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HALIFAX, FRIDAY, APRIL 29, 2005

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

9:18 A.M.

CHAIRMAN

Mr. James DeWolfe

MR. CHAIRMAN: The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, would you please call the estimates of the Department of Health.

Resolution E9 - Resolved, that a sum not exceeding $2,559,740,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health, pursuant to the Estimate.

MR. CHAIRMAN: The honourable Minister of Health.

HON. ANGUS MACISAAC: Mr. Chairman, first of all, I want to begin by introducing Allan Horsburgh, who is our Executive Director of Finance, who is with me today and I will be joined by the Deputy Minister, Cheryl Doiron. I expect her to be here momentarily.

Mr. Chairman, our government continues to deliver on our commitment to provide faster, better care to Nova Scotians. Evidence of this commitment is our growing investment in health care. At $2.5 billion, the Health budget accounts for more than 40 per cent of the province's overall budget. This year alone, we will increase our health care spending by $218 million and that's in excess of a 9 per cent increase over last year.

Close to half of these dollars go to the district health authorities and the IWK Health Centre for the delivery of quality programs and services for Nova Scotians. We know these organizations face continuous pressures and challenges to deliver the kind of care Nova Scotians need and want.

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The process of assessing and approving their business plans is underway and we hope to be in a position to communicate final decisions to the DHAs and the IWK in the reasonably near future. In the process, we want to be sure that we're fair and thoughtful in our approach to the approval process. Mr. Chairman, I can say that we are making continuous efforts to come to a greater understanding of the challenges faced by the district health authorities. We have recently been impressed with value for money assessments conducted at the IWK Health Centre and Capital Health. These audits are very helpful to us as we gauge the effectiveness and efficiency of our health care delivery system.

We hope to implement further audits this year which will help in our decision making about future investments in the health system. I want to point out, these audits are helpful not only to the district health authority, but they are helpful to ourselves. The district health authorities have found that as a result of these audits, we have learned things that previously we perhaps were not fully appreciative of with respect to some of their challenges.

Last year we were pleased to receive an additional $62.5 million in federal funding for health care as a result of the September 2004 First Ministers' meeting. This funding has enabled us to do some positive things for Nova Scotians. We've allocated it to the areas of health care that Nova Scotians care about - the purchase of cancer drugs, orthopaedic services and recruiting and retaining specialists. With these dollars we will also purchase specialized equipment, including new MRIs for rural Nova Scotia and the Capital District Health Authority.

We will continue to move forward on new capital expansion projects at the IWK, Capital Health, Annapolis Valley and South Shore Health - that is, Queens primary health care centre - as well as make repairs to nursing homes and other long-term care facilities. This year, an additional $29 million from the 2004 First Ministers' meeting will help to support additional capital projects, address drug costs, purchase much needed equipment and help to train and recruit health professionals.

While we are pleased with the dollars we received, Ottawa's contribution to national Medicare continues to fall short of both need and expectation. At the 2004 First Ministers' meeting, Nova Scotia presented $175 million in additional needs, but the federal government's additional contribution of $92 million to this year's budget is significantly less than that amount. Without additional support, we continue to increase the provincial budget to address the shortfall in federal funding as we can. This means some programs have to make do with current funding levels. There are many innovative ideas, treatments and services that we could deliver, but only if the federal government kept pace with the cost of health care.

While the federal government may not be fully present, the commitment of our health care providers and administrators is evident every step of the way. Because of this commitment, we are able to announce new expanded initiatives for next year.

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There is important news for Nova Scotians suffering from diabetes in this year's budget. Working with the Diabetes Association, a program will be offered to families with low incomes and no prescription drug insurance. With $2.5 million invested in 2005-06, the new program will cover insulin, oral diabetic drugs, glucose test strips, syringes, needles and lancets. The cost to the family will depend on their income. Self care will also be developed and offered to new patients, helping to promote links to existing services and resources while helping to prepare people to better manage their own health.

Mr. Chairman, stroke and heart disease is the leading cause of death and disability in Canada. We believe that improving the care and prevention of heart disease and stroke will have significant and positive effect on the lives of thousands of Nova Scotians. With an investment of $500,000 this year, we will work with partners like the Heart and Stroke Foundation of Nova Scotia to pilot a comprehensive and integrated stroke program. The program will include stroke prevention, emergency and acute care, and rehabilitation.

I am pleased to say that Nova Scotia is making good on our promise to help children with autism. By investing $4 million to introduce a new early intensive behavioural intervention treatment program, we are able to support many Nova Scotian families who are challenged every day.

The province is investing $275,000 to begin the Sound Start Program, through Nova Scotia Hearing and Speech. This initial investment will improve access for preschool children in five areas in the province with the highest wait lists. The program will be fully implemented next year. Early detection and treatment of hearing loss can have a profound impact on a child's speech, language and literacy skills.

We have invested an additional $17 million this year in the Pharmacare Program, meaning increases in drug costs will not be passed on to our seniors.

This government stated its commitment to address wait times and access to care in its plan for improving health care, Your Health Matters. People are waiting too long for some tests, treatment and care here in Nova Scotia and across the nation.

I would like to be able to say that this is an easy fix and that adding more dollars to the system is the answer, but it will take much more than money to resolve the wait time issue. It takes having province-wide access to the right information to pinpoint specific problem areas. We're working on this now and soon, Nova Scotians will have Internet access to wait times information for diagnostic services that can help them make choices about their care options.

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[9:30 a.m.]

It takes investing in state-of-the-art equipment, as we've done with the purchase of four new MRIs across the province, and three new mammography machines for the Nova Scotia Breast Screening Program. A fifth linear accelerator at Capital Health means that 30 more patients per day can be treated with radiation therapy.

It takes recruiting and retaining the right mix of health professionals to deliver services to patients when and where they need it. Under the Nursing Strategy, 160 nursing school graduates will be hired across the province. An estimated 50 trained and experienced nurses will return to the profession and another 75 nurses will be recruited from outside the province. Since April 2004, more than 50 new physicians have been recruited to Nova Scotia, family physicians and specialists.

Mr. Chairman, you can see we are making good progress in responding to wait time pressures. We also know a long-term plan is the next important step, in order to leave a quality health care system for future generations.

To that end, we have welcomed members of the public and health care professionals to a new Wait Time Advisory Committee. The committee will help identify key wait time pressure points throughout the system and make specific recommendations to help reduce these long waits.

As with all of Canada, Nova Scotia's population is aging. People are living longer and the percentage of our population over age 65 continues to grow. To help seniors maintain their independence and remain close to their families as long as possible, they require service that is accessible, affordable and appropriate to their needs.

As Minister of Health and Minister responsible for the Senior Citizens' Secretariat, I can assure you, the Department of Health is committed to providing the most effective and efficient range of continuing care options for Nova Scotians.

This year, the province has allotted $246 million towards long-term care, a $50 million increase over last year, and $128 million to home care. In 2005-06, we will spend $31.3 million to fulfill our commitment to take over the health care costs in long-term care and enable seniors to keep all their assets.

Most importantly, Mr. Chairman, we have embarked on a province-wide, continuing care consultation process, to ask Nova Scotians for their input on this important topic. This Spring, consultations will explore new ideas and new ways of supporting Nova Scotians who need care. The ideas that come out of the consultation process will help us develop a long-term plan that responds to community needs with the most efficient use of taxpayers' dollars.

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Part of this planning process began in Cape Breton District Health Authority last year. We worked with the district health authority and continuing care providers to understand the current and future needs of their communities. An interim report identified the need for additional beds in the short term. In response, the Department of Health has committed $1.5 million to open 25 new nursing home beds in Cape Breton next year. Planning is also underway to open an additional 100 nursing home beds in the district, to help alleviate pressures on the system and ensure seniors receive the kind of care they need, as close to their homes as possible.

To better meet the needs of individuals who require short-term rehabilitative care, the department will spend $1.65 million to establish 50 new restorative care beds throughout the province. Introduction of these new beds will help to increase access to the appropriate type of care patients need, while an assessment of the province's continuing care and alternative levels of care service is compiled.

Delivering on our previous commitment, we will open more than 100 licenced beds in the Bedford-Sackville area, to replace beds previously housed at Northwood. We know that beds are not always the answer. Individuals want to be able to stay at home as long as possible, that is why we will invest $750,000 this year, to increase the scope of home care services. This will begin an alternative level of care that will allow individuals to remain at home longer, and will defer or prevent admission to long-term facilities and hospitals.

Also, $500,000 has been allotted for new, self-managed care programs for individuals with disabilities. This program provides an alternative to home care service and allows individuals to take a more active role in managing their care needs.

Our government made a commitment in Your Health Matters to plan to improve health services and make them available to Nova Scotians closer to home. Part of that promise is providing Nova Scotians with access to high-quality mental health services, no matter where they live.

In 2003-04, we added $2 million in funding for mental health. Earlier this month, we announced a further $2 million for this year and $2 million for next year, signalling our ongoing commitment to making mental health services a priority of this government.

With standards for mental health in place - the first of their kind in Canada - we know where these dollars are needed most. We will continue to work with the district health authorities and the IWK Health Centre to fully implement those standards through enhancing services for children and youth, crisis and emergency services, and mental health community supports for individuals with chronic and persistent mental illness.

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We are now faced with another opportunity to work together to accomplish the next step, new legislation. Mental health legislation is vitally important. Let me explain, Mr. Chairman. Most people have the ability to make decisions about the kind of treatment they need to get better, yet there are some who cannot. It is our responsibility to make sure those who are unable to make treatment decisions due to a mental disorder can still get the treatment they need, when they need it. A bill like the one we've introduced here in Nova Scotia will speak for these individuals. We all share the responsibility of making sure that appropriate laws are in place to protect the health and well-being of our fellow Nova Scotians. We're committed to working with our colleagues in Opposition to produce an Act that works for Nova Scotians.

Mr. Chairman, health care professionals are the backbone of our system, and I would like to take this opportunity to applaud their dedication and commitment in the care for patients and their families. The work they do is invaluable, and it is my job to ensure we continue to have enough talented professionals to provide quality care into the future. This is a challenge that reaches across North America. We have begun to address that challenge and I am pleased to say we are seeing some early successes. As I mentioned earlier, at least 50 new physicians have been recruited to Nova Scotia. We are in the midst of province-wide physician resource planning to match our recruitment activity with areas in the province most in need.

For the third consecutive year the province is funding eight new students at Dalhousie University's undergraduate medical program - a $450,000 investment in future doctors for Nova Scotia. In 2005-06, the province will invest $300,000 to attract and retain nurses in our rural communities. Another $650,000 will help form new community-based collaborative teams as part of our primary care strategy. This year we will hire four new nurse practitioners to enable us to be creative in how we meet the health needs of people in rural areas of our province. Over the past two years the province has funded 50 seats in the Medical Laboratory Technology Program, and there are a number of bursary programs in the districts and the Department of Health for a variety of health care professions.

Mr. Chairman, one of the reasons we are succeeding at recruiting health professionals to our province is the focus we are placing on introducing the latest in information management technology. I am pleased to tell you that we are leading the country when it comes to modernizing the collection and sharing of health information. As an example, a picture archiving and communication system will replace nearly all film-based imaging in the province and give physicians instant access to results of diagnostic imaging tests including CT scans, X-rays and ultrasounds. Our plan continues to introduce new information technology in hospitals and in communities that will ultimately improve the quality of care and access to tests and treatment.

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Mr. Chairman, I cannot talk to you today about our investment in the health care system without acknowledging the countless Nova Scotians who volunteer their time each and every year. Whether they serve on a board, support fundraising campaigns, or sit at the bedside, their care and concern for families in need is heartwarming and we truly appreciate the positive impact they have in our communities. Together with our partners in the health care system we continue to deliver on our promise to make better, faster health care available to Nova Scotians. We are guided by our plan, Your Health Matters, to continue to invest our money when and where it counts. We know there is more work to do and we are committed to find new and better ways to care for the health needs of the people of Nova Scotia.

Mr. Chairman, I am pleased to see the investment in the Office of Health Promotion that Minister MacDonald will speak to. Healthy choices and healthy living is vital to creating healthier communities, and so we share a common goal in that regard. I want to thank your committee, Mr. Chairman, for its attention and I look forward to the discussions of my estimates.

MR. CHAIRMAN: The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Mr. Chairman, at the outset I want to indicate that I have an appointment at 10:00 a.m., at City Hall, with the Mayor, that I've been trying to get for some time, so I'm not going to be able to be here for much of the time this morning. My colleague, the member for Sackville-Cobequid, will use the remainder of my time.

I want to start though, as I have one or two questions. I'm very curious about knowing more about the Diabetic Assistance Program and I think that all Parties here in the Legislature have been very supportive of the need for a low-income program to support those with diabetes who do not have their own health care insurance. I've noticed that in the various announcements that have been made, nobody has really quantified what they mean by low income, so I think that we've waited for a very long time for the introduction of this program and it's time that we have more details. So, I have a number of questions: What are the income cut-offs; who will be administering the program; and when will the program be available? I think those are the three most pressing questions that people who approach me, and other members of this Legislature, will want to know. These are the questions that I would like answered before I have to relinquish my place.

MR. MACISAAC: Mr. Chairman, I thank the honourable member for that question. Indeed it is an appropriate question because when you're introducing a new program such as this, all of the questions the honourable member raised are natural questions to be asked.

One of the things that we learned in the process of preparing for the rollout of this program is that when we investigated what happened in other jurisdictions when similar programs were implemented, we were rather surprised to learn that the uptake on the program was much slower than one would anticipate. It was a source of a considerable

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amount of discussion within the department as to why that would be so. I'm not in a position to provide any definitive answers as to why it is so but it certainly is something that is of concern to us. When you want to embark on a program like this, the more take-up you get, the better it is in the long term because people are in a position to manage their health much better than if they're not able to access the drugs and the strips and everything that goes with it.

One of the things that we're going to try to do better than other jurisdictions - and I hope we succeed - will be to sort of launch a campaign that might result in a faster take-up. In terms of the numbers that will respond, we're ballparking the numbers. We hope that we've overestimated in the sense that we're prepared for as much take-up as possible. Naturally, there is a time frame involved in preparing for this. The amount of time we require will be several months in order to get everything in place with respect to it. We anticipate the department, through our pharmacy group in the department, will be responsible for the implementation.

[9:45 a.m.]

We have a number of models also. You had asked about who would qualify and we have a number of models in place in terms of other programs that we have that will help us form a definitive guide in terms of who would qualify. Certainly, we would be doing an evaluation in the case of children, family income and the family's capacity to be able to respond and provide treatments.

I want to remind the member it is targeted to those with low income and no insurance to be able to meet these needs. So we will, as time goes on, be in a position to provide more and more detail, but I can tell you that we hope by the Fall that we would be in a position to be up and running and have all of our guidelines in place at that time. As I indicated, it will be delivered by the department.

MS. MAUREEN MACDONALD: I don't know that I really got any of the details that I was seeking, but I want to say to the minister that one of the greatest needs that gets presented to me are people on CPP disability without any drug coverage. This is a very serious matter for those folks. They often have just a small budget surplus when it comes to income assistance and so they don't qualify for provincial Pharmacare under the social assistance Income Assistance Program, but they certainly don't have the kind of surplus resources that they can afford their insulin or the strips for testing on a regular basis. So they're a group that I think would have to have priority - and another group are young people who are on their parents' insurance programs, but at the stage where they graduate from university or community college or high school and leave home and become independent. They have a very, very difficult time getting private insurance because of the pre-existing condition, and they're very often in dire straits.

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These are the two groups I hear from most often. Additionally, there are people who are working with low incomes and not covered by any health plan. You see this particularly for workers who are casual, part-time and in those situations. I think this is also a serious problem, so I would hope that priority be given to looking at how people in these circumstances can benefit.

I'm also hoping the low-income situation not be driven solely by social assistance. So much social programming in this province is determined by the social assistance rates which have not kept pace with inflation, continue not to keep pace with inflation, and leave people robbing Peter to pay Paul. They either have to not have nutritious diets in order to have medications or not have medications in order to try to eat properly. It seems to me that we have to try to reconcile these situations.

Anyway, I'm going to turn the remainder of the time over to my colleague, the member for Sackville-Cobequid and I'll have a chance to come back a bit later on. Thank you.

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

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I want to thank the member for Halifax Needham for allowing me to stand and have the attention of the minister and his staff with one of the most important departments in government. Every poll that our Party does, the Liberal Party does and, of course, government, shows that Nova Scotians and Canadians have dire concerns about health care delivery in our province and across the country.

I have a few brief comments and then I'll get into some of the issues I'd like to see some answers to, and especially some of the concerns the people I represent have brought to me over the last two years, as member for Sackville-Cobequid, what really pertains to my area and what we have concerns with. I know the member for Halifax Needham, who is our Health Critic, will actually investigate and ask questions on a lot of different aspects of health care and the numbers concerned with what we will see in the next year or so in our province.

In the highlights it states, Better Health Care . . . Better Health Investments, and that's great to see and great to hear and great to read, but many Canadians, especially many Nova Scotians, have been hearing it for many years. It's an important issue that we see a lot of our taxpayers' money going into - as the minister stated, nearly 40 per cent of the provincial budget goes into health care.

What people really want to see is the differences when we invest in health care. People want to see a difference when they call their family physician and don't have to wait a week or two to have an appointment - and that's if you have a family physician because

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there are a lot of residents here in the province who are finding it difficult just to get a family physician.

People want to see a difference when they enter emergency rooms - especially in the waiting rooms of the province. They want to see a difference in the times they have to sit in the waiting room to seek medical attention. They also want to see a difference when they, or a family member, are actually lying on a bed in the emergency department and are admitted to the hospital because of a certain illness and have been there for several days - it's not uncommon for patients in our emergency rooms who have been admitted to hospital to wait days in those beds.

People in the province want to see a difference if they need to see a specialist and they want to know that the health care dollars that are being spent, especially this year, are going to address the needs of waiting sometimes a year before getting in to see a specialist in this province.

There's a lot of things people have brought to my attention - they want to see a difference. When government stands up and says they want to invest in health care, they want to put money back into the system - they want to know it's actually going somewhere and that if they, their families or their friends and community members, find themselves entering the health care system that they see a difference. That's the major issue, they want to know their tax dollars are going to programs that change and improve the health care system when they enter it.

As I said, there are a lot of issues in Sackville and I know there are issues throughout the province, so I hope the minister and his staff can address some of the concerns that I have and the residents I represent have. Those include long-term care beds - definitely a concern in my area, and I know the minister spoke on that in his opening statement. I'll be asking the minister definitely about concerns around the new Cobequid Health Centre, so I'm sure the deputy minister will hopefully be able to answer some of the questions I have around the new centre. It is a needed facility that the community has waited for a long time there and they're looking forward to its opening - especially around the facility and what we're going to see in there. It's important to realize that if we're having that investment in the community, in the province, that we see certain programs in there that will really address the needs of the community and the needs of all Nova Scotians. I think that facility can help alleviate some of the problems we see here in Halifax and radiate throughout, down toward the Valley and up toward Truro.

Initially what I want to talk about a little bit are some questions around the long-term care beds. I know in our community I think it's roughly around three years ago the department recognized and promoted the fact that the Bedford-Sackville area was in need of long-term care beds and the number of 100 to 150 beds was put out then. I want the minister to tell the members here, and the people in our area, where that program is and when are we

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going to see some movement on it - or any information the minister has on that, it would be greatly appreciated.

MR. MACISAAC: Mr. Chairman, the honourable member indeed has raised quite a number of concerns that he has and I know that they are concerns shared by all members of the House with respect to the receipt of health care. Just a comment I would like to make - despite all of the concerns that are out there that the honourable member articulated, I can also tell you that, from reading my mail, I get a lot of those concerns but I also get, and I was surprised by the amount of letters I get which speak very highly of the level of care that citizens receive in our health care facilities in the province. I wanted to raise that because while admittedly there are challenges, and I addressed those challenges in my opening remarks, but I also spoke about how fortunate we are with respect to the health care professionals that we have in this province and the dedication that they have to their work.

I think we need to be balanced in what we say about the health care system because these people work very hard at providing Nova Scotians with the very best of care, and most of the time they succeed in doing that, and I think we would all be not fully accepting our responsibilities if we were to leave the impression that they're not doing that on an ongoing basis. So, I just want to put that in perspective and say that yes, we have challenges but we have some very dedicated health care professionals in this province who are doing a tremendous job on behalf of people.

We are increasing the number of physicians that we have in this province and 94 to 96 per cent of Nova Scotians have family doctors, and those are among the highest figures in the country. Now, unfortunately, our challenge is the fact that we have 4 to 6 per cent of our population who don't have a family doctor and that's where we need to focus our attention, but in comparative terms we're doing reasonably well; as a matter of fact, we're doing quite well in comparative terms. That's not to say that we're not without challenges.

In terms of specialist care, one of the things that our Wait Time Advisory Committee is doing is examining our capacity to be able to get to the care of specialists in the province, that's taken on as a responsibility of those individuals. In terms of the long-term care facility that the honourable member is, safe to say, most concerned with his own area, I can say that we are at the stage of doing the site selection for that facility, but we are also taking a very close look at what the nature of that facility will be.

Is it appropriate to build simply a facility with long-term care beds and nothing else, or should we be considering facilities that allow people to gain access to a host of other services in addition to long-term care? Services by way of community services that they can access and go to and make purchases, go to a hairdresser or whatever other things they need, but also to look at whether we should have, in combination with the long-term care beds, other levels of care available, so that individuals might want to have basically their own

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apartment but be able to access some services. So we need to get the proper blend of services and we're involved in a major consultation to help define the services that would be required.

[10:00 a.m.]

Hopefully, Mr. Chairman, I've addressed all the issues that were raised by the honourable member. If I haven't, I'd be glad to touch on anything else.

MR. DAVID WILSON (Sackville-Cobequid) Mr. Chairman, I guess I opened the door for that longer answer. Some of my concerns were just observations of mine and definitely I would like to echo - as I'd be the last person in this Legislature to criticize any of the health care professionals in our province, definitely by my background . . .

MR. MACISAAC: I wasn't suggesting you were.

MR. DAVID WILSON (Sackville-Cobequid): I know the minister wasn't suggesting that. I have seen the dedication and the commitment from the health care workers in this province and I must say we have some of the best in the country, definitely.

The point I was trying to make is that we could have the best trained people in the world in Nova Scotia, but if they don't have the resources, the funding and the access to the programs - and one of the points I made was, the emergency departments, if they don't have the access to clear out those emergency rooms, especially the beds, then it gets backlogged and we saw it a year, a year and a half ago with some of the health care professionals standing up and speaking out about some of the problems we've seen at the QEII Emergency.

So, getting back to the long-term care question, especially with the number of beds that were indicated is needed out in the Bedford-Sackville area, it's no secret that the Minister of Finance, in his role as MLA for the Bedford area, has endorsed a project in an area in his community, the Rocky Lake Commons, and there has been a lot of publicity around Northwood going out and creating and developing, almost what the minister was saying is a community. A facility that complements each other when it comes to seniors, seniors' condos and that transition, when seniors find themselves in the need of additional care every day, into a nursing home environment.

So I'm wondering, can the minister give us a timeline of when a facility or a site would be announced? I know definitely, I'm sure the Minister of Finance would love to hear that this site is announced and maybe the area of his community will be chosen. I know that they were kind of ramping up some of the information we had in the community and, all of a sudden, it's kind of been clawed back. Do you have a timeline, or when can you say that the department will announce that choice of where that facility will be?

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MR. MACISAAC: Mr. Chairman, just a quick review, if I might, of the process involved. We would put out calls for proposals relative to the site and once those proposals are received, an examination will be done, an objective examination, and recommendations would be made to me. I understand the proposals are ready to go, and I don't know if they're going to go out Monday or sometime in the next week or so, but they are, as I understand it, ready to go. So the criteria is developed, based on that fact we can get it out there, it shouldn't take very long after that for the process to be complete - perhaps a couple of months and we would then be in a position to identify the site and proceed from there.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, are you saying that the department will open up or call for proposals or sites, locations throughout, that any private developer could do that? Could the minister indicate - from the comments the minister made about trying to create that community-style environment for a long-term care facility, could the minister state that Northwood Care would be one of those companies that would be most favourable in creating this community that the minister was talking about when it concerns a long-term care facility?

MR. MACISAAC: Mr. Chairman, I was making reference to the selection of the site that the proposals will be called. In this particular situation what has happened is that in the past - about four or five years ago - Northwood lost 100 beds that had been part of their operation. As a result of that, there has always been a recognition that they would have the capacity to operate the 100 beds. So these are replacements beds that they lost as a result of change in the building plans when their last facility was under construction. So it is now going to be provided to them, this opportunity to operate these beds. The proposal call is a proposal call for site selection only.

MR. DAVID WILSON (Sackville-Cobequid): From all indications from that answer, I think Northwood would be - and I don't have any problems with Northwood being identified as probably the lead organization or group that would facilitate this new long-term care facility. The minister stated that they had lost some beds, I know they had, I believe, done some renovations. Several years ago when they identified the Bedford-Sackville area as needing those 100 to 150 beds, I'm sure at that time they didn't realize what was going to happen with this area in Halifax, I'm sure they could use those 100 beds they lost - I don't know how long ago they lost those. Also, what's going to be the criteria for people entering those beds? I know from dealing with many people in my community that when they're looking for a long-term care facility, they'll take anything within a 100-mile radius of this. Is there going to be a criteria to try to address the needs of the community when it comes to long-term care beds?

The most important thing we have to remember with our seniors is that they want to be around their family, around the community that they've lived in, some of them, most of their lives or all of their lives. What kind of criteria or what kind of assurances can we have

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from the minister that these beds will be identified for that region and are there going to be any kind of rules, regulations or policies that indicate who accesses those beds?

MR. MACISAAC: Mr. Chairman, the single-entry access is the method that would be employed with respect to identifying who would be eligible for residency in the facility. The facility we're speaking about is not intended to be the final answer with respect to the number of beds that are required, but it is deemed appropriate for that number of beds to be in that part of the Halifax Regional Municipality.

Obviously, the need for additional beds will be there, and as a result of the province-wide consultation that's taking place, we will have a clearer indication as to where additional beds should be located, and further decisions will be taken with respect to that. So this is not a decision and not a project that is taking place and is sort of the end of the line, it's an ongoing process that we're dealing with, and this is one step in the way of addressing the long-term care needs in this area of the province.

MR. DAVID WILSON (Sackville-Cobequid): I look forward to that announcement, hopefully, in a couple of months, as the minister said, because it has been years in the making. I'm sure all members - especially a few of the members on the government side who represent that area - will be excited about that announcement, too.

When we look at the issues - and I mentioned emergency room wait times and the problems seen when you enter the door in the emergency room, the wait there, and then once you get into the department itself, the wait there, if you are trying to get into a bed, it radiates right through into long-term care beds. There are a lot of Nova Scotians in our hospitals who are waiting for beds to open up. So I think the quicker we can proceed with this project the better it will be for all Nova Scotians trying to access some of the emergency rooms in our province.

I want to switch now to talk a little bit about health care professionals, specifically around nurse practitioners. I know I mentioned to the minister the other day that this is an area and profession that we really need to look at and progress what we have in the province today in what we've seen with the concerns around retaining physicians to the province, that can be addressed with the use of nurse practitioners.

I remember reading through a study done in Ontario where they said, 80 per cent of patients that a nurse practitioner has seen were able to address the needs of those patients. Only 20 per cent of those patients had to be referred to a physician. With that study - and I know there are many of them - it just emphasizes the fact that nurse practitioners are desperately needed to address some of the concerns not only in just our small rural communities in the province, but I think you could expand the role of nurse practitioners in the province to address some of the needs seen in some of our larger areas like Sydney, in the Cape Breton Regional Municipality, and here in the HRM. I know the initiatives initially

[Page 15]

are targeted for rural communities but I think we need to expand the use of nurse practitioners.

I'm just wondering if the minister could tell us how many nurse practitioners are actually practising today in the province?

MR. MACISAAC: Mr. Chairman, currently we have 14 nurse practitioners practising in the province. It is our hope, that as a result this budget, if it's accepted by the House, we would have at least four more and possibly as many as six more that we could bring into service this year. We have a number of excellent proposals before us with respect to the employment of nurse practitioners and we're evaluating those proposals. Of course, once we know what our numbers are going to be as a result of the budget process, we will begin to (Interruption) Sorry, we have 16 nurse practitioners now. That, could bring us to 20 to 22 nurse practitioners in the province in the next year. It is my hope and the hope of the department - and Cabinet colleagues understand - that we need to continue to expand the number of nurse practitioners that are employed. There are 16 in primary health care, and we have 19 specialty nurse practitioners.

[10:15 a.m.]

I had a very interesting conversation recently with a specialist, a doctor who was talking about nurse practitioners and suggesting that he could save a lot of people a lot of trips back and forth to Halifax, to simply come in and be told that your test results are good,

you're doing well and carry on. He felt that nurse practitioners could very well fulfill that role and they could be located in various parts of the province.

There's a tremendous scope of opportunity to provide better care for Nova Scotians closer to home through the employment of more and more nurse practitioners, it is certainly something we're dedicated to. I'm encouraged by the level of acceptance that is growing out there with respect to the employment of nurse practitioners, acceptance on the part of the population generally, but also the acceptance on the part of physicians who are, more and more, seeing the value of nurse practitioners. When you combine that with alternative funding programs, you start to get a very good combination of medical service.

I recall visiting a clinic in Scotland where the local doctor who had responsibility for not as many patients as we would have in a practice here, but it was a very rural area, a very widely-spread area, where 600 families are residing. He had the services of - for all intents and purposes - of a nurse practitioner - he referenced her as something else. The nurse practitioner did her rounds and was available in the clinic in the same way the doctor did. It was very much a collaborative practice, but they were employed as a team delivering health care in that part of rural Scotland. It seemed in conversation with some of the citizens there, I was naturally curious because I was a newly-minted Minister of Health when I was there,

[Page 16]

so I was naturally curious to see how they responded. To them, that's the way you deliver health care, there was no question about the acceptability of it.

The honourable member is quite correct to point out the value of nurse practitioners. I would love to have the resources to go even faster, but what is encouraging is that I think the demand is growing and then we're going to have to start focusing on responding to that demand. I think if we try to move too quickly, then we wouldn't get the success that we needed. There needs to be an acceptance on the part of the medical profession to the employment of nurse practitioners and we need to understand the development of our models so their services can be employed most efficiently.

MR. DAVID WILSON (Sackville-Cobequid): I know Nova Scotia nurses have been leaving our province for many years in great numbers, they're being recruited by other provinces and definitely recruited by the U.S. - especially our young, educated nurses right out of university who are holding large debts due to their education - it's very appealing to go down to the States to get those debts off their backs.

I know the government invested in tuition fees for nurse practitioners, I believe in 2002 or 2003 it was $150,000 annually for three years. I personally knew several nurses that took the challenge and it was a hard decision. These nurses I knew had to go back to school and they're highly trained nurses. I just know there have been problems in the province when it comes to nurse practitioners and some of the placements they have.

So, could the minister state what some of the biggest hurdles they're finding to keep these positions are. I know he said there was about 20 in the province, but I think there was many more than that initially, especially going through that initial training the government put money into. What are some of the problems they've run into and could you tell the House where in the province some of these programs, some of these relationships have broken down and the community is left without this program?

MR. MACISAAC: I guess in the beginning I was listening to the honourable member and he was speaking about nurses and then he got into nurse practitioners.

I do know that in terms of nurses, in 1999, approximately 50 per cent of the nurses that were trained in this province left the province and didn't remain here. We now have 80 per cent of the nurses that are graduating remaining here and over 90 per cent of that number are getting full-time jobs here in Nova Scotia. As I indicated in my opening remarks, the number of nurses that we're being able to get in the province as a result of retaining our graduates and as a result of individuals renewing their skills through programs that are available to them and as a result of nurses being recruited from outside the province to Nova Scotia, our numbers are growing. It continues to be a challenge, but we have made very significant progress.

[Page 17]

With respect to nurse practitioners, I do know that one of the challenges we faced was in the area of remuneration to the nurse practitioners, but we have recently come to an agreement with respect to that issue. There is a contract in place that puts them in the position of being competitive in other areas.

I know the honourable member would also recognize that we have nurses studying in various parts of the province - here in Halifax at Dalhousie University and in Yarmouth through an extension of Dal's program, there are 20 seats, I believe, in Yarmouth - and that is proving to be very helpful to that part of the province in terms of their capacity to recruit and retain nurses. Nurses who train in a particular area tend to have a strong affinity to that area in terms of where they make their decision to work. So that has been helpful to the Yarmouth area.

We have a school at St. F.X. and an extension of St. F.X.'s program at the University of Cape Breton - as it is now called - and we are also in discussions with Acadia University and the Valley District Health Authority with respect to the possibility of additional nursing seats in that area. Part of the motivation for doing that is to assist the Valley in their recruitment and retention issues.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, maybe I wasn't clear enough on the last question. What I was trying to show is that the nurses have been leaving for many years and I'm aware of the same situation with the nurse practitioners. I know one in my community that is finding it hard to get a placement and is actually, I think, on her way now to New Brunswick.

The same thing that is happening to our nurse practitioners. They're being recruited out of this province and one of the major concerns I've heard from several of them is that they're finding it hard to meet the requirements to maintain their licence. There's not enough avenues, not enough placements for them to continue their patient contacts. Myself, as a paramedic, to maintain my licence I need to do so much in patient care, patient contact and skills. So, are you aware of the difficulties that many of the nurse practitioners have in just maintaining their licences? I know several of them are working as nurses, they're unable to work to their level of training as nurse practitioners, but are you aware of the difficulties that many of these nurse practitioners have in maintaining the requirements needed for them to continue to hold their licences as nurse practitioners?

MR. MACISAAC: Going back to an answer I provided earlier when I spoke of the rate at which we would introduce the program of nurse practitioners. Part of the challenge is the acceptance of that profession into the health care delivery system. An important element of that challenge, of course, is the co-operation of physicians in order to work with the nurse practitioners so you have the collaborative practice that is required. There are, from time to time, some bumps along that road and that creates situations where a nurse practitioner who perhaps felt there was an opportunity to be able to do something, gets into

[Page 18]

a relationship that doesn't work. Unfortunately, we're going to have some of that, it's part of the growing pains of introducing a new program such as this.

[10:30 a.m.]

Obviously, I hope to get four to six new nurse practitioners in practice in the province over the course of the next year. That points to the funding challenge that is there in terms of being able to get enough funds out there so that individuals can indeed get involved in a practice that allows them to keep up their credentials. I also made reference earlier to the remuneration issue and that has been settled for a period of time now, so that should help.

Obviously, the honourable member puts his finger on some challenges. These challenges will exist and hopefully, as we expand the program, there will be sufficient opportunities for nurse practitioners to maintain their qualifications because they wind up getting enough work to do that.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, definitely with any changes, especially to a profession in health care, there are always growing pains and hurdles you need to jump over. I have witnessed it myself as a paramedic, with the evolution of our profession where we've increased the skills and the procedures we can do. There are always groups that think that maybe they should not be allowed to do that. I know that's part of the concerns the nurse practitioners have and are dealing with, to try to get over that hurdle of physicians in the province accepting that their responsibility as a physician is going to be passed down to someone with less education. Nobody will say different, that nurse practitioners don't have the level of training of a physician but I can tell you, they spend a lot of time in school learning their skills.

Nurse practitioners are registered nurses who have been educated in health care assessment, diagnosis, management of illnesses and injuries, including prescribing drugs, which is one of the major things we see that I think overload some of our emergency departments, those less urgent emergencies where people go to an emergency department and kind of overwhelm that system. I think that's where nurse practitioners could really help alleviate some of the problems.

The minister did say they were going to expand and develop this program which is very promising. As I mentioned earlier, the nurse practitioners are concerned with maintaining their licences and meeting the requirements for them to continue to be registered as a nurse practitioner. I'm just wondering if the minister could commit to even bringing back to the deputy minister, and his department, looking at the roles of nurse practitioners and expanding it to include placements in some of our emergency rooms, like the new Cobequid Community Health Centre?

[Page 19]

I know one nurse who works there, who is a nurse practitioner, works triage when patients come in and enter the emergency room there and she said she could really divert a large number of those patients away from that department. I think that could be said with any department throughout here: the emergency departments in the Valley, in Cape Breton, in Yarmouth, and especially, here in Halifax. That is where we seem to get the most publicity around emergency rooms when they're congested and there's problems seeing people. Could the minister state today that he'll go back and look at the possibility of expanding the role of nurse practitioners to have placements in some of our emergency departments? It's my understanding that nurse practitioners, under the laws and regulations of their licences, have to be placed under a GP or a family physician. They are not allowed to practice under an ERP, an emergency room physician.

I know many of the nurse practitioners did their practicum in the emergency departments throughout our province, but yet they're not allowed to practice to their full potential as a nurse practitioner when they're in those departments. As with the case out in the Cobequid Centre, I think that would be a great way of expanding the role. Could the minister maybe comment on the expansion of their role and placements in the province?

MR. MACISAAC: Mr. Chairman, certainly, what the honourable member references is essential to the expansion, not just of nurse practitioners, but to the development of a health care delivery system that is designed so that all health care professionals are working at their highest skill level; that's where we need to move. (Interruption) That's a yes, absolutely it's a yes because we're committed to doing that. We know that if we're going to be able to effectively get a handle on the increasing costs of health care, that is one of the things that has to happen where all health care professionals are working at the upper limits of their skill level. We are committed to doing that and I want to say that we've received excellent co-operation from Doctors Nova Scotia, in terms of moving in that direction.

We also need to get the co-operation of pharmacists moving in that direction, your own profession, all of us involved - I don't have any skills in terms of health care - in health care delivery need to be allowed to operate at their maximum capacity in terms of skills and that is, hopefully, the direction in which we're moving. It is certainly a major thrust of our primary health care initiatives.

MR. DAVID WILSON (Sackville-Cobequid): That's great to hear from the minister. Definitely, I see here we have some nurses who are trained as nurse practitioners who are currently working, many of them come from certain floors or emergency departments in the province and as of today, they can't practice to that level of training that she was trained to. We are paying this nurse, we've invested in her education, we're paying these nurses when they're on the job practising as just a nurse. I think, to allow them to do that and do their job, and do all the skills they are trained to would be a step in the right direction when it comes to the changes and the evolution in that system.

[Page 20]

Now, I would like to change a little bit - and I'm going through some of the figures here, but I'm not too worried about exact numbers but I'll try to get some from the minister - about hospital infrastructure. The one concern that I and many of the community members I represent have is the new Cobequid Community Health Centre. I know I asked the minister several times to give me a date on when it opens, and I know he's reluctant to do that because I'll stand up the day after that day, if it's not open and ask the minister again. Could you give us an idea or a rough timeline on the facility? I know it's going well with the construction and the community is excited to see the progression, so could the minister give us a bit of a timeline on the completion of this site in Sackville?

MR. MACISAAC: Mr. Chairman, I will say this, I fully expect to be able to join the Premier and other members of the House at the official opening of that facility. I'm not planning on making a long-term career out of being the Minister of Health, it should be in the reasonably near future. I hope before the end of this calender year that we would be there.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I don't envy the minister on his portfolio, definitely it's one of the ones that has seen quite a bit of controversy over the years, but I think since the minister has been here, it has been pretty smooth sailing. We haven't had too many health care professionals circling this building over the last 18 months or so. I'm wondering if the minister could state how much of the provincial funds are going toward the Cobequid Centre this year? What's this year's number for the investment for the Cobequid Centre?

MR. MACISAAC: Mr. Chairman, it's approximately $13,337,000 being expended this year to finish it off.

MR. DAVID WILSON (Sackville-Cobequid) Mr. Chairman, so definitely that is a large amount of money and I'm sure if we go back there's even more that has been spent to get us to this point, and that's one of the concerns the people in the community have. It was recognized many years ago that this was a facility we needed to have in the community since the Cobequid Multi-Service Centre has been there for many years and we've really outgrown it. The area it serves is the catchment area, the population I believe is about 100,000 people. This is a facility that serves the population of Prince Edward Island, I said that before. It's amazing to look at it in that scope where the potential population that are going to use the facility is large - I think it's a third of the population of HRM here - it definitely was needed. It was recognized by government and we're going ahead with this.

The investment that taxpayers are putting into this is large, this year alone, $13 million. Around the operation, once it starts going, I know there's going to be a lot of programs in there, a lot of initiatives, which is great to see go to the facility. But around the emergency department there have been a lot of concerns around the number of beds and what's going to be used, or how many beds we're going to see in there. Can the minister state

[Page 21]

today that all the beds in the emergency department, when the doors open, will be utilized to address this large number of people that it serves?

MR. MACISAAC: Mr. Chairman, I can tell the honourable member that when the doors open, all of the beds will be available to be used. It's our intent that when it opens it will be fully operational. I can say in addition, the total price tag - for the record - is $34 million for that facility, and we anticipate that when it opens, it will be fully operational. It will also be integrated into the total health care infrastructure that's here in the Capital District.

There may be services that are provided at Cobequid that would result in individuals coming from other parts to go there and, of course, there might be situations where Cobequid is not able to provide for the needs of all people who go there. There will be an enhancement of diagnostic services at that site, we'll have more clinics operating there than is currently the case and as a result of that, more people - the 100,000 to which you refer - will get better care closer to home.

MR. DAVID WILSON (Sackville-Cobequid) Mr. Chairman, definitely that's the great outcome of having such a facility built and an expansion of the facility that we have seen. Definitely there are going to be a lot of clinics from my knowledge, and I think one was in the chemotherapy area, so patients don't have to come into the city to receive that treatment, especially when they're battling a disease such as cancer. It definitely is going to be an asset to the community and you can see, those people suffering from these dire illnesses will be able to get access closer to home, definitely that's a big concern. Yes, $34 million is a huge investment and the people of Sackville and the surrounding areas appreciate that investment in the community.

I'm encouraged by the minister when he states it's going to be fully operational. The Premier also said this the other day when I asked him the question in the House, because definitely with an opening and a project like that in the community, there are rumors and people are always concerned with what we're going to see when the door is open.

On the other realm of fully operational, just pertaining to the emergency department - I know that there's going to be tests, more clinics, more areas in the facility that will increase staffing levels - but the concern people have in the community is, yeah, it's great to spend $34 million on the facility, and one of the main reasons is because the community has outgrown the old facility, so when the new facility is opened, just in the emergency department itself, will there be an increase in nursing staff and physicians for that department to address the larger number of beds that we're going to see in the new department?

MR. MACISAAC: Mr. Chairman, we are involved with the district health authority on an assessment of the total needs and requirements of that facility. In terms of the emergency services, we anticipate that they are part of the solution for the total district in

[Page 22]

terms of easing the pressures on emergency health care, so we would anticipate that there would be an enhancement of that service at Cobequid.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, well that's somewhat encouraging. I don't think I heard a yes that there is going to be an increase in staff but I know you said it's part of the assessment (Interruptions) More staff, more nurses, more doctors? More nurses, more doctors, that's very promising. That's one thing I definitely will bring up again in this Legislature if . . .

MR. CHAIRMAN: Order, please. The previous speaker did indicate that she was sharing her time, so the time has expired.

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman, and I appreciate that, a slight mistake there in time, but I will donate those extra two minutes toward the New Democratic Party. I'm sure they'll be very appreciative for the fact that I did that.

MR. CHAIRMAN: Thank you, member.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I'm pleased to rise in my place today on behalf of the Liberal caucus to begin debate on the estimates for the Department of Health. I do have a line of questioning that I would like to undertake, but before I do that, I would be remiss if I didn't take this opportunity to just express some general thoughts and concerns about the health care system, in particular, what was contained and not contained between the lines of the Health budget.

Mr. Chairman, I stated for the record last year that the statement "lack of planning" immediately comes to mind when one looks at this budget. Well, it's perhaps déjà vu, all over again, because in 1999 it was this government that said, health care did not need any more money, it just needed better planning. Well, here we are, five years later, spending almost a billion dollars more since 1999, with no real indication that the system is or will be better, and most importantly, is or will be accessible to Nova Scotians when and where they need it. This government seems to be quite proud of itself that they've spun this budget into an Education budget, which it isn't. Ask any of the people out there who are taking a look at this budget, they'll tell you it is not.

They down play the fact that health care spending has gone up again by 9 per cent, an increase of $218 million, as noted in the second paragraph of the budget under Better Health, Better Health Decisions, or 9.3 per cent over 2004-05. The operating budget for the Department of Health now hits $2.56 billion. The 9 per cent increase, or 9.3 per cent increase, does nothing for the acute care sector which has been begging the minister to do

[Page 23]

something about the issue of long-term care beds, and a better, more enhanced home care program.

[10:45 a.m.]

The health care budget itself has a lack of vision. Even health care professionals themselves are beginning to lose faith in this government. Last evening a media report indicated that Nova Scotia is about to get a new hospital. That probably should be good news but it isn't, because apparently, at least according to the media report - and I hope to question the minister later on during my hour - this private hospital will be built and financed by physicians in the province, it's a cash-only facility. There's a potential to drain more than financial resources, it will likely have a significant drain on human resources as well.

That report went on to say that this hospital will handle many of the surgeries that are now being postponed and cancelled across the province. That would lead to even more frustration, which is already at its worst. Perhaps, it would be just the thin edge of the wedge and this minister and this government would have to be held responsible.

This government - with their complete lack of a plan, their complete lack of management, their inability to recruit, their inability to retain specialists, doctors and nurses, their inability to ensure that health care is delivered in a timely manner - has to be the one to take responsibility when something like this happens. For instance, we already have a shortage of anaesthesiologists, many indeed have left, others could eventually make their way, for instance, to such a private facility if it were to be set up. How will this latest millstone around the government's neck affect the public health care system? These are all questions that I'm posing that I hope the minister, at some point during discussion on estimates will be able to answer.

While that isn't startling enough - the latest announcement about that potential private hospital - there are other issues that this government has managed to bungle as well. We have a number of specialists, who, as a result of mismanagement, are no longer working on alternative funding arrangements, they're now back to fee-for-service. The government has managed to remove one of the major fundamental building blocks of health care reform. This dismantling has the potential to result in dire consequences and this government just doesn't seem to care.

The primary health care sector is also suffering as a result of neglect. Based on last year's numbers, which are produced by the government - these are not my figures - we still have over 41,000 Nova Scotians who don't have a family doctor, 41,000 people in this province without access to basic, but very necessary health care and services that keep people well and keep them out of the acute care sector of health care; basic service, having a doctor.

[Page 24]

We keep hearing about how this government is going to put in place multi-disciplinary health care teams. We hear it again and again in this year's budget but we haven't seen any action.

Let me give you another example, Mr. Chairman. Year after year we hear from the government about regulating midwifery. There's some action there but only after certain areas have continued to experience challenges with respect to obstetric care, in other words, when a crisis hits. Long-term home care, the sectors of health care that has all been but forgotten by this government.

I quoted last year, when the estimates rolled around, a health care administrator that stated last year: Pretty soon in this province, you will have a Minister of Health, and you will have a minister responsible for what's left over in province. I'm sure it's not the first time that the minister or his staff has heard that, but if you take a look at the expenditures that are now very rapidly approaching 50 per cent of all government expenditures, and a health care budget with no vision, you can see where that day is very quickly approaching.

It is not acceptable for this government to say they are spending more money on health. They have to demonstrate that they are investing in the right areas of health care so that everyone in this province, irrespective of where they live or the type of health care that they need, is able to access it in a timely fashion. While restorative beds have been announced and a mini-investment in self-managed care has been announced, you've thrown to these programs, mere crumbs; that's all they are.

In budget investment you talk about a Sound Start Program, again it's a small step and yes, it's welcome, no one's denying that, but you're only providing resources to a universal screening program. What happens when problems are detected? Do these children then go on to a wait list for pre-school speech pathology services? So you've addressed one small piece of the program but you've neglected the most crucial component, treatment services in the most crucial years in which they are required.

Since this government was content to go back and revisit 1999, then I think it's probably appropriate that I spend a couple of minutes on the election of 1999. Let's go back in time a bit. Here's a quote from back then: We can provide quality health care and balance the budget. That was a quote according to the now Premier John Hamm who said he'd do that, during an election campaign stop on June 22, 1999, at a children's centre. At the time Premier Hamm didn't say he'd balance the budget at the expense of health care, he said he would balance the budget and provide quality health care. The sad truth is that he could not deliver one promise without compromising the other.

[Page 25]

It's no wonder that people had high expectations of this government six years ago, because later, during the same election campaign back in 1999, John Hamm said - this time at the Yarmouth hospital - We don't need to mortgage the future to meet today's health care challenges. Well, all you have to do is look to the $1 billion extra that's being spent in health care and you know just how badly the government has failed. What is the minister doing to meet the health care challenges of today?

Instead of ensuring that rural hospitals complement the services being offered in regional hospitals for tertiary facilities, they turn them into nursing homes. Emergency room closures - still unacceptable but still happening across this province. Health care was the first priority back in 1999 in that election, and the man who ran and won the job of being Premier repeated the message on a daily basis.

I find it incredible that the former Third Party Leader was allowed to, rather skillfully, deliver such a simple message. In 1999, John Hamm stated, we needed less spin doctors and more real doctors. Too bad he didn't really mean it, because if you take a look at the budget for spin doctors, that approaches $1 million, about $800,000 to be exact. The Premier then must be held accountable.

Health care, according to John Hamm, did not require a massive investment to stabilize costs back in 1999. All that was needed was a pinch of restructuring and maybe a dash of investment. Well, again, Mr. Chairman, $1 billion later, still the health care system is not fixed. Two days ago we learned that surgeries were being cancelled at the QE II. What happened to the plan for health care? It never existed, we know that and we are now paying the price.

The Premier promised to reallocate resources from administration and make a small investment and that would be that. Now, either that was a case of wishful thinking or it was a case of pure fiction. Perhaps it was a case of maybe the doctor telling the patient to go out and heal thyself.

Mr. Chairman, the system is broke, a system that continues to consume almost 48 per cent of program expenditures. Six years, $1 billion, and health now consumes almost 48 per cent of expenditures. What is worse is that the Premier, in 1999, won government by telling people that better management of the health care system would fix the system. When he came to office, the Premier spent the next six years blaming Ottawa for all the problems and when Ottawa wasn't available as a scapegoat, the Premier blamed health care workers. Nobody in the health care field will ever forget Bill No. 68 and its effect on the health care system.

I must admit, over the past year or so, the lessons that I've learned lead me to the conclusion that this budget - and I will admit there are some baby steps in here that have been taken - is a long way from curing the health care system. It is not a cure for the health care

[Page 26]

system. We see in this budget, on a budget line item to monitor wait time lists, $465,000. Where are the lists that are going to be monitored? Why isn't government sharing them with the public? Where are the action plans to deal with wait lists? This government has failed to realize again, for the second year in a row, that in order to deal with the issue - and one of the issues in health care is the issue of waitlists - that you have to deal with the health care system. You just can't keep shovelling loads of money into acute care when the system can't sustain what it has now, because there is insufficient support for Home Care and insufficient support for long-term care. Again, Mr. Chairman, in other words, there is no plan.

[11:00 a.m.]

Radio therapy treatment for cancer patients, wait times are still increasing. We do finally hear that the Cobequid Health Center will finally be built after delays by this government, and it will open this Fall. But a question could be asked, does this budget provide for 24/7 ER service at Cobequid? We asked that question last year, we didn't get an answer. We're still waiting for the answer a year later.

The minister has somewhat evaded a question asked by stating the facility will meet the health care needs of a growing community. Well, of course it will, any facility should. That's a given, but will it meet those needs 24 hours-a-day, seven days-a-week? That's the question that has to be answered. Then we have mental health, the forgotten health care component. It's given some support by this government. The question is, is it enough? That question still remains. How about community health clinics, are there resources allocated for community health clinics? What about the community health clinic in Bear River, any support there? What about resources for doctors' offices that would enable them to stay open on weekends, maybe, and in the evening. Resources have been allocated and we finally see movement on this, but not until 2006-07. For emergency rooms coping with an influx of patients who are unable to gain access to either an office or to a doctor the message is, just carry on operating as you are.

There are no resources in the medical agreement to deal with Level 4s and 5s that visit ER's on a regular basis where the problem areas are. No measures are there to deal with them whatsoever until next year or the year after that.

Perhaps this minister would like the people of Nova Scotia to believe that this Health budget has gone up and, because it's gone up 9.3 per cent over last year, then everything will get better. Mr. Chairman, it can't get better without a plan that encompasses the entire health system. This budget is not going to lead to better health care, because it can't happen without a plan. The flow of patients won't improve this budget either. This budget continues to put money into hospitals without providing resources for those components of the health care system that keep people out of hospitals in the first place. It is true, it is very true, and the former Health Minister, who should know better, knows that it's true because the former Health Minister helped put this health care system in the mess it's in, so that former Health

[Page 27]

Minister should know that it's true. It enables patients to leave hospitals for other levels of care that they have decimated over the past six years, part of it while you were Health Minister.

Now, if you even allow patients just the basics, to be better treated in their own homes. You know what this budget is? It's nothing more than a PR budget, that's what it is. This government is hoping that the people will say, well isn't this government great, they're putting more money into health care. As I stated last year, we would be back next year with a large infusion for health, no plan that would enable government to shift the burden of cost from one component of the health care system to another.

I stood in my place last year and said that the health care system this time next year would be no more accessible as a result of this government's investment for wait times. People are still waiting for surgeries in this province, they are waiting and waiting and waiting. You cannot throw money at the health care system and hope that the problems will simply go away. Throwing money at health care without a plan does not make Nova Scotians any healthier, and I see very little difference in this year's budget compared to last year. So Mr. Chairman, with those few brief remarks, perhaps now I could ask the minister a few questions.

I'd like to start out with perhaps some shocking news that I watched last night on television and I'd like to know directly from the minister, why wasn't the minister - and he wasn't because he stated in the report last night that he wasn't - aware of a private hospital being built in Dartmouth?

MR. MACISAAC: With respect to that facility, it's not something that they came to the Department of Health to provide any consultation on. I don't employ a fleet of detectives to be out all over the place looking at things. I do, however, understand that Capital Health is monitoring the situation very carefully. Really, what needs to be (Interruption) perhaps Mr. Chairman, someone else wants the floor?

MR. CHAIRMAN: No, carry on.

MR. MACISAAC: What's required, of course, is to satisfy ourselves the services being provided are services that are not covered under the terms of the Canada Health Act and that is what we will be extremely vigilant about with respect to this facility. That is very important, relative to what's happening.

The honourable member asked more than one question in his opening remarks. He raised quite a number of issues that would be appropriate for me, as Minister of Health, to address, because if one were to listen to what the honourable member had to say and simply allow that to sit on the record without any response, it would be to suggest that everything he had to say was complete and accurate.

[Page 28]

I would like to put into perspective some of the comments that were made.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, on a point of order. I asked one direct question. The minister will have his time to reply to any general remarks that were made at the end of the estimates. I've asked one direct question, I think I received the answer and I have many more.

MR. CHAIRMAN: I'd like to thank the member for that. Member, I'm not going to consider that as a point of order, but would ask the minister to understand what the member has asked. Member, earlier on you did ask more than one question, so minister, you do have the floor, would you continue with your response please.

MR. MACISAAC: Thank you, Mr. Chairman. The honourable member suggests there isn't a plan with respect to how this budget was compiled, relative to health care. There definitely is a plan in place, it's called, Your Health Matters. That influences the direction on the governance of the Department of Health and how we formulate our budget and bring matters forward for consideration.

We have in place - and it's a very important element - our strategy in terms of dealing with wait times - the Wait Time Strategy Project of the Department of Health, and I can tell the honourable member and all other members of the House that we will soon have in place a Web site which will provide very up-to-date and complete information to Nova Scotians with respect to wait time issues in this province. That is very much a part of the plan that we have in place relative to the delivery of health care.

We have in place a nursing strategy. That nursing strategy has done a great deal to ensure that the number of nurses educated in Nova Scotia are sufficient, that their opportunities are real within the province, and that is something that we're going to do.

The honourable member suggested there was not a single bit of additional resources with respect to acute care delivery in this province. If the honourable member were to examine the budget and the estimates, he would find there is $102 million in additional funds with respect to the delivery of acute care services over the course of the next year. An important element of that is the issue of salaries that are provided for within the budget and comes out of the additional money that's provided to the district health authorities. There is money in the budget to deal with issues such as dialysis - that is very definitely related to acute care.

We talk about the need for additional long-term care beds and we make reference to our planning with respect to long-term beds. That is an issue that is directly related to the provision of acute care because it eases the pressure on the acute care system by freeing up beds for acute care patients. So, that's a very important part of our plan.

[Page 29]

The purchase of diagnostic equipment and the upgrading of diagnostic equipment is a very important part of acute care. That is being addressed within this budget. We have money for pain management, a stroke strategy . . .

MR. DAVID WILSON (Glace Bay): Mr. Chairman, on a point of order. This is nothing more than a blatant attempt by the minister to eat up time during estimates. I asked one direct question. In an opening statement I made general comments that were posed in the form of a question. The minister has ample opportunity to answer a lot of questions under the estimates. I asked one direct question. The minister is simply wasting time right now and I would ask that I be allowed to get back to the rest of my questioning, please.

MR. CHAIRMAN: To the honourable member for Glace Bay, as Chairman, I have been sitting in this position for six years now. It's been the tradition of this committee - and that's what we are, is in committee - for the minister to take ample time to give an appropriate response. As Chairman, if I would detect the minister is not speaking in a relevant manner, I would check the minister. But, minister, at this point, I know you are answering the question to the best of your ability and you need a certain amount of time, but I would ask you to sum up as soon as possible so that we can get on with other questions. I'm not going to take that as a point of order, respectfully, honourable member for Glace Bay. Mr. Minister, you still have the floor.

MR. MACISAAC: Mr. Chairman, I believe the purpose of examining the estimates is for members of the House to come to a greater understanding of how the money is being spent. When statements are made that don't reflect completely the situation that is contained within the budget, I feel it's my responsibility to draw to the attention of the members of the House when there may be some misunderstandings. Perhaps that's all the honourable member has done, misunderstood some of the numbers that are in the budget, so it's appropriate to take time to make those points with respect to his presentation. Just several more points and I believe I will have dealt with all of those issues.

I want to point out to the House that 73 per cent, no about 75-plus per cent of all of the money that's spent in health care is spent on wages. Honourable members make reference to the shortage of specialties that we have in various fields. It's important for us, if we are going to stay competitive with respect to attracting and retaining and recruiting specialists, health care professionals to the province, that we compensate them appropriately. If you're going to compensate them appropriately, you have to do so within the realm of the North American market. That means that every year there is additional pressures put on the health care budget in order to meet the salary demands. That's a fact of life.

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[11:15 a.m.]

What's interesting is - I'll have more complete figures on this later in the estimates - that if you look at the period of the last five years, the budget for acute care has increased in the vicinity of 50 per cent perhaps. The budget for long-term care and home care has increased in the realm of 200 per cent to 400 per cent. I'll provide more accurate figures on that later in the estimates.

Mr. Chairman, I think I've dealt with a number of items that were raised by the honourable member and I certainly do not want to interfere unduly with his time in terms of being able to ask questions. I will stop at this point and give him the opportunity to ask other questions.

MR. DAVID WILSON (Glace Bay): Let's get back to the only real question that I asked and the minister replied. I asked the minister why he was not aware of a private hospital being built in Dartmouth. He said he does not hire detectives in the Department of Health, but I don't know if you need detectives to see a great, big four-story building being built in Dartmouth and not know that is something connected with health. Do you know anything about your department, Mr. Minister? You don't know that hospitals are being built in Dartmouth right before your very eyes and that eventually surgeons - so they say - are going to be moonlighting over there? You have to know something about it, but apparently you didn't. Then, let me ask the minister, how does he plan to monitor the services that doctors are now saying are going to be offered in that new facility? They are saying that they're going to perform procedures such as plastic surgery not covered by MSI as well as operations for the Workers' Compensation Board. So, how are you going to cover and monitor those services that are being offered in the new facility that you didn't know about?

MR. MACISAAC: Indeed, the services that are purported to be offered by this clinic are services that are not paid for under the terms of the Canada Health Act or through MSI. The member is correct to raise a concern with respect to how the clinic will operate because we need to be vigilant to ensure that the resources that are available in the province are not compromised with respect to the delivery of services to citizens that require services under the terms of the Canada Health Act, and those services which are covered under MSI.

It is obviously the intention of the department and the Capital District to monitor those services very carefully, we will be taking great care. We are, also, in the process - and this is not happening as quickly as I would like to have seen it happen, but it is moving along very well - of providing new legislation which will cover the issue of private versus public health care in the province. I can assure the honourable member and all people of the province that we will be extremely vigilant with respect to these services.

[Page 31]

What we're talking about here is not something that is new in Canada. Dentistry is part of the service that is going to be provided in this clinic, while dentistry service is provided right across the province, they're not part of the Canada Health Act.

On the surface, there isn't anything that would suggest that monies would be spent inappropriately with respect to the operation of this clinic. But, the honourable member is correct to point out there is a need to be very vigilant. In fact, we will be very vigilant along with Capital Health.

MR. DAVID WILSON (Glace Bay): I'd like to know, the minister said that he knew absolutely nothing about this facility. So, in other words, there's no government money going into this building, this facility? There's no Workers' Compensation money going into this building because surgeries for WCB are going to be performed at the facility? You weren't aware if there's any Workers' Compensation money going into the facility? You weren't aware of anything whatsoever - this monster of a building being built behind the Dartmouth General, popped up overnight, but you weren't aware this was going to be a private hospital? Is that correct?

MR. MACISAAC: I'm informed that within the past month, there were discussions between my department and Capital Health with respect to this facility. It is not something that came to my attention in terms of its operation, but it was being monitored by officials within the department.

First of all, I want to point out the honourable member raised the question as to whether there is any public money involved in the building of this facility. There is no money being provided through my department or any other department of government that I'm aware of with respect to this facility, certainly none from my department. The Workers' Compensations claims and the work that's done around those claims are claims that have always been provided outside the terms of the Canada Health Act and MSI. They're services that are paid for by Workers' Compensation and this is nothing new in terms of what's taking place, it's a normal practice with respect to the provision of service to Workers' Compensation clients within the province.

MR. DAVID WILSON (Glace Bay): I'd like to ask the minister to clarify then, because I'm a bit confused right now because last night he told CBC reporter, Rob Gordon, that he only learned about the hospital when he was asked about it by the CBC reporter. As a matter of fact, your quote was when Gordon asked you if you intended to look into it, you said, you've piqued our interest. That was your reply to the reporter. Now you're telling us here today during estimates that about a month ago your department did know about this hospital, that it was being monitored by officials in the last month or so, but you didn't personally know about it? Would you clarify that, please?

[Page 32]

MR. MACISAAC: The honourable member has quoted me correctly in terms of the news report last night. I didn't see it, but I recall having said those words to the reporter. What I said in the House this morning is the department was in consultation with Capital Health with respect to this particular issue. It is not something that had been brought to my attention by the department. I can tell you the department, along with Capital Health are examining the issue and continue to examine the issue. When they feel they have something comprehensive to report to me, they will bring it to my attention.

MR. DAVID WILSON (Glace Bay): Just a little more clarification. Let's be perfectly clear here. Your department knew about this, but they didn't tell you. You're telling us, as you told the reporter, you knew nothing about a private hospital, but someone in your department knew that a private hospital was being constructed in Dartmouth - they didn't think that was important enough to tell the Minister of Health? Hey, there's a private hospital being built, Mr. Minister, you may want to be aware of it. So, you're saying that someone in your department didn't bother to tell you that a major story like this was going on behind your back? Is that what you're saying, Mr. Minister?

MR. MACISAAC: What I've indicated to your committee, Mr. Chairman, is that the department is in consultation with Capital Health with respect to getting a handle on what services were intended to be provided in this facility. They are doing a joint evaluation of what was taking place with respect to that facility. As is usually the case, when they have something that is complete and comprehensive, then it is brought forward to the minister for consideration. I'm sure I will get the comprehensive report of what's taking place there when that process is complete.

MR. DAVID WILSON (Glace Bay): I find it disconcerting to say the least that Health Department officials, Capital District officials, would be aware of something of this magnitude happening and not at least give a heads-up to the Minister of Health that a private hospital is now being built in the metro area. You should be made aware of that, that it's happening - never mind waiting for the full details, but the minister should at least be aware of it so that the minister is not taken by surprise in the lobby of Province House by a CBC reporter who asks him, are you aware of a private hospital being built in Dartmouth? And the minister has to reply no, but you've piqued my interest.

I would think that our Minister of Health should be more on the ball and that the department should be keeping him more on the ball than the current situation - and it leads me to ask the next question, Mr. Chairman, isn't the minister concerned? I mean just the notice that this was being built, wouldn't that have raised a flag, Mr. Minister, that you could be concerned that this is going to be a drain on some scarce human resources in the health care industry already in this province?

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Let me say that they call these things pay-for-a-slice facilities - that's the nickname. The doctors may call it an ambulatory clinic, but the nickname is pay-for-a-slice facility and the doctors are going to be asked to moonlight their services in addition to their regular duties that they have within the health service itself. So aren't you concerned that this is going to be a drain on those already scarce human resources that we have in health care, Mr. Minister?

MR. MACISAAC: Mr. Chairman, obviously the Minister of Health is concerned with all aspects of the delivery of health care and the honourable member is quite correct to point out that if I had my druthers I would prefer not to have had to respond the way I did yesterday - saying that I was not aware that this facility was under construction for the purposes for which it was under construction. Now I cannot, however, accept the responsibility to know what every building that is being constructed in the metro area is going to ultimately be used for, that would be a rather difficult task for anybody . . .

AN HON. MEMBER: A hospital.

MR. MACISAAC: You know, to distinguish what's a hospital and what isn't a hospital in terms of what is being constructed . . .

AN HON. MEMBER: It's a great big building with beds in it, where they do surgery.

MR. MACISAAC: Well, the honourable member might have nothing more to do with his time than to wander around and wander through constructed buildings - I hope he wears a hard hat when he does this and steel-toed boots, otherwise, the honourable member should also be reasonable in terms of what one is legitimately expected to be able to keep track of relative to responsibilities.

Now, Mr. Chairman, I want to point out also that relative to the issue that he raises on the "moonlighting", to use his phrase, that currently Workers' Compensation cases are all attended to by physicians who provide service to our public health care system, but they are compensated differently than our physicians who are operating within the public health system. They are compensated directly with direct payment from Workers' Compensation, so there's nothing new here in terms of doing that. The member is correct to raise concern that the human resources in the province are not deployed in such a way that it is taking from our capacity to be able to deliver services to people under the terms of the Canada Health Act and the services provided by MSI and that, obviously, is the concern of the department, it's the concern of the Capital Health District, and will continue to be the concern of those agencies.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I'm not going to get into the trading of barbs with the minister over whether or not I know what a hospital is or whether or not I could recognize it being constructed, or whatever. I'm not the Minister of Health, Mr.

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Minister, you are the Minister of Health and your Department of Health should know what's going on in this province. If there's a private hospital being constructed in Dartmouth, I would assume that someone somewhere within the Department of Health and/or the Minister of Health in this province would know that that is taking place.

[11:30 a.m.]

Obviously I'm right because it has been confirmed here today that your department did know about it and that the Capital Health District did know about it, but maybe you just had some blinders on and you did the same thing that this government has been doing time and time again, you just said I don't know, I don't want to know, not interested, don't want to know if there's a private hospital going up behind the Dartmouth General, don't want to know that you can go there with cash and get operations, don't want to go there, because eventually you're going to have to address it as the minister that that potentially slippery slope - and you know what that is - where we're headed, when health care professionals will start leaving the public system to work at a private facility, and you can see the potential of that happening.

If they're going to have surgeons and health care workers going over to work at this private hospital and moonlighting to start out with, there is the potential that eventually they will be gone from what is already a system that is scarce on human resources. So I want to ask you, Mr. Minister, how do you plan to address that potential slippery slope of health care professionals leaving our public system and going to a private facility such as the one that is now under construction in Dartmouth?

MR. MACISAAC: The honourable member does in fact raise a question that's appropriate and a matter that we will first of all, in the first instance, monitor very carefully what's happening at that clinic. Our concern is the same as his, that human resources not be diverted away from the public health system to the extent that the delivery of public health care is diminished as a result of the operation of a clinic of this kind. In the longer term, Mr. Chairman, we will be bringing forward legislation that will deal with this issue and deal with it effectively.

MR. CHAIRMAN: Member, you have a little over 10 minutes left.

MR. DAVID WILSON (Glace Bay): I should advise my colleagues I won't be taking up the remainder of the 10 minutes, Mr. Chairman, only because of the fact that I have a sore throat, and I know the minister is saddened to hear that - no thanks for the lozenges, I will skip the medical advice of the minister right now.

Let me ask the minister though, he just referred to the fact that there's going to be legislation coming to deal with that -we have the private MRI clinic, we now have a private hospital, and there's no more daunting challenge in health care right now than the issue of

[Page 35]

wait times. These private clinics, these private hospitals are eventually going to put people in to get services that are now requiring people to wait in public hospitals for a very long period of time - how does the minister hope to meet those challenges? What's this legislation going to do to prevent that issue of these wait-time lists being jumped in the private sector simply because you have the cash in your pocket?

MR. MACISAAC: Mr. Chairman, really the fundamental concern that we have with respect to this whole issue is that whatever services are provided in the private sector are not provided in a way that will allow people to jump the queue, with respect to the delivery of health care, and that is the fundamental challenge. The other challenges sort of flow from that, raised by the honourable member, and very legitimate concerns raised by him, that the resources not be diverted away from the public health system in a manner that diminishes our capacity to deliver public health. The honourable member is quite correct to raise this as a concern and it's certainly a concern that is shared by us and that's why we're in the process of developing that legislation, and the fundamental thrust of the legislation will be to ensure that people are not able to jump the queue when it comes to the delivery of health care.

MR. DAVID WILSON (Glace Bay): I just wanted to ask the minister one additional

question. If you could, and it may take a little bit of looking into your book or whatever the case may be, but I'm interested in knowing how much money our district health authority is currently making from non-medically necessary surgeries such as plastic surgery, because this is what these private hospitals are talking about. Are you worried about losing the revenue that would go to those hospitals, are you worried about losing that revenue through public hospitals? I'm not sure if you understand the nature of my question, but they're saying, at least in news releases anyway, what's going to be done here is apparently a lot of plastic surgery. If that's the case, then what happens? That is currently done in our hospitals, is it not?

MR. MACISAAC: The honourable member again raises a question that the level of concern that we have around it will very much depend upon how a clinic such as this will wind up operating. If it operates in a manner that sort of clears out a backlog even though there might be some revenue generated within existing hospitals, if those people are looked after outside of those hospitals and we're able to accommodate more people in providing them with the services covered under the terms of the Canada Health Act and MSI, then there could well be a very positive result in terms of wait times. However, the honourable member in his previous question raises the issue as to whether or not too many resources would be diverted from the public hospitals. That's the challenge that is involved here in terms of the revenue issue. I think one of the things that may be a benefit to an operation such as this is that, indeed, procedures that are not covered under the Canada Health Act or MSI may be done elsewhere and that would free up more time for procedures covered under the Canada Health Act and MSI.

[Page 36]

MR. DAVID WILSON (Glace Bay): That would conclude my time for now, Mr. Chairman. Thank you, very much.

MR. CHAIRMAN: We'd like to thank the member from the Liberal caucus and certainly hope, member, that you're feeling better. Honourable member, the time being 11:38 a.m., you have one hour in turn. I'd like to inform the committee that the time of committee today will be 1:18 p.m.

The honourable member for Sackville-Cobequid.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman, and I welcome you to the Chair for this next hour or so talking about Health and trying to get some answers from the minister. This is a great forum, as an elected official, to have the attention of the minister for such a long period of time and to be able to ask more than the normal three questions we have during Question Period. I'm sure the minister is aware that if he doesn't give a good answer, we'll just keep asking the same question for an hour or so.

When I was up earlier I was talking about an important project in my community, which is the Cobequid Community Health Centre. I know the minister answered several questions about that and I'm encouraged with the answers he gave. He pointed out that the investment this year is about $13 million to that facility and an overall investment around $34 million. That just shows the commitment from government, but it also shows the amount of taxpayers' money going into this facility. The people of that area and the people who are served by that facility now are grateful and excited to see that investment.

Health care definitely, as I mentioned before, is an important issue to all Nova Scotians and all Canadians, and the question I get quite often in our community is when is the facility going to be open, and I understand the minister has some concerns with giving me a definite answer to that but other issues are, as I mentioned, the ability to increase the staffing level there in the emergency department, so I am encouraged that the minister answered that the facility will be fully operational. Many of the residents of my community will take that with encouragement, the news about that statement from the minister.

One of the most important things - and I know I've asked the minister this several times over the last 18 months - is really around the hours of operation for the facility. The minister in the past has stated that he takes direction from Capital Health and listens to what the area needs, the studies and the number of calls after-hours in that area. That's all well and good, if you are just simply looking at data. What the government needs to realize, especially from my background, is that emergencies definitely don't happen just between the hours of 7:00 a.m. and 10:00 p.m., the current hours of operation for the Cobequid Community Health Centre in Sackville.

[Page 37]

The concern I hear from a lot of my residents, if not every single person I've talked to, is that question around operational hours for the facility. It wasn't too long ago when I gave a news pamphlet out to the community about what was going on in the community and what I've been doing here in the Legislature and things we'll see in the future. One of the topics was the Cobequid Community Health Centre revolving around the issue of facility hours. It's my understanding that once the new facility opens it will continue to be operational with those hours from seven o'clock until ten o'clock at night. People were really taken aback by that, Mr. Chairman, and were wondering why, if we're having such a commitment and such an investment with taxpayers' money to build this state of-the-art facility.

The Premier said that - and I'd have to agree with him - it's a beautiful facility, it's really going to address some of the concerns we see in our community about access to quick and appropriate services when you enter the health care system, but they were really taken aback and very, very concerned with the idea of such a cost incurred by government and by taxpayers and that they're not going to address the issue around operational hours of the facility.

I'd like to ask the minister once more, has there been any decision, or are you looking at increasing the hours of operation when the new facility opens, hopefully within the next six months or less?

MR. MACISAAC: Mr. Chairman, I know this is a subject of considerable concern to the honourable member. I think the honourable member would not feel I was doing my job if I were to simply get up and say, because it's the easy thing to say, that yes we're going to open for 24 hours and that all is going to be rosy. It's really incumbent upon us and Capital Health to do the kinds of analyses that are required to ensure that if a decision were taken to open for 24 hours, that decision would be justified by the flow of patients to the facility. We would be in a very difficult position, from a fiscal perspective, if we were to take the decision to open it on a 24-hour basis without having done the analysis, then we would find, as the facility started operating, that there wasn't a justification to keep it open for 24 hours, and it would become extremely difficult to take the decision to then cut the hours back - I can just imagine the tone of speech the honourable member would have in this House if that scenario were to be played out.

[11:45 a.m.]

We are not ruling out 24 hours, Mr. Chairman, but we are not going to take that decision lightly. We want to be sure that we have done the analysis that would justify the 24 hours in terms of the volume that would be there. It's not just a matter of doctors and nurses being on duty in that time frame, all the backup facilities and the backup human resources that you need to be able to operate in an emergency also have to be there and that becomes a very expensive operational item and it's one that we need to satisfy ourselves is justified

[Page 38]

before we ever take such a decision. I can assure the honourable member that the analysis that will be done will be comprehensive and it will be based on anticipated volumes and it will be based on what is anticipated would be the real catchment area in the hours from 10 to 7:00 a.m. in terms of people who would go to that particular facility.

It's an issue that is under active consideration. It's being analyzed and I can assure the honourable member that the decision that's taken will be based on the very best evidence we have available to us.

MR. DAVID WILSON (Sackville-Cobequid): Definitely one of my next questions was is this analyzing the data being done at this time, and I think the minister said they are looking at it now. But one of the things is you can analyze all the data you want, you can't predict when an emergency is going to happen or what time of day someone's going to need a facility such as the Cobequid Community Health Centre. Really the data that you receive won't reflect what the community could use or the number of people that would use that facility through the evening.

A prime example - and I don't like talking about myself in here but I was playing in a hockey game last evening and I took a slapshot in my arm and, as a health care professional, I noticed with my assessment that I probably should go to the hospital to get an X-ray of it, but the one thing I did - and I think every person who lives out in my community, what they do in times of deciding if they're going to seek that expert advice or require service for the facility is they look at their watch - I looked at my watch last night and realized it was five minutes to ten and that I wouldn't get from the rink in Halifax to Sackville in time to get an X-ray and decided not to go.

Maybe I'll do it after this but that's a lot of the philosophy and a lot of the decision making that happens in our area. We know that there is such a backlog of people waiting to get into the QE II, especially when it pertains to not such a severe or urgent case such as maybe an X-ray for a possible sprain or fracture, people just decide not to go or they decide to wait longer, especially when it pertains to things like suturing, the minor things, because I know and I advised people many times in my career as a paramedic when we go and assess a person and they ask "What should we expect?" or "Should we go to the hospital?" and the biggest thing I say is, again, I look at my watch as a health care professional and say well, it's a quarter to eight, we could go down to Cobequid, get you assessed, it doesn't look that serious, it's minor and then hopefully you can get out and on your way. Far too often, it's after the hours of closure out in Sackville and paramedics in the community find themselves looking at their watches and wondering what the best course is for this patient.

Health care professionals are always concerned with what's in the best interests of the person they're trying to help. I'm honest with many of the people I've assisted over the years when it comes to whether they should choose to go into the QE II, as to what the atmosphere in the QE II is that night. One of the first things that we do when we come on

[Page 39]

shift as a paramedic is try to judge the backlog of the Dartmouth General ER and the QE II ER so we know what we're going to see when we get in there, not only for the patient but for the paramedics themselves, because far too often now it's the norm that an ambulance will do a call in this province, especially around HRM, go to the QE II and wait for hours.

I remember, in the early days in my career, we thought 20 minutes was long before we got assessed by the triage nurse and progressed into a bed in the emergency department, but I speak to paramedics who are involved in the service today here in this area and, just in the short time that I've stepped away from that profession, the numbers and the length of time that paramedics are waiting in our emergency room hallways has increased. It's not abnormal for them to sit there with a patient on a stretcher for one, two, three hours. There are even protocols and policies now in place for EMC that allows paramedics who are waiting for hours on end to get off, because what they'll do is a crew in the city here will come on duty and they'll say, your posting is at the QE II emerg hallway because they'll go and relieve that crew to allow them to get off duty and hopefully get home to their families.

So the data you look at, you have got to take into account what benefits there are for 24 hours. I agree with the minister when he says you can't just open it 24 hours tomorrow, and definitely it's harder to retract that down the road if it doesn't warrant that. One thing you could do - and I hope the minister could maybe respond or give comment on this - is do a bit of a trial or look at extending the hours a little bit, especially during the peak hours. It does get busier certain days of the week, you can't predict when the busiest times are but from working in the field for many years I realize there are certain nights of the week, weekends, that are busier. Is this something that your department, your deputy has looked at - maybe increasing or extending the hours of operation at the new facility when it's finished?

MR. MACISAAC: The honourable member does indeed put on the table a suggestion that's worthy of consideration and I understand that currently in the analysis that's going on everyone is open to - people are not stuck in a mould, let me say it that way, they're looking at this with open eyes and prepared to obviously want to ensure that the facility is deployed in a manner that provides the best care in the most efficient manner to as many people as possible. That is the objective of the analysis that is taking place.

MR. DAVID WILSON (Sackville-Cobequid): Again, I think the people of the area who use that will be encouraged by those words. That's the only thing we want, to really look at the issue, look at the investment the government is putting into this facility and it's a real shame and people are upset, they are really upset - I mentioned that I put out a news pamphlet a little while ago and I was amazed at how many people actually called my office saying they didn't know it wasn't going to be 24 hours.

It wasn't just supporters of mine and, funny enough, I was attending a meeting that really was initiated by members of the Progressive Conservative association out there and even those members, their initial reaction was that I was misinforming the public when I

[Page 40]

stated that it wasn't going to be 24 hours - they said "No, no that's not going to happen, our Premier is not going to build a facility and not have it 24 hours." Oddly enough they came back to me and said "You're right, it isn't 24 hours and we're concerned with that."

I really want to emphasize that people in that area are very upset with the fact that we're spending this kind of money on a facility and that right now, the way things seem and the way things I think will go, is with the opening of that facility it won't be 24 hours. Just so the government knows there will be a public outcry when the facility opens and it remains at the same hours. I hope that the minister is genuine when he says that it could be an option to extend the hours of the facility, because I think that definitely could indicate how busy it could be in that area if the public knew it was open a little longer.

Before we take that step and I hope that someday, maybe I'm standing here, maybe I'm not, maybe I'll be back working in the health care profession at the time that the facility should be 24 hours and hopefully the government, if it's this one or another one at the time, recognizes that this facility can play an important role in addressing the issues seen throughout, especially throughout the HRM, it could really address the issue of hospitals in Colchester, the hospital down in Windsor.

What we see now is the QE II is a tertiary care facility. They receive patients throughout this province and sometimes it comes down to other hospitals transporting those patients to the QE II just to rule things out, things like a CT scan of their brain to rule out possible aneurism or strokes. From my understanding, the new facility in Sackville will have a CT scan in place.

I feel that that facility could alleviate what we see, the other hospitals transporting into town after hours, because I know other facilities throughout the province do close down or do cut the services offered in the later hours of the morning and night. That's where we would hope that we could see the government see the utilization of Cobequid and really play a role in the whole picture of some of the congestion we see at the QE II.

One of the other concerns that I want to bring up, and maybe get some comments from the minister on, is before we take that step to 24 hours, the concern that many of the staff at Cobequid Centre currently, many of the doctors have when it comes to them trying to transport or transfer patients into the QE II system. Presently the facility closes at 10:00 p.m. - they actually stop receiving ambulances at 9:00 p.m. to try to alleviate that problem of kind of getting as many patients as we can in there before 10:00 p.m. and then they're there until 2:00 o'clock, 3:00 o'clock, 4:00 o'clock in the morning, which is not uncommon. It happens a lot.

The problem and concerns that these health professionals have, the doctors and nurses at the Cobequid Centre, and the paramedics, is that policy or procedure of transferring patients in the QE II. There are times that the QE II is overloaded and they can't receive those

[Page 41]

patients at that time. They often go on divert, where they'll go over and say we can't take any patients right now, you'll have to divert to the Dartmouth General Hospital. Ironically enough, even though we have one health care system, one Capital Health region here in this part of the province, there is animosity between emergency departments, with staff, when it comes to an emergency department choosing to go on divert.

I just wondered if the minister knows, or does he get updated when a hospital, especially here in HRM, like the QE II or the Dartmouth General Hospital, goes on divert? Is he aware of the problems in that service of transferring patients into the QE II, and the inability of, especially, the Cobequid Centre at times to do that, and our needing to stay in the Cobequid Centre longer hours with nursing staff and doctors because they can't get those patients into the QE II? Does the minister have any comments about any awareness around that problem, especially in HRM?

MR. MACISAAC: Mr. Chairman, I apologize. The honourable member for Glace Bay is not the only one who's struggling with a throat problem today, so I have a lozenge in my mouth. That seems to be a difficulty for me the last couple of days.

We have a diversion policy in place within the Department of Health, and it involves all of the district health authorities. There are circumstances that arise when it's necessary for there to be a certain level of co-operation between district health authorities or among district health authorities, and the honourable member, in his professional experience, would be aware of that.

Those figures are made available to the Department of Health when it is necessary to have the Department of Health become involved in the process. They are figures that are analyzed by the department, along with the district health authorities. It is looked at to ensure that no unusual circumstances are arising on a regular basis, because if they start arising on a regular basis, obviously some things need to be looked at.

So the answer to the question is that my department is certainly in tune with what is taking place relative to those issues. I would hear about it if it were something that required a major reallocation of resources in order to deal with a situation, but for the most part those situations are accommodated by the policies that are in place, and those policies are deployed when circumstances warrant.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I would hope that maybe in the future the minister would be aware when problems arise. I know that he has staff members who take care of it, and the deputy minister may be aware at times, but that's one of the concerns a lot of health care professionals have, especially the ones I've come across in my career, the nurses and the doctors, the respiratory techs, paramedics and everybody, that they feel there are problems in the system - like the concern I just brought up about being on divert and the transferring of patients between hospitals and facilities.

[Page 42]

That's one of the things that these health care professionals want, to know that the Minister of Health, who is making and oversees a lot of the decisions, is aware of these problems. Some of the concern they have, also, is that there's a disconnect from government and from what people actually do on the ground, the people who are working every day in the system. You oversee a department that makes and spends millions and millions of dollars to hopefully improve it, and I have to tell you there are problems out there, especially when a hospital goes on divert. I've been in the other hospital when we hear that the QE II is on divert.

Health care professionals just want to know that the minister is aware of some of the situations that we see when we're working in the field, especially on the ground. If I may say, Mr. Chairman, I know that one of the things we really need to do and I hope the government looks at it, is how we utilize the hospitals.

[12:00 noon]

I know I talk quite a bit about the Cobequid Centre, but it's a passion of mine, definitely, and I know the potential we have with that facility to address so many issues in the province, and one of them is when we see the problems in our emergency rooms with congestion, and utilization of the Cobequid Centre could be as simple as if an ambulance does a call in Clayton Park and knows that the QE II has a two-, three-, four-hour wait, or the Dartmouth General Hospital has the same kind of wait, that maybe that patient - and the paramedics are well trained in the acuity level of the patient, the urgency to see a physician - maybe we could get them, if there was some kind of collective analysis of what we see on a daily basis, have someone who's in charge of checking what departments are backed up and maybe that ambulance could be diverted to Sackville, if they're not as busy, or diverted, say go across the bridge and go to the Dartmouth General Hospital, but that doesn't happen now.

I know you need to look at revamping the way dispatching is, the way these hospitals have their intake of patients. I think that's an avenue, like I say, the Cobequid Centre could help alleviate many of the problems when it comes to patient diversion of calls in hospitals. One of the major concerns with the Cobequid Centre is getting those patients out the doors when the doors close and getting them into the QE II. One of the main issues is here we have physicians who work at the Cobequid Centre, who are ERPs, emergency room physicians, right now there's a huge pool of them, and it's not uncommon to be at the QE II today and if you needed to go to the Cobequid Centre tomorrow the same physician might work there. They seem to work in each department.

The thing that frustrates many, especially paramedics, is that you'll have a patient who enters the system at the Cobequid Centre, goes through the triage, goes through the testing, and there's a decision made as to this patient's need to go to the QE II or Dartmouth General Hospital, and the problem we see is if the decision was made that the patient is going

[Page 43]

to be transferred, they call for an ambulance to transfer them in, they enter the system - they're already entered in the system, but then they have to enter the QE II and they have to go through the same procedure.

They enter the QE II emergency, they go through the same thing; they see the triage, they see the ERP, sometimes they may see a resident first who then has to consult with an ERP or specialist, then they'll come to the same conclusion that the ERP at Cobequid had made saying, yeah, okay, this patient needs to be admitted to the hospital, then they go through that process of trying to get upstairs to a bed. So is your department looking at making that flow, once a patient is entered into the system like Cobequid, Colchester, Valley Regional, all these hospitals, easier access to the QE II, so they don't have to repeat the same steps over and over again? In my view, an ERP in Cobequid, an ERP at the QE II, an ERP at Valley Regional, are trained the same and most likely work in the same kind of area, but work at different hospitals. Why can't we make it a little easier for these patients to get into the QE II, do you have any comments on that?

MR. CHAIRMAN: I'd like to thank the member for the question, but member, I would like to know if you would allow for an introduction before I direct your question to the Minister of Health.

MR. DAVID WILSON (Sackville-Cobequid): Yes, no problem.

MR. CHAIRMAN: The honourable member for Pictou East on an introduction.

MR. JAMES DEWOLFE: Mr. Chairman, through you to all members of the Legislature and the staff of the Department of Health, I'd like to introduce to you, from Newfoundland, Elaine Rumbolt and she's with MHA Yvonne Jones, a former Cabinet Minister in Newfoundland, who was the youngest member at one time to serve in the Government of Newfoundland and Labrador, and currently a member of the Opposition. I'd ask all members to give them a big hand as they rise. I hope you enjoy your stay in our beautiful city. (Applause)

MR. CHAIRMAN: I would like to thank the member for Pictou East on the introduction and at this time I would like to direct the question from the member for Sackville-Cobequid to the Minister of Health. Mr. Minister, if you can remember the question.

MR. MACISAAC: Mr. Chairman, the top is getting grey and thin, but the memory is not that bad yet. The honourable member indeed raises a question that is of considerable importance in terms of the efficiency with which we were able to deal with patients who are, in fact, processed in one facility and then come to the Capital District or are transferred within the Capital District with respect to services. The policy surrounding that, is something that rests with the Capital District, but it is something that we are keenly interested in and are

[Page 44]

working with the Capital District to bring about a change of that particular policy. The honourable member is quite correct, once you do the necessary admission procedures and do the processing that's required, you should be able to move to the next step in the process, that is the objective, and we're working with Capital Health to try to achieve that particular objective.

The other issue raised earlier by the honourable member, I just want to point out to him that indeed from time to time I do get reports that show me where there are bottlenecks. It's not something that I see on a daily basis by any means, but I do see them. I would tend to see them if market changes were to come about that perhaps required our attention, but for the most part, the policies that are in place are policies that look after this. I am reminded by my deputy whenever crisis patterns develop. I don't see many of these, so I don't get to see the good news reports, Mr. Chairman, it's only when your attention is required by them. So fortunately, I don't see them often but from time to time I do.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I too would like to welcome our guests and hopefully they enjoy the proceedings. I know it's probably not the most exciting thing for you to sit here on your vacation and watch, but I know you have an important job as Opposition, as we do in this province, to bring awareness around some of the problems that we see happening through government policies and procedures.

I want to change a little bit now and talk a few minutes on something that I've been dealing with over the last several months and that's the area of procedures not done in the province here. A patient - I'll give you an example and I won't use any names of people that I was trying to help - who needs a lung transplant, and we don't do lung transplants here in the province, these patients who require and actually are accepted into the transplant program out of Toronto, they go through quite an ordeal just to even get on the transplant list. I was helping a young lady who was in that situation, who wasn't able to get that here in the province and I understand the inability of the province to do every procedure here in the province and we want to go really where the experts are in that, but my concern with it, when I got involved with this case, is around the idea of what's required of the patient when they do get accepted into the program and go to Toronto. The example and some of the questions I have is around what does MSI pay for? It's my understanding that they pay for the procedure, the stay in the hospital and the medication in the hospital, but what concerns me is that these patients, once they enter into this system and are on the transplant list, have to actually move to Toronto, and they need to be a certain distance from the hospital, they wear a pager and are on-call, just like an emergency personnel, that if they do get the word that there's a set of lungs that is going to come in, they need to be in that distance. This young lady who has been fighting and battling a long illness, has limited movement, and is on oxygen, needed to go up to Toronto to do this.

[Page 45]

Could you tell me why it is policy that whole procedure of taking this patient out of our province to Toronto, Ontario or wherever, why they only have coverage for their actual stay in the hospital? Why are we not covering the cost of them to be that certain distance from the hospital when they find themselves in circumstances like this?

MR. MACISAAC: Mr. Chairman, I thank the honourable member for the question. Obviously it's a situation where people do indeed find themselves in difficult circumstances. Our responsibilities to the Department of Health are to ensure that we pay for the appropriate medical services. We indeed have circumstances where patients must travel from the extremities of the province to metro in order to receive certain treatments. When they are here, we pay for the medical treatment that's involved.

Very often we hear of fundraisers in our communities, where people are trying to raise money to help the family because they have to come to Halifax, or because they need to go to Toronto to the facilities there. That is a challenge with respect to these situations. I can tell the honourable member that what we do attempt to ensure is that we pay the appropriate medical costs in these circumstances. I don't, in any way, minimize the difficulties that families face when they're put in those circumstances, but families can find themselves travelling from the extremities of our province to the metropolitan area, or in some cases, travelling from parts of eastern Nova Scotia to Sydney, for treatment. Then people find themselves with undue personal expenses and that's a challenge, and it's not one where we find ourselves in the position to be able to step in and pay for all of those services. I might point out that with the exception of Newfoundland and Labrador, our practice in this province is consistent with what takes place in other jurisdictions across the country.

[12:15 p.m.]

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, it is a big concern with many people who find themselves in the situation where they have to leave the province. I understand we have a large province that people come up to Halifax here for procedures, but it's a little easier I think to gain access to some of these organizations that help to facilitate some of these concerns when they do come to Halifax. Yet when you send someone out of province, it's harder for them to gain those same, they don't have the same access I think as someone from Ontario would have if they had to go to Toronto and seek the same situation.

It's a tragic case, Mr. Chairman, because it really shows, and there's not that many of these patients who have to leave our province, I think we may have seen six or seven last year. So it's a small percentage of people who actually find themselves, especially when it pertains to lung transplants, in the need of leaving the province and going to Ontario. I know that I was in contact with the minister's office about this and his staff members stated the same thing the minister has stated and also we were kind of pointed over to the Department of Community Services. I know we're not here talking about that but, the thing that concerns me is that here we had a lady who was on a fixed income, on disability, and was finding it

[Page 46]

very difficult to afford all the costs incurred for leaving the province for something that she had no choice in doing. She had to go because we didn't do the procedure here in the province.

So this will lead me into the next group of questions. One of the things I tried to help this lady with was the fact that before she left the province to go to Ontario, she incurred several ambulance trips to the hospital. She had four trips over Christmas and then, of course, now has those bills. One of the sad things was that, she was receiving final notices of payment and somewhat threatening to go to collections while she was in Toronto fighting for her life, to get this transplant. I'm sorry to say that she didn't make it, she passed away about two weeks ago. One of the last things I was trying to do for this lady and her family was to try to address the need of trying to not go after her so much about these user fees. That's some of the questioning I'll have now, is around the user fee, the ambulance bills that patients get in this province.

I know I couldn't go through here and find out which line that's under and I'm just wondering if the minister could tell me, is it the responsibility of EMC who manages the ambulance service in the province to collect those fees and do they keep those fees or is that line in here, does the government get that money back in the user fees that they collect?

MR. MACISAAC: I understand, Mr. Chairman, that EHS does collect, but the money that comes in is shared between the department and EHS.

MR. DAVID WILSON (Sackville-Cobequid): So do you have that figure on how much the province has taken in with user fees, the whole figure and maybe the portion that the department receives? I can ask a couple more questions, you know, to give the time to get that information.

The one thing that I was trying to help this lady and her family with was the fact that she couldn't afford it at this time. She was paying I think around $1,600 a month in Toronto for her apartment and she was taking in about $900 on a disability pension. So I got in contact with EMC that I know has a department that issues the user fees and the charges for the ambulance services and I received a notice back from them that they wouldn't continue that kind of aggressive attempt to recover that money and that it was kind of computerized. If a person doesn't pay a bill at a certain time, they get this letter and then to the next step, but they advised me that under government regulation or policy they could not just eliminate or forgive a non-paid ambulance fee. So could you, minister, tell the House if that's correct - is there an avenue for them to forgive an unpaid bill?

MR. MACISAAC: Back to your original question, in 2004-05 the collection was $7.7 million and 2005-06 it's estimated to be $8 million. The sharing that takes place with the department and EHS is above 80 per cent. When they collect above 80 per cent, we do the sharing with them.

[Page 47]

There are two things about the fee and the bill. Number one, there is an appeal process in place. That doesn't seem to be the situation with what the honourable member is referencing. There is, and this is the challenge, you know, in circumstances such as the one identified by yourself. The challenge is to make sure that the managers of the computer generated system are able to get relevant information that will tell them that, you know, put the brakes on, we're dealing with somebody here who's seriously ill and just not in the position to be able to deal with this circumstance at the moment. EHS does have a very lenient payment program with respect to these bills that are outstanding. They do allow people to pay them over a considerable period of time, recognizing the hardship that it does create. The honourable member is correct to point out that there is a policy of non-forgiveness with respect to these bills, but certainly nobody will go without the service of an ambulance regardless of the status of their account.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, definitely I've stated that many times in my career to individuals when they call an ambulance and, you know, it's sad to say that some of the reasons why patients didn't want to come to the hospital, or didn't want to take the ambulance trip to hospital was because of these user fees. It's usually patients who are ill and have severe illnesses that use the system quite often and realize there is quite a large amount of money that is charged to use ambulances in this province.

Unfortunately enough, not everybody has the luxury of having optional coverage when it comes to their work, or if they're even working. In a lot of the cases these individuals who are frequent users of the ambulance service and the health care system can't work because of their illnesses. They find themselves strapped dealing with these user fees and, in the correspondence I had from EMC, they stated, yes, you know, they'll accept $2 a month. I understand that, you know, it could be acceptable to a lot of people, but it really concerned me when they said, you know, but we can't forgive it.

I would hope the minister would look at an avenue of trying to give EMC that ability to analyze the data they have with the user, the patient that they're dealing with, in order for them to possibly forgive that. Could the minister tell us - I know there's been a lot of concern in our caucus about user fees, are you looking at appointing anybody to look at ambulance fees in the province or user fees in the province?

MR. MACISAAC: The ambulance fees are in fact reviewed on an annual basis. I appreciate the concerns being put forward by the honourable member, but it's appropriate for the House to understand that in 2004-05, the average cost per ambulance trip is $816. The amount individuals would pay, for instance, being transferred from the scene to a hospital is $120. There is a tremendous subsidy involved with respect to the provision of that service within the province. That subsidy is paid for by the taxpayers of the province.

[Page 48]

That's not to say that $120 isn't a significant bill for some people. I grant you that it is, but it also needs to be recognized that the service that is being provided is a very expensive service, it's probably the best service that exists in Canada and the honourable member would be quite familiar with it. You don't provide a service like that cheaply, it comes at quite a price - $816, the average cost per trip this year.

There is also some discussion, and I believe a commitment on my part, to have someone of stature have a formal look outside the Department of Health and EHS at ambulance rates. Following the session, I will be putting that process in place.

MR. DAVID WILSON (Sackville-Cobequid): My next question is, are you going to appoint somebody? I understand the costs that are involved in the system we have, we do have a state-of-the-art system and there is a cost involved. What we have to realize is, there has to be an avenue for the people of our province - and there are many of them who are on low income, fixed income or no income - for them to not be affected severely, especially with some of these user fees.

You know, Mr. Chairman, your government has raised user fees quite often over the last several years. When I started in the ambulance service, user fees were $60 so they've more than doubled. I hope you realize how much of an impact that has on some of the residents of the province.

I just have a few more questions and then I'm going to give the remaining 10 minutes or so to my colleague. And she has advised me it's 10 minutes now so I have one more question.

I know you announced the creation of a college for paramedics, I know it's a piece of legislation now. Did you forecast or estimate the revenue that may come with the charge of a professional fee to the paramedics? Have you looked at how much revenue the province is going to take in? Realistically, that's one of the components of creating a college, to self-fund registration and licensing, and paramedics know that's coming. Do you have any numbers on how much revenue will be taken in by the paramedics?

MR. MACISAAC: That question is really a question that will be addressed by the college itself because they will have the authority to set the fees and they will have to set those fees based on their anticipated expenditures. I understand there is money that we currently make available for this process and that money will continue to be made available. We don't know the precise numbers, and that is something the college will have to establish when it's up and running.

MR. CHAIRMAN: Mr. Minister, I would like to inform the member for Sackville-Cobequid that you have eight minutes left in turn.

[Page 49]

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. I know the member for Dartmouth East has a few questions and I apologize for taking up most of her time.

MR. CHAIRMAN: Member, you have approximately seven minutes in turn.

The honourable member for Dartmouth East.

[12:30 p.m.]

MS. JOAN MASSEY: All right, I'm just going to jump right in. I do have a number of questions that I guess will have to wait for another day, and steal some time from one of the other members.

This week I did ask a question in the House regarding self-managed attendant care. There's a constituent that lives in Dartmouth East by the name of Bob Venus who has been very active in pursuing this issue with the government and through myself. As you saw, there were people here in attendance yesterday - disabled persons - that want to take this issue up with the government. I'll just go over a few of the facts as I understand them.

The amount of money set out in this year's budget is around $500,000 which would equate to possibly extending the service of the self-managed attendant's care to maybe 20 people. The problem here is that people that are in their homes are at the beck and call really of these home care attendants who don't get there until 8:00 a.m., and so disabled people who are in their homes and who really would prefer to be out in the community on a daily basis are stuck with these schedules these home care attendants put on them. It's not flexible right now.

MR. CHAIRMAN: I would like to ask for order in the committee. Thank you.

MS. MASSEY: Thank you, Mr. Chairman. Another thing that holds these people down is that when they do try to get out of their homes and they have to schedule an appointment with Access-A-Bus and if something crops up in the meantime, they have to cancel. You have to make these appointments around two weeks before your actual trip, then they are charged a $50 cancellation fee. This is another part of that whole home care issue.

Bob Venus is a person who has a lot to offer the people of Dartmouth East, the people of Dartmouth, the people of Nova Scotia, and he is an example of somebody that wants to have more flexibility in his life. He wants to contribute to society and the community that he lives in. We have the Office of Health Promotion that every time you listen to them, they're always talking about getting out in your community, let's design trail systems that people can move around in their communities. But, what's happening is the department is not making this possible for people like Bob Venus.

[Page 50]

Yesterday I did notice in the newspaper the honourable Minister of Health made some statements to the fact that he was examining types of continuing care and perhaps many other people could use self-managed type of attendants, but there would be a cost involved.

I guess I'm going to lead up to my question now, if he's looking at examining these types of continuing care, and the pilot project for the self-managed attendant care has been underway since 1994 - which to my calculations has been 11 years - how long will it take this department to collect that information? That's my question.

MR. MACISAAC: The honourable member is correct, it is 11 years. The information that we are collecting is not related to the analysis of the operation of that program over 11 years, but rather it relates to the range of self care, of home care options, whether it be self care or home care provided by others, the analysis of the range of options that we should be attempting to provide within the province. So that is the reference that I made when quoted in the press, it was related to that analysis that is taking place as a result of the province-wide consultations.

The honourable member does point out that $500,000 does provide this opportunity to a limited number of people. We will take some time to put in place appropriate guidelines surrounding this and it's not going to take a long time, but it will take some time to put those guidelines in place, so that when the program is up and running, it will probably accommodate more than the number of people identified by the honourable member and that, of course, implies that there would have to be additional funds provided for this program in a future year, in order to accommodate the number of people who would get involved in the take-up of the program this year.

So there are two things and one is the fact that as the program rolls out and gets fully implemented, we will need to look at the number of people who are being provided the service this year and ensure that they're cared for into the future. The second thing that will influence our decision making will be the consultation that is taking place on a province-wide basis and allowing us to understand the nature of what's needed to be provided. I understand I'm cutting into the honourable member's desire to ask another question so I'll yield the floor.

MR. CHAIRMAN: The member for Dartmouth East has approximately 30 seconds which is entitled to your caucus. If you would like to finish up with one quick closing comment, then I'm going to recognize the Liberal caucus.

MS. MASSEY: I thank the honourable minister for his comments and I guess we'll just have to look forward to more money in the future.

[Page 51]

MR. CHAIRMAN: Honourable member, your time is 12:38 p.m., the committee's business will end for the day at 1:18 p.m.

The honourable member for Annapolis.

MR. STEPHEN MCNEIL: Mr. Chairman, first of all, I would like to express appreciation from my office, and from the people of Annapolis to the minister and his staff. When we have contacted your department dealing with issues relating to health, you've been timely in getting back to us, not always with the answer we might like, but I do want to express on behalf of the people of Annapolis our appreciation for that.

One of the interesting things that has happened here has been the self-managed attendant care and, as you're well aware, that's an issue that I brought to this floor regarding a constituent of mine and the passion that I have towards this program. Recently in the budget bulletin there was talk of the $500,000 and there was a mention of a new program. I'm wondering why there is a new program and why we wouldn't be just putting that money into the existing program that has been there now for 11 years?

MR. MACISAAC: Mr. Chairman, I thank the member for asking that question because it provides me an opportunity to clear up any misunderstanding that might exist around that. The program that he references that has been there for 11 years was a pilot and pilot programs come to an end. So this pilot will get incorporated into the new program, so it will be more than a $500,000 program, it will be an approximate $775,000 program because it will incorporate those clients who were served previously under the pilot.

MR. MCNEIL: That program, you know, I recognize it has been a pilot and it has been there for 11 years and has been administered by the Independent Living Society. Who is going to be administering this new program and when will this new program come into effect?

MR. MACISAAC: The program will be administered by the Department of Health and we hope to have that rolled out as quickly as possible. As I indicated before, it's not something that we anticipate taking a long period of time to be able to do, but part of the resources will be combined of the approximate $275,000 that is currently being spent and the $500,000 new money.

MR. MCNEIL: In the budget bulletin, as I mentioned, you talk about the new program, that it was for seniors and people with disabilities. Your director of continuing care has since said that there was an error in that and that the new program does not include seniors, it's directed toward people with disabilities. Could you clear that up for us? Is that correct?

[Page 52]

MR. MACISAAC: Mr. Chairman, really perhaps the better description of the program should have been that we will care for people requiring that service regardless of age, you know, the people in need of the service will be the main criteria that would be applied.

MR. MCNEIL: I know presently there are nine people still left in the pilot project, originally there were 10. Can the minister give me any indication of how many new people will be brought into the program under this $500,000, and whether or not this program will be offered province-wide beginning immediately, or is it just going to be something focused on metro?

MR. MACISAAC: Mr. Chairman, it will be a province-wide offering and the number of additional clients we anticipate will be in the vicinity of 20. It depends on, you know, when we're able to get it fully operational and it depends also on the services required by clients, that will vary and that might impact the number slightly one way or the other.

MR. MCNEIL: Given the fact that the home care budget last year was underspent and considering that the Independent Living Society was looking for $1.8 million, I believe it was, to implement this program across the province fully and to get geared up for this year, I'm wondering why we've chosen the $500,000 - and not taken the organization that has actually been shepherding this project for the last 11 years, and providing an invaluable service to people with disabilities - why we didn't take their lead and push this program forward?

MR. MACISAAC: Mr. Chairman, I think what we need to keep in mind, with respect to the home care services, is that if we had the human resources to provide that service, then that money would have been completely spent and we want to strive to provide as much of that service as possible, and we're moving in that direction. So the transference of the money is not occurring. The money that we have committed to the program this year is a beginning and, as I referenced earlier, one of the things we're involved in is the province-wide consultation relative to the whole question of continuing care. An important element of that, indeed perhaps the most important element in terms of the long-term use of resources within the province, is our capacity to be able to have people remain in their homes longer. As a result of that initiative and that examination, we may very well get recommendations that will cause us to look at this program in an enhanced manner in the future, following that report. We very much view this as an initial step but did not want to predict what would be forthcoming from the province-wide analysis that is taking place, the consultation.

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[12:45 p.m.]

MR. MCNEIL: For clarification, I didn't quite hear what you said when you said why your home care budget was underspent.

MR. MACISAAC: It relates to the availability of personnel to be able to deliver the service.

MR. MCNEIL: I think that leads into why this program is so valuable. Presently there are people who are providing their own care, they're hiring their own personnel. What we are asking for is that people who are currently receiving home care services from the province to be moved out and have decisions made by themselves and they'll do the hiring of the personnel. That would also take the pressure off the system, not only resource pressure, but on the personnel issue that you're talking about. It goes back to when the independent living study asked for that $1.8 million, why that wouldn't have come forward. Some of that money could have come out of what you spent last year because you were spending it on those clients that they will be looking after.

If it's a personnel issue, you remove that responsibility from your back onto the client, the person who is hiring. It self-monitors. If you have a client who is continually requiring the acute care system, you quickly begin to learn they are not receiving the proper care; you can step in at that point. This all leads to this program being implemented immediately. I would like some thoughts around that and clarification from you.

MR. MACISAAC: The honourable member has done a very effective job of advocating on behalf of this particular program and he has been very persuasive in the arguments he has presented. The decision that has been taken this year with respect to the initial investment of $500,000 is a decision that is viewed, not as a final amount of money that would be invested in this program, but we will do - as I indicated earlier - a complete evaluation of our needs. We're looking at, for instance, a number of people who are currently in long-term care facilities to see whether a home care setting, a self-directed care program might not be a better option for them. We do not want to take the decision to commit the funds to that, until such time as we have done the analysis that we feel is necessary. I don't anticipate that analysis taking that much longer to complete, so as we bring forward a budget next year, I'm sure the honourable member is going to see the numbers being different, and the number of clients being served as being quite different, compared to what it is now.

MR. MCNEIL: One more question on this issue. The nine who are presently in the program, will they be moved into the Department of Health?

MR. MACISAAC: The answer is yes.

[Page 54]

MR. MCNEIL: One of the highlights, one of the successes in my constituency is the Annapolis Community Health Centre. I think, quite frankly, it should be held up as a model for the province. As you are well aware they are now doing a collaborative practice, which the hospital is in the process of developing, where there will be a nurse practitioner, dietitian, four or five physicians will be moving into the facility. They will be working on a salary basis, the new structure. I'm wondering, is that the model that we're going to be seeing across Nova Scotia? Will we begin to see those developed in other parts of Nova Scotia?

It is one that is being received very well in the community and it's a true testament, quite frankly, to the physicians, the nurses, and the people of the Annapolis Community Health Centre that this has gone off so well, so I would like to hear your thoughts on that.

MR. MACISAAC: I thank the honourable member for his comments about the new facility and the program being offered in Annapolis, it's certainly one the Department of Health is very excited about and we were very pleased to be able to work with the district health authority in accommodating the financing of that facility, because it did require a little bit of imagination, changes and regulations, in order to allow that to happen. We did expedite that happening because we felt that this model was one that deserved to be implemented and evaluated. It is one of a number of models that are being implemented across the province. We are looking forward to the investment that is currently taking place in Liverpool with respect to the Queens facility that will be operating and we're anxious to see the best practices that emerge.

What is important about all of these models is that they are models that have come from the community and as a result of that community input, what fits for Annapolis may not be precisely what would fit for another part of the province. So it's appropriate for there to be flexibility relative to these models but some core elements, of course, are an important part of it. The fact that you have various health care professionals gathered and there's a collaborative practice taking place, and that you have numbers of physicians being able to provide these services, then it creates an environment where health care professionals are not put in a situation where they're being overworked because they are receiving alternative funding programs, then there is time for them to spend more time with their patients.

When it is appropriate that only a nurse is required in order to be able to serve the needs of that patient, then the nurse is employed to be able to do that, freeing up physician time for other things. To go back to a phrase I used earlier in the estimates today, these are models that allow our professionals to work at the highest skill level that they have in order to be able to provide the health care service to individuals.

I appreciate the comments of the honourable member, this indeed is a very exciting model with respect to the delivery of health care and we have more that are being developed in the province. As we move in that direction we will start to make real progress with respect to primary health care in the province.

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MR. MCNEIL: I appreciate those comments. I think one of the reasons that the health centre has been so successful is the fact of the community involvement and community input and them taking ownership of it, really. With all the changes that have taken place in health care throughout the western part of the Valley, quite frankly, that's why I'm standing here, they as a community have adapted and accepted some of those changes and said, how can we do the best with what's still here.

One of the other things in my constituency is I also have Soldiers' Memorial Hospital. When you look at the district health authority and the Department of Health, there seems to be a vision for a regional facility. You ask anyone, what do you envision for a regional facility and they can tell you. You ask them to describe a community health care centre and they can do that for you. It's when you get to a small community hospital where the problems start.

No one seems to be able to give you a good description of what they envision a small community hospital would look like, what services are provided, how many doctors would be there, all those kinds of things. That has created quite a bit of anxiety in the east end of my constituency around Soldiers' hospital, with some concern. I'm wondering, does your department have any contact with the Annapolis Valley Health Authority on Soldiers, but also on a vision for a small community hospital?

MR. MACISAAC: I think the honourable member appropriately identifies a situation where a facility has been impacted by changes in the way we deliver health care and the traditional view of a "hospital" is something that communities have considerable difficulty in accepting. Traditionally, we have tended to think of health care as being measured by the numbers of beds. Increasingly, as the honourable member pointed out when he made reference to the primary health care initiative in Annapolis, that is no longer an apt measure of the health care that is being delivered in communities.

When you look at a facility that has previously been operated as a traditional hospital, in an historic sense of a hospital, and as that facility sort of changes, in terms of being an integral part of the delivery of health care services within a community, then there are certain challenges. First of all, there are challenges with respect to the decision makers who are attempting to look at that facility and find the most efficient use of it, relative to the whole district, and, of course, the challenge of the community being able to understand what's happening to their traditional asset, and for the community to be comfortable with the fact that the way that facility is being used is appropriate to the needs of the community, and that is a real challenge.

I can tell the honourable member in that facility, the current belief is emergency services will be provided there; there will be in-patient beds and diagnostic services and there will be an addictions unit for the district. Those have been identified to date. There are some other potential services that are being examined, I'm reluctant to be specific because if they

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don't develop then somebody might suggest that I had promised that they would be provided. I don't want to put myself in that situation. I provided a list but that's not necessarily a complete list, I'll put it that way.

MR. MCNEIL: I would never hold you to anything that you say in here. I've been here long enough to realize that everything out of here is not actual, factual. Well, actually, this is a much better setting than Question Period, I'm actually getting answers today. In Question Period if you get an answer it's a surprise.

One of the issues you mentioned was around the emergency and outpatients in Soldiers and it has actually been closed once or twice this past year, and part of that is around physicians. It's a major issue not only in my constituency but around Nova Scotia. The age of physicians who use Soldiers' Memorial Hospital is getting up there, they're wanting to slow their practice down a bit, they're getting to that stage of their career. I want to know from your department - and I'll speak specifically of Annapolis, I know you can't talk directly to that - what you are doing for physician recruitment in rural parts of this province?

MR. MACISAAC: That is an ongoing challenge. We certainly have made progress in the Cumberland area with respect to the recruitment of physicians and specialists in that area. As you make progress, you get a few wins and then there are a couple of losses and the situation changes. We are working very actively with the district health authorities in order to provide them with the best service we can, with respect to enhancing their capacity to recruit physicians and rural Nova Scotia is an important part of that.

As I indicated previously, we're adding to the supply of doctors that will be available to Nova Scotia through the additional seats of the medical school. Our challenge will be to make sure we get as many of those as we can to practice here in Nova Scotia.

[1:00 p.m.]

I can say at this stage that at a future date I will be involved with groups in the province who are making a major effort to bring into practice foreign-trained doctors for the province. Out of respect for the people I am working with, I'm not going to say more about that at this juncture. That will be a significant part of the solution. It is a continuous challenge and as long as we're in the situation where we are dealing with a shortage of physicians on the North American market, we're going to have to scramble and work very hard to make sure we get our share of those and that when get them that we keep them here.

That is one of the reasons why we've decided to invest the money we did in the new MRIs around rural parts of the province, to ensure that when we recruit we are able to say to new graduates, in particular, but those who have trained recently, that they will be able to operate with equipment that they have trained on, and that's very important. You are not going to ask somebody who is trained at farming with a tractor to go and get the same

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satisfaction out of farming as they might with a team of horses and some old rusty machinery. You want the best equipment that they have and what they have gotten used to.

We continue to have debt repayment for new graduates and perhaps the most effective tool that we have - and you made reference to it earlier - is the AFP, it is a very effective recruitment tool and is proving to be very helpful whenever we are able to employ it around the province.

MR. MCNEIL: The provincial recruiter that you have in place now, it has been interesting - I'll just speak of my own constituency - I find it extremely hard to actually be able to pin down a doctor who he would have had any input into whatsoever. The successes we seem to have in the Valley - I'll speak of the Valley but in my constituency - in retaining doctors is because they have been recruited by the community, or the district has taken over a good portion of that. I know in the Valley we have our recruiter and unless I completely misunderstand the role of the provincial recruiter, that the successes we seem to be having are without him. So I wonder why we have that position - and this is strictly my own view - in my community when the district health authority or the community hospital seems to do a better job of recruiting and retaining doctors? As part of that, you mentioned about the new seats at Dalhousie. How many of those are specific for Nova Scotia students?

MR. MACISAAC: With respect to the number of seats at Dalhousie, I'll take that on notice, because there is a specific number that are available to other provinces. I would want to have the precise number and I'll take that on notice and get that for you.

When the honourable member mentions the success of the local community, with respect to recruitment, he really puts his finger on the essence of recruitment, that in the final analysis, it is the local community that is going to succeed in attracting personnel to their communities. The provincial recruitment facilities and resources that are available, are available to provide information whenever possible, to both the communities or individuals who are interested in coming to the province, they operate in the milieu. I hope, as much as possible, the communities find that they are able to supplement their efforts. I certainly get comments from various communities to that effect from time to time but I can tell you that the areas of the province that are experiencing success with respect to recruitment are areas where there is very active community involvement related to recruitment. That is borne out in the successes that have taken place in various parts of the province, that the local input is extremely essential for there to be success.

MR. MCNEIL: I would like you just to expand a little bit on the provincial recruiter and the role that he's playing, if any?

MR. MACISAAC: The provincial recruiter very much operates as a facilitator with the district health authorities. They will identify needs to the recruiter, the recruitment office will do its utmost to identify prospective professionals who might want to go to the area and

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try to provide the match, whenever possible. There isn't a precise science to all of this, it's really a matter of sharing knowledge, gathering knowledge, bringing it all together, and doing the best that can be done with respect to knowledge. It is all about identifying who might be available, who might be interested, and making sure the contacts occur so that the local community gets an opportunity to sell what they have to offer as a good place to live and practice one's profession.

MR. MCNEIL: I would send this caution out, and that is I believe there are communities who hear the term "provincial recruiter" and they believe someone else is out there looking for a doctor for them, when that's actually not the fact. I think that message needs to be spread around that perhaps the provincial recruiter is formulating resumes, ideas, contacts you can look at, but communities should not be standing by thinking that they're going to be sent a doctor by the provincial recruiter. I think that's something that needs to be put on the record and spread out across the province. There are communities - and I have some of them - who did that for awhile, believing that their answer to a doctor shortage is going to be looked after by the provincial recruiter, which couldn't have been further from what was happening.

I would like to shift gears a little bit to long-term care beds. As you alluded to the other day, there are some being set for Halifax and Cape Breton. There have been 32 temporary beds put in place in Berwick, and I stress the word "temporary" because it was told to the Middleton Nursing Home group, when they were looking to build a nursing home that those beds were not permanent, that those beds were temporary. They were told and I was told by the department that those beds were temporary, and if the need was shown somewhere in the Valley that those beds actually could be moved and renovations would take place in the rest of the manor to make up for those 32 beds, then the complement of beds would stay at the old level for the manor and those 32 new beds would be shifted somewhere else, if the need arises.

[1:15 p.m.]

I think the community of Middleton and surrounding area has put their case forward, they have gone out and recognized and proven the need for long-term care beds in Middleton and surrounding area. At the present time, you go from Bridgetown through to Berwick and there's a gap from Kingston, Greenwood, Middleton, and surrounding area that there are no long-term care beds. I'm looking for some direction from you in when that community can have a yes or a no on whether or not their desire for long-term care beds will be addressed?

MR. MACISAAC: I know that this has been a question of concern to the honourable member. I have met with the group that is working very hard to secure long-term care beds for Middleton. I have referenced earlier the consultation that is currently taking place across the province, with respect to the whole issue of continuing care. A very important part of that is looking at long-term care needs. I anticipate receiving an interim report from that

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consultation early in the Fall. Based on that interim report, we can start responding and looking at the areas of the province that we would consider to be priorities, based on the evidence that we will have at that time. Shortly after that, we would hope to be in a position to start identifying those areas where additional long-term care beds should be located.

MR. MCNEIL: I look forward to that report as well. I assume part of that will be assessing existing long-term care beds, where they're at now, what facilities, the modernization of those facilities and perhaps the redistribution of some of those existing beds. I do want to clarify one thing, that those beds that were put in Berwick were temporary?

MR. MACISAAC: The answer is yes.

MR. MCNEIL: Thank you, Mr. Minister, I appreciate that. Yesterday in the budget there was an item, New Restorative Beds, there was $1.65 million for that. I'm going to show my ignorance, what's a restorative bed? Is that similar to a transitional unit that I have at Soldiers' Memorial Hospital?

MR. MACISAAC: The honourable member shouldn't at all be concerned about asking a question such as that, because I spent a few weeks calling them by another name and the department decided that that name was not as appropriate as restorative care was. Perhaps I can try to use a couple of examples that may help the honourable member.

Very often patients will come to a hospital and receive acute care treatment. A stroke is a good example. You get the acute care treatment, and then once that's over, what's required after that is no longer acute care but rehabilitative care. That is provided by physiotherapists and occupational therapists. It's not appropriate to occupy acute care beds to be able to provide services such as that. With the exception of the rehabilitation process, acute care is not required. It's appropriate to have beds where people receive the rehabilitation services that they need to bring them to the point where you're able to say, it's appropriate for this person to return to their home, fully recovered, we would hope, or return to their home and needs some level of home care in order to be able to carry on with their lives or, worst case scenario, that they would have to go to a long-term care facility in order to be cared for appropriately.

So, rather than these people occupying acute care beds while this rehabilitation is taking place, it's appropriate to have what we call restorative care. The term, restorative, we hope can restore 100 per cent, that's not always possible, but restore to a level where the individual can get to their home or, worst case scenario, to a long-term care facility. It concentrates resources and staff on special skills for the level of care. It's better for the patient. The focus in these facilities is recovery.

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MR. MCNEIL: They're obviously the same as the transitional care beds that are actually at Soldiers' Memorial Hospital presently. You've just renamed them, right? (Interruptions) Do you know where the 50 new beds are going? That will take place in the Fall when you announce that new nursing home for Middleton.

Also in the budget was the assistance for low-income Nova Scotians with diabetes. Part of that, you announced, I think it was $2.5 million. In the election of 2003, there was a commitment of $3.2 million. I'm wondering why we're $700,000 short. When will families be able to start applying for that? And I just want to know what the income threshold will be for that.

MR. MACISAAC: Over the next year, we'll be developing these numbers. They're not available at the moment. The reason the numbers differ from the commitment is that our research tells us there's a lower than anticipated take-up on these services in other jurisdictions.

MR. CHAIRMAN: Time has elapsed today for the estimates. At this time I would like to thank the Minister of Health and the good member for Annapolis.

The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, we will remain in committee, however, I'm asking for a recess for approximately two minutes to await the Red Chamber reporting back, and then we'll report out of committee. Mr. Chairman, we will recess until 1:22 p.m.

MR. CHAIRMAN: The committee is in recess until 1:22 p.m.

[1:18 p.m. The committee recessed.]

[1:26 p.m. The committee reconvened]

MR. CHAIRMAN: Order, please. I would like to call the committee to order.

The honourable member for Kings North.

MR. MARK PARENT: Mr. Chairman, the Subcommittee on Supply reports we have finished our four hours and made excellent progress.

MR. CHAIRMAN: The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, I move that your committee do now rise and report good progress.

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MR. CHAIRMAN: There's a motion on the floor for the committee to rise.

Would all those in favour of the motion please say Aye. Contrary minded, Nay.

The motion is carried.

The committee is adjourned.

[The committee adjourned at 1:27 p.m.]