick and P.E.I. is a first requirement.


            What happens with those who are trained outside, they will apply through an organization with the acronym CaRMS. It has been a while since I took a look at CaRMS, because when I look at it it's one of the few times my blood pressure really does go up. It is absolutely a lottery, because we can have 1,000 doctors applying across the country and only a set number are going to be able to go through CaRMS and get a residency in the province.


            In Nova Scotia we will have maybe 20 or 30 Nova Scotians who were trained elsewhere, put their name in CaRMS, but we can only take 11 doctors trained anywhere else in Canada or offshore, to get back into the province for a residency. That's usually a complement of about five or six GPs and five or six specialists, depending on what our provincial need may be. So we have a problem there.


            When I was in B.C. I had a sidebar meeting with the Minister of Health around the great frustration they have where they have a significant number of B.C. students who go into Washington State, who go into California for their training and can't get back into B.C. Again, they have a need for doctors. So we have a number of frustrations that are both provincial and national when it comes to recruitment.


The retention part is one that we do have a number now that have taken the tuition relief program and have actually made a five-year commitment to the province. So the rule of thumb seems to be that if you have a Nova Scotian or an Atlantic Canadian who makes a five-year commitment to a community, the outcomes improve dramatically for them staying longer than the five years.


            Just this morning I met with and had a short conversation - the deputy had a much longer conversation - with Dr. Lynne Harrigan, and the physician recruitment and retention is right now their number one priority. Many elements of the Health Authority and the IWK are up and running. So now taking a look at our physician needs across Nova Scotia - where are the hot spots that need recruitment right now, or perhaps retention?


            I believe this is the work of not just the Department of Health and Wellness and the Health Authority, but that the absolute strongest work and team must now be in place to do national recruitment - go to the 17 medical schools, go to the seminars, and provide an array of programs. We have four or five programs that financially support people to be recruited here into the province, but also I believe Doctors Nova Scotia and the college, we must all work together.


            We've had some elements of work and support around recruitment and retention. I think to lay out a plan for the next 10 years is absolutely critical. There are a number of areas that I believe need to be addressed immediately, and one of the areas is having knowledge very early of somebody who is planning to retire, somebody planning to leave the province. We have a number of situations where it has been relatively sudden. If a doctor gets sick - and I know we have a couple of practices now that have been interrupted by a doctor's illness, and that's going to happen. So we put about $2.8 million into locums to get doctors into areas as quickly as possible. But I think building on what the previous government did, which was to have a physician resource plan, and making it much more responsive to community needs as they arise in the short, medium, and long term, is absolutely what we need to be doing.


            The cohort of doctors is not unlike the cohort of the baby boom population. We have a lot of doctors in that 50 to 65 age group who are not always retiring in the sense they leave their work, but maybe they reduce their hours, have a long-term plan to move out of their practice, so we know that now we have to recruit more doctors to get the same work. Doctors are coming to the workplace with a very strong work-life balance, and getting doctors that will work 70 or 80 hours a week, like my family doctor used to do, is disappearing. So I think we have to look at the whole doctor recruitment and retention area, but it is very competitive across the country in terms of incentives. I think the time is now, and I'm pleased to say that the Health Authority has taken this on in this fiscal year, the second year of the Health Authority, as their number one priority.


            I think with a concerted effort we can certainly do better; we must do better. I think as we further develop that collaborative practice, that collaborative model of care, where we have a complementary team that is going to help get patients in front of a doctor when they need to, in front of a nurse practitioner when they need to, in front of a mental health provider, or in front of a family practice nurse, and a few have dietitians - so I think building that comprehensive team as opposed to physicians buying a building, recruiting a couple of doctors to work in their practice, because that model is not working so well for us. We're in a very strong transition period. The Nova Scotia Health Authority is very aware of it. Our municipalities are wanting to work in co-operation with that effort; in fact, I believe we are going to see some results in the near future.


            One of the areas that I have found wanting is that the physician resource plan maybe became a little bit more of a bible than a guide. I see the member opposite would like to see it as a bible; he can relate to that. But anyway, it really needs to be a guide. We've had some communities that were assigned 3.5 physicians or 2.75 physicians; it's very difficult to get a new recruit at 0.5 or 0.75. So we've had to make some of those kinds of corrections along the way, and I think we'll make further corrections to the physician recruitment and retention.


            I think one of the real heartening signs is that every medical school in Canada has increased the number of students that are in the medical school. We went through a period where there was actually a reduction of placements in our medical schools across the country. I see a number of strong developments. It doesn't mean every community is looked after to the extent that it needs to be and should be, but I think that's what will start a much more rigorous program. Some of the recruitment will not be seen necessarily this month; many residents will start their practice in June or July. Two new doctors came to my community and they started in September; they took a holiday after slugging it out for eight or nine years of education. I think we'll still see some recruitment going on in the next months as well.


            MS. MACFARLANE: There are all kinds of questions I feel I should be asking and wish there was more time, but I am going to wrap it up with regard to capital projects.


            Mr. Chairman, Nova Scotians in general are very generous people. I know whenever there's a fundraiser in Pictou County, they come out in droves, and we're always amazed at how much money we can raise. I know that happens elsewhere within the province too. We're lucky in Pictou County that we have a wonderful foundation, and I know other areas in Nova Scotia have foundations. A lot of these are charities; therefore, they are given an expiry date that they have to use their funds that they have raised.


            I'm wondering if the minister can explain to me how his department works with foundations to invest their money into capital projects and if he could actually provide a breakdown as well of submissions that are given to his department. So I'm curious: does the foundation come to your department and say, oh, we have a project idea and we have X amount of dollars, and you're going to put in 75 per cent and we're going to put in 25 per cent? So if he could explain to me how the process works, if it's someone in his department that comes into communities to talk to these foundations, what the relationship is. And once again, more importantly, I would like to see a breakdown of the submissions and where capital projects are happening, because I know one thing: they're not happening in Pictou County.


            MR. GLAVINE: We know that refurbishment at the Aberdeen, of course, is going to bring new life to that hospital in many, many regards, and I think the member is remiss in not highlighting the work and the commitment that is going on there.


            In terms of foundations - and I was very pleased to address the foundations well before we moved to the one provincial Health Authority, because again, that was one of those worrisome areas. Would the zone or would the one provincial Health Authority have funds channel to maybe some of the projects or any particular equipment that may be needed? I assured the foundations, and the foundations know that whatever is raised in the name of the Aberdeen or the Sutherland Harris - whatever hospital - those funds are dedicated 100 per cent to those sites.


            The Department of Health and Wellness has nothing to do with foundations in terms of what pieces of equipment they may get. The department provided the districts, now the Health Authority, with block funding. They decided in conjunction with the foundation what they would support, and generally it was 75-25. So if a new piece of equipment like a fetal heart monitor, which is one that I have supported recently in a Valley Regional campaign, in some cases the foundation will actually raise or provide 100 per cent of the funding. They will make a piece of equipment their goal, and 100 per cent of the funding for a piece of equipment will be provided by the foundation, and it's simply carried out.


            The work of our foundations across the province is really extraordinary. We're now going to see two of our foundations, the foundations at the Dartmouth General Hospital and the QEII that will certainly have big challenges as construction programs get under way there. Very often, it's a particular item that a foundation will identify and put the monies up for it.


            MS. MACFARLANE: You mention block funding - so the amount that we received for block funding before, are we still receiving that in Pictou County?


            MR. GLAVINE: When it comes to construction projects, obviously, the Department of Health and Wellness and TIR are involved with those, and again, a contribution on the basis very often of 75-25 is the model that is there. So this block funding would go to the Health Authority. Sometimes there has to be prioritization, but there are times when a foundation will simply set a goal to procure a piece of equipment that is identified as being needed, and perhaps that will even be separate from something that the Health Authority has identified that is now needed. So, generally, there are small repairs, small projects, but very often foundations are involved with the procurement of equipment that has become outdated. Those are the priority of the Health Authority as it has moved from the district to the Health Authority.


            MS. MACFARLANE: I do want to thank the minister for his explanation on that. I still would like to have him table a breakdown of submissions or a list of the projects and what the actual block funding was in accordance to what those projects are.


            Following up though, most hospitals within the province have gift stores within them; often a lot of volunteers work in these gift stores and they raise quite a bit of funding. I know specifically for the Aberdeen Hospital there was $250,000 raised to go towards a project, and it seems like it has been ongoing for about four or five years. I'm not sure if the minister is specifically aware of this particular project, but I guess where the frustration comes is that you raise the money and you put every effort to get the community involved to raise the funds. Then, they're like, what are you doing with the funds? How come we haven't seen any project come out of the money that we raised? Now you're starting another fundraiser but we haven't seen any results from the previous fundraiser.


            So, once again, can the minister stand in his place - I want a list of projects tabled. As well, I would like to have him specifically speak about gift shops, in particular the Aberdeen, and perhaps when some of that $250,000 that I'm speaking about will be utilized to benefit and improve health care within the Aberdeen Hospital.


            MR. GLAVINE: Mr. Chairman, maybe the member could provide me with more detailed information on what the foundation was fundraising for and then I'll be able to deal a little bit, I guess easier, with knowing if that is, in fact, something that the Health Authority is involved with or if it was something that the foundation decided that they would take on.


            We know that in some hospitals, in fact, foundations have done an entire - like a palliative care unit, for example, and I think the Aberdeen is an example of that. In fact, when I went to the Aberdeen and met Dr. Farrell and the team there, again, it's one of those very impressive moments of the highest quality of care that we would find for palliative patients.


            Now one of the big dollar items that the Aberdeen foundation is currently providing funds for is the redevelopment at the Aberdeen. That is a 75-25 split. So when the new emergency room is open and the pharmacy is open, I think we did decide that the upgrades on the electrical were kind of more basic infrastructure that required - I know there's a bit of a dispute there that went on, but I know that overall it's a 75-25, and that's a model that has worked very well across the province.


            I know that all foundations can point to some outstanding fundraising, some outstanding improvement in the site or in the equipment in their hospital.


            MS. MACFARLANE: It looks like I'm going to have to make this really quick. I understand there's a strategic plan that's in the works. I am aware, though, that Pictou County hasn't been consulted at all in putting this strategic plan together, so I'm wondering if perhaps we are going to be asked to be involved in the strategic plan or is it already almost done and going to be completed without our input? Thank you.


            MR. GLAVINE: As the member would know, when she takes a look at the regional hospital, the Aberdeen, the other clinical sites, the collaborative practices, the community, the community health hub, nursing homes and so on, it's a big endeavour that the Health Authority has taken on. I know there are many of the old districts, if that's how the approach is being carried out, that have not started the consulting process at all.


            MR. CHAIRMAN: Time has elapsed for the Progressive Conservative Party. We'll now rotate to the New Democratic Party, with approximately 25 minutes left.


            The honourable member for Sackville-Cobequid.


            HON. DAVID WILSON: I should talk about the health care services out of Yarmouth, but I might hold that off until Thursday because I know the member for Yarmouth would want me to make sure that I question the minister on the services in Yarmouth. I'm going to kind of pick up where I left off in my last hour of questioning, and that was some of the line items under Other Programs on Page 13.11. I know I talked about the metro health and addiction budget is still there, about $8 million, even though there has been kind of a huge drop in personnel in the department.


            One of the areas that caught my eye was Canadian Blood Services. I asked the minister recently in Question Period about some concerns around for-profit plasma clinics and blood clinics in Nova Scotia, but I'll get to that in a few minutes.


            The Canadian Blood Services line item budgeted about $40 million last year - that was the estimate - and ended up at a cost of about $47 million. I'm just wondering if the minister could indicate, why is there about a $7 million increase in that budget line item?


            MR. GLAVINE: I guess when you come from a briefing in the morning of estimates you can speak very strongly. One of the areas that we're very concerned about in Nova Scotia and right across the country is that rising cost. Utilization is a factor, the price of products alone, and we are being hit unbelievably hard with the exchange rate that's currently there. Immunoglobulin - plasma - is a big requirement, and that is the area for which we are paying huge dollars at the moment. It's one that the Canadian Blood Services, I guess overall on their prices, have been challenged with. I'm pleased to say that our department challenged the Canadian Blood Services on our contract and we were able to do a bit better this year.


            This area now is one that the Canadian Blood Services are starting a conversation with across the country on what the future needs to look like and how we can make sure we have a constant, safe supply of products from day to day and really from year to year.


            I'm pleased to say that in just a few days I'll be meeting with the CEO of the Canadian Blood Services to have our province engaged in that conversation, our department bringing forth their expertise, doing that inventory of where we are in our province. So it's very early, I guess, to address the bigger picture, but without question, the cost is rising and may very well continue to rise.


            We're finding new treatments, as well, for blood products. In the briefing today one of the real enlightenments was that those who suffer from COPD are finding extremely significant improvement with a plasma treatment. So the need is not going to be curtailed, it's only going to grow.


            MR. DAVID WILSON: I want to thank the minister for that. It's interesting that we're here and the minister will meet with the CEO of Canadian Blood Services.


            So the future for blood services, the direction that the government relays to Canadian Blood Services, I would hope, is one of a voluntary blood and plasma collection future. I know when I asked the minister in the House around the possibility of a for-profit, paid blood and plasma clinic, the potential for them to open in our province is still there, the door is still open.


            I know the minister quoted and acknowledged his knowledge of the World Health Organization's resolution that was reaffirmed a number of years ago, or confirmed a number of years ago - I think it's from years ago, the original resolution - of 100 per cent voluntary plasma and blood collection world-wide. They're hoping that can be achieved by 2020. The minister quoted that but I didn't hear the minister give his commitment, as a government, as a minister, that the province would close the door on potentially having these for-profit companies coming into Nova Scotia, setting up shop and paying either gift cards, or whatever, for donations.


            I'll give the minister a chance now to be very specific. Will he allow these for-profit companies to open up in Nova Scotia or will he close the door, like the Liberal Government in Ontario has done and other jurisdictions, to make sure we concentrate our efforts with the Canadian Blood Services, and that we emphasize to them it's their job to increase the awareness around the need for donations of either plasma or blood products? I'm wondering if the minister can give me an answer on that.


            MR. GLAVINE: What I can convey to the member and all members here and to Nova Scotians at this stage is that the Canadian Blood Services has probably voiced to their board, those who work in the system across the country, they have voiced a very significant concern as to where the blood plasma issue now is; 75 per cent of what we use in Canada is paid for and coming out of the United States.


            With the dramatic change in exchange rate, plus the growing demand, the Canadian Blood Services have kind of issued a bit of a warning statement, I guess, that we really do have to take a look at how we will provide plasma for the future.


            I wanted to hear first-hand from the CEO as to whether or not they are coming up with a strategic plan, whether they have a new education for Canadians on how important it is to give blood, or take the plasma from a person. We wanted to hear first-hand what the future may require of Canadians to meet this growing demand. Until I sit down and have that opportunity to explore, I certainly remain in an inquiry state about this particular issue. I know it is one that is a growing concern across the country, Nova Scotians are aware of the issue as well.


            MR. DAVID WILSON: I'm a bit disappointed that the minister hasn't taken the opportunity to address a serious issue that many people have brought up. We know that the minister met with the CEO of a private clinic, a paid-for private clinic, a for-profit clinic.


            I want to remind the minister that Canadian Blood Services' existence is to meet the mandate of the provinces and the territories, which is similar to our association with Atlantic Lotto. It's the jurisdictions that drive Canadian Blood Services to meet the needs of our province and our country.


            It's great that the minister is going to listen to Canadian Blood Services, but I think he needs to attend that meeting with a strong message. Unfortunately, I didn't hear that from the minister, that as Nova Scotians, just like the Province of Ontario - I think the Liberal Government in Ontario has sent a strong message that they do not want to see the private clinics opening up in Ontario. Actually they did open up in Ontario.


            One of the reasons why Deb Matthews, who was the Minister of Health, stepped in was because this private clinic opened up a clinic next to a shelter, knowing full well that vulnerable individuals were there, and they took a strong stance. I think we're going to see jurisdictions across the country take that stance.


            I hope the minister is not only there to listen to what Canadian Blood Services has to say, I'm concerned with some of the things they've said and the CEO has said in the past about potentially having the door open for these paid clinics. I don't think it's an area that most Nova Scotians would want to go down. We know the tainted blood crisis that happened in Canada and so many Nova Scotians were affected by it, so many people lost their lives; 30,000 Canadians were affected by hepatitis C and HIV.


There are survivors today in Nova Scotia who are concerned because I believe it's one of the largest inquiries or most expensive inquiries that the Canadian Government has ever performed - I believe it was around a $17 million inquiry around the tainted blood scandal. Justice Krever in the inquiry, in the reports and the recommendations out of that, even though they were a number of decades ago, I think still stands firm that for us, as Canadians, to ensure the security and the safety of the products that we have, that in that inquiry and the recommendations it did say that a voluntary donation should be something we strive for in Canada and it needs to be there.


            I hope the minister understands his role, the Canadian Blood Services works for us, as Nova Scotians. I don't want to see them lead us down a path - not the minister but the Canadian Blood Services - that most Nova Scotians wouldn't support, and I believe the minister understands that.


            I'll be looking forward - I believe he said in a couple of weeks he's meeting with Canadian Blood Services and I'll make sure that I keep on top of that, to find out what happened. I hope the minister is open and transparent on that meeting and what transpires.


            I want to go to Page 13.10, Continuing Care. It's an issue that I've talked about often here in the House - of course, that's long-term care and the budget. We know the long-term care facilities were asked to take a 1 per cent decrease in their budget. Over the last number of years I've requested from the department a detailed breakdown of the budgets of each of the long-term care facilities and the cut they will receive. So instead of going through the normal process of freedom of information, and I have to say the department has been very accommodating in providing that information, but I'm just wondering if the minister - and he doesn't have to do it right now but maybe by Thursday - could he provide us with a breakdown of the long-term care facilities and the reduction in budgets that they're going to receive due to the reduction in the overall budget to facility- based care?


            MR. GLAVINE: I know the member moved on to a different topic but I was listening intently to what he had to say in terms of plasma, blood collection, Canadian Blood Services. I've also met in recent days with Janet Conners who many Nova Scotians identify with in terms of the past and the blood issues, the tainted blood scandal that we had and its impact on the province, so I'm certainly looking at all sides of this issue.


            I know that Canadian Blood Services is truly concerned about how we will look after a growing utilization across the country so I think it is time for us to pause and make sure that we look at the needs, the 75 per cent that we purchase now from the United States, I think we are in a pretty good place in our hospitals here across the province. We're using that product each and every day so I think the safety issue is perhaps at a little different stage.


            I can answer the member very quickly that we will provide him with that information as quickly as possible.


MR. DAVID WILSON: Thank you, minister, for that. Of course, as you sit down, you always think of another question, and you move on. But I will go back for one moment to blood collection and the compensation for the tainted blood survivors.


            There was a fund. I know it's a federal issue, but I was approached recently by media to comment on the possibility of the federal government clawing back some of the monies that are earmarked for compensation. To my knowledge, there may be close to $1 billion in that fund where there are pensions set up for survivors. There's word that potentially the federal government will claw back about $250 million of that. I wonder if the minister could indicate if he's aware of any of that. If he is or isn't, would he commit to engaging the federal minister, the federal government, on the importance of securing that compensation?


            It was put in place for a reason, and the federal government should not be looking at clawing back any of those funds. It's meant for a reason, and I think Nova Scotians would want our government on a provincial level to stand up to the federal government and say, do not touch this fund. It's there for a reason, and it should not be looked at as a way to address the fiscal challenge that the federal government is in.


            MR. GLAVINE: I say to the member opposite, the former minister, he must have some contacts still that I don't have because I know it's an issue that has not come up at the deputy's table; it's not one that has been presented by the Canadian Blood Services. But we know that's a very, very important fund that has really shaped the quality of life for those who were so unfortunate to be affected by HIV and hepatitis C, even though we are moving into a period of much better quality of health as a result of the new medications that have come on the market. It's something that we would have to inquire into to see if there is something emerging in that area.


            MR. DAVID WILSON: I want to turn now to Page 13.12, under Health Authorities Spending. Provincial Programs is a new line item right at the bottom of that chart that's provided, some $17.4 million. I wonder, could the minister give us some details on what programs are involved that will utilize that $17.4 million?


            MR. GLAVINE: The member would be very familiar with the nine provincial programs that I think have been a tremendous strength to health care delivery in our province. It's an area where we're a bit of a model, along with EHS. We're taking a look at how we do things on a provincial scale, how we improve the standard of care, and how we measure those standards. The provincial programs are these ones here. They are cancer care, breast screening, diabetes, Legacy of Life, the Nova Scotia Renal Program, provincial blood coordinating, and the Reproductive Care Program. That money has now gone to the Health Authority. The one that remains is hearing and speech, and they have a different governance model that required that we not move them to the provincial Health Authority.


            MR. DAVID WILSON: So it's $17.4 million. I'm trying to coordinate where it came out of. Can the minister provide us information about last year's budget towards this year's budget? Was there an increase? A decrease? Or is it relatively the same amount of money being provided to the Nova Scotia Health Authority now for those programs? I know you'd have to take out the hearing and speech portion but I'm wondering if the minister could give us a little bit of detail on how that budget looks this year compared to last year, if he can. If he can't today, if he could provide that to us.


            MR. GLAVINE: What I can convey to the member is that at this point it is absolutely a straight transfer of monies into those programs and whether or not the Health Authority will look at that in the future, but for this year it remains the same.


            MR. DAVID WILSON: So I'd be remiss, when I hear about the hearing and speech, not to talk about another area of concern, especially in last year's budget, that's the call for rehabilitation of loss of sight in our province. If you're a Nova Scotian and you lose your hearing or your speech, physio, that rehabilitation is paid through the government, through services that are provided and funded under MSI.


Has there been any money allocated this year to move in the direction to include vision loss and rehabilitation for Nova Scotians who find themselves, either due to an accident or a disease, where they lost their vision, that it would be funded under what we would call public funding programs through Health and Wellness?


            MR. GLAVINE: What I can tell the member with his question here is that we transferred the monies that were traditionally given to CNIB from DCS and we have now incorporated that grant in the Department of Health and Wellness . . .


            MR. CHAIRMAN: Order, please. The time allotted for consideration of Supply today has elapsed.


            The honourable Deputy Government House Leader.


            MR. TERRY FARRELL: Mr. Chairman, I move that the committee do now rise and report progress to the House.


            MR. CHAIRMAN: The motion is carried.


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


            [The committee adjourned at 7:38 p.m.]