HALIFAX, MONDAY, APRIL 22, 2013

 

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

 

5:11 P.M.

 

CHAIRMAN

Ms. Becky Kent

 

MADAM CHAIRMAN: Order, please. The Committee of the Whole House on Supply will come to order. We will continue with the estimates of the Department of Health and Wellness. The Progressive Conservative Party has 40 minutes remaining.

 

The honourable member for Hants West.

 

MR. CHUCK PORTER: Thank you, Madam Chairman. It's good to be back this afternoon, through you to the minister; it's good to be back this evening as well. I have a few questions left for you that I didn't have a chance to get in my first hour on Friday. When I left off I was talking about long-term care facilities, and I want to go back to that. I was just about ready to leave it. I had an interesting issue, it was interesting - I'm going to sort of set the stage for you, minister, to sort of sum this all up and then eventually we'll get to a question or two, maybe.

 

When I left Friday I was thinking I was almost maybe where I wanted to be with this and probably never had much on long-term care and I was going to get on to the next piece, and I left here Friday afternoon, like I usually do, I went back to my constituency office, and lo and behold, I pick up the phone from a caller and it was on a long-term care issue, which is not uncommon, as I alluded to before, and we deal with those. This one was rather interesting, and I'm not going to use their name, I don't believe in doing that here, I'm not going to do that, but I'm going to table some documents for you to have, minister, through the Chair, and you can look at that for yourself.

 

We talked about how important it was to have people stay in their homes as long as they wanted to, and we agree, we think that's a valid thing. As I mentioned, I had said if you went to any of the long-term care facilities and you asked anybody if it was their first choice to be there, none of them would say yes; they all would have loved to stay home as long as they could. We realize there comes a time that they can't stay home: physically, sometimes mentally, there are issues with dementia, and so on, and families just can no longer do what they do; home care workers and support staff come in and they can no longer do what they do. The load becomes heavier and people eventually qualify and need to be somewhere to be assisted with their living.

 

So this is really the case of this lady I want to bring to your attention - 94 years old. We could never stand in this place and say that she didn't stay home as long as she could. At 94 years old, I think it's probably safe to say that she is a living example of what we were talking about on Friday and what we really are happy about, in all honesty. We want to see people staying home.

 

This woman has had dementia for two or three years now, quite bad. Prior to 2011, her daughter and son became her enduring powers of attorney and, of course, have been looking after things. Fortunately this woman lived at home, had the financial ability to hire health care workers to come in and assist her, and her family assisted as well as they could, which they continue to do. There came a point when that could no longer be, because this woman - who was now 94, as I said - her dementia had such an effect that she never bathed for a year, according to the daughter, because she wouldn't trust the personal care worker coming in enough to commit to that.

 

Here is a women who has Alzheimer's and whatever else, who every day gets up and does the exact same things she has done her whole life: dresses herself, puts her linen away and whatever, and does all of these things regardless of the condition they're in. I think you know where I'm going with that - even if they should have been up in the laundry, I'll say, they still were folded pristinely and put away in a drawer, and the bed was made even though it should have gone to be laundered.

We've both worked in health care, as you'll recall. Unfortunately, we've seen these kinds of patients and folks out there as well. For a large part, these folks remember the long-term stuff; it's the short term, in a lot of cases, and the last few years. They'll put on a good front.

 

I remember my mother doing that prior to her going into a nursing home. She was assessed, and she would be asked the questions by the coordinator or the lady doing the assessment. She answered them all just as though everything was wonderful, when in fact it was by no means that. This case is very similar: the daughter goes in, there was to be an assessment done. Well, it got done with no family present.

 

MADAM CHAIRMAN: Order, please. The chatter in the room is quite loud. It is difficult for me to hear and other members to hear the actual things that the member is saying, so I'd appreciate perhaps taking your conversation outside.

 

The honourable member for Hants West has the floor.

 

MR. PORTER: This lovely older lady needed to be assessed a while back, and of course the thought was long-term care facilities, so an assessment was done. It was set up to be done with family present, because that was the wish of the daughter, who has the power of attorney. It was done without her, so when all the questions were asked, her mother gave some wonderful answers that made it sound like everything was great, when in fact we know - as does the family - they were nowhere near great. They were inaccurate.

 

It was done without them. That was the first scenario, and it gets a whole lot more interesting from there. I couldn't believe the story as she was telling it to me on Friday. I'm taking all the notes, scratching on any piece of paper I could, and I'm saying "What?"

 

So she goes through this and finds out, all right, what do I do from here? Well, you need to call this one and call that one. She was calling the Department of Health and Wellness, the single-entry system, trying to find out where everything was. She would dial the 1-800 number and they would say, well, your number comes up, and you live in Windsor - because she does live in my constituency in Windsor - well, you need to call this number. Okay, so she called this number. No, that's the wrong number. You need to call Kentville. Well, I just talked to Kentville.

 

This didn't happen once or twice. This happened multiple times, until she was just about pulling all her hair out and decided, you know what? I've had enough, I don't know what to do next - and she hung up the phone. She couldn't figure out from what they were telling her - well, your number comes up from Windsor, you need to drive to Kentville. This is what she tells me now. She was told on the phone, you need to drive to Kentville or somewhere so it comes up that you're in the western Valley region. I mean, you can just imagine the bizarreness in all of this. I couldn't believe it myself.

 

I met with her again this morning and said, look can you bring me in some paperwork, and we can go through this? I'm going to have a great opportunity this afternoon to talk to the department and the minister and just sort of bring this to light. I stood here the other day. I've stood here many times and given my opinion on the single-entry system and why things didn't work. There were a number of things that came out of all of this: they really didn't know what to do next, so they do get frustrated and they walk away.

 

She wrote down a couple of things, and I'm just going to touch on it. I'm going to table this as well, Madam Chairman, so the minister and his team will have this after I go through some of it. She took some time and put this in a bit of an order and called about a whole variety of things, and I'm not going to read it all. Everything from picking up papers from doctors and trying to get things organized, to making the calls I was referring to, to mailing papers and having no record of her. This 94-year-old woman has a sister in the system in Dykeland Lodge, so when the daughter called and inquired about her mom, oh, she's already in Dykeland Lodge. The daughter goes, oh my, hold on a second. She's not in Dykeland Lodge. That's my aunt. Where is my mother's paperwork? Well, we don't have any record of that.

 

You can imagine this whole thing unfolding, as I said. They go through the assessment, and the paperwork is somewhere - we think, but we're not sure. It's somewhere.

 

There are so many hands involved in this. She's called so many numbers and talked to this one and talked to that one, and she's even listed some of the workers' names. I'm not going to bring those names here. That's not important. I don't believe in dragging them through this place.

 

Finally, she talked to a woman who set up an appointment to see her mother on April 25^th, which is coming right up. I said, I hope you have some kind of luck with that. An organization offered her some points, some questions on where to go and what to do. She makes it clear that she has had no co-operation from anyone she spoke with along the way at all. I've only barely touched on this, but you can appreciate her frustration - an hour on the phone telling me this story. I said, why did you call me now? Why didn't you call before? She said, you know, I run an ad in this local paper. She said, I saw your picture. It came today in the flyers, and I said, I'm going call you. I said, great, that's what I'm here for. No problem. Your timing is good.

 

She says, I'm the least political person there is in the world - great, that doesn't matter, we don't care about that - but she's not happy. She sees that ad and she sees all the things that government is trying to do, in all fairness - Better Care Sooner, all of this stuff - and she looks at this as a marketing campaign that is just down the toilet, if you will. She thinks about her mother's case and others, and she wonders, where is this going? Why is this taking so long? Why does nobody know what is going on? Then she says to me, what is this single-entry system thing all about, anyway? What is this about? Where is this going? What's the problem with it?

 

Out of all the people not to ask that question of, minister, I'm sure I was probably that person. You know my opinion. I've expressed it many times in here, and I told her what I felt - you know, that there were some issues. Not that there weren't good people working in the Department of Health and Wellness, and not that there weren't good people trying to get things the way they need to be. Right now there are no real solutions that will fix this overnight. I think this is an ongoing effort, and there are a lot of different fronts here that will hopefully guide this into something. What that something is, I don't know.

 

One of the biggest concerns - not that that wasn't a big enough concern coming out of that - is that she was told by the hospital - somebody there, somebody on the phone who she spoke with - that the power of attorney that was in place was no longer any good. Her 94-year-old mother - who has already signed off on a power of attorney because of her dementia, when she was able to do so before it got to the point it is now - has to sign again. You have to convince your mother to sign herself into a nursing home. I'm going, hold it now. Something is wrong here. Something is not right.

 

My question to begin with - after this bit of a rant, if you want to call it that - the point that I'm trying to make is that a power of attorney, an enduring power of attorney that was signed off - and I've got a copy here in front of me, and again, I'm going to give you this, minister. It talks about the revocation, the appointment of whom, the effective date; it talks about the authority - you, my attorney, have general authority and such to make decisions and so on.

 

It's the typical thing. It talks about hospitals: you will manage my property and affairs for purposes of the Hospitals Act if I am unable to do so, therefore the provisions of the Act, et cetera. Permitting the Public Trustee to manage my property and affairs will not apply, compensation - you know, it's the typical signed-by-lawyer, stamped, dated, et cetera, and she says she's told that's no longer any good, and what am I to do now?

 

What she sees is her mother at home, unable to look after herself and not trusting the health care workers coming in the door. I know when they call about health care, they say, do you have a dog, do you have this, do you have that? The area has to be secure. We've been there. We know what that's about. I think most of the time families don't understand in some situations. They wonder why we go through all those steps. We understand clearly that those steps are about the safety and security of our staff and workers of health care, folks going in to do the job. I explained that to her as well. We know what that's about, but she doesn't understand this other piece about how it is possible that she would ever have to try to get her mom to sign another document to put herself - I thought that's why we did the enduring power of attorney, and I know from experience, having done that with my own mom, that that's the process.

 

So the first question I have after all of that is, has something changed here that we're not aware of?

 

HON. DAVID WILSON: Not to my knowledge. I appreciate you bringing this situation forward, and I guarantee I'll look into it for you. As you said, I won't mention any personal cases on the floor, so we'll take whatever you have back to the department. When it comes to the power of attorney, we can get our legal people to look at it. From our understanding, nothing has changed on the ability for someone to have those types of power for a loved one, so I hope I can get some clarification for you, and afterward, I can get my department to look into it a little more closely to see what happened.

 

I would hope - and I believe - that the situation you just mentioned and went through is not the norm when someone is accessing or trying to access long-term care or getting the assessment. As I think I said in an answer the other day, this is probably one of the most difficult times in somebody's life, or if you're dealing with it as a family member, to take that step to possibly put a loved one into a long-term care facility. So I don't believe it's the norm. If what you described has taken place, it's definitely an unfortunate sequence of events, and I would hope that anybody who calls the 1-800 number would get the information they need. It shouldn't matter where you call from. You could be calling from Halifax for someone in Cape Breton, and I would think you would be able to gain the information that you need.

 

The assessments are a key to try to figure out how an individual is in their ailment. For example, if it is Alzheimer's we're talking about, what are the needs of that individual? As you said, if we can provide them with some of the other programs that we have available, then I think it would be better to have those options available to them so that they don't have to make that difficult choice to move into a long-term care facility.

 

We have over 2,000 people a year entering long-term care. I'm hoping that the experience they have is one that is understanding by staff, one that is compassionate and knowing. I truly feel that not only the health care providers who are involved in long-term care but those assessing an individual show that compassion for individuals in that difficult time, so I hope it's not a norm, and I believe it isn't. We'll do whatever we can to look into making sure that that procedure or process of getting someone assessed is a positive one. We'll look into that as we move forward.

 

I believe that the power of attorney would still be valid. I don't understand why the hospital would be in a position to say that it's not, so we'll endeavour to look at that. But I hope, as we move forward - one of the emphases I've stated that we want to work on is trying to ensure that the general public know the services that are there. You mentioned ads, and they got your name and called. One of the things we are moving forward with is ensuring that the public know exactly what's available, what supports are there.

 

It's not only the public, but the district health authority. There are so many people who have a hand in potentially dealing with a patient who might be ill all of a sudden, who might show up at the ER, or a paramedic, or a family physician, or a specialist who realizes something has changed with this individual. They may require additional help, or they can't be discharged home, for example, on their own without some kind of support system.

 

I said this on Friday: I wish we could cover the costs for every service anybody would need in the province when it comes to home care or community care support. The reality is, we just can't do it. We spend a lot of money in home services and community care. I think we're just over $196 million a year in home care services. As we move forward in trying to ensure that we invest enough in that, and invest in long-term care - that the people who are out there who are engaging with Nova Scotians through the health care system, in whatever capacity they're trained in, know and are knowledgeable about all of the services.

 

That's part of the $22 million that we invested last year. The additional $22 million in home care was to start working on packaging what is actually available for Nova Scotians. Our hope is to go out to all senior associations, for example, or to go out to the care coordinators and go out to clinicians. One of the things I also want to happen is to go out to all the MLAs. Each MLA office is an avenue that residents can go to seek some support. It's our hope that soon each MLA will get a package from our department that outlines some of the programs available and the numbers and the criteria that go along with those programs.

 

If you provide me with some information later, we'll get staff to look at it. I don't want to see anybody go through that type of situation that you described. As I said, it's a difficult time for anybody, especially someone who is 94 years old - who I think we all would agree would deserve our utmost respect and comfort and compassion when a difficult decision like choosing to go into a long-term care facility is in front of them.

 

MR. PORTER: I just want to point out before I move on that this started almost a year ago. In May it will be a year since this whole placement thing started. I'm sure in describing what I did you can understand the frustration, and in all of this story, like I said, there were many things.

 

One piece I'm going to table here, and I'm going to read from it. This is from Adult Mental Health in the Valley in Kentville: The above name was reviewed today, March 31, 2011. She shows evidence of Alzheimer's, dementia, moderate levels. She is not competent to manage her finances and is not capable of making decisions regarding personal care or place of residence, and I am recommending her enduring power of attorney be enacted.

 

That was two years ago, so you can see how this has been long and drawn out. It's worth pointing out. It's significant to them, obviously. Anyway, I'm going to give you a copy of that, as I said.

 

The other issue, of course, is that there were a calamity of errors here with the record keeping, mixing up with her sister. We worry, I guess, that they could put her name or her SIN number in - or her health care number, or whatever it might be - and get confused with her sister. With the technology the way it is today - and I know in Public Accounts, Madam Chairman, we've had the Department of Health and Wellness in. I know the deputy minister has been here before us at times and has answered questions with regard to health records and our technology and our systems and our record keeping over the last few years - all these sorts of things. We've had a variety of issues there, but we continue. The Auditor General makes recommendations and we review those.

 

There's a whole array of things here that have left many, many questions, and I've barely touched the surface on what the issue here is. Given the difficulty that is - and you mentioned that as well, minister - it is a difficult time when you're putting a loved one in a nursing home or a long-term care facility - I should use the appropriate terminology now - and trying to deal with all of the things that go along with that.

 

It's very difficult. I doubt very much if this is the norm. We've seen many, many people who've gone into these facilities and it has been uneventful. They've gone through the process as they should, been assessed, been placed - a wonderful thing, lucky to have the home there to go to. But some of these stories do make us worry, and I agree with you: I don't believe this is the norm, from what I've seen in the past. The long wait time is more the norm when you think about accessing, actually getting into the facility. That is more the norm than what we are talking about here today, and I'm glad that's the case.

 

It brings me back to what I started on Friday, which I've talked about many times in here: it's not local. There is a piece of this that really needs to remain localized, I think, when you think about these people and working with these fine folks who are waiting to get in when they have to go, who have stayed home, who have paid their way.

 

We talked a few minutes ago about the cost that the Department of Health and Wellness puts out each year. We're lucky to have that in this province, and I think that anybody would tell you they're very lucky to be able to go to a hospital and be looked after. It is unlike other countries where you don't have that kind of health care. We would both agree about the excellent emergency care that we have and the street care that we have. We are very, very fortunate in this province, and I think most people recognize that. We're very fortunate to have that system available to us.

 

We also know and have to understand clearly that it comes with a large cost. Yes, it would be a wonderful thing to be able to cover it all. But you know, the people who have paid their own way, in all honesty - even those who can really not afford to pay their subsidies, their daily costs, and are in hospitals waiting to go and being asked to pay - they're not complaining. You know that? People are calling more about the wait time. They're not even complaining about having to pay the minimum $36 or $39, whatever the daily rate is. It comes up in conversation, but they're not complaining about it, like I wish I didn't have to pay it, or I won't pay it, or I don't think I have to pay it. It's more of, let's get to where we're going. They would see that as more acceptable to be paying for at that point.

 

There are some who can afford to pay for it. I've known people who saved their whole lives to be looked after today. The doctor who brought me into this world, who died in the last year, is a guy who comes to mind. His wife said, you know what? We're going to put him in a long-term care facility, because that's what he wanted, and oh, by the way, he saved throughout his entire working life to make sure that he was looked after with private care coming into one of our provincial facilities to help look after him around the clock, because that's what he wanted. We know and understand that not everybody is in that position financially, but some are, and they don't mind doing that.

 

I've been dealing with some recently who are not in that position but whose families are still putting out the necessary funds to pay those monthly installments to keep them in places like Unit 500 while they await long-term care families like the Elms or wherever, Dykeland, et cetera. I think people understand the system itself, and they are happy to be able to be looked after. Yes, there are times when their fuses are short. We've both witnessed that. In times of distress and urgency, when people's lives are interrupted by emergencies and things happen that are uncontrollable, we see and hear things that we know are not normal.

 

When people sit back and think about this appropriately, they know that we have a good service in this province. Again, it's the wait-list that's the biggest issue. Minister, I asked you a question twice on Friday that never really got a clear answer. Maybe you'll answer that today - maybe you've had the weekend to dig up some information, I don't know. When we call the 1-800 number, or whatever the number is, either on behalf of our constituents or advising them to call, it's the same answer about what is the wait-list time? Where they are on the list, can anyone tell us? We're just not able to access that.

 

I think I might have mentioned on Friday - I'm sure I probably did. For some reason, when we have the answer they find some relief in that. Whether they're down the list or they're next, there seems to be a bit of hope somewhere that goes along with that. I'm not sure if there is another reason that the department doesn't want to give that out or maybe just the opposite. I'm not sure what the thought process is there, but I think it is important that they do have some kind of answer.

 

I would like you to touch on that today. I would like you to answer why we're not getting that information, because we don't think it's anything vital, in all honesty, that people couldn't know or shouldn't know or don't want to know. I think that they really do want to know, regardless of where it is. I'll leave you with that for the time being.

 

MR. WILSON: On your last question, that's a very difficult one to answer, just because there are so many factors at play when someone is placed or asking to be on the long-term care wait-list. First of all, with the case that you brought up, I'm not asking you to table anything here. Please don't table it here. Hold it until afterward, because you didn't refer to anything personal. I wouldn't want anybody's personal information to be - have access. We'll get that outside, first thing.

 

I think the reason why we're looking at the home care services now in relation to the long-term care is so that someone like the person you mentioned, who is 94, who in my view has shown the ability to take care of themselves, to live on their own through either good health or the support of the family, a loved one, or a neighbour - when you get to the age of 94, you would hope that would be a smooth and quick transition into a long-term care facility, if that is what's needed.

 

The challenge over the last couple of years is that we've seen a system where we've built over 1,000 new beds and replaced over 800, yet we still see the wait-list increase. The budget has almost doubled in the last seven years in long-term care, and I mentioned it Friday - over $537 million. So we're putting a lot of money into it. We're building new long-term care beds and facilities and we're replacing some, yet we still see the long-term care list grow. That's what the challenge is. So we were reflecting on that list and realizing - and I mentioned this before, but 40 per cent of those on the list - or 43 per cent, I believe - have never accessed home care.

 

That's where I think we need to do some work so that when someone who's 94 years old gets to a point where they can't handle it on their own, or their family can't handle it on their own, they can transition into a long-term care facility. In my mind that's how it should work. If you need some support, then those supports should be there through home care or community care services. I know there are private ones, but if you don't have the means to fund it privately, then the public system should be there to support you to a certain degree.

 

I would hope the work we've been doing over the last year or so, and the work we're going to continue to do, will reflect more of what it should really look like, and I just mentioned that. Someone who's 94, who comes to a point in their life that they cannot maintain a house, live on their own or independently or with the support of family, should have easy access into long-term care. We know that's not happening, because we have these wait-lists, and when you do get assessed and it's recognized that you fall under the parameters of someone who would be able to get into a long-term care facility, there's a lot of factors at play. It's difficult for the care coordinator, for example, to say, you're number 12 on the list at Dykeland Lodge or the Elms. They have admission rates of maybe one a month, two a month, so it might be six months or something like that, because of all the other factors that play into how someone gets into one of those long-term care beds.

 

We look at adult protection, for example. You never know when there's going to be a serious issue at home where we have to step in or the government has to step in and apply adult protection rules and laws that would deem it unsafe for that person to remain in the environment they're in. Also, hospital - at any time, a senior or anybody could have some kind of ailment or accident that causes them to be unable to take care of themselves, but they don't have the home support as family or a loved one. They may need to gain access to long-term care facilities.

 

The challenge is trying to advise somebody of exactly where they land on the list. I think you can give something of a ballpark timeline, but that's challenging, because as I also said, there is a high percentage of individuals who don't accept their first placement in the first place. Of course when you're assessed, it's discussed with you where you would like to reside, and you can list a number of options, so they do have the option to refuse that first call. There are a lot of things at play that won't allow someone to say it's going to be in two months or it's going to be in one month, because some people don't wait a year to get into long-term care. Some wait a month or two.

 

That's the challenge and the difficulty in trying to nail down exact times when you call. I know I had those calls in Opposition for six years, trying to figure out where somebody falls on a long-term care wait-list, and it's difficult for that individual who is assessing the wait-list, or is a care coordinator, to say exactly when, so there are challenges around that.

 

I would think that, as we move forward and we work more on trying to ensure that people can gain access to home care services, it'll be easier in the future to tell somebody exactly what kind of a real wait-list there would be for long-term care. We've noticed over the last number of years that the wait-lists have gone through the roof in the new facilities, the newly-built long-term care facilities. I know the Elms - I know you know Sherry, and I know Sherry - is a great facility. It keeps people in the community where they grew up.

 

As you build new ones, they're much better than the old ones, and I know the member opposite would remember one of the old facilities in the area where we used to work. It was very old, and it was really nice to see them do some renovations to it. You'd never think you were in the same building after the renovation as you were 20 years ago. But some of the new facilities are really nice, and some of them are actually better environments to live in than what people are living in now - the conditions, I mean. Maybe not a better environment, but the conditions are much better. They're brand-new, well-built, expensive facilities.

 

That's one thing we've seen over the last couple of years with the new facilities in my riding of Sackville-Cobequid. We never had a long-term care facility right in the community. We had the Beaver Bank Villa, which was outside, and then you'd have to go to Dartmouth, Bedford, or Halifax. Now we have a beautiful facility. The Sagewood is in Sackville, and it's a beautiful facility that is quite remarkable. When we did the opening, I could hear people say, oh, I would live here in a minute - which is strange to hear, because in the past you never heard that from people saying, oh, I'd love to go to that long-term care facility - or "nursing home," as they were referred to many years ago.

 

There are challenges. I think as we move forward with trying to ensure that people out in the public, people in the health care system, organizations that deal with the elderly or home care or community care - more information for them that we package, and they are aware of more options - then hopefully what we can do is have a better system to get people into long-term care and be able to inform them better. We know we need to do some work on the single-entry access system or way of accessing long-term care. We're working now to try to better utilize the beds that are out there. We don't want to see any of them go unoccupied for any length of time, especially where we know we have individuals who are in hospital settings waiting for long-term care.

 

That's some of the work that the department and the continuing care division are doing: trying to see how we best facilitate that work with the operators, the non-profit, and the companies that run the long-term care facilities for us around the province. We want to work with them to try to make it the best possible transition from an individual being assessed and recognizing that they need long-term care to hopefully gaining access to a long-term care facility close to their home. We know we need to do work, but I think we're moving in the right direction as we try to clarify and figure out exactly how this whole long-term care and home care system has been evolving over the last couple of years.

 

MR. PORTER: I would have to say, that's probably as close to an answer as I've gotten yet, so thank you for that. It was a detailed explanation that some people might actually understand of the difficulties and the challenges that go along with, oh, you're fifth on the list - that it's not quite that easy. The question they would have just to top it up, and I'll ask it - okay, that's good, I appreciate the answer, don't get me wrong - until four, five, or six months ago, though, you're fifth on the list, you've got an answer, and then all of a sudden they're shut off. The families wouldn't realize that as much as our office would, because we would call on behalf of a lot of different ones that would come in and ask us to do so. Bonnie, my CA, would say to me, we can't get an answer, and we don't know what's going on anymore. That was obviously a concern for us.

 

You talked about the long-term care at home, and I agree that people would be thrilled with that. One of the challenges we've seen with that, however, has been that when they do call asking for long-term care, they're put on a list, and they could be potentially quite a while getting long-term care to actually come to their home. Some people need more care than others, and we know the challenges that go along with that as well. I think it's an easy statement - and I think you'd probably agree - but it's certainly harder to get put into place, to set up and get done.

 

One of the challenges is that if you're waiting, if somebody called tomorrow and said, all right, I want to go to a long-term care facility - not really, I'd love to stay home, but I need home care - the wait time for home care can be excessive as well. But if it was readily available to you, and I think about here this afternoon when you talk about that, you made a comment the other day about what a long-term bed costs per person - hundreds of thousands of dollars. I forget the exact figure, but it was a couple of hundred thousand, anyway, and probably more. I think about those dollars now being invested in home care, programs that are trying to keep me at home, instead of building new long-term care facilities.

 

We've got a demographic that's not getting younger in this province. We know that. A lot of our young folks are - some we hope will stay, but some are moving on. They're doing their own thing, and generally, I think that they're concerned about their health. We can't help the fact that we've got a senior population that is reaching the age that they're going to need some care. That's all fine, that's fair, but it is what they are expecting at the other side of this that is important. If it's home care, again, I would argue that people would like to stay at home. I know that most of us would want to stay at home right to the end if we could, if it was set up appropriately. You've talked about being able - you know, we've been thinking about this or that or moving toward that - am I okay?

 

MADAM CHAIRMAN: One minute.

MR. PORTER: One minute, thank you. I see you're looking, Madam Chairman, so I will wrap this up here.

 

You're talking about it and talking about it some more, and we've continued to hear about what you'd like, but I'm not sure at what point we plan to put it into place, and what that will look like. I assume that at some point there is going to be a major investment by a government that maybe cuts in one place and gives to another to move more dollars into what will be that investment for long-term care at home. I think that's pretty broad as well.

 

There are a lot of different issues. Everyone is a little bit different, and their needs are not all the same physically or mentally or whatever their challenges might be. Some people need a lot more, and looking at it, I'm getting to wrap this up, so I look forward to coming back after the Opposition has their opportunity. We'll come back to it.

 

MADAM CHAIRMAN: The time allotted for the Progressive Conservative Party has elapsed.

 

The honourable member for Kings West.

 

MR. LEO GLAVINE: I'm pleased to welcome Deputy Minister McNamara to this afternoon's proceedings.

 

Before I ask a few questions around physicians, I have one for the minister to clarify a response that was provided on Friday in regard to the funding allocated for Nova Scotia's Nursing Strategy. The minister indicated initially that the $9 million for the strategy was used to fund nursing training seats. However, then you proceeded to explain that $5 million was going to Dal, St. F.X., and CBU for the nurse training seats. I'm wondering if the minister could provide a list of some of the initiatives that will be funded with the $9 million in the Nursing Strategy. There seems to be, again, not quite a full explanation there.

 

MR. WILSON: Just before I get into that, I believe that on Friday I indicated I would provide some additional information, so I will table some information for the member opposite. It's the Barrington Consulting Group Incorporated, some of the breakdowns, and also the graphic display breakdown for CNS. I'll pass that in as tabled.

 

As I mentioned in the answer on Friday around the Nursing Strategy, $4.3 million has moved out into Labour and Advanced Education. That was roughly $800,000 for CBU, $2.2 million for Dalhousie, $1.2 for the Yarmouth School of Nursing, and about $13,000 - so it was about $4.3 million, which comes off the $9 million. Of the other $4.6 million, which would make up the total, about $1.4 million goes to new employment orientation. We have $1.5 million going to continuing education at the district health authorities, IWK, VON, and long-term care. We also have co-op learning for third-year students at $1.1 million, new grads transition support at $150,000, and a little in other initiatives. That's a total of $4.6 million, so together it will be $9.05 million. That's the breakdown, so the $4.3 million will be going over to Labour and Advanced Education.

 

MR. GLAVINE: On Page 13.5, under the line item Academic Funding Plans, we see a reduction of about $18 million. Could the minister please outline the reasons for the reduction? Has there been a reduction in specialists, a reduction in funding, or a renegotiation of the agreements accounting for this reduction of $18 million?

 

MR. WILSON: It's a realignment of the program. So we have the Academic Funding Plans, in which we see a reduction of $18.9 million, and it's moving into what we call Physician Services or other programs. That has seen an increase of about $17-some million. What that mainly does is it takes from district psychiatry and regional hospital ICUs and moves them into the alternative funding plan and the alternative payment plan. It's not really - because to realign and better account for it, we found it wasn't under the Academic Funding Plans. It was through the transition into the AFP and APP.

 

MR. GLAVINE: How many specialists would be on the Academic Funding Plans?

 

MR. WILSON: We have 520.2. We could probably figure out what the 0.2 is, but 520 are under the Academic Funding Plans, and there is a whole range of examples. So Department of Medicine would be in there; IWK Pediatrics, QEII Pathology, Radiation Oncology, Dalhousie Family Medicine, Critical Care, Anesthesia, Women's and Obstetrics, Pediatrics Anesthesia and Critical Care, IWK Diagnostic Imaging, and also Gynecology and Oncology. There are a number of them who fall under Academic Funding, so a total roughly is about 520.

 

MR. GLAVINE: I guess you've explained some of that $18 million, because I was thinking that if the Academic Funding is cut, remaining competitive to have our specialists who are also holding down teaching positions at the Dalhousie Medical School - I guess could be compromised in a very, very competitive field. That's why I went on to ask about the numbers that have Academic Funding Plans, and whether the number associated with med school is staying consistent. We have certainly heard of a couple of losses in the past year, and I'm wondering, are we staying competitive in this particular area?

 

MR. WILSON: Just quickly on the 520 - some of those 520.2 are FTEs, of course, so a lot of them are in and out part time. Some of the work they do through the Academic Funding Plan. We've looked at different reports, national reports, to see exactly how we're doing here in Nova Scotia, and from all indications, we actually are doing quite well with the mix of physicians that we have here, especially the specialist-to-GPs. Also, the overall physician-to-resident ratio is really good.

 

Now, saying that, I know the member comes from an area that has had some difficulties at certain hospitals and in certain communities. We know that, and that's a challenge. That's one reason why we took the steps to bring forward a physician resource plan, so that we can really have a snapshot of where we are right now when it comes to the complements of physicians that we have. We have a number of them who solely do their work and provide services in small community clinics or hospitals, and we have some who work in multiple different disciplines and areas when it comes to research and development, or through the Academic Funding Plan. Of course, a lot of them teach, a lot of them do research, and a lot of them provide the care. So I think - I know - we're doing quite well here.

 

As I said, there are some challenges in areas of the province, and that's why the physician resource plan is a plan to move forward. It's a plan that we need to stick to. It's really easy not to stick to something. It makes for some difficult choices, and I'm sure the member opposite will mention them as we go through, when we're talking about the recruitment and retention of physicians, no matter what they're doing - if it's a general practitioner, or if it's an orthopaedic surgeon - and it presents challenges.

 

I think we have a good plan in place that recognizes the complements we have in the region. We support the district health authorities throughout the province on their complements of specialists, and we really need to stick to the plan so that in the future, we won't have as many affected areas in the province that might find it difficult to find a physician. We've gotten a lot of buy-in from Doctors Nova Scotia. We've been working with them over the last number of years to try to ensure that the direction we're going in is the direction that they see we need to go. With the physician resource plan, for example, we even have interest from medical students at Dalhousie Medical School for us and our department to come in and explain the physician resource plan so that they know, when they're making a decision in their early years of med school, that they're making a wise decision.

 

I see it as a positive, because I see it as students trying to look forward to what the demands and the needs of the province will be when they're done their schooling. I mean, some of them are going to be in school for another five, six, seven, eight years longer. So I see it as a positive. I think we do now have a good mix of specialists and of general practitioners in the province. It's a matter of trying to make sure that we get those underserviced areas, and we give them every opportunity to tap into the resources we have.

 

It's great for me to say that we have one of the highest physician-per-capita ratios for the number of people we have in this province, and it's true, we do. The numbers don't lie. We know they tend to congregate in the city, in Halifax, because of all the opportunities. I believe anybody would like to do as much as they can when they're working in a certain profession, and physicians are no different. If they can have an opportunity to teach, if they can have an opportunity to do research and development, if they can have an opportunity to work as a specialist, or even just in a regular clinic, they want to do that.

 

I know a lot of doctors who work in a number of settings, and I think that contributes to a good system. But we do need to do some work in some of the underserviced areas as we move forward with implementing the physician resource plan, ensuring we give as many resources as we can to the district health authorities to meet the needs of the residents. I think we'll see that it will change in some of those areas that have had more difficult times finding physicians.

 

We have a couple of programs in place that help them now. It hasn't eliminated the issues of finding physicians to go to certain areas of the province, but I think everybody understands that we need to make the best environment possible to attract someone to that area of the province, or that clinic, or that facility. As we move forward with technology, through IT investments, I think we're going to connect more with the new students coming out of school. They want to work in the type of environment that has the most up-to-date IT, and having the most up-to-date IT in the health care sector is not a cheap venture. It's expensive. We all know how technology changes, and we need to continue to plan for that. I also think working in an environment that not only has the technology but a support system - so more collaborative types of clinics out there across the province - is appealing to Nova Scotians and to physicians who may work there.

 

One of the things I've seen - I know we always have an issue around rural Nova Scotia and health care delivery in rural Nova Scotia. As you leave our borders - and we've done a lot of work, and I've done a lot of work with my colleagues across the country, to figure out how to best address health care issues - some of the other jurisdictions are much more challenged than we are when it comes to rural delivery of health care. I think we're in a good position because we could have a physician here in Halifax go down to any of the communities in the Valley to do extra shifts. We need to work on making sure that they know about those opportunities.

 

That's why we're trying to break down some of the barriers that have been in place for years around physicians working in different health authorities. You needed a licence to work in one, you needed a licence to work in the other - I mean, in my mind if you're a physician and you're registered under the college to work in our province, you should be able to be given any opportunity to work anywhere in the province. So we're working on that, to make sure that it's easier for physicians to move around the province, to support another community or another facility, and I think we're on the right track when it comes to the number of physicians we have here in the province.

 

MR. GLAVINE: I'll probably come back to a few of the areas that the minister has addressed, because while we do have that figure of the highest number of physicians on a per-capita basis, it doesn't seem to account for the clinical needs of our province - proper distribution, the amount of work time that physicians are providing in the province in terms of health care delivery. There are some challenges, to just state that, as the minister is aware.

 

I will move on for the moment to Physician Residents. I'm going down Page 13.5. Again on that page, the budget line item Physician Residents has increased by about $675,000. Would family medicine residencies be funded through this particular line item?

 

MR. WILSON: As you can appreciate, there are a lot of different line items that deal with residency. That has to deal with the recent negotiation agreement with residencies here in the Province of Nova Scotia. I think it was an arbitration decision that came down just recently. This was an increase for nine new physician residents, at a total of $679,000, and then, of course, the Other Master Agreement Initiatives. One of the things we need to recognize is ensuring that they're fairly compensated.

 

One of the things I forgot to mention in the earlier answer was that one of the initiatives we just took part in last year was a new family general practitioner residency program in the Valley. It's a first for the country. It's a new model to deliver a GP residency program. We have five individuals who are in the Valley now, who are going to be placed there for the full two years of their residency program, where in the past they may have been in the Valley for a month, come up to do a module at the IWK, and then move on wherever. With this new residency program, those five new residency graduates will now stay in the Valley for the next two years, for the whole component of the residency program. We had five come in last July, and we'll have another five this year, so there will be a complement of 10 each year going forward.

 

It's our hope that we'll have a large percentage who will remain in Nova Scotia, but more importantly, remain in a rural-type setting for general practitioners. The exposure they're getting is that they are getting into the ERs and stuff. I'm hoping that it really appeals to them.

 

I met with all five of them when they first came. Every single one of them loves the Valley. There are a couple of them who are actually from Nova Scotia - and you have to appreciate that the residency program is a national program open to any medical students from across the country, so they come in from schools all over. Actually, none of the five who are here graduated from Dalhousie. Hopefully over time we'll get some who will choose to take their residency program here, but we'll have another five next year. We have two who were from Nova Scotia and trained in other jurisdictions, in other provinces, and I would count that they're going to stay here. One was a great, nice lady who has a family here in Nova Scotia, who took the step in her life to go on and educate herself to become a doctor, and I would think that we might be able to count her in to stay in the Valley or at least in Nova Scotia.

 

We're very excited to see how that program moves forward. I think it's going to help with the retention and recruitment of some of the physicians who we need in those underserviced areas, like in the Valley, but more importantly, in some of the smaller communities. I hope that answered part of your question.

 

MR. GLAVINE: I know that this whole area of attracting residents here - because getting residents here, as you have pointed out, is very often a first step at an important bridge to perhaps having them stay here as GPs, or going on to do speciality work. When they come here, such as - let's take the five who are currently in Kentville. Would they all receive the same residency fee structure, or is each one of those negotiated individually in terms of their two-year residency in Kentville?

 

MR. WILSON: We have nine of the 10 positions now who are residents here in the province, so I think we're doing well on that front. Just for some clarification, the $675,000 - I don't know if I was clear or not; I know I was talking about different areas - was the increase of the nine new physicians, so nine of the 10 of that line item would account for the $675,000.

 

MR. GLAVINE: One of the areas the deputy minister and I have chatted about in the past - and really, I'm probably going back a couple of years here - is CaRMS, in terms of getting back some of our students who are educated outside the country or outside the province. I'm wondering, is the province able to have a say, or do they have input into how those positions will - you know, the categories of specialists and GPs. I'm wondering if the minister could provide an explanation. It seems to me to be a somewhat computer-driven exercise that perhaps doesn't always align with the needs that we have in the province, as well as the capability and potential of these young med students. I'm wondering if there is any negotiating by the minister, by the Department of Health and Wellness, in terms of that Canadian structure, in terms of allocating residents to our province.

 

MR. WILSON: The quick answer is no. That is done through the national CaRMS match, so it's a national approach. Like I mentioned, the five GP residents we have now in the Valley - all of them were trained outside our jurisdictions. As you graduate medical school, you apply for whatever route you're going to take. If it's general practitioner, then of course you apply into the residency program. That could put you anywhere in the country, from B.C. to Newfoundland and Labrador - I would assume Newfoundland and Labrador has residents there. You can end up anywhere in the country, so that's a national match or program that recent graduates or soon-to-be-recent graduates will apply for.

 

I know the member opposite has talked to the deputy minister about foreign-trained physicians. I've known many over the last number of years, and actually colleagues of mine, who were paramedics who went down to Saba, for example, to medical school in the Caribbean. I don't know how much of a vacation it is. I'm sure any medical school is quite demanding, and it's probably not life on the beach, as some might think it is in the Caribbean. One of the challenges for those Nova Scotians - and that's really most of the people in the correspondence I get and that the department gets and that members bring forward - Nova Scotians who couldn't for some reason get into Dalhousie, for example, who apply for medical school outside the jurisdiction. Most of the time it's outside Canada, so then other layers of regulations and review need to take place.

 

I encourage anybody who chooses to go outside the jurisdiction to fully understand what is required to get back into the system here in Canada. There are things that you need to do, and if you have enough time you can try to jump through all those hoops - there are hoops that people need to go through. It's similar to years ago, in the paramedicine profession. There were schools all over, but certain ones weren't recognized. If you were trained in one province, you couldn't go to another. One of the things that we did as a profession, or as they did as a profession in paramedicine, was to try to get standardized training and CMA-accredited, so that it makes it easier for that portability of being hired or trained in certain jurisdictions.

 

The same thing applies to students who choose to leave Canada to become or get trained as a doctor. There are hoops that you need to go through to try to get back to our jurisdiction. I wish we could say, let's open up our residency programs for just Nova Scotians, but we know we wouldn't get enough applicants, and we'd be left in a dire situation. So it is a national program. Those people who do go out need to know, and there are opportunities for them to get in, but I think - I mean, there are certain numbers under the CaRMS match that they go to and they do try to support the schools and the medical students who are trained here in Canada first. I think everybody would appreciate that. Those outside our jurisdiction or outside Canada can have opportunities to get into it.

 

It is challenging, but I encourage everybody, especially if you're a young student who is deciding to go to medical school, especially if you're leaving our borders - and I mean our country borders - to know exactly what you need to come back in. There are other additional programs that they need, additional courses that they may need to take, and there are parameters around them getting access to the residency program in Canada. We don't have - that's a long "no" to your question, but we're encouraged that we have an opportunity to invest in residency programs in the province. We have them in Cape Breton and throughout the province in different disciplines. We have the new one in the Valley that I just mentioned, around general practitioners.

 

I think the more opportunity that we have to invest in residency programs, the more opportunity Canadians or Nova Scotian medical students can have to get back into Nova Scotia and hopefully finish their training here, and hopefully work and stay here.

 

MR. GLAVINE: I just want to be clear, minister, of the number of family physician residency positions that will be funded this year. What would that total number be for the province?

 

MR. WILSON: Last year we had 349 and this year we have an increase of nine, so 358 medical residency positions funded here in the province.

 

MR. GLAVINE: I just wonder if there are other residency positions that will be funded through this line item this year, or is that the total number that we will have?

 

MR. WILSON: That's the total number funded this year, so the 358 will be the total in this year's budget.

 

MR. GLAVINE: In 2008, the previous Progressive Conservative Government announced an expansion of five seats at the Dalhousie Medical School in Fall 2008, five in Fall 2009. I believe all eight of those seats were added in Fall 2008 and two international medical graduate seats were also added. These 10 seats were to have tuition provided in exchange for a return-of-service agreement. How many of the 10 students who had their tuition paid would be on return of service, presumably once they completed their residency?

 

MR. WILSON: The government of the day was just funding the seats themselves. They had no agreement that they would cover that total cost.

 

MR. GLAVINE: In terms of positions funded in 2012-13, how many family residency positions are there that have a return-of-service agreement?

 

MR. WILSON: None that we're aware of. We don't have anything on the books for this year to support in that way.

 

MR. GLAVINE: According to the Department of Health and Wellness Web site, incentives provided to doctors included debt assistance plans to physicians who choose to practise in certain specialities or areas. They could receive between $20,000 and $45,000 for up to three years. Could the minister please indicate on which line items these incentives can be found? We know that they are available, they're there, but in terms of tracking them through the Budget Estimates, could the minister please indicate on which line item they can be found?

 

MR. WILSON: Thank you. We're just trying to figure out our numbers; 2012-13 was 315, and it's under Physician Services and Other Programs. So where we had moved in the academic funding, it would be under that line item.

 

MR. GLAVINE: And Mr. Minister, what would be budgeted for this fiscal year for debt assistance?

 

MR. WILSON: We're trying to find that line item, so we'll keep looking. As soon as we get it, I'll share that with the member opposite.

 

MR. GLAVINE: Mr. Minister, I know that some jurisdictions, in order to deal with the recruitment issue, have made an extra effort to identify medical students in their province who have gone to practise in other parts of Canada, who have gone to the U.S., and who have their full Canadian medical certification. I'm wondering if we in this province have made some efforts at identification.

 

We know that recruitment still remains a challenge. I know that the residency program that we now have has expanded into the Valley. Hopefully clerkships will also become a regular part of the Dal program in our province. But I'm wondering, what efforts have we made? I remember just a couple of years ago going through Logan International Airport in Boston. There was a recruitment sign for Ontario that was appealing to doctors in the U.S. who wanted to return to Ontario to practise, and what programs and assistance and so on would be available to them. Looking at the fact that we still have too many Nova Scotians - somewhere between 50,000 and 60,000 - who don't have a family doctor, I'm wondering if we are making that extra effort as part of a master plan in terms of our recruitment.

 

MR. WILSON: Yes, and we've worked over the last number of years to get individuals under the CAPP contract. I know it has worked quite well in Yarmouth, for example. I was down there recently - it would have been before Christmas - seeing some of the benefits of having that type of program. So we have a budget of $5.5 million for the CAPP this year. It's about 24 individuals, and for them to maximize what they can get in return, of course, would be a full five-year service. But there is a percentage. So we're not saying it's mandatory to stay the five years - we want them to stay, and that's why we go into the agreement with them, but there is a percentage. The longer they stay, the more they can receive. So the budget for this year is $5.5 million.

 

MR. GLAVINE: If I could just go back for a minute, I know that the Department of Health and Wellness and recruiters attend some of the shows that are put on for recruitment across the country. I'm just wondering if we are making some special or extraordinary efforts in terms of our recruitment. We know that we can't always get the number through Dalhousie. They have time here in the province, both Nova Scotians and those who come from Prince Edward Island or from New Brunswick or other parts of the country - we still don't get as many to fill all of the positions that need to be filled. And we all know, of course, that doctors, like many other professions, have a high average age at the moment, and that as we look over the next decade, there is going to be a considerable number and need. So I'm wondering, as part of a master plan for recruitment, what are our one-two approaches that we do use in the province?

 

MR. WILSON: One of the tools that is going to help us as we move forward is, of course, the physician resource plan. We know that we can identify where we're going to be over the next few years, taking into account retirements and that flow - there's a definite flow of health care providers who come into the system and for some reason leave the system. But we do have a full-time recruiter, and when we do find ourselves in need of a pathologist, for example, then that recruiter will go out, as far-reaching as possible, and try to find anyone to fill that position.

 

We're committed to that. We're committed to making sure that we have the right mix of physicians here in the province. As I said, I think we have a 50-50 split between specialists and GPs in our province, which is one of the higher ones. A lot of provinces are 60-40 or 70-30 GPs to specialists. So we do have a high number of them, but we know there are times when certain areas are in need of physicians, so we do have that opportunity to have a full-time recruiter out, wherever possible, to try to recruit and fill those holes that we have around the province.

 

MR. GLAVINE: Mr. Chairman, I'm going to switch topics here. This one I had referenced with the minister on Friday.

 

We all know that prevention has to remain a pretty strong and major part of our health promotion profile in the province. As I've gotten around since becoming the Health and Wellness Critic last October, one of the things that I have noticed around the province is that is the tobacco control strategy has many different formulations in the nine district health authorities. Could the minister please tell us where in the budget one can find provincial funding for the tobacco control strategy? Is it under the Chronic Disease and Injury Prevention area?

 

MR. WILSON: Before I get to that, I know the member opposite asked a question around the debt assistance budget. The 2013-14 budget is $315,000, the same as last year.

 

The tobacco strategy and that funding falls under Public Health, but it's all funded through the district health authorities. So the $1.6 billion that we provide the district health authorities within the $3.9 billion budget is where you would get the accounting for any of the work that the districts are doing around the tobacco strategy.

 

MR. GLAVINE: Mr. Minister, while that takes place at the district level, and you have provided funding, I'm wondering, if we have what is termed a tobacco control strategy, why wouldn't we have at least some basic or core elements that have to take place in each of the districts? We have two districts with nothing really going on whatsoever. So I consider this a really important issue.

 

We've had the unfortunate development in Nova Scotia of seeing our rate of smoking increase. I've looked at this over a decade, and as more and more effort was being made with public places, with new legislation, with campaigns and so forth, we've actually had a percentage increase in the rate of smoking in our province. So I'm asking the minister, why wouldn't we have a core platform piece in terms of rolling out a tobacco control strategy?

 

MR. WILSON: One of the things that is in this budget - and we're committed to it - is to try to ensure, as we move forward - especially around tobacco use in the province - that we try to encourage and support district health authorities in having programs available for smokers. So that's why we're committed this year to increasing the smoking cessation component of programming by an additional $400,000. So I think that shows that we're committed to trying to reduce the number of smokers here in the province.

 

We're glad that we have recently - well, it was in May or June of last year, I believe, or in the summer of last year - released our childhood obesity prevention strategy, or Thrive!, which I think can lead to a lot of partnering with organizations across the province to do exactly what the member opposite is saying: trying to target certain groups, especially when it comes to smoking, if it's young people.

 

We're more than willing to work with organizations like Doctors Nova Scotia on their running club for youth - which has been very successful across the province, with young people in schools all over the place taking up running, trying to be more active - and with organizations like the Lung Association. Louis Brill, for example, the director of the Lung Association, recently brought forward a running program for smokers. He's excited about it because, you know, you get somebody who has an addiction like tobacco and smoking to start exercising more and realize there are limitations because they're smokers. It's a great program.

 

We're encouraging organizations like that to continue to bring forward programs, and this is a program that they did on their own. We're also willing, through Thrive!, to work with partners, to work with businesses or whoever to try to tackle the prevention side of things, to try to encourage people to be more active. I recently did an announcement - or not an announcement, an event - with Canadian Tire, for example, over in Shannon Park Arena, over on the base. They had the base commander there, and the chief of the base, and what Canadian Tire was doing was supporting arenas that chose to have a mandatory helmet policy for anybody on the ice. So Canadian Tire was giving - I think it was $500 gift certificates to 10 different arenas across the province, because they chose to come forward with a policy like a mandatory helmet rule. Dalhousie Arena was the first one in our province that chose to take that stance, and now we have a number of arenas.

 

So through Thrive!, we're looking at opportunities to support and promote other programs. It doesn't have to be the province. We see other businesses that are more than happy to work with us. One of the things we did just after releasing Thrive! was an editorial board with The ChronicleHerald. They realize the importance of having more people take responsibility for trying to get our population a little healthier and trying to make sure that prevention is a key when you're moving forward on any initiatives or programs. So I'm glad we increased the money toward the tobacco cessation products this year.

 

I hope that all district health authorities - and it's my understanding that every district health authority has some type of program or initiative around tobacco use. Some are doing way more than others - I understand that - and I'm hoping that, with the additional support through the additional $400,000, most if not all districts will move forward and say, here's an opportunity to expand a program to try to target eliminating those who smoke around the province - not eliminating them, reducing them. (Laughter) Just smoking alone will eliminate them at one point in their lives - but try to encourage Nova Scotians to lead a healthier life and stop smoking.

 

MR. GLAVINE: Well, we'll change the topic and move on to EIBI funding. Page 13.8 of the Estimates and Supplementary Detail shows funding for mental health programs to total close to $6.3 million - an increase of $815,000 over the last fiscal year.

 

One of the items listed as being funded under Mental Health Services is the EIBI program for autism. Could the minister please indicate how much of the $6.3 million is spent on EIBI, as indicated on Page 13.8 of the Estimates and Supplementary Detail?

 

MR. WILSON: This is an area that we have been trying to place more attention on over the last number of years. The EIBI program, for example, was in place when we came into government in 2009. It's a great program. Unfortunately for Nova Scotians who were trying to access that program, they had to go into a lottery scheme to get access. It was random. You didn't know if you were getting into it or not.

 

So we were glad, early on in our mandate, to come forward with the province's first mental health and addiction strategy. What that does, again, is lay the foundation for mental health and addiction services in the province.

 

We've really tried to put an emphasis on children's health and children's prevention in all the things that we've done over the last couple of years. In the EIBI program, for example, we got rid of that lottery scheme where any child that needs to get into that program will gain access to that prior to them getting into school or starting school.

 

I know early on, when I first became Minister of Health and Wellness, we went to an event at the IWK-Grace Hospital to give an update, how appreciative families were. More importantly, what I've seen is the impact on a young person who went through that program, or the mother telling me about the positive impact it had on her daughter. She said that at the start of the EIBI program, if her daughter was on a playground, she would not interact with anybody. She wouldn't play on the equipment, and she had very few verbal skills. She offered to come down to the school after the program, and within a year of her entering school, go to the playground and you would not be able to tell that her child had autism, because of the positive effect the EIBI program had on her life and how her ability was to enter school and be productive and, I think, contribute a lot to the school program.

 

We're still trying to get the breakdown, but this year we increased the mental health programming by $2 million. We want to ensure that we continue to put emphasis on increasing the services that we can provide and supporting the programs that there are now, so that as we move forward with implementation of the mental health and addiction strategy we have a lasting impact on the residents we're trying to serve. Mental health and addiction have been overlooked for so long that we're really seeing the need to ensure that we're continuing to invest in it. We really see the positive impact just a little bit of funding can have on a group or organization.

 

I had the privilege of hosting the Ministers of Health in September of last year where we had all the Ministers of Health from across the country here. We had the federal minister here. At one of our receptions, we had an organization from, I believe, Antigonish way, who put on a skit. They're actors, and they bring light to mental illness and living with mental illness, and I've got to say, they had just come back from winning a national award. I believe they were all in British Columbia that week. So they all flew back from British Columbia; they took the red-eye, landed in Halifax, and then put a performance on for the Ministers of Health. They were so appreciative of just a little bit of funding - not a heck of a lot. It really showcased what the potentials are - trying to engage individuals in our community who have mental illness and what they can do and how they can participate and how they can contribute to a positive community.

The local paper in Antigonish - I'm not too sure what it was called - had a very good profile on this group. Well attended - I think they sold out a number of events. I think it's important that we continue to invest in that.

 

Now that I have the total for the EIBI program, it's a $4 million total for this year.

 

MR. GLAVINE: I know there's a large budget to go out to the districts - the IWK-Grace Hospital for mental health services - so I thought maybe there was some from that total amount that would go to EIBI. The Autism Spectrum Disorder Action Plan funding was to double from $4 million to $8 million for pre-school EIBI. I'm wondering - are we at $8 million or is it, as the minister has just explained, that there is $4 million toward the EIBI?

 

I checked with the Valley District Health Authority, and they do have at least a small wait-list. It may not be a lottery, as the minister has said, but I know there are now parents through the IWK who are waiting up to nine months to get the EIBI. One of the things, as the minister is well aware of, is that the professional development of our GPs has gone a long way with early diagnosis, and early diagnosis is certainly a key to getting some of the EIBI prior to children entering school, and also the training for parents and other care providers when the children are young. Could the minister let us know what the figure is now for pre-school EIBI?

 

MR. WILSON: One of the challenges we have is that there are different areas that are providing support. Hearing and speech, for example, has speech pathologists; the IWK, of course, is the bulk of that money; and then central Mental Health with other support services that we provide. As we move forward, one of the commitments we had was to ensure that every 4-year-old, preschool, would gain access to the programs. There are small wait-lists in other regions, but it's more on the front. There are some parents who want access earlier on. I know I got a letter from somebody who has a 2-year-old, and our commitment to that individual is making sure that they get access to the program before they enter school. That's our commitment: to make sure every child who needs to gain access to the EIBI program before they go to school will get that.

 

We have a commitment in a number of areas. We work with the schools afterward; we work with the IWK and the district health authorities, hearing and speech. So our commitment right now - what we have within our budget - is a $4 million earmark for the EIBI program.

 

MR. GLAVINE: I know I just have about a minute and a half or so to go, so this is probably a warm-up for the next hour. When I was out in the community on the weekend, two of the local family doctors I did have an opportunity to chat with - and during the discussions, it was interesting that both came around to the Nightingale problem. I really got a tremendous sense that the frustration is deepening, especially when a doctor goes home after a long day and he still has an hour more to input information into the system, and it's not going to upload and take any information at all or it's down for a period of time.

It is becoming problematic, and I think the medical profession wants to have a better system as we move forward. As we start my next hour, maybe the minister could provide a bit of an update on where we are and some of that guarantee that doctors are hoping will come from the investment that has been made. With that, I finish my time, I believe, with just a few seconds left.

 

MR. CHAIRMAN: Order, please. An excellent ending to the hour allotted to the Liberal caucus.

 

The honourable member for Hants West.

 

MR. CHUCK PORTER: Mr. Chairman, I will pick up where I left off an hour ago. We were on long-term care, and we were just getting ready to wrap that up.

 

You talked about a few different things there - where we were going, and some of the challenges that we have. We agree, as I think most people would, on the idea of long-term care being mostly at home or as long at home as we can. I'm wondering, knowing what budgets are and what some of the issues are, what the wait-lists are to get people on long-term care at home - or home care. We should call it what it is.

 

Workers seem to be - or must be - the issue, I'm assuming. I'll let you clarify that, but they must be the issue if we have a wait-list for people who have called looking for home care to have their needs met, I guess is the simplest way of putting it. I'm wondering - I usually don't ask to speak to too much by way of numbers, and this isn't a budget item, but it's more of a people number here. Could you speak to how many we have by way of home-care workers - maybe you don't have that; I don't know - and how many we actually need, based on the challenges that lie ahead, knowing what your wait-lists are for those with home care?

 

You talked earlier, too - it was an interesting number - I believe you quoted 43 per cent of those who have applied for long-term care as never having been assessed for home care. You know what the challenges are, I think, from the numbers you're quoting. We agree that there is a challenge there. I think it's important to see how much we have of a shortfall - and I'm saying there's a shortfall, obviously, because there's a wait-list for those people at home who need care.

 

MR. WILSON: One of the figures I do know - that's why I've asked this, and I talk about it often - is the wait-list for long-term care and the percentage. Forty-three percent haven't accessed home care, so they're on the list and they don't receive any kind of support through home care or community care - not to say that they don't get support from family members, because we know - and I've been there where you've done a call to a residence where you can tell on the face of a loved one that they've been taking care of someone for quite some time and are exhausted and in need of respite care and all that.

 

That's another area I forgot to mention when I talked earlier in my answer around trying to nail down a timeline on access to long-term care. A respite in there is a much-needed avenue for people who are taking care of someone at home, so another reason why maybe a bed would be protected - if you would say - in a long-term care facility would be to provide respite for the region. You have somebody who needs a break, who is a caregiver at home, and they can go to that respite care.

 

We've worked over a number of years to try to make sure that we have the right complement out there. We have a number of agencies, like VON for example, that provide home care services. We have a number of contracts through the district health authorities, through different organizations within the community, to provide home care.

 

I believe we have a good number of organizations there, ready to provide the services. No question, finances have a big part to play with it. I think the largest wait-list was in Halifax, or HRM, for the last number of years. That's why last year a portion of the $22 million extra that we put into home care went toward trying to clean up and hopefully get rid of the wait-lists here in Halifax.

 

Each region is different. Some regions of the province don't have any wait times; you go in, you're assessed, you need some support, you get the home care quite quickly. We're really monitoring that, and that's why we made such a big investment. I mean, our budget before that was about $170 million, so we brought that up - it was $174 million, so we brought that up to $196 million, I believe, or just above that last year. We have another additional $2 million going into home care services, and hopefully we'll see the difference here in the next six to eight months with the additional funds going to all these agencies that provide home care services.

 

In home support and home care, we have over 2,210 FTEs. So over 2,000 - mostly women, but men and women - across the province who are working in the home care sector. We have a wide range of opportunities for people to get into that profession through the community colleges. A lot of the private nursing homes and the nursing homes that provide care for residents through the provincial program offer incentives themselves. They'll hire you to train you to work in their facility.

 

A number of years ago we were really struggling, because of course we were bringing on new beds. We brought on over 1,000 new long-term care beds over the last couple of years, and there was a need to accelerate a lot of the programs. I think we're at a point now where we see there is enough interest within the population, who look at this as a viable career to go into. So really, I think your main question was how many we have. We have over 2,210 FTEs in the home support and home-care sector, working in the province.

 

MR. PORTER: You mentioned respite care. I know in years past we had a couple of beds at Dykeland Lodge - and I'll just use my own areas for examples. I think we probably had at least one over at the Elms at one period in time. I don't think we have any anymore. That has obviously had an impact on those folks who are looking for respite care. They may be able to help as they can, but there are times when I know that I've spoken with family members who just can't get the respite care unless they're able to find another family member to come in and do that. I do know that those couple of beds went a long way in years past.

 

You talked a little bit there about the time frame, and in some areas it's better than it is in others. Can you answer why that might be? Is it just the available working population that's out there, or is it the demographic? I'm not sure what that is. I'll leave that to you to answer, if you know.

 

I'm wondering also, in the same one - just two quick questions here while I'm at it. Can you speak to the general needs - because we know they're assessed at a certain medical/physical/mental level - as they deem long-term care is or isn't appropriate at the time? I'm thinking about that 43 per cent, again, who haven't actually done that. Can you speak about the general needs of somebody at home who would qualify and what the requirement would really be - you can stay at home, this is what you need? In general, what are those average needs - what people need, and how many hours a week does that consume? What's the average - if I were at home or a family member were at home receiving home care, is there an average number, or is there too much variance to pick that up? They're not all the same - if you want to speak to those couple of quick snappers.

 

MR. WILSON: As I said earlier, one of the areas of the province that had the greatest need or had the largest wait times for home care was Halifax. It's simply on the demographics and the population base. We know what's happening out in rural communities and the out-migration. They're coming to Halifax. You just have to drive out through Bayers Lake and those places to see the sheer number of condos, apartments, and housing that are going up in HRM. We have over 400,000 of the 900,000-plus here just in Halifax. As we see that shift and the movement to move closer to Halifax, I know some of it has to do with following family members. If their kids are working in Halifax, they're deciding to come to Halifax and live in apartments, so we see higher demand.

 

As they get assessed for home care, there are certain criteria, and then they have a plan in place on what they would be allowed coverage for, for example. I might not have that - we'll try to find it. If we don't have it, I'll try to get you something - maybe by tomorrow, since it's a late evening - on average numbers of hours of home care allotted to certain people, but there are levels or an evaluation that's done, and their needs are charted out and trying to figure out what exactly is needed. That's the thing that it's so important that Nova Scotians realize.

 

Of course, there's the private sector that many Nova Scotians use. They save money through their lives; they have the means of going out and personally purchasing home care services. A lot of people do that. Of course, the province does provide some and there is a ceiling on - a limitation on an income level, for example, so it's all geared toward income level. We really want to go toward ensuring those low-income Nova Scotians who don't have the means to pay for private care can still gain access to some of the services.

Some of the services that are available are something as simple as the HELP program. That's the program that loans hospital beds out for individuals. If you all of a sudden have a broken hip or limited mobility and you live in an old farmhouse in Windsor and it's two storeys, you may have to stay on that main level. So by providing a bed through HELP, we can facilitate and hopefully keep that individual at home instead of in the hospital, for one, or requiring a long-term care facility.

 

Another program is the home oxygen service. If you have an ailment like COPD or any of the lung diseases that require you to have oxygen, we have a home oxygen program that can support someone who might need additional services. That's available throughout the province.

 

We also have the Personal Alert Assistance Program, where of course it's like - I'm trying to think of the old names. As a medic, they would have a unit in the house; you'd carry something around on your wrist or neck. If you have a fall or need assistance and you can't get to the phone, you can just press the alarm; they try to make contact with you and if not, then EMS, fire, or police will be dispatched to your house. So there are a number of programs as they do those assessments, and they try to figure out the needs of individuals.

 

What's important is to ensure that people's loved ones are engaged in that process too. I think you mentioned earlier in your previous question, if you were to ask an individual who might be 94 years old if they need any help, they're going to say, no, I'm fine, I don't need any help. You talk to their family member who might be taking care of someone and that changes. It's so important to ensure that people who have a loved one, who might have an elderly parent or family member, they discuss this stuff before something serious happens. If you're prepared, that's when I think it has less of an impact on that loved one.

 

I'm hoping that through our engagement with ensuring that people know that there is better care for seniors out there; that there are programs there for them; that they engage with their families; and they know that there's some support.

 

The maximum home support hours per month are 150 hours plus 60 nursing visits a month. They might be eligible for other programs, but under our home care it is 150 hours max and 60 nursing visits a month per person. That would be the maximum. Now you can, of course, buy more, but anybody who is getting that probably has a couple of things. One is they're in need - they have a lot of needs, but more importantly, probably don't have the means of paying for the private. That's why we do allow for quite a number of visits, and 60 nursing visits per month can do for wound changes and stuff like that. There are a number of other things that people could do.

 

The average time for nursing visits for all home care is one hour and 26 minutes. Last year alone, there were over 647,044 visits in 2011-12 to someone's home. So there is a lot of engagement, and there are a lot of dedicated individuals who work within the home care sector who are providing care for Nova Scotians. We always say how difficult someone else's job is, and I know they said that about being a paramedic - and they say that about being Minister of Health and Wellness, too, and an MLA - but definitely those individuals who are on the road in all kinds of weather, who go to individuals' homes and provide care are dedicated. It's a tough job, and they deserve all the respect we can give them and the appreciation that goes along with that.

 

There are a lot of individuals meeting the needs of Nova Scotians. Can and should we do more? Yes. That's why we're continuing to invest in home care and in long-term care, but it's a challenge, especially where we need to ensure we have the right mix now, because we know that demographic shift is happening. The baby boomers are turning 65. We're going to have less - there are 2,000 fewer Primary students this year than last year. As I think I said in one of my other responses: that's 2,000 fewer graduates who are going to enter the workforce in 12 or 13 years.

 

We need to ensure that we have a good mix of professionals working and working together so that the system is there to support the aging population. That's why it's so critical now to make sure that we take the time to evaluate why we see a long-term care wait-list growing even though we've almost doubled the budget in the last seven years. We've increased over 1,000 beds - 800 replacement beds - and we invest almost $200 million in home care. We need to make sure we get a handle on this now for whoever comes after us in the jobs that we have now. It would be much, much later for replacing my replacement. Whoever comes later is going to have a challenge in the next 15 to 20 years from now, when you and I may be looking for home care services.

 

I hope that we have a sustainable system, that we have a system that can react so that when you're 94 you don't have to wait a year to get into a long-term care facility. You should be able to gain access to that. That's why it's critical.

 

I know we're in the political game and we're going to be sending out stuff - why you didn't do more, you didn't do enough. It's so important to get the work done now. We're going to build on what has been happening in the past, but it's so crucial at this point to try to reflect on why we see those numbers in the home-care wait times increasing when we're increasing investment and we're increasing the stock of long-term care facilities. I think home care is the area where we can help with that.

 

In the past we've also talked about other professions, other clinically-trained people to provide care and services. Paramedics, for example: their scope of practice and the environments they work in have now expanded just in a short 15 or 20 years. They used to provide care solely in an ambulance; now we have them in long-term care facilities, and I think the last time I saw some figures, in one year that reduced over 2,000 transports to the hospital. That's just amazing. So it's a very successful program. We need to continue to have nurse practitioners in long-term care facilities.

 

The more we maximize the ability for people to provide care for someone, I think is where we need to go. Who knows how home care will evolve over the next 10 or 15 years, but I think we need to continue to invest in it and hopefully make the right decisions so that long-term care is there for the 94-year-old who needs it down the road.

 

MR. PORTER: I agree, it's probably never-ending, and you'll be investing in it for some time to come, and for God knows how many years. I'm kind of curious - you talked on a lot of different pieces; that's a lot of hours and a lot of people. Yes, there are a lot of different programs out there, and I think we spend a lot of time trying to help people through those programs at times and direct them to this or that. We're fortunate in my area to have the Lions Club, which does a wonderful job of supplying everything from chairs and walkers - you name it - as they can to clients who can't afford to buy them new. There are all kinds of different things.

 

On the levels of care, I guess - and we're familiar with it, and I'm trying to put it in simpler terms, maybe - we have the home care level, and then the level ones and level twos, which, of course, are a little heavier and more work. I'm thinking about the numbers. You've talked about the number of staff and the number of hours, and that sounds very large when you equate it to the number of hours spent.

 

With all of that said, I guess the question is kind of twofold: are we meeting the needs? I think the answer is, not quite. I don't know that we'll ever meet the needs totally. How many more people would we need? How many more person-hours or people? I know that you're investing more money. There are a couple million dollars more you talked about there - maybe even speak to what the couple of million dollar investment does to the number of people or hours of support given. What does $2 million equate to in a year? Is it 25 people and a couple thousand hours? Maybe you can break that down for me, just to give us a better idea of what that actually means.

 

I'm kind of curious on - as we continue to grow that piece of the budget - you can't keep growing your budget. Pretty soon you'll be the whole budget for the province. We know that can't happen. You must be cutting somewhere to be able to continue to invest and hopefully not grow the budget. You're $4 billion or thereabouts - half the provincial budget, nearly. I don't know how many people realize the big piece that this equates to, which is huge, but you also take in many, many different aspects of what we do here.

 

Maybe speak to what the couple of million dollars means, and how much more we need to get to where you, as minister in the department, think we might need to be. If you had the money today, what's the investment to take us where we need to be?

 

MR. WILSON: Well, that's a loaded question, I think. The challenge is trying to make sure that we're meeting the needs of the residents of our province. As you stated, the cost of health care has risen dramatically over the last 10 to 15 years, but I'm glad to say that I think we've done a good job at managing the growth in health care over the last four years.

 

This year we'll see about a 1.3 per cent increase in the health care budget. We're at 41 per cent of the total budget of provincial spending, and a 1.3 per cent increase is around the $50 million mark. Last year we were just above 2 per cent, which was about $100 million. When you look at what we've done here in the province, compared to other jurisdictions, one of the things that was being looked upon is how we're managing the health care system. Over the last four years, we've brought in and changed models of care, for example. I think of that in mental health and addiction services, how we're trying to transform to better meet the wait times. One of the areas, of course, was with children's mental health at the IWK. We made some tough choices and decisions to try to have a better flow so that more people can get in and gain access and have the assessments done, and then try to get in to the specialists that they need.

 

On a national level, 12 hours after I became the Minister of Health and Wellness, I was in Toronto with the deputy minister, chairing the ministers' meeting, and within five minutes they were talking about Nova Scotia. They were talking about some of the initiatives we've done over the last couple of years. I'm very proud to be from Nova Scotia. When you go to these big meetings with all the players across the country, you tend to think Alberta, Ontario, British Columbia, and Quebec are the ones that are moving forward on everything because they have more population and revenue - well, they used to have more revenue coming in. That's not the case anymore, and I can say that, especially in health care.

 

We've had more jurisdictions in our province looking at the models that we have now in mental health and in emergency services, like Collaborative Emergency Centres, and also looking at how we've been able to - we haven't cut the health budget. We've managed it. It continues to rise, but we've managed to keep that growth under 2.5 per cent over the last couple of years, where the norm over the last 10 years was 6, 7, 8, or 9 per cent. I think we had a high of 11 or 12 per cent in 2007-08, somewhere around there.

 

We've been able to do that because we've tackled the need of trying to reduce our health administrative costs - something we've done in the last four years where we've redirected that money, so we don't ask for that money back. If you could find savings within health administration, you can redirect that and utilize it within the districts on front-line health care.

 

Yes, there are a lot of issues out there. We still have ERs that are closing in certain regions, but I'll tell you, the ones that have accepted and implemented the CECs, they've almost eliminated that close. Whatever you think about the model of care, it's utilizing the health care providers, who we know are going to be shrinking over the next number of years - yet more people are demanding the services from them. So moving to a model that implements utilization of health care providers to the best of their ability is something you need to go to.

 

The days of having a surgeon in every single hospital across the province went bye-bye a long time ago, but ensuring that people have good access to it - and the days of having a doctor in every hospital 24 hours a day, seven days a week, is something that has been challenging, because we just don't have the physicians there. By bringing forward the change in model care for Collaborative Emergency Centres, we're utilizing those physicians during the peak times in the day; we're utilizing paramedics who can do assessments, who can respond to an emergency. We have nurses and nurse practitioners who are instrumental in working with all kinds of different disciplines within health care to provide care.

 

We've been looked upon at the national level on how we've managed to sustain that growth curve that we've seen in health care budgets over the last couple of years, and really what we've done is reinvest the savings we have within health administration, so that hopefully we're having a better impact on the service deliveries - still trying to address some of the needs. We talk about surgeries, for example. I can say, without a doubt, that if you require emergency cardiac surgery because you have a blockage in your heart or an aneurism or anything like that, you're going to get the care here in the province and you're going to get it in a fast manner.

 

We have a new initiative where we have stroke management, stroke policies, where if you're having a stroke in a community and paramedics pick you up - in the old days, the old model would just drive you to the local hospital, and then they'd say, oh, this person, we can't deal with that here, let's transport him again. Now we have stroke centres across the province, so they know now there's a protocol in place where if you pick up somebody who has signs of stroke, you go right to those stroke centres and they get the care they need. It's saving lives.

 

As we've moved to ensuring people have access to those types of services, we need to continue to look at how do we change it, how do we evolve models of care, how do we reinvest savings that we might have? I've said this often, that just because we fund something doesn't mean it should be funded forever. If we're not getting the outcomes we need from a program, we need those providers who are providing that service to say okay, let's look at it in a different way. We've seen that with a number of initiatives.

 

That's how I think we need to continue to move. I don't think we'll see the 10 per cent, 15 per cent - and there has been a 22 per cent increase in the Health budget within the last 25 years - I don't think you'll see that, because we can't sustain that. That's what the rest of the ministers across the country are saying: health care isn't sustainable the way it is.

 

We see the federal government coming back and trying to renegotiate - well, they didn't renegotiate, sorry - to tell the provinces what they're going to get in the future. We had the Health Accord that's going to be up come 2014, and we're going to a new model that wasn't negotiated. The provinces were just told, this is the money you're going to get into the future. We knew that as a province here, in Nova Scotia, we had to get our own finances in order. We have a bigger battle that we're going to have to continue to fight with the federal government to make sure that they remain at the table when it comes to health care.

I was at an event today where we officially launched and talked about the expansion to the newborn screening program at the IWK, for sickle cell anemia and for cystic fibrosis. We were talking to some of the clinicians there, saying this is a great move, and it was good that we had the opportunity to look at expanding that screening program, but they also said there are some challenges with some of the diseases and chronic disease management, and that is, of course, the cost of pharmaceuticals and trying to make sure that we can get a handle on pharmaceutical costs. A lot of the new medications that come out are expensive. There's one - I believe for cystic fibrosis - a new trial medication that is over $300,000 a year.

 

I know I get off topic a little bit, but the reason I bring that up is that's where we are going to need the federal government to start looking at supporting the provinces, especially smaller provinces that have smaller demographics, that don't have the income base that you might see in Alberta or B.C. or Ontario. We need them to be at the table.

 

I think we've done a good job at trying to get our finances in order in the province in all departments, but more importantly in health care, where we do consume over 40 per cent of the provincial budget. It has allowed us to reinvest in things. We have brought all of these new initiatives forward, but still managed to harness the health care budget. I'll leave it there, and I'll look for your next question.

 

MR. PORTER: Mr. Chairman, I guess I'll make a couple of comments. One, the question wasn't really meant to be loaded, although I guess it was perceived that way. It was meant to be what it was.

 

You talked about health care changing in the last four years. I guess I would argue that health care has been changing in this place and in this province for many years. When you talk about old guys or old days, I guess probably I was back there at some point, some 20-plus years ago now, when things were just as you described them. In a lot of ways you put people in an ambulance and you hurried to the hospital, and things have changed for the better. I also recall in those early days the budget was somewhere around $14 million to run the provincial ambulance system, and today - you can holler at me what the figure might be, but I know it's a whole lot more than that. (Interruptions) It's a lot of money. I would say that it is a lot of money.

 

But we have seen great improvements from what we had in the past. Anyone who ever used the service would argue that it is a good service. There is a lot that has been done. We were fortunate in the mid-1990s to see some of the changes that started to come in here.

 

I think health care has always evolved, especially with the technology. We're seeing people live longer. We're seeing surgeries that wouldn't have taken place with regard to cardiac problems. A lot of people would have passed on, when now there are simple things like bypasses that are getting done and you're going home in a day or two. It's amazing how far that has come.

 

There is a huge cost to doing business when you're in the health care business in this province or any province, as long as you're helping to fund it. I think that's important, and I think there will always be a place where the funds are needed, but we have to remember it didn't happen overnight and there is a long way to go yet. I agree with you - you have to continue to do what you need to do with all levels of government, whether you call that fighting or arguing or negotiating or whatever that might be. That's what we're here to do, and to get it done, and to make sure that we can get whatever we can get and what's best for our constituents.

 

I do want to move on from that, finally, and you'll probably be happy with that as well. I want to touch on the insulin pumps. I think it's great that we're going to be able to put our program in place, and that there's an investment there finally. It's something that we've all been concerned about in this Legislature. Many people have talked about it and have been asking for it, and we'd certainly like to see it take in everybody, at all age levels, because there is definitely a need.

 

I'm curious - I know you spoke the other day in detail about the numbers that you think you would be able to assist and so on as we move along. One of the key things here is, what about the time frame for starting? There are children right now - I call them children, and I shouldn't do that - teenagers who are going to turn into adults; they're 18, they're going to be 19, maybe before January 2014. Where are these folks in the middle here going to fall? Are they going to be eliminated from the program? Correct me if I'm wrong, please, but I think the announcement was that January 2014 was the kickoff for this, and then you spoke the other day in the estimates about being able to start and implement this program before that. I'll give you a few minutes on that to clarify.

 

MR. WILSON: Compared to the increase in dental coverage for children, that one is much easier. We'll be able to do it a little more quickly. It is an existing program that is in place, so we'll be able to ramp that one up quite quickly. Of course, we can do some of the work, but nothing can be done officially until the budget is passed. We know it is going to pass, but this is still a process where we allow for Budget Estimates to happen.

 

The insulin pump program is a $5.3 million program. We're hoping that by the end of the year we'll have it up and running. That doesn't help anybody today who might be purchasing one tomorrow, but if they do have a pump, they will be able to get their supplies paid for right away when the program comes live.

 

We understand that there are people today waiting for that program to come in. We're going to move as quickly as we can on implementing and having it in place. We need to set up a program, create a program. We're going to look at other jurisdictions on what their programs look like, because there are other jurisdictions that do have a similar program that we want to implement. We're going to try to move that as quickly as we can. We have to create the program; we have to make sure there are policies and procedures in place - potentially an RFP to get the supplies and the type of insulin pump that you're going to utilize.

I think people will respect the fact that there has to be time between now and the day it starts. We're really going to try to expedite that so that we can start supporting those individuals who have type 1 diabetes in the province. We have 640 type 1 diabetics who are under the age of 19 currently, I believe. The other part of that program, of course, is supplies for the insulin pumps, so kids under 19 will get the supplies and the pump covered. Individuals under 25 will get the supplies. We believe there are just over 1,000 people who will be able to access the program who are type 1, so we're going to try to move quickly.

 

One of the things we have done prior to this, of course, is we just recently added a couple of long-lasting insulin to the formulary that we would cover under the province. When we made that decision it was because we knew that we wanted to try to impact as many people with diabetes as possible, similar to when we talked the other day about dialysis and trying to locate where we should put - if we could invest in one additional satellite office, where it should go. We looked at the map and said, if we can address and try to touch as many people as possible, that's how we move forward.

 

We have limited dollars, and if we had more we could expand the program, the same as dialysis - we could have more dialysis units all over - but it's expensive, so that's why we made the choice initially to move first on the long-lasting insulin. It was something that the industry, patients, and health care providers said was really important.

 

We've moved forward on a number of initiatives around diabetes over the last couple of years. I was glad to be in the position this year to entertain and look at what an insulin pump program would look like in the province and how much it would cost. That is why the work that we've done over the last four years was so important. For us to get back to balance gives us more opportunity in the future to look at new investment. As a province, we are going to need to continue to invest in health care, especially knowing that something new is around the corner when it comes to trying to support someone with diabetes or any of the other chronic illnesses. We need to be in the best position to be able to at least look at it as a province, as a department, to see if we can help fund that.

 

We have so many dedicated people within the health care sector, who I must say over the last four years have worked extremely hard to recognize the need to reform some of the models of care that we have, and the need to redirect any savings found through reduction in health administrators to front-line care. It's an easy area to go to, to talk about health administrators - I know I talked about it on a number of answers - but I want to say how important health administrators are to the system.

 

We have health care providers and front-line workers, and we know how important they are. We do have people behind the scenes who are working extremely hard to make sure that the programs are there, that the protocols are in place - people who work within the Department of Health and Wellness and also those who work within the districts, who are health administrators. They are a key component of the health care system, and they're an easy target when we're talking about trying to find savings and the cost of wages and FTEs.

We've worked hard in the Department of Health and Wellness over the last four years to reduce our number of FTEs within the department itself. I believe we were up well over 800 when we came in in 2009, and we're at about 465 now. Those 465 people who work within the Department of Health and Wellness work extremely hard to support and to give support to the districts to perform their duties. They give support to clinicians who are working in the field, who are providing the front-line health care.

 

I don't want anyone to think at any time that health administrators aren't important to the system. They are. In this example, where we're bringing on a new program, we're going to have to rely on the health administrators to do all that backroom work so that those clinicians who work within and provide front-line care to diabetics - that that's all in place.

 

We're going to try to move forward as quickly as we can on the insulin pump program. There are a lot of people who are excited about it. I know there are a lot of Nova Scotians who were rallying around this cause in support of it; I mentioned it the other day around the young kids who got involved in different communities, who started petitions and wrote letters and talked to their MLA and sent a couple thousand e-mails to the Minister of Health and Wellness's e-mail account over the last couple of months.

 

I appreciate all of that, and it really gets your attention. I want to thank everybody who worked hard for this. I wish we could have done it sooner, but I'm glad we're in a position now that we were able to entertain the option of bringing forward a program like an insulin supply program here to the province.

 

MR. PORTER: Just a quick question, and if you can, a quick answer. How many other provinces in this country are offering this sort of program?

 

MR. WILSON: I can get the answer, but it's not all of them. There are maybe four or five, I believe.

 

MR. PORTER: That just leads me to the next piece I wanted to clarify. You talked about policy and procedure and RFPs and so on. I'm going to assume we don't have to reinvent the wheel here. It's obviously working in a number of other provinces. It shouldn't take a lot of time. Yes, our demographic is different, but it's specific to an age group. Our numbers may be more or less in comparison - probably less, given that we're a smaller province - so I wouldn't think that we're looking at a lot of time here. You can certainly speak to that and correct me if I'm wrong, but I wouldn't think the way that we do that specifically in this province would be a whole lot different than anywhere else.

 

Yes, tomorrow we know the budget is going to pass. Well, tomorrow we run out of time, and given that the hours are 12:00 noon to 12:00 midnight, I'm going to assume that the budget will pass sometime tomorrow, and how I vote, we'll see. (Interruption) You just never know, Leonard.

 

Having said that, this is a good program; this is something that we certainly support, that we think is valuable and long overdue and needed. You can call it whatever you want - entertain it or put it in place. Yes, there are a lot of people, and we both know a lot of those people, too, over our careers. We've run into this and we know the stressors that can put - maybe especially when they're children with this problem, as opposed to some adults, but it's still a stressor regardless. It's a nice investment, $5.3 million; nobody would ever argue that. Could we use more? We could always use more.

 

I want to go back just for a minute on the age group thing, and this is where it gets imperative. All of what I've said so far is about - how come it takes so long, or exactly how much time, we really don't know. Was the announcement that you made with regard to this - and I could pull out the budget book and look back at the numbers and dates if I had to - but January 1, 2014, was this to be effective then? I thought that it was, and I see the deputy saying yes, so that's okay. I think in the Budget Address that's what it was. Again, I could pull it out, but you've probably got it there anyway.

 

The concern, of course, is here we have a bunch of 18-year-olds - I don't know what the numbers are. Anyway, there are a bunch there who are going to turn 19, and I think of one case that comes to mind specifically - they're 18 today, they're going to turn 19 in July - so what that basically means is they're not going to opt into this program; they're going to be left out of the pump piece of it being supplied, but until 25 there is a supply issue of what's needed, accessory-wise.

 

Given that the program is announced - the budget will pass tomorrow, as we talked about a few minutes ago, I'm going to assume, but I'll ask the question. So this person goes out and buys their pump. Let's say that they were able to, or take out a loan, if need be, or something like that; they probably can't afford it, but if they did and they bought the pump, is there - I'm going to call it a "rebate option," for lack of a better term. That's something we're familiar with in government. When the program comes into place, is there an opportunity to say, here's my receipt, minister - after your budget passed and the announcements were all made, which are well and good - the pump had to be purchased. Is there an opportunity there for some of this, or is this just no, sorry, when the program is in place we'll look at whatever the numbers are at that time?

 

MR. WILSON: I think that's one of the challenges any minister or any department has when they bring new programs forward or announce new initiatives. It's very hard to try to have any kind of retroactive policy in place, because there will always be somebody who falls just short of that. So if you said from January 2013 on, someone in December who might have received one in 2012 would say it's not fair.

 

It's a big challenge when you do go forward with a new program and you put parameters in place. It's a challenge. We are not in a position right now to say that we could implement that, so really, no, there won't be an opportunity for anybody to come forward with a receipt who has bought one in the last year or maybe the last two years. That's unfortunate. We're just not in a position to be able to do that now.

What I would like to say, for those who were there, who are out in the community, who are dealing with diabetes, is that the best person to talk to is their primary care clinician, their family doctor, their nurse practitioner, or their specialist to see where they are in their treatment or their control of diabetes, and to make a decision on what they can do. A couple of options - should they try to seek the possibility of utilizing the long-lasting insulin, for example, for some time? That could be an option. Should they continue on the path of injecting themselves in the normal manner that we know about right now, and maybe hold off a little while?

 

I wouldn't want to be the person to give any of that advice. They need to have that engagement with their clinician; they need to ensure that they discuss it with their family doctor. Our commitment is to get this program up and running as soon as we can. We have a diabetes program that is well-recognized across the country. I want to make sure that we provide a program that meets the best standards. We know that our neighbours to the north in New Brunswick have a program there, so we want some discussions with New Brunswick to see if there are opportunities to work with them to get the best possible price, for example.

 

We're going to try to move forward. I encourage people to have that discussion with their doctors to see what options they have over the coming months, but in the environment we're in now, we're going to go live with a program, and it will start on that date. To the best of my ability, I'll try to tell Nova Scotians exactly when that's going to happen.

 

MR. PORTER: I guess I wasn't really thinking about - "rebate" might not have been the right word, but I was thinking about - going back a year or two or anything like that - even from the time that the budget passed and we're into a new budget year, the money has been allotted in a program, the $5.3 million, in the coming fiscal year. That's where the idea came in, that it would be pertinent. If the money was there, why wouldn't we cover the cost of that? It is in this fiscal year and shouldn't matter when it really starts. It certainly won't matter to those individuals who are caught in the middle, if you will, for lack of a better term. It will certainly matter to them.

 

I know I only have a few minutes left - about nine minutes, if I'm looking at the clock right. I want to move on to one last thing to finish off, and that is the mobile breast screening units. I've probably written to you in the past on this. I'm sure I probably have, and I know we've talked on it outside of this Chamber. I still have quite a few people who come to me, the ladies who use this unit. You're probably familiar with where I come from in Windsor. The hospital there was widely used, and every year it grew. We were up to three and four weeks of this unit being in place. I know that you've moved to the hospitals and the digital mammography; I understand that from a medical perspective and the idea behind that, and I think some people do.

 

There are many others, though, who come from more remote areas, who probably - I don't want to say all they would do, but what they would do is come to Windsor - are not going to go to Kentville or to Halifax, and probably won't go to the hospital to have it done, for whatever reason. They have come in. They've signed petitions. This concerns them a great deal. I'm not saying that where we've gone with better technology isn't a good thing; I think anything that we can use to detect the problem of cancer earlier, the better. We want to catch it early.

 

I have a house full of women, and I can tell you that the scenario at one point in time - the data was one in four would have breast cancer. Well, there are five in my family, and that's always on my mind when I think about this topic, and I wonder on the averages and numbers, who will be affected? The potential that somebody - maybe one or two of them - especially with history in families and how that all goes, you often worry about that.

 

The breast screening program is an important one. I would be the first to stand here and say that. I believe the mobile unit is also extremely important, and the taking away or moving that from the area of Hants Community Hospital - the many, many appointments that were set up, so many people have gone through that who we fear now will not and have said that they won't. I guess that's where I'm more concerned.

 

We can say all we want about the programs that have been moved elsewhere - the fact that they're not going, and said no, I'm not going to bother, is the greater concern. You know, they didn't mind going to the mobile one, but I don't know what your thoughts are on that. We probably won't see a mobile one again, and given that, how are we actually educating? There must be a record - I'm going to assume there's a record of all the folks who have come in over the years and gone through the process of mobile. Are we sending things out and educating, encouraging, and telling them why? I'm just going to assume that we are. Is there contact being made with them to continue to go to breast screening even if it isn't the mobile one, and if so, what does that look like?

 

There is one lady who has been driving the charge at home, and I've been dealing with her. I haven't talked to her in a little while, but I did want to raise the issue, and I'd like to hear your thoughts on that before we close in a few minutes.

 

MR. WILSON: This is an important area for everyone. I think we all know someone, either a family member or someone in the community, who has dealt with breast cancer. This is an area where I wanted to ensure that we were moving in the right direction.

 

I know early on in our province we had limited access to old technology, which wasn't reliable. It often gave misdiagnoses and the need for other, additional tests. When the government made the commitment to upgrade the technology to digital mammography from the old film technology, it was a wide consultation. They looked around and tried to engage as many people as possible to move that technology and make sure that we had access to the digital mammography. The original site was in Halifax, and then we had three mobile mammography units that used the old analogue technology. They travelled all over the province getting into those rural, remote areas.

 

Today we have 11, I think, but we started in Yarmouth, in Sydney, and then Halifax, and now we have them throughout the province. We have really good data on this. Dr. Judy Caines, who is well respected in this area, wants to ensure women have access to the care that they need when it comes to mammography testing. I'm very confident with the recent changes of not only having all of the fixed sites, but we have a good map of the province. Now we have a mobile unit that has the digital technology on it going around the province. There were some standards that were accepted, some communities that were really close to the fixed site, and we encourage people to utilize them.

 

The mobile sites - Dr. Caines said that we'll continue to look at the program, and if there need to be shifts and changes, then we will. We have really good data on this - and I'll try to get it for you - that shows that one of the trends we've seen was that there was a huge drop in the use of the mobile units and an increased use of the fixed sites, because they have better digital testing. With the mobile units that we had, the old analogue, if there was a movement or you didn't get the right picture, you didn't know about it until they were done with that site - move to the next one, move the films to wherever they had to develop them, and then say, oh, by the way, go to a fixed site and get it.

 

You might have more questions, so I'll leave it at that.

 

MR. PORTER: Mr. Minister, just quickly in finishing - I know our time is drawing close, and I appreciate the opportunity to come back to you - I guess all I wanted to say to finish this piece off was, given that we were a big user, if you will, many weeks at a time in the Windsor-West Hants area, I would still see it as vital that we consider - I know we're close to Kentville and close to Halifax, but just given the amount of use it got, I hope you give it some serious consideration. They would love to see it come back. I think it would continue to go for weeks, to be perfectly honest with you, because it's something that the local ladies there did believe in very much.

 

In closing, with just a minute or so left, I want to say thanks very much. It has been good, the back and forth for a few hours that we've had throughout the course of the estimates. I know that the member for Argyle will pick up where I've left off, and probably have some fun back and forth as well, and ask some good questions. With that, Mr. Chairman, I'll end my time, and again, thank you very much.

 

MR. WILSON: One of the things about the changes that happened to the mobile unit was the fact that there is such good recordkeeping, and we're going to continue to monitor that. The program itself is going to monitor, and they encourage women to get the testing done. We'll continue to evaluate it, and as I said earlier, we have really good data on the usage.

 

Now that we have the 1-800 number, one number for people to call, it might be as easy as if they're coming up to Halifax to go shopping they might be able to get an appointment in Halifax. We're really trying to make it as easy as possible for the access to the screening and to the test, so we will continue to monitor it. If we need to make improvements, we will.

 

MR. CHAIRMAN: The time has elapsed for this round of the Progressive Conservative caucus' questioning. I have been asked to take a break at this point, so I think what we'll do is recess for five minutes.

 

[7:51 p.m. The committee recessed.]

 

[7:58 p.m. The committee reconvened.]

 

MR. CHAIRMAN: Order, please.

 

The honourable member for Kings West.

 

MR. LEO GLAVINE: Mr. Chairman, just at the end of the last hour I had asked the minister to make some comments about the Nightingale program. I've now heard from enough doctors to realize that there are concerns. If it continues, as it was on some occasions last week, it is going to be an issue that could be more public than it is at the moment.

 

MR. WILSON: As I said in a lot of answers over the last couple of days or sessions that we were up in estimates, IT definitely plays an important role in recruitment and retention - providing a good work environment for us to make sure that we have doctors, for example, but other health care providers working in an environment that is supportive through technology.

 

Of course, we have the Nightingale system here in the province. We have 864 physicians or individuals on that system. We spend $2.6 million a year on that, so we pay for it, the physicians use it, and we even provide some support for physicians who are willing to come on to the system for technology upgrades to their offices. This is a program that we pay for, and we know that with any system there are challenges and issues, and we're trying to work through that currently. With any system - it doesn't matter what system you have in place, there are going to be some bugs in it. We all run offices, we all have computers, and we all have software that at times goes down. We want to limit those numbers, especially where this software is utilized by physicians to implement and support individuals who are getting care within the health care system.

 

We know that there have been some recent issues around it. We're working closely with Doctors Nova Scotia to see how we can ensure that we do the upgrades that we need to the system and that we look at what options are out there, if any, as we move forward. I think it's important to recognize that the province is the one paying for this service. It's another opportunity for us to try to create an environment that is appealing to new graduates.

 

We have 864 individuals on the system now, and we're really trying to work out those bugs. We are hearing from physicians, we know that, but I think we have a good handle on it. We are hoping that we can fix those bugs in the system in a quick manner so that it minimizes the disruption to a physician's office when they find themselves yelling at a program on a screen.

 

MR. GLAVINE: I thank the minister for that response. I guess it's something that the doctors themselves will be providing information as time goes along.

 

I'll move to the Wait Times Reduction Fund. I have a couple of questions about the Wait Times Reduction Fund. It's found in General Revenue on Page 2.3 of the Estimates and Supplementary Detail. Could the minister please indicate what initiatives will be funded with the $6.7 million the department is receiving this fiscal year?

 

MR. WILSON: We're trying to go through and get an exact itemized list of some of the initiatives. Wait times is an area where we want to make sure that we have an impact on any of the investments we do - it doesn't matter in what area of health care. We'll take orthopaedic surgery, for one. When we see a long wait-list, one of the things we want to do is bring forward initiatives that can have a positive effect to them, by reducing them for the most part. This year, of course, we're providing $6.7 million in the Wait Times Reduction Fund that will hopefully do just that, to really go after some of the wait times that we see within the health care sector that are unacceptable. As we're trying to get those, we'll get a detailed list for you, and I'll provide you more of a detailed list on all of the initiatives that would contain the $6.7 million investment.

 

MR. GLAVINE: Mr. Minister, under General Revenue, Page 2.3, we noted the feds transferred $6.787 million last year - $6.8 million was spent. I guess - much like what I have just asked - what initiatives to reduce wait times were spent in 2012-13?

 

MR. WILSON: One of the things we're going to try to do is pull all that information, because it resides in different areas. As much as we try to provide as much information - you know how thick this Estimates Book is - there is a much larger one sitting in the Department of Health and Wellness, where we really drill down. We'll endeavour to get that breakdown for you and provide it to you as soon as we can - hopefully by the time we're finished here - but if you can continue on with another question?

 

MR. GLAVINE: This is related in the sense that since 2009, the NDP Government has received $34.246 million from the federal government in the form of a Wait Times Reduction Fund. I know it's not the same amount that was received when the Progressive Conservatives were in government, but it's certainly a major amount of money.

 

So here we are, ranked as one of the worst performers when it comes to some of the national benchmarks for wait times in the country, when we have been in receipt of $34 million - not to mention the multi-millions that were received prior to 2009.

 

I'm wondering if the minister could indicate why we have not seen the sort of accountability report when it comes to the receipt and spending of the $34 million for the Wait Times Reduction Fund. I think that's one of the areas that Nova Scotians need to have some clarity on. I mean, we heard about the direct $2 million blitz to try to reduce orthopaedic surgeries. The minister referenced orthopaedic surgeries just a few moments ago. Through March we did have a concerted effort to try to bring some of those numbers down, and they still remain very challenging.

 

MR. WILSON: Thank you for the question. It does shine a light on a little bit of what the environment has been like over the last couple of years with our relationship with the federal government when it comes to health transfers. We all know - or Nova Scotians should know - that the accord will be wrapping up in 2014, and the federal government has decided to go to a new model of funding health care for the provinces. I think we're at about 20 per cent to 21 per cent of our overall budget in health care coming from federal transfers, when originally the transfers were set up to provide a 50-50 cost share.

 

We've seen over the years the federal government scaling back its - I would say - obligation to the provinces and territories, where we're now at roughly about 21 per cent, I believe, of the federal transfers. Just recently, we got word from the federal Finance Minister - not the federal Health Minister - about the winding up of the Health Accord, and the new agreement would be as stated by the federal Finance Minister last year.

 

So we are concerned about the future funding of health care. It's going to be really tied towards the demographic population or the population of a jurisdiction around the country, which isn't very positive for us. We know our population isn't growing. We're less than a million people; we'll probably sustain that over the next number of years. Our projection - if you were to keep the same annual increases that we saw under the 2014 Health Accord, we knew where we would be in the next number of years, and the funds that will come to us are significantly less. Jurisdictions like Alberta, who have seen a spike in population, are going to receive a lot more money. I know there have been figures thrown out, but over the next number of years they will see an increase of over a billion dollars of health transfers to Alberta.

 

It concerns us to the point where what that does is it limits smaller jurisdictions like Nova Scotia on trying to promote and provide as many services as possible in our small jurisdictions. When we look across the country at what jurisdictions can give and provide, it depends on the money and the revenue that you have.

 

We're concerned that we're going to see more of that health care transfer to larger populations like Alberta. I have to say - and I don't think I'm divulging anything that I shouldn't - at one of our more recent meetings with the ministers across the country, we were all taken aback by the way that there was no real negotiation when it came to the health transfer and the Health Accord - even from Alberta, who said, listen, we're going to benefit from this, but - and this is a Progressive Conservative Government Health Minister saying it - we understand there is some unfairness around how this was negotiated. There was no negotiation. It was just told to us: this is how it's going to be.

 

So we're going to be challenged over the next couple of years. We've now seen the federal government walking away from a lot of the initiatives that they had responsibility over. We've seen a reduction in funding, and some funding stopped completely - around supporting Aboriginal Nova Scotians in nursing homes, for example - a cost that we're going to have to look at back-filling. We see a shift on providing experts for rabies testing, for example, which we're probably going to have to back-fill. We've seen changes to the refugee health care program that we're probably going to have to back-fill. We've now seen suggestions around changes to the services provided to RCMP members, to veterans, that we're most likely or probably going to have to back-fill, which is going to create a lot of pressure for us over the next number of years.

 

So if we don't see the increases or the changes or the amount of money coming toward us through the Health Accord that we have now, we're going to see less money, but we're going to see more need for the province to back-fill some of the programs.

 

The other area - I just received a letter within the last couple of weeks from the federal Minister of Health that stated that they're going to withdraw and start reducing - well, reducing over the next two years, but stop funding toward the Health Council. The Health Council was in place to oversee - I think where you were going - around wait-time reduction strategies around the provinces and territories.

 

Now we have a decision to make as Ministers of Health of provinces and territories: do we now back-fill the Health Council? That will be on the agenda of our next provincial-territorial meeting. I'm sure it will be brought up in the federal-territorial-provincial meeting in September, I believe, in Toronto.

 

We're going to be challenged over the next little while. We're seeing the reduction of some of those programs, and that's the challenge when we have the federal government, who want to be part of some of the initiatives in health care, often just for the start-up, really, and then they kind of walk away a bit and leave the provinces in a position where they need to make some tough decisions.

 

I talked about the long-term care for veterans, for example. The federal government provides long-term care for veterans across the province. We have a great long-term care veterans' facility here just down the street from the Legislature, but we also have veterans' beds designated in many long-term care facilities across the province. We don't know the intention for the federal government to continue to fund those. These are going to be empty rooms, technically, that got federal funding from the federal government - we're going to have to pick that up. I mean, I'm not going to say, oh, we'll think about it. These are rooms in existing facilities that we fund, so we're going to have to come up with that.

 

That dollar figure alone is in the tens of millions of dollars; it could be upward of a hundred million dollars. We don't know the exact impact. Part of the challenge is trying to get the federal government to be at the table and negotiate and talk this through. That has been the challenge over the last number of months.

 

Another area - and it goes to the Nightingale technologies sector - is the federal government looking at cutting off the Canada Infoway initiative. It's extremely important to the jurisdictions across Canada to have that support. So we have a number of challenges over the next couple of years that we're going to have to face when it comes to trying to reduce wait times, but more importantly, to continue to provide services for Nova Scotians but then try to back-fill all these initiatives that we've seen a reduction in from the federal government.

 

It was interesting in our meeting here in September, I believe, of last year when the deputy minister and I were there. We had a private meeting with the federal minister, saying that many of the ministers across the country - and this is every political Party there is - were upset with some of the reductions. The response I got from the federal minister was, well, that's not my department, we didn't make those cuts - which I can appreciate. The cuts for the veterans' beds, potentially, and the RCMP came from Veterans Affairs. The reduction in Aboriginal support for health care came from Aboriginal Affairs. They all came from different departments federally, but provincially they all land at the feet of the Minister of Health and Wellness, and the Department of Health and Wellness.

 

That was our concern, and we relayed our concern to the federal minister, saying, we appreciate the federal Minister of Health at least being at the table with the provinces and the territory ministers. We appreciate that because we don't have that luxury when it comes to the Premiers of the province and the Prime Minister. He has refused to meet with the Premiers, and so that was my message to the federal minister: you're my avenue to your federal caucus members in Ottawa. That's why we're concerned about it, because most of the reduction we're seeing in the federal government is landing at the feet of the Health Departments across the country.

 

So that's a little broader than what you talked about or your question, but wait time reduction is important for us, so we're trying to invest. We did the investment for the orthopaedic blitz that we did, the $2 million, to try to reduce those wait times. I know - and I said this earlier in an answer - we do really well in the province for those emergency surgeries. Those cardiac surgeries, those life-saving surgeries, we do extremely well. We know we're challenged and we need to do a better job when it comes to those non-urgent surgeries - the hip surgeries, the knee surgeries. Most of those orthopaedic surgeries do have a longer wait time. That has been a challenge over the last number of years for consecutive governments that try to harness and figure out exactly how to support and fund reducing those wait times.

 

MR. GLAVINE: I guess I will just probe one little area. I'm not going to do a post-mortem on the Valley having lost Dr. Andrea Veljkovic. That has been looked into. The minister has spoken as to why not keep her in the province at this time and so on, but during what became a public look at one of the areas of orthopaedic surgery - and that is foot-and-ankle - Dr. Mark Glazebrook was very public about his very long wait-list.

 

What I am concerned about is, when you have that kind of lengthy wait-list - many in the five to eight category - we also know that there are some complicated and needed surgeries from week to week. I'm wondering if the province ever sends a patient who needs orthopaedic work, especially when we have such a long wait-list for foot-and-ankle - do we send patients out of the province? Our highly trained orthopaedic specialists, are they able to handle all of the cases here in the province? We know that there is a great need to work more toward the benchmarks that are there.

 

I'm sure many of us, as MLAs, have had people visit our office who are in the one year-plus category, and how it has impacted their lives when they can't have that hip and knee surgery. In many cases they are not always the elderly or the very elderly. They are people who are still working, and they've been off work for nine months, a year, 15 months. We know getting these Nova Scotians back to work is certainly good for our province, good for the well-being of those people.

 

But my original direction there was, do we send people out of province? We know some people who were told, it will be very difficult to get your surgery done within 12 months. You can put your name on a wait-list, but there are some who opt - who are in that financial position - to go to a private clinic, go to another country for their surgery. I'm wondering if we send patients from time to time to deal with their needed surgery.

 

MR. WILSON: That's why it's so important for the province to have what I think is something that will allow us to look into the coming years on the requirements of specialists here in the province. I'm talking about the physician resource plan that we have. It took a snapshot of what we have, and then it is a document that will show where we need to go into the future - really trying to make sure that we have the right mix of specialists in the Province of Nova Scotia.

 

When it comes to orthopaedic surgery, we have a number of orthopods across the province. In the Valley, for example, we have a lot meant for that district to have five orthopaedic surgeons. We know in recent years we are finding more individuals having those sub-specialities like foot-and-ankle surgery. There are new techniques sometimes that someone might have learned in their training somewhere in other jurisdictions, and they come here and are recognized as an expert in a certain aspect of orthopaedic surgery.

 

For many years the orthopods in our province would perform the whole range of orthopaedic surgeries. They would do the ankles and feet; they would do the knees - all through the spectrum. We know that some of them - when you do find a physician who comes into our complement or into our system, if they are known to be more of an expert, we tend to see a lot more referrals - well, go see Dr. X, because they've learned from the best surgeon in the world and they're experts - so that puts a greater burden on that individual surgeon. Their wait-list can tend to grow because of those referrals to that person. They know that they're one of the best at it. The unfortunate thing is that we can't ensure that we have the best subspecialists in all disciplines here in the province.

 

We do allow for Nova Scotians to leave our jurisdiction and seek surgery in another part of the country, though - for example, under the public system, where we will cover that cost. We have had examples where someone has gotten a referral to go to Moncton, for example. We will not cover the travel costs, but we will cover the cost of that orthopaedic surgery anywhere in the country - in the public system, not the private systems. If you're in Vancouver and you can get in and see an orthopaedic surgeon for knee surgery, the Province of Nova Scotia will pay for that surgery or compensate British Columbia for that surgery. We won't pay for the travel costs or anything like that.

 

It's another option for Canadians. I don't think a lot of Nova Scotians know about that option. If you have a family member and you're visiting, there's another option there.

 

There are challenges, because if that jurisdiction has wait times you're not going to be able to jump the queue and get in there, but there are jurisdictions around the country that are doing good jobs on managing wait times for orthopaedic surgery and other surgeries, so that option is there.

 

As we move forward, we are going to continue to work with our orthopods in the province to make sure that we have a good complement. If we can bring on a new physician, if there's a position available, we want the best candidate to apply for that job, and we want to be able to provide as many services and subspecialists as possible. We do need to recognize that one orthopaedic surgeon, for example - I think the base minimum would be about $0.5 million a year. In the Valley and the member opposite's region we have five orthopaedic surgeons, so everybody can do the math. I mean, it's a large investment, and part of the challenge has been trying to ensure that people have access to and are referred to specialists who can provide them the service.

 

Each orthopaedic surgeon does manage their own wait-lists, and there needs to be some work done on that. That is the engagement we're going to have in the coming months, is to try to support those surgeons to maximize their ability to perform the surgeries that are needed for Nova Scotians who are waiting, but there are some challenges by the system we have in place now.

 

The surgeons in our province, especially the orthopaedic surgeons - all surgeons, but the orthopaedic surgeons do important work. I know, as I said earlier, we do a really good job at managing the wait times for the serious illnesses. If your condition is life threatening, you're in there and you're getting the support. We know that we need to do some more work on those that are less urgent, but not to diminish the importance of those surgeries.

 

I know the impact on someone who might be waiting for knee or hip surgery, and the limitations that they have. The less mobile they are, they may even be more of a shut-in in their community, especially if they're in a rural community, if they can't get out and walk around or they find it difficult. We know we need to do some work on it.

 

As I started with, I'm disappointed with the federal government's approach to backing away from supporting the provinces on some of the initiatives within health care, and what I feel is the opportunity for the federal government to be partners with all jurisdictions across the province, as we try to make sure that all Canadians have fair access to health care and try to make a real impact on those surgery wait times, especially in orthopaedics.

 

MR. GLAVINE: One of the areas that will lose an orthopod in the coming months is Pictou. I'm wondering if the planning is in place to be able to provide a replacement. The minister has certainly outlined the need in this area, and as we know, the need in our province is going to grow. Do we have advance planning to make sure that that position is filled?

 

MR. WILSON: Yes, we do. We actually have posted the position. I believe the last information that I received, or that the department received from the area, was that there were over 35 applicants for that position. I remember the days when you wouldn't get that many, so that's very promising for our province - 35 applicants for that one job, and hopefully we'll be able to announce soon who the successful candidate is. I look forward to them getting to work and reducing the wait times.

 

MR. GLAVINE: I'm moving to a different area to talk a little bit about the Stroke Strategy. It is my understanding on Page 13.11 of the Estimates and Supplementary Detail that funding from the Stroke Strategy - a line item has been cut, with some of it reallocated to Cardiovascular Health Nova Scotia. I'm wondering if that is a correct development.

 

MR. WILSON: Yes, the budget for that is the same, which would be $2.8 million. That has been reallocated to go directly to the district health authorities, so they will be accounting for that funding.

 

Again, a bit of a theme this year with a lot of our programming is making sure that, as we report it, it's under the most appropriate line. So no reduction - same budget, but you'll find that in the district health authority's budget. Some of it also - I want to be very clear - went to a transfer of the stroke budget to the district health authorities, but also the Nova Scotia Hearing and Speech Centres and Cardiovascular Health Nova Scotia. It's the same budget, just aligned better with the programming and access to that funding, and better reporting under the budget.

 

MR. GLAVINE: Do you have the amount there that did get transferred to Cardiovascular Nova Scotia?

 

MR. WILSON: The breakdown would be a transfer to the district health authorities of $2.1 million; the transfer to the Hearing and Speech budget would be $248,000; and then the transfer to the cardiovascular health budget is $471,000 - so that's $2.848 million, and that was what was in last year's - $2.848 million.

 

The Stroke Strategy is something that we should be proud of in the province. One of the key things for anybody who is dealing with or finding themselves having a stroke is to make sure you get access to care as quickly as possible. That's why we have changed the protocols for paramedics: if you go to a call and know that someone is having a stroke, you don't just take them to the closest hospital. You take them to an area that's ready to receive them - there are stroke centres throughout the province that are best suited to provide the care.

 

The fast access for the care is extremely important. The sooner you can get in there and hopefully clear up that clot, the better outcomes you have, and the less rehabilitation. We know that the sooner you can get in and clear any issues up, the less impact there is on the overall health of an individual.

 

We're very proud of the Stroke Strategy moving forward with it. We've been recognized as having one of the best stroke strategies across the country. What we've done with the transfers of the budget is make sure they align with the appropriate organizations that provide the services, but more importantly, access the $2.8 million that is utilized to implement the strategy.

 

MR. GLAVINE: Other Program Initiatives, on Page 13.11 of the Estimates and Supplementary Detail, has been reduced by $796,000. Could the minister please outline what specifically has contributed to the $796,000 reduction, and what program initiatives will be impacted?

 

MR. WILSON: As we see the movement of some of these allocations and other program initiatives - when we have that kind of line, it's trying to combine the stuff that doesn't have a defined home, I guess, within making up the budget. One of the things we've done is some savings we realized as a result of the program delivery rationalization and internal transfers of HANS funding. I'll try to explain that fully.

 

What we've done is tried to transfer out - trying to clean up the budget of the Department of Health and Wellness, for one, to try to ensure that those programs that are utilizing the funds that we allocate are housed in the most appropriate thing. We've transferred some funds over to HANS - and we can get into more of that, or I can get more details for you on that. We've realized some savings as a result of - that covers that first one. Operational efficiencies, which is Miscellaneous, and that's in there. Over the last couple of years, one of the areas we've really worked on is health administration and any savings we could find. The next one - reallocation of administration for strategic initiatives.

 

What I'll try to do over the next day or so is get a little more breakdown on exactly what those terms mean. As I said, one of our exercises over the last little while is to ensure that we are presenting the budget in the most efficient way with some of the changes in accounting - making sure that HANS, for example, if they're utilizing the money, they have to account for it. I'll try to get a better breakdown for you, and I'll just leave it at that.

 

MR. GLAVINE: On Page 13.11, I note that the BTO - Boarding Transportation and Ostomy Program - has not increased from last year's estimate. Could the minister please confirm this means there have been no changes in the income thresholds for this program?

 

MR. WILSON: It really just reflects what we've been spending. As I indicated when we started our Budget Estimates, we have a small increase of 1.3 per cent this year. We're really trying to ensure that we have a budget that is sustainable as we move forward, so programs like this are important. I've asked questions about it myself to the former minister on a number of occasions.

 

I wish I had some of the money that the former government had in actual royalties, for example, so that maybe we could increase that, but when you don't have access to - the last year they were in government I think it was $450 million in offshore royalties, I think we had $20 million last year - we're limited on what we can increase on some of the programs. I wish we could increase more.

 

One of the positives, and I think it is a positive, is that we've protected the funding for that this year in the program, but unfortunately we weren't able - I guess we weren't allowed - to look at increasing that this year.

 

MR. GLAVINE: One of the areas the minister is very familiar with - and I know we had a wonderful presentation around arthritis right here at Province House - and the scenario that is going to continue to have, I think, exceptional demands as our population ages. In 2011 the Arthritis Alliance Report noted that the price tag for arthritis in Nova Scotia is probably in the vicinity of $1.5 billion a year, with $500 million of that being a direct impact on our health care system.

 

Given the impact of arthritis on our health care system, what steps is the government taking to reduce costs by cutting wait times and helping people receive earlier treatment?

 

MR. WILSON: One of the things we're doing is trying to reduce wait times. As we move forward, we try to look at best practices, try to see where we need to put more energy in services in the province. It's a challenge - when you have limited funds, you have limited opportunities to provide additional services. We depend on organizations to come forward with initiatives; we depend on organizations to work with government and work with the district health authorities to see if there are opportunities there that might not cost a lot of money.

 

There are a lot of changes that can happen within the health care system that can happen without spending a lot of money - everybody just assumes that you bring in a new program or bring in a new service, that it's all about just having the funds to pay for it, but there are a lot of opportunities. We look toward organizations out there that are providing support for individuals, no matter what their ailment is - if it's arthritis or there's the Heart and Stroke Association, the Diabetes Association, we'll look at all of those partners.

 

I meet with a lot of them on a regular basis; I try to be very accessible to them - sometimes a little too accessible because over the years, 10 years in this job, as you said, as MLAs alone you meet and you build relationships with a lot of these organizations. A lot of them I know, a lot of them I consider friends.

 

The challenge is trying to work together. I have to say a lot of the organizations, a lot of people within the health care system over the last couple of years have really wakened up to the fact that there's not going to be a lot more money coming into the system. We have a lot of money in the health care system now - this year we have $3.9 billion. There are a lot of opportunities within that budget envelope to see how we can have an impact on wait times, for example, or improve health outcomes.

 

I've said it before, and I'll say it again - I'm very open to look at a program. If we're not getting the end results and the positive impacts that we desire, then we should be looking at those programs to see how we can improve them, change them, and mix them up. We rely on a lot of the organizations to educate us on what's new out there. Often organizations have access to information that we might not have, or a connection with other organizations that might be doing something different in another jurisdiction.

 

We're going to continue to work in that manner and, hopefully, have a good impact on the health outcomes of Nova Scotians.

 

MR. GLAVINE: I'm sure the minister is aware of national reports that clearly show that inflammatory arthritis has a greater mortality rate than we find with melanoma, arthritis, and HIV, combined, and despite that we have only, I think, four provinces in Canada that recognize it as a chronic disease: B.C., Alberta, Ontario, and Newfoundland and Labrador.

 

If we take a look at the cost impacts and the mortality effects of inflammatory arthritis, could the minister please indicate whether he agrees that inflammatory arthritis should be considered as a chronic disease and is it within the current purview of the Department of Health and Wellness to re-evaluate where we are in terms of that recognition of inflammatory arthritis as a chronic disease, because we know that gives a different status within the health care system?

 

MR. WILSON: I know all members over the last number of months have had discussions with the Arthritis Society; I know they held an information reception here in the Legislature in our last session. I've met a number of times with them; we know former members are involved; a former Speaker; a former Minister of Health - they are all involved in that organization. I see the merits of what they're trying to do, how they're trying to move forward but to designate it as part of those - I mean it is a chronic disease, what they want is for us to define it as one of the chronic diseases that receive funding, a lot of it federal funding, to manage.

 

The challenge we have is I don't think, as Minister of Health and Wellness, even though I do have a background in health care as a paramedic, I don't feel that I am the individual, or any Health Minister in the future, should be the sole person to say yes, let's deem that a chronic disease, let's start ramping up the information and the support for it. That's why we rely on the experts, we rely on those within the field to push those policy changes forward.

 

I relayed this to the Arthritis Society - we do have a committee currently looking at chronic disease rates in the province and in the country. They are looking at a number of new areas where they may identify something new to the province as a chronic disease. I encourage them that that's the dialogue they need to have with clinicians and family doctors to make sure that if this is an area where we need to have what they want designated as one of the big chronic diseases, then that needs to come from the profession, that needs to come from the experts in the field who are dealing, on a regular basis, with treating people with arthritis.

 

I think that is the process we need to make sure happens. It shouldn't be my decision alone, as minister, to just name a new one. So they are working now. Part of the challenge is - because I know in all the presentations they made to all caucuses they said there was no real financial impact, but there is when you really drill down and look at it. The federal government has a pot of money that goes toward chronic disease management across the country. It's sad to say that they're not increasing it, so any addition in Nova Scotia, for example, to that chronic disease list means that the money that we have allocated from the federal government will be dispersed or watered-down even more, so there'll be less for the other ones to bring in a new designation.

 

I'm concerned about that, because we know that many of the chronic diseases are challenging to manage, are challenging to try to ensure that we have the right policies and procedures in place to target them or to reduce the impact that chronic diseases have on the health care system.

 

We're not saying no about the request, all we're saying is that they need to make sure that they're doing their work. I think it has moved quite quickly - this is an initiative that they just started, I believe in October, maybe November. I've had a number of meetings with them; I have the literature; we've passed it on to the experts that we rely on in the committee, and we are encouraging them to do the same.

 

This needs to be a groundswell from the clinicians who are treating patients in the province who have inflammatory arthritis. Just like us making the announcement to increase the newborn screening programs for cystic fibrosis, for sickle-cell anemia, we relied on recommendations from an expert committee, the Reproductive Care Committee - they're the experts, so they make the recommendations to the province.

 

Of course for this one, as minister, you would have to try to see where you can get the funding, and go to Treasury Board and say this is a new initiative, we want to up our budget to cover that. So we're not saying no, but we are saying they need to continue on educating not only MLAs but the health care providers so that this push comes from the ground up, so that yes, this is an area that we need to designate as a chronic disease and then move forward.

 

So it's open, but it needs to come through the proper channels. I think they're moving pretty quickly, but it is somewhat of a process to make sure that it's all followed.

 

MR. GLAVINE: I thank the minister for that background and also reference to where the process is currently. There is, however, a more immediate concern and that's with the Nova Scotia Rehab Centre, which is the provincial arthritis centre. Last year's budget saw blood collection services at the Rehab Centre reduced from 40 hours a week down to 10 hours. The centre is designated as a patient centre facility for all the services for people with arthritis being housed under the one roof, services of a rheumatologist, nurses, OTs, physical therapists, et cetera.

 

Could the minister please give the rationale for the reduction in blood services - I know it resulted in a saving of around $45,000 - and could the minister provide some basis for that decision?

 

MR. WILSON: This question is a little harder to explain, just because, of course, we allocate funding towards the district health authorities. In this year's budget it's $1.6 billion of the overall $3.9 billion that goes to the district. So the districts take that money, it's split up, of course the larger portion of that goes to the Capital District Health Authority that oversees the Rehab Centre. They are allowed to provide the service and they have a business plan that they produce. So for the more technical reasons on why they reduced it there would be best asked of the district themselves.

 

I know, though, that they've been doing some work around blood collection, especially in the Capital District area. We've recently seen an increase of the private blood collection agencies or companies, a spike of about 25 per cent over the last little while. One of the recent investments that Capital District made, and the province made, was to streamline blood collection and the analysis of that.

 

At the MacKenzie Building, which I think is just kitty-corner of where the Rehab is, is a new automated blood analysis machine which is quite impressive - and I welcome and would try to facilitate a tour for the member opposite - what it really does is address a few issues. One is that we've seen over the last number of years the number of technicians who are working in that field reduced, so we need to maximize the numbers we have and work and utilize them to their best efficiency possible. So this new automated system really can run through a lot of the tests a lot quicker, so that we utilize the clinicians to analyze the testing and, once the testing is done, figure out what is actually going on.

 

One of the things Capital District has undertaken is a change in policy that starting with anybody who doesn't have a current contract with the Capital District Health Authority, will have to provide the blood and make sure it gets to the new processing facility at the MacKenzie Building. Before they could drop that blood off at the Dartmouth General or the Cobequid, and they used to do it there but then those facilities would transfer it in. So it makes sense that if these private companies are working, they should get that specimen to where the test is going to be done.

 

Any current people with a contract will have a year to change over the system. That may play a role a little bit in what's going at the Rehab, where it's so close to the QEII or the old VG site, but to get the specifics I'd have to maybe get hold of someone within the district to give you a little bit of breakdown of why they reduced the hours that they did.

 

MADAM CHAIRMAN: The honourable member for Kings West with one minute and 30 seconds.

 

MR. GLAVINE: I guess with little time, we probably won't go back there at the moment, so just one quick question to finish up from the earlier hour. You did indicate there were 358 medical residents across the province. Of course we all know that the GP area still remains with some challenges. I'm wondering, how many of those 358 medical residents are family medical residents?

 

MR. WILSON: I'm sorry, I put that page back in the book - we're going to try to find it. I know for a fact a large portion of them are general practitioners. We'll try to get you that information.

 

It reflects, too, the new residents that come on the new program down in your area of the province. We're going to try to get the breakdown because there are about seven different types of residency programs - so of the 358 there are seven different types. We've just got to figure out which type it is, and I'll get it back to you.

 

MADAM CHAIRMAN: The time allotted for the Official Opposition has elapsed.

 

The honourable member for Argyle.

 

HON. CHRISTOPHER D'ENTREMONT: Madam Chairman, it's my pleasure to stand for a few moments this evening and I'm going to make my research staff really happy, I'm going to ask some questions that they actually prepared for us so I just want to thank Kaitlin Saxton for being here today and providing us with this - I think Linda would probably be happy, too, because we're actually going to ask about numbers, so we'll see how this goes.

Page 13.18, Capital Grants and Health Care Capital Amortization, there have been steady increases under Hospital Infrastructure. The department is cutting $18.5 million this year. The November 2012 report by the Auditor General examined this very issue with about $600 million worth of capital infrastructure needed over the next 10 years - why is that line being cut?

 

MR. WILSON: Well, I hope the member appreciates this answer - the main reason for that reduction is the completion of the hospital in Truro. I could elaborate on that, but I think since Kaitlin did a lot of work on some of the figures, I'll just leave it at that for now.

 

MR. D'ENTREMONT: You see, this is what happens when you actually have a relationship with the minister a little bit - sometimes he saves me from myself.

 

Page 13.3, Operating Costs, this year's estimate for Operating Costs is $12.3 million higher than the actual for 2012-13 - could you explain the reason?

 

MR. WILSON: Whenever you have these figures here, especially with the sheer number of the numbers we're talking about in Health - we have roughly about a $5.6 million increase - one of the things that we tried to do in this budget and I know I mentioned it a couple of times earlier, is make sure that we have the programs, the grants and the money we offer to services and organizations to make sure they are under the appropriate areas. It's those numbers I can say, and hopefully the member opposite can appreciate from being a minister, that's a very small variance from year to year and it's just making sure that we best account for things within the department. We shift them, next year those shifts could be the other way depending on the influx on the utilization of a program, for example.

 

We had a total increase over all of those line items in department expenses by objects in thousands of about $49 million in total. A lot of that just is reflected in the line items. I don't know if that answers his question, but it's relatively small, that change of $5.6 million is relatively small when you're talking about $290 million, $295 million.

 

MR. D'ENTREMONT: Maybe a quick follow-up on that. What's included in that meaning it's a change from - so if you go forecast to the estimates or forecast what you're actually going to spend this year versus the estimate you're planning on spending, so the difference between $282 million to $295 million, what's included in that group of services under operating costs - and I'm sure that will finish off our hour.

 

MR. WILSON: As I mentioned a number of times, one of the things we've seen is a modest increase, so modest I would say is a small increase of 1.3 per cent this year. That total, we were at $3.8 billion and change, we went to $3.9 billion, so we've seen an increase of $49 million to the overall budget of health care. Hopefully the member can appreciate that a $49 million increase is not a lot of money. We can give an example of $5.3 million for insulin pumps, for example - so a very small increase.

 

One of the things that we had to adjust for is, of course, CPI - so the annualization of CPI makes up the majority of the increase. The overall budget is $46 million, but it was an increase of 1.2 per cent from last year. The other thing is, within that $49 million are new initiatives or expansions of programs - I mentioned the insulin pumps; newborn screening, for example is in there; and increase in home care support. So those numbers are very limited on how we see an increase, but the most is under the utilization, annualization, and CPI, which consumes the most of that. So overall budget increase of $49 million, which is very small - less than 1.3 per cent, and of course some of the new initiatives that we announced.

 

MR. D'ENTREMONT: I'm trying to knock a few of these off as we go. Page 13.11, Programs and Services - the Emergency Care Fund - this was something that was transferred from the Treasury Board Office. Could you please give us some background on the decision and maybe what is included in the Emergency Care Fund?

 

MR. WILSON: That accounts really to the implementation of Better Care Sooner. With the Dr. Ross report that we had, there are about 32 to 34 initiatives that we need to work towards that will improve care to Nova Scotians. Emergency room standards for example - in the Aberdeen Hospital we're moving forward with the redesign of that emergency department to meet the standards set out in the Ross report. This will be our first emergency department in the province that will be built to meet the standards really with a patient-focused approach to it. Often a lot of these emergency departments that we have across the province - and the hospitals that we have - were built a long time ago.

 

One of the things we want to ensure is any new construction, any new renovation that takes place, that we have those standards in place that we can really utilize patient-focused centres as the key - especially we've realized with the seniors who enter our facilities, the system was never really geared up to them. So ensuring that they have a quiet place, for example, is extremely important if you're a senior who finds yourself in the emergency department.

 

I said Aberdeen will be the first in Nova Scotia to have these standards - it actually is going to be the first emergency department in the country that will have ER standards in place and have the focus placed on the patient. So we are very excited. I was down there, I believe I was there in January, to make the announcement with our members from that area. They were excited about it. I received a lot of e-mails and letters from people who congratulated us for moving forward with that. It's important that as we move forward not only do we have the services provided for individuals - especially emergency rooms - we have a system that can react; a system that welcomes people in a much better way than we have in the past.

 

We've all heard the stories of an individual who goes into an emergency department, is probably going to be admitted and finds themselves on a stretcher in the hallway. I've seen it myself, hundreds of times, as a paramedic - taking my patient from a stretcher, putting them in a hospital bed and then placing them under the exit sign by a certain door. We need to get away from that. For an individual who is sick or has an emergency and finds themselves in the emergency department, sitting in that type of environment puts more stress on them. It is not a welcoming place - not that we want a welcome mat in our emergency departments; that needs to be part of the care that we provide an individual.

 

We're glad to see that the standards in the Better Care Sooner plan and the Ross report will be implemented in our province in the Aberdeen as the first one - and the first for the country as a whole. That reflects in some of the changes in the line items on Page 13.11.

 

MR. D'ENTREMONT: We don't want people waiting in hallways more than we need to, and being that I had the opportunity to wait in a hallway a couple of times, it's no fun, so let's see how it works at the Aberdeen. Hopefully there can be some good rollout to other emergency rooms as it goes, whether it's full-service emergency rooms like in Yarmouth, Kentville, or one of the larger centres as well.

 

Let's spend a couple minutes talking about physician services for a few moments. On Page13.5 the Academic Funding Plans are being cut by nearly $19 million - could you give me an explanation of what's going on there?

 

MR. WILSON: Quickly - I know we don't have much time - I'll go back quickly. I think I talked about the ER standards on the last question a little more. Just to give you a couple other areas that that $3 million for the Emergency Care Fund goes toward is the emergency department locum program, so finding physicians to go into those harder-to-fill shifts around the province, that program is $200,000. Another one is the paramedic medical oversight and CEC coordinator costs. Of course, with the CECs, you have a paramedic and a registered nurse in those facilities after-hours, but they also have access to medical oversight.

 

The paramedic program that we have in the province has had a medical oversight for a number of years. If you're a paramedic in someone's home and you have a complicated case where you think it might be different and you're trying to figure out exactly the treatment options, you can call medical oversight. We transferred that in the CECs, so you do have access to a physician even though the physician who is in that community might not be on that night and available the next day for same-day or next-day appointments, you have the use of a medical oversight, who is a trained doctor, who is ready to discuss the case with them.

 

We did have this question earlier, I know you were out doing some agriculture - I don't know what's going on over there, it actually is a transfer and we broke it down and I can get the same breakdown for the member. All we did there was to move it into Physician Services - Other Programs, that's where it was, right? That's where we moved it to and it came from Academic Funding Plans. So it went into Physician Services - Other Programs and that pretty much accounts for everything there, it was $18.975 million moving into that program and that mainly is moved toward - I'm just trying to find it here, sorry - district psychiatry costs and making sure that we account for it in the right line item. One of the things we did is try to clean up some of the line items in the budget this year and what that has done is it reflects a movement of that. The movement was just to Physician Services - Other Programs.

 

MR. D'ENTREMONT: I remember my time as minister and I remember hearing from the previous minister who talked about alternative payment plans as well, but this year I think we're showing about a $4 million decrease in that, so maybe a quick why and maybe what is the status of the plan to encourage more of these alternative payment plans going forward?

 

MR. WILSON: What we've done there is we've transferred FTEs to the emergency departments - Collaborative Emergency Centres - so that was $3.3 million. Also the budget transferred two other programs - the intensive care unit, for example, for the new cost of the centre, it was $3.1 million. The decreases are partially offset by following increases in six physician transfers from fee for service of $1.6 million, and a 2 per cent MUV rate increase, and that's a cost of about $729,000.

 

Of course when we brought forward changes in models of care, for example with the CECs, one of the reassurances we needed to make sure was in place was that when we went into a community to try to figure out and change and support the emergency department was to reassure the physicians who have been working extremely hard in those communities that what we were doing wasn't an exercise that saved money - we weren't going in there to say, how do we save money, how do we reduce what we're paying physicians in those areas and reallocate those funds?

 

The first thing we had to do is ensure and engage the physicians in the communities that have CECs or were expecting to open a CEC, so that they could maintain the income that they had. That was important because that's the last thing we want is a physician who is in a rural community feel that we were coming in to take money away, and we weren't - we wanted to ensure that they could make the living they were making, but utilize them to the best of their ability.

 

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

 

The honourable Deputy Government House Leader.

 

MR. CLARRIE MACKINNON: Madam Chairman, I move that the committee do now rise, and that you report progress and beg leave to meet again.

 

MADAM CHAIRMAN: The motion is carried.

 

[The committee adjourned at 9:17 p.m.]