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5 mai 2016
Comités pléniers
Sujet(s) à aborder: 
CW on Supply (Health & Wellness and Seniors) - Legislative Chamber (1927)















3:40 P.M.



Mr. Keith Irving


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


            The honourable Deputy Government House Leader.


            MR. TERRY FARRELL: Please call the resumption of consideration of the estimates of the Department of Health and Wellness, and Seniors, Resolution Nos. E11 and E38.


            MR. CHAIRMAN: We will return now to questions from the New Democratic Party caucus with 35 minutes remaining.


The honourable member for Sackville-Cobequid.


            HON. DAVID WILSON: I want to thank the minister and his staff for coming back as we go through the Health budget. I know in Question Period I've asked the minister on a number of occasions questions around long-term care, more recently around some of the wait times that are out there with long-term care. This is hopefully just a reminder to the minister about a previous question around information we're looking for to be tabled, a breakdown of the cuts to the long-term care facilities. I know we've received that in the past from the department. I'm not asking for it today, but a reminder to make sure we get that.


            I tabled in Question Period yesterday I believe, wait times for long-term care. I only have one copy now, but I'll table it afterwards again for the minister's information. The data source is the Department of Health and Wellness, Continuing Care branch. The information that we asked for, the data period was actually April 1, 2015 to March 31, 2016, so it would be the most up-to-date I believe that the department provided us. The next update, they had indicated, is May 2016. I'm wondering if the minister or the deputy minister could indicate when that will be ready to be distributed. I wonder if he could maybe give us a bit of a timeline on that.


            HON. LEO GLAVINE: What I will provide to the member opposite is that we can get the latest information, and that would probably capture to the end of April.


            MR. DAVID WILSON: Thank you for that. I do want to continue on a little bit with long-term care. I know it has been the priority of the government to look at home care and home care services. There has been, and I'll acknowledge it, some investment over the last couple of years in order to improve home care services. I think it's something that's needed. I definitely would agree with the minister's comments in the past that more seniors, more Nova Scotians would want to stay at home as long as possible before going into a long-term care facility.


            When I asked the minister during Question Periods in the past, when I talked about long-term care and the wait for long-term care placements, the minister often went back to the number of people on the wait-lists. That's one issue, it's the length of time that people are waiting to gain access to long-term care.


            Cumberland County, for example, is one of the areas of the province where the wait is less, on average about 73 days, Mr. Chairman. But as I indicated yesterday, the worst place in the province is actually Richmond Villa which is 1,088 days, and it's everything in between: the County of Antigonish, roughly the average is about 418 days; Hants County it is 533 days; Cape Breton as a whole, the average is 608 days; Halifax is about 290 days and Lunenburg is about 237 days.


            What is the minister doing, and what is the department doing specifically to address that wait time? It doesn't matter if there are 10 people on the wait-list or if there are 5,000, if someone has to wait almost three years if they are in Richmond, what is the department, what is the government doing to address that, especially when we've seen in the budget a number of line items where the budget has been cut for long-term care?


            MR. GLAVINE: I thank the member for that question. I know nursing homes and home care are always on the minds of Nova Scotians, especially those who have a family member who could be on a wait-list, that's when it becomes most pronounced for them to be looking at what that wait time is.


            I think one of the significant ways that we're working to address the nursing home list is to actually also improve home care. One of the areas that as we started to look at was Phase 1 of a two-phase policy change and the first phase of course was that, you know, we know that over the years people went on the list - a lot of perhaps workup in the assessment, you know, maybe a report from a doctor, many ways of advocating for their loved one. In some ways the list became somewhat self-fulfilling because the wait-list was long and therefore the word in the communities was look, we had better get our mom or dad on the wait-list because it is long and that's what in fact caused the list to grow. Once we said that Phase 1 of the policy was simply that if the next person on the list was called and they didn't want to go into the home, they would come off the list and in 90 days they could apply to get back on the list.


            As those calls started to take place it wasn't just a matter of asking those seniors or disabled persons about are you ready to go into the home - that was an obvious question - but they were also asked, have you accessed home care to help you look after your needs in the home, to make sure that you have properly prepared meals, that your personal care is being looked at? That was a critical and very important question to ask and that's why, as we started to ask those questions, there became an even bigger demand for home care. Some people came off the list, no question, because they weren't ready to go into the nursing home, and they're able to stay off the list longer, which is the goal - to stay in their home longer until the need is there.


I think the real effectiveness of the policy was that if somebody came off the list - and we had some of these examples happen fairly quickly - where they said, I'm not ready to go to the nursing home, and over the next two or three weeks, they had some medical incident and went into hospital. Very often, cases I heard were stroke. Then they became a high-risk person to go home, so very quickly they were moved to get in the nursing home. That's an improvement in the policy.


            The second part of the policy is starting to emerge now, and that is in the assessment phase. Again, during the assessment, when a family asks that their family member go into a nursing home, it is really now totally based on what the risks are. What are the risks to that person needing to go to a home? We will offer home care to people, and nursing homes to those who are most in need of what nursing homes and nursing care offer. That's what's helping us reduce that list from almost 2,600 down to 1,492 - it was I think about a month ago when I got the last update.


            I know what the member is asking, and it's about the wait-lists that are in certain homes. There are certain homes that are absolutely more desirable. If we were to, for example, get on any nursing home list, we'd actually have an average of 10 people now on each nursing home of the province. It doesn't work that way because people want to be in the vicinity or close to the vicinity where they live. Some people also, when you start to analyze and drill down on the list, you soon find out that some of those going to a nursing home have one nursing home only; that's the only place that they're going to enter. Again, that wait-list can be long for certain homes.


            When we go across the province and take a look at our 138 nursing homes - and I'm pleased to say that I've now been in about half of our nursing homes across the province - there is indeed a wide disparity in terms of the newness of the home. I certainly see great quality of care going on in a nursing home. One of the nursing homes that I've been in is almost 100 years old. Well, the layout of that home compared to one of the homes built, and some were opened by the previous government, it's a very different model of care that you would find in a Shannex in Kentville, Bridgewater, Greenwich, any of the last 11 that they built. What happens now is that family gets a nursing home in mind, and that's what they'll drive towards.


            I believe we will improve that list, again, as our home care improves as well. Just in the past six months, we have seen a very, very strong movement to get people the care they need in home and reduce that list. We have started to take a look at a better practice, one that would create a high-efficiency model for our providers, our care providers, to look after more by clustering patients together.


            We had some of our agencies who really hadn't done any kind of modernization around . . .


            MR. CHAIRMAN: Order, please. I'd like to ask all members to try and keep the chatting to a minimum and at a very low tone. We do not want to disrupt the minister during responses to the questions.


            MR. GLAVINE: You know, in taking a look at modernizing practice it's looking like we probably won't have to use an RFP, we obviously haven't ruled it out because our new contracts will have requirements. There haven't been requirements in the past, other than work to provide a top-quality service, but not around the best scheduling, reducing the number of care providers going into a home. These two, in fact, are top of mind today at a Canada-wide conference going on here in the city. They are going to look at how we can improve home care. We know that this is going to be where more and more care takes place, whether it's for our seniors and disabled or those who come home from hospital and need nursing care in the home.


            We have the double-barrelled effort where we're looking at both the home care and the nursing home and the two are very connected, we cannot work on one in isolation. The stronger home care that we provide and now, as we sit down with agencies across the province and even signalling to them, and some of the RFP was about signalling that we needed to see their service, their agency, modernize and give us a better quality of service, a more efficient service.


            The Premier and I can talk about the last 10 or 12 years when it comes to the Annapolis Valley. We've had one of the longest wait-lists in the province. We had a deficiency of about 5,000 to 6,000 hours and at the last count were down to about 1,100 hours. That is a huge gain in a very short time. So if we can get that kind of improvement by better practices right across the province, we're going to get to where they are now, in Pictou, in Cumberland, and that is a just-in-time service. Ultimately that is obviously the bar set high to get there and achieve that.


            We'll need to improve the service because that cohort that is coming at us now, each and every month, you know 22 per cent, 23 per cent of Nova Scotians between 52 and 67 years of age are going to have huge demands on home care and eventually those who are very frail going to a nursing home. I believe as we strengthen home care we will also be right-sizing the number of nursing home beds required. It doesn't happen overnight but seeing the progress made just by Phase 1 of two phases of change in the policy of nursing homes gain has gone on.


            What was really surprising to me and really gave credence to our policy was that when those seniors were called and asked, are you ready to go into Windsor Elms nursing home and when they said no, I'm going to defer going in, there was not a negative pushback about the policy because they understand that the nursing homes should be for that level of care. For whatever reason, people were on the list a lengthy period of time - a bit of that insurance that when they really did need it, they were pretty high up on the list. If we can work both our lists to providing quick support to people, I think it's a much better day for our seniors. Also we can't just use that kind of phrase that I know a few people took issue with when I said more and more people need to stay at home longer. I incorporate in that statement "staying at home safely." This was the big area that many people hadn't explored, and that was, would home care be available to them, how much home care, and how long a period of home care? As we come to deal with those two areas, I'm pleased with the progress we have made.


            I know, however, that the pressures are constant. How can we improve the wait-list for Richmond Villa? I've been to Richmond Villa. It's a facility that is very desirable to go to. I certainly look forward to continuing to strengthen our policies around entry into nursing homes while now working on new contracts with our 19 agencies that provide home care. There's a lot of very positive work that's going on both by the agencies and by the department. NSHA is also starting to do some advanced work in that area. Again, ultimately, operationally, it could come under their purview.


            MR. DAVID WILSON: As the minister has done in Question Period, I heard no answer to that. The minister continues to go back to the change in the requirement to be on the list for long-term care. I understand that. People understand that.


            What I'm talking about and what I asked was, what is the government doing to try to address the long waits that people have to get into a long-term care facility? There are seniors today for whom home care and the use of home care is not meeting their needs. That's why they're on the list for a long-term care placement. Some of them are in transitional care beds in our hospitals.


            I heard nothing, and I don't see anything in this budget that will address that issue. I agree with the minister; he has changed the criteria. Some people came off that list, but there's still well over 1,000 people - 1,400-and something people - on the list who, if the criteria has changed, need placement in long-term care.


            When you look at how many days people are waiting, I would agree with the minister, there are some facilities that are newer that have longer wait-lists to get into. But by no means does it mean that there's no wait-list. Villa Acadienne in Digby, 270 days people are waiting. Tideview Terrace, which is a newer facility, is at 500 days. I understand, yes, to get into Tideview, 500 days; Villa Acadienne, which has its own issues, is 270 days. That's at the bottom end of it. Mr. Chairman. Windsor Elms, 561 days.


            The government came forward pretty quickly saying that they were not going to build any new long-term care beds. I think the data is showing that we don't have the supply we need right now. We can't wait for people to pass away or hope that their condition might improve so that they can get home care and continue that home care service. There's a need in this province. Our population is getting older and older as we speak and the government has made the decision not to increase the number of long-term care beds in this province. I don't believe that is going to address the issue the minister brought up around long wait-lists, people are still waiting a long period of time to get into a nursing home.


            A specific question around the requirements on the wait-lists; there was a 100-kilometre kind of rule that if you were asked, if you were on the list, that this is the next available long-term care facility, is that 100-kilometre rule still in the mix? Can people say no, I'm not moving 250 kilometres away, and will they maintain their position on that list? Is that 100-kilometre rule that has been there for a number of years still in effect, where people can say no because the closest facility is maybe 200, 300 kilometres away?


            MR. GLAVINE: When we consider that this change now has only been implemented for a short period of time and to see the amount of progress made and since providing the member opposite with the number waiting for nursing homes, and I know he doesn't like me coming back to that but the reality is in fact in just another very short period of time we have moved the wait-list for nursing homes from 1,492, which was there I think in February, down to 1,345 - 147 moving down which is a 42 per cent reduction since we started to really gear in.


            Colchester is a wonderful example where we there have reduced the wait-list by 30 per cent and we're going to start to see across the province those incremental gains because of the 1,345 that are on the list, some of them haven't been asked yet, in fact will home care in the short term work out fine for you? We're going to see a continuous gain there.


            One of the areas - there's a couple of areas that I think, yes, do need to be explored I believe over the next number of years. There may, in fact, be areas where there never has been quite a number of nursing home beds, based on the population. I look, for example, at the area where I live in the Annapolis Valley we have five of the eight communities in Nova Scotia that already have a population of 25 per cent who are over the age of 65, so obviously it's one of those pressure areas. Some of that fine tuning perhaps can be done.


            We're going to see in a very short time right across the province we have veterans' beds. Veterans' beds are not confined to Camp Hill. We know there are a number of communities, whether it's in Cape Breton, Lunenburg, Middleton, and obviously here at Camp Hill where we have 175. Some of those beds, certainly ones that are already built and in place, are going to be less costly if the decision is made that we would now have seniors go into those beds. Some of them are very accessible, Soldiers' Memorial, Fishermen's Memorial - I'm looking for the one in Glace Bay. I always have trouble with the name of the Glace Bay home that has a significant number of veterans' beds - those are now community health facilities very easy to access to bring about that changeover.


            Speaking about hospitals, I'm sure this number would register with the member opposite: today in Nova Scotia, and this is part of really good news for the members observing, we are down to 120 people waiting in hospitals right across the province. When I became minister, it was twice that. It was twice that number. Again, it's about the priority. Somebody in hospital identified as needing a nursing home is getting in quicker. I believe those are great improvements, ones that we need to keep effort to get even greater gains.


            As we all know in this House, when a person who has gone to hospital and received the care that they required and is ready to either go home or to a nursing home, the quicker that happens the better. Hospitals are an area where it's easy to get an infection just by the very nature of the hospital. That's tracking to pretty significant improvement.


            I do take the member opposite's strong position that we do have some real issues in some nursing homes, but I like to look at the bigger picture, and that is having a strong track to improvement. It will be a great day for whoever is minister at the time when that comes down to 300 or 400 and is almost just-in-time nursing home admission.


            Today, when I said home care, stronger home care, innovation in home care - when I said that to this national group, they applauded because they saw too many governments getting caught up with another building, another nursing home, without ever looking at what more could be done at home. I believe for acute care and for those with disabilities and the frailties of age, staying at home as long as possible is what we must look at. But getting the care for those three that I just mentioned in the home is going to be our home-first policy. There are provinces that are very committed to this and others that are starting to really take a look at whether they have reached their capacity pretty well for nursing homes. We know that there will be some private bills. We see that going on.


            I think the other big advantage and value to this whole area is the focus on assisted living. That focus now on assisted living is making an enormous difference and again shortening the time that somebody is on a list waiting to get into a nursing home. There is an absolutely natural transition there. (Interruption)


            The member will have more time, but that being said, the 100-kilometre rule absolutely does exist. Are there exceptions when somebody will go beyond 100 kilometres? There are in fact sometimes, as I've discovered in the department, requests from a family member that they would like to see their loved one out of hospital, in a nursing home and get back to the one in their area as quickly as possible.


            MR. DAVID WILSON: I will have more time. It took a while for the minister to answer a simple question, eating up time - I think I could keep the minister here for another week, really.


            I think I ask specific questions, I think they're important questions. When you are dealing with people who are waiting for long-term care, I think giving an answer so we can get on to the next issue is important.


            The minister mentioned that the list is down by 147. I wonder if the minister would be transparent and open and indicate to Nova Scotians how many of those in the 147 were either removed from the list or actually were placed in long-term care? Those are some of the details that would be nice to know.


            When I talked about the wait times; Braeside Nursing Home, 228 days; Melville Gardens Nursing Home, 302 days; Arborstone, 169 days. These are facilities in our communities that seniors are trying to put their loved ones in or put themselves in and we've heard nothing at all from this government about the investment.


            The minister just mentioned in his long-winded answer to the 100-kilometre question that potentially the veterans' beds will be opened. I've been asking the minister on a number of occasions what kind of budget will that be? I don't see anything in this budget that reflects that there's going to be additional costs and there will be a cost. It probably won't be to the point that Veterans Affairs is paying the facilities for but there is a cost. I'll come back and ask those questions the next hour.


            MR. CHAIRMAN: Order, please. Time has expired for the New Democratic Party caucus.


            The honourable member for Dartmouth East for one hour.


            MR. ANDREW YOUNGER: Thank you, Mr. Chairman. There are a few issues I'm hoping to get to here over the next hour and some of them you can probably guess. We'll get to the Dartmouth General, don't worry.


            The first one I wanted to start with is actually interesting. The member for Sackville-Cobequid just finished and I want to start by quoting a letter from him back when he was minister. It's about the Kronos project, which I know you would be familiar with. I know the former member for Dartmouth South and I both appreciated that you and your staff met with Computerease about this. At the time the former Health and Wellness Minister said that the project will help ensure the right number of clinical staff are available for patient care and staff members are scheduled to work in the most efficient manner. Then he provides context. Of course this was the Kronos tender.


            What I'm wondering is - this letter was in 2012, we're here in 2016 - what is the status of implementation for Kronos scheduling?


            MR. GLAVINE: I thank the honourable member for the question and for raising this issue. In fact it was a very short time after becoming minister that I was apprised of the challenges with this particular program. It was one that Capital Health was certainly struggling with. They have the largest staff to obviously provide scheduling for.


            I know that the Health Authority has taken this on and they are still continuing to work out and refine all those parts of the program that can make the scheduling much more responsive than I guess probably what was embedded in the original program.


            I can certainly get an up-to-the-minute answer for the member from the Health Authority - they had to take over that project - and just to see where it is.


            MR. YOUNGER: I appreciate that and I do want to recognize that it is something that the minister inherited. What I'd be interested to know, and if he doesn't have the information now perhaps he could get this information to me because we've tried to get the information from the Health Authority and the IWK and they came back and said no, it's the Department of Health and Wellness that has this information. We went to the Department of Health and Wellness and they said no, it's the IWK and the Nova Scotia Health Authority, so nobody is quite sure where the information we're looking for lies.


            What I'm interested to know is how much has been spent on implementation of the Kronos project; whether it's considered to be on budget; and whether there is a dedicated budget over the next five years for the continued implementation of this? Maybe the minister can let me know whether he has the answers and, if he doesn't, I'm perfectly happy getting those at a later date from him.


            MR. GLAVINE: I thank the member for the question, knowing that it's always important not to just have a program but what is budgeted for it, how it's progressing and so forth. We'll get that level of detail for you. Some could be in the department but I know in terms of the operations, indeed it is the Nova Scotia Health Authority that would have the fine details about where that is.


            MR. YOUNGER: I appreciate that. Does the minister know whether - one of the challenges, as I understand it, was the implementation with the SAP system, which obviously was required, and I also understand that one of the other systems - I know it's all one Health Authority now - the Antigonish area is still running one of the legacy systems and is not yet on Kronos so I'm just wondering, is it still the plan to implement Kronos across the province or is that going to be abandoned in favour of another option? Has it been successfully integrated with SAP at this point?


            MR. GLAVINE: I think as the member can appreciate, when the Health Authority came into existence on April 1, 2015, they inherited a lot of variation across the province and I certainly discovered in some cases there were six, seven, even eight versions of a program that was under the direction of the department but once it moved out into the eight or nine districts, we would have different versions of it.


            This is very important, of course, to scheduling. Right now as the Health Authority takes a look at what can be the best program for the value and the dollars invested, that's one of the areas that they have under their review. In terms of where that is, I will provide the member with details and an update.


            MR. YOUNGER: I look forward to getting that information and I do appreciate that that's some detailed stuff that you wouldn't necessarily have right at hand.


            I'll just close my thoughts on that by saying I think that's an important issue because it went out to tender originally in 2011 - obviously long before the minister was there - you hear reports sometimes from different hospitals and you never know if the reports you hear are completely accurate and I understand that but there are some areas where they're not using that scheduling software, areas where it hasn't been implemented across the payroll system and then, of course, in the Antigonish area where they're still using the legacy Computerease system. They don't have money to upgrade it because it wasn't the actual plan.


            My concern with that, as you can imagine, is if they have to replace it, they probably want to be moving on that but the other concern I have on that is that if the purpose of a single health authority was to get efficiencies and to have better use of resources, if the scheduling software that was intended to facilitate that and help with that isn't operating properly, then that obviously would be a barrier to the success of a single health authority. That's why I think that's important.


            I understand that probably people listening are thinking why are we talking about a tender or a piece of software but I think that one is fairly important so I appreciate that you'll get me the answers on that.


            MR. CHAIRMAN: Order, please. Just a reminder to the honourable member to not refer to "you" and to direct comments through the Chair.


            MR. YOUNGER: Mr. Chairman, I appreciate that the minister has agreed to get me that information. It's very easy to slip into the "you" thing when we're in the committee especially.


            I want to move on to the Dartmouth General Hospital because there's a number of issues that we've got to cover here. As the minister would be aware, we found out very quickly that the third and fourth floor had to be done. I've seen it, I've been taken on a tour of that and that's very successful.


            When the renovations were announced for the fifth floor, under the previous government, there was considerable concern that they were wrapped up in the renovations of the QEII and the replacement of the Centennial and that it was just getting bogged down. The minister will remember that he and I had a meeting with the Chief of Staff of the Dartmouth General at my office at the time and he outlined that. The minister, to his credit, split the projects - I don't know whether he officially split them or how that was done - and that project was separately announced.


            There is a bit of fear that now, with the exacerbated problems at the Centennial Building, that once again the two projects are colliding because they are being talked about together again and that would delay the completion and the work on the fifth floor and the planning of the fifth floor. I'm just wondering, has there been any impact on the timeline for the construction of the fifth floor? What is that timeline that we would expect at the moment?


            MR. GLAVINE: I understand completely the member's high level of interest in this project and his involvement over a period of time. As I went to take a look at the third and fourth floors and the need for a significant renovation and one, of course, that the Auditor General said needed to be done, when I looked at the configuration of the third and fourth floors, which are very significant floors to the Dartmouth General, one didn't have to be a clinical expert to see how easy it would be to have infection control problems.


            I've also now been able to take a look at the work as it's proceeding and to kind of have a little bit of an unofficial opening of one half of a floor and see the change, the transformation that has gone on and how it has buoyed the staff to work there and to see what a significant part of their future work life but, more importantly, a higher quality of patient care that will be able to come as a result of not having those worries and relocations when infections did take place.


            In terms of the fifth floor, the fifth floor and the surgical tower, if it was at one point a stand-alone project, it was certainly a capacity there that needed to be addressed. The day that I got off the elevator on the fifth floor and looked out over what was nothing more than a football field, I said why would we ever be launching a massive build that would at least over there accommodate 50 beds and a state-of-the-art ICU and that was an immediate reaction when I took a look there.


            We know that now it's incorporated in part of the entire distribution model of care that the VG and Centennial replacement will be changing over the next probably five-year period.


            So the fifth floor this summer had a Class B estimate carried out. I met recently with the architects, Lydon Lynch, and it was nice to hear them say we'll be on time, we'll be on budget and that work is going to be complete by late summer. At that point we'll be ready to move on the fifth floor and the surgical tower.


            While there have not been significant dollars placed in the budget of this year, we know that it's a project we want to see moved along as quickly as possible so that those surgeries can get operating and that fifth floor brought to completion.


            I'm pleased to say that in 2016-17 fiscal year there will be work on the fifth floor or surgical tower or a combination of both. The project will not be delayed, it will move in parallel with work on the fifth floor at the Halifax Infirmary. There's a firm commitment to have this project scaled up. We never know when there might be another mishap at the VG or Centennial so it's now being well scoped out, it's not just a plan. We'll see obviously big dollars in the next fiscal year put in place for the actual bill.


            I think it goes without saying, and maybe the member is perhaps more aware of this than I am, but a real excitement around Dartmouth General and its potential and the role it will play in a full provincial hospital system. I see it becoming one of our centres of excellence. There's a lot of talk about building on the tremendous orthopaedic team that is there and to be able to set up an orthopaedic centre of excellence and have all the equipment permanently in those surgical theatres. Again, it will allow for more surgeries and I think a higher quality to be carried out.


            I'm certainly excited about the future of Dartmouth General and so should the residents of the city be. They will be looking after people from across the province, I believe, if it does become one of our centres of excellence.


            MR. YOUNGER: I would agree with the minister that people are excited. One of the questions is, from what you just said, do we understand that just the architectural drawings and then the tenders would happen in 2016-17, or do you anticipate construction to actually begin on either the surgical tower or the fifth floor work in 2016-17?


Tied in with that, the big question everybody is trying to figure out is, we understand that the Dartmouth General Hospital Foundation is expected to raise a certain amount of money but they're not aware of how much money that is going to be. That's a bit of a concern because obviously we have the big lobster dinner coming up in June and so forth but there are many fundraising efforts they take and it's hard to go after large donors without knowing what the expectation would be on the foundation.


            The two questions I would have at this juncture are, when the minister says the project will be going ahead in 2016-17, what does that actually mean, what should our expectations be? What is the financial expectation by the foundation?


            MR. CHAIRMAN: Thank you for framing the question in the proper manner. There were two items in which you used "you" directly. We'll move on now to the minister.


            MR. GLAVINE: A couple of very significant questions placed on the floor there. One of the areas that has really changed over the past couple of years, a lot of experience gained and knowledge from some of our major builds. I know Colchester-Truro has a tremendous facility but it did get off track in terms of the cost. This is why we haven't put that out there in an absolute, firm manner. We want to see what the design obviously looks like and, as I said, late summer for the design. At that point we'll be able to say if it's going to be early 2017 or a little bit later into the next fiscal year.


            They're starting to target some work in this fiscal year. The foundation has been having conversations with the Health Authority and those again now are being bridged by the fact that this is part of the larger provincial requirements for health care and some of that traditional 75/25 I'm really pleased to say is under review. Some of the early thoughts around that, you know, if we're going to total some big millions of dollars I think it's important that it is looked at differently than those smaller community hospitals, community projects. That discussion and that information is now there to be looked at.


            MR. YOUNGER: So without a specific number - and what I'm concerned about, Mr. Chairman, is that we're fast approaching the construction, which is exciting, like say it's a year, say it's two years out, that's still reasonably soon. To raise the kind of money that we expect the foundation will have to raise would be a challenge in any community and I appreciate the minister is talking about changing the traditional 75/25, I think that's good.


            Now as a regional facility there's potentially the possibility to draw from a wider base to raise money. Since he doesn't have an exact number, is there an order of magnitude that we can expect the foundation would be looking at? Are we talking about them raising $2 million or $10 million?


            I ask this because this is becoming - we're within a month and a half, well, a month - of the foundation's biggest fundraiser of the year, that happens again the following year so we're barrelling down the road of time in terms of raising these kinds of dollars.


            I understand he doesn't have an exact number and I think maybe the minister is probably smart in not putting out a number that ends up being wrong. In the end that's probably a good idea but maybe there's an order of magnitude that we might expect the foundation to be responsible for.


            MR. GLAVINE: What I can convey to the member is that we've made now the VG/Centennial replacement but more importantly, focus on those facilities, whether it be the Halifax Infirmary, Dartmouth General, Hants Community Hospital, all these will move forward in parallel. We don't want to put any brakes on that project and this is why I was so pleased to hear that the architectural work and design is well on schedule, well on budget. It's a new day in the province when we've taken this stage-gated approach to doing work and if it's five stages, then at each stage the quality of the work has to be there, the cost has to be on budget.


            Mr. Chairman, in fact I was with him and the member for Kings South on a tour of the Wolfville school that's undergoing a magnificent renovation, again all being stage-gated and to hear the construction company folks say well, you now, we hope we got the whole contract. That's certainly a whole new way of thinking, at each of the stages there's a set of requirements and criteria.


            So it will be the same here and to get this project underway early in 2017 is the goal. Hopefully we'll be at that place with all the required details that such a project requires. What I'm pleased about in terms of the Dartmouth General Hospital Foundation is that they have had some consulting with the NSHA on what that final arrangement may look like, what they will be asked to participate in.


            At this stage it is very difficult to be completely into that $10 million ballpark or any figure for that matter. I think it's a matter of it goes out to tender, this is the scale, scope of the project, here's the timeline. We know the foundation's commitment is extremely strong and they've done a great job in terms of the current project.


            I've met with the foundation and to know what work they'll put into fundraising, I think they will meet whatever that expectation is, that is finally agreed upon, and I believe that is the operative word, they will agree together to say it won't be that full imposition or taking the formula that we have traditionally used.


            MR. YOUNGER: Thank you to the minister. I will just say that I - and hopefully he will take this in the light-hearted manner that it is intended - stage-gating is good and I agree with it but what I will mention through you, Mr. Chairman, is that the Muskrat Falls dam was also stage-gated and budgeted with the highest calibre and highest level of estimates and that is now many times over budget, so that doesn't always work out the way you hope it would and I think the minister probably understands that.


            The last thing I wanted to ask about the Dartmouth General project is when I participated with the minister in the original announcement there was talk about it being the orthopaedic centre for - I don't know whether it was for Nova Scotia or for the region, I wasn't quite sure how that was going to work. It was being referred to and it was referred to in many of the media articles from the time as it will become the orthopaedic centre.


            I'm wondering if that is still the plan? If it is not the plan, what is the newly-projected role for that facility in this broader transformation of, I'll call it Capital District but it really is the Capital District area hospitals?


            MR. GLAVINE: I guess I need to react a little bit to the Muskrat Falls in that I know many things can happen. First of all, I always look at the climate in which the work is going on. Having grown up in Newfoundland, sometimes we say we have two seasons - winter and last winter. Very often it can impede construction work.


            I know, because there is a very strong orthopaedic team that's currently in Dartmouth that certainly gets one of the references that could happen. To see Dartmouth double its surgical capacity I think is a significant change for the Dartmouth General and to have a floor dedicated to surgical patients with a state-of-the-art ICU, you know that still remains one of those areas that is being talked about. In fact, I believe there was a reference when the announcement of decanting the VG and Centennial was announced and you know it certainly could be one of those areas.


            We know that the Halifax Infirmary is going to be now the centre for all our high, intense surgical work, like transplants, oncology and cardiac, those areas in particular. All our major trauma will go in there so it becomes our teaching, learning, innovation, research and tertiary and quaternary care centre. Dartmouth will obviously play a very significant role in building surgical capacity in the province, where they're going to move from four surgical theatres to eight. So orthopaedics is a strong consideration.


            Final determination, I can say to the member and to all members here, there is a clinical services review going on. Probably the first time, in my understanding, in the history of the province to have that kind of thorough review.


            At the announcement, if the member was there, was Dr. David Kirkpatrick. When I became a minister two and a half years ago and we were wondering if we could ever get a handle on orthopaedic work in the province, I was really buoyed by the fact that the orthopaedic community were the first ones to come together and plan their organization around dealing with wait times. As challenging as it currently is, by some additional money but more importantly, doing some change around the surgical theatre capacity, moving patients to other sites, you know, they're going to be doing somewhere between 500 and 600 additional hips and knees this year. That's a tremendous step forward.


            I know for future orthopaedic needs, Dartmouth will indeed play a very critical role. Dr. David Kirkpatrick has been heading up that perioperative area and so when the clinical services review is done, that's when they'll determine that whether it's in Truro, at the Aberdeen, Amherst, Yarmouth, all of our regional hospitals in particular, what will take place in those, based on the needs. Needs are changing as we take a look of course at that huge demographic that does have certain surgeries at a higher level.


            One of the ones that I'm certainly hearing about in that big cohort is increase in cancer rates so whether some oncology goes there, we'll have to wait and hear what Dr. David Kirkpatrick and his team assess as they complete their work, really. They are well underway with it. They've put a couple of years of planning into this and it's to distribute and have surgeries in the right place.


            There are some areas, in fact, where corrections will need to be made in that there's too few surgeries being done of a particular higher level and better outcomes occur as well with volume.


            MR. YOUNGER: Thank you to the minister. I want to move on to some of the mental health funding in the budget. I want to start by - there's funding set aside for risk mitigation in primary and acute care. I notice that budget has gone down but I assume that's because some of the money is transferred to the Health Authority.


            What I'm wondering is whether, within the department or through the Health Authority, there is a plan to review how patients who present with suicidal ideation or previous suicide attempts are handled in the primary and acute care system.


            The reason I ask about that is I have had a number of cases come in over the past while from different parts of the province and talked to a number of ER Chiefs of Staff in different parts of the province and there is a very inconsistent protocol in different hospitals, in terms of how this is dealt with. You have people coming in who have had previous suicide attempts and yet are sent home and in other places are put in a bed and it seems to vary significantly.


            I guess the two parts to that would be; first, is there a plan to review how it's done? The second part would be whether there is a plan to establish a set protocol for all the ERs in the province, rather than it depending on who happens to be the ER physician of the night?


            MR. GLAVINE: I thank the member for asking the question, this of course being Mental Health Week for one reference point but one that is of great concern to Nova Scotians and especially to families who have had tragic consequences, those who have a family member who are living with a loved one who has attempted suicide or present with strong suicidal thoughts.


            One of the areas that - and again, speaking with a couple of our leads in our emergency rooms, again these doctors, you know our ERPs, our emergency room physicians, who work at the QEII and our regional hospitals have years of training in terms of the medical saving of a life and a very small amount in terms of those presenting in a psychiatric crisis or a mental health trauma.


            One of the areas now that Dr. Linda Courey has been tasked with is in fact taking a look at what we do have in place across the province - do we have, do we need, for example, a psychiatric nurse as part of the team to deal with that trauma. In our bigger centres, you know, the number of heart attacks, the number of strokes, the number of internal bleeds, you know saving a life in that medical sense I think occupies a huge amount of their requirement. In fact that's why sometimes the ERPs who are our best trained in the province when somebody is in and triaged at a Level 5 needs one stitch or some symptoms of flu - all important - but their drive to save a life is really at the centre and the heart of their work.


            I think as we take a look at what Dr. Linda Courey uncovers and points to what will happen in Pictou with the new emergency room there because I know I have expressed concerns from patients who have written me, whose families have come down to my office in the Valley to talk about losing a loved one to suicide and it has been several families. One of the most heartening moments for me is that they came not to complain about the system but how we can improve the system, how we can make it just that little bit more responsive in that time of need. They came offering solutions and it was a wonderful moment for me to share both the heartache but the heartening measures they were offering as solutions.


            At the Aberdeen they will have in the emergency room, probably not right in that trauma location but within the emergency area, they will have two dedicated beds for those who present with attempted suicide, significant suicidal thoughts, any of those kinds of areas. I think it's that recognition that there has to be a separate protocol, there has to be a separate plan to do assessments and give them the care they need.


            What we'll put in place across the province through Dr. Courey's work I believe it will be very significant and I'm hoping we don't hear of anybody presenting with any degree of mental illness being turned away or not being given the needed assessment that is required. I think we will start to embed, if you wish, in terms of our emergency room doctors, that protocol across the province.


            When we started to plan and think about the one provincial Health Authority, when we looked at the strength of our nine provincial plans, you know whether it's cancer care, breast screening, breast health, all of those areas we have made huge gains in our province from those nine provincial programs. So now we have this opportunity not to just look at it from an economic lens, as a district may have, or we just don't have a resource for that, we will now have that provincial approach to a very important treatment requirement that we don't have at the highest level right across Nova Scotia.


            MR. YOUNGER: I guess the obvious follow-up to that is, what is the timeline for having that rolled out? I'm happy to hear there is a plan to have consistency when it comes to that but how long would we expect to wait to see that rolled out and in place across the province?


            MR. GLAVINE: At this point even small changes towards an improvement path to reduce the variability of care and who is admitted to a short-term psychiatric unit for assessment, who stays in one of those observation beds, you know, for overnight until those proper therapies can be set in motion. That's still a work in progress and it's probably now about three months since I had an update from Dr. Courey on how her work was progressing. I really wanted to identify where some of the high needs areas are across the province, both on the acute mental health and on the mental health day-to-day work that is done by a variety of providers in the system.


            It is certainly my hope that as we conclude the clinical services review there will be a statement about the amount of time required to make sure that we have a robust plan in place.


            MR. YOUNGER: I think the timeline is going to be critical and it's critical because so many things in government - and it really doesn't make much difference what Party is in power on some of the stuff - there are things that can go on forever and ever in the planning and never get completed. I think that one of the goals of having a single health authority was to have some consistency and this is one that I am repeatedly seeing, there isn't just inconsistency by virtue of the location, say the Dartmouth General versus the hospital in Yarmouth, but by who the attending physician is at the hospital on that given night and whether they have a psychiatry locum or on call. I hope that's something that would be somewhat of a priority.


            Tied in with that, one of the things I want to know is whether there's a plan to address the availability of psychologists and the wait-list for psychiatrists, I guess. We have a system in place where if you have a health plan and honestly, I don't know what the percentage is of people in Nova Scotia with a health plan but it wouldn't be that high. They may have access to psychological services but it's probably $500 or $800 a year or maybe it's eight visits or 10 visits but it wouldn't be very much for somebody who would be in the more critical cases.


            Then you can go to the government system and I don't know what the minute-by-minute wait-list is but yesterday I was told that for some of the more critical cases it's still a 10-month waiting list to get in to see a government paid-for psychologist. I don't know whether that is accurate or not.


            Psychiatrists really have a different role in the system, although there's a fairly significant wait for them, too.


            What we've done is we've created a system that if you can either afford to pay for a psychologist or you have a health plan that will pay for a few visits, then really you have the ability - it's almost like queue-jumping to some extent - you can get access to those services. So the access to services in mental health is very dependent on your economic status in this province. Someone who is a millionaire can go out and get those services in Nova Scotia, no problem. You don't even have to be a millionaire, but have a reasonably decent salary.


Somebody who is making $20,000 or $30,000 as an annual income is not going to be able to pay for their child or for themselves, for that matter, to have much by way of private psychological counselling. I think that's a real serious problem and that's why I think you end up with a backup of people - particularly younger people but some older people as well - who end up in the ERs with suicidal ideation or other psychological - quite frankly, we bring up suicidal ideation all the time but there are plenty of other things, such as schizophrenic episodes, dissociative disorders, bipolar, there's any number of these things that you can end up on a waiting list and clogging the ER.


            I'm wondering if there has been any thought given to a plan that would address the disparity between economic ability to meet your mental health needs, between those who can afford to get the private health care, either by virtue of their Blue Cross or Manulife plan or by just virtue of the fact that they have enough money and those who cannot.


            MR. GLAVINE: A very important question that the member asks. In fact I don't mind relaying that I encouraged a few of my colleagues to ask questions about mental health. I know how significant an issue it is for all of us, there's nothing partisan about working to deliver the strongest mental health services in our province.


            I can point to one of my colleagues that I certainly told him that I would be more than prepared to answer whatever he has asked in that vein.


            Just to give a little update in terms of the latest information I have, for an adult in the central zone, 90 per cent of people are seeing a psychological service - because it could be psychiatrists, psychologists that work in the system as well - but 90 per cent now are seen within 105 days and 50 per cent are seen within 33 days. Again, you know, to be on the path of improvement.


Just at the time the Together We Can strategy was brought in by the former government, children and youth in the province were waiting 501 days for treatment. They may have had an initial assessment and contact but for actual treatment, 501 days and in 2015, 118 days, which is still too long, absolutely. But to see that progress that has come from a plan. Now what we have to do, in my view, is absolutely build on that plan.


            There are many elements of the Together We Can strategy. There was no need to reinvent or put another name on it, it was simply a matter, it was there for five years, it was to get at the work, get as many of the 33 recommendations out the door.


            I've met with a good number on that advisory or really an implementation team and again there are some very highlights of what has gone on but they all point to we need to keep doing more, just like a few weeks ago signing off on 50 doctors who have taken the mental health professional development course to help them work with their patients who certainly maybe have lower levels of anxiety, depression, you know or an array of personal problems that are certainly of a mental health nature, but to get the majority of our 1,335 GPs with some mental health training, it was one of the real deficiencies in medical schools but now there's a growing awareness that our 17 medical schools in the country absolutely have to do more for that front-line care.


            You know the wait-lists have some ups and downs across the province, it depends where we are. I think the member mentioned the word "consistency" and I believe that's really what we have to now strive for and get the right complement as well of people who work in the mental health field available to people, you know psychologists don't use a medicative approach and they have I think a very strong place in our system and again building teams. I know we hear from the members from Pictou that there's more in Truro, but if we can attract 10 top people in the field to a hub and strengthen that hub and move people there for the best short-term care, I think that's an advance.


            All across the province it is difficult to recruit for every single community but if we can have smaller little hubs that again provide the service, I think it is a strengthening of mental health services.


            MR. YOUNGER: It strikes me that sometimes wait-lists, you know if you need a wait-list for a heart bypass, everybody who needs a heart bypass is going to be on that wait-list, I'm pretty sure. It strikes me that wait-lists for psychological services, anything in mental health, it is going to be a little bit like the unemployment rate, where when people give up, the unemployment rate goes down because there's less people seeking work. So the people who either give up trying to use the public system and go to private options, either because they pay for it themselves or on a health plan, are going to come off that waiting list, presumably, and so I think those waiting lists can be difficult.


            The same would probably be true for government-funded physiotherapy and things like that, anything that you can get privately that people can ship themselves off, that wait-list is going to change. I'm not sure that's always a measure of success, although I don't dispute the fact, Mr. Chairman, that that wait-list has gone down and I'm happy to hear the minister say that he still thinks it needs to come down further but I think we need to be very careful about relying on wait-lists for things that people, if they are in dire circumstances, can go elsewhere because they came off that list.


            I don't have a lot of time left so I wanted to deal with two other issues with this, which is really around the teen mental health. I'm wondering, obviously we're seeing a lot more of this at the university level - the minister would be aware that I sit on a number of committees with the local universities and we're seeing a lot more - really a wide variety of mental health issues in young people. When I say "young people" I'm thinking like really 25 and under. It isn't always around universities, obviously, but a lot of those people are there.


I'm wondering whether his department has a strategic plan to fund adequate mental health care in the universities to provide better access at the universities? I'm not taking away from the fact that I understand part of the answer is that the universities are putting money into it themselves in providing these, I understand that, but they can't be expected to be the deliverers of health care.


            How much money is the government putting in, if any, into mental health clinicians into the school system? Maybe there's no money going in there, I'm not sure. I'm interested to know.


            The third part to that, I guess, because I know you'll probably fill the rest of the time, I know the minister well on that, is there a difference between the urban areas and the rural areas when it comes to delivering any of those services in the schools? Thank you.


            MR. GLAVINE: I thank the member for that question. Part of it, which I'll get to, referenced in fact one of the major requests at the last Provincial-Territorial-Federal Ministers and that's around that transitioning of the 19-year-old out of the youth mental health system up to 25 years of age. Everybody has some real challenges there.


            One of the quick analyses that I have done from 2013 to now shows that right across the province, on adolescent care, we're seeing a downward trend, with the exception of the IWK. Of course the IWK has our most specialized care going on at the Garron Centre. In 2013 we really started into the SchoolsPlus program so for the youth and adolescent area the time is getting shorter for the provision of mental health services. We're talking here mainly those professional services offered right across the province with our adolescent psychologists, our youth counsellors. From 2013 to now, there's that downward trend. It was right about at the time we started to get more of the counsellor that's in the SchoolsPlus program. We're increasing that every year.


            I was at a recent Annapolis Valley School Board meeting where I know the members for Kings South, Kings North, we attend as a group and for Annapolis and also Hants East, we all come to the same meeting, share in the same information. One of the strongest statements they made which really gives that on-the-ground credibility to what Dr. Jana Davidson said when she came in to take a look at youth and adolescent mental health services, and certainly did it in conjunction with people at the IWK; Dr. Jana is from B.C. Sick Children's. She said, the work that you are putting in to the SchoolsPlus program is lead work in the country and you will gradually see positive dividends from that.


            I think we're starting to hear that. The school board people in unison, if my colleagues remember, they said whatever you do in terms of change, don't reduce the SchoolsPlus program. It is helping our teachers, it is helping parents but, more than anything, it is helping our young people be stable to a greater degree in our school system.


            They are supported by an area that the member also asked about and that was, what about clinicians? What about those who are the psychologists? One of the people that I know who does fabulous work in my area and she has probably gotten better known because of her book, The Cancer Olympics, Dr. Robin McGee. We have 29 of those professionals now in our school system. They will generally work with a family of schools, so we're not without that higher level of trained mental health provider in a number of our schools. Again, getting that right number is certainly always a challenge.


            I think I see good things happening, I see now that in the western zone, in the northern zone, in the eastern zone - and in the central zone, that's where we have our biggest population, it's a little higher - but three now we're seeing that in 50, 60 days a youth and adolescent is getting the full treatment. They may be even prior to that getting help at school with our clinicians. So I think there is a good track of improvement that is taking place there.


            I think our most challenging area is the one that the member has raised, that is in the 19 to 25 age group. Last year I attended an end of university session for all universities in Atlantic Canada as they were starting to take a look at how we meet the psychological, the mental health needs of our university students and again, those demands that they are placing on those services. I believe the recognition of the need is that first step but it is a common ask right across the country and I hope it's one of the areas that Dr. Jane Philpott really does place some emphasis on.


            In our university and college communities we have at least, you know, from 19 to 23, 24, we have a bit of a captive audience and a real chance, I believe, to work with those who are having an array of mental health issues so it's an area that I hope we can go.


            I just received a document from B.C., they've done a lot of work in this area and I think it's a document that we need to take a look at here in the province and it's one I certainly don't mind sharing with the member, that he may be able to use in his work. I believe it's the area that I know I, as minister, do need to give greater attention to and find ways in our community - community colleges and our universities - to simply do more.


            MR. CHAIRMAN: The time has elapsed for the honourable member for Dartmouth East. We will now move to one hour of questions from the Progressive Conservative caucus.


The honourable member for Northside-Westmount.


            MR. EDDIE ORRELL: Thank you, Mr. Chairman, for allowing me to ask a few questions this afternoon. I don't plan on being too long, I have a few very specific questions that relate to health care in the hospital in the area where I live and work. Hopefully with some good answers I won't be as long, I won't have to torture you, but without them I will be a little longer.


            I guess my first question is, the Northside General emergency room is open from 8:00 a.m. to 3:00 p.m., which is a steady opening, we understand that and it's good to know that when the evening comes that you have to go to Sydney because the emergency room is not open. It's a 20 to 25-minute drive from the Northside and depending on what side of the Northside you are on, it could be longer. That amount of time could be life and death for some people.


            I know we have a great emergency medicine EHS program and the paramedics are excellent but nothing really takes the place of emergency room care when someone really needs it. I wonder if the minister can enlighten me and the residents of the Northside what the plan is for the Northside General emergency room, is it to stay as it is? Is it to be open at different hours? Is it going to be open longer? We know that most emergencies don't happen between 8:00 a.m. and 3:00 p.m. and when they do, most of the doctors are in their office and could be called and could meet somebody there. I wonder if the minister could enlighten me on the plan for the Northside General.


            MR. GLAVINE: I thank the member for the question, it's one that begs to be addressed. I absolutely believe that the foundation to overall improvement in both health delivery and the health of the citizens of the Northside and really any part of the province is to have the best of primary care. Northside is fortunate to have about 15, 16 doctors who work in that area.


            However, for a whole wide range of reasons the GP covering an emergency room for a higher level of care is really disappearing or has disappeared pretty well across the country. People want to go to the provider in a significant emergency to the one who can deliver the best care.


            In the region of the member opposite, and I've met some of the doctors when I've toured Cape Breton Regional, there's no question that it is at Cape Breton Regional where our emergency doctors or highest-trained doctors are performing 24/7, 365 days a year.


            In some of our communities now really to have what I call a comprehensive model for primary care is the direction that we have to go. While you have only a short number of hours currently in what was the traditional emergency room at Northside General, many of the Collaborative Emergency Centres have some staggered hours; one doctor may work from 8:00 a.m. to 4:00 p.m., another one from noon until 7:00 or 8:00 in the evening. 


The collaborative practices can be set up to do a greater degree of accommodation of both the ongoing management of chronic disease, investigation of new medical issues that a citizen would have but I think it's being able to serve a lot more patients over an extended period of time for their primary care that is really the model that we are moving to. It will take some time and I believe Northside does have some physicians who now want to adopt that model and it may, in fact, allow a doctor, a nurse practitioner, a family practice nurse, in front of more patients for a longer period of the day because doctors are sharing in a different model of practice.


            We have some very small communities, one of them being Annapolis Royal, our oldest community in the province. You know they struggle to keep their emergency room open and was one of the first sites in the province to adopt a collaborative care model. They now have people who access some of the testing at the hospital and doctors working within the old structure of the hospital, providing collaborative care medicine.


            They are not open as an emergency room; if you have a serious bleed, a serious trauma, you are not going into the Annapolis Royal hospital, you are going to where there is a full-fledged ER that is open. But to look after that baby with the 102 or 103 degree temperature, that's where they're going to go, they're going to go to that Collaborative Emergency Centre and get the care they need. This is why previous governments set up the CECs, to provide a level of primary care for those extended hours. Some are through the day but to have a paramedic and a nurse available to our citizens.


In fact, as the member stated when he mentioned EHS, we should want to use EHS. If we have the best system in Canada, when there's an emergency those are the people we need at our home, at our door. Sometimes we don't have necessarily that level of training perhaps in some of the other settings. We are way ahead of the game in that area.


            One of my sidebar conversations with the Minister of Health from Quebec, when he heard me talk about what our paramedics do, assisting with palliative care in the home, going to a nursing home and doing assessment of a patient and keeping them there, not just trucking them off to an ER. In Quebec even today, May 5, 2016, they have a "scoop and deliver" model, is how the minister described it to me. They are not delivering care, they are not delivering clot-busting drugs, they are not at a home at 2:00 a.m. dealing with a medication to reduce pain for a palliative care patient.


            We are a light year ahead, we need to be using 911 in the appropriate manner. We need to be in front of a primary health care provider and not at the emergency room. If I were living on the Northside, in my view, anything serious, which one of my brothers encountered there, it was the Cape Breton Regional that dealt with his emergency.


            We have to look at the delivery of care in a different way. I believe having an emergency room open, covered by a GP, is going to provide great primary care, maybe can put in a stitch and do a few small procedures but they're not going to deliver life-saving. So if we look at the collaborative model, doctors can be expanded across the day hours to do more and see more patients when you have other providers that are part of that model.


            MR. ORRELL: So from what I'm hearing then, the emergency room at the Northside General will be no more, it's going to turn into a collaborative practice with collaborative medical practices handling the rest of the care on the Northside for any new doctors who come here.


            I have to say, minister, with Marine Atlantic that comes and goes in our area every day, with some of the industrial things that happen, an emergency room at the Cape Breton Regional Hospital only, it cannot handle emergency cases that have to be or may be required in industrial Cape Breton if those other emergency rooms close. I will say that I'm disappointed to hear that answer that we have to move to primary care. I understand that, but in the meantime, we have to have emergency care for the people and for what may happen on the Northside especially with the amount of people who travel through there on a regular basis through Marine Atlantic on the ferries, and some of the industrial things that can happen. (Interruption)


            That's the first I've ever heard any heckling during estimates, Mr. Chairman. I'm disappointed to hear that the member for Yarmouth is complaining about our ferry and our emergency room hospital. (Interruption)


            MR. CHAIRMAN: Order, please. The honourable member for Northside-Westmount has the floor.


            MR. ORRELL: I guess I'll ask the minister, what is the plan for the CEC? When will it be up and running? What will the hours be? How is the emergency room at Cape Breton Regional Hospital going to handle the volume of people who are going to have to go there for emergencies that I know they can't handle now because I've been there?


            MR. GLAVINE: To speak to the member's issue here, I put before him what is to be a likelihood in changing the model of care. There's going to be some change; we know that. Has that final decision been made as to what it will actually look like? No.


            But what we have now happening - I think the member has those conversations with doctors - it is really primary care that happens at Northside General in what is identified as an emergency room. It's very often patients who don't have a doctor, patients who can't get into their doctor on that particular day but have a severe pain that needs to be investigated. So it's primary care that is there. Should it have extended hours into the evening it would still be primary care. I think that's the question and that's the area that citizens need to have addressed and to have advanced.


            It takes a while to do this kind of work, but the clinical services review is absolutely critical to the future best care in the right place all across our province. Some of that will take time.


            Should there be extended hours of what's taking place there now? I believe that's the big question. I know that where communities have started to make the changes, they're pleased with the changes. They know the level of care in their facility. They know the other centres of care when they need them.


            It is a concern, but I think changing is the right way to go. I'm certainly hearing - I heard first-hand about a year ago - a continued commitment in New Waterford to community-based care, that people should not be looking just to the hospital site as the place of care but rather community-based care. That's the model for the future, and it already has some variations taking place across the province.


            I know that the operational side now of what we do is handled by the NSHA. The NSHA is in communication with the doctors in Northside General. They will have a say on what they can do and can deliver, so they are not in any way out of planning and getting that picture for the future. That, I can tell the member opposite, is very much in play.


            MR. ORRELL: Thank you, Mr. Minister. I think it's just that people want to know that whatever is going to be there is going to be there. When the emergency room closed we had a number of experienced nurses who used to work in the emergency room who weren't sure what was going to happen and they left. They either left the area, they went to work at one of the other hospitals in the CBHA, but whatever, but they did and we lost that experience. So to know that that's going to be, if it's a collaborative practice, that's what it's going to, then at least we know that between whatever hours we have a collaborative practice.


            I know the emergency room at the Cape Breton Regional can't handle the volumes if it's an actual emergency and I'd like to see if that was going to be the boost up.


            I'll go off the emergency room now and get into just recently we've heard a little bit about the pain clinic in North Sydney. In speaking with the gentleman who runs that pain clinic there, in trying to recruit a new physician he has been having some difficulties because they're not sure of what the complement of support staff are going to be, plus the ability of the gentleman or the doctor that comes in to take over, what is the scope that he will be allowed to do without or with supervision. The gentleman who wants to retire has a complement of two nurses and two support staff there now and the clinic runs quite well. It sees, I'm told, about 80 per cent of the pain people in Cape Breton, compared to the 27 per cent at the regional.


            I'd like to know if that complement of staff would stay there with the new gentleman or lady coming in and keep that pain clinic running as it is and smooth like it is, so that the people in Cape Breton - not just the Northside - will still receive that amount and quality of service for pain.


            MR. GLAVINE: Again I know during the time and the ferment of change that it's only natural to wonder about a service that is at Northside, that's in the community, that's regarded as a very good service and meets the needs of a significant number of people actually in an area, as opposed to just one single town.


            My understanding is that the doctor you referenced was looking at retiring. The one area that they were perhaps looking at was maybe having a director for both sites. It is my understanding that as NSHA looks at the needs of the pain clinics in the area, that conversation continues.


            What I have been told, and I have been told this directly, is that there will be no change in the delivery of service in that site. When I first inquired, that's what I've heard, that's what I stand by. If there is a change and we get a picture of what is going to emerge, I'll certainly convey that to the member.


            MR. ORRELL: Thank you, minister, I appreciate that. I'm sure that the gentleman who wants to retire and whoever he is trying to recruit will appreciate that as well. I assume that would mean staffing and levels of care would remain the same, which is a good thing to hear because since this has happened, I've had a number of different people in my office who are concerned. The nurses that are there, well-trained, well-qualified - they've been there 20 years; they're very capable of doing the work alongside of the doctor. The doctor is confident with those nurses there so he can do more with what he has compared to what he would have if he had people rotating through there all the time, so thank you very much for that.


            I guess one of the other questions I have is with the setup of a collaborative medical practice. I had this conversation with Dr. Vaughan in the past, and I know there were no immediate plans for that to happen. I'm just wondering, since I've had that conversation have there been plans about the collaborative medical practice? What will it look like? If there are plans for it, when will we see something start to happen?


            MR. GLAVINE: What I can convey to the member for Northside-Westmount is that there are those conversations going on about the need for moving to one or two collaborative practices in that area. Those conversations are going on. There's certainly some doctors - I met two when I was there just over a year ago - who are very keen to engage in that kind of practice. So hopefully that will emerge.


            What I really like, what I've heard so far about collaborative practices, no matter what stage of development they are at and ones that exist, is the fact that they aren't a cookie-cutter model. They look at the communities where they're going to go in terms of location. In many cases, they're looking at reducing the footprint of owning a clinic and rather leasing an area and establishing the practice sometimes within an existing facility. We've had a few collaborative practices where a pharmacy decided that they would do the build. Of course, it's a pretty complementary business. That being said, it's a model that works in some communities very well. I know the member is known by many in his area and regarded by many in his area. If he would like to see a collaborative practice in session and see what's there and what the arrangement is, I would certainly be willing to identify one where he could go and actually take a look and see how it functions.


            One of the realities is that - and I know he would probably be able to tell the general age of many of the practitioners in his area - there is going to be a natural transition. He may have heard me say this before, but now in our medical schools overwhelmingly that's the model of care that young doctors want. They want the work-life balance. They want the benefit of collegiality where they can discuss difficult cases. That's what they're committed to. In a survey at Dalhousie, it was unanimous that a team practice, a comprehensive practice, is what they wanted to engage in.


            I'm pleased to hear the member say, if that's what's coming, let's get an idea of when and how it will fit into his community. That's a very fair question to be asking.


            MR. ORRELL: Thank you for that answer. It's just that some of the older doctors who are looking at retiring would either like to have some say in how these practices are set up or even get involved in those practices so that it could be the best thing they'd have to wind down. We could have some young doctors with some of the older, more experienced doctors helping them along the way. They could see more students, they could take more residents. There's all kind of benefits we'd have with that.


            The one thing they are worried about is if four or five new doctors come in and they are on an alternative level of pay and they're not seeing the numbers so when one of the older guys retires, those numbers have nowhere to go, the levels wouldn't be the same even with four or five doctors if two of the older doctors retire, you're looking at thousands. So the concern is that when they go, that the collaborative practices not necessarily wouldn't be able to handle them but there would be more chronic illness because of the length of time these doctors practised, so hopefully they'll have some say in how they are set up, where they are set up and who gets to do what and where.


            Hopefully the numbers - we just recently heard about an orphan clinic in Sydney for unattached patients that recently had to close its doors to new patients because it's full, so the numbers that come in, obviously the new doctors aren't taking the numbers because there are still people without doctors who are going to these clinics. God bless the people who work those clinics because they're working a regular practice, they're working the emergency room and they're working the orphan clinic. They're doing a really good service to our community and I want to commend them and I want to commend the doctors who do work in our community for the work they do because a lot of them have way more patients than the average would take today, especially the idea of medicine has changed. I just hope that someone will have some of that say in how they are set up. I am assured that that will be the case when I talk to Dr. Vaughan, that that would happen. 


I hope that the numbers that are coming in new doctors would be enough to cover the patients who need care. I know that not everybody is always going to have a doctor but the fact that there are thousands who don't have them now who are going to these orphan clinics or evening clinics really concerns me about the health care as our population ages. With that, I'm going to pass the rest of my time on to my colleague.


            MR. CHAIRMAN: The honourable member for Kings North.


            MR. JOHN LOHR: Mr. Chairman, it's my pleasure to stand and ask a few questions of the minister about the situation maybe more specific to the Annapolis Valley. I know I have had opportunity today to ask about the hospice so I'd like to ask first of all about dialysis in the Valley Regional Hospital and if the minister could tell me what is in the plan for the Valley Regional Hospital in dialysis this coming year - I'd like to know that.


            MR. GLAVINE: I'll respond in a moment here but I wanted to say to the member for Northside-Westmount that he is aggressively preparing the ground for his daughter, I hope, to return to North Sydney or somewhere in that general area. I thank him for his questions and I know how committed he is to whatever change there is, we still arrive at the best medical services for his community. I know his mind and heart is in the right place when he speaks and does ask a tough question and I certainly always appreciate that.


            I know the dialysis unit at Valley Regional, perhaps a little bit like the hospice, has become one of those topics and areas that remain challenging for us. What I can tell the member is that in recent weeks the Premier and I have met with the provincial renal program. We need a new look at not just the locations that have been on the list and what should be the utmost priority. We asked the renal program to go back to the drawing board. We know that Kentville is very high on the list - no question about that. But it is time we got a plan and a timeline for the delivery in that area. We do have renal dialysis in Berwick, but the plan is to have the regional hubs like Kentville, like Bridgewater. We'll soon see where that goes - places like Digby. We hear of Barrington having an ask. We want to get the role of the satellite community very prominent as well, not just our major centres. We'll have more to say very shortly on that. We asked for some update on the document that is currently being used.


            One of the areas where I believe we have a lot of work to do and we have to do it differently: generally when it comes to home dialysis, we rely on people pretty heavily to come in here to Halifax and get the training for it. I believe we have to move the training to sites across the province. When I look at areas of B.C. that are not too far outside of the southern corridor around Vancouver, a lot of B.C. is very much like Nova Scotia in terms of its nature and structure of communities and where regional hospitals and everything are located. They have 30 per cent of their patients requiring dialysis on home dialysis. We're at around 17 per cent. I believe that's an area where we can make some gains and some ground as well.


            Ultimately, there are many who qualify for the final treatment, which is a kidney transplant. Again, it's one of those areas where perhaps not many of us know enough to speak about how strong a program we have. We have one of the best outcomes of our kidney transplant and rival centres in the country that are much larger than ours.


            Dialysis is a life-saving procedure. It's generally required three times a week. Some have even a fourth dialysis treatment. So getting as many of our units close to patients so that we can at least eliminate the longer drive. If we can get right across Nova Scotia down to an hour, less than an hour - about an hour I believe is the goal, I'm pretty sure that's the commitment of the provincial renal program. But it will take time to get all the sites that we need.


            MR. LOHR: I don't have the document in front of me, but I think I've tabled it in the House before, a press release from 2013 essentially announcing dialysis in the Valley and I think a couple of other sites.


            What I do have in front of me, Mr. Minister, is the capital plan for this year, 2016-17. I notice Buildings, Other, Health and Wellness, Dialysis Unit, Valley Regional Hospital. I have highlighted that. I'm wondering if you can explain to me why . . .


            MR. CHAIRMAN: Order, please. Please direct your comments through the Chair and refer to the minister through the Chair.


            MR. LOHR: I'm just wondering, Mr. Chairman, if the minister can explain the fact that I think I heard the minister say consultation was still ongoing about dialysis in the Valley and I have in front of me the capital plan which shows: Dialysis unit Valley Regional Hospital.


            I would like to know how this is in here, given his comment already that seems not to indicate that and maybe we can reconcile the actual document, the capital plan and the actual plans of the department.


            MR. GLAVINE: I know that money is allocated. Part of it obviously remains on the plan. Again, we went through a couple of stages, as the member is well aware, of having hospice and dialysis as one building, where one floor would have hospice and one would have a dialysis unit.


            We know that plan now is no longer part of the future. Hospice will be a stand-alone building and the dialysis unit obviously will be attached to the hospital. So some of that planning, some of it in relation to the clinical review that is going on and that operational piece now will take our final word of advancing that project from the Health Authority but considering the fact that the current CEO of the Health Authority was the former CEO of the Annapolis Valley District, I think we should be at a good place to see this project move along.


            MR. LOHR: I'd like to thank the minister for that answer. I guess my next question would be - I believe I heard the minister say that money is allocated - how much money is earmarked or allocated there for the dialysis unit at the Valley Regional Hospital, on Page 6 of this current Health and Wellness plan?


            MR. GLAVINE: In terms of this project moving out and how many dollars are for what part of the design and moving into build is always - until the project actually gets announced and, you know, the RFP is out there, we certainly don't want to tip what we anticipate to be the cost of a unit that will have 12 Chairs and so forth.


            We're well positioned on this project, the foundation is well positioned on it. We wanted to do a bit of an update on the provincial plan and that was the direction that the Premier and I gave the renal program. We think we'll have this back and in discussion very shortly.


            MR. LOHR: What I understand, if I could just repeat back what I think I just heard; there is money allocated but because whatever is in the envelope, if that number is revealed right now, that would affect the contracting process. Can the minister show me where in the Health and Wellness statement, here in the main Estimates Book at least, where that line item would show up because presumably there would be many more items in that line item, can you show me the line item that would include that number?


            MR. GLAVINE: There's a real estimates question that has come across the floor. It's on Page 13.14 and it's incorporated in Hospital Infrastructure.


            MR. LOHR: Hospital Infrastructure, so I'll read those numbers out and maybe the minister can explain this to me: the estimate for 2015-16 was $42 million; the actual, which is listed here as forecast because as we know, it still could change slightly but in reality that is actual, was $15 million and the estimate for this coming year is $34 million. So that number, this $34 million, would include in the envelope among other things, the line item from the Capital Plan for dialysis unit, Valley - I just wonder if the minister could confirm that.


            MR. GLAVINE: The answer there is correct, and as we've had some discussion here on the floor of the Legislature about the unspent capital dollars and that if we go back in time we would see, in fact, that there's very often a history of what is estimated and then what the forecast does bring. This is really nothing new.


            Inside of that $34,144,000, that's where the money for whatever design work and advancing the project is contained.


            MR. LOHR: The minister is right because it wasn't my intention to drill down into this book but I find it shockingly underspent to have $42 million budgeted and only have spent $15 million on hospital infrastructure when we have so many huge hospital infrastructure needs. I presume some of my colleagues have drilled down into that number. Maybe the minister could give me a brief synopsis of why that was so shockingly over-estimated, to put it that way, last year.


            MR. GLAVINE: The underspending, as I said, comes about for a number of reasons. Sometimes the design will undergo maybe a fairly significant change from the clinical community, they may make a different recommendation than what was in the original design. For example, there were delays last year to account for that money, South Shore Regional Hospital expansion, North Cumberland, Shelburne and Digby General had some work as well and some boiler projects and we can keep going to show that some of these just don't get out the door.


            What I did reveal tonight is that we are working more and more since we've moved along in government, gaining more experience, really putting in timelines that are requirements. The Dartmouth General is a big project, and I said earlier tonight, the design there is on time and on budget. I think we need to have that incorporated; in some provinces there are actually penalties when they run over the anticipated time. Anyway, that's where that money can be accounted for.


            MR. LOHR: Time doesn't permit me to drill down into that any further at all. I want to move to some other topics.


            I know that the minister recently, as we did in our caucus, had students from Dalhousie Medical School talking about the huge needs of Syrian immigrants in regard to medical services and in particular the amount of time it takes for translation services. I'm just wondering if the minister can comment on programs or what's available to help doctors deal with that situation of the amount of time it takes to work through a translation program or go through translation when you're dealing with a new immigrant and a Syrian refugee and what his department is doing about that.


            MR. GLAVINE: What I'd like to convey to the member and all members of the House is I guess one of the great responses here in the province that we probably haven't talked a lot about and presented to Nova Scotians; prior to the influx of the Syrian refugees, our recent 1,000, to the province, a clinic was set up at ISANS headquarters so that as they came in for processing and, in some cases, were moved out to other communities across the province, we did have doctors who were very familiar with the toll that life in the camps would take on people and doing an inventory of whether children had immunizations. They became sensitive to the needs of the refugees. But also, a number of doctors have volunteered to be part of a larger service to the refugees.


            The big issue now, as we know, is in communities, whether they be Paradise in the Annapolis Valley, Wolfville, Port Williams, there are families in those communities, and they will have to move into our health care system, either getting a family doctor, going to outpatients, all of those kinds of areas. In the first year, certainly a good amount is being covered, their medical costs, by the federal government. Some of the final picture of what will emerge is still ongoing of course. A lot happened, as we know, in just a matter of months, when the commitment to 25,000 was made and that process started.


            Currently, there is a translation service offered. I certainly don't disagree with the member that even that process simply takes longer. I had a wonderful presentation during what I like to call Advocacy Week, they call it Lobby Week. I said I love advocacy, you come in and advocate any time to me. Four of the second-year doctors at the medical school came in to talk about are we at the point of taking a look at, as we work to increase more immigration in our province - not just refugees, should there be, where we have those language issues, a separate billing code because of the length of time that is required? It's an interesting concept and I'm sure it's one that Doctors Nova Scotia would probably, if there's that need that is presented by the medical community.


            The group of young students were being very proactive and extremely knowledgeable about the time element and the nature of the billing code. I think the member has raised a very good question but the fact that we have put translation service in place so that a doctor can pick up the phone and get some help.


            MR. LOHR: I appreciate the minister's answer. The translation service is of interest. I know from talking to doctors in the Annapolis Valley who have phoned in on that translation service they have been told that that was only available in the HRM and the translation service, even though it was offered by phone, was not available to Valley doctors who were wanting to use that phone service for their refugee families. They are in a situation in the Valley of having to have a translator come in at sometimes $50 an hour.


            The phone service translation which was recently advertised or mentioned in the Doctors Nova Scotia newsletter is not available to Valley MDs. Will the minister be making that phone service translation for Syrian refugee families in the Valley available to doctors in the Valley to access? It's just a phone call, it shouldn't matter if you are calling from the Annapolis Valley or from HRM, so will that service be available to Valley MDs?


            MR. GLAVINE: What I'll convey to the member for Kings South is that we will certainly have a conversation with the Nova Scotia Health Authority to see if that advertised service was to be province-wide or it's gradually moving to that. We'll find out what the service is. I think it's an absolutely timely one that we should have a resolve to.


            MR. LOHR: Thank you to the minister for that. From what I understand from the doctors I talked to, it was not available to the Valley MDs and it doesn't really - if it's a phone-in service, that doesn't really add up that it would not be available.


            Another issue, Mr. Chairman, that I would like to ask the minister about in the time remaining is, I understand that in metro family doctors who make visits to senior citizens' homes on the weekends receive a pay, some sort of fee in the billing code for that call, the fact that it is a house call to a senior citizen's home but in the Valley this fee is not paid. That may be something in the billing codes, I don't know. Can the minister confirm that there won't be a two-tiered system where metro doctors are paid for something and Valley doctors are expected to do the service for free?


            MR. GLAVINE: I thank the member for raising that issue. I know one of the driving premises of what we do in the province now is in fact to have consistency across the province. If the billing code is being used in one area and is one that doctors traditionally used in another, if that is what is causing the dissonance between what one MD would receive and another, it's my understanding that Doctors Nova Scotia, in their current conversation around the master agreement, some of that is to be consolidated, and some refinement to that process is being worked out. Of course, we don't have a final outcome of that at the moment,


            MR. LOHR: Maybe I shouldn't have been offering an explanation of billing codes because I really don't know why there would be a discrepancy - I really don't know the reason is what I'm saying. I presume it's in the billing codes and possibly in what was the old agreements between the DHAs and how they dealt with the doctors. I really don't know the answer, but I have been told that a family doctor who makes a visit to a nursing home on a weekend is not going to be paid for that, but if that doctor did the same thing in HRM, they would be. I really don't know the reason why. I presume it's in the billing codes. It's something that should be cleared up because, clearly, if the service is being done, and it's easy to understand why doctors might do this, it's important that this sort of thing be cleared up.


            Another issue I would like to ask the minister about, Mr. Chairman, as he knows and as I know, in the Valley we lost Dr. Charlie Hamm, one of the best OB/GYNs in the province. Can the minister tell me what's being done to replace him? Unfortunately, I know Charlie Hamm is in St. Thomas, Ontario, now. Can the minister tell me when we will expect a replacement? What's being done?


            MR. GLAVINE: Just to track back for a moment with the question around a visit to a nursing home, the member alluded to an area that was likely the reason for the discrepancy. In Capital Health, they had a program called Care by Design. There was something within the Capital Health jurisdiction that allowed for that to take place. Now we'll see that consistency across the province emerge here through the NSHA.


            In terms of the obstetrician/gynecologist, it's my understanding that those who are in the team there are dealing with the number of patients that require obstetrician or gynecological services. I know because there were two retirements and Dr. Hamm leaving the province it really triggered a strong recruitment effort in this regard. I know they were able to recruit for Antigonish when they were in perhaps the site with the greatest need in the province.


My understanding at this stage is that their complement is meeting the needs. Ongoing recruitment is part of NSHA's plan.


            MR. CHAIRMAN: Time has elapsed for the Progressive Conservative caucus. Just before we move on to the New Democratic Party caucus, I would like to check in with the minister and his staff on whether a break is necessary. We have about an hour and 20 minutes remaining. Good to go.


            The honourable Leader in the House of the New Democratic Party.


            MS. MARIAN MANCINI: I've been learning a lot listening to the minister for the last few days, and I absolutely appreciate the thoroughness of his responses. A little earlier today, my friend from Dartmouth East asked questions, and a lot of them centred on Dartmouth General Hospital - we're both quite connected to that - so some of the questions may have been answered. Hopefully I won't belabour this.


            This is certainly exciting. What other way can we describe what's happening at the Dartmouth General? I've had the opportunity to meet with Dr. Howlett, and he's certainly a very enthused individual about the prospects for the Dartmouth General. I've also had an opportunity to meet with Adrienne Malloy, who's the chair of the foundation. She took the time to show me some of the renovations that the foundation had been involved in - again, very impressive, what you can do with space. 


I had the real opportunity to contrast one space with the new space. It had the whole sense of being expanded and really efficient in dealing with the infectious issues that the minister had referred to earlier. It was simply done by reconfiguring: no walls were taken out. It was the exact same space, but it was incredibly spacious. It was good to see. It was really good work to see.


            Just by way of a little background, on April 28th, there was that announcement of $6 million for the Dartmouth General Hospital, which at the time I had understood was for a facelift, and then that was followed in October 2014 by the announcement of a five-year plan with a budget of $132 million. That was announced in October. I'm sure the VG certainly was on the radar and whatever, but it was afterwards that we had some more significant issues at the VG, and since then the minister has announced the plan. Has any of that plan altered what was intended in the announcement in October?


            MR. GLAVINE: I welcome the questions from the Leader in the House of the New Democratic Party. There were a couple of different announcements there; she's absolutely right. One of the early goals was in fact to see Dartmouth General, a general plan has been there now for a few years, and once realizing the potential to bring that hospital to its full higher level of service, to its full regional nature and get the fifth floor done and add more surgical capacity, that was the first and highest priority that we gave to looking at replacing some of the capacity of the VG. In many ways, it has all of the ability to have been a stand-alone project, but it's now a very integrated part of moving services from the VG to the Dartmouth site. 


I was pleased that we were moving on that project pretty well from the beginning of our time as government. We saw it as a valuable addition to the Dartmouth area, a growing part of our province. Once we saw the benefits of the provincial Health Authority and to have people come from other areas that could benefit from surgery and services there, now they do orthopaedic work for people with a fairly far reach, on a pretty regular basis.


            I'm pleased to say that Dartmouth General is well in scope. In many ways we were probably hoping to have Dartmouth General finished and have 48 additional beds, four additional surgeries, all eight theatres being of course a modern style, and size in particular is very big.


            It was interesting hearing Dr. David Kirkpatrick speak about the general size of an OR that we currently would have at the VG or even at the Halifax Infirmary. When that team is in the OR and you have your residents, you have nurses in training to be OR nurses, he said it's pretty well full, so there are some new requirements around the size of ORs, so they'll be up to the highest standard.


            It was our thinking at first that we could get Dartmouth in place and then start the new work at the Halifax Infirmary but now they will go in parallel. The need is so strong after the problems that have become very severe with the flood. We know that the hospital itself is on life support, to some degree, so moving the whole project now as quickly as possible is what is in the plan.


            MS. MANCINI: I think I know the answer to this question but in the current budget is there anything that incorporates the $132 million?


            MR. GLAVINE: What I can convey to the member is that the full amount for the design, which will finish in summer, is included in the budget and a small amount towards getting construction underway. The goal certainly is, as we escalate this project, to have some work underway in early 2017. By the time the final design comes in and we get it out to tender, that's the goal at this stage.


            As I did say earlier, the design is on time and it will put us in a good position to get this project underway.


            MS. MANCINI: I'm just wondering if you could point out . . .


            MR. CHAIRMAN: Order, please. Direct your questions through the Chair.


            MS. MANCINI: I wonder if the minister could just point out to me in the budget line where that would be reflected, for the Dartmouth General Hospital, please.


            MR. GLAVINE: The Hospital Infrastructure contains the dollars that will be allocated. That's on Page 13.14, Health and Wellness. It's in that envelope of money that the work for Dartmouth General is contained.


            MS. MANCINI: Has the RFP been developed? If it has, is it available? Could it be made available?


            MR. GLAVINE: Looping back to the previous question asked, of course the design we're into a Class B, which puts us on the edge of construction. In checking in with the architects and the company there, they are on time with this work but it needs a final - maybe "rendition" is the word - it needs that final draft before an RFP would be developed, in order to contain all the specifications for the build. That's not being formulated at this point.


            MS. MANCINI: In the lead-up to the announcement on October 14th obviously I am sure a lot of planning took place, cost analyses, timelines, et cetera. I'm wondering if the minister could indicate to me if that information could be made available.

            MR. GLAVINE: What I want to be able to present to the member is that the amount of the project, the scale, the projection, was that envelope of $132 million. Nothing has changed since then. That detail of cost analysis really comes after we get the final design because then there's a check back on what the cost analysis will be. Very often I think it's actually an independent look at whether those costs are in line with the projections.


            MS. MANCINI: I guess maybe I should reframe my question; I'm thinking that in coming up with a plan in October that would go over five years and the cost of $132 million, there would have had to have been some planning. That's essentially what I would be interested in seeing if the minister could provide that.


            MR. GLAVINE: The general figure was put out there to give everybody the assurance that in order to do the fifth floor and build a tower, this is a ballpark, it certainly was not based on any detailed design at that stage. What we do know is that there's a general cost for square footage of a hospital plan. So this provides that ballpark figure that we put forward.


            MS. MANCINI: I feel a little bit worried by that answer as I expect there would have been quite a bit of consultation that would have taken place and concerted efforts toward putting forward a plan to reach that. But at this point I will move on in my questions.


            I do want to ask the minister about the Dartmouth General Hospital Foundation. I believe you probably addressed some of the questions that I did have . . .


            MR. CHAIRMAN: Order, please. Please go through the Chair.


            The honourable Leader in the House of the New Democratic Party.


            MS. MANCINI: I want to ask the minister questions in relation the Dartmouth General Hospital Foundation. I think the minister alluded to a standard 25/75 ratio with foundations, noting that there could be some flexibility with a project of this size with the foundation. What I wanted to ask the minister, when the foundation takes over the responsibility for that particular wing I had alluded to earlier - I believe it was primarily the foundation that had done that work - does that contribution from the foundation show up in this budget?


            MR. GLAVINE: No, that wouldn't show up as part of the budget. It never has. Looking forward, having met with the board, I know they'll do a great job in coming to an agreement with the NSHA in terms of what they will arrive at for a goal and target in terms of their fundraising. So far, every indication is that they're pleased with the very early conversations. They have noted to us that everything is at a good place for them. Both the work at Dartmouth General and the work at the Halifax Infirmary we know is of a scale that in recent memory they haven't had to work to achieve. But I think that the right balance - the NSHA will recognize what the community is able to raise. As well, I believe based on current fundraising in the community, and as the community becomes aware of the tremendous enhancement of their general hospital, I think we'll see what Nova Scotians often do, and that is rise to the challenge before them.


            MS. MANCINI: I would like to discuss the EIBI program that the minister had referred to in his opening comments. The minister has indicated that $3.6 million has been committed to this program. My question in relation to this for the minister is, does his department have data comparing the EIBI results for children who received services before the age of four versus those who received it after the age of four?


            MR. GLAVINE: The member raises a wonderful and timely question. This is a program I'm very, very familiar with as I worked with VAST, Valley Autism Support Team, when I first became a member. The Valley was one of the first areas to get EIBI funding. Of course as we know, it has moved across the province.


            One of the areas that the IWK team is very interested in is, we do hear that the earlier the intervention the better the outcomes, so whether it's best with a three-year-old, a four-year-old, or a five-year-old. It's only natural to think in terms of a three-year-old and the language development they have versus a four-year-old in language development, which is a very big part of a requirement on the autism spectrum. The IWK now in fact is looking at the program and what level of intense therapy is required and trying to do this more on an individual basis as opposed to saying that a child needs eight months of intensive therapy and how much training and involvement with parents and with daycare centres as well. The best results that I hear about are when in fact there is a wider amount of work going on than just the therapist. The IWK now under their program is wanting to get more identification. Is it three, is it four, or is it five?


            The one area that they've been able to determine conclusively is absolutely before a child goes to school. That's why when we started in government two and a half years ago - it had been continuous pretty well all along, but there was an immediate need to look after five- and five-and-a-half year-olds who were ready for school. Parents did keep their children home until they had the EIBI. However, some parents saw, oh, they're at the chronological age, let's put our child in school, not having had the program. There was a marked difference between those who get EIBI before going to school and those then who enter school without the program.


            The commitment now, and this is why the extra $3.6 million, is to have enough therapists trained so that we will be able to offer every child on the autism spectrum EIBI before they go to school. Everybody is indicating the earlier the better. The IWK wants to put a bit more science behind that, and that's part of their project work right now.


            MS. MANCINI: It's not an area that I am overly familiar with, although I've had conversations with constituents in relation to it, and there does seem to be a pretty strong belief that the earlier the intervention the better. Early intervention is better for any of the childhood conditions that might emerge. I believe there's some concern about whether the $3.6 million will actually target children even younger. I believe that some psychologists feel that starting just before children enter school, sometimes it's difficult to see if it was the EIBI program or if it was just the increased socialization that the child had access to once in school, so it does seem to be of a concern. I think that the programs should be geared to children at even a younger age.


            I'm not sure if I'm getting from your response about the IWK if that is part of the target, to provide the EIBI program with these funds to children who are below the age of four.


            MR. GLAVINE: The monies in the budget this year of course are in addition to what previous governments have been putting in place, so this is going to position us to now guarantee that all children on the autism spectrum will get the EIBI program before going to school.


            Again, research will be part of the decision in terms of getting it in earlier years. In some ways it depends on what part of the province you are in as well. In some parts of the province we would have four-year-olds getting the EIBI program. I've been in a couple of homes just to get a sense of what the therapist is doing, what functions they are performing to have the children benefit from the intervention.


            I know we'll continue to take the best lead and information from the IWK, heading up the program across the province. One of the areas that was problematic and a deficit in the program was needing more therapists. That's part of where the $3.6 million - it will be the training and the pay for those therapists as we work to reduce the age when a child will be getting the EIBI.


            MS. MANCINI: I have just two final questions for the minister and, if I may, I'll ask them at the same time. First, I'm wondering if the $3.6 million increase is primarily for training and secondly, is there a budget breakdown available for the EIBI program?


            MR. GLAVINE: We can get that information in a detailed fashion but I know it is both training and certainly a lot for the human resources that will be needed to deliver the program.


            MR. CHAIRMAN: The honourable member for Sackville-Cobequid.


            HON. DAVID WILSON: I want to get right into a couple of questions. I know there are trauma-specific therapy services offered to sexual violence survivors, I believe in Antigonish and then through Avalon Sexual Assault Centre. I know there's some concern or uncertainty that these critical therapist positions should be under the operational budget or funded through the budget for operating budget. I wonder if the minister could indicate if there's funding in this year's budget to make sure that those trauma-specific therapy services can get direct funding from the department.


            MR. GLAVINE: There is money budgeted for those two centres. There is an additional $750,000 that will be for a provincial coordinator as well as getting the site in Cape Breton and in the western part of the province up and running during this fiscal year.


            MR. DAVID WILSON: I want to go back quickly to a couple of questions within long-term care and then I'll move on. I know we were on that topic in my last hour. I asked the minister in Question Period, and hopefully he found out some more information, around the transitional care beds at the Cape Breton Regional Hospital. I believe there's 11 rooms but 18 beds. I asked the minister if he was aware that those beds would be closing in the fall. I'm wondering if the minister has found any information and can maybe tell us if those transitional beds at Cape Breton Regional Hospital will be closed. We heard the reason was to expand the OR capacity there. I'm just wondering if the minister could give us some information on those.


            MR. GLAVINE: Again, being on that operational side of the ledger and checking with staff, there haven't been any conversations around those particular beds in terms of having closures occur. I would consider those in that category of the clinical services review. We certainly may hear more from the NSHA.


            MR. DAVID WILSON: One of the reasons why patients and staff within those transitional beds are concerned, I indicated the long wait-list for long-term care placements in Cape Breton; it seems to be the highest in the province, that region. I would hope that that is not the case, and if it is the case, that a plan is in place. Hopefully the minister can provide that to us.


            Quickly on VAC beds, the Veterans Affairs Canada beds, in the province. I know they're situated throughout nursing homes, that the federal government funds those beds similar to the veterans' wing over next to the QEII. Has there been any indication from the federal government yet if they're going to divest themselves of those beds? If not, has the minister brought that up with the federal government? It could potentially be a budgetary pressure in the future. I'm wondering if there's any information from the federal government on if they're going to transition those beds and give them up so the province may have to find some funding to support the long-term care facilities that actually have those beds in them currently.


            MR. GLAVINE: What I can inform the member of in this regard is that we've had an initial conversation. Ruby Knowles had informed me that they were starting some conversations around the veterans' beds. Again, at this point, there's no decision. The reality is coming at us in that now we do have some veterans' beds that are not filled by veterans, so what of the future? I believe the federal government is making a plan for when the day comes that there will be no Second World War or Korean conflict veterans and we know every day there are less veterans who could occupy these facilities so it's important that at least at the initial stages of knowing what the federal government's plan is.


            There has been a lot of ask, of course, to the federal government to look at current members of the Armed Forces, those who were in some of our special conflicts in the 20th and early 21st Century but that's an unknown at this stage as to what Veterans Affairs Canada will do.


            MR. DAVID WILSON: I know the minister mentioned less veterans under the definition of the federal government's veterans and that's of course Korea, pre-Korea and the World Wars. Of course all of us know there are many veterans now that I think the federal government needs to step up to the plate and make a commitment to support them because the province will have to pick up that cost. The province will have to ensure that the current day veterans are taken care of under our health care system. If the minister needs an ally to push the federal government to maybe look at that definition, he can definitely count on our support in our caucus.


            I want to turn to EHS now. I just wonder if the minister is aware or can the minister confirm that EHS, EMC - the defibrillators that are used now on the ambulances are Lifepak 12s. Can the minister confirm or give some details that there's going to be a new distributor of Lifepaks in the province, going from Lifepak 12 to a company called ZOLL. I wonder if the minister can indicate if that is true and then that is going to happen in the future as we move forward on changing and upgrading the Lifepak 12 or the 12-leads that we have on our ambulances across Nova Scotia?


            MR. GLAVINE: Probably an area that the member for Sackville-Cobequid is very familiar with indeed. What has taken place is that this procurement has gone through Internal Services and has gone to tender to establish a purchase or lease standing offer contracts with qualified proponents.


            The negotiations haven't quite been complete by March 31st but they will be confirmed during 2016-17.


            MR. DAVID WILSON: So it's my understanding that yes, that procurement process is within Internal Services, but definitely some concerns. I'm hearing from medics from across the province on the transition from Lifepak to a ZOLL unit. A Lifepak 12 is what is there, it's a 12-lead capability. From my understanding, there was a committee of paramedics and those within the EHS field that I think, from my understanding, were very supportive of going to a Lifepak 15, which is just an upgrade of what the unit is now being used across the province.


            When we change and when the government, if they decide to change to a ZOLL unit, every single paramedic will need to be retrained. I believe there would be a significant cost to that and there's some concerns with that. Is the minister aware of what that cost may be to do the training so that the paramedics in our ground ambulance service are familiar with this unit? It's a different unit, there would be significant training to learn about this new unit - when an upgrade from a Lifepak 12 to a Lifepak 15 could have been put in place I think much more easily - and potentially cost money on the retraining.


MR. GLAVINE: I think the Minister of Internal Service wants to join the conversation here, but maybe that's for Question Period tomorrow.


            No, my understanding is that when a new piece of equipment is brought into service, training is part of that contract. But I don't have final details. The member does raise a very good point that if this new piece of equipment is considerably different, my hope is that it's every bit of the quality and of the ability for paramedics to quickly access and use. Yes, training is always necessary, and I know paramedics, whenever there's a small change, they make sure that they are 100 per cent knowledgeable about what the equipment can do, how you get it up to speed when there's something new. I'm well aware of some of the continuous training that paramedics do have as part of professional development, but in terms of the cost here, we'll have to scope that out.


            MR. DAVID WILSON: I hope the minister and the deputy go back and try to get more information on some of the concerns. That was one that I brought up.


            The other is the capability of the age limit of the ZOLL unit compared to a Lifepak unit. When you're dealing with doing 12-leads, for example, the protocol now, I believe the Lifepak 12 can do a 12-lead on a 16-year-old, but with the ZOLL the cut-off age is 18, so you're potentially missing a couple of years of doing tests on younger patients who might have cardiac conditions.


            The other concern that people are bringing to my attention, and I brought it up in the meeting I had with Janet Knox, was the capability and the compatibility when ambulances go into ERs across the province. Right now, if you have a 12-lead or even defibrillator patches on, can just unplug it, plug it right into units that are in the ERs, and continue on. The concern is that there needs to be some adaptation going on, that you might have to take those patches or those leads off and replace them. That takes some time, and Ms. Knox was unaware of it and was concerned because of course she said there was a committee set up within the Health Authority to mitigate when technology changes happen and wasn't aware of this.


I'm concerned that with that potentially being in Internal Services, where it's purely a procurement type of issue, they're not connecting the dots of what's actually happening in the field and what's happening in the hospitals because there are different organizations overseeing all of this. I hope the minister can clarify some of this and hopefully come forward and ensure that the medics who are bringing these concerns to my attention - some of these can be looked at.


Hopefully we're not going down the wrong road. I'm just wondering if I can get a commitment from the minister to go back and look into this and provide me with some information on the concerns and a response to the concerns I have. I'm more than happy to discuss this afterward to make sure that the continuity of care from our ground or air ambulance continues on when they enter the emergency room or a hospital setting.


            MR. GLAVINE: I thank the member for bringing forth his concerns. I certainly regard his professional perspective, and also he has gathered information from a number of paramedics in the field. In terms of procurement, it's certainly well known that professional health personnel are consulted but he does raise a number of issues here that I think need to be addressed and it's one that I'll commit to having addressed, to make sure that those who will use the equipment, those who will have a handoff of patients in terms of monitoring and we'll certainly get some of this information as quickly as possible.


            MR. DAVID WILSON: I do appreciate that. The one thing I did forget about and I've mentioned this before, on some of the pathology testing that we send out of the country, ZOLL's headquarters is in the U.S. and that was another issue brought up, where paramedics in the field can transmit tests to - and I might not have the technical terms right - but send tests to some kind of holding area that gets transmitted to hospitals, cardiologists. From my understanding with ZOLL, if they are the winners of this tender, that information could be held within the U.S., which opens up privacy concerns around the Patriot Act and the ability for the U.S. Government to look at that information without the knowledge of Nova Scotians and the patients.


            We can put the laws in place in Nova Scotia and in Canada but once that information goes across the border then we lose control of that and that was another concern. I don't need an answer on that but that's another area that hopefully we can get an answer to.


            CECs - Collaborative Emergency Centres - are something that of course we're very supportive of. We know there haven't been any announcements or any real information on if the government is going to move forward with opening new CECs. They did do a review, Mr. Chairman, which I think was favourable to what CECs have been able to accomplish.


            I think the one that stands out is in Lunenburg where there have been issues with closure. I wonder if the minister could give us an update - is the government committed to move down that road or are they putting the brakes on and specifically, what about Fishermen's Memorial in Lunenburg, are we ever going to see it there? I know there were some issues within the medical field itself so I'm just wondering if the minister could give us an update on commitment to CECs and possibly seeing more of them in our province, specifically maybe the one that was supposed to open in Lunenburg.


            MR. GLAVINE: What I can say specifically to Lunenburg is that it is tied in as part of the - I guess within the zone but for the South Shore area - it's tied into a redevelopment of emergency care. There is going to be some construction needed. Work on that project is underway. There's monies allocated for it. Certainly Lunenburg, even, you know, I think as the clinical service review may have some further statements to make but Lunenburg certainly is one of those areas that has the requirement for some version of CEC.


            We know that CEC has different iterations in different parts of the province, in terms of how long they are open on a particular day and how they are human resourced, whether with a primary or an advanced care paramedic. So Lunenburg is certainly part of that picture of development.


            MR. DAVID WILSON: I look forward to trying to get some of that information and potentially in this year's budget maybe is there a specific dollar amount that the minister could point to, to that work, or even roughly a figure of what is being allocated for the South Shore? I don't know if it's called the South Shore zone; I'm not too sure of the four zones, but that zone. I wonder if he could be specific maybe about a dollar figure.


            MR. GLAVINE: What I can convey to the member is that there is a line item in the budget for CEC development, and I'll get what could be applied to that area.


            MR. DAVID WILSON: Just quickly, when I mentioned pathology, last year I believe it was well over $1 million or roughly $1 million spent on sending some of our pathology tests stateside. I'm wondering, in this year's budget, is that amount constant? I wonder if the minister could indicate how much money is allocated for those additional tests being sent to Minnesota, I believe, or the U.S. and just give us a brief update on whether that's going to continue to be the practice for the next year.


            MR. GLAVINE: What I can inform the member is that those details are within the Nova Scotia Health Authority's budget. They'll soon be passing their budget, in fact, at their next meeting; it's all complete. There's a couple of I think very relevant factors here. Part of the cost to us is really what we had been doing for Newfoundland and Labrador, so we had to send theirs on as well as part of that. So we get reimbursed. I'm pleased to say that we have hired two new hemopathologists to carry out our work here in the province, so that obviously dramatically reduces our cost as well.


            MR. DAVID WILSON: I assume that the budget for the Nova Scotia Health Authority and the IWK will be approved soon. I read an article, actually from the former deputy minister, talking about the Nova Scotia Health Authority and the openness of the board meetings. I'm wondering if there has been any consideration to follow suit of South Shore Health a number of years ago and have those meetings open to the public, of course realizing that at times there is sensitive information that needs to be discussed in camera - personnel matters and preparing for the budget. I completely understand why that would not be something we could have open to the public until it was approved. I'm wondering if the minister has given any direction to the Nova Scotia Health Authority that would require them to have open board meetings so that the public, the media, Nova Scotians, can see what's going on within those meetings.


            MR. GLAVINE: We go back here to the old district format. It's my understanding that South Shore was the only board that had regular meetings open to the public. Many of the other districts would have an annual meeting where they would present highlights of their year's work and reference some of the budget allocations, but it was not on a regular basis.


            The Health Authority is actually considering what direction they will take in terms of having some public engagement, again, having more Nova Scotians know about the work of the board. I think it's at a good place after a year of being up and functioning. I'm sure we'll hear that in the coming year.


            MR. DAVID WILSON: Thank you, minister. See? When we have short answers, short questions, we get some information exchange going on.


            This last question I have to ask comes from the Bill Estabrooks of MLAs on cost of things. Of course, with the amalgamation, there's a cost to the branding, for example, new business cards, new letterhead, and new signage. Can the minister give us a figure? If it's not today, can he provide a figure of the cost of utilizing the new name, Nova Scotia Health Authority? It's not Capital District. I would assume there's a significant cost there. I wonder if the minister could provide us with that cost, if not today, later when they can compile that. I would assume they're keeping track of that.


            MR. GLAVINE: That will be one of those numbers that will be made available with the passing of the Nova Scotia Health Authority's budget. What I am aware of is that, yes, when any new entity gets under way, there are those new costs, and they cover a wide variety of requirements. But I know in terms of how they function on a day-to-day basis, week over week, they have been very conscious of what things cost and how they spend money. The final budget will be one very deeply appreciated by Nova Scotians, and we'll get those details and breakdown of what their budget line items look like.


            MR. DAVID WILSON: In the last few minutes that I have, I'm going to go to an area very dear to me, and that's of course PTSD and coverage for first responders. I know it's not in the minister's wheelhouse, but we've had exchanges on the floor of the House talking about presumptive coverage, talking about extending coverage to that. The minister, in a response some time ago, indicated that potentially they were going to send that kind of question of coverage for volunteer firefighters to the Nova Scotia Health Research Foundation. I'm wondering if the minister could advise us: (1) does he support the idea of presumptive coverage for first responders, and (2) what role is he playing to move the question around those benefits to first responders across the province, specifically what the minister indicated around the Nova Scotia Health Research Foundation?


            MR. GLAVINE: I know this is an area of not just deep interest, but the member is hoping to see our province take on more of the both medical and financial costs that somebody suffering from PTSD does incur. What we have done as a government is bring four departments together. The four departments have been meeting. The ministers and designates are attending those meetings. I know I have been there of course with Labour and Advanced Education, also Justice, the Department of Health and Wellness, and we are now formulating a plan. I think it remains very timely, very much a requirement to be able to give Nova Scotians, and especially those who are suffering from PTSD and their families, what we will be doing in the province both in terms of those who suffer and I think those in preparing first responders and especially those who are in the volunteer sector, we in Nova Scotia, a huge number of people in the volunteer sector who are first responders. So work continues in this area and I think we'll have more as time goes on.


            MR. CHAIRMAN: The time has elapsed for the New Democratic Party's one hour of questioning. We will move back to the Progressive Conservative Party with 20 minutes remaining.


The honourable member for Pictou Centre.


            HON. PAT DUNN: I want to thank the minister for the answers he has been giving and his staff and the dialogue back and forth. I'd like to take the first 15 minutes but I can't and ask him about some of the well-known and famous hockey players from his home town in Newfoundland, the Faulkner family. I'm sure that many of your colleagues around the House are not aware that one of them played with the famous Gordie Howe but anyway, that will be for another day.


            I have just perhaps four or five questions and I'm sure you've tapped into them during your many hours here in the Legislature. The first one is dealing with mental health and the beds in the Aberdeen and the beds in Truro. The first question is dealing with the cost. I guess the amount of dollars that actually went to Truro to increase their beds from 10 to 14, my understanding is that money came from Pictou County for those four extra beds. I'm just looking at an approximate cost for that move.


            MR. GLAVINE: I know this is a challenging area and if I was on the other side of the House I'd probably be asking the same question. As we go into one provincial health authority we are having I guess a line item that is there for the entire province. So what has taken place is that we are building a mental health hub in Truro that will have more beds open. At this point I'm not sure if it involved more psychologists and psychiatric nurses and additional personnel, just that the unit has the capacity to add four more beds and that they have done.


            This will be the first budget report from the NSHA and that's on the verge of being approved. There may in fact be reference in their budget to how allocation of resources from one area has impacted on another but it's not a dollar amount that we have here in our provincial budget.


            MR. DUNN: I thank the minister for that answer, and I'm looking forward to some additional information.


            I noticed earlier in the evening you were talking about the SchoolsPlus program, and I assume you're working with the Department of Education and Early Childhood Development on that. I'd better talk through you, Mr. Chairman.


            You mentioned the SchoolsPlus program and the benefits of the program and so on. I think it's a great program, a wonderful program. I'm looking forward and hoping to see every school in Nova Scotia involved in this particular program.


            I know when I entered North Nova Education Centre back in 2003, they had a health centre, and I think it was very beneficial to the students to have this health centre. Every year, it seemed to grow, where we were having more resources available to help students with particular issues and so on. I believe that there are personnel going in there at the moment a couple of days a week. This particular person has a caseload of about 18 students that they deal with. Again, I'm sure we could have someone there every day of the week, and they would be busy.


            In the province right now, Mr. Chairman, we're touching on maybe 200 schools. I know in New Glasgow, we have New Glasgow Academy, A.G. Baillie elementary, and North Nova Education Centre, which is a Grade 9-12 complex. I guess one question surrounds that, minister, do you foresee this program being pushed really hard? It seems to be a very successful program. It seems to be working. I think it's an inroad to solving some of the problems that we have had with our youth in communities across the province.


            MR. GLAVINE: Without going back and going through the research that was done by Dr. Jana Davidson on how strong the SchoolsPlus program is - the member himself is aware of some of those benefits. I think the real benefit of that program is that the person who is doing this work is very involved with the school, involved with the home, and involved with agencies in the community. It's a chance to do that wrap-around service for a child who is having mental health issues of whatever nature they may be.


            We're providing the funding for the mental health component of SchoolsPlus, and it's delivered, of course, through the school and community. This is something that in each of the past three years we have put additional money in the budget for. Again, the member is correct, we want to see this grow across the schools, have that family of schools that eventually are all embraced.


            I think there are great dividends to this. It's interesting that some of the new wait times are actually paralleling for our adolescents and youth. Their drop is paralleling adding more and more SchoolsPlus personnel into our communities. I think there's a really strong relationship there, that a child is getting help early, not leading them to either their family doctor or a guidance counsellor recommending professional help beyond the school. I see this program as one that the goal is eventually to cover our 420 schools in the province.


            MR. DUNN: I had the opportunity to talk to many teachers, administrators, guidance counsellors in our schools, Mr. Chairman. There's certainly an opportunity for further professional development.


            One of my questions to the minister would be, will there be any extra funding in the very near future to train teachers who don't have the training, to train guidance counsellors who often don't have that training in mental health issues? And perhaps a third question would be, have they looked or will they be looking at our Bachelor of Education program, the two-year program within our province with regard to having our teachers who are coming out in the future years, having some background, having some training to be able to go into the profession and be ready to deal with students with mental health issues?


            MR. GLAVINE: I thank the member for that question. It has a couple of different parts to it. First of all, there has been a considerable amount of training and I know Dr. Stan Kutcher has been involved with teachers, to help with the very early years all the way through the school system. In fact it's now quite a number of years ago that having spent my career in junior and senior high and when I was approached by an elementary principal to convey that they wanted to have Dr. Kutcher come and be a resource for their staff to help with a growing number of issues that children were presenting to teachers.


So this I know in a number of our school boards triggered a lot of professional development around training the teacher to be the front line, the first person to provide some intervention. I know a significant number of teachers have been trained. I'm not sure if this position is right across the province but the Annapolis Valley School Board now has a person who is dealing with the mental health issues of staff, of students and directing training and appropriate supports for the whole district. So it is getting so much more attention than just even 10 years ago.


            The member raises a wonderful area. If we think back to our days of the Bachelor of Education, the curriculum was pretty much defined for what we would take. A lot of it would focus around the philosophy of education, comparative education, psychology of education, the methods, teaching methods, all of these especially in relation to your subject area.


            You know, looking at the total picture of the child and their developmental needs, you know, some of that was there just in relation to education, not so much in terms of the growth and development of the child around what they were experiencing in their family, you know, how they were adjusting to adolescent issues, that was probably not as big a part of the training as it could have been. It's a great question that I should ask my colleague, the Minister of Education and Early Childhood Development, as to what is happening in our universities in terms of teacher training to look at the determinants of health because again, what happens in the school, those 195 days and the kind of care that teachers provide we know is very instrumental in terms of their growth, their development, and their adjustments to different age groupings. How well teachers are trained is a great point that is being made.


            MR. DUNN: Just continuing on in that vein with the growth and development of our students, I think, as I mentioned earlier, the dollars are well spent; we're getting a bang for our buck. Sometimes we spend money and we don't see positive results, but there's very positive results when we spend money in this particular area where we are looking at the growth and development of students, we're training teachers, and so on. I hope that sometime soon, if it's not already happening, it will be part of our B.Ed. program in the universities, that teachers will come out with some confidence in identifying and maybe an early diagnosis that they can pass on to the professionals and have that taken care of.


            I guess another question I would like to just quickly go over is one that has been handled many times in Question Period and debates and so on. It's around the Aberdeen Hospital and the two beds that are available for potential patients who arrive there suffering from mental health issues and so on. I guess I'll word the question around this. It appears that what has been created and is there now, the two beds - I'll call them temporary beds - that are there in case you have to be moved on to another facility, that particular model looks like it's going to be a permanent one. Maybe what I'll do is see if the minister will just comment on that - what we have at the present probably will be the model going forward at the Aberdeen Hospital.


            MR. GLAVINE: We all know how significantly the model of medical care is changing, how few days now a person is spending in hospital after a surgery, a major procedure. The model for mental health care is also changing. What will happen at the Aberdeen is what I think we will see certainly in our regional hospitals, and perhaps wherever we have, at a full-fledged emergency room, a patient come in presenting some mental health issue, some trauma, we see this even with people who are well-known and speak about their mental health issue. Periodically, they may go off their medication, and there's a relapse. Having that person come in, whether it be the Aberdeen or one of our other regional facilities, to have an observation bed to make sure that there's an early assessment and that patient is then getting the appropriate treatment, I believe that's the most significant part of where the change is going about: getting them in front of the right provider at the right time.


This is what our care response has to work to be more and more. Just placing a person in a bed without the right treatment is definitely not the way of the future. Having people assessed and spending a very short time in a unit, moved on to either further treatment or back home with follow-up counselling, you know that's where we need to arrive, that's the work that's now in progress.


My belief is that the Aberdeen will actually become a model, you know construction is under way, those two beds will be identified, determined, and how the psychiatric team assess and relates at whatever hour of the day, you know that could very well be one of those models that then we'll see develop across the province in the most appropriate places.


            MR. DUNN: One quick question to the minister, I believe this is dealing with dialysis; I believe there are four beds in Pictou, eight in Truro. My question to the minister, does he foresee that particular type of unit being in the Aberdeen in the near future?


            MR. GLAVINE: Thank you very much, Mr. Chairman, I think there's just a matter of seconds remaining, I do believe. What I can tell the member is that for now . . .


MR. CHAIRMAN: Order, please, time has elapsed.


The honourable Government House Leader.


            HON. MICHEL SAMSON: Mr. Chairman, I move that the committee do now rise and report progress to the House.


            MR. CHAIRMAN: The motion is carried.


            [The committee adjourned at 7:42 p.m.]