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29 septembre 2017
Comités pléniers
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CW on Supply (Health & Wellness) - Legislative Chamber (2167)










11:08 A.M.



Mr. Chuck Porter


            MR. CHAIRMAN: Order, please. I call the Committee of the Whole on Supply to order. We will resume the estimates of the Department of Health and Wellness.


The honourable member for Cape Breton Centre, who has 31 minutes left.


            MS. TAMMY MARTIN: Mr. Chairman, we had a great discussion and/or debate yesterday around health care. I want to be clear to the Minister of Health and Wellness, and to the rest of this House that my concern of course is for Cape Breton, but it's for the Province of Nova Scotia. As a health care worker, as somebody who has worked in the system for a very long time, I have a lot of first-hand knowledge of exactly what takes place. I see nurses working every day short staffed, I see them working in less than standard conditions. I see them being injured on the job every day. I see them doing lifts for patients that they have to do without the full complement of staff because they just aren't there.


            Recently there has been maybe an unwritten rule, in order to cut down on costs, that they don't replace the first sick call. You have to realize what that does to a floor when you don't replace the first sick call. You have people that are working short, they're working without their allowed breaks and lunches. They are doing the job of two when there's only one person. To see the state of our health care system is no less than atrocious, what goes on day to day in a hospital.


When you see seniors in a hospital setting who should be in a long-term care facility and can't get a bed, they are in there in a lot of cases without any family members. In one instance, I took clothes in from my grandmother who had passed away because there was a dear elderly lady. She was on an ortho floor because she couldn't get a bed in a long-term care facility. An acute care setting is nowhere for a long-term care patient because acute care is just too acute, for lack of a better word.


The injuries that occur even with these patients who are in an acute care setting because of the fast pace - by no fault of any staff member. Some things happen to these seniors who are not in the right place for the right type of care, and there are serious injuries that happen. This leads me to a very distressing story, and I don't know if the minister heard me the other day in my comments, but when I was campaigning, I knocked on the door of a beautiful elderly man who was 81 and he asked me in and we went in - and it was extremely hot in the house. However, we went in and had a wonderful conversation with him and he was broken-hearted because that day he had placed his wife in a nursing home in Tatamagouche. Tatamagouche is at least four hours away from New Waterford, a drive that not every 81-year-old can do every day. So, they had spent 60-plus years together and they were ending their lives, or the last part of their lives would be spent apart.


What part of that is justified for the people who came before us to provide us with the right to vote, fighting for our freedom, giving us this wonderful country that we live in? Maybe I get too attached to these people that I see but that's the reason I'm here.


Just recently, I had to take my uncle to a home in Truro because, again, there's nothing in Cape Breton, and he has no idea where his family is. His wife doesn't drive. Obviously, I'm a little busy to drive her back and forth to Truro. We do when we can but he has no idea - when he's having lucid moments, he feels as if he was dropped at the door and forgotten about.


I wonder, did this government forget about long-term care? There was an initiative that the government told us that they would open long-term care beds, and since you've been in government, there hasn't been one new long-term care bed opened in the Province of Nova Scotia, and I think that's disgraceful. When you see - and I don't know if the minister has gone into long-term care facilities. I worked in one, my in-laws were in one for quite a long time, and my daughter worked in one when she was going through school - and you see the conditions that some of them live in.


I don't know if you're aware but, because of the budget cuts, there is a nursing home that only allows the CCAs and/or staff to change the patients four times a day. Can you imagine if that was your family? I know if it was my family my head would blow off. My daughter has come home and said to me, I'm probably going to be fired because there is something on the go, you know, with incontinence and different conditions, and she said, I cannot let them sit in their own feces, I can't do it. So, she said, I'm probably going to be fired - she wasn't. But until you work in there, until you see the conditions, until you see - imagine, telling your mother or your father or your grandparent, it's okay, just sit in your messy diaper and that's okay. How does the province justify this? How does this government justify four diaper changes a day?


[11:15 a.m.]


You talked about in - I can't say the Throne Speech because I was absent for some of it, but I have heard remarks that your initiative is to keep seniors in their home for longer. How could that happen? Obviously, one, it has to happen, because there's no long-term care beds available. Two, this government is really cutting back on home-support services. In fact, I think in the last election, the previous Health and Wellness Minister referred to them as nothing more than dishwashers. I can tell you as their union rep, and as a family member whose grandmother received care from those dishwashers, they are a heck of a lot more than dishwashers.


            They go into people's homes. They are the first person to see that resident or patient sometimes for days. They have no idea if they're walking into somebody dead on the floor, somebody who has fallen and split their head open, or somebody who's violent - a lot of times, an Alzheimer's patient has violent tendencies.


            So, these people, one, are disrespected by our government; two, not paid accordingly; and now, three, are being monitored almost to the minute by the agencies who are funded from this government, because they are paid by the minute. They are given tracking devices, for lack of a better word, so they know exactly when the staff member goes into a resident's home and exactly when that person leaves.


My grandmother used to do the floors herself because she would rather have the person sit there and have a cup of tea and have a conversation. These people are no longer allowed to sit and have a cup of tea. Sometimes this is the only contact that the seniors have. When did we get so hard that we can no longer even have a conversation with a senior, who may not have had any other conversations that day?


I will speak briefly though about the situation in Cape Breton, which is atrocious. One of my colleagues talked today about, in excess of 400 days for mental health. My first week after the election, on a Friday afternoon at three o'clock, I had a call from a constituent who said, what should I do? My daughter is threatening suicide. To be quite honest, I almost had a stroke because I had no idea.


I knew the statistics, from working in the hospital. I know that there's no psychiatric services available after 7:00 p.m., and it was a Friday afternoon. So what do I tell this constituent? Let's hope she doesn't decide to - whatever she was going to do; I can't do anything for her. I suggested, of course, that she go into crisis - that would be about 24 hours, but at least, she would be in the system - and/or phone the police. Should that be our advice? I'm sorry, there's nothing we can do, it's Friday afternoon, it's getting close to 7:00, gotta roll the dice and take your chances. Is that what we're saying about the lives and the well-being of Nova Scotians, especially young people?


We have situations in long-term care and in hospital settings and acute care settings, where they don't have the proper equipment. I know I wrote you a letter about a bariatric patient, who is a patient in the NSHA; they do not have the proper equipment for this bariatric patient. I didn't hear back from you. I visit him whenever I'm I town. I saw him on Monday, and he tells me that the hospital has found him a bed, but that's all. Somebody from that floor actually - one from the medical team is off sick because to try to move a bariatric patient without the proper equipment - she has injured herself. So she is off, which will affect her livelihood. Whether she may ever be able to return to work or not, I have no idea.


But I find it very disturbing that there's no faster correspondence between us and between parties, when there are such dire issues that we need to talk about like this bariatric patient.


As I said yesterday, I've had many conversations with doctors from across the province, not just in Cape Breton. One of the most recent worries that I've heard is that at the VG, they no longer call Code Census. So I said, why would they no longer call Code Census? Because now the people know what Code Census means and they don't want the public, who are waiting in an emergency room, to know that oh shoot, they're ready to bust, they're at the breaking point. That's a major concern for doctors, because the province and the government are more nervous that the patients will know exactly what's going on rather than trying to rectify the problem.


            From working in a hospital, I can almost - and I don't know if you read or saw one of my many statements on the mobile care team being closed, but I can almost write the memo that's going to come in January because I've worked there long enough. So in June it came that summer is here, staff shortage, they need more trained emergency room nurses, et cetera. So at that point I said okay, it's not coming back because in September there will be another issue, there will still be no trained emergency room nurses and sure enough, when I met with some hospital officials, they said we'll get back to you. Well the initial memo in June didn't say we'll get back to you, it said the MCT will reopen in September.


            Then September comes along and sure enough, another memo comes, we're pushing it off until January. My comments to my caucus and the people who use that facility and that service are, January will come, flu season will hit, there will not be enough trained emergency room staff, they will have to pull from the other floors and they will have to do a shift again. That will put us off until the Spring and then the Spring will come and I can almost guarantee you that we'll be back into summer vacations and shortages and empty lines and so on. That MCT is one of the services that are slowly disappearing from the New Waterford hospital.


            Now, if I may ask the Minister of Health and Wellness for some clarification, it was brought up in Question Period - I think it's a pretty straightforward answer, or at least it should be - in your document that was given to us on Budget Day, it says: Health Care Infrastructure, create space for collaborative teams in Shelburne and New Waterford. When you were asked the question the Minister of Health and Wellness said - first you said it was $9 million and that the locations hadn't been determined. So to me this says, Mr. Chairman, that either this document is wrong or you're going to change your mind because this clearly says New Waterford and Shelburne. So which is it? You don't know or you do?


            HON. RANDY DELOREY: To the specific question about collaborative care practices in the province, two things. One, the dollar amount that I referenced, I think there's some concern about that, that was mentioned across the way about the $9 million versus the $6 million. Again, there are two variables that go into the $9 million, that's the $6 million towards the collaborative care advancing initiatives and the $3.6 million towards collaborative care teams - staffing through those. So that's why I said it was over $9 million.


            The other thing I believe, in referencing the comment I made earlier today during Question Period, Mr. Chairman, I believe what I stated was I don't believe there had been an announcement of those locations. Although it was in the document, I don't think we had come out with a formal announcement beyond the documentation there but yes, the member is correct, those are the two locations we're focused on with the resources we have allocated in our budget for this fiscal year. So again, that work is continuing and ongoing and we look forward to getting the collaborative care practices up and running there and in other parts of the province.


            With that, Mr. Chairman, I apologize to the member opposite - if I can have a recess, there has been a request for me outside of the Chamber.


            MR. CHAIRMAN: We'll take a short recess.


            [11:24 a.m. The committee recessed.]


            [11:31 a.m. The committee reconvened.]


            MR. CHAIRMAN: Order, please. We will now call the committee back to order.


I wasn't sure, honourable minister, whether you completed the answer there, given the interruption, so if you have, that's fine.


            The honourable Minister of Health and Wellness has the floor.


            MR. DELOREY: I guess just a couple of things, Mr. Chairman, perhaps some supplementary information for the member. I believe I answered the specific question that was asked. Just some of the other comments and concerns that were brought up. I think it is important for Nova Scotians to recognize that the seriousness and attention that we provide towards long-term care and home care for our seniors and the population that requires those services, I believe we do invest significantly. The total budget between home care and long-term care is over $820 million.


            Earlier today, or maybe it was in Estimates yesterday - I think last night during Estimates, I believe when the PC caucus were asking questions about physicians, physician services, that $800 million figure is about the same amount we spend on physician services across the province each year. So, essentially, we're putting almost the same amount of money that we put into our primary care physician services work into our home care and long-term care continuing care investments.


            Those investments we've seen include over the last four years an increase of just under $65 million and so we not just invest but we continue to increase investments, where we can, to support those individuals.


            I would like to say that I think the member raised a very important point with respect to one of the scenarios that was raised or examples, talking about the notions of our aging population and the seniors, when giving the example of the role that a home care support worker or the nurses that provide home care nursing support go in and sometimes one of the few people that the individual, the patient, or the client gets to see and have that conversation with.


            I think the member phrased the concerns in that example, I think questioning when did we stop caring to have a cup of coffee - something to that effect. And you know, Mr. Speaker, I share that same sentiment with the member but I think that issue is not simply a government issue, is not simply a health care issue or concern, I think that's a social issue that the member opposite raised there.


            She's right, it is concerning if a senior citizen or an aging person or person who would require supports within their home, if the only support and social interaction they have is with their care workers. But if the only interaction and social engagement that those individuals have is with the care workers, I think the question the honourable member would really be getting at, or at least the way I received that question and think that it goes to, is really as a society, where are we with checking in on our neighbours, our family members, the people next door?


            I come from a rural community myself, Mr. Chairman, and we still engage with our community members, even individuals who are quite far off the beaten track. You're right that in many cases, those individuals cannot drive or get themselves outside of their home. So it is incumbent, again, particularly for the social interactions, opportunities where we can as neighbours - and I certainly hope more Nova Scotians take that into consideration - check in on their neighbours, particularly if they know that they have elderly neighbours or neighbours with care needs.


            MS. MARTIN: I just want to be clear to the Health and Wellness Minister, because it did get a little noisy there when you were going out. You said that the collaborative money has been set aside. This document lists New Waterford and Shelburne. Is that $6 million just for advancing a collaborative care plan, or does that mean that these two locations will receive a new building? Are you buying land? Describe it to me please. There's $6 million for these two areas in the province. What do you plan to do? Plain and simple, is it a new facility? Is it just buying land? Is it just implementing something that we already have?


            MR. DELOREY: For clarification to the member, the advancement of the $6 million is, again, doing work to develop and move forward with establishing a collaborative care team.


            The infrastructure aspect in either situation that may be required comes out of our capital infrastructure budget. That is a separate allotment of funding. The $6 million is for supports and work right across the province in collaborative initiatives.


            Our focus area, again, is those two locations. We know the infrastructure work in Shelburne is already well under way. It started a couple of years ago, so there's a lot of work on that. Whereas in New Waterford, any infrastructure requirements would be in very early stages. We don't have full details of what the infrastructure needs would be for collaborative practice in that site at this point in time.


            Again, the advancement of the $6 million is identifying and working to identify what would be needed in the configurations of collaborative care in communities. Part of that process when you identify those needs would be the infrastructure requirements. Those funds for any infrastructure needs, whether that's renovations of existing facilities or new facilities, would all be advanced under our capital budgeting.


            MS. MARTIN: Pretty simply, what site? In April, you announced a community health centre in New Waterford. What site is in the very early beginning stages? I'm the MLA for the area, and I'm not aware that anything is being done anywhere in my riding.


            MR. DELOREY: On the specifics around the New Waterford site, what I have been advised and the department has been advised is that those preliminary discussions with the NSHA and some representatives in the community to advance that work have begun. As I mentioned, it is fairly early on. We had conversations where the question has come up in the House about the Roseway site in Shelburne and how long that process has taken, going through multiple governments, to advance. We're at the point of the actual infrastructure equipment and work being done on the ground there now.


            When you get into health care complexes, it is a complicated process. You want to make sure you get it right. I think there are numerous examples where governments in the past have gotten it wrong by not taking the time they needed to ensure they had done the appropriate due diligence on the front end. That work, as I said, is under way.


            MS. MARTIN: On April 5th or 6th, this government announced that there was going to be a new collaborative care centre facility in the Town of New Waterford. What is the street address where that is going to be?


            MR. DELOREY: As I just mentioned, Mr. Chairman, the process by which the collaborative centres or other infrastructure get established, whether that's the announcement and the allocation for new schools or other infrastructure the government deploys - step one is announcing what and where the commitment is in a general sense. That announcement, that commitment, that would have been made back in April which is being referenced is saying that, as a province, amongst the many communities that could use and are interested in expanded access to collaborative care practices to have that service to enhance the primary care services in their communities - that announcement was to let the people of New Waterford and surrounding areas know that that is a priority area for us, that we are committed to having a collaborative care practice centre established in that community.


            But that is the very early stages. That does not come with the exact street address, as the question was just posed. That is just the starting point. From there, the NSHA is then able to begin those conversations to engage within the community. Again, there's a lot of work to find out what potential opportunities within the community are for siting this type of service, the specific needs and infrastructure requirements for the services that might be part of that collaborative practice that will be established there.


            Again, I would just conclude that there isn't a street address for a facility, but I assure the member opposite that the commitment remains, and that is a priority area, as is Shelburne. As previously noted, the Shelburne one is a project that's quite a bit further along, but we look forward to seeing the advancement and progress within the New Waterford community as well.


            MS. MARTIN: Well, as the MLA for Cape Breton Centre and as the Health and Labour Critic, I would appreciate being included and involved in this whole process, since it's specific to my area as well as the area of Health. Not to mention, I would expect that as the Minister of Health and Wellness, you would also be included in those early consultations and early discussions about where and when because there have been many conversations in the community about where this is actually going to be housed and/or built. There are lots of discussions about things being torn down and rebuilt, and that it's going to be separate and apart from the hospital.


[11:45 a.m.]


            I would hope as the funder and the one ultimately responsible for the health of Nova Scotians, that the Health and Wellness Minister would know exactly before any announcement would take place - and you may not know the exact number of the houses or the number of the buildings, but I would expect that if I was going to build something or put something in place and I was paying for it, I absolutely would know where it's going to be and how it would affect the currently existing New Waterford hospital and where it's going to be, who is going to work in it, where we're getting the staff, what the timeframe is and all of this discussion - I hear Shelburne has being worked on for years. Am I to deduce from that that we stand here today in 2017, will we be here after the next election, still talking about where this new facility for Cape Breton Centre is and specifically the New Waterford hospital?


            You've not talked about timelines, you've not talked about specific dollar amounts for this facility, you've not talked about when it's even going to start. Initial conversations - what does that mean? We can have an initial conversation about anything. That doesn't mean that you are actually putting pen to paper and getting down to getting something started. That gives us no guarantee that on February 1, 2019 . . .


            MR. CHAIRMAN: Order, please. Time for the NDP has expired in this round. We'll pick up with the Progressive Conservative caucus.


The honourable member for Cole Harbour-Eastern Passage.


            MS. BARBARA ADAMS: There are quite a number of issues that have come up over the years both on all of the boards and committees that I've been on and as a health professional, working in both the private and public sector. I can appreciate that although it's my new role here in the Legislature, I've been in that field for a long time, but the new Minister of Health and Wellness may need some time to answer some of the questions because it may be the first time that they've been brought forward and I respect that. I am just wanting to bring forward some of the issues that have been brought up to me over the years.


            The first one is I'm wondering if there's a breakdown of how much money is going to all the non-profit organizations in the province that provide health care assistance to those in Nova Scotia. I'll just mention a couple of them specifically. It's my understanding that in previous years the Arthritis Society and the Alzheimer Society, as an example, did not receive any funding from the government but a few years ago that the Alzheimer Society did receive some funding for the dementia strategy. I'm just wondering if there is a list of all the non-profit organizations in the province that provide health care-type services, if that list includes those who gotten funding, those who haven't gotten funding, and if there's any plan to change who has gotten funding and by how much.


            MR. DELOREY: The member mentioned for an example the Alzheimer Society and I think she's right, I think it's about $480,000 allocated in this year's budget for the Alzheimer Society and work on that strategy.


            As far as the broader question that was posed, like all of the list of organizations that may provide services, I think the question is far more complex than - I don't think the member realized, but it is a complex one because when one talks about providing health care services, particularly when you look at the scope of services provided by numerous organizations, there's often overlap.


            For example, you may see services being provided by organizations in Community Services or our education system. I'll use a prime example, there's a lot of discussion today about sexual assault and violence against women in Question Period today. Much of the references there were to the resources and the focus of the Sexual Violence Strategy that was developed and implemented by the Department of Community Services, under her responsibilities as the Advisory Council on the Status of Women Minister, but yet there's a health care aspect and component to some of that work and, at the same time, the Department of Health and Wellness, I know - and I speak not from a list but from being a local MLA and knowing that a local women's organization in Antigonish gets funding both from the Department of Community Services and the Department of Health and Wellness to provide a variety of services. So, it does get complicated to break that list out.


If the member would like, Mr. Chairman, either to kind of narrow the focus, that we could narrow in and frame up what we'd be looking at, it might make it a little bit easier to get the information but certainly, broadly speaking, the notion of transparency of the financial information of organizations that receive funding from the government is, of course, available to Nova Scotians. How it's actually broken out or displayed in the systems would, again, take some time sometimes but, again, if the member wants, we can have a conversation either now to get more details or even take it off-line. We can work on that to get the information to her. Thank you.


            MS. ADAMS: Mr. Chairman, I thank the minister for his answer. I think what I'll do is compile a list of the ones that I'm most interested in. (Interruption) Yes, a shorter list, not all of them.


I would like to specifically ask about The Arthritis Society, in part because it is near and dear to me but also the physicians in the province who specialize in arthritis care provide care for those with rheumatoid arthritis but many, many years ago they had sent a letter around to all family doctors saying that they were not going to be able to see those with osteoarthritis or those with fibromyalgia. So those physicians don't take on those clients so it has fallen more on The Arthritis Society to help those with those conditions because they don't have a specialist that they can directly refer to. When we refer people to the chronic pain doctors, they don't specifically have a specialty in arthritis care, so they're sort of being ping-ponged back and forth between, well, you should go here but, no, they're saying you should go here.


I'm wondering, is there any plan in place to provide funding for The Arthritis Society, given that the number of Nova Scotians who suffer from these conditions is quite substantial? Thanks.


            MR. DELOREY: Mr. Chairman, I commend the member for her interest and commitment. I believe as I listened a couple of days ago to that member's Address in Reply to the Speech from the Throne where she detailed fairly extensively her experiences and work experiences within the health care system and, of course, she did acknowledge and recognize that work with patients with arthritis and earlier today we talked about continuing care and our aging population - but not just our aging population - that are afflicted by this condition. So, I do commend the member for her interest.


            As far as specific funding with The Arthritis Society, again, as I mentioned, I don't have the dollar amount that they may be getting for programming on hand, but in terms of if they're looking for new or additional funding, the department does have, as does the Health Authority from time to time, grant programs that do exist. What I would really encourage would be to let the representatives from the society directly get in touch with their contacts at the Health Authority or the Department of Health and Wellness to look at the grant program or programs that they may be eligible for, where we put an allocation available for organizations but really the applications come in and the organizations would be assessed on their eligibility through that process.


            I would encourage the member that perhaps if she has contacts there that are asking or interested, that might be a way, certainly in the short term, to look at how one could advance funding for those services.


            MS. ADAMS: Thank you, Minister of Health and Wellness for that one. The Arthritis Society does quite a bit of donation or funding for research as well. I think they have a fairly extensive and robust grant application process for that as well. I think they were specifically looking for some funding for the programs that they offer so I will certainly relay your message to them as well.


            My next question is about private blood collection in Nova Scotia. I am familiar with quite a number of the private blood collection agencies in Nova Scotia and I have to tell you, as somebody who specializes with seniors, that private blood collection was a huge success and when they expanded across HRM in particular, but around the province, seniors and their families were thrilled because it meant you could just go right down the street to get your blood collection and not have to go to the hospital and wait an hour to an hour and a half.


            One of the things that has happened is that the number of blood collection agencies has been going down. I know a number have felt that they have been pushed out by some of the decisions by the Nova Scotia Health Authority with respect to changing regulations and when people have to deliver blood to the hospital. Quite frankly, it has created such a barrier that the one that I actually had the privilege of going to - I won't mention it but it was one of the larger ones in town - simply stopped providing. Then all of a sudden people were wondering and they were told, well she just retired. Well she didn't retire, she could not make it economically any more, because of the changes.


            When people were calling the private walk-in clinics, where they used to go get their blood collection and the two places that I could go that were on my way to work, they just disappeared so now we're all back doing that.


            More importantly, those who had disabilities or seniors are quite upset because it means that if I had to take my mother now, I'm going to have to leave here, drive over there, take her, sit in the Dartmouth General Hospital for an hour and a half and take her back. We're talking a three or four hour trip when it used to be 15 minutes.


            I have two questions. One is, is the minister aware of this issue? Number two, do we have the numbers of how many blood collections there were by both private and public service over the last 10 years? My instinct is saying that it was continuing to increase into the private sector, which took time and money away from having to go to a hospital, so that was actually a good thing, we were moving it into the private sector and we were all happy to pay $15, but has that started to go back down now, now that the government is having to fund it in the public sector? Thank you.


            MR. DELOREY: Mr. Speaker, I'm going to make this statement before I continue, just to verify that I'm on the right path with the question. When the member is referring to the blood collection this would be not the same conversation of the private blood collection that I believe the member for the NDP caucus brought up - which would be competing with the Canadian Blood Services for blood donations - this is blood collection for lab testing results and so on. I just wanted to make that clarification for anyone who may be listening who may be confused by references to blood collection in two different contexts. So again, there are blood donation collections and then there are clinical health care support purposes, blood collections that would be samples collected for lab analyses and that's what we're talking about here.


[12:00 noon]


            It's interesting, it's not something I was aware of as an MLA, not something that I'm aware of in my community, those types of services. The member use the examples of the experience here in a Halifax context. I think this is just one more example of how systems were developed - and we see differences in communities and areas across the province. So, again, I think it's part of looking and seeing how things are done and looking to improve opportunities.


Since becoming Minister of Health and Wellness a few months ago, it is something that has been brought to my attention - the concerns have been brought to my attention. I have looked into it a bit, and I guess what perspectives come into play. I know the member presented the concern that the changes in policy or approach that the NSHA put in place were not an explicit "thou will not be able to collect" but I think, as I understood the description, it was more the changes in the rules around how the process would work. There were individual providers that didn't find it economical for them to adhere to the criteria that were put in place.


            I guess building on that, that is somewhat consistent with the information that I received from the Health Authority although the context of the "why" is a little different. So, as was presented in the question, the "why" that seems to have been insinuated was, these changes were in place to push providers out of the system. The context that was presented to me was that these parameters and changes were built around trying to improve quality control, to ensure standards that were put in place.


I know yesterday the member's colleague did ask a lot of questions, in fact, I think, probably most of time yesterday from the PC caucus discussion on Estimates. A lot of it did focus on measurement and accountability for the system including the question of private contracts or public. So those types of questions were being asked yesterday and I think this is perhaps an example of where the Health Authority is working to do that and ensure that we have higher-quality services. I think that's what's happened but, again, if there are specific instances and challenges, we are working to improve the systems across the board.


            MR. CHAIRMAN: Just before I recognize the honourable member, I want to remind all members and their guests in the gallery, any phones or other devices are to be on silent or off, please. Thank you.


            The honourable member for Cole Harbour-Eastern Passage.


            MS. ADAMS: I just want to respond to the statement there. There are some other serious issues that those who were doing private blood collection in the past or still doing it now, have, so I think there's a couple of other issues that they would like to bring to your attention. I am going to sort of encourage you to have a meeting with all them because there are some things that they can say outside of this Chamber that I can't say here now.


One of the things that I do want to do - because I know that it happens here a lot - is I do want to acknowledge the tremendous skill and experience that these private blood collection agencies have. I must admit that some of them were quite offended when the Health Authority assumed that they were making changes to improve the quality because some of the very people that I know were the ones who trained the staff who work at the hospitals. So to insinuate that those who have moved on after 30 years and have their own private blood collection agency suddenly don't know how to do it properly - that wasn't received very well. There are some issues and, again, I don't want to go into them here but I would encourage you to meet with them because they have a lot they would like to talk about. It is a serious issue especially for seniors and those with disabilities. It was such an economical thing.


            I would like to ask, though, if it's possible because I'm a huge numbers person if we had - I'm going to make a number up. If we had 18,000 private blood collections last year and the year before we had 27,000, then we're all actually paying for that as opposed to it being a private thing. If there are numbers available for how many there were private and public and what the percentage was over the last 10 years - if the percentage is going up in terms of private, then that's a good thing for us. It saves us all money. I'll leave that with you.


            The next question that I do have is about the long-term care wait time versus home care wait time. I have heard the CEO of the Nova Scotia Health Authority and the Minister of Health and Wellness mention something about wait times being eliminated or reduced to almost nothing, and I want to get some clarification. My experiences in home care certainly differ from what I'm hearing. I need some clarification. When you say that you have almost eliminated - is it nursing care in the home, or is it nursing care in the long-term care facility, or is it the wait time to get into a nursing home? I wonder if you could clarify that for me because I have some questions about that.


            MR. DELOREY: What the member was referencing, I think in my opening remarks I may have made reference to it. I believe it was home care specifically. I'm going off the top of my head here - I think it was 800 or 900, the wait-list back in 2015, and I believe it's down to about 90-some most recently for home care services. But the wait-list for nursing care in home care services was virtually eliminated. That was to highlight the significant advancements in reducing home care wait times specifically as we continue to work across all of our continuing care services.


            MS. ADAMS: Thank you for that clarification. When we talk about home care - and you specifically mentioned nursing care was eliminated - there are a number of different types of nursing care. There's nursing care where you go into the home, and you assist the person in putting on their support stockings. There's a lot of nurses who do that - they just go into the home, put the socks on, and leave. Then there are others who go in and help them give out their medication, and then others who stay quite a bit of time. But home care itself encompasses a whole slew of things. It includes bathing and dressing and making somebody meals. There are home support workers. There's all levels of nursing down to somebody who just sits with somebody with Alzheimer's.


            When we say that we went from 890 waiting for home care to 90, I'm just wondering what level of care we're talking about. I'll give you an example. I had a number of constituents call me this summer because they were given home care services. Some of it was for bathing and dressing, some of it was for making a meal, and then a third part was for actual medical care from a nurse. But several times throughout the summer, especially on the weekends or on holidays, they were called and told, we have no worker for you on this day. I did call all of the agencies that are given the contracts, and I have worked with all of them professionally, and they all have the same response, that they don't have enough staff.


            So when we say that we're getting people off a wait-list, it doesn't necessarily mean that they're getting full or adequate care. When people hear that there's no wait time, they're like, yeah, but I get them once a week, and I was supposed to get them every day.


            I'm just wondering, when we talk about home care, I think we need to be more specific, number one, as to whether we're talking about somebody coming in to cook meals or somebody coming in to do housework, because we have some people who are getting housework and meals, but they're not getting any health care. There's a difference between home care and health care.


            I just wonder if the minister could talk a little bit about the difference between the two. As well, are you aware that almost everybody that I heard from did not get the kind of coverage that they were told they needed by the person who assessed them, by the care worker who came in and said, you need twice a day for whatever, they're not getting the kind of level of care that they were told? I acknowledge up front that I know it's due to staffing.


            Supplemental to that, if there's only a certain number of agencies that were given a contract, and they can't provide the number, could we not expand the number of companies that are being given a contract?


            MR. DELOREY: I thank the member for making the important distinction and clarification, recognizing the magnitude and the scope of services and practice that are available by the various professionals that provide home care services to the people of Nova Scotia, reiterating that that includes nurses so when we're talking about the nursing side of the home care services those nurses are professional nurses - RNs, LPNs and so on that would be the scope of practice.


What service is provided by each of them, as the member noted, does vary, based on the client assessment that gets done when the services are being allocated. Similarly, when you look at the non-medical services, if we simply classify the nursing supports as strictly medical, that the other home care services that are provided by home care or continuing care professionals include the many things that the member cited, including bathing and meal preparations, housecleaning and things that may be needed for the individual to continue to live a healthy life in their home. So while it may not be explicitly classified in the way that we think of health care as being something provided by a medical professional, certainly those services - be they meal preparations or cleaning the house - those do contribute to a healthy environment for an individual to live in so it does contribute to the health of those individuals.


            To the question of the breakdown of data, I think we can break down for you perhaps on the notion of partial versus full services but I don't believe we're able to necessarily - I know you had mentioned because there's a wide scope. Again, data - I love data and I love numbers, too. The challenge is the more finite we break our data down into, obviously it costs more to track data and things to that level, as I think the level that we would be tracking, and I can get that information to you on the current wait-list in the home care, continuing care and broken out, I believe on the complete or full service and those with a partial service, recognizing that under partial there may be a wide range of different types of services that are there. I'll get that back to you with the current numbers.


            I do have one last thing to note, when we are talking about wait-lists and times, I want to acknowledge and recognize of course and I guess caution perhaps the member and others when they're looking at these, that it does change, it is very dynamic. So although I referenced some numbers in the speech yesterday and I ballparked what it was, I just want to caution or encourage the member - if next week they see a wait-list or a number that's different than that, it does vary on the basis of people coming into the system and going out of the system at any given time. I just want to make that clarification as we're talking about numbers and lists and so on, that the numbers when we get the breakdown to her may be different than the ratio that was here today because again, a lot changes even week to week.


            MS. ADAMS: One of the programs that was started a few years ago and I don't have the exact date, was the Quick Response Program, the QRP. What that provides is that if somebody is injured and they come into the emergency room, in an effort to keep them home, they get up to five days of care for about 12 hours a day.


            Two parts to that. It is a very successful program and for those who benefit from it - I see some nods back there - I couldn't be more thrilled because it's in those first few days that families sometimes from around the world are trying to scramble to find that help, so it is a blessing.


[12:15 p.m.]


            I had a situation with one of my constituents where she fell and broke something in the middle of the night and was taken to emergency and they sent her home but they didn't arrange for this. Of course she got home and she was quite groggy because she also hit her head. Her family took her home and sort of assumed something might have been in place but it wasn't. When they called back the next day, they said, oh we could have set you up with this program but we didn't because it was the middle of the night. So, could you come back in, come into emergency and we'll set it up for you. So the daughter called and said, well, you have her records, do I really have to drag her out of bed with a smashed-up face and something that's broken and in a cast? Do we really have to bring her back in and they said yes. So, then, they called me and so I called and they're, like, none of your business. What are you doing calling us and I'm like, well, you know, as a health professional and as a friend and as her MLA I'm just wondering, she's in bed but, no, she had to be dragged out of bed to go back.


So the other issue was she didn't need 12 hours a day, five days, a week, because she broke her hand. She needed help with bathing and dressing and feeding a couple of times a day and, so she said quite reasonably, if you were going to give me 60 hours, could I have two hours in the morning, two hours at night and just spread it out. No, nothing doing. It had to be those set hours, and it didn't make any sense to me. So I'm just wondering if the minister is aware of that program and if there's any flexibility.


The other question I have is how well is this run all over the province and are they having equal success around the rest of the province? Because I would hate for somebody to hear about this for the first time and say why isn't this is in my community. So, thanks.


            MR. DELOREY: Thank you, Mr. Chairman. I get that the member describes a program that is helpful, you know, but raises some concerns on a specific case and I think those concerns really go to the heart. I guess what I'm trying to say is trying to get to the heart of what the concerns are rather than on a specific case but fundamentally what the questions are trying to get at with what the program is. Is there flexibility in the QRP program? How can it be managed and why is it set up this way? 


So, I don't have the exact criteria with me on that specific program for where there may be flexibility, so to assess whether or not on that specific example that was brought forward, whether the response that was provided was really within the policy framework or if it was an interpretation of a policy framework that gets applied. We understand that that does happen from time to time.


Again, it is one of the challenges with whenever an organization in the health care system, other parts of organizations but also in the private sector, I think, when they develop programs - whether in a customer service context or in any other - that you try to design a program that works the best for the most and sometimes in a particular program, you can find a scenario or an example in which an exception occurs that doesn't really fit well. So, I think we can often find individual examples where the existing parameters don't work well but let's not lose sight of the fact that in many, many circumstances they do work well but that also doesn't prevent us certainly from hearing and it is important to hear those examples where, even if they are an exception, to hear about them so that we can assess and keep an eye on to say, well, is it truly and how and where can we do better. So, again, for the specifics on the criteria and stuff, we'll bring that back as part of our follow-up information.


            MS. ADAMS: Thank you, Mr. Chairman. During my Address in Reply to the Speech from the Throne and at the rally for the physicians at their town hall meeting last Saturday, I mentioned an instance where I had been told by the Department of Family Practice to tell women who called me asking what to do when they were pregnant and they couldn't find somebody to take on their baby when it was born, and I was advised to tell them to call and register their fetus on the 811 call list. I had heard that and sort of put it in the corner of my mind because I couldn't really conceive of telling somebody to do that.


            I mentioned this before that I met a nurse who is in the military and whose husband is in medical school - they've given me consent to talk about this. They got here and they both got a family doctor because they are in the military, but their son didn't. She advised them that she was pregnant and asked, would the military take on her child? They said no. She did call and register her fetus on the 811 call list.


            I guess my question to the minister is, was he aware that people were doing that and being told to do that? I hate to even ask it, but do we have any idea how many fetuses are on the 811 call list?


            MR. DELOREY: I can advise the member that the first I had heard of that scenario would have been, I believe, remarks being made in that member's Address in Reply to the Speech from the Throne. That was the first time I have heard of a scenario like that.


            I can say that, via personal experience, the first time I heard of something similar - it wasn't in the Province of Nova Scotia, but with my first child when my wife was preparing to go back to work. We started calling around to visit daycare centres and so on. It was in an urban area in another province. That's the first time I heard, were you on the list? I never even realized - coming from a small rural community where there is never an issue or challenge within that space and that context to find safe quality care for our children.


            So again, I've heard of the concept before, of getting on wait-lists at conception, but never in this context. Thus, I clearly don't have the capacity to indicate if we would be able to pull that particular statistic from the 811 list. My assumption, however, is that we would not in the sense that really it's the contact information that's being collected on individuals.


            MS. ADAMS: I'm wondering if the Minister of Health and Wellness is able to tell us how many people are on the 811 waiting list now for doctors and if there is a written breakdown of the regions. A number of people are wondering, if they're put on the list, how are they called when a doctor has a vacancy?


            I will tell you it's all over Facebook. Facebook has become the new way to try to find a family doctor. People are putting it out there, and everybody is calling everywhere. I have to say, I feel bad for the physicians in the province and, more importantly, their receptionists because they're getting all the calls. We are taking up a considerable amount of their time to answer those calls, and they feel bad every time they have to say no.


            I'm just wondering how you are selecting them, and what the geographic regions might be - just to help explain to everybody how they get picked off the list when it's their turn.


            MR. DELOREY: Again, as we talked about wait-lists before, the data does change daily, weekly, and so on. We tend to get updated information through our primary care providers and 811 and try to synchronize on, I believe, a monthly basis. I believe the most recent data we have is to the end of August. That would have been data collected by then and provided.


            We have approximately 33,000 patient names on the list. That would be consistent with the approximate number on the list in August. It's a stabilized net number of names on the list, at the beginning of August and at the end of August.


            With respect to how the system manages the names, it's a great question. It's one that I asked recently. I have made reference previously about one of the collaborative care centres in Dartmouth in a bit our conversation because it was a new practice, really their level of engagement and work with the 811 list came up. That practice - we had the conversation to explain how it worked for them. They felt the process worked very well and what it was was that they contacted 811 - obviously they knew that they would have the names so the information that 811 documented they provide, and they provided it broken down to them as really a zone.


            This particular clinic was over in Dartmouth and the level of detail they indicated that the names were broken out. I forget which section of Dartmouth but it was even subdivided within Dartmouth.


            I apologize, Mr. Chairman. I know there are members from Dartmouth sitting here and I'm loath to actually say which geographic direction of Dartmouth the names are coming from, to avoid any discontentment amongst the members. Suffice it to say, I was advised by the clinicians that the list of names they were provided were going out to the primary care providers, broken down geographically, not just at the zonal level but at a level as to where they practice.


            What the clinicians in that practice also advised me was, as they've been very successful and they've been again adding - I think it was about 800 names off the list within I think between two to four months, and that's on top of the many people who they had on their internal list from a retirement or two that took place in that practice. They indicated that as the list in their community decreases, they are already in discussions with another geographic community, also in Dartmouth. I think the members would be pleased - at least the members from Dartmouth would be pleased.


            They indicated they are actually already in discussions with one of the clinics and the groups in another geographic part of Dartmouth that essentially when, if they finish off the wait-list on 811 for that geographic area that they would be picking out of that other geographic area. So the intention is to try to get people attached as close to the service providers as possible, and work their way out. Now that again is how the 811 system distributes the information out to the clinicians. It's at a much more granular level than certainly - it would be driven up and I think you can appreciate - for the work that I would have.


            I do have some data broken down here for the member, if she would like. This is from last month so this would be data as of August 1st. As I said, it was 32,753 as of August 1st that were on the list; 16,048 were from the Halifax area or Central Zone; 7,597 in the Western Zone; 5,026 in the Eastern Zone, which would encompass Cape Breton, Antigonish and Guysborough; 3,977 in the Northern Zone; and then about 105, where they didn't provide sufficient data to really have the geography of where their location was. With cellphones and things these days, if they didn't provide the address you wouldn't have the exact info.


I believe that adds up to the information.


            MS. ADAMS: I appreciate those numbers. I'm wondering, we had a physician tell us he was retiring and he had gone through his list of about 1,800 patients and there were about 35 of them who he felt were absolutely critical that they had a family doctor - not to dismiss the importance of everyone else, but there were 35 with such acute or terminal or whatever condition that he had identified. He had written letters to all of his colleagues in the area and said please, would you each take five people? He was begging literally and he had no responses from any of the letters, so of course he is heartbroken. That's why many of them are delaying retiring, which is sad for them but fortunate for us. I am wondering because of that, two things. I'm wondering if there is a breakdown in the numbers based on age. So of the 16,048 in HRM, what percentage would be babies, children, young adults, middle age up to seniors? And the same things of course for around the province.


[12:30 p.m.]


The other thing I am wondering and I don't know, I don't believe it's being collected but some people are saying, well I've got terminal cancer, could that not bump me to the higher part of the list, or I have diabetes or kidney disease. There are others who have mental health issues, as you know, and intellectual disabilities. So I am just wondering - and I cannot imagine how easy it would be to create a priority list, but I know they exist - is there any priority list in terms of condition or age?


The other thing I am wondering because it comes up quite a bit with my Shearwater constituents. Does it matter if you, like somebody just lost their doctor yesterday, but they live in an area where there might be a vacancy but there is somebody 20 minutes away who has been without one for two years. So does the person who just had one get it because they live closer to the doctor, or is there some way to pick the people who have been waiting the longest? So I guess I am wondering if there is any priority list and, if so, what it might be.


MR. DELOREY: I appreciate the opportunity to have the discussions about the, what we call the 811 family physician list. Because really it is worth noting that this list is the first time we've had this in Nova Scotia and yet, again, the demands and the individuals who have not had a family practice clinician or a primary health care provider does go back into our old multiple district health authorities structure. So while the problem has been around for a long time, again I just note that establishing a single provincial view, it's one of the advantages.


I just want to highlight that this, you know, our ability to have this conversation now, could not have taken place prior to us moving forward with this initiative. So it is in a general sense, fairly early days in having it established. Step one was getting it established. Certainly, I recognize the multiple scenarios in the examples - I won't reiterate them - that the member has brought up Mr. Chairman. I guess what I caution, though, or just counter, is the notion that one can place themselves in any situation and make a very strong reasonable argument as to - rather than argument, a case - make a reasonable case for why the list should be prioritized in a particular way.


So in a broad sense, I want to acknowledge to the member that these questions are questions that we are asking ourselves. We recognize the notion of, how can we ensure that the process is - again, if we go back to our fundamental objective - to provide the best primary care we can to the people of Nova Scotia. So now that we're starting to collect - we have a, you know, what is looking, at least it's very short and, I am not going to say stabilized, but again if we have two months with around the same number of people on it, we are seeing progress in that regard. Stabilizing that number of people looking for a family practice at about 33,000 people, that is step one. Now that we have that list, what is the best way for the care that we are providing. The member provided a couple of different scenarios and how it might conceptually break down or be broken down.


            I want to let the member know that it's not just about the 811 list and those scenarios, really. One of the examples was about a retiree coming up. Our first objective, again, if you can be proactive and ensure those individuals who are in that practice, that is, that as an individual retires that there is a replacement for those people that prevents the growth of the wait-list, that that is a priority.


            The member's Leader, the Leader of the Official Opposition, just a couple of days ago tabled a stack of documents which I think represented somewhere in the vicinity of between 100 and 150 positions, four positions that are posted currently, while at the same time we have somewhere between 50 and 60 vacancies. Clearly, Mr. Chairman, we are actively trying to recruit not just for existing vacancies but also for upcoming ones.


            Again, I'll reiterate that back when we had multiple health authorities across the province, the nine different regional locations, we didn't have the ability to even plan at that level because each one was preparing and planning differently.


            There are many very positive things that are coming out of this although they're not perfect. In fact one could argue that what they actually do is make it easier to highlight the challenges in our system. I think that is much of what we're seeing here but I will acknowledge again that the first step to solving and improving on problems, the opportunities for continuous improvement, come from first identifying. So while it is challenging, I know very challenging for people in the health care profession, those providers, to continuously see the system that they are working so hard in to provide the best care and services to the people of Nova Scotia, that at the same time this is a transition point; it really, truly is, I think, that we're seeing these things, or taking steps. The 811 list is just one of those examples. We are looking to see how we can do better with that data and again, those suggestions from the member are for consideration. Where we will land I can't say at this time.


            MS. ADAMS: I appreciate that. I would not want to be the one who might have to decide that priority list, because you're going to make anybody who is not at the top very unhappy.


            The next question I'd like to go to is, for those, especially who don't have a family doctor, they're turning to either the walk-in clinics or the emergency room departments. I'm wondering two things: number one is, do we have numbers - of course it's always going to be my first question - do we have numbers showing how many - well I'm going to start over again. When we talk about family doctors and how many doctors we have, I think we know how many are teaching and we know how many are in family practice and how many are specialists. What we don't know, and it was a statistic I used to be responsible for gathering, so that's why I'm asking the question - how many visits have there been by family doctors, because there would be, I'm assuming, the actual number. So if this doctor saw 1,400 last year and this doctor saw 800 and this doctor saw 300, they are not equal, they are not full-time equivalents per se. I'm not sure if anybody has decided what a full-time equivalent doctor's number of visits would be, because the conditions vary.


            I'm wondering what the number of ER visits are, the number of family doctor visits are and the number of walk-in clinic doctor visits are, because if you add them all up you are going to come to a consistent number. I'm wondering whether we have more people going to more doctors or whether the number of total visits is actually going down?


            I do know there are a number of people going out of province and out of country and I'm wondering if we have that number as well. So how many Nova Scotians are going to Ontario or the United States or around the world for their procedures, in which case that might actually be saving us money because they are leaving.


            I guess the question I have is, how much more are we utilizing walk-in clinic doctors and emergency room doctors, compared to 5, 10, 20 years ago? That's going to give us an indication of how people are utilizing those services. Certainly it's not as effective to go to a walk-in clinic doctor and it's certainly far more expensive to go to an emergency room. I'm wondering if the Minister of Health and Wellness has those numbers.


            MR. DELOREY: Thank you, Mr. Chairman. If you'd just indulge - I just want to make one last statement on the previous question and then I will definitely get this one.


            It was just one thing I forgot to say because in your comments about the 811 system you had made a reference to how some physicians were being bombarded, or their offices, with calls to take on - and what I forgot to mention was, of course, the encouraging of Nova Scotians to get on the 811 list. Again, back to the one of the advantages of the 811 list is that physicians don't have to be bombarded with these calls only to say no, or their office staff don't have to be bombarded with them. So, I'd certainly encourage members, if they have constituents who - again, encouraging people to get on the 811 list is actually, in part, to be a more efficient process and also to help reduce the burden and administrative calls in offices that are particularly full. So, that was kind of more of a public service announcement, I guess, than a response to the question.


            So, to the current questions about the visit rate, I don't think it's necessarily possible to - and, again, you can subdivide it and you can break it up in a lot of different ways - to be 100 per cent accurate in what the member was looking for, which is about the office or the visit breakdown, particularly about walk-ins versus offices, because the way we are able to track information is actually based upon how the physicians charge. So, really, the data that we'd have would be based on billings and so the way that they are classified is how we would have the breakdown.


I do have some data that I can provide but, again, I just caution the interpretation of the data is based on some billing codes and doesn't necessarily reflect all and, from my review of that data, we don't have a mechanism, certainly in this data set that I have with me, to identify the distinction of an office visit in a family practice or collaborative care environment or a walk-in clinic, so, I don't have that level of breakdown, but in 2015-16 - this is the other thing, it's always historical data for collecting - office visits are about 3.7 million office visits. Emergency and outpatients was about 458,000 visits. Would you like the exact number or is that close enough? Do you want me to round it? As a percentage of all visits, those office visits represented 40.2 per cent and the emergency room visits represented 4.9 per cent, from a service perspective. Again, broken out to, based upon, again keeping in mind this is fee-for-service billing code data. That doesn't reflect necessarily all services and so on but it's the best data that, to answer your question about office versus the ER-type breakdown.


            MS. ADAMS: Thank you, Mr. Chairman. In the last couple of minutes that we have, I just want to clarify as well that the people who are calling the doctors' offices, they are all on the list. They're just anxious and eager and I have to point this out, that on Facebook this morning as I was coming over people were saying, oh, you should call so-and-so. I know somebody who just got in. So they're thinking, that person must be taking on clients, when it was just that lady's number to come off of the 811 list.


[12:45 p.m.]


            I think to add to your public service announcement, we need to be very clear with people that if you don't have a family doctor right now, calling the doctors' offices will not get you off the list. It's just the reality of the moment - or calling the wife of a physician that they know themselves. I do want to respect all the doctors who are there, who are seeing a family member but they're not able to take on the spouse or the child or the kid who moved back home.


            With the last remaining second there, Mr. Chairman, I'm just wondering, since we have the number of office visits and we have the number of ER visits, without upsetting the doctors, who might have to change their coding, is there a way to find out how many walk-in clinic visits there are? I think that's an important number to collect.


            MR. CHAIRMAN: The Minister of Health and Wellness. There's about 30 seconds left in this round.


            MR. DELOREY: This is the data that I have here, to respond to the question. As I have mentioned with some of the other examples, the granularity - for example 811 does have data broken down perhaps differently for different purposes. I don't know if there's another way that we can find it. But it's certainly a good suggestion. We'll keep that in mind and take a look at the data that we do have, that way.


            I thank you for your questions. We'll chat again.


            MR. CHAIRMAN: The time for the PC caucus has expired.


The honourable member for Cape Breton Centre.


            MS. TAMMY MARTIN: To go back a little bit just on discussions we have had, when you answered my question about home care specifically. Absolutely, it should be our social responsibility to look after our neighbours. I would hope that, in more cases than not, that is actually what is going on to make sure that our seniors are not left to just - for lack of a better term - rot in their homes and then die. However, I think the disconnect does come between home care and long-term care and when that time comes to actually get them placed in a long-term care facility.


            Again, I will say, as the funder for health and wellness for the province, you have a responsibility to know what's going on in your home care facilities with the workers and how they're paid, and you do have control over that. I would like to be clear on that. If I was paying somebody to do a job, I would know what that job description was, and I would know that it's okay to take five or 10 minutes to sit and have a cup of tea with Jane Doe across the street because that's what she needs. It's not just the requirement of the neighbours and surrounding area, but it's also part of their job, and that should be recognized.


            During my many years of bargaining collective agreements for health care, at least two rounds, we tried to bring the wage for the lowest-paid health care employees up to a living wage, and we were unsuccessful. Time and time and time again, the money goes - while I understand recruitment and retention, I'll go back to my previous remarks about the spoke in the wheel. If you don't have trained, qualified, professional, environmental services people, laundry, personal care workers, then your wheel is not turning. You cannot have a functioning operating room unless it was cleaned and sterilized properly.


            I think this government lacks, clearly with this wage freeze, but specifically in those in the lower-paying jobs that I asked you about yesterday. Off the top of my head I would think personal care workers, laundry, and environmental services are at the bottom of the list. They work full time, and they barely make a living wage. If they are a single mom, which a lot of them are, they are hard pressed to own their own home, feed their family, put oil in their tank, and get back and forth to work. Time and time again, we see them in low-income housing while they're out working. They are the working poor, and I think this government fails to realize that.


            Yesterday we talked about administrative vacancies. Or I tried to talk about administrative vacancies in the Nova Scotia Health Authority and the discrepancy in the estimates in the actual and the underspending of last year's budget.


            So my question to the Minster of Health and Wellness is, can you give us a list of the administrative vacancies, their job descriptions and/or classification, for the entire Nova Scotia Health Authority?


            MR. DELOREY: I will touch on two. I know that there is a specific question there but there is also some information or comments around home care and the roles or responsibility of government and whether or not we do take into account those Nova Scotians who may require additional supports, particularly financial supports.


            That's why I think its very important to recognize some of those programs and initiatives that we do have in this budget and commitments we have made, that includes a tax cut. But not a tax cut in the way that we have seen governments really - on a few occasions we may see a government make a tax cut, it's not what governments are known for.


            That cut was one that was very thoughtful, that the focus of the approach to the reduction in taxes was targeted to ensure that the people who receive the value of the tax reduction in provincial taxes were our lower-income Nova Scotians. That focused approach really ensures that Nova Scotians with lower incomes get the greater value of the tax break versus those who make more.


            I think it is somewhere in the vicinity, that it caps out somewhere in the $30,000 range, $25,000 or so, then it reduces down so that individuals making more than somewhere in the vicinity of $75,000 - I apologize, I am not the Finance Minister any more so I don't recall the exact cut-off point.


            The point of it is that, again, we have made those changes. So we certainly are not turning a blind eye to the concerns that the member has raised. We certainly recognize that and we have made thoughtful approaches. The member mentioned the concern about some of the employees' ability to purchase a home. That is why we have a number of initiatives both through initiatives of Community Services, in terms of focusing on moving forward with affordable housing. But also with initiatives to help people with their first home purchase, to help with the ability to get their down payment, which is often a big part of the challenge of becoming a home owner, is that first down payment contribution and so.


These are new programs this government is bringing forward to help people in those circumstances that the member cited so. Really, those things would not be possible if we continued to disproportionately put resources into compensation. If you look at when we came into government what the deficit was at that point in time, and you compare that to the 7.5 per cent of the previous collective agreement over 3 years, in that, net annual increase in costs over the term of that collective agreement across the public sector - somewhere in the vicinity of approximately $375 million each and every year, increased compensation, by the end of year three. That's $375 million that's not available to go towards those people in Nova Scotia and those programs and services and many of the things the member and her colleagues have been asking or encouraging the government to invest in, and that's the reality.


We have a finite amount of money available in the Province of Nova Scotia, as do other jurisdictions, to spend on. My colleague, the Minister of Education and Early Childhood Development last night in one of the bill debates made reference to our commitment and the approach that we are taking to fiscal management of this province and the importance that we put on managing our finances, you know, a concern that clearly is a clear distinction in the political philosophies and approaches between the member's political philosophy and approach to financial management and ours.


The reality is, Mr. Chairman, we spend almost $900 million each and every year to pay for our debt. That is our debt-servicing cost. If you break down the provincial budget, you will see that the fourth largest expense by department, if you are breaking it down by department, is our debt-servicing cost. That means the Health and Wellness which we're focused on here today is the single largest item, over 40 per cent of the budget, followed by Education at over $1 billion and, then, Community Services which is only slightly higher than our debt-servicing cost.


I think something that many Nova Scotians, as surprised as they may be that from a departmental perspective, in fact, our debt-servicing cost is essentially the same amount of money that we spend in health care on physician services. In fact, it's actually more. I believe physician services was $880 million and we're talking about that same amount towards debt.


            So, where did that debt come from? Well, 60 per cent of that debt, so, 60 per cent of our financing costs if we're to break it down that way, comes from past governments who lived outside of their means. So, of the $900 million, 60 per cent of that amount, each and every year that we are paying, is as a result of goods and services consumed by those who came before us, because governments and people sitting in this Legislature made the decision and took the decision from my children. The Minister of Education and Early Childhood Development did an introduction this morning of his young daughter up in gallery, only eight months old. Is it fair or appropriate for a government of any political stripe to make decisions, to consume programs and services today that that child will have to pay for tomorrow, that the decisions and the priorities of where government should be spending when that child is our age in this Legislature, is that the appropriate way to manage our finances?


I can appreciate the concern indeed. This government shares the concerns being raised by the member opposite, but we approach them very differently and, so, again, I think it's incumbent to recognize that this question about deficit financing or not, or living within our means, that is a very big distinction and I'd remind that member, as well, that, through that process, we did have an election both in 2013 and again in 2017 and the people of Nova Scotia have spoken and they recognize that the approach and the fiscal management in Nova Scotia to ensure that we live within our means is a priority of Nova Scotians. So, what it means is that the decisions that we have to talk about here and the priorities of where we put our resources, has to do with living within our means. So, it's starting with we have a finite amount of money. How do we target those resources and, as I've already demonstrated to the member on those concerns that she raised, for those people who need supports, that this government has been making smart, strategic investments to support those individuals going through.


To the specific question on home care, a couple of things. The member was raising questions about home care and whether we know or should know what's happening on the ground. Indeed, I share that concern, Mr. Chairman, with the member opposite. It's why, recognizing that the home care system historically has had very little oversight and engagement, such that the employer and, as the member cited multiple times, that is the minister and the department responsible for these services, that I believe the member has indicated, that well if I was in that position I would know this, know exactly what people are doing for the money that we are spending for those individuals, the services that are being provided, what those individuals are doing and that's true, I think we share that same opinion.


[1:00 p.m.]


            What the member misses out of that is what was the status and the nature of those services when we came into office. Again, program services have been around for many years, that the nature of the contracts and the agreements for those service providers didn't provide necessarily those provisions.


            The member has noted that she has worked in the labour industry, negotiated contracts, including it seemed at least - and I stand to be corrected if I'm mistaken - in the home care or continuing care sector. So, recognizing that, Mr. Chairman, she understands the importance of those contracts that are in place and what information can be gleaned.


            I assure the member there are efforts to identify and, as the member for Cumberland North, we spent much of yesterday evening discussing the need to do a better job of collecting data, of assessing, of establishing criteria and frameworks so we can assure accountability, and the services that we're paying for are being delivered. That's why key performance indicators are being developed within the home care sector, to identify what's being done and how providers are performing, so we can ensure that we are both getting value for the money that's being spent in this area but, more important, what I think is an objective and a priority for all of us, that the clients - again as the member has raised her concerns about - are getting the services that they so deserve.


            To the specific final question that was asked of me, Mr. Chairman, as I indicated yesterday we don't have the full details of the NSHA staff list and their vacancies but, again, we've added it to the list of requests. We'll provide that, engage with the NSHA to collect that information and provide it to the member or her caucus.


            MS. MARTIN: Funny enough that you mention KPI because I was interested to hear the government's position on KPI because from our information the government again is the funder for home care and there are KPIs being introduced or established in order to measure these measurements of the service. From what we understand is that if these aren't measured and if the standards are set so high that if they don't fall within that certain criteria, then they can go outside the normal processes and contract the service out for a lesser amount of money.


            Having said that, can you tell us what monies in the budget have been specifically allocated for continuing care, home care? I can continue it, but if you'd like to answer that first.


            MR. DELOREY: The contributions to continuing care through the home care services budget is about $255 million this year, and long-term care is $565 million, for a combined contribution of about $820 million. As I believe I mentioned to an earlier question, that is just a bit under the total amount that is budgeted in physician services as well.


            MS. MARTIN: To be specific, then, to the Minister of Health and Wellness, with that $565 million budget for long-term care, how many new beds will be opened by this government?


            MR. DELOREY: Long-term care, which is the $565 million the member was referencing, breaks down to 7,800 beds, or to be more precise 7,851, serving 11,000 people. That would be 6,923 nursing home beds and 927 residential care facility beds across 137 facilities in the province, I believe.


            MS. MARTIN: I'll say again to the Minister of Health and Wellness: How many new beds are being created with your budget? Not existing, not the ones that are already in place - how many new beds, new spots for seniors, will be created from your budget?


            MR. DELOREY: I apologize to the member opposite. The data that I provided was actually 2016-17 at the close. That's what was actually spent in home care. The numbers in the budget that I had indicated should be $260 million budgeted in 2017-18 for home care and another $4.5 million, so just under $570 million for long-term care, for a total of $829.5 million. The increased investments to our long-term care in 2017-18 is an additional $4.5 million to the long-term care services in the province.


            MS. MARTIN: One more time to the Minister of Health and Wellness, how many new beds are being created in the Province of Nova Scotia for seniors who are currently staying in acute care or living four or five hours away from where they currently are - how many new beds for long-term care will be created with your budget?


            MR. DELOREY: I don't believe we have the exact number, but I can assure the member opposite that I am well aware that there are beds opening up.


            I know that there are beds opening up in a facility that the former member for Halifax Needham was quite an advocate for. In fact, Mr. Speaker, I can recall fondly during the first session of the Legislature that I served in in 2013, when the member for Halifax Needham, the Acting Leader of the New Democratic Party, actually sent me a little note and asked to see me in the library. I have to admit, as a rookie MLA, getting a note from the Leader of another Party was a little nerve-wracking in my first week or so in session. But in fact, it was actually an illustration of how this Legislature can work and, although people may not see it when we're standing here and having our conversations or debates in the Legislature, indeed people do work together to advance on behalf of our constituents.


            The member actually brought this particular facility to my attention. It was a facility that the member had been working on while she was in Cabinet herself, while she was in the previous government and encouraged to ensure that that work got done and delivered. I do know those beds are scheduled to open up, I believe, in February of this year in Antigonish. I'd have to look up to see any other ones that are taking place and coming on line in this fiscal year.


But as I said, I do know there are new beds that are opening up. Completion of the work has been ongoing over the last year or so, and the scheduled opening date is in February. But again, how many other beds across the province? I'd have to track that down.


            MS. MARTIN: So as to not beat a dead horse, again, as the funder, and the payer, as the overseer of the finances for health care for the Province of Nova Scotia, how can you come to a budget session, an estimate session, and not know how many beds are being opened?


It's a simple question - is it ten? Is it five? Is it 50? You're saying, in Antigonish, what about Yarmouth? So, we're still going to travel; residents are still going to have to travel eight hours to see their loved one. How many new beds? Period.


            MR. DELOREY: Again, as the member has raised concerns about long-term care services in the province, raised concerns about the infrastructure in facilities, there are a number of projects and work ongoing, to look at our long-term care infrastructure needs, and the work that needs to be done to modernize these facilities, and that work is ongoing and continuing.


We continue to invest in our continuing care supports, as I indicated earlier, increasing the long-term care budget by $4.5 million this year, much of that going towards food and recreation budgets, again, to ensure that those services are provided.

To the member's question about the need for individuals to travel to see loved ones within home care facilities, indeed that is the case from time to time. In the province, the member is likely aware, the process for obtaining a long-term care bed actually, interestingly, relates back to the conversation that we had a little while ago on the 811 list with the member from the PC caucus.


That is an area where there is some prioritization on getting appointments and, I think, in some of those examples that the member raised about the concerns with travel, these individuals were getting placed on the list. It would seem from the description, because they were in a more acute state, I think the example that was used was an Alzheimer's patient that needed those supports.


I think the member would agree that having the individual placed in a facility as soon as possible, for the care that the individual needed, would be the appropriate priority, and that, I think, is the way the system is designed, to ensure those individuals get into the facilities, and in some cases the nearest opportunity to get the appropriate care for the individual may be some distance away, but again in the system, the primary focus is on the client, the patient indeed.


Efforts then get made for opportunities to transfer to facilities that are closer to an individual's home, and their family, and community members, and friends. So, as time comes up, those individuals have those opportunities to move closer to home.


The other thing that's really important is that with all of the investments in our home care, it has been a significant part of our Continuing Care Strategy, since coming into government, continuing this year, with another $5 million increase in our budget for home care services. Again, recognizing that - as the member suggested, in the long-term care context, that individuals want to stay near their home, indeed, what we've heard is that in many, many cases these individuals actually want to stay in their home, and that's why putting major investments and supports targeted towards home care, as opposed to putting a focused effort on, and measurements of, explicitly, a bed count of new beds when, again, as the member has already noted, there are existing beds and facilities that need infrastructure investments to provide the care and services and supports.


[1:15 p.m.]


So, as I spoke last time, Mr. Chairman, to the member about the fact that we have to live within our means, would people of Nova Scotia prefer to have access to a home care facility bed within five, 10 minutes away from their existing home, from their communities, from their family members? I think of course people would have that preference to make it easier for loved ones to visit while in a facility. Unfortunately, that's not possible to ensure that all Nova Scotians have a facility within that distance, but we do endeavour to ensure that we can provide the best services, the best care as a priority and, again, as time permits and vacancies arrive, to those individuals that may have been provided a bed at a rather large distance


I think the duration of the travel time, it was decided was four hours away. I'm not sure the scenario of that travel because I'm doing the math and that would be quite a distance away. I'm not aware of, you know, in my case it's very seldom maybe an hour away for people in Antigonish that they have concerns with. So, four hours seems to be, again, I think the nature of that specific example, I think, again, the acuity of that individual's situation I would assume would be a bit higher, or the preference and priorities for the individual's family and the individual would be to get that placement as soon as possible.


            So, that's the work that's ongoing. As I said, lots of investment moving towards home care. We've done a great job with those investments and that's helped us with our work, with the individuals looking to go, so the needs and the demands on our long-term care system aren't as significant as they may have once been.


            MS. MARTIN: Mr. Chairman, just to be clear, absolutely not was the family's preference. Maybe you didn't hear me, but the gentleman was 81 and there was no other bed in the province, so his wife had to be put in a home in Tatamagouche, the same instance with my uncle.


But to use your words, and you talk about fiscal responsibility and Nova Scotians would rather live within their means. I think the word there that we missed is "lives." I think Nova Scotians would rather live than have a surplus budget from what I heard knocking on doors and travelling across the province talking to people.


            People would rather this government invest in long-term-care beds, invest in seniors care as well as acute and all of the other portions of health. I would much rather spend for the sake of health care of Nova Scotians than continually tout that I have a balanced or a surplus budget.


            Mr. Chairman, to use the Health and Wellness Minister's words of how important it is to note, I would like before I pass it over to my colleague who will ask some particular questions she's interested in, I would like to say how important it is to note that, at the end of the day this government cannot give me a number, cannot give me an answer on new long-term care beds for this province.


            MR. CHAIRMAN: Just for some clarity, honourable member, were you looking for an answer from the minister on this question?


            MS. MARTIN: Well, Mr. Chairman, I guess I'm still beating that horse. There was no number given. I'm . . .


            MR. CHAIRMAN: Okay. The question is, is there a question, honourable member?


            MS. MARTIN: Yes, yes.


MR. CHAIRMAN: Thank you.


MS. MARTIN: So, at the end of the day, this Health and Wellness Minister and this government are not prepared after preparing a budget - are you prepared to give me the number of new long-term-care beds? That's all I want to hear is the number.


MR. DELOREY: I did answer the question I thought, Mr. Chairman, when I indicated that, indeed, there's work ongoing in facilities across the province, part of the revitalization initiative for our home care. Again, yesterday, many of the concerns that were raised by the member about investments in infrastructure and supports to ensure that individuals in our care - I used one example, one that was advocated for on behalf of the member's former member of the Party, under the previous term in office, one that, again as I said, representatives of our own caucus had advocated for that work and it's work that's ongoing to, again, revitalize the infrastructure and get those new beds for the facility in Antigonish up and running again, but that's part of our revitalization project, Mr. Chairman, which is ongoing within the province.


            If the member is asking how many new within the system as opposed to new infrastructure beds right now, as I thought I had indicated our focus is not on building the new beds, Mr. Chairman, but rather on the home care on which we've seen significant impacts, positive impacts, by reducing the number of people and the time pressures of moving into the long-term care facilities while, again, at the same time focusing on revitalization plans for the infrastructure within our existing facilities and those beds in the system today.


            There is, certainly, a number of groups that have proposals that they have brought forward in the long-term care space; I have had meetings with a number of organizations interested in pursuing in various communities across this province. So again, as those proposals are coming in, they are being reviewed and considered within the context of the demands and the anticipated demands and needs within the province.


            Again, there are many, many different areas and aspects and approaches to providing the care that our loved ones, particularly our seniors and our parents and grandparents, Mr. Chairman, so need and, indeed, deserve. Thank you.


            MR. CHAIRMAN: The honourable member for Dartmouth South.


            MS. CLAUDIA CHENDER: Thank you, Mr. Chairman. I couldn't help but notice the minister mentioned Dartmouth earlier, so I do have a number of questions.


To start with I'll say that in the last few months that I've had the privilege of holding this position, the number one issue in my office has been lack of primary care. I have pursued that at a local level and found that according to folks like Doctors Nova Scotia, your own Dr. Rick Gibson, the Dartmouth Medical Staff Association all identified Dartmouth, and that would encompass all of our Dartmouth seats I think as having the single most acute issue with regard to the loss of primary care, both right now and in the next five years.


            We have 71 physicians currently and 33 of them we know will retire in the next five years. We already have thousands of people without a family doctor and we know we'll have thousands and thousands more, so I have a few questions related to that. The first one is I was interested to hear you give the breakdown of statistics around the list - I think you said something like 17,000 people were on the list in the Central Zone, so I wonder, do you have a further breakdown for the Central Zone?


            MR. DELOREY: To the specific question, I didn't have the breakdown any further; it's just at kind of the zone level. When the member for Cole Harbour-Eastern Passage was asking about that same list, that's the detail of data that I would have, looking at kind of the bigger picture.


            As I also mentioned at that time, the system when working with the providers and the caregivers and the primary care providers, they do provide the details. They extract the list of names from people to ensure, and the example that I was using was, in fact, at a collaborative practice in the Dartmouth area, that they have indicated they were provided in a geographic range there.


            The last comment I wanted to make about the retirements and that concern that was mentioned in the preamble, it is something that we recognize and are concerned with, and as I mentioned earlier, there's a reason why the number of positions posted by the NSHA for primary caregivers and family physicians is in excess of the number of vacancies currently in place. It's the recognition that it takes time to recruit and have individuals choose to come and practise here. They're trying to do a better job.


            It's a job that wasn't able to be done and certainly wasn't being done prior to the establishment of a single Health Authority. Again, each jurisdiction was working with physicians in a very different way, and we never did realize what and where exactly the demands and the pressures were. We didn't know when physicians were retiring. Much like 811, these initiatives are really improving, I believe.


            But you don't see the results of these initiatives that are just starting in the last year or two. It takes time for those initiatives to really start to show the fruits of those efforts.


            Again, I just want to encourage the member that certainly those upcoming retirements are part of the recruitment initiative and strategy to ensure that her constituents - as it is across the province - are a top priority to get primary care to all Nova Scotians.


            MS. CHENDER: I just want to follow up and say that I'm glad that the minister's office is aware of this Dartmouth issue; it doesn't make it less worrisome, however.


            Just to elaborate a little bit on what I mentioned at the beginning, based on the folks that I have spoken to, they have very little faith in the current recruitment processes. There is a widespread feeling amongst physicians and administrators with whom I have spoken that the traditional recruitment methods are somewhat too little too late and are not effective, and that there's going to have to be some real out-of-the-box thinking around how to fill these spots and how to fill them quickly.


I know that that has been a topic in this House for this past week. I do want to ask specifically - I know of a number of doctors, and I know we have heard it from my colleagues in this Chamber who are just holding on with huge numbers of case files because they can't find anyone to take their practice - I'm wondering whether the minister knows of any committees, is there anyone thinking about a way to recruit differently and more quickly? Are there specific incentives we might see somewhere in this budget around moving physicians into the areas where they are most needed more quickly?


            When I ask that question, I just want to qualify that I'm not suggesting, as I think we have acknowledged here, that forcing physicians to go to one area of the province or the other is the answer. However, I think we can certainly incentivize particular locations where we think there's an issue. In Dartmouth South, we have a huge number of seniors living in isolation, living in relative poverty - they're in our office every day, and they are not getting the health care they need.


            Mr. Chairman, if we could hear a little bit about the recruitment efforts, and if they're the same old recruitment efforts, I would love to hear about maybe some other thinking that is going into solving this problem.


[1:30 p.m.]


            MR. DELOREY: I appreciate the topic being raised by the member opposite. It is both timely and relevant.


I've mentioned before in this House that I had recently gone through and met with a number of people. I think at one point I even stressed - at least I tried to stress, whether it came across that way or not - one of the things that was most important to me when I was getting around to meet with care providers was to not just restrict those meetings to our existing service providers. So, as you say in your conversations with existing providers, their concern is for the impact to the system, which is great and they're providing concerns and input on the recruitment process. I thought it was also very critically important to get out and meet with our care providers who are on the verge of entering our system.


So, from a medical perspective we're talking about residents, the nursing students who will be coming up to graduation over the next year or so, to hear from them, because really regardless of what changes come into place in our health care system, for these individuals who are on the verge of completing their studies and training, those changes in that environment is what they will be working in for really the bulk of their careers. It is important that we get it right and ensure on a go-forward looking basis that it's attractive and works for them.


It's interesting because most of the conversation that I had with the medical residents actually did focus a lot on recruitment and some of the differences they see in a Nova Scotia context from other jurisdictions. Those residents, particularly the second-year residents would be looking at where they're going to settle down, where they want to move to practise. They provided a lot of great input and suggestions on how we could perhaps - particularly for young doctors just getting started - things that we could do to help them and do better. So, certainly that feedback has been taken to heart and to look for how we can respond.


It wasn't necessarily always solutions, but rather examples of some of the challenges or concerns from their experience. So that's something we've taken back to try to figure out. We don't have the solution to it, but we've certainly received the input and where their concerns were as well as - in some cases they made references to how they thought something might have been done better in a different jurisdiction, so we have some jurisdictions that we can look at to see what we can do a little bit better.


Even within that space, we do know in terms of recruitment the recognition of how some initiatives - again, I think there's very clearly a recognition that things have to change. I think out of the member's own words, it was that the old way or the traditional practice wasn't working anymore or not as productive as they could otherwise be. I appreciate those comments and that acknowledgement because when you take that in the context of the fact that an area where there is much criticism of the NSHA and the recruitment initiatives, they were at least trying to do something different - when they were trying to target physicians and restrict, to try to ensure that the physicians were going to those practices they felt were most acute in need, but clearly there were issues with that and that had unintended consequences.


So obviously, it wasn't the right way. The member acknowledged we're not going to be forcing and she wasn't advocating to force physicians to work in a particular area, but what I was just noting was that that is an illustration of the fact that the NSHA is trying to address these issues by trying a different approach. It wasn't the right one, so now they're bringing the flexibility into the system and the recruitment.


There has been an expansion and the establishment within the regions to have a recruiter help with a more localized context rather than simply in the central. I know this is still an area for my tour and having conversations with physicians in particular, so there will be existing physicians who have presented differing opinions on whether having a more central and regional lens and view on recruitment is the right or the best model. Some argue that, in fact, it is of course a good model, but actually perhaps it should go further and there should be more localized attention and focus on individual communities, but others said that we cannot go that route, we can't create an environment that communities are competing and stealing from one another.

            So, it is a complex challenge when the demand is spread across the province with our recruitment efforts. You know, if we target resources for recruitment in a particular community or area, then the community next door is saying what about us, when the need is spread across the province. So, again, to answer the question, the member was wondering whether there are activities or initiatives being undertaken to improve the recruitment process, the answer is yes.


            It's a work in progress. We know that the way people practise has changed, so how the opportunities are presented to individuals needs to be changed. That's our focus on collaborative practices. So even things in some of our investments and priorities outside of explicitly recruitment can be seen as means and investments to encourage and, hopefully, support recruitment of physicians.


            Again, the resources being targeted towards collaborative care practices in the province to establish those collaborative care teams, those investments are designed to encourage those young physicians who have trained this way and are really expecting to work in a team or collaborative-based environment, to make it more attractive for them to either come from other jurisdictions and practise here or for those who have been doing their training, their residency here in the province, to stay here.


As part of my tours, it was surprising, but then I learned how the residency program worked. What I was surprised was that only one of about eight or nine of the residents I met down in Yarmouth were from Nova Scotia - all the rest of them were from other provinces.


            But again, I think I spoke yesterday about that process is a national pool of residents' opportunities and just how they got matched. What was really exciting about that experience was the fact that nearly all those residents had very positive experiences with the system and were very willing to consider practising in Nova Scotia even though they are practising primarily in a rural context. So, there are reasons to be optimistic and encouraged taking the feedback from those individuals and what we can do to make it easier for them, will hopefully pay dividends as they come into the final year of the residency and they are ready to set up a practice.


Again, as I talk about those residents and the evidence we have as to the success of residents staying in the area in which they complete that level of training, that's one of the reasons why we are investing in additional resident seats because we have more residents and, contrary to some of the suggestions that have been made by some members of this Legislature that there would be no value in those resident seats for from two to six years - different individuals have cited different time frames for when you might see some value, I would like to encourage or recognize the vast amount of schooling and training that these residents have and their capacity to actually provide care and service to Nova Scotians.


            So when a resident is in a seat, rest assured that they are providing care to patients and Nova Scotians even during the residency program and then they have a higher probability of staying in the province. This is not an initiative or a program that is only designed to give value in many - so really a lot of different things going on around recruitment.


            It is a priority area because, again, to increase that service we need to get more people practising primary care. Also, I would like to highlight that it is not just with physicians where the focus on recruitment is, but also with our nurses, family practice nurses, nurse practitioners, other care providers who can help address particularly within their scope of practice, to provide primary care services.


            So, there are a wide range of things, not just on the physician side but recognizing the scope of practice of many different health care providers are all part of the solution as we move forward


            MS. CHENDER: Although it sounds good, I would like at the minister's earliest convenience some examples of what those things are.


So, we heard some ideas. I appreciate the point about residencies. I appreciate, I guess, that the NSHA was in fact trying something new with restricting practice areas although, clearly, it was a failure, and so I still am waiting to hear the concrete things that may be tried now and also any price tags that may be attached to those things where we are talking about the budget here.


I guess a very specific question which is to follow up on something you mentioned earlier which was noting a Dartmouth clinic that took on 800 new patients; I'd love to know what clinic that was and where it is situated and obviously we're looking at that area. So, if the minister could give me a specific answer on that and we do have more questions but I'm expecting we might not get to them within the next five minutes and 55 seconds.


            MR. DELOREY: The clinic was the Woodlawn Medical Clinic. I don't remember the exact address of it. It used to be on Woodlawn, but then moved but kept the name.


            MR. CHAIRMAN: The honourable member for Dartmouth North.


            MS. SUSAN LEBLANC: Thanks. I'm a little bit late to this party, so I apologize but I thought in the last couple of minutes that we have for our time I would ask some Dartmouth North-specific questions. I am part of a community organization that is lobbying for a health centre and we've met many times with members from the NSHA and who are very generous with their time and information.


I guess my question, well, looking at the last time we met with them, we were in Preston, actually. They took us on a little tour of the community health home in Preston which was very impressive and we looked at their metrics and, you know, my understanding is that the metrics for health clinics is, well, in terms of the doctors, four to five doctors for 10,000 people. We have 20,000 people in our area with four doctors currently, so, you know, when I saw those metrics, I was like - I know, I know, four is better than zero but I was thinking, well, it must be any day now that we're getting this clinic, so I just wanted to know if I can report back to the committee that we are a top priority for the NSHA and that we will open doors for a clinic soon.


            MR. DELOREY: Mr. Chairman, you know, as the member noted, I think every member in this Legislature would ask essentially the same question but what I do know about that particular one I'll answer up front. I don't know exactly what the final status or the most current status of those discussions are. I do know that those discussions were taking place in Dartmouth about opportunities. Again, as you can imagine, there are conversations going on in communities across the province to find the ways to provide the care in the best way possible, those care providers and, as I said, in the budget we do have money allocated to help establish and get practices up and running for those who wanted to move in a collaborative way and so, again, that's why we're investing in that way because we do know physicians want to work that way. They have good outcomes, but on that specific one, I don't know what the most recent status is but I can take a look and get that back to you in conversations with the NSHA.


            MR. CHAIRMAN: The honourable member Cape Breton Centre.


            MS. TAMMY MARTIN: Mr. Chairman, we're tag teaming. I'm just wondering if you have the numbers and the statistics on the exit interviews and if they're performed in every instance for doctors.


            MR. DELOREY: Mr. Chairman, the exit interview process is part of the operational side of work that gets done in the NSHA not information that was brought in to the budget estimates, so, no, I don't have that information here with me. I think, certainly, we'll reach out and try to pull that data together to let you know, but it's not something that we brought in as part of the preparations for budget.


[1:45 p.m.]


MS. MARTIN: Mr. Chairman, thank you to the minister because I think that would be very important information in all these situations that we're talking about, doctor shortages. If you could get that back to us, because like I said yesterday, what I'm hearing is that by the time the exit interview happens, it's too late. So, if we could find out for sure that this is actually the case and what's going on we would be truly appreciative of that. Thank you.


            MR. DELOREY: Just one thing and just part of the conversation piece - I know it wasn't a question - again, I think the exit interviews are an important part but again I think as I mentioned yesterday evening when we talked about this, the exit interviews, by definition, do happen after someone leaves.


            I think the concern you were actually getting at is not so much about exit interviews but rather what kind of, from a human resource - first, as a point of order, I apologize, Mr. Chairman, I think I used the term "you." I know that's not appropriate so I'll apologize for that.


            Mr. Chairman, through you I believe we talked about it and it's about the HR side of things and how people can voice their concerns, employees, and not just with physicians but I think all front-line care providers can provide that information and feedback to their employer so the employer can take that information in and make changes to improve the environment and hopefully prevent, I think, is ultimately what the member is trying to get at and I think we all do share that concern.


            MR. CHAIRMAN: The honourable member for Cape Breton Centre, with very few seconds left.


            MS. MARTIN: Mr. Chairman, I thank the honourable Minister of Health and Wellness for his time and answers.


            MR. CHAIRMAN: The honourable member for Cumberland North.


            MS. ELIZABETH SMITH-MCCROSSIN: Good afternoon, everyone. There was a question at the end of my session yesterday, Mr. Chairman, that we didn't have time to finish and I wasn't sure if the minister and his department had a chance to look at this - it was the cost comparative analysis for nurse practitioners and fee-for-service family physicians and looking at a comparative analysis when you compare all the costs involved - overhead, Merck costs, staff and pension, vacation, those kinds of things, and the reason I'm asking the question is more in line with making sure we are putting the right professionals in the right locations and also making sure that we're looking at all the costs involved.


            MR. DELOREY: I thank the member for the question. I hope the member can appreciate that level of data or analysis that she's asking for obviously would take some time to pull together, not having a specific report on hand when you break things down. Again, there's a lot of data that would have to be accumulated and assessed and that would be in terms of actuals in the current system.


            What I can assure you, Mr. Chairman, and the member opposite is that professions in the health care system, there is lots of research broadly, so I think just to let the member know that there are of course specific operational assessments and analyses but also, more broadly, research within the health care systems that does get performed, making reference to these types of things. I mean, it's in a general sense and you try to apply it in a local context. Again, through a lot of research, it's already adopted in many cases with the training of our physicians and our care providers, that this whole notion of team-based practice I think it's what I've seen in my short time here that really, truly, that's what - it's both the information I'm receiving through the department and the NSHA and the IWK, but it's also what I've been hearing and seeing with people out in the front lines. Again, not unanimous, everyone is not on the same page.


Also, I want to stress that again it's about collaboration and working in teams, how those teams work, how they are structured, what the mix is. I think the member, Mr. Chairman, made reference to make sure we have the right care providers performing the right tasks to provide and optimize our primary care - not just optimize it from a fiscal perspective but optimize it on an outcomes perspective as well. Those are really certainly the priorities, the focus and objectives of the Health Authorities, but also of government and, I think, all Nova Scotians.


            MS. SMITH-MCCROSSIN: Thank you for that answer. I would encourage the department to take a close look at that and do a cost-benefit analysis. In particular, I know there's some research that you can pull, but there's nothing specific to Nova Scotia in looking at our numbers. I think it would be valuable information to look at closely in helping make the best decisions moving forward.


            I also had a question specific to Public Health. I noticed in the estimates that the Public Health budget has decreased significantly. I'm wondering if you can share with me what changes are reflected in these costs and in these changes and a follow-up to that question is, what percentage of our health care budget is allocated for Public Health and health promotion?


            MR. DELOREY: A very quick clarification for the member - you made reference to the line - can you just provide the line number? I think Public Health is referenced on two different lines.


            MS. SMITH-MCCROSSIN: It was on Page 13.11, under Programs and Services. Public Health last year was $3.907 million. This year it's only budgeted for $1.736 million - a significant decrease, and I was just curious about what those changes are reflective of.


            MR. DELOREY: I appreciate the member's attention to the Public Health line, I suspect a line item that doesn't often get a lot of attention, perhaps the attention it deserves. At the front end, I would like to take a moment to recognize and acknowledge the great work that the many professionals in our Public Health offices across the province do provide for the people of Nova Scotia.


            The specific answer is the bulk of the reduction has to do with not a reduction in services but a transfer of those services to other locations. There are some grant funding programs that were transferred to the NSHA and IWK out of Public Health, so the work is being performed in our Health Authorities as opposed to through Public Health. We also transferred a program and funding around water safety to the Department of Communities, Culture and Heritage, so we moved money there.


That's just part of ongoing operational restructuring. With the work and the restructuring we did around Communities, Culture and Heritage the last number of years - they also have sport and rec there now - this was a program that just didn't get caught in that previous restructuring. We looked at it and said that fits a little better over there in Communities, Culture and Heritage.


            MS. SMITH-MCCROSSIN: I'm trying to be respectful. I know so many of my colleagues have questions, so I'll try to be efficient.


            I had a question to the minister about Pharmacare and the high cost of drugs. It's probably the fastest-growing cost in our health care system. I'm curious, when I look at the budget lines for Pharmacare and the other related programs, there aren't any significant changes there.


            My observation in this short time as MLA, but also in my years of being a nurse, is that Pharmacare, in particular the Family Pharmacare Program, has been a real barrier for people getting off of income assistance. My first question on that line is, is there any work being done with Community Services to transition people? I know some people are staying on income assistance specifically because as soon as they get off, they lose that Pharmacare component, so it's a barrier to helping people get back into the workplace, especially if the job they're going to take doesn't offer private health insurance.


            I was curious about that, and then also, following up on that, is there any current work being done by the Department of Health and Wellness with regard to looking at a national strategy for a Pharmacare program - or a Maritime?


            MR. DELOREY: Mr. Chairman, the member is right. You know, certainly, drug costs are a challenge. It's one of the reasons why in this budget we committed to an initiative to help particularly an area where we see significant cost pressures and, in some cases, really, they are almost a catastrophic impact to individuals in the area of take-home cancer therapies, and that's why in this budget we're taking steps to mitigate those particularly catastrophic situations, but in addition the efforts and work that we're doing.


The member made reference to a national program. We certainly have indicated and the Premier has taken a very strong leadership position on this, looking to partner with our sister provinces. I think you hear from time to time people talk about a national program. It hasn't seemed to have gotten the traction across the country but that's why we thought let's look at opportunities to have discussions about drugs and partnerships and collaboration at the local, more regional level, so that's why those conversations have started at the Atlantic level and we'll see what happens. So, we do recognize that sometimes doing more together than apart, individually, yes, those conversations to do more with the resources we have to do better, we recognize the pressures and the growing pressures within the area, and so that's work that we are doing.


            In addition, I don't want to leave members with the impression that work doesn't get done at the national level. I think work, and it predates my time in office, certainly has been around a lot of progress not on a Pharmacare Program but on national collaboration on the purchasing of drugs to try to have a better negotiating position and get better prices for drugs. I think we've seen a lot of benefit, and so although we see increased pressures and demands because there are so many new therapies coming out and being available for people to receive, those would be cost pressures going up, but by doing better negotiating and managing the costs of those more expensive new drugs but trying to reduce with generics and other systems coming in line and, also, again, working with our sister provinces to negotiate better deals.


            The other thing I think that came up in the question was about the DCS and the role of the DCS program. I know they do have a program to provide some Pharmacare benefits. I don't recall what the name of their program is, but just to highlight to the member - and I don't know if all Nova Scotians realize this, but through the Department of Health and Wellness, we do have a Family Pharmacare Program as well. So, it's just not the seniors - we actually have the Seniors' Pharmacare Program but we also have a Family Pharmacare Program that Nova Scotians can register with through the Department of Health and Wellness as well, and that's open to anyone and even if you have other coverage you can still sign up and obtain some coverage through a provincial program there as well.


Again, recognizing the circumstances and the financial challenges obviously of individuals who are receiving support through the Department of Community Services, obviously they've stepped in with a program that provides additional supports and benefits to the people requiring their services. So, that gets to the heart of your problem, but there are programs, if those individuals weren't aware of it, that they could look at, again, the family program that we do have, and see how that can fit in, and work with them as well.


            Again, a lot of the work we do is trying to keep the costs down but even within that, with the multiple programs, our Family Pharmacare, Seniors' Pharmacare, special drug programs, and all of the programs that we have invested in, we have a net increase of just under $8 million for this budget, just targeting in the Department of Health and Wellness budget, going towards Pharmacare-related and drug coverage-related investments.


[2:00 p.m.]


            MS. SMITH-MCCROSSIN: Thank you for those answers. I know my colleagues are getting anxious, so, I wanted to bring up one concern. I'm not going to probably ask you for an answer to this question but one of the things that has been said is that there's a reduction in long-term care, in the wait-list for long-term care beds.


            I know in the field the people that you talk to will share different numbers and different reasonings than our bureaucrats - so I don't want to dispute those numbers right now. One thing that has come as a concern from front-line staff is that there have been many beds over the last, say, 10 or 15 years, that have been - they're acute care beds, in our regional hospitals that have been used for long-term care placement. Some of those are being freed up, which is great, for our acute care patients. The wait times, waiting in our emergency departments have lessened some; people are getting acute care beds.


            However, one of the significant challenges that our nurse managers are facing is the nurse staffing formula is still based on having long-term care placements. I know, in particular, there are some situations that have arisen, that have created unsafe working conditions, because the ratio of CCA to RNs and LPNs hasn't been reflective of the type of patients who are in those beds. So that's a real concern I just wanted to bring up to the minister, and encourage the department to look really closely at that because, even though you may on the front end see a cost-savings, in the long run you're seeing higher burn-out of your staff, you're seeing unsafe situations for your patients and you're seeing higher Workers' Compensation claims being put in, in those situations. So, I did want to just bring that up.


            My last question today, before my colleague comes, is, looking at the budgeting costs for mental health services, and I'm asking this more for my own understanding. I realize there has been some increase in the budget for mental health. We see mental health in two different locations in the Estimates. One on Page 13.11 and the other on 13.12, and I'm just wondering if you could explain to me what the programs are and what that money is actually allocated for? Is it acute care beds? Is it outpatient services? I just wanted to have a better understanding of what is budgeted and for what areas?


            MR. DELOREY: I thank the member for raising that question. Of course, the two locations are the departmental mental health contributions and the Health Authority's contributions, I believe. Really, it's broken down that way because, as I've talked about the structuring or restructuring that took place, we're really trying to delineate and have operational front-line delivery, so when you're talking about the beds and services and the clinicians being provided, that is coming out of the Health Authority's mental health budget.


            What you're looking at in the department budget would be really the earlier stages, the delivery or development of program initiatives that we might want to be looking at if there are changes or new programs that we might be looking at developing. For example, one of the recommendations Dr. Stan Kutcher would have addressed would be, like the suicide framework, having that re-evaluated and assessed. We would be looking at doing that in the Department of Health and Wellness so the funding would be going towards that.


            Once that framework is reassessed and redeveloped and established, then the implementation of that work would be done and the operational, on an ongoing basis, would be delivered through the Health Authorities, both the IWK and the Nova Scotia Health Authority.


            I don't have a specific list of all of the individual items, but at a broad category, the other one would of course be in both budgets, grants to third parties. I think you asked this - one of the two of you on the PC side - sorry, Mr. Chairman. One of the individuals in the PC caucus I believe asked earlier about some non-profits that provide services. These grant pools would also be funded, but there would be funding opportunities and grants, I think, and supports to third parties, both being delivered from our Health Authorities but also from our work. Just give me one second here, I want to verity.


            The other thing that I'm just being reminded of here is that in addition to these costs, I want to highlight that in the area of mental health services, our physicians - like our psychiatrists who would be providing very important services, particularly to our most acute patients - that funding doesn't get flagged necessarily as mental health but rather through the physician services budgeting. Similarly, those of us who are familiar with acute mental health challenges, sometimes they require pharmaceutical interventions, so that would be in our pharmaceutical budget.


            MS. SMITH-MCCROSSIN: I have a follow-up question and it's more just for clarification. Under Programs and Services it shows a fairly significant increase in the budget, under Mental Health and Addiction Services. Last year it looks like it was budgeted $8,103,000; this year, $11,040,000. From what you shared, am I correct in saying that money is more for planning only? I guess what I'm questioning is, is some of that money also used for direct patient care or is it only for department planning?


            MR. DELOREY: To clarify, those are the additional investments. So when we budget it, we have it in the department. It's not just for planning but we're not moving the money over to the other budgets until they are ready to be operational. So when you look at the end of next year, it might play out a little differently in terms of where it gets recognized, depending on the work that gets delivered. Also, as I mentioned, you know, investments in our Kids' Help Phone, for example, funding and so on that goes into some of those - that money, the Central Intake program which is being developed to roll out and so on. So, again, it is the total amount we're putting in but also for the delivery of services. When you first get them set up, it gets allocated and then we move over, much like the question that was asked earlier about Public Health. Again, some programs were here and then we moved them over into the Health Authority so the budget goes with the programs once they're ready to roll.


            MR. CHAIRMAN: The honourable member for Cole Harbour-Eastern Passage.


            MS. BARBARA ADAMS: Thank you, Mr. Chairman. I'm going to move on to a different area but I wanted to just go backwards for a second to what we were talking about earlier. On Page 13.10 of the estimates, under Health and Wellness, the budget for Home Care - Nursing Services was $74,734,000 and then the actual was slightly less than that. I'm assuming that's because of staffing. The budget for 2017-18 is lower, $74 million down to $72 million. So, I'm just wondering why when we were talking about the success in home care in nursing services and reducing that wait time, why the budget has gone down rather than likely up, with the aging population.


            MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for that question. It's actually an interesting response because it brings both the member's questions but also her colleague's, the member for Cumberland North, together. This, I believe, is a situation where we have more outcome - that is, more delivery of services - for the money, and the rationale for that is, actually, it has been a better alignment of ensuring the right practitioners are providing the scope of service.


So, for example, you may have had scenarios where a more expensive service provider was providing a service that was at the lower end of their scope of practice. By aligning a service provider where that is at the upper end of their scope of practice, you're getting the right or the best care from people. So, that's how you cover off that we are actually still providing more services but we're doing that by being more efficient both in the delivery in volume but also in the care and, again, making sure that it aligns and that, again, goes into much of what your colleague has been - sorry Mr. Chairman - what much of the member for Cumberland North has been really asking about and encouraging us as a government to focus on, is doing that tracking and identifying how and where and making sure that we are getting the best value, again, not just dollar value but also service value in our health care system.


            MS. ADAMS: Thank you, Mr. Chairman. I'm referring to the investing in the stronger Nova Scotia document here, where it talks about, the third bullet down, that there's approximately $800,000 more for supports under the Opioid Use and Overdose Framework, including expanding the opioid treatment programs to eliminate the wait-list. What I'm wondering, to the Minister of Health and Wellness, is does that extra amount of money go towards direct patient care? Does it go towards training physicians as to how to manage patients who have chronic pain conditions? Does it include extra staffing? I'm just wondering what that extra $800,000 - because that's a significant boost, which is great, but I'm just wondering what it goes towards.


            MR. DELOREY: Thank you, Mr. Chairman, and I'm actually very proud of that particular line item. A quick aside, because earlier today there was actually a press release in this area of the opioid framework so just for the record, another public service announcement if I may be indulged, that the Naloxone kits in our community pharmacies, that news release went out. So, again, for the members in the House who may not have seen that because they have been sitting here, we have over 240 community pharmacies of the 305 pharmacies across the province, already signed up and have stock for Nova Scotians to go in and receive that. That's just another part of the plan.


            The work for the just under $800,000, I think it was, around $800,000 that the member is referencing, that is really primarily - I've made reference to it, I think, in my opening remarks. We have wait-lists, so it's treatment, it's operational. So for those treatment sectors, that investment is estimated to address the wait-lists in all of our communities across the province but also increase capacity by approximately 200 to 250 additional spaces across the province, recognizing that this is a growing problem in our communities.


            I believe the member made reference to the opioid framework. What's important to recognize is there's actually a multi-pronged approach to that framework. This is one of those initiatives that is about ensuring they get the treatment, but that is not in isolation because we are looking at harm reduction and so on.


            In the meantime, we are in a situation where we do see increased demand and we want to be proactive, not just to address the wait-list but also to ensure that we invest, that we have the capacity in those communities that seem to be showing signs of needing it the most. So it covers both.


            MS. ADAMS: Thank you for that clarification. I'm not sure if you're familiar with the Atlantic Mentorship Network. It's a provincial organization of physicians and allied health professionals who meet and host programs to help train physicians and allied health professionals in how to manage those with chronic pain issues. I'm going to put in a plug for them because it is the first of its kind, which means that at least once a month I can go online and talk with physicians and allied health professionals around the province. We do have regional representations, so regional groups do get together, but we do have the ability to meet provincially as well. They host a conference every year and several other things. One of their biggest initiatives is to try to train allied health professionals and physicians in how to manage those with chronic pain, so that they can use all the support they can get.


            I'm going to be referring to the "Support for an aging population" document now. One of the things on here is, the third bullet down, it says there is going to be $30,000 to work with partners to promote entrepreneurship for older adults. Of course, being in the workplace gives older adults access to health benefits and it gives them a purpose in life and a social life.


            I apologize but the amount of $30,000 doesn't seem like a whole lot of money. I'm just wondering, for an entire province, what is that actually going to be targeted to, or what are we going to do with that money?


            MR. DELOREY: I think the member is referring to, kind of a bulletin page which  - those bulletin pages aren't aligned explicitly by department. I think those bulletin pages that went out with the budget were aligned with themes or categories.


            As I've mentioned previously to the question about non-profits that provide health services, there are overlaps in some areas. I believe the specific item the member was referencing, I think, is under the Department of Seniors, which prior to this year would have fallen under my mandate but apparently I was deemed perhaps not the best candidate to continue that portfolio.


            My colleague, the former Minister of Health and Wellness, continues to carry his portfolio on behalf of the seniors of the province.


            MS. ADAMS: Again on the same page, I am going from referencing the same page. This one mentions that there is $5.1 million for home care initiatives, including an increase for a self-managed care program, an expansion of the Caregiver Benefit program. So I'm just wondering if you can explain for those who are watching, what you mean by self-managed care program.


            MR. DELOREY: I'm actually very excited that the member asked that question because it is a very exciting and very good program. I know I've had constituents in my community who make use of that and they find it very - I don't know if liberating is the right term - freeing, perhaps, because it gives those members in the self-managed care program, if they have physical disabilities, they get the pot of money, and they get to hire their own care providers. So, rather than receiving care, for example home care where they would go through a care-providing organization - when we talk about home care and home care-type services. These individuals can actually choose to develop a personal care plan and put those resources towards individuals.


When you identify the needs base, they can work and hire directly their own care providers, rather than being assigned specifically to a particular organization. It allows a little more flexibility for the individuals and is particularly helpful when individuals, particularly with disabilities, have the capacity to do a lot of the work and the planning and develop a customized, personalized care plan.


            MS. ADAMS: I apologize, I'm still a little confused. Does this mean that instead of saying you're going to get your home care from Northwood, you're going to be allowed to pick your care provider?


            MR. DELOREY: Essentially. They have the opportunity to work - there is an application process and verification that goes through, of course, for the program. It is not something that's for everyone, but for those who are eligible, again, that makes sense.


            I made reference to one of my own constituents. The individual was a minor at the time, so it was actually the parents who stepped in. They were brought in as the care managers to identify and develop the services that they needed and the balance that they needed between respite and whether it was physiotherapy services or other types of services that were appropriate. In their case, they found it very beneficial because, as the client grew and aged, the needs and the services shifted a little bit. It brought that kind of flexibility that worked very well for them. It was also very good for them because as the individual went off to university, they were already developed, and they were able to bring that with them. That transitional piece also worked very well for them in that situation.


            That is essentially how the program works. But again, I recognize while it can be very good for people that it works for and who are eligible, it's not necessarily for everybody in all circumstances. It's an investment there to support those who value this type of approach.


            MS. ADAMS: I want to thank you for that explanation because greater options are always something - recognizing that not everybody is going to be able to do that.


            It does sort of bring back the concern that I expressed the other night during my Address in Reply to the Speech from the Throne, about the difficulty we have with those who work in the hospital system not just being pressured, not to mention private organizations, but being flat-out restrained from doing so and penalized if they are. So I'm really hoping that this might be a movement in that direction as to how we get the word out as to what these private organizations are. I know there's some concern. Thirty-five years ago, there were physicians in Ontario where I worked who owned their own physiotherapy clinics. I was seeing patients at the outpatient clinic at the hospital, and then the next thing I know, they're being directed over to this doctor's own private physiotherapy clinic. The College of Physiotherapy put a little bit of a stop to that one. So I can appreciate that there are some conflicts of interest, but in the interest of knowledge, we want to share that.


            The next thing I want to talk about is the reference here to $3.7 million more to provide additional orthopaedic surgeries and offer prehabilitation services that help patients prepare for a successful surgery. Prehabilitation is what you do before you have your surgery. Post-op rehabilitation is what you get afterwards. I happened to be at a meeting at the Dartmouth General two weeks ago. They were showing me where the extra orthopaedic beds were going to be, which is, of course, one of the top issues for seniors in this province. When I asked her if they had done an impact analysis on what other services you were going to need after the surgery, this person said, I don't know that we did.


So, I reference what we used to do in Ontario because I was the one doing it, is that if a new physician came on board to the hospital, there was an impact analysis done on what other services you were going to need to support that person. For orthopaedic surgery, for every one orthopaedic surgeon we added to the hospital - and this was University Hospital in London, Ontario - they got three outpatient orthopaedic physiotherapists and one occupational therapist. So, in this case, I said are you expanding the outpatient physiotherapy department at the Dartmouth General Hospital in order to see these patients once they've had surgery and she did not have the answer to that, but I noticed in here that it only refers to expanding prehabilitation not postop follow up. I can guarantee you that that would irritate most surgeons because they know that the success of their surgery is almost, not entirely, but is significantly dependent on what kind of follow-up services that the person gets once they have their surgery and then once they get home. Thank you, Mr. Chairman.


            MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. I guess I'll get to the very specific part but, I guess, where the confusion may have come from, is the fact that prehabilitation was highlighted or stressed and the post was not. I just explain for the benefit of the Legislature that I think it's because the prehabilitation portion is something that's relatively new, that many people aren't aware of. The member opposite is indicating, based on her clinical experience, it's not something new to her, but I think in a general-population perspective and, you know, the nature of prehabilitation services can vary. I know a former teacher of mine, who over the last number of months has been on the wait-list. I can tell the members that this individual, although it has been a long time since I've been in high school, I think he looks like he's in the best shape he's been in, certainly better than when I was there, because of the requirement that he was going through, programs to get in a situation, in a healthy situation to ensure the best possible outcomes. So the importance and the value - and the individual recognizes that, recognizes that it may take him a little longer to get into the program but he's seeing the benefits, like I said, he looks phenomenal. When he gets those new knees, it will be really life-changing for the individual.


            So, to the specific question of what the resources are going towards, you're looking at four extra orthopaedic doctors, with the four anaesthesiologists for the actual service. I think the ratio that the member mentioned was, for three posthabilitation, we have and I don't have the breakdown of exactly where it's going in, but it's about 40, around 40 staff including the physiotherapists that go along to support the ortho services, so, I'm pretty confident that efforts to ensure that the appropriate people are there for both pre-op and, obviously, the surgery and post.


MS. ADAMS: Thank you, Mr. Chairman. It'll be good to see what that staffing level is like and I look forward to hearing it.


            There is a mention here about the $7.9 million to meet the needs of Nova Scotians aged 65 and older enrolled in the Seniors' Pharmacare Program. I think most members here today will recall what happened when we were looking at the rollout of the previous Pharmacare Program. I served on CARP Nova Scotia at the time, so, I heard quite a bit about it. I'm wondering whether there is any changing of the formula for calculations. The dollar amount doesn't seem to be any different from what it was before or is just slightly off, but I'm wondering if there's any change in terms of the formula for calculating what people are payed and owed. Thanks.


            MR. DELOREY: Thank you, Mr. Chairman, and I can assure the member opposite, as promised we didn't make changes and we don't have plans to make changes to that plan other than the changes that were made the other year, the final changes that were in place, which was really an improvement to the plan to ensure that there are a large number of seniors who no longer pay any premium at all because we've expanded the eligibility for those waivers to those seniors in the plan base, so we've increased the income. That's what happened a couple of years ago. The increase is related to a combination of utilization, essentially the utilization of the program, not change in formulary.


            I should clarify, I said the term "formulary". What I mean is the formula, not the formulary because, obviously, the formulary of the drugs that are covered and so on does change over time. I apologize if there was any confusion when I said formulary, I did mean formula.


[2:30 p.m.]     


MS. ADAMS: One of the major issues people face when they go to a walk-in clinic, is that they can only get certain services while they are there. Certain medications can't be prescribed, there's reluctance to refer to specialists, there's even reluctance to fill out any forms or prescribe equipment.


            So I'm wondering, given that difficulty where people think they can get that kind of service from a family walk-in clinic, if the Minister of Health and Wellness has thought about doing either one of two things with the private health insurers, where they all require prescriptions for everything from glasses to orthotics to wheelchairs to a cane, whether there has been any consideration about requiring the private health insurance companies to pay for that doctor visit, in part or in full, if it's their requirement, for them to have us do that before we get access to the benefits that we've paid for. Thank you.


            MR. DELOREY: Mr. Chairman, I can advise the member opposite that in my time in the office, that's not something that I've looked at but it certainly seems like something that could merit looking into and for some consideration. But again, I can't say for sure if it has been looked at before, in which case maybe the information might be there and the case has been made one way or the other, I'm not sure. But again, possibly something worth looking into.


            MS. ADAMS: Just in the last 15 minutes that we're here, there are an awful lot of allied health professionals around the province who are telling us that they would like to help take up the slack of what the physicians are not able to provide. Most health professionals aren't territorial although they do like to think they are specialists in their own fields, but we're all feeling the pressure. I know when I have a patient come to me who has been in a car accident and they wanted to have a disability form filled out and they wanted equipment recommendations, I can do all that, but then it has to go get signed off by a doctor.


            We've got this bottleneck that is forcing them over to Community Services for help. So I'm wondering about efforts, whether future or already ongoing, that I might not be aware of, to make greater utilization of the other allied health professionals. Although there are two physiotherapists in the House, we are not the only ones who can help.


            I have some specific questions but I just want to put the general question out there because there are a lot of us, and especially a lot in private practice, who would be more than happy to have some additional work. Thank you, Mr. Chairman.


            MR. DELOREY: Yes, and to explain that, Mr. Chairman, yes, the awareness of the scopes of practices of the many health care providers and their ability to help move the province forward, particularly in the situation where we are really working to ensure that Nova Scotians get the care they need. I think in some of the examples I've used, whether it's in the notion of collaborative care teams, there are certainly opportunities there for consideration to work as part of a team. That's what we were saying when we were talking about flexibility of coming together with teams and not just explicitly in what you may even consider as the allied health. I think the Premier made reference to it earlier today, social workers, which many people wouldn't always consider as a health provider, but they certainly have a scope of practice that provides, particularly in the mental health space, but also they provide that liaison and connection and awareness into those other supports that get into our determinants of health. They would be in a far better situation in many cases than what I'll call, for lack of a better term, our clinical health professionals who would be focused on delivery of a particular treatment of a particular type of health care. I think in the broad sense of the path that you're referencing of how do we maximize the utilization of individuals and their scopes of practice - I think earlier this afternoon I made reference to one example in home care where we actually got some efficiencies both in delivery of services and more efficient use of our resources by doing just that.


            MS. ADAMS: One of the things that I have experienced because I worked in both public and private in the same area, is home care wait times for occupational therapy and physiotherapy. Sometimes we forget that that is another care provider that has a really long wait time.


            I know when I was speaking to the CEO of the Nova Scotia Health Authority and one of her staff, they were not aware - because they can't know everything - of how long the wait times were. Just for reference, if somebody here had a mother who fell and hurt herself and needed home care for physiotherapy, if it wasn't the quick response program, they might wait somewhere between three and six months.


            I'll actually use another example. I was seeing somebody on an outpatient basis, who was a young mother who had a baby, who had a neurological disorder that was progressively getting worse. She needed to use a walker in order to walk, so she couldn't carry her baby, and she had no benefits. She was on social assistance, no benefits, but her family chipped in to pay for her to come and see me once.


            I put in an urgent referral to the Nova Scotia Health Authority for home care, OT and physio. It took three months before she was seen by either one of them. These are great people, but they came out once, and they made a bunch of recommendations. They didn't have time to do a report because that's one of the things we lose in a hospital setting when you're so overworked - you don't document the way we were trained and expected to do. She got one OT visit and one home care physio visit in the first three months. Then she got another follow-up visit three months later.


            That's the reality of home care physiotherapy and occupational therapy. I don't want to sound like I'm constantly pitching for my own profession, but I know that in a private setting, we often in the home care, physio and OT, went into the home once, made an assessment, looked at the environmental barriers, said, you should apply for these renovation grants or these assistive devices. We were able, with one visit, to make the home safer, and tell the family what they needed. Then they could stay there while they waited that three months to get somebody else to come out.


            Mr. Chairman, what I'm wondering is, while we have some savings because we can't get enough physicians here, until such time as that is there, is there any way that we could possibly add to the home care, OT, physio, social worker budgets, even for a one-off visit? I liken it to getting your eyes checked. It's something that I did hundreds of myself - one visit into the home. We even have safety service coordinators who go into the home and can identify those.


            I'll end up with a last rationale for where the idea came from. I served on Community Links and partnered with Tisha White from Northwood Intouch. They provide the call buttons for people if they fall. Right now, the ambulance providers in this province, if you fall, they will go to your home, pick you up, and leave. If they don't take you to the hospital, you don't pay for that service. You and I are going to come back with public service announcements, if you fall, and you can't get up, and the ambulance comes to pick you up and doesn't take you to the hospital, they don't charge you.


            But then that's the end of it. There's no reporting to the doctor, necessarily, that you fell. There's no care provided if you tripped over something. We've sort of left you in the same hazardous environment perhaps or the same weakness of frailty.


            I guess what I'm wondering is, can we look at possibly something like a one-off visit once a year? Everybody could call up and get some kind of home care intervention. You just come look at the home, look at your mobility and even partner with the home care, OTs and physios to do that, and maybe in the private sector, like we do with the home care nursing agencies.


            MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question or suggestion. I'm not sure, kind of maybe a mix of both. Really, again, in terms of at the high levels we just talked about, of course, getting these aspects and opportunities to get to the scope of practice, that's part of the ongoing work that we're doing. It certainly ties in well with our collaborative practice concept, again, noting that collaboration doesn't necessarily have to be co-located collaboration either, that doesn't mean that.


Mr. Chairman, as the member mentioned, allied health professionals may want to work and join. I would encourage certainly those health professionals, again, if they may consider themselves not being looked at as part of the health care system, or they feel that they've been, for lack of a better term, the poor cousin of the health care system, that doesn't prevent, in many cases, these individuals reaching out to try to connect and partner with the others.


            To the specific program suggestion or recommendation, again, that's the type of thing that we would consider going into a budget, as opposed to at the tail end of a budget. So, I certainly wouldn't want to set the member's expectation in these budget debates that this is a program that we would design and roll out but, again, certainly as a government, as I think all governments would when good ideas or concepts get pitched and, again, certainly we will be completing this budget in the fall session and, based on my past experience, I suspect my colleague, the Minister of Finance and Treasury Board, and her team will be moving directly into preparation for the next fiscal year's budget time. You might want to submit as part of the budget consultation process some suggestions there too.


            MS. ADAMS: Thank you, Mr. Chairman. I appreciate that. I realize there's not a lot of time between now and the next budget, so, I'm patient. Probably with the time that we have remaining, one of the other professions we haven't talked about much is the pharmacist and I know that they were given some extra abilities to prescribe certain medications and that has worked well. It is a bit of a well-kept secret because they're not big on promoting themselves and so it's difficult for people to get the message out. So, I would suggest that, as another public service announcement, that it could be an idea to let people know what their pharmacists are able to do to help them out.


I'm also wondering though, if there is any plan to expand the ability to increase the drugs that they're allowed to prescribe. They're also not paid necessarily for the consult like a physician would be, so, if they have to take time away from dispensing to go sit and talk to the person, they're not necessarily getting paid for that. So, they're feeling a little like the poor cousin right now because you're willing to pay the doctor who's not available, but you're not willing to pay them, the person who is available. So, I'm just wondering if we could talk about that a little bit. Thank you.


            MR. DELOREY: Thank you, Mr. Chairman, and I am, I can say honestly, personally pleased that you brought up specifically pharmacists. You know, as I mentioned earlier, the announcement today with respect to, on the opioid side with a Naloxone rollout, that that program really, I believe, is truly a lifesaving program opportunity, could not be rolled out in this way without the support of our community pharmacists. I would like to acknowledge the role that the Pharmacy Association of Nova Scotia, both the organization for their leadership and collaboration with the Department of Health and Wellness and Public Health to both design and prepare and engage and work with their membership, which means also recognizing the individual members and the pharmacists and those pharmacy organizations for stepping into this, to support the program.


[2:45 p.m.]


            I've had meetings with PANS. I've also as part of my tour of the province included pharmacists, so I have been out to a number of community pharmacies, independent of PANS. So, again, PANS is representing the collective but, again, hearing the front line as well is important, which is what I've been doing with the other health care professions as well, is meet with the professional organization representatives, but also catching individuals - the grassroots that are on the front line.


            What's potentially amazing - although it shouldn't be surprising, but in some cases in organizations or in professions it's not always the case, but I've seen very much a consistency in the front-line concerns, or proposals and recommendations, and those being advocated on their behalf through their organization. So, really, I've seen a lot of consistency which in some cases is part of the challenge we've had with health care - and I think in other cases it is when the message is being received through the organization or the entities acting on behalf of a membership, where the information and the feedback there is not always consistent with the priorities that we hear from the grassroots, and it makes very difficult situations.


            So again, in respect to the pharmacists and the Pharmacy Association, I've actually been quite impressed with them being consistent. These concerns or suggestions - rather than concerns I'd say suggestions, I think advocacy for improvements - ties in very much with our goals and objectives. When we're talking about collaborative care, I know we'd often focus or seem to be focused on the notion that comes up when we're talking about physicians, but again as a public service announcement, it recognizes that our concept here, that is exactly how our vision of care is different, by including them as part of the conversation as well.


            MR. CHAIRMAN: Order, please. The time has expired for the PC caucus. Just before we move on to the NDP caucus, we have a request to take a five-minute recess, which we will grant.


            [2:47 p.m. The committee recessed.]


            [2:51 p.m. The committee reconvened.]


            MR. CHAIRMAN: Order, please. We'll now call the committee back to order.


The honourable Leader of the New Democratic Party.


            MR. GARY BURRILL: Thank you, Mr. Chairman. I was wondering if we could direct our conversation a little bit around some of the details of the bilateral federal-provincial agreement from last December. I'm sure the minister would be aware that in our Party we were very disappointed in the agreement. We have thought for a long time that the adequate funding for our province's health system does, indeed, require a recognition in the funding formula for our particular demographic situation and also our particular geographical situation. But I want to think about the dimension of the bilateral agreement of the two amounts for home care and for mental health that were provided as the, well, so to say, as partial compensation in some respects for the fact that there is not at least an overt recognition of our demographic situation.  


So, about the $157 million for home care and the $130.8 million for mental health, we understand these to be 10-year agreements. I wonder if I could ask for some detail about how that money has been allocated precisely, this year, in this budget. In other words, ought we to look for one-tenth of that amount or is it being done in a different way?


            MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. You know, with respect to those two categories, I think the member would agree, notwithstanding the concerns that were raised in the member's opening remarks with respect to a preferential outcome in a particular way, I believe that the member and his caucus would agree that these two areas in particular are priorities and important areas for investment. We do certainly, and I suspect they would concur, think that these increased investments on behalf of the federal government to the province are good and are positive outcomes.


            As far as the question about how the allocation of the funding is, it's not linear, so you know, it's not one-tenth each year. It is spread out over the years but the first year is not a direct linear allocation. One of the things we spent doing, so, in terms of where the money is going, clearly in our budget we have significantly increased investments in mental health and in our care initiatives. So, with these investments, of course, some of that funding would be flowing from the federal agreement and we would be looking to allocate as the funds come in from the federal government, targeted towards those specific areas.


Some of the things that we look at - what we worked on early on was identifying, as we allocate, what kind of falls into that classification, of what's eligible to be allocated against this funding. The member for Cumberland North spent most of yesterday in our discussions talking about the notion of accountability and measurement and so on. There has been a lot of work to try to assess and identify those areas where we can focus, and shared priority. When we talk about mental health and addictions services, there's certainly a focus on youth services - that's important and eligible. Really a focus on evidence-based models of care and community-focused care are important. Similarly, the notion of home and community care for continuing care is really about identifying evidence-based and research-based and rolling out programs that really will result in better outcomes for our population.


            As I said, this year I think in home care we were looking at just over a $5 million increase, and in mental health I believe it's somewhere in the vicinity of $6.6 million with a variety of services. That's just on the health side of things. Those mental health investments do not include supports and investments being made in the Department of Education and Early Childhood Development through programs in SchoolsPlus and other programs over there that are also targeted, in particular, towards our youth mental health initiatives and are health-related. But again, it's one of those areas where there's a bit of overlap between the departments. But the objectives and the supports that go out to help people are the same.


            MR. BURRILL: Thank you, minister, for that answer. I'm trying to understand, then, about the pattern that we can look to for the allocation of these funds over the next decade. Is it the case that the plan in the department is for roughly parallel amounts to be applied in each of these two areas over each of the next 10 years? Or are we looking at an escalating picture or a diminishing picture? Could you provide us some sense of the pattern, the shape in which this decadal funding is going to be provided in these two areas?


            MR. DELOREY: Generally, we're looking at an escalating pattern in the rollout of the funds. Part of that is, again, ensuring we get the programs, models, and where we want to focus on having evidence informed. We want to ensure we get that and get the programs. As has come up in some of the other discussions, there are a lot of advancements and changes and learning being done in our programs in the health care field, so it is recognizing that. We want to make sure that the money not just flows, but that we're able to actually get it in the right places as well.


            That of course doesn't suggest that the need isn't there. Again, we can always use more, can put more there, but we want to make sure that as we roll out, we're rolling it out and getting the best value in the programs and services that are available. The expectation and the planning are based on escalating contributions over the 10-year period.


[3:00 p.m.]


            MR. BURRILL: I would like to think further along these lines just with another health accounting question. We see that in these areas, home care and mental health, in the budget that is being put forward, the amounts are roughly parallel to what they have been in previous years. We know that these are areas with bilateral agreement of significant federal contribution being used this way along the lines you have spoken about. Are we to understand that federal money here has, in effect, taken the place of provincial money, that that has been reallocated, or does it work in some other way that you can speak to?


            MR. DELOREY: The answer to the question is no, that's not what you should draw from the conclusion. In fact, what I think should be recognized is that the investments being made particularly, again, around mental health, really exceed the contributions coming in this fiscal year from the federal government. This work and our commitment as a province is not just in relying on the contributions from the federal government in these two areas.


            We certainly welcome the contributions and the support in these two important areas but as you know, when looking at the budget, the contributions that they are making, even over the 10-year span, when you look at the total amount of money being put into these programs, it is only a percentage of the contributions we put in and, again, we have continued the investments. To the member's question, that wouldn't be the conclusion that I would draw.


            MR. BURILL: So I just want to pursue this to make sure I understand it. Is it the case then that the federal money comes without any specific home care and mental health programming that it must be attached to? If that's not so, could you speak to some of the programming that the bilateral agreements are, in your anticipation, going be making possible - some of the initiatives that we, perhaps, might not otherwise have been able to develop but which the department is looking forward to developing as a result of this.


            MR. DELOREY: I appreciate the question from the member. Actually it is, I will say, a hybrid answer. What I mean by that is, I will just summarize the question to make sure I understand it. The question was, is the funding kind of carte blanche or is it attached to some programs or objectives of the federal government. It is tied. The federal government, of course, has some objectives and parameters around the funding. But at the same time, they recognize that we are a diverse federation in Canada. And so, what the focus has been and work, not just bilaterally but across collectively with the federal, provincial and territorial representatives, has been to work together and come up with kind of categories that we would fit in. I just made reference to some.


            I made reference to, again, the focus on the youth and community-based type of programs and initiatives. So, in the Nova Scotia context, what are some areas that we identified? Again, things like the work in the education system through the investments in our school, would be the type of things that would meet that criteria. To highlight and stress the fact that, again, those are programs and initiatives where although it is identified as Canadian Health Transfer funding, it is about the outcomes, so again the flexibility that exists allows us to deploy programs which might not necessarily be rolled out through the Department of Health and Wellness or our Health Authorities.


            MR. BURRILL: I want to thank the minister for this exploration of how these bilateral agreements are going to work in these two important areas. I'd like to switch gears a little and just speak to some specific accounting questions relative to particular program areas in the budget. Could the minister please speak to the amount of money that has been allocated through the budget, particularly for this coming year, in the dementia strategy?


            MR. DELOREY: I believe the main investment being made in this fiscal year would be about $480,000 which we're flowing through to the Alzheimer Society of Nova Scotia to really provide a lot of supports and work in that regard.


            MR. BURRILL: A parallel question in another area. Could I ask for the details about the money that has been allocated for the coming year in the palliative care strategy?


            MR. DELOREY: I think just for clarity, in the palliative care I think we'd look more at the hospice, just the terminology side. I think there are clinical differentiations between the hospice and the palliative services but the work that has been ongoing has been focused on the space of hospice and over the last year or two is developing a framework. The focus of that framework was to work with and provide the guidelines for communities and groups who have an interest in establishing hospice facilities or services within their communities. So by developing the framework first, was to provide really the negotiations and the structure for how we roll those out.


            I think right now the two that were and have been announced that have work underway on actual hospice facilities are in Halifax and in Kentville, the Valley Hospice. But again, those projects are in the early stages of the development side and the infrastructure and aren't yet operational.


            MR. BURRILL: I'd like to continue on these couple of specific areas that our caucus is interested in understanding more clearly. Could I ask the minister to speak as well, to what the financial allocation within this budget is within the overall framework of the mental health and addiction strategy?


            MR. DELOREY: I appreciate the member's question and, in particular, as the member mentioned, Mr. Chairman, this is on behalf of his caucus, which again I want to reiterate and thank all the members, and all the members of all caucuses, all members of the Legislature for their interest, particularly in mental health because it is so important for our communities and for our families and friends.


            With mental health, as we've mentioned, our investment for this budget is in the vicinity of about $6.6 million in our budget coming through, but the specific question that was asked by the member - I guess I'll just talk about a couple of those things. These are things that we would have announced. These are expansion of the crisis services, mental health central intake, community-based program supports, investments in sexual assault trauma therapies. We have our Naloxone and our opioid programs, our Opioid Action Plan investments, and then youth mental health initiatives including outreach, expansions in community-based mental health initiatives, investments in expanded clinicians, as well as our Kids Help Phone. These are just the health-based investments.


            The member's specific question was about the Together We Can mental health strategy. Within that category, I believe the total budget is $6.3 million for 2017-18, going towards initiatives that fall under Together We Can.


            MR. BURRILL: Thank you for these answers. Just in this series of accounting questions there is one other. I want to ask if you could speak to the monies that have been allocated to specific programs in this present budget within the opioids framework.


            MR. DELOREY: The two larger components are the Naloxone program. The announcement about the program came with the rollout of our Opioid Action Plan. That program, which we mentioned earlier today that the news release went out to pharmacies within our province. Of the 305 pharmacies that we have, 240 are already signed up and that number changes daily, so we're continuing to have community pharmacies sign up and receive the product to carry.


            That's a program in the Naloxone - in about the $560,000 range. I want to clarify that that covers more than just the community pharmacy investments in Naloxone. There are other Naloxone investments where we have some outreach and some needle exchange that come into play there for that total budget amount.


            We also have our Opioid Action Plan initiative, which we talked about earlier today. It's just under $800,000 - it's $799,000. That is the investment we're making as a government, recognizing that we currently have somewhere in the vicinity of, I believe of 200 - just one second to confirm. I just wanted to confirm that. Again, I made a disclaimer earlier today about numbers changing, so when I cite numbers, I do put it with a big asterisk that says - in things particularly around wait-lists because they do change day to day, so please recognize that.


So I'll stick with a more general - that we do in the province have somewhere in the vicinity of a bit more than 200 people on the wait-list for these types of addiction treatment services. So this $799,000 is committed to eliminate that wait-list. That is recognizing where the wait-list exists in the existing communities. This investment is to expand the services to ensure that everybody on the wait-list gets access to that service.


            In addition, these funds will also increase capacity throughout the province, I believe in the vicinity of between 200 and 250 additional treatment spaces, that will be available. So as I mentioned a little earlier today in Estimates, that $799,000 is to address the existing wait-list, but also in recognition that as we're moving with our opioid framework, that this is a problem that's growing, not one that has plateaued. So we recognize that if our real objective is to gain traction and get ahead of this, which is part of the reason why we rolled out a multi-pronged framework, to introduce harm reduction and education and multiple approaches to this, and treatment is one of those approaches. We recognize we're not in a situation where we can prevent or ensure abstinence in all cases. So, we want to ensure and settle the investments to get the capacity built up as well, proactively.


[3:15 p.m.]


            MR. BURRILL: Thank you, Mr. Chairman. I wonder if in the few minutes we have left if I could direct the minister's attention to a different area. I'm thinking about the number of the recommendations to government which came from the recent Doctors Nova Scotia report. I would like to ask about some of the, if any, provisions in the budget which I want to ask the minister if he'd speak to those recommendations at all.


The first one I wanted to ask about, there's a recommendation there that the province establish a health system physician coordination council and so I would like to ask, are there dimensions of this budget which we are to understand as being addressed to that health system physician coordination council recommendation?


MR. DELOREY: Thank you, Mr. Chairman, and I thank the member for the question. I guess the short answer for that specific program or recommendation in this budget would be, no. You wouldn't see a line item or a direct allocation but, again, with that qualification in there, this report and this information from Doctors Nova Scotia's information, that really only materialized about a week or a week and a half ago. I'm sure the member and all the members can appreciate that the details that go into budgeting and budget preparations, that those things would have been closed off because it has to get to the Auditor General and so on, well before we would have received this.


MR. BURRILL: Thank you, Mr. Chairman. Yes, of course, minister, quite right, I've used the wrong word. I shouldn't have said address those recommendations, but which elements of the budget could we understand as being potentially supporting those recommendations? So, with that understanding, could we return to the question of the health system physician coordination council recommendation?


MR. DELOREY: Mr. Chairman, you know, I think the overall budget, I think there would be many aspects, it would be difficult to itemize and be specific, recognizing that really what gets to the heart of that recommendation, although very specific, of creating a council or having a council, again, that specific wouldn't play out. But if you get to what precipitated that recommendation, which is really about the engagement, the communication, the collaboration, I think much of the objective within the health care system, you know, when we talk about engaging professionals - when the representatives from the Progressive Conservative caucus were speaking, much of what they were speaking about was about not just physicians as well, but other health professionals who are looking for the same type of engagement. So, that is ongoing work within the departments, but part of the general budget allocation within the department as well as the Health Authorities.


MR. CHAIRMAN: Order, please. Time for Committee of the Whole on Supply has expired for today.


The honourable Government House Leader.


HON. GEOFF MACLELLAN: Mr. Chairman, I move that the committee do now rise and report progress to the House and beg leave to sit again.


MR. CHAIRMAN: The motion is carried.


[The committee adjourned at 3:19 p.m.]