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HALIFAX, TUESDAY, MARCH 27, 2007

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

2:35 P.M.

CHAIRMAN

Mr. Chuck Porter

MR. CHAIRMAN: The honourable member for Halifax Clayton Park to continue debate. You have about 15 minutes.

MS. DIANA WHALEN: Thank you very much, Mr. Chairman. I have a couple of questions that I would like to start off with, and I imagine I will have to come back, because I don't think 15 minutes is going to do it. We know that the Health Minister will be with us for a number of hours yet. I am sure you will enjoy that.

I wanted to start with some of the financials. I know there are a lot of issues around programs and the delivery of different programs in health care, but I am interested in reading the Budget Bulletin, where it refers to $140 million in extra spending and says that is a 5 per cent increase this year. At the same time, when we were studying the budget, we were given an increase of each of the departments and it shows a 7 per cent increase. I wonder if you could clarify the exact amount that the operating budget has gone up - operating, I assume. I don't know if capital is in that; I think it is an operating budget? This particular one, which is Net Program Expenses, shows it going from $2.76 billion to $2.9 billion, almost $3 billion, that is a 7 per cent increase by my calculations. So I wonder if you could just refer to that.

MR. CHAIRMAN: The honourable Minister of Health.

HON. CHRISTOPHER D'ENTREMONT: Thank you very much, Mr. Chairman. It is good to be back for another four hours of estimates and debate the budget of the Department of Health.

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To the member opposite - the member for Halifax Clayton Park - in regard to the increase, if we look at the total increase in dollar amount for the department, we are looking at a $140 million or $142 million increase, I think, which represents 5 per cent. The issue that we are showing is that 7 per cent increase, if you take out the revenue piece, and the revenue piece actually is held by the Department of Finance, and the Department of Finance would be showing that within their piece. It is accounting rules that we have made some changes to. I would probably ask you to maybe ask a few of those questions to the Minister of Finance when he has his opportunity here as well.

MS. WHALEN: Just as a clarification again. It says this is Net Program Expenses, so if it is net it should already have taken out the additional revenue. Is that not right? It's not the gross expenses, it's netted against something, and I would say it is netted against your revenue. I just want to clarify it, because I am still not clear on it.

MR. D'ENTREMONT: Mr. Chairman, I am trying to get my accountant friend here to explain it a little more to me as well.

Basically, if you look at the increase for this year - which represents the 7 per cent - it is $194.6 million. There are revenue generations within the department, and the department would generate somewhere near $48.6 million of revenue. That is taken out of our number, so it ends up showing the $146 million for our actual increase. That $48.6 million is held for us centrally by the Department of Finance, so that is why we only reference the 5 per cent increase in our total budget.

MS. WHALEN: If I understand the minister correctly, the $48.6 million would not be clear to anybody unless they spoke to the Minister of Finance and found that line item somewhere in his budget, which I think is a little bit confusing. I am glad you clarified, because I used the figure in my reply to the Budget Speech that, in fact, it had gone up 7 per cent, and I think we want to be talking the same language.

The concern we have around the Department of Health is the rapid and dramatic increases year by year. A number of years that I have been here it has been double digit, around 10 per cent, 8 per cent, in that range. So very high increases and definitely higher than the increases we have seen in our economic growth and our revenue growth. So for all of us in the Legislature, that is a concern, and I think it is important that we raise it again here and have that opportunity, as the estimates continue, that we are looking at program delivery and how we can perhaps make more efficiencies and save money. It's important that we do that in the context that we cannot continue this dramatic increase from year to year. I know that the needs are acute and that many people need help. We heard today in Question Period about the wait times for oncology - I don't believe people should have to wait eight weeks for radiation if you have cancer. The deputy minister is here today as well. I do understand the pressure that you're under with that.

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I wanted to speak a little bit, and I won't have time to go very far with this today, Mr. Chairman, I'm not going to have too far to go but I'd like to start on the links between health and economic development and ask the minister about the doctor recruiting in the Yarmouth area. It was my understanding, from a visit to the regional development authority there, that they have jointly gotten together - and it actually covers the minister's riding, as well, so he may be well familiar with this - that the regional development authority has stepped in to help in the recruitment of doctors and, in fact, has helped to see that a clinic would be built and ready to go. Basically a turnkey operation, where all you would need is have a doctor walk through the door. I believe that is very forward-thinking. It is going outside the box and actually connecting the dots, which are that you cannot have economic development in an area without the social and the necessary health infrastructure. That is something I thought was a very good move on their part, and something we should celebrate. I wonder if you could tell me a little bit about it?

MR. D'ENTREMONT: Mr. Chairman, thank you again to the member for Halifax Clayton Park for that question and, of course, for some of those statements, as well. Just to sort of start off where we were when we talked about the increases in the health care budget where we were talking about average increases over the last number of years anywhere from 8 per cent to 9 per cent, you know, from the last year, this would be one of the first years, as we completed 2005-06, where DHA budgets came within 1/20th of one per cent on budget, which is the closest ever I think DHAs have come to completely balancing since regionalization was changed into districts. We have caught up, and have a good feeling of what our budgeting process is. This year, it looks like we are performing very well in coming into budget again. The forecast for the Department of Health, for one of the very first times in a very long, is on budget as well.

The member also talked about the work being done in the Yarmouth County area in regard to doctor recruitment and working with a committee. The committee is made up of, of course, the regional development authority, the South West Shore Development Authority, with members of the local council. So the Town of Yarmouth, the Municipality of Yarmouth, and the Municipality of Argyle - they are working toward recruiting physicians. They are actually taking some of their dollars and investing it in locating, going to different shows where we recruit our physicians, and also offering a fair incentive to attract doctors to Yarmouth and surrounding areas.

I think really the success in this one is that you have your municipalities and your economic development - which is not just economic development but community development. I think we really need to focus in on there, to look at our rural areas, but also physicians and some of the people from our hospital are actually on that committee as well.

So you are using a whole bunch of - I am thinking french again - résultats. You are actually working with your contacts, and it has actually shown us a fair amount of success. If you look at District 2 - which is the southwest - there have been three family practitioners recruited and there have been two specialists recruited. Then the CAPP for physicians, which

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is being run out of the Yarmouth site, has been doing - I think there are four or five going through the program and two of them have actually stayed in the area. That really is not even speaking to the proposed clinic that is being proposed for the south end of Yarmouth, converting the old liquor store into a clinic, and basically trying to build a clinic where there is a little more free flow of patients, building in a walk-in section of that, and trying to bring in the rest of those people in southwestern Nova Scotia who don't have a family physician today. So they are working on a whole bunch of levels in order to make this one work.

[2:45 p.m.]

MS. WHALEN: Could you tell me how much time I have left?

MR. CHAIRMAN: About five minutes

MS. WHALEN: I wanted to know from the Minister of Health if he has been in any way involved in the issue around the proposed tire burning in the area of Brookfield, only because there are a lot of health concerns that the individuals in that debate have had. I know it's an Economic Development debate, or perhaps the Department of Environment debate, but what we need to think of - and I'm sure the government is looking is this way, I'm sure they're making these connections - that it is multi-departmental, really, and the health concerns are based on air quality. I think perhaps the Department of Health should be part of that debate.

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and to the member opposite, it is an issue that I am aware of and one that as a Cabinet member, I am aware of. Ultimately at this point, you know, my concerns have been brought forward. It is under the purview of the Minister of Environment and Labour and, as well, I believe a little bit of work and input from the Department of Health Promotion and Protection, from the public standpoint. At this point, as we know from the questions in this House and other ones, there is no industrial permit at this point to burn tires at the Brookfield site and I will let the process follow itself with the Department of Environment and Labour.

MS. WHALEN: Thank you for that answer, I appreciate it. I wondered if you could tell me how many Nova Scotians do not have a physician, have not got a primary care physician. It follows from the Yarmouth example, I understood last year there were 10,000 in Yarmouth, but they've made some real headway, as you mentioned, with the number of new physicians coming into that area. Do we have figures on how many people just don't have an available physician?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and to the member for Halifax Clayton Park. We have actually the highest ratio of physicians to population in Canada. At this point from our estimates - and I mean you can't always estimate who doesn't have a physician, there's really no system to collect that data - but from what we can understand at this point, we're short about 24 family practitioners and we're short about 30

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specialists. So what that exactly rolls into how many patients or how many Nova Scotians don't have a physician - I don't know how the calculation can be done, but I know there's still a fair amount of people who do not have service, but we are making some good inroads on that.

MS. WHALEN: Mr. Chairman, I am surprised that the minister and the deputy minister don't have figures on the number of Nova Scotians who are not served by a doctor because that's a very critical element to the cost of delivery health care. When you don't have a family physician, that's when you end up going directly to emergency rooms if anything should happen to you or your family. We know that the emergency room stress is where a lot of the costs are coming from. The waits are unreasonable in an emergency room, especially for the elderly who go there or for children who are lined up, but if you have a doctor or you have community health care, then that would obviously be your first point of contact and you wouldn't be lining up in emergency rooms. So I wonder if the minister could let us know if there is a method or a means to capture this information, because I think it is something you should be tracking.

MR. D'ENTREMONT: Mr. Chairman, we do have a vacancy of physicians in the province. The problem we have now is that the model is changing all at the same time where one physician is not replacing another physician. So we don't know exactly what the complement is of physicians. My example yesterday for the member for Clare, where their physician is actually quite sick at this point so a lot of people are worrying, he used to see about 6,000 patients. It would take probably two or two and a half new physicians in order to cover that same cover. So to make the calculation down, you know, I think one physician would see about 3,000, or somewhere near 2,000 and 3,000 patients, so we can just work our numbers up from the 24 family practitioners missing and the special vacancies of 30, and we could work that one back.

MR. CHAIRMAN: Order, please. The time has expired for the honourable member's questioning.

The honourable member for Sackville-Cobequid.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman, and welcome back, deputy minister and staff and the minister, to Health Estimates. Yesterday when I was questioning the minister, I was revolving around the physician recruitment and retention and emergency room closures. So I would like to start off this afternoon with that area.

One of the things that we've come forward with in supporting is the initiative around our medical students and the need to ensure that the medical students, especially at Dalhousie, remain here in the province.

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I know that Memorial University in Newfoundland and Labrador does a great job of retaining a lot of their residents who go through medical school to stay in practice in Newfoundland and Labrador. The majority of Newfoundland and Labrador is a rural province. What they do is they have a portion of the education, or their program, that offers students and residents within the medical school rural visits or rural practicums so that they can get out to the rural areas and look at what rural life is, what it has to offer, maybe entice them and encourage them to return to rural communities.

I know that in Dalhousie Medical School, currently, there is no, I don't believe - and maybe the minister or the deputy could inform the minister on a program that would encourage, or part of their program that would encourage medical students here in our province to have those rural visits or their rural practicum aspect of their medical training here at the medical school at Dalhousie.

MR. D'ENTREMONT: There are a number of things going on at the same time when it comes to the retention of physicians, especially if we are talking about the new physicians who are graduating from Dalhousie, also working with those physicians who have had to go other places in order to receive their training and trying to find ways to entice them back.

At this point, there is a proposal going on at Saint John for Dalhousie to provide a medical school in Saint John. What that would see is that over the next year or two years, you would see some of those people who are being trained in Halifax moving back to Saint John. It would open up about 10 seats here in Halifax so that, in my estimation, 10 more Nova Scotians would be able to receive training at the local school. I know there have been some discussions about loan repayments and those types of things through the Department of Education and we will continue to provide that.

The other thing that we really need to continue to look at is that we do provide those residency seats for those graduates and we are actually going to start looking at those people who are getting trained outside - that we give them a number of residency seats as well so they can actually come back home, get their residencies and hopefully keep them here to practice. But we still have to continue our discussion on return for service where I would think we put some money into a program where a physician who gets trained here, and we will help them with their training here, he or she can give us a five-year plan and of course at the end hope that they fall in love with the community or somebody else and get married and spend some time here. Ultimately, a lot of these things take time to set up and we are in discussions right now with Dalhousie University and those 10 spare positions as they develop that program in Saint John.

MR. DAVID WILSON (Sackville-Cobequid): As the minister's answer comes in, I have a bunch more questions. So hopefully I will be able to get to all that I remember. I think it is imperative that the minister and his department recognize the importance of what the minister was stating around an agreement of service here in the province, because we don't have to look far.

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We go down the road here to the military. Recently in the papers - I don't know if the minister read about the success rate of the military on their initiative of attracting physicians to go into medical school but to give, I believe it is a five-year service, to the Canadian military, and they have been very successful in increasing the number of physicians who are taking them up on that option and I think our province needs to do that. I think it would be an important step to try to keep doctors here in Nova Scotia. Exactly what the minister said, we need to ensure that they start putting roots down in this province if they are not from here. They may meet somebody, get married, have children so that they enjoy the way of life here in the province, because we can't compete with Ontario and Alberta and the States when it comes to the large incentives, especially cash incentives, that they offer medical students with residencies or those students ready to complete their studies at medical school. I think it's important that the government recognize that is something we need to jump on. I think it will pay off dearly in the end. I know there is a cost but I think in return that some of our physicians will stay here and practice, especially in rural communities.

Ironically, and maybe the minister knows this - I know it is a bit off the topic, he might not have the information but he might - on the number of Nova Scotia residents who go to medical school here at Dalhousie. Would you have the number of Nova Scotians who attend? Maybe I'll see if you have that answer to that question.

MR. D'ENTREMONT: Thank you very much. I'm not too sure on what the breakdown is of the students right now at the Dalhousie school. What I'll do is endeavour to have those to you either today or tomorrow or Thursday during our estimates debate. As I said, there are a couple of things going on and some negotiations that have been ongoing with Dalhousie University with respect to the physicians who are there today, as well as those 10 physicians who will be coming available to Nova Scotia students as they develop that program in Saint John.

The other thing that I think is looking very promising as well is that we also fund, or share the funding with three seats at Sherbrooke University for French medical school for those Acadians and Francophones who are interested in pursuing their education in the French language. There is also a proposal right now in New Brunswick for the development of a program at Moncton and we are actually in negotiations with them as well to see if we can secure a few seats there as well.

So the issue of Francophone or Acadian doctors - we've had some really good retention rates with those folks where they are coming from our rural communities and Francophone communities, that they do want to go back and serve those communities which brought them up.

Also, before I sit down, I do want to table the information that was requested yesterday. I believe the - I can't remember if it was the member for Sackville-Cobequid or the member for Glace Bay who had asked about health profession legislation that has not been proclaimed yet. We have been waiting for regulations and stuff, so I just wanted to table

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that, some information around the Dispensing Opticians' Act, the Licensed Practical Nurses Act, Massage Therapy Act and the Registered Nurses Act, so I just wanted to table that for the information of this House.

MR. DAVID WILSON (Sackville-Cobequid): I appreciate and look forward to the information the minister will try to provide because I think it is important not only for me and our caucus but for the minister, for his staff, to be aware of what the stats are and ironically getting ready for estimates, it was easier for me to get some stats from Memorial University in the faculty of medicine than it was to get our own information. For example, 40 per cent of the population of students enroled in the faculty of medicine at Memorial University come from rural areas of Newfoundland.

That brings me to my next question - why don't we have designated seats in our medical school for rural students? I think that is another area where we can try to capture those individuals, like Dr. Petrie, I believe, who just made an announcement recently who is going to return to the Valley, I believe, after residency. I mean that is a prime example of hopefully, we can entice some of those rural residents, especially the young residents, to attend medical school and then hopefully return to rural areas of this province. So I'll ask the minister that, why don't we have rural designated seats in our medical school here in the Province of Nova Scotia?

MR. D'ENTREMONT: Thank you, Mr. Chairman. This has been, I think, a basic ongoing discussion with Dalhousie University. I do want to thank during these estimates the work of that school and, of course, of its Dean Harold Cook, who does a phenomenal job in making sure that we have probably one of the best schools in North America. But, at the same time, a lot of their admission policies we feel have been excluding some Nova Scotians who we feel should be going to medical school who are from rural areas but they have a very open policy where, through test scoring, that they admit, of course, those students who rate the highest.

So there has always been a bit of a discussion on actual designated seats. Even though I mention those 10 seats of New Brunswick, at this point, it has not been necessarily a written rule or a written policy of the admission policy that New Brunswick students would have these seats. It has just thankfully worked out that way for them, that they have been able to have those seats and actually have them funded by the Government of New Brunswick. So as we roll around, I would really like to continue making negotiations with Dalhousie and really be the crux of our negotiations with those 10 seats that are going to be coming available. We would want to put some conditions around those 10 seats to ensure that they are Nova Scotians and, in my estimation, Nova Scotians from maybe some more rural settings.

I don't know exactly how you would do that to make sure that you're not really impeding on somebody else's right for those seats, but ultimately we would feel it very important to get those Nova Scotians from rural areas, or from Nova Scotia, who have an

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attachment here. It is our summation, just like Dr. Petrie made the decision to provide medical oncology to Kentville, that this would follow through with other physicians as they graduate from that program.

MR. DAVID WILSON (Sackville-Cobequid): I know, Mr. Minister, through the Chairman, I've written many letters to the minister over the last year and a half and especially over the last several months. One of the replies I received, and it was concerning retention and recruitment of physicians especially in rural communities, in the response in one of the letters you sent back to me, I believe in February of this year, was around the current master agreement with the physicians and that it expires in four days, I believe. So I'm wondering if that has been settled and that there's either an extension or is there a new agreement signed here in the province around the master agreement with the classification of emergency room physicians and the parameters that they work in?

MR. D'ENTREMONT: Mr. Chairman, I just wanted to maybe quickly talk about the master agreement, of course, with physicians. I believe, and the deputy is just checking that out as well, that that agreement comes due, I believe, next April. I think what we've talked about is that we're preparing now in discussions with Doctors Nova Scotia on what the new master agreement is going to look like.

I think over the last year or year and a half or two years, we've been working quite diligently with different units through our health care system - whether they be anesthesiologists, whether they be different professionals - designing academic funding plans where there's a sharing and a recognition of the work that they do in research and in training, as well as the services they provide to patients. There has also been sort of a reiteration of that programming as well where we have what's called an alternate funding plan where the physician basically foregoes the issue of fee for service but is duly compensated through this funding plan where that funding plan is built on what they feel will be the people they will see, other services that they provide, looking at the overheads of what their practice would cost them plus a bonus for other works that we would feel are necessary in the region that that physician serves.

The information that we have here is that another $22 million is being spent on doctors in the province, so that would be the redoing of some of the AFPs and APPs and as well it is preparing for our renegotiation of the master agreement with those physicians.

MR. DAVID WILSON (Sackville-Cobequid): Just to go back to that, I think the minister just said that the agreement you believe is next year, but in your letter that you sent back, in here it says, and I quote, "The current master agreement, which expires March 31, 2007" and then you go on just to say that you are working with Doctors Nova Scotia to hopefully look at the classification and parameters. It was around funding, especially around Cumberland County hospitals and the physicians and some of their issues on that. So maybe just for clarification, you know, is the current master agreement expiring this year at the end of this month or is it next year?

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MR. D'ENTREMONT: Mr. Chairman, what we will do is just confirm the date with staff, make sure we have the right one. I know the deputy feels that it is probably not until 2008. I know the document that maybe you have there talks about 2007. We do have a number of AFPs that are coming due the end of this month but I don't know if the master agreement is or not. I will provide that information for you.

Sort of on the broader issue, we have a lot of physicians providing some wonderful services in many areas of this province but we still continue to see ER closures and those kinds of things. Really what we need to do, through discussions with Doctors Nova Scotia is looking at the other services that we might be able to have provided by physicians and other pieces of work, whether it be in-patient work at a hospital, whether it be maybe some emergency coverage on an occasionnal basis and those kind of things. That really has to be a big part of the next negotiation of the master agreement.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, minister. I appreciate you trying to get that information.

Now I would like to go in the area of cancer care and I know that the Leader of the Opposition, in his questioning, asked some questions around the colorectal screening program. I'm not going to spend a lot of time on that, even though I think it's vital, it's important and it was a choice and a commitment from your government prior to the last election. Ironically, today, I received word that the Province of Alberta, on March 23^rd just announced that they will have a province-wide colorectral screening program. They know - and I know the minister, and I hope he knows and his department knows the importance of it and the great potential, I think, on catching those individuals who might have prostate cancer and treating them early and being successful.

As my colleague said earlier, I think it is 90 per cent of those with colon cancer are curable. So it is a huge savings on our health care budget and on health care spending in this province. I know the minister - and he will probably say it again, that they are putting forward $300,000 but when you made that commitment and you were Minister of Health prior to the last election, when you made that commitment, was it your intention to try to implement a province-wide screening program as quickly as you could? Or, when did you realize you couldn't follow through on that commitment and that promise to provide that program here in the province?

MR. D'ENTREMONT: Mr. Chairman, just to follow up on the information, the previous question in regard to the expiry of the master agreement with physicians, that will expire on March 31, 2008, which we are preparing for that one. So I need to correct my letters. Bring it over here and I will cross it off and maybe initial it to be sure. But there are a number of AFPs coming due at the end of this month and we have to continue to negotiate.

If we go to the colorectal screening program, you know back in the Spring we asked Cancer Care Nova Scotia to develop some recommendations on what a population-based

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colorectal screening program would look like. That report was available to us somewhere near the end of November into December where we have had a few months to look at those recommendations, come up with a few ideas on how we want to go forward with this program. I am very happy that we have been able to fund it in budget 2007-08.

There is still a lot of work to be done to ensure that we have the right program and have it available to Nova Scotians as soon as possible. I wish there was a way to develop programs to take programs and turn them on the next day you announce them but the reality is that we don't have necessarily all the capacity that is required in the province today. We don't have exactly all the specialists that are required. So at the same time we are developing a screening program, we also have to develop the components in it to treat those individuals who will be unlucky enough to be diagnosed with cancer, but I can also say that we've been doing a lot of other things at the same time when it comes to cancer care in this province. You know, the recent announcement of the expansion of the medical oncology satellite clinics in the province; the addition of one at the Kentville Hospital; the announcement yesterday of more funding for radiation oncology; and now the announcement of the colorectal screening program - we are doing a lot of things that all tie together into cancer care in Nova Scotia.

The colorectal screening program - as I responded to the Leader of the Opposition's question yesterday - we need to have the pieces in place. We need to have the human resources available because, of course, we're criticized on that every day as well. So I don't want to set up a program that we're not ready for and I think it's going to take the better part of this year and the investment of $300,000, to get that program up and running and being able to see patients as soon as possible.

MR. DAVID WILSON (Sackville-Cobequid): So, going from colorectal colon cancer to breast cancer and some questions around that, I know that Theresa Folley is the manager of the Nova Scotia Breast Screening Program. She sent out a news release back in the beginning of the year, January 9^th of this year, and I'll quote her here, she says: "We're a victim of our own success." I would have to agree because there has been a lot of education, a lot of awareness around breast cancer and the need for screening and for women in Nova Scotia to have mammograms and go through that process. Nova Scotians understand that and have done that.

So one of the things - the implications with the knowledge of our educating Nova Scotians on hopefully screening and obtaining these tests - is that the wait times for mammograms are growing every day here in this province. I believe, on the Web site for Capital Health, it's nearly 300 days for a mammogram to be done once it's requested here in Capital Health and that's not only just in Halifax.

On the Web site - which I checked, I believe it was yesterday or the day before - it was 280 days in Capital Health, it was 300 maybe a month ago. Bridgewater is a little less but it's still well over 100 days. So in the news release from Theresa Folley, she had

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indicated on the bottom that a new, full-field, digital mammography machine is expected to be located at the new Cobequid Community Health Centre this Spring. It said it should help reduce the wait times for these tests. So I would just ask the minister if that's correct and can you give a timeline on when that piece of device will be located and up and running at the Cobequid Community Health Centre.

MR. D'ENTREMONT: Mr. Chairman, I'm very glad that the member opposite - the member for Sackville-Cobequid - has brought this issue forward. There are a couple of things that we're doing for mammography in this province. One is setting up a site in Antigonish, I think is just ongoing at this point, so people in the Antigonish area can be served closer to home and that will, of course, take burden off the nearest mammography unit which I think is in New Glasgow. So that will take a little bit of load off the systems around it.

The other thing that's going on, and the member is quite right, is the digital mammography issue. We are purchasing two digital mammography units for the province. One of them will be located, I believe, in the Cobequid Community Health Centre. As far as I understand, at this point, that has been ordered, so we're just waiting for the delivery of the unit. Of course the Cobequid Community Health Centre - being a brand-new centre - has the space available and is ready to go. So all we really have to do is receive the unit, get it set up in the facility where it's designated to go, and then start seeing patients.

[3:15 p.m.]

The other thing about digital mammography, which is a really good step forward on this one, is that there's a lot less time required with the unit, where the patient would come in and get the scan, because it's digitally taken, the radiologist can see those almost immediately so there is no developing time required on this one. Through our new PAC system, a number of different radiologists can now see those and continue to go through them at a quicker pace. So not only are we increasing the scan time, we are also increasing the amount of time required to review those scans by the radiologists. So we will greatly improve the amount of people who can go through that system. What we hope to do, over the next number of years, is continue to invest in digital mammography, get those replacements of those systems in order to better see and better serve. That will see, of course, more patients.

The other issue is that this will also lead to less invasive surgery because, of course, we will be getting it a lot sooner or at least it will be seen a lot sooner. The other issue that is happening, sort of in tandem, all at the same time, is that Nova Scotia has the highest retention rate for females to get this screening done. I forget the number. There is like a 46 per cent of people - 38 per cent of females are receiving this service now, which is of the highest rate anywhere in Canada. So I think it is kudos to the physicians and of course for our population of knowing the importance of getting a mammogram. It also creates a bit of a problem on the other side, making sure that we have the system available to respond to that need.

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MR. DAVID WILSON (Sackville-Cobequid): So I hope I understand the minister's answer - that you are waiting for that piece of equipment to come and that there shouldn't be very much delay in putting that in place. Hopefully by the time we get here in the next session, if the budget passes, that I can maybe stand and say that is going on. I thank you for that.

The other thing is the Cobequid Community Health Centre is a great facility. I know the minister has been there, I know the deputy minister has been there, and many government members. It's a great facility. It services not only the people in Capital Health but it has broad arms on who they see there and it's kind of a great location because it can help address some of the issues from down in the Valley, down near Truro way and play an important role. I think it is important to recognize that facility and the need - possibly in the future - to have many more facilities like the Cobequid Community Health Centre across this province. I think it will bring services to rural communities that they need, in a timely manner, and I think it's a great model.

There have been delays with the Cobequid Centre leading up to the building of the new facility. There has been a lot of talk around the services that are going to be delivered there. One, as I mentioned, was the mammography machine for mammograms but another one is cancer treatment. It's been in a lot of the literature. The facility itself is promoting the fact that that is coming to the facility and I believe it is in the way of chemotherapy and chemotherapy treatment so that individuals further out from the capital here don't have to come in as often to the cancer treatment centre or the Dickson Building. Do you have a timeline or any indications? I know recently the minister has been making announcements for satellite offices, for cancer care and other treatments across the province, so is there any indication on when that service will be provided at the Cobequid Community Health Centre?

MR. D'ENTREMONT: Mr. Chairman, again to the member for Sackville-Cobequid, I think the great thing about digital mammography, just to finish off that thought, is that the new machines can actually see - it can double the capacity- twice as many patients through those systems. So we hope to roll that out right across the system over the next number of years. Of course it would drop our wait times down dramatically.

The services for Cobequid Community Health Centre have sort of been a work in progress as we just recently opened that wonderful facility, with some great fanfare as well. Of course, that facility is designed to be a health centre, providing some basic health services to Bedford and surrounding areas. It is not, I guess, qualified as being a full-service hospital. So we need to look at those services that best fit into that kind of health centre. We are continuing to look at some further diagnostics that would be available at that facility. I'm not too sure on what the plans are for cancer treatment there, but I would probably suggest that there might be an opportunity, over the next number of years, to have cancer drugs administered there so they can actually go in to receive their treatments for medical oncology.

[Page 80]

On Wednesday, as we rolled out the satellite programming for cancer treatment, we looked at a bunch of different areas, looking at the kind of services that were being provided. Of course, we took some of the experts in the systems and then looked from a population standpoint where the prevalence of cancer is, looking at the services that are being offered at this time. So, of course, we have seen some improvements on some existing sites, the expansion, of course, for Inverness and Kentville. At this point there is no plan from that particular investment for the Cobequid Community Health Centre, but we will continue to expand the services there for all residents of the Bedford and Sackville and all that area. We can't forget Fall River.

MR. DAVID WILSON (Sackville-Cobequid): Of course, I'm disappointed in that answer but I anticipated that because there hasn't been much in announcements, or inquiries, or information from government around that. I think, as I said before, we need to ensure that a facility like this, where taxpayers have spent hundreds of millions of dollars setting up this facility and having it manned by professionals, that we continue to look at other ways and other services that provides. I'm sure there will come another day when I will criticize your government on that decision or that choice that you have.

Now I would like to turn to another area, which is definitely dear to me and maybe the chairman of the committee right now, around Lifeflight. We all know that there have been issues around that service, not the service that Nova Scotians receive from it, but issues around the management and running of the service itself. We know that there was a report - a consultant firm that was given the okay by the government to review Lifeflight and the services that they had and there were 29 recommendations. I believe, in a news release from the minister himself, that you stated that you would take - I believe it is the Lars Report - back to Cabinet to look at the recommendation. So I am wondering if the minister could inform us of that process and if he has taken those recommendations to Cabinet and what was the result of that meeting.

MR. CHAIRMAN: The honourable Minister of Finance.

HON. MICHAEL BAKER: Mr. Chairman, I would like the indulgence of the House to make an introduction today. In the east gallery we have today a visitor with us, Ms. Courtney Langille, who is a Grade 5 student in Bridgewater Elementary School. Courtney is visiting the House today with her mother, Kim Langille, who is my executive assistant. Of course, Courtney's father is Andrew Langille and I also wanted to say that Courtney and the other students in the Grade 5 immersion class at Bridgewater Elementary School were here in Halifax today visiting the Discovery Centre and actually over at the Provincial Building with the Nova Scotia Museum and the Nova Scotia Art Gallery with respect to an Egyptian exhibit. Courtney's class won the first prize for the province in a science project that they did on peanut allergies. Courtney was the narrator, among other things, on that project. I would like Courtney to rise and get the greetings of the House. (Applause)

[Page 81]

MR. D'ENTREMONT: Mr. Chairman, I too welcome Courtney to the Legislature to see the debate here and I can attest that they probably had a really good time visiting the exhibit over at the Art Gallery of Nova Scotia, seeing the Egyptian display. I really enjoyed it as well and I know that my two children loved it as well, the 4-year-old actually talked about it afterwards. So I knew even though he was running around, he actually was paying attention. So it's a good surprise that my little guy, Alec, actually paid attention to his visit to that art gallery as well.

Going back to the questions of the member for Sackville-Cobequid, I can tell you, it probably would be more fun to talk about the art gallery some too (Interruption) Well, you are a metro seat, aren't you? Ultimately the EHS LifeFlight, Fitch &Associates helped us in principle to provide us with some recommendations on the improvement of LifeFlight.

To go back at the issue really that's before us with LifeFlight, there have been some disagreements between some of the members of LifeFlight through crews being supported, of course, by their union and management of LifeFlight. Really because of the model it uses, there are some very difficult relationships because, you know, certain people belong to certain groups where some of the workers belong to the union and belong to the QE II site. The management, of course, belongs to Canadian Helicopters and some of that management belongs to the EHS system. So people are from everywhere it seems who offer this wonderful service to Nova Scotians.

The one thing I do want to make clear is that the LifeFlight system is still probably one of the best air ambulance systems in the country, if not in North America, which was substantiated, of course, by Fitch & Associates. What they did recommend to us - and we have in principle accepted all their recommendations, pending, of course, a couple of budget decisions and some of the things that we see here today. One of the main recommendations that has been brought forward to us is developing a model where basically everyone works together. You know, I don't know whether they all work for one unit, whether it's a contract from an operator, or whether it's a contract from the district health authority, or what have you, but to basically have one set of managers who work with the one set of employees so that there can then be better flow of information and better flow of knowledge and much better teamwork happening to ensure the safety of the patients on all flights.

The other thing I do want to say about this LifeFlight program is, under the direction of medical directors, two medical directors, of course one through QE II, Dr. Petrie, and one from the IWK, Dr. Soder. These two individuals provide what I believe is probably some of the best advice and best oversight of any physicians that we've come across in any system across North America as well. So there are a couple of steps that we have to move forward with and we're hoping to do those, of course, in the next number of weeks.

MR. DAVID WILSON (Sackville-Cobequid): I think what the minister has stated is exactly why I think a review was done at a cost of $98,000. So there was an issue there. Government reacted to it, had a consultant go in, you know, in principle - I hope that means

[Page 82]

you will implement the recommendations. But I would like to quote in one of the news releases that was from, I believe it was from Christine Zalar who was the consultant, why she did the report. The title was "Single boss recommended for air ambulance system" which, I believe, is one of the recommendations. In it she says there are too many bosses, and I think that's what I've been hearing from all the different crews in the aspects of LifeFlight, that's why there's an issue. That's why there's a big issue between those health care providers who are providing the service and the management.

[3:30 p.m.]

I know there have been several recommendations and talks within the interest groups that are involved in this and one of them, I believe, is that Capital Health should, or may, or could take over the management of it. So with that recommendation and the emphasis around that, there are too many bosses, which I think, and truly believe, that's what's leading to a lot of the disconnect between the professionals that are working and the management and the running of the system as a whole. So is that something that you're looking at and maybe a bit more of a timeline on when you will act on those recommendations?

MR. D'ENTREMONT: Mr. Chairman, as I said, out of those 29 recommendations, probably the biggest issue that's underlined is exactly as the member opposite brings up, that there basically are too many managers and I sort of underlined why. We have, of course, the contract for the helicopter, which is Canadian Helicopters. We have the adult crew which basically works out of the site. We have a specialty group that comes out of the QE II. We have the pediatrics group which comes out of the IWK, all fitting under medical oversight by our two medical directors. So you understand, there seem to be a lot of chiefs there in order to run this program.

What we want to do over the next couple of weeks, and what I'm hoping - I know there has been an RFP proposed. We've had an opportunity to sit down with management, we've had an opportunity to sit down with union and those employees to look at what's best and we have to make our decision. What we think we're going to do is put that out to an open and transparent RFP where one individual, whether that be a company or whether that be the district health authority, will bid on that contract to provide the LifeFlight service. We will still maintain all the good things that we have in this system, which of course is medical oversight and, of course, the employees, the actual flight nurses, the flight paramedics and those people, because they are the core of why this system works so well.

You know, we need to have a better management structure there and there have to be some clearer directives of who is boss. I think that's probably another big part of it as well. I know the RFP has been prepared and what we'll try to do is have that out over the next number of weeks in order to have a clearer direction for all employees and, of course, for all Nova Scotians in regard to LifeFlight.

[Page 83]

MR. DAVID WILSON (Sackville-Cobequid): I would agree with the minister that the core of the service and the excellent service that we have is because of those individuals, the men and women who work to provide this service and the care for Nova Scotians across the province. Even though we have a small province in population, they play an important role because of how stretched out our province is. It's amazing, the timeline that this service can get the critically ill to the tertiary care hospital, especially here in Halifax, or more importantly, I think, is some of the children who are injured in a lot of our rural communities. It's important that we recognize it. We have one of the best services in the country, I think, or in North America, that we address this issue. Even with this issue going on, we still have the best, so it's important that you look at that and implement those recommendations as quickly as you can.

So I would like to ask kind of a mish-mash of questions on a few things before I get into some questions around long-term care. One of them, recently, we know we asked you in the House last week, I believe, around the ambulance fee report that was commissioned by your government, I think over a year ago or more than that. You had it for more than a year. We know that your government is going to increase taxes, as we would call it, you might not call it an increase in taxes but an increase in user fees. One of the things I've seen over the years is the user fee for the ambulance service here in the province. I know that the chairman would agree with me. When I was first trained as a paramedic, I believe the user fee was $40 to $50.

MR. CHAIRMAN: I trained you, didn't I?

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman said when he trained me, which I will correct, is true, he was one of my preceptors, but I believe the user fee was $40, maybe $50. That was a short 10 years or 11 years ago. We currently see it at $150. In the report that we saw, which we had to get through the Freedom of Information and Protection of Privacy Act, the recommendation there is to set it at, I believe, $230. We know the fees are going up, user fees in this province are going up. So I'm wondering if the Minister of Health could tell us today, what will the ambulance user fee be and when will they make the decision to increase that fee?

MR. D'ENTREMONT: Mr. Chairman, this has been a long process, I guess is what you probably could call it, looking at the recommendations. Of course, the member for Halifax Fairview has brought this issue to the floor of the Legislature on many occasions and basically what we had is that a part of the recommendations that are held within the report talk about, of course, what we would qualify as hardship cases, where those people are unable to pay for the transfers from hospital to hospital, or seen to hospital to hospital, and those kinds of things.

What I wanted to do, prior to the release of the report, is have the funding available within my budget to take on the extra billing that we would be taking on in covering the costs for what we call that again, these hardship cases. If you notice in the budget, there is

[Page 84]

$432,000 put aside to help low-income Nova Scotians get the service so that they wouldn't have to pay for it, or for those options where they cannot pay for it.

The other thing that was going on at the same time, is we're talking about the actual fee for transfer, which was $120. We're looking at, because of the fee increases across the board that we're doing, bringing that fee up to $128.16. That's a 6.8 per cent increase that we're doing to the majority of our fees across the province and, Mr. Chairman, you know, that's still a far cry from the total costs of transfer of the patients. The average number, or costs of ground transport through our EHS system with EMC, is $836 per patient, you know, so we're asking for some cost recovery on this one; but in order for that report to come out, I wanted to make sure that this number was correct, because we had been talking about it for some time and wanted to make sure that we had the funds available to take on that low-income piece that the member for Halifax Fairview speaks about on regular occasions.

MR. DAVID WILSON (Sackville-Cobequid): Yes, definitely, it has been a passion of his and I know he has brought the issue and fought for many Nova Scotians, because right now, currently, you know, EMC, which runs the ambulance service in the province, is unable, from what we know, to just wipe out an ambulance bill. So it takes someone in the Legislature, or someone to get in touch with your office or the government, to erase that. So if I understood right, you said $128, an increase to $128 for a user fee. Okay, and I'm sure we'll have questions on that at a later date.

So quickly, now I would like to turn to another issue that I've brought up in the Legislature quite often and that's around the issue and the problem of Legionella at the Victoria General Hospital. I know that there was a pilot program, or whatever the terminology is, to address that issue, that they're trying to address the issue of Legionella disease at the VG site. So I would like to maybe ask the minister, when will we get kind of a comprehensive update or report on that issue at the VG Hospital, and has it improved or does it still remain the same on the quality of the water at the VG site or at the VG Hospital?

MR. D'ENTREMONT: Mr. Chairman, that is a study that is ongoing. Remember what exactly the proposal was, there were a couple of - the jury was sort of out on exactly what we could do to that water system to address the issue of Legionella. Now, Legionella is a bacterium that can be found in many municipal water systems. There had been some success in some jurisdictions on treating the water with chloromines and the chloromines would be injected into the water and would kill the Legionella, but the problem was that it did not address the other issues of - and I forget the other bacteria that can be present in water that created the Walkerton trial stuff. It's funny how I can come up with one word and I can't come up with another.

Anyway, there are, of course, other bacteria that are in the water that the chloromines did not address. So they were trying to figure out what kind of concentration or how you could treat the water sometimes with chloromine and sometimes with chlorine in order to address the whole issue so that you could actually have completely safe drinking water. You

[Page 85]

know, this study was a little late getting started; I think we were looking at a projected start date somewhere at the beginning of January. Apparently there might have been some problems in getting the equipment that was necessary.

The lucky part of this project at this point, which is lucky for this project but actually kind of concerns me a little bit on the other side, is that there is one water source for the full VG site. So there's basically one pipe that services that whole campus. So it was relatively easy for us to adapt that system for the injection of chloromines and chlorine at that head. The concern, of course, that gives me is that gives us one entrance for a water system so should something happen on that main pipe, we would have some difficulty in providing water to that campus. So there are a couple of things that, you know, keep coming to light as you investigate it further and some other things that come up that we have to address probably in the future.

The information I have right now is that study is ongoing. We haven't heard any of the results yet. I think it was a six-month trial and then take that data and basically testing at different sites throughout the hospital to see if there would be any appearance of Legionella. The issue of Legionella is not necessarily the ingestion of it as water, it's the breathing in of that bacterium where if you were in a shower or you're somewhere where the water is being oxidized, for lack of a better word, that you would ingest it into your respiratory system and then it would affect you at that point.

There is still currently ongoing on the cancer floor in the Centennial Building a bottled water policy where the water itself is being brought in through bottles. There is no shower there at this point, but the other thing that we need to remember is that really the suggestion is for those cancer patients with immune deficiency syndromes because of their treatments, are asked to stay away from showers and those types of things anyway because of the oxidation of water. So, you know, that can be apparent, of course, in any water system here in the City of Halifax or, of course, anywhere in the province.

MR. DAVID WILSON (Sackville-Cobequid): I hope when those results come forward that you're prepared to try to act on that if it's a positive or a negative reaction. The sad part about it is that we do have patients who are there fighting a disease like cancer and I'm sure you're aware, I know I am, of the complications of that and, you know, of people feeling sick and the need to maybe have a shower, it's important. I hope that with this report we can take some firm steps to address the issue. If it means replacing the whole system, it means replacing the whole system. We're going to have to make that choice. Government is going to have to make that choice and I know there have been issues around what we're using there now and other initiatives, or other ways of dealing with it, ionization units and all that. So I will keep requiring the government to ensure that the patients who are there being treated at that hospital have the proper water system.

So now I would like to go - and I know the member for Glace Bay mentioned it, I believe, yesterday - quickly to the Heart and Stroke Foundation. It was my understanding,

[Page 86]

and I think the member for Glace Bay's understanding, that the foundation was looking at an increase this year in the budget for $1 million to improve programs and initiatives through the Heart and Stroke Foundation and through the programs that they give. So was that something you're aware of, was that they were in need or were requiring, or may have been indicated by government to them that they would receive $1 million in this year's budget to provide services for Nova Scotians?

MR. D'ENTREMONT: Mr. Chairman, just to finish off the issue of Legionella within the VG site, within the Centennial Building, which will be a challenge even if we find that the chloromine or the actual water treatment doesn't work, we have to look at a couple of other mitigation strategies. I know where I'm going at this point, which probably would mean moving some of those patients to another site where, you know, hopefully the water would be better.

[3:45 p.m.]

The total issue, again, looking at the facilities that we have in HRM, what really concerns me, of course, is this VG site and what we do with that facility going into the future. So we really have to have a better idea of the structure as it stands today, what kind of shape it's in, what kind of things we can do to it tomorrow to ensure that it continues to serve patients as a tertiary care unit and, you know, should that not be able to happen, what the strategy would be for replacement of that facility in the long term as well.

So there are a number of challenges that this presents to us, because we can't necessarily just replace a water system. As much as we would like to be able to think that we can go and pull the pipes out and put new pipes in, Legionella still exists within the system somewhere between here and the Pockwock water system and it can be anywhere in it. So there's no way to really stop some of these things from happening and by removing pipes, you really don't know where it is, because I'm sure there are miles and miles of pipe within that huge facility.

When it comes to the Heart and Stroke, or the stroke strategy, which the member for Glace Bay brought up yesterday - and I thank the member for Sackville Cobequid for bringing that up again - there still is a contribution of $500,000 to continue the development of that stroke strategy and the implementation of that stroke strategy. The current provincially-led work includes the development of the stroke acute care guidelines, the departmental scan for stroke rehabilitation, development of post-acute stroke rehabilitation and community reintegration guidelines, a provincial stroke audit, and a provincial professional education needs assessment. So a lot of this is still ongoing.

This year is one of those - I'm pretty sure that the Heart and Stroke Foundation and those partners felt that they required $1 million to do that this year. From a further look at it, we felt that an investment of $500,000 was adequate to keep the program going and continue the work, and the good work, that it's doing for all stroke patients in the province.

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MR. CHAIRMAN: The honourable member for Sackville-Cobequid with just over two minutes.

MR. DAVID WILSON (Sackville-Cobequid): I think that leads me into my comment that somewhere the Heart and Stroke Foundation had some kind of indication that they could proceed and expand the programs that they deliver. I've said it before and it's so important that government invest in those programs that, hopefully, will reduce - I think is the objective of what everybody wants and what government should want - the health care costs in the future. I think the programs that the Heart and Stroke Foundation, especially around prevention of strokes and the indicators and treatment and programs early on before an individual or a Nova Scotian has a stroke, it puts such a great burden on the health care system that that's what they were looking at.

So I don't know where the mis-communication was, but I know that the foundation was hoping for better news. I know the minister said that $500,000 is in this year's budget, which was in last year's budget, but they were looking for and hoping for additional funding. And, as I said before, programs which the Heart and Stroke Foundation give and promote are important, just like programs around diabetes and ensuring patients with diabetes in this province have the medication and the access to care early on so that the complications from diabetes don't happen and don't incur increased costs in health care in this province.

That's why it's important, Mr. Chairman, and important to government to do that. So I don't know if it came from your department or you, Mr. Minister, but did you give any indication to the Hearth and Stroke Foundation that there would be a possibility of $1 million or more in this year's budget for programs?

MR. D'ENTREMONT: No, we in the department, or I myself, gave no indication that we would be funding that to $1 million. Again, $500,000 we felt was adequate to support the program and continue the good work they do. But it really brings up the issue of, you know - there are many programs that come to us, people with proposals, and all of them are geared towards making patient outcomes better, helping Nova Scotians.

You know the best example is, on one day I met with the Hospice Palliative Care Association of Nova Scotia, I met with the osteoarthritis association of Nova Scotia as well as the Heart and Stroke Foundation. So at the same time, they all have multi-million dollar proposals in order to help Nova Scotians and we have to find that balance between the resources that we do have available and funding those programs as best we possibly can, and it's good to go forward with a lot of these programs as well. So with that, I want to thank the member opposite for his hour of questioning.

MR. CHAIRMAN: Order, the time has expired.

The honourable member for Glace Bay.

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MR. DAVID WILSON (Glace Bay): Mr. Minister and staff, welcome back to the greatest time of your lives in estimates, I'm sure. The other day, during discussion, we went into some general discussions on many aspects of health care and today, if I may, during the time allotted to me, I would like to go through some line-by-line items, if we could, so just to prepare you to get your sheets out there because that's what we'll be dealing with. Starting on Page 13.3 of the Supplementary Detail, under Acute Care, Addiction Services, Public Health Services and Mental Health Services, all are seeing an increase in funding. My question is, why and are those new funds going to administration and salaries or are they going to additional or expanded programs?

MR. D'ENTREMONT: Mr. Chairman, I will probably do my best impression of a radio announcer, wasting a little bit of time until we can find Page 13.3 within the documentation that we have so that I can address it correctly. It's my best impression. I know that my CFO, Allan Horsburgh, has done a phenomenal job of putting together this book, and I'm sure he'll get used to it as the number of hours continue to go throughout this debate.

So Page 13.3, I believe is what the member opposite has brought forward and we're talking about the increase in care coordination, home care services and long-term care. Which book are you in?

MR. DAVID WILSON (Glace Bay): Supplementary Detail.

MR. D'ENTREMONT: Supplementary Detail, there you go. Do we have the Supplementary Detail? We don't have that. All right, I'm trying to draw time here and it's not working. The member for Timberlea-Prospect looks some good with those sunglasses in here. I'll tell you, his life is so bright, he has to wear shades. We are going to have to get that document for you. We actually don't have that with us and I apologize to the member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, would you like a moment, because most of the (Interruptions) Perhaps, if we could then, if you want to take a couple of minutes to recess, that's fine by me, to straighten things out.

MR. D'ENTREMONT: I think we would appreciate just maybe so we're clear on what we're talking about through this discussion. Again, I apologize to the member for Glace Bay.

MR. CHAIRMAN: We'll recess, then, for about five minutes.

[3:54 p.m. The committee recessed.]

[3:59 p.m. The committee reconvened.]

MR. CHAIRMAN: Order, please.

[Page 89]

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I don't know if the minister wants me to repeat that question, or does he just want to take it from where we left off? That would be fine.

MR. D'ENTREMONT: Mr. Chairman, again I apologize for not having all our documentation with us because of the - I know some printing happened relatively quickly and the department actually had not received the copy of Supplementary Detail. So we were lucky enough to have it, of course, in the library here, and we'll go forward from this one.

[4:00 p.m.]

So we were looking at Page 13.3 which, of course, is District Health Authorities Spending: Acute Care, Addiction Services, Public Health Services and Mental Health Services. What that will include as we see the increases, of course, is the 7 per cent non-wage issues of increases to the district health authorities. It includes funding to help settle the CUPE settlement, in order to have the funding for that one. It does include the new programs that we're talking about, whether it be the oncology unit expansions or the satellite stuff that we're talking about in districts. We're talking about the safety in legislation. So it does represent most new programs that are listed above, being Page 13.2, and some of the other pages in the Supplementary Detail.

MR. DAVID WILSON (Glace Bay): So just to further explain, those new funds are going to additional and expanded programs? Is that what you're saying?

MR. D'ENTREMONT: Everything is included there. So, you know, the pension issue at CUPE, that's included there. The additional salaries are in that number as well. New programs are in there. The 7 per cent increase on non-wage items is in there. So all the current funding for DHAs, plus the new funding for DHAs, is included in the numbers we find on Page 13.3.

MR. DAVID WILSON (Glace Bay): Mr. Minister, we see a decrease in funding in certain district health authorities for Addiction Services and Mental Health Services. Why the decrease in those DHAs when overall spending is actually increasing?

MR. D'ENTREMONT: Mr. Chairman, to the member for Glace Bay, I would indicate the reallocation of funds is really a tuning up on our programs to make sure that we have the correct expertise in different areas for them. So you'll see the programs being run, I know some Addiction Services stuff is run out of Kentville that serves, of course, all of the southwest, and those kinds of adjustments are happening, which is representative of the information that's before you.

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MR. DAVID WILSON (Glace Bay): Mr. Chairman, just as a reminder to the minister that district health authority business plans were unacceptably late last year and some DHAs didn't have their business plans approved until nine months after the fiscal year began. So a question to the minister then, how can the DHA plan its year unless they have the approved business plans?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, business planning for the current year, so business planning for 2007-08 actually started process, I think, in November, getting the numbers ready, getting ready for these days when we know exactly what the budget is. As soon as the budget is approved, the letters would go directly out to the district health authorities giving them their final spending targets. Then there would be further discussions with the department and the district health authority on those final pieces.

Last year, again, it did take a lot longer than anticipated. Of course, some of the district health authorities did a wonderful job and had their business plans in and we've had them approved for quite some time. Other ones required some more mitigation and some more work with it and, you know, the example, of course, of District 1 would have received its final approval on its business plan for last year probably sometime last week. The system itself is not perfect and is one that we want to continue to improve upon to make sure that all district health authorities have their budgets approved early so that they can work and live to that budget as set forward for them.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I know the minister takes that subject very seriously and I'm sure the department is a little bit perplexed about how to bring everything together. I'm sure you're taking the process seriously but, you know, I think at all levels, to improve business plans early in the fiscal year is a goal that can be achieved and I don't think that any later than, you know, 90 days perhaps is reasonable, or whatever the case may be.

On Page 13.4, under Executive Administration, all of the funding in that area is budgeted to be increased this year despite the fact that all offices are forecasted to come in under budget for the 2006-07 fiscal year. So why such a large increase in budget compared to the actuals and forecasts over the last two years?

MR. D'ENTREMONT: Mr. Chairman, those numbers would be representative of new wage settlements for some of these employees. It would also be representative of the hiring of a number of other professionals. We are, in my estimation, in a lot of cases, understaffed at the Department of Health for the amount and volume of work that goes through that department. There are a number of positions and the forecast estimate is representative of that, or our forecasts, when we're doing estimate to estimate and forecast, anyway, is representative of positions not being filled during this current year, and basically not being able to recruit to some of those positions. So our hope over the next year is to get the department, again, up to full staffing levels and, of course, we're including a Health Canada project that's in there as well as covering those increases as per negotiated salaries.

[Page 91]

MR. DAVID WILSON (Glace Bay): Mr. Minister, the increase, as I read it anyway, is over $6 million for the year compared to forecast from the last fiscal year. So that additional money is going where this year?

MR. D'ENTREMONT: Mr. Chairman, you know, if you look from estimate to estimate, I think it looks at $39-some million versus $42-some million. It shows in the increase that we did have a number of positions that were vacant, but also taking into consideration the cost of living increases in contract negotiations for those employees. So it is representative of pretty much those and regular increases that we would receive year over year.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, Page 13.6, under Other Insured Programs, Assistance for Low Income Residents with Diabetes, in the 2003 election there was a promise to spend $3.2 million on that program. You budgeted $2.5 million for last year but forecast it to come in at just over $1 million. So why the low uptake on that service, Mr. Minister?

MR. D'ENTREMONT: Mr. Chairman, that would be representative of the uptake of the program. The uptake of the program I don't think has been as good as we had envisioned. I know we'll probably have to do a little more work around making people aware of the program, of course, and how it works. Of course, the other issue that brings up over the next number of months is how that program works in parallel, or as a part of the Nova Scotia Pharmacare Program and the Working Families Pharmacare Program into the future. So, again, the performance of the program hasn't been as good as we envisioned and we will continue to promote it to help out all those low-income residents with diabetes.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, well, the minister outlined the purpose of the program, but I'm wondering, is the minister saying that it wasn't perhaps properly communicated to health care providers or to the general public, because the actual for 2005-06 was even lower. The budget was $1.5 million but, again, only $144,000 was actually spent, and why would that happen? So is the program working and, if not, why not, or could the money be better spent, or budgeted, for a different program, or is it simply a question of poor communications for that program?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I will pick a few of those questions out of there and try to answer them as best I can. As we found out with a lot of programs, the uptake itself takes probably three years in order to become fully subscribed to a program. So of course, in a best world, if everybody had subscribed to it immediately, we would probably see a program that would be in that $3 million range. What we know today is that we're looking at a subscription rate of about 33 per cent of the population that's eligible for the program. We're still looking at an increase of about $625,000 for that program.

[Page 92]

You know, I think we've done a relatively good job of advertising it, but we have not gotten to everybody yet. I think what we want to do is continue to promote it with, of course, physicians, with communities, and those types of things to make people aware that there is a low-income diabetes assistance program.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, we're still on the same page, under Prosthetic Services Payments. There's a decrease there, Mr. Minister, why?

MR. D'ENTREMONT: I guess I could probably have answered this one quite quickly. It is a utilization-driven program. The requirement for prosthesis in the province has diminished so, you know, we're looking at a program that is, of course, representative to the demand for that service. So, of course, the demand has not required us to expend that much money on prosthetic services.

MR. DAVID WILSON (Glace Bay): The same question, Mr. Minister, under the next category, Sign Language Interpreter, decreased as well. Why?

MR. D'ENTREMONT: Again, it's representative of utilization. Looking at its requirement over the last number of years, we feel that the $126,000 is representative of the requirement for across our system and I believe that's the program that helps them provide to our hearing impaired folks within our hospital system.

MR. DAVID WILSON (Glace Bay): Mr. Minister, we're still on the same page, but just for general information, Special Consideration, Special Drug Programs, Special Dental Plans, Special Programs, what programs fall under those budget items?

MR. D'ENTREMONT: Mr. Chairman, I'm hoping that this is the information that's required. We need to look, and I just want to make sure that we're not doubling up on some of these programs. We have the Cystic Fibrosis Program; Diabetes Insipitus Program; Growth Hormone Program; Cancer Drug Program; the Diabetes Assistance Program, we've already talked about that one; the Children's Dental Program, okay, that's by itself; IWK Block Funding; Dental - Surgical; Optometric Payments; Prosthetic Services Payments, I guess it was already there; Sign Language Interpreter is there; Special Consideration, we probably still need to get further information on that one, I'll try to have that for you tomorrow; Special Dental - Cleft Palate; Special Dental - Mentally Challenged; Maxillofacial Prosthodontics Program; and a few other insured programs. So I'll try to get, as best I can, a listing of those special programs for you tomorrow.

[4:15 p.m.]

MR. DAVID WILSON (Glace Bay): Mr. Chairman, there was $32 million under Special Drug Programs. Is that the catastrophic drug fund and if not, where is that money going?

[Page 93]

MR. D'ENTREMONT: Mr. Chairman, Special Drug Programs are sort of the exemption drug programs: the Cystic Fibrosis Program; the Diabetes Insipidus Program, the Growth Hormone Program; the Cancer Assistance Program, for those individuals - I think it's for under $15,000 of income; Diabetes Assistance Program, and I'm just wondering why it's showing twice there - oh, previously existing ones, so there were some people on a previously existing program; and I would probably also guess that some of the funding there is for Fabry's disease and a couple of those difficult, one-off kinds of drugs that we provide to the citizens of Nova Scotia.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I'm sure the minister knows, because we referred to this yesterday as well and others have asked questions about it, but we know that the cost of medication is, to say the least, getting out of hand in this province and elsewhere. This province has one of the worst records for the number of approved drugs that aren't covered under insured plans and we have heard the stories about Avistan, and so on, that are not covered, people losing their homes or their life savings and families, and the cost associated with those, literally with our life-saving drugs, and also the cost of lives that are lost because people simply don't have the ability to continue to pay for them. It's a troubling area of health care and one that I know - it's going to be around for some time. It's not going to go anywhere, it's only going to get worse. That's just a comment, it's not a question for the minister.

On Page 13.7, under Emergency Health Services, under the title of Communications and Dispatch, there is an increase there of $1.2 million since last year's budget. Why the large increase?

MR. D'ENTREMONT: Mr. Chairman, I think last year what we had is a one-time payment that we provided through to EMC or to the dispatch centre for some operations, some system upgrades. Basically what you see today is that increase that was actually there last year is now being provided into the base funding of the communications and dispatch centre for EHS.

MR. DAVID WILSON (Glace Bay): So I take it that is technological, whatever the case may be, so that it would continue to be the best service that you could possibly offer in terms of EHS. I sound like I'm speaking on behalf of the minister. I'm not, I'm just assuming that - assuming that the minister and the department have done the right thing there, then they would have the most up-to-date equipment that they could possibly get their hands on.

Under the next category, under Provincial Programs, the total is $9.6 million being spent in that area. Just if we could, Mr. Minister, some detail on exactly what that is and what it is being spent on.

MR. D'ENTREMONT: As Allan tries to find some further details on it, what I understand is that a lot of those are contractual obligations that we have to continue to fund, whether they be wage settlement or what have you on that one. We are still trying to find

[Page 94]

some further detail on that. Maybe what I will do is I will come back with some further detail on that one, subsequently after.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, that's fine. That's what we're looking for, is some detail. I'm wondering if it's been thought about, the pending contract negotiations with the paramedics, is that being taken into consideration? We have heard from paramedics across the province. They are among the worst paid in the country, but we have one of the best ambulance services in the world. We have received accolades from not only other provinces, but from other countries on our air ambulance service, on the quality of our paramedics and so on. I'm wondering if the minister would answer the question, is the government prepared to go to the bargaining table with the paramedics? Has money been set aside to address the salary concerns of the paramedics in this province?

MR. D'ENTREMONT: Mr. Chairman, just to the previous question on provincial programs under the EHS line, Provincial Programs would underline the air ambulance system so the air ambulance system, the difference between forecast and estimate would mean the difference in funding in those types of things as per wage adjustments and contracts.

The issue of the paramedic wage settlement, of course the contract does not come due until March 31, 2008. So there's a full year right now remaining within this contract. Of course, we would support a normal bargaining process where the two parties would have the opportunity to sit and discuss the situation and hopefully come up with a mutually beneficial agreement. For the purposes of this year's budget, of course we can only account for the amount of funding that we would anticipate to have to come up with in this fiscal year only. So the number would not be representative of the paramedic contract. Again, the paramedic contract is one that does concern me a little to hear the displeasure with the current agreement, but it was one, in our estimation, that was negotiated fairly and one that did provide a fair increase to those professionals. We would hope that future negotiations, through the bargaining process, would benefit them as well as it has across our system today.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I'm sure the minister can see the irony, I guess, is the best word I can find to - we have the lowest paid paramedics in the country, but we have the best ambulance service, the best care that we can give in an ambulance service throughout not only the country, but one of the best ambulance services in the world. I'm sure that we're all hoping that negotiations will prove to be fruitful and work out and that both sides can iron out all of their differences before it gets to the point where we wouldn't even want to contemplate what would happen if it didn't work out.

Anyway, on the next page, Page 13.8, under Other Health Care Initiatives, under the topic of Dialysis - Provincial Program, the budget for dialysis has been cut almost in half. Perhaps the minister could explain why.

[Page 95]

MR. D'ENTREMONT: Mr. Chairman, again, I'm just going to apologize for getting further information from my officials to make sure I had the correct answers for all of these. When it comes to the provincial dialysis program, there had been a fair amount of work done over the last couple of years in the development of what that provincial program would look like. The number you see today is representative of what the implementation of that program would be. The actual funding, I believe a lot of the funding will be found over with the Capital Health Authority budget, they will be the managers of that provincial program. So the $800,000 is representative of the administrative costs and set-up costs in continuation of that provincial program, while the actual dialysis costs, nursing costs and those kinds of things are held within the QE II budget or within the Capital Health budget.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Minister, for that explanation. You will also see on the same page Information Products Development, the budget, the same as last year; however, the forecast for 2006-07 is coming in at less than half what was actually spent. Why is that?

MR. D'ENTREMONT: Mr. Chairman, that line item, Information Products Development, would indicate the development of the Web services around, I believe, the wait time issues. What we found is we were unable to implement everything that we could in the last fiscal year, so it would show that we spent a little less money than we had anticipated. We know there's still a fair amount of work to be done in this current year, so that funding will remain at that $355,500.

MR. DAVID WILSON (Glace Bay): Under Mental Health Programs, Mr. Minister, it shows it's cut by more than half - again, an explanation of that, please.

MR. D'ENTREMONT: Mr. Chairman, that would underline a reallocation of funding from the direct provincial program to the district health authorities that actually administer and operate those programs.

MR. DAVID WILSON (Glace Bay): And below that, Primary Care Programs, again, the same situation, the same answer?

MR. D'ENTREMONT: Mr. Chairman, again, it would be the same answer where, as we continue to evolve through primary health care and some of these other provincial programs, we do start to flow the money to the district health authorities as they actually administer those programs.

MR. DAVID WILSON (Glace Bay): I just have a couple more questions for the minister and I will indicate to the Chair, please, that I will be sharing my time with my colleague, the member for Kings West, in just a moment or so.

I just wanted to touch again on Page 13.9, Mr. Minister, on the Working Families Pharmacare Program, which is a new program, but $5 million towards a functioning

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Pharmacare Program just doesn't seem to be enough. It's not close to what was actually promised. Under that situation, I'm wondering if the minister is confident that indeed that program is going to be of some use with just that little amount of money being spent towards it, not that $5 million is a small amount of money, but it's much less than what was promised.

MR. D'ENTREMONT: Mr. Chairman, of course, the funding that we see today for the Working Families Pharmacare Program, the Nova Scotia Pharmacare Program, is representative of the set-up of administration costs, the computer system that we required in order to take in the premiums or the co-pays and monitor those issues, and also the hiring of professionals in order to administer the program. It's still my estimation and my want to have this program up and running, hopefully, by March 2008.

I know that the division of Pharmacare is sort of pleading with us to give them time to set it up correctly and that the issue that we have right now is that we're still working on a couple of models of what this Pharmacare Program will look like in the end. The estimation in our first full year of operation will probably cost us somewhere in the range of $30 million to $40 million, fully subscribed, and again this depends on the model, it would range anywhere between, I believe, $60 million and $75 million, $80 million, once it is fully subscribed and kicking out the benefits to Nova Scotians. So it's a sizeable program, but it does require a fair amount of lead time to make sure that we set up the systems that are required to administer a reasonable Pharmacare Program for all Nova Scotians.

[4:30 p.m.]

MR. DAVID WILSON (Glace Bay): As I indicated, I'll be sharing the remainder of my time, which I think is approximately 20 minutes, with my colleague, the member for Kings West.

MR. CHAIRMAN: The honourable member for Kings West.

MR. LEO GLAVINE: I am pleased to have the opportunity to ask a few questions, make a few comments during this segment of the estimates on the Health budget. I welcome the members present from the staff.

With that, recently I joined the minister in the official opening of the MRI at Valley Regional Hospital and I felt that was a great step forward in providing the services that we've all come to expect from a regional hospital. We're all hoping that, within time, it will reduce the wait times for MRIs. On that occasion, we were made very, very much aware of how valuable that piece of diagnostic equipment has been.

Also, in the budget, I was more than pleased to see that funding is going to be in place for an oncologist. About three years ago I had asked that question and followed it up in other

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estimates on the budget, talking about the toll that travel does impact on people who are sick and in the process of treatment.

Along that theme, there still is one area that I don't think has the medical complications associated with it that requires a need for patients to be going to Halifax for treatment. That's in the area of certain dialyses. Currently there are patients who cannot get the service in Berwick where there is a dialysis site, so we still have patients who move from the Valley to Halifax. So I was just wanting to get some background in terms of what a long-range plan may be in the region, to be able to look after dialysis on 100 per cent of the cases, 100 per cent of the time.

Again, in this one, sometimes unlike a cancer treatment which may be once a week, dialysis patients will go to Halifax three days a week. So it's a huge toll on the patient and on the family. I was just wondering where this area may be going.

MR. D'ENTREMONT: Before I get to answering the question, I want to make a few comments around the issues that were brought forward by the member for Kings West. First of all, the first comment is that Allan here, who is my CFO, had the opportunity to come from Berwick, to go through the wonderful institution of Kings West High School, where I know the member opposite was a teacher. I know he didn't have the opportunity to teach Allan, but I know they did share some hall space on a couple of occasions. I think that good Berwick common sense has rubbed off on my CFO.

The issue of the expansion of MRIs is one that I wish I could take full credit for, but it was an initiative started by some previous ministers and I want to thank them for the negotiations that they would have had with the federal government on the expansion of MRIs in the province. As we look at that, we do now have more MRIs - or will have once they're all fully operational - per population of any province in Canada. I think that's a testament to their work and the work of the district health authorities in making us understand the importance of that very important diagnostic tool.

I think the announcement that we had the other day - of course, my colleague, the member for Kings West was there, and my colleagues, the members for Kings South and Kings North - really celebrating having that type of restructure at the regional hospital in Kentville. Really, to underline the importance of it, during our visit the MRI was seeing patients and what we did find out throughout that day, we did not have our opportunity to really go into the machine or see the machine directly because it was seeing the patient and because of that machine, they were able to find some pathology with that patient and were able to provide more care for her through her illness, whatever that illness was. It's just a testament to having that piece of equipment, that resident was able to get the service there in Kentville and to get that follow-up almost immediately after finding that type of pathology, or whatever they found.

[Page 98]

The area around dialysis is one that we have been working towards and the member for Glace Bay brought up the budget line for the provincial program in dialysis. As we know, we provide hemodialysis in many different areas around the province - the Cape Breton District Health Authority, the Southwest District Health Authority, who do manage their own programs. Then the Capital District Health Authority and IWK Centre operate in-centre, hemodialysis programs in Nova Scotia and operate about 10 satellite sites, one of them being the one in Berwick. So even though it's within the Valley Regional District Health Authority, the dialysis site is actually being managed by the Capital Health dialysis group.

What we're trying to do is continue to develop what that provincial program is looking like, to look at where our populations of people requiring dialysis are going to be in the future and to make sure that we make those adjustments as we go along. We are also looking at new models of care. If we look at what's happening at St. Martha's Regional Hospital in Antigonish, the brand new facility opened up there, again in conjunction with Capital Health and the dialysis group there, and I know the member for Antigonish worked long and hard during his tenure as Minister of Health, as well, to make sure that was there for the patients and residents of his community.

What we're also doing there is looking at the model of care, of how it works, using some other nursing staff in manning - I think "manning" is the right word - that facility, making sure that they are receiving quality care at that site. So there are a number of things going on with dialysis and I know there is a review and some thought going into the site in Berwick to make sure that's the correct site for dialysis or maybe it should be moving to another site to better respond to the majority of the population that requires hemodialysis at this point.

MR. GLAVINE: Mr. Chairman, thank you very much for that overview of where things are. I will just follow up with a very quick ask here and that is, is there some timeline being placed, at least on the review process leading up to, of course, a decision on this and, perhaps more than anything, will it offer that full range of services? I know that there is a certain type of dialysis and you will have to provide me, maybe the deputy, with what exactly the name of that dialysis that patients must come to the city for. So is there a timeline on the review and is it possible that a different site, or an enhanced site in Berwick, will offer the full range of services?

MR. D'ENTREMONT: Mr. Chairman, I think a couple of the issues, especially with the renal dialysis unit in Berwick, I think the issue is really, from the recommendations that are coming forward to us, that they are requesting to have certain infrastructures in place around it, which would include a regional hospital site. So there are a couple of issues around what is going to constitute safe renal dialysis, what kind of other services are going to be there, what kind of quarantine capabilities are available. I'm just sort of trying to guess why some of your residents would be coming to Halifax for their service or for their dialysis, but it would probably be because of certain diseases, or blood diseases, that might be in their

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systems that they require quarantine during that dialysis that might not be offered at the Berwick site today.

The other thing that we're trying to do as a provincial program, and especially through our continuing care strategy, is trying to provide more peritoneal dialysis, which is more of a home-type process, where a lot of people can get along quite well at home, with a little bit of help from VON or from nursing staff. So there are a number of things going on and the provincial strategy itself - I'm not too sure what the deadline is and when we expect to have that program available, but what I'll do is try to communicate that to you before the end of estimates.

MR. GLAVINE: Thank you, Mr. Minister, for that perspective. One of the areas that has been pretty much a success story in the Annapolis Valley District Health Authority is certainly around the collaborative practice in Annapolis Royal, and now, of course, they're looking at a site in Middleton. I guess I would say that if we're out in the media with it, it's pretty well been given the blessing to go forward, with two doctors, but certainly more personnel perhaps required there, especially around medical staff. With the retirement of two doctors, you know, what one time was probably not a big story and you just wish the doctor the best in retirement, or if he had scaled his practice down to a few nursing home visits, or things like that, you wished him well as he changed direction. But today, when a doctor leaves a community and a small rural community, it is big news.

There are probably 2,000 to 3,000 patients who are without a family doctor. So recruitment for the Middleton area, with two doctors retiring in June and another, certainly at least four or five doctors who are 60 years of age, concern is mounting. I know there's a team in place to do some investigation, but I'm wondering if the minister could update how things are going in that very critical area. We all know the importance of a GP.

MR. D'ENTREMONT: Thank you very much to the member for Kings West. In the issue of Middleton, I think the issue that we're trying to pull off there is of course making sure that service still continues, as best it can, from the Middleton site. I know the district is working right now with area physicians to look at another form of enumeration so that we might be able to get more service out the existing physicians. I know there's a recruitment campaign on right now, looking at replacing a couple of physicians in that area as well.

The other issue that I think is probably really good for the Middleton area, as well, is that as we look at alternate service delivery, as we're looking at community health care clinics, community health care centres, population health pieces, we're not just looking at maintaining ERs, we're looking at making the population healthier, and I think that's a valued piece. So not only will there be a doctor waiting for an emergency to show up, you'll have some doctors with maybe some nurse practitioners, with some other health care professionals, working toward keeping the community healthier. So not only would you come in with an emergency, but you would come in for some basic health advice, some basic health referral, and those kinds of things.

[Page 100]

In communities where this has been used, in other areas in Canada, in North America, and really in Europe, there has been some tremendous success with it, even to the point where they wouldn't want to go back to the old model if they could. So a number of things are going on that really bode well for the Middleton site.

MR. GLAVINE: Thank you, Mr. Minister. I do, however, want to press a little bit further there, just to, I guess, find out whether or not there are at least some doctors who are taking a look at the area and that may possibly be in place by as early as June or July, to pick up once we lose a couple of doctors. So I'm just wondering, how is recruitment going generally in the province this year and in particular for the Valley area?

[4:45 p.m.]

MR. D'ENTREMONT: Mr. Chairman, as we would, we will be trying to identify areas where we need a little more work done, to make sure that we're focusing in, to make sure those physicians come to the area. Of course, Middleton is one of those areas that has been identified. So our provincial recruiter, Frank Peters, is available to the district health authority to continue to help them in finding positions for that area. I would probably have to get you further details on really how they're doing. I don't know if they have identified a couple of people who might be interested in the area or what have you. So I would endeavour to get you some further information on the recruitment process and how it's going for the Middleton site.

MR. GLAVINE: Mr. Chairman, through you to the minister, I guess one of the personal experiences of the past year was to have to use the emergency ward in Valley Regional prior to hospitalization. Certainly on all occasions there, it's truly an experience and I know they have tried to reduce the number of patients and get rid of the overflow. I'm just wondering what the progress report is on the emergency ward make-over. Certainly, in having taken a look at the plans, having been in the hospital and having the communications director, Jan MacKinnon and Dr. Harrigan give me an overview there, I'm just wondering about, again, what is the timeline, what is the plan when we can see the emergency ward take on a whole new look?

MR. D'ENTREMONT: Mr. Chairman, I don't have necessarily all the details on the Valley Regional Hospital or redevelopment plan. I know that there has been a fair amount of work ongoing in those areas where there hasn't been too much patient flow. I think the next step really is they're moving a certain bunch of, I don't know if it's diagnostics or administration, they're moving it into one area. It's sort of a living plan of where people are going in the interim as places are redeveloped into in-patient beds and/or diagnostic areas. But I would again maybe endeavour to provide further information to the member for Kings West on the renovations at Valley Regional.

MR. GLAVINE: I'm not sure of how much time I have left here.

[Page 101]

MR. CHAIRMAN: About eight minutes.

MR. GLAVINE: About eight minutes, okay. Probably we'll get another opportunity later to continue with some questions, but just in case, we've got a lineup here of colleagues to ask questions. Recently I had a call and a conversation with one of the doctors who practise at the Valley Regional. I'm wondering if there is a provincial policy, or is it a DHA policy, or was it just the state of the demand and the pressure on the beds as we know at Valley Regional, but the doctor was certainly in a state of awe that he was called, at midnight, to give discharge orders to take a patient, a 91-year-old patient, at the Valley Regional, out to Soldiers Memorial.

I'm just wondering if there are some policy pieces, that when you get somebody at that age and probably, you know, frail, to have to endure this plus get the doctor to come from a neighbouring community to discharge such a patient. It was just something that caught my attention, that I thought I should ask, whether it's just one of those kinds of immediacies or whether there is some policy to perhaps try to prevent that kind of movement.

MR. D'ENTREMONT: Mr. Chairman, to the member for Kings West, I thank him for that question. That one really revolves around, I think, a policy of the district health authority and what I would probably guess as well - and I shouldn't be guessing, but I will in this case - and speculate is that there was probably an impending code purple at that facility and they were looking for ways to free up some beds in case of emergency and those types of things.

From time to time - not a regular occurrence - would they be looking at those patients who could receive that alternate level of service? I don't know what the situation would be with this patient, but I would guess that they were trying to free up some space within that hospital, in case of emergency, to make sure that they would not be hitting that code purple.

I would question the time of night in calling in a physician to do the discharge, but ultimately I would guess it would have to revolve around the issue of code purple that we have been having at Valley Regional and other sites around the province.

MR. GLAVINE: I have a short time left, so I will probably just end here, and maybe start here if I get another opportunity. Certainly the role, the position of the nurse practitioner has been given a lot of talk and a lot of attention over the past while, and there's no question about the value of that specialty area of nursing and where they can fit into the delivery of a range of services in different communities, in different health settings.

I'm just wondering, for the continued development of the nurse practitioner position and especially along the lines of emergency departments, clinics, also rural and remote areas, I'm just wondering, is there a master plan from the Department of Health that sees the progression and the movement towards more nurse practitioners in the province?

[Page 102]

MR. D'ENTREMONT: Mr. Chairman, just to close in on this one, nurse practitioners, we feel, are a very important addition to the Nova Scotia health care system, which is why again this year we have increased the number of positions from 19 to 25. We are focusing in on some primary health care clinics - South Queens, which is an investment of about $225,000, as well as Inverness, which is looking at an increase of $150,000. If you look at the added work we were including in the budget this year of $1.2 million for nurse practitioners, DHA 3 has seen an increase in their budget for nurse practitioners of $180,000. So as the DHAs develop and bring their budget plans to us of services they want to provide, which would include the usage of nurse practitioners in different settings, we would fund those accordingly.

The thing that we want to continue to do with nurse practitioners though, is really use them where they're working in communities, community health, primary health care, rather than working in emergency rooms and more critical care settings. I know your seatmate, the member for Digby-Annapolis, is a real advocate of that community involvement that nurse practitioners have been exhibiting across the province.

The other place that we would really like to work with nurse practitioners is in the long-term care setting. We have a pilot project, of course, at Northwood where we're utilizing the nurse practitioner to see those patients, to work on their wellness, and what we're seeing is that there are a lot less visits to emergency rooms from the Northwood site on North Street to the ER at the Infirmary site. So they know the health of those individuals, they know of the indicators, and they're keeping those individuals a lot healthier and keeping them out of the acute care system, where we know the pressures that we have there.

So we will continue to focus in on nurse practitioners and hopefully the next few budgets will show fair increases in that realm as well. I thank the member for Kings West for his questions.

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

MR. DAVID WILSON (Sackville-Cobequid): Sorry, I thought I had a minute there. Thank you, I appreciate the acknowledgment. What I'm going to do, actually, I'm only going to use probably half of my hour, then share my time with my colleague, the member for Queens. What I'd like to do is maybe ask a question on Pharmacare, which I forgot earlier, and then go on to long-term care stuff, which I know the minister will be quite interested in.

One of the things that we've heard quite often, we've brought it up in this Chamber, is around drug coverage. I think there definitely is a huge gap in the services between the Department of Health and that of the Department of Community Services, especially around the cut-offs for programs for drugs, especially the drug assistance for cancer program. That cut-off - I know there's an acronym for it - the cut-off is $15,720 currently. Actually, in my time off, Mr. Chairman, I just met with the Canadian Cancer Society and we're talking different issues and I indicated that I was going to bring this up with the minister, so my

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question is, when is government going to look at increasing the allowance or the cut-off for the cancer patients through the drug assistance program that they deliver?

MR. D'ENTREMONT: Mr. Chairman, really, what we're trying to accomplish through the modeling for the provincial Pharmacare Program is to look at some of the other programs that we have available today. One of them would include the low-income cancer program - I forget the exact name for it - and we would look at rolling some of those programs, including this one, into the main Pharmacare Program, so those folks would be able to receive the help that they have today, plus maybe even a little more.

MR. DAVID WILSON (Sackville-Cobequid): But we know, Mr. Chairman, that program is well off more than a year now, it will be over a year before that program is up and running, hopefully fully. It's interesting, because when you talk about the Canadian Cancer Society being involved in this program - years ago, I believe the cut-off for any drug assistance program was around $12,000. The Cancer Society at the time, and it was years ago, prior to this government, had indicated to government that they didn't want it anymore - government, take back delivery of that program because they're tired, as an advocacy group for cancer, of declining Nova Scotians the ability to gain access to drugs. I think at that time there was an agreement that, well, we'll increase it, we'll raise that limit and that's how we came to the $15,720, I believe.

So it is important that we recognize that within the next year there's an area, it's not as broad with the number of individuals that would take advantage of it compared to a family, low-income - whatever the terminology - the working family Pharmacare Program will take. So are you going to wait, or does the Cancer Society have to wait until the implementation of the working family Pharmacare Program that you're going to introduce before you increase that?

MR. D'ENTREMONT: Mr. Chairman, one of the directives, as we work on the development of the Pharmacare Program, is to look at the existing Pharmacare Programs that we have in the province and see how they could work within a new Pharmacare Program, which is exactly what we're doing with this one.

Mr. Chairman, I think there continues to be a little bit of misunderstanding from the member for Sackville-Cobequid on the timing and the set-up of the Pharmacare Program and as I've said before, it's going to take us about 10 months to set up the program, to advertise it and have people benefiting from it in March 2008, which I think is an extremely fast turnaround for a program of its size.

Mr. Chairman, I think the crux of the issue is that we will be looking to see how we can roll these programs, which I feel do not address the needs of Nova Scotians, and roll them into a program that truly does.

[Page 104]

[5:00 p.m.]

MR. DAVID WILSON (Sackville-Cobequid): So I'd like to go now to a quick line in the estimates, on Page 13.8 for the minister. I talked a little bit about diabetes and those initiatives and the groups that support initiatives like diabetes and the Heart and Stroke Foundation. In there it's under Dialysis - Provincial Program. So again, it's Page 13.8 of the Supplementary Detail. The line item last year had an estimate of $1.5 million and had a forecast of $1.44 million, and this year it's at $800,000. So I understand that there would be a decrease of about $640,000, so I'm just wondering if the minister could inform me, why such a dramatic decrease on that line item for Dialysis - Provincial Program?

MR. D'ENTREMONT: Mr. Chairman, what that program is indicative of, especially the funding that we do find there, is that the $1.5 million, or the actual forecast of $1.4 million, is the set-up of a provincial program, consulting work that has been done, those kinds of things.

What we're moving on to now is the hiring of an individual who will be responsible for the provincial dialysis program, but the actual programming is funded through the district health authorities, so the $800,000 that's showing here is only indicative of the administration costs of that provincial program now that the development has been pretty much completed for that program.

MR. DAVID WILSON (Sackville-Cobequid): Okay, thank you for that clarification. I mean there are so many line items, you never know where the money is going, so when you see a reduction like that, it begs the question.

Now, I'd like to talk around the issue of the long-term care. Of course that has been a main topic, I think, in this province for several years, definitely with our caucus, and I know in the recent election that long-term care and home care is an important issue here in the province and one that residents expect government to implement changes and increase the number of long-term care beds, transitional care beds, increase home support systems. So with this strategic framework or the plan that the government had unveiled to the province, in that announcement - I believe it might have been earlier this year or at the end of last year in Truro - that there was going to be a creation of 150 additional transitional care beds, I just wondered if the minister would enlighten me - and I can't remember if I got this information - on where those transitional care beds will be throughout the province.

MR. D'ENTREMONT: Mr. Chairman, I'm glad the member for Sackville-Cobequid has brought this issue forward, because I think there's probably no one issue in my mind that's more important than addressing the long-term care issue in this province. If you look at what the effects are of not having enough beds across the system available for our seniors, it has impacted the operations of the acute care system for some time now and it's really turning into a bit of a crisis where a lot of hospitals now, because they're not able to utilize beds the way they want to, we're seeing some hospitals actually having utilizations between

[Page 105]

somewhere near 104 to 106 per cent, where probably an efficient hospital should be working at somewhere near 92 or 93 per cent, so there's actually some room to react to different situations.

The transitional unit piece that we've talked about, which is about 150 beds, is representative of about 50 beds available across the province in DHAs, and we have made the district health authorities aware of this issue and we're waiting for their proposals to come forward and where they want placement of those beds. There have been 40 beds committed to Northwood for sort of an interim unit at their facility. They had a floor that had been basically gutted and they were going to be transferring that into a number of beds, into 40 beds. There are then 31 beds that we're working at right now in the HRM area, as well, through Melville Gardens. There are some issues that we're trying to work through with the city and the operator when it comes to the correct permitting and the construction of the beds that they have now. There were six beds made available through Peter's Place, as well as a number of beds available in the Cape Breton District. As well, there were the Bayside beds that were being transferred from the Department of Community Services to the Department of Health and of course there'll be an expansion of that facility as well.

So, we really understand the issue that before the 832 beds are available across the province, that we're going to be still having to work on some mitigation strategies to make sure that our seniors and special needs individuals receive the services they require before these beds are open for use.

MR. DAVID WILSON (Sackville-Cobequid): Actually, it's kind of a shame because I know I don't, and our caucus doesn't like promoting the fact that we want to see more transitional care beds in the province because ultimately that's not the most appropriate space for our seniors and for those who need care because they don't have the services like a long-term care facility would have. So we know the need for it, but I hope it's a temporary thing.

One of the things we've done is to speak with a lot of nursing homes, the administrators and those who run them throughout the province and I know that many of them have proposals and ideas on how to expand their secured care capacity, because that's an important issue. I know we've mentioned many times to the minister about the increased number of Nova Scotians with Alzheimer's, with dementia, and those requiring secured care in this province. So I'm wondering if the government has any plans to provide capital funding to convert beds into secured units, to mitigate the situation while they unfold their strategic framework plan with the increase of new nursing home beds down the road. So is there any capital funding available now for those nursing homes that could convert some of their rooms into a secured room or facility, Mr. Chairman, to the minister?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and what we would expect to see as we work through this RFP process of making it available, hopefully into next week, I believe, is what our deadline is to get the RFP available, is that through the new

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construction of beds, there will have to be some renovations done to the facilities that will be having expansions. Of course, we'll be having completely brand new facilities built in some communities across the province as well. What we would expect from the data that we've been able to collect and the information that we have that some of those beds would be available in a special needs configuration, where you would take people with Alzheimer's and other dementia, so we basically call it a challenging behavioural unit. So we would see the expansion of that happen in conjunction with the construction of new beds across the system.

What I can also say to the member opposite is that there have been a lot of discussions happen since we made that announcement in Truro a number of weeks ago. There has been a lot of discussion with current operators, current associations that operate some of these facilities, some of the private operators as well, on exactly what the new beds will look like, what the new construction guidelines will be, and what our expectations are going to be. Part of those expectations, of course, is making sure that we have those challenging behaviour units available.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I think it's important, I hope the minister realizes the need is yesterday and, you know, we continue to bring cases to the floor of this Legislature and outside the Legislature, to the minister's attention especially around the 100 kilometre rule and how we feel that it's a rule especially with those families and loved ones who have to place a loved one into a long-term care facility with a disease like Alzheimer's or dementia, that 100 kilometre rule really doesn't apply to them because it goes to the nearest appropriate facility that can handle the situation or handle their behaviour especially.

So we need to look at that now. We need to ensure that, from now until the time that government can stand up and say that we have a brand new room or a long-term care bed in the province and the construction of new facilities, we continue to ensure that families who have a loved one who is being placed, that it's not detrimental because of the distance travelled in between and especially around the 100 kilometre rule. So with the government's plan, or the strategic framework plan, and the number of new beds that the minister has stated, 823 I believe over 10 years, can he tell me what portion of those new beds will be capable of handling clients with challenging behaviours or with dementia or Alzheimer's?

MR. D'ENTREMONT: Mr. Chairman, it would be very difficult to really define the actual percentage of challenging behaviour units that will be available to Nova Scotians once the beds are constructed. What we are trying to do in conjunction with this RFP process, I think once that's out there and we have the proposals come back, we've sort of made it known that we do want to have more beds available for challenging behaviour. But also what we're doing at the same time is we're investing in some community development around challenging behaviour, how to keep some of these individuals in their homes and their communities longer, or in different levels of care without having to go to a full Alzheimer's unit or challenging behaviour unit.

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What we're seeing is that this year we've invested an extra $75,000 to help out in home care in challenging behaviours to a total right now of $300,000. But, Mr. Chairman, you know, the 100 kilometre rule, even though it is one that we would like to change and one that is very difficult, we understand and we know with families there are sometimes a lot of decisions that have to be made on patient safety, making sure they're in the correct facility, making sure that they have the correct services. Also because of adult protection orders, you know, we have to find beds for certain individuals and that may bump some other people who, of course, have been waiting on those waiting lists. So I know it's sort of a program that's in flux, but it is one that we are striving and we know we are making better. Hopefully, over the next three years we'll see some dramatic changes in the way that we react and how we work with our patients who are going to long-term care facilities.

MR. DAVID WILSON (Sackville-Cobequid): That's why I bring awareness around this issue, is that it's important to recognize that, you know, I don't want to see a single facility in the province for individuals who might need a secured treatment. We need to spread it out so that families, people in the community, their friends, can assist a facility, especially with someone who's fighting these diseases because I think that's the most important thing, is change for someone who has dementia or Alzheimer's is huge and it's detrimental to their health. There have been studies that say that those individuals who are taken out of the community, out of the areas that they have their support system in, do worse in other communities when they don't have that support of their community. It's not just the health care needs that we need to ensure that they have, we need to ensure that they have the support of their families, friends and ultimately their community, Mr. Chairman.

[5:15 p.m.]

So one of the things that we have mentioned, and hopefully the government will seriously look at, especially in our announcement of what we can try to do, or what government should try to do on the 100 kilometre rule, is to have an appeal process because families feel they have no option. Here they are requesting a long-term care facility and yes, maybe they do have the challenging patient, or their family members have challenging issues that secure a proper secured treatment facility, Mr. Chairman, but they feel they have no option, they just take whatever comes to them because they know they need help for their loved one.

So I hope the government looks at one of those issues, especially on the appeal process, to allow families, because it's usually within a short period of time that they have to make a decision on transfers, especially if they are in an emergency room or on a floor of a hospital, they have that option to give them just a little bit more time to talk with their families and figure out if that is most appropriate. So I hope government looks at some of the recommendations that we brought forward last week.

One of the things we have heard about from front-line health care workers and those health care providers is that sending a senior, or someone from a long-term care facility, or

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a home for special needs, is a huge cost for primary care, is a huge cost on the system. I think some of the quotes that we've seen, some of the numbers that reflect in Capital Health alone, are in the vicinity of about $10 million that the health care cost incurs because they need to send someone from a nursing home to the emergency room for treatment of some kind for primary care. So I wonder if the government tracks the amount of money - not the amount of money, sorry, Mr. Chairman - if they track the number of individuals who are in a nursing home or a long-term care facility who require transport to a higher level of care like an emergency room or a hospital? Do you track the number of patients, number of residents we have who do that and need the care of a hospital or an emergency room?

MR. D'ENTREMONT: Mr. Chairman, to the member, the district health authorities do track the ER visits from long-term care facilities, so there are some numbers maybe we can help provide. What we are trying to do in order to alleviate that issue, because there is tremendous cost to the system but it's also the inconvenience to the patients, to the residents, of having to go to emergency rooms to receive services. We have been working currently with the chiefs of staff of the district health authorities, the chiefs of staff of the hospitals, to work and try to find more coverage for long-term care facilities. Of course, we are talking about the pilot project for nurse practitioners that we are currently going through at Northwood. I know that even in my area, there is some work ongoing with one of my nursing homes and utilizing a nurse practitioner or geriatric nurse practitioner in that area so that individual can actually work with the health of those patients and really keep them out of the emergency room and keep them in the homes, of course, where they are much more comfortable and where they enjoy being a lot more than they would in the emergency rooms.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I think it's important that those stats are looked at because I think that is an area where if we can assist a long-term care facility when dealing with hiring and human resource aspect and the scope of practice, all that would dramatically reduce the need for further treatment in a higher level of care facility like an emergency room or a hospital. We all know what a domino effect that has on the system, when someone in a long-term care facility ends up in a hospital where, if we could avert that, it would go a long way.

One of the things I would also like to talk about is around private nursing homes in the province and around the RFP process for nursing homes and for them gaining licensing and going through that process. Many of the small operators and non-profit groups feel the process currently is a bit unfair. It seems to benefit those larger groups that run nursing homes here in the province - like Shannex, GEM and the MacLeod Group. So, what is your department doing to try to reassure some of the smaller ones and to encourage the non-profit groups to take advantage of your program, over the next 10 years, to provide new nursing homes and nursing home beds here in the province?

MR. D'ENTREMONT: I know, at this point in our continuing care system, within our long-term care system, there is, I believe, a good mix of private and public nursing homes

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where you see local organizations, in conjunction with their municipalities, running and owning long-term facilities.

What I think we've done over the last number of months is provide a lot of expertise and a lot of help to some of these non-profit organizations with the help they require to get through this RFP process so they can bid on new facilities and expansions of their facilities. At this point, what we also feel, and there will be some further legislation on this, is trying to create as level a playing field for people to bid on these and being able to receive the financing help for this as well.

I believe there's been a lot of work done and I do have to commend my continuing care division, the folks there, on the work that they're doing in preparing the industry, or the groups, in being ready for this RFP process that will be here in April. If we look at what we have as a distribution of operators in our province, about 1/3 of those operators are private for profit, which would include the GEMs and the MacLeods and other organizations, the Shannexes and also private non-profit, which is about 1/3 of our groups and, of course, the public non-profits are 1/3. So I think there's a good mix of different types of operators in our province.

MR. DAVID WILSON (Sackville-Cobequid): What I was trying to get at to try and make sure government recognizes is, and I hope with this question you might give us some reassurances that, what we don't want to see in the province is some of these large, for profit, health companies, especially the ones from the United States, coming into this province and saying, here the Government of Nova Scotia is going to implement 800 new beds, if we can get 500 of those- and I think they refer to big box kind of companies that will come in and take over the system. Are you going to put in place regulations, or policies, or legislation to ensure that we don't see an influx of these huge health care companies, especially from the United States, come in to the province and try to get the licensing for these new nursing home beds. I've read reports that these larger facilities actually give poorer care than the smaller, local companies. So, are you going to put checks and balances in place to ensure that doesn't happen here in the province when you unfold your strategic framework plan for the creation of new nursing home beds?

MR. D'ENTREMONT: There are really three things that we're doing to ensure we don't have a huge proliferation of beds going to one company or one of those companies coming in and really eating up the whole industry and trying to run it for us.

Basically, through the licensing standards and rules that people are going to require does set a fair amount of expectations on those operators no matter who those operators are. The other issue, of course, revolves around the issue that we don't want to have a facility that is too small nor one that is too big. So we would want to see a facility somewhere in the range of 34 beds, upward to 100 or so beds. We don't want to see huge facilities. We feel that it's easier for us to keep them homeier and easier for the operators to run. The other issue is that there is a provision within, I believe it is within the Act, that basically doesn't allow

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any one company or group to own any more than, I believe, is like 10 per cent of the beds in the province. I'm not too sure on the exact percentage, but I can provide that number for you. So there are a number of checks and balances there to ensure that the very thing that the member opposite is talking about does not happen.

MR. CHAIRMAN: The honourable member for Queens.

MS. VICKI CONRAD: Thank you, Mr. Chairman. My questions today, in the interest of time, I will try to make them brief as I'm going through my preamble beforehand. First I want to thank you, Mr. Minister, for all of the work that your department is doing and certainly I know that, given the huge portfolio that the Department of Health has, staff have an incredible job before them each and every year that are health care issues grow across the province.

What I want to address first are some questions that I brought up before you in the House sometime ago and I want to refer to the conditions of Simpson Hall. So I guess in some ways, I'm talking about hospital and facility infrastructure here. When I brought the issue to you in the House sometime ago, some photographs were tabled showing the conditions of Simpson Hall at that time. We understood at the time that a previous review in 2002, showed that indeed this hall should be vacated. Unfortunately, it is now 2007, and we haven't seen that take place. Meanwhile, many consumers of mental health services are in and out of this building, daily, to get the services that they need and there are a number of government employees working in this building. So I think the government does recognize, based on the recommendations from that review in 2002, that this building is posing some serious health risks to both consumers and to staff working in that building.

You did indicate, at the time, that your department and government was trying to find ways to either renovate that building or replace it. When I look in the budget document here, and I'm looking at the supplementary estimates here, on Page 1318, when I look under Capital Grants, and I'm assuming that this is where some funding for infrastructure would come from, under Capital Grants, under Hospital Infrastructure, I see no increase, at all, to any of our hospital infrastructures. So, I'm wondering, if your department is considering, even though there hasn't been an increase here on this line item, and your suggestion and your answer to me earlier, in the House, where you had indicated government and your department would be looking at ways to renovate or replace Simpson Hall, whether indeed that is going to happen over the next short term?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Just to the previous question from the member for Sackville-Cobequid, before I get to the Simpson Hall issue with the member for Queens. No group can own more than 20 per cent of the beds, under the Act. So there is definitely a good piece of regulation there that sort of doesn't let any one company own any more than they should in the province. So not one big operator can come and take up all the beds that are going to be available.

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[5:30 p.m.]

Simpson Hall, I know we've had a couple of discussions around Simpson Hall and I know that facility, which is under the purview of DHA 9, is in dire need of replacement, just like a couple of other facilities that are under the purview of DHA 9 as well. The challenge that we have is that in order to offer the outpatient services that are available there, we need to identify other space to use. I know that is in discussion now with the DHA, because the DHA are the ones that would bring a plan to us for us to react on. We don't mandate them to replace a building or give them the money to do something and they have to have that as a part of their budget plan. So right now we're awaiting a bit of a facilities' review on DHA 9 to look at what their requirements are going to be, which includes Simpson Hall, the Nova Scotia Hospital site, as well, I believe, a couple of other locations like the Centennial Building, which the member for Sackville-Cobequid brought up in an early questioning during these estimates.

To talk a little bit about the budget line or the $38 million, the $38 million is our capital infrastructure fund each year. So each year we get that new $38 million for investing in hospital projects. What I'll do is - I don't know which one I could use, I've got two great pieces of paper here, which talk about what we are working on today. There are a number of projects that are in progress or just about to start and that's where that $38 million is used. I know I've gone, on a lot of occasions, back to my Cabinet colleagues looking for some more funding in that but, again, we have to balance the priorities of capital spending with the operational pieces, with the issue of funding our human resources.

So if we look at our cash flows or funding, the Cobequid Multi-Service Centre still has about $288,000 to spend. The IWK for children's building looks at the 2006-07 allotment, I'm just looking at projected (Interruption) All right, 2007-08, let's go down the list a little bit. So the Colchester Regional Hospital development, should we come up with a final decision on that one? It would see the flowing of $18 million to that community. The Lillian Fraser Hospital, which is a primary care program, looks at a flowing during this year of $1.3 million; the Valley Regional, which is the 21-bed, the ER expansion of $1.575 million; the Halifax Infirmary, which is the ER expansion, which is a $4.2 million expansion; St. Martha's master plan implementation, which is a $3.4 million program.

The province-wide infrastructure master plan, which is just some regular maintenance if something happens around the province, is about $250,000. The Nova Scotia Hospital master plan, which is Phase I of the Mental Health Program, which is the new community-based in-patient facilities for the Nova Scotia Hospital site, is looking at the flowing of $3 million. The Cape Breton ER expansion is $2.18 million. The Inverness Hospital master plan is about $2 million. The Nova Scotia Hospital, which is a natural gas conversion, is $145,000. To build the infrastructure around all DHAs, which is the regular maintenance that will be happening in all our sites, is about $10 million of infrastructure funding.

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So, as you can see, the $38 million, even though we find a lot of places to invest it, there are probably a lot of places that we should invest it as well. Simpson Hall really is one of those sites that we would really like to find an opportunity to replace and/or move the services into another location so the residents and mental health consumers can receive those kind of services.

MS. CONRAD: Again, in the interest of time, I thank you for the answer, minister. I do hope that the department is also looking to the future in terms of any health risks posed to both consumers and staff working at Simpson Hall, that there is that forward-thinking and that there will be services in place should either a staff member or a consumer be affected by working in that environment. Environmental illnesses are on the rise with individuals who are exposed unnecessarily to asbestos, mould conditions, variances of temperatures in buildings such as Simpson Hall. So I hope that the department is thinking forward about those possibilities and the costs that will be incurred should those risks be found with consumers.

I want to move on to adolescent mental health issues. We recognize that there are a lot of gaps between the Department of Health and also the Department of Community Services. There is a huge lack of services for youth in this province who are facing mental health issues and it seems that when the question is asked, which department is responsible for mental health issues facing youth, we're told from the Department of Health that it's a Department of Community Services issue. We're told from the Department of Community Services that it's a Department of Health issue. This creates a huge problem not only in the eyes of consumers but it must be very confusing for departments involved as well.

Part of the new initiative in the budget document here talks about the partnering or the working together of the various departments - Departments of Community Services, Health, Education, Health Promotion and Protection, and Justice - all working together to improve services to youth, but it still doesn't answer in my mind what department is the lead department for youth with mental health issues. So if you could give me some specifics as to who the lead department actually is and where dollars are being spent within this new initiative. Will money primarily be spent on consultation services or will they actually go into programs themselves, if you could clarify that?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and to the member for Queens, there has been a lot of work in regard to a provincial youth strategy over the last number of months, especially with the recommendations at the conclusion of the Nunn Commission, and ultimately it is the responsibility of the Department of Community Services to develop that youth strategy, to be the department lead on this issue, yet it still falls to the Department of Health on the treatment of those individuals with mental illness. So there is a fair amount of collaboration that needs to happen, and has been happening, between our two departments.

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You know, the children's mental health issues have been managed through the IWK. There has been an increase in funding for part of that program which really provides the youth ordered court assessments, which is an increase of about $461,000. We are continuing to support, through our department as well, $208,000 for the Mental Health Attendance Centre in collaboration with Justice and I think there's Health Promotion and Protection, I think Community Services is on this one as well.

So this is really turning into a great collaborative approach of basically bringing down the silos of all those people who provide mental health services and treatment to youth; because I think really what was happening in the past, and this happens in governments and it's really one of my great frustrations being a government member now, is that you can see these silos still exist and, you know, if it's not my thing, I guess it must be your thing and if it's not your thing, it must be my thing, and you still have this battle between silos. I think what we've agreed upon as ministers - the Minister of Justice, the Minister of Community Services, the Minister of HP&P - is that those barriers need to go down, the silos need to disappear, and we should do the things that we're supposed to do, which is help our youth and make sure that those youth at risk are helped, of course, to the best possible level.

MS. CONRAD: I want to draw your attention back to the budget here. I see that there has been an increase for mental health services of over $8 million to the district health authorities, but when we move on to mental health programs, we've actually seen a decrease of well over $3 million. I'm wondering if this is a transfer or download of program deliveries from the district health authorities. When I try to crunch the numbers, it still seems to me that there has been a substantial decrease to mental health programs, even though the increase to that budget item for the district health authorities has actually increased, but when I look at different ways of crunching those numbers, it looks like overall there has been a decrease in programs, which is a concern if that, indeed, is the case, because we know how important it is to make sure that we have adequate services and programs in place.

There is an increase of mental health issues in individuals across this province and certainly we have seen an increase in mental health issues for youth. Depression and psychoses are on the rise, so I'm hoping that this isn't about transferring or downloading those programs to the DHAs where they already have an overload, to try to preserve those services.

Also, another question in there, I'm hoping too that the department is looking toward mental health and education awareness that needs to be taking place in our schools and in our workplaces. I'm hoping that the department is moving those initiatives to the forefront, we really need to remove the stigma of mental health issues or people suffering from mental health. If you could answer my question on the budget lines and ensure me that indeed we're not seeing a decrease?

MR. D'ENTREMONT: Mr. Chairman, I can assure the member for Queens that there is no decrease in mental health services from the Department of Health. What I will

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endeavour to give her, because it does make it difficult to crunch all the numbers and find out all the budget lines, that what we'll do is provide her with a breakdown of that tomorrow, to really understand where that funding is going.

There has been no decrease, as a matter of fact, there has been somewhat of an increase, but it has been shifted from provincial-wide programs to the District Health Authorities with the funding. They are the individuals who provide the service to begin with and what used to happen really is through their process, they would sort of bid on the money that was available at a provincial level and we would sort of flow it down to the system. What we've done in this budget is make it apparent and flow that money directly to them now for their mental health services. We will provide that funding breakdown to you tomorrow.

MR. CHAIRMAN: The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Thank you, Mr. Chairman. Mr. Minister, I'm wondering if there's any new money in this budget for families with children with autism spectrum disorder?

MR. D'ENTREMONT: Mr. Chairman, to the member, there has been no increase in the programs for autism spectrum disorder, but the base funding for that program is remaining at $4 million, as it did last year.

MS. MAUREEN MACDONALD: Mr. Chairman, I think that that will be a disappointment. When the former Minister of Health was the Minister of Health and money was announced for children with autism, we were all of the view that it was a beginning point and that there would be a gradual increase in the supports and services that would be provided to families with children with autism. I think that we are all very aware that not all of the families were able to get access to some of the programs that were introduced. That is somewhat disappointing. This is a serious problem for many families.

[5:45 p.m.]

At any rate, I want to ask the minister, is there any new money in this budget for the palliative care strategy?

MR. D'ENTREMONT: Just to finish up on the issue of autism, we have not seen an extra demand for the services of autism. We feel that the program is doing very well and we have transferred that funding to the DHAs that do offer the services in the regions.

The palliative care program has seen an increase this year of the $2.27 million on top of the $832,000 in the previous year. We continue to make, I believe, good investments in palliative care services that are so much needed in many regions in our province.

[Page 115]

MS. MAUREEN MACDONALD: Thank you. So, there's $2.2 million additional dollars in this budget? That's actually very welcome news. It has been an area that members of the NDP caucus have wanted to see some expansion of for some time.

It has recently been brought to my attention that there has been a jump in adult protection referrals to the Adult Protection Services in the province under the minister's direction, a jump in the number of cases, particularly referrals from the Capital Health District. I'm wondering if the minister can provide some information about why that might be the case and what his department would be prepared to do to address that situation?

From time to time I encounter a family who is very frustrated because they've had their loved one waiting for a long time for long-term care, trying to provide care at home and often they are unable to do that and perhaps they'll take their elderly relative to an emergency room and insist that they be provided with some level of care. Perhaps these folks are being referred on to Adult Protection Services, I'm not sure, but I'm wondering if the minister could speak to that issue, the increase in the numbers of referrals, the number of people who are going through the adult protection system, through the court process and what, if anything, his department attributes this to and how you plan to deal with this situation?

MR. D'ENTREMONT: Mr. Chairman, to the member, I'm not aware at this point exactly why we would see the increase in adult protection referrals, but what I will do is try to provide some more information around that. I can only surmise right now that it would maybe have to do with the acute pressures we have in finding long-term care facilities.

Because adult protection orders do take precedence on the system, we do try to place those because of dangerous situations and those types of things, but I will endeavour to have some more information for the member opposite tomorrow.

Also, I forgot to mention in the palliative care expansion of money, we're also hiring within the department, which is one that the Palliative Care Association of Nova Scotia has asked for, is a provincial coordinator in order to try to continue on that standard of palliative care across the province and make sure that all Nova Scotians receive a fair kind of service in palliative care.

So, palliative care, we finished that one, adult protection I will endeavour to have more information.

MS. MAUREEN MACDONALD: Mr. Chairman, as the Labour Critic for the NDP caucus, I have been approached by some of the unions that represent workers in the continuing care area with a concern they have about their workloads and the difficulty in getting adequate numbers of personnel in the continuing care field.

They express concern about the tuition costs to attend the Community College program. They express some concerns about a rule that says that if you're out of that work

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for 12 months, you have to do some kind of a refresher. They've identified a number of issues that they see as barriers to increasing the supply of workers available to do continuing care and to lessen the workload.

I'm wondering what the department - I'm sure this is not news to the minister or the deputy - I'm wondering what the department is looking at doing to address these very important concerns and what money has been allocated to increase the supply of continuing care workers and make it possible to have adequate staffing in these facilities?

MR. D'ENTREMONT: There are a couple of things that are going on at the same time. One is that with our work with NSCC, we now have a continuing care assistance program which is now fully subscribed and we will continue to work with NSCC and the Department of Education on finding ways to increase the number of seats that we're going to have available for that type of training.

At this point, we're finding we're still having some trouble in getting individuals to go into more of the home care field, of getting them to go out in communities and provide personal care and those kinds of things. Maybe there's a tune-up to the training program that we might have to do, again, sell the field or the profession maybe a little differently.

We are providing through this year's budget $900,000 in bursaries for individuals wanting to take that continuing care course, but also, at the same time, we have to be looking at the availability of LPNs and RNs for their services within those long-term care facilities as well. So, as a part of the continuing care strategy, we're very aware of the situation and we'll continue to work with those partners to make sure we have enough workers to work, not only the existing beds, but the expanded beds as well.

MS. MAUREEN MACDONALD: Mr. Chairman, I won't name names, but I had written the minister some time ago about a situation in my constituency of an individual who had a tumour and was having difficulty getting a diagnosis and later on, treatment. This is a question of wait times. I could name any number of people who have come to me concerned about the extraordinary waits they have to get important diagnostic and treatment services. I know the minister and Mr. Clement, the federal minister, had an announcement earlier this week with respect to benchmarks and working toward reducing wait times for radiation. I won't minimize that, that's an important development I think.

I guess I'm very concerned about the wait times for things like ultrasounds. I had a mature woman in my constituency who's waiting - I was quite shocked to hear this, you can't get an ultrasound until sometime this Fall. When she indicated she was prepared to go out to Sackville to have one done there, she was refused even though she knows that the wait list isn't as long there and she lives here in the Capital District.

[Page 117]

So, I'm wondering, beyond the announcement on Monday, what exactly is the department doing and what monies are allocated in this budget to reduce wait times for procedures like ultrasounds and to get timely treatment.

MR. CHAIRMAN: Order, please. The time for the NDP caucus has expired.

The honourable member for Glace Bay, for the next five minutes.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I know we only have a very brief period of time left and instead of just continuing on the line that I was and line-by-line questions and so on, I probably should be kind enough to offer the minister some time to wrap up for at least this portion before he moves on.

I wanted to make sure that the minister has had a chance to give us his opinion in the next two or three minutes on exactly where we stand in the province today. In particular, I asked him last night about his vision for health care and where he thought we were going in terms of where we will be and where our budget will take us and the fact that we are getting to the point where it is almost 50 per cent of our provincial budget that health care is taking up right now. I'm sure over the past couple of days the minister may not have had that much time to think about what that vision is or where it is going, because he has been on his feet continuously for hours at a time in estimates and so on. I know we will continue after the late debate later on, but I am wondering if the minister has any new thoughts since I last asked him that question yesterday.

MR. D'ENTREMONT: I want to thank the member for Glace Bay for, of course, offering loaded questions there. Maybe what I will do is I will get to his issue in just one second. What I would like to do is maybe use a couple of minutes just to answer the question for the member for Halifax Needham.

The ultrasound one I find a bit troubling. I am just wondering, maybe we can chat after, I am just looking at the site that they are suggesting to get that ultrasound, because different sites, of course, have different wait times. So I'm just wondering if there might be an opportunity to maybe use the Cobequid Health Centre or another facility in order to get a more timely test.

The wait time strategy that we talked about, if we look at what we need to do, there were going to be some costs that we would have incurred anyway, as a government, on the updating of the linear accelerators, the hiring of more nursing staff and technologists. This funding will help us avoid those costs where we can actually use that funding that has been avoided now, that we can use the funding that we saved in the other areas of wait time avoidance, or wait time helping, or helping within those wait times. I feel that almost every cent that we put into the health care budget is aimed at reducing wait times, therefore increasing access. So there are a lot of things going on.

[Page 118]

From the wait time committee, they came back with a wonderful set of recommendations, it is now available on the Web site so you can see what the provincial strategy is going to be on bringing down wait times and I offered the member to download that or we can even print it out for you and you can have a good look at that. A lot of it includes spending a fair amount of money on new equipment, continuing our training programs with our facilities to make sure that we have the right types of professionals available to offer those tests. So there are a lot of things that really have to go on at the same time in order for a lot of these things to improve that access and help those wait times. If we could share that ultrasound issue and even the issue around the individual with the tumour, of how that is going, I would appreciate to hear that and see what we can do as well.

On to the broader question of our member for Glace Bay who brings on the issue of vision. We have been working on a number of visions and if you try to pull them together, the number one vision is making sure that the patient is first. It's all designed toward the patient to make sure that they are going to receive fair treatment for whatever ails them. We need to continue our investments in long-term care, which I think we have a clear strategy on what that is and where those investments are going to go in the future and we will continue those; because on the back side of that, it will free up beds in our acute care system so we can actually use those facilities for what they were designed for, which provide acute care services like surgeries and treatments and therapies. I think that is a very important part of my vision for health care into the future.

Also the issue of continuing to invest in diagnostics, to continue to work on public health care and primary health care.

MR. CHAIRMAN: Order, please. We have reached the moment of interruption. We will now recess for 30 minutes.

[6:00 p.m. The committee recessed]

[6:30 p.m. The committee reconvened.]

MR. CHAIRMAN: The honourable member for Kings West.

MR. LEO GLAVINE: When I finished off, I was talking about nurse practitioners and it's a role that is developing here in the province. I think from all the health personnel that I speak with, it's one that's very welcome. As the minister said in a previous question, it is continuing to expand and the scope of practice for them is getting well defined. He also spoke in terms of additional monies - I think about $180,000 in DH3 in the Annapolis Valley. I'm just wondering, is there a plan for that at this time, or is there still some flexibility as to where we may see them show up in the coming fiscal year?

HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, again welcome to another riveting half-hour or so of questioning on the estimates for the Department of Health. I again

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thank the member for Kings West on bringing forward the issue of nurse practitioners in asking how we're using them. Using is the wrong word, really - utilizing their services within the health care system.

The scope of practice is becoming well defined on exactly how the nurse practitioner works in concert with their physician, what they are allowed to do, what they are not allowed to do. The bill that we brought forward in the House back in November really defines and expands the scope of what that nurse practitioner can do and how the collaboration actually can happen.

What we will try to do is continue those annualizations, continue to invest in the district health authorities and their needs for the usage of nurse practitioners and through the business planning process, we expect the district health authorities to continually ask us for more and more nurse practitioners, to utilize them in collaborative practice settings. So, looking at those areas, whether the hospital setting or, in our estimation, better in the community setting, to use them in concert with other professionals like physiotherapists, massage therapists. You could put a whole bunch of people together and really provide those wellness clinics and those kinds of things. We want to see some more of those things happen in the province and we'll continue to fund those as best we can. Again, this year's increase is from 19 nurse practitioners to 25.

MR. GLAVINE: Just to move that one little step further, certainly one of the areas that a nurse practitioner in our area, probably several areas, but one that has some immediacy about it is the Grandview Manor where you have over 200 people in that institution and a doctor who probably won't be practising too much longer, who makes frequent calls there and, again, if you take into account how much each of those calls will cost the system versus having a nurse practitioner there. I'm not asking the minister to place one there tomorrow but what I'm really interested in, is there any kind of interim report and assessment of how the nurse practitioner position has gone at Northhills - sorry, at Northwood, Northhills is down my way as well - but at Northwood, and I'm wondering if the minister has any comments to make on how the position of nurse practitioner has been executed and what is the general acceptability and so forth in that context?

MR. D'ENTREMONT: Mr. Chairman, to the member for Kings West, you know, I think we've had a fair amount of success with our pilot project with Northwood on using a nurse practitioner for primary care within a long-term care facility or long-term care setting.

I think the comments I'm hearing are reminiscent of the comments from the member for Digby-Annapolis on the usage of a nurse practitioner in the Brier Island area. I think wherever we establish positions for nurse practitioners, we tend to get the same rave reviews on the kind of services that they provide because not only do they see patients, you know, the patient comes to visit, you see the patient, you diagnose them and send them on their way. There is a whole wellness piece that continues to work to the health of a resident and continues to work on making that individual better over a longer period of time rather than

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just seeing someone, prescribing them a drug to help whatever the ailment may be, and send them on their way. So, you know, the type of collaboration is far-changing. We've been seeing good reviews on our Northwood project.

Also looking at what we're trying to do in making sure that our seniors and people in long-term care facilities receive the services they require, there has been some work being done with the chiefs of staff of the district health authorities to make sure that we have physicians to work in long-term care, whether it be on a, hopefully, regular basis. The continuing care branch as part of the strategic framework project has received an extra $1.35 million in 2006-07 and 2007-08 to establish physician leaders in each health district. The implementation will begin this first quarter.

So, you know, the problems we had in getting physicians to be in long-term care facilities was really the time it took to move to go from their practice to the facilities and weren't being paid for that travel time because they were probably on fee for service. Of course, the visits, the collaborations, or consultations with the resident was longer. So they weren't getting the same return for the same amount of remuneration as they would have had they stayed in their clinics and seen patients that way. What we've done is provided funding for that travel and really taken into consideration the different kind of work that they would have to do in a long-term care setting.

So, Mr. Chairman, you know, just to basically quickly sum up on that one, is that I think we've done a number of really good things. Within this budget there is still some funding towards that and we will continue to change the model, if you will, of how nurse practitioners work and how Nova Scotians expect to get health care services.

MR. GLAVINE: Thank you very much, Mr. Minister, that was lengthy but also had a couple of very concrete pieces in there that I think should prove to be very valuable for our district health authorities as we see that nurse practitioner role developed further.

One of the areas that I want to go to now and it's one that I, first of all, want to at this time commend the deputy minister who appeared before a standing committee a couple of months back, on her candidness at that time about the long-term care bed conundrum I guess, that we have in this province. How we are probably several years behind, in as much as can be launched and put forward in terms of the number of beds and the long-term care strategy that we see unfolding in this province. There's no question that in the Valley, in our area we do have that population cohort at one of the highest percentages of 65-plus in a number of communities, Digby-Annapolis, there's one other that had 25 per cent of its population already at 65 and over. Berwick is the other. So we know that there is an immense coming crush in terms of beds. We saw that during the last couple of months. In fact, one of the doctors who I consulted with on this, he didn't have the stats, but it was his view that there were as many days of code purple at Valley Regional as there were days without for January and February of this year. They went through a very difficult time and I remember on one day of the 98 beds, 28 had patients who could have been moved out to some of these sites.

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I'm wondering, Mr. Minister, I'm certainly pleased and I know residents in my area are pleased that Middleton will gradually see a development there but I'm wondering if there is any look at some contingencies for placement. I say this from a real worry position and I hate even hearing this being voiced in the medical community or the larger community that yes, we had the wonderful piece of equipment, the MRI machine christened, unveiled - christened, I like that. But you know I hear- will we be able to keep our specialists if Valley Regional can't operate as a full regional hospital? Get people in and out of the OR in a timely way and keeping those so many beds that are in transition.

I have dealt, in my office, obviously we can't use names here and you don't want that anyway, but I have dealt with three or four in my office who have been in Valley Regional for three months or more and they are ready, they want to get home. I just wonder if there is anything going to be on the contingency side of dealing with long-term care beds?

MR. D'ENTREMONT: Mr. Chairman, again thank you to the member for Kings West. There are a number of things going on, sort of at the same time in order to address the needs of long-term care in the province but I want to go back just a little bit. We are sort of behind where we should be and the best reasons why - and I just want to sort of lay that out - is that probably seven years ago, and Alan can attest to that, is that probably on a daily basis, he would be getting calls from our long-term care providers who were on the brink of bankruptcy. There had not been an increase in their daily rates, there had not been any injection of funding for a variety of different things in their homes for over a decade.

From that point to now, when we were finally able to make that final, large investment, there have been millions of dollars invested in our long-term care facilities in order to put these groups, these private and these public non-profits back into a place where they can say that they are surviving. It hasn't been now until we can actually move that next step forward which was working toward the construction of those 832 beds. Mr. Chairman, we also have to say that we have these beds and once those are complete, it is our vision to implement 200 new beds per year after that so by the time that 10 year or that plan is worked out, all the beds would have had to be in the system and we'll be able to respond to the needs of long-term care in the province.

The interim piece, and there has been a number of million dollars available to help district health authorities to expand beds in places like Northwood, Melville Gardens, Peter's Place and some other various places where we feel our pressure is today. We have monthly meetings now, and even almost bi-monthly, twice a month, where we have meetings with our CEOs and chairmen of the boards to know exactly where they are at that point in time, to look at what those pressures are and how we can help alleviate some of those issues.

So if you look at the placement as of April, our alternative level of care placements, where DHA 1 will be getting, I believe, is what we're talking about - oh, the contingency plans, the extra beds. It would be about five beds for DHA 5, 12 beds for DHA 6, nine beds for DHA 7, IWK is looking for six. DHA 2 is looking for five for Roseway. DHA 2 is also

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looking for, I believe, five mental health beds as well. DHA 4 is looking for three. DHA 9 is looking for four. Trying to find within the hospital acute care system the availability of some beds, in order to provide a level of care that is better than staying in the regular hospital population, but really is not where they need to be, which is in long-term care facility.

Just quickly speaking, a snapshot in time, of the people waiting for long-term care facilities or people waiting to placement by district. So I'm guessing that this is numbers of people of ALC people, sitting in hospital. So these are numbers as of February 14^th: 33 people were waiting in DHA 1; 38 people waiting in DHA 2; 50 people waiting in DHA 3; 72 people waiting in DHA 4; Cumberland, DHA 5, 19 people; and Pictou County, there were 52; Guysborough 51; Cape Breton District, and they've had some challenges on getting beds available too, 234; and of course here in Capital District, we've been talking about a larger number of 380 people waiting for placement in long-term care beds, which is a Nova Scotia total of 929. Which also underlines another issue is that even with the 832 beds we're not envisioning wiping the wait times at this point. We need to have some kind of a wait list there, so that our utilization can continue to stay in that 95 or 96, to 100 per cent.

[6:45 p.m.]

I know I provided an awful lot of information there - oh, DHA 3, back in June, would be looking at some extra ALC beds or will require a review because of renovation costs. DHA 3 is looking at nine ALC beds or an expansion of nine ALC beds in that district.

MR. GLAVINE: Thank you, Mr. Chairman. One of the areas that I've talked about in the past is home care, and first of all, just a quick question around this. I know that there has been some discussion about having the DHAs look at administering the home care program. I'm wondering if the Department of Health is possibly looking at a pilot DHA, or advancing perhaps more of the administrative and logistical requirements that home care sometimes struggles with a little bit. I would have to say, there have been some improvements, without doubt, but I'm just wondering if that's still something that the Department of Health would be continuing to possibly implement?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. The member for Kings West underlines probably the most important problem we have in DHA 3, which is the issue of home care utilization, and the wait list that we have there. Currently, I believe, the number of clients waiting, as of February 2007, is 180 people waiting for home care service in that district. We are seeing some improvements though and I want to commend the new nurse manager for the VON, where apparently she has done a fair amount of work in addressing the issue here. We still have some recruitment issues of getting the right amount of people to be able to work and provide that service.

The issue of devolution is really what you're talking about, is basically trying to take the programming, which right now resides in Halifax, and let the decision makers and the district health authorities basically take that over. So really you have a continuation of care

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from the acute system into the long-term care system, and back and forth if need be. That has been a want from the district health authorities for quite some time, and we're looking at the possibility of piloting that, maybe in a couple of districts, but right now we haven't made that plan within this budget. We'll continue to manage it as best we can at this point because of that gap. I think we would like to see that gap closed before we would devolve that off to the district health authority and maybe get that full complement up.

The other issue for DHA 3, we're looking at the benefit of a daycare program or an adult daycare program that we would implement as soon as it can be set up, which would allow people to stay in the community a little bit longer as well. Caregivers could actually have that respite time or the time to do other things. There are a number of issues we are really working on with DHA 3 to try to alleviate the pressures they are seeing today.

MR. GLAVINE: Thank you, minister, for that very specific and concise review of a very challenging area, home care, but one again that continues to grow in demand in the province.

What I would ask, from a provincial perspective, but also has impact on DHA 3 and that is the training of LPNs and attracting nurses to VON home care, is that able to keep up or is it also one of the stumbling blocks or difficulties around a greater degree of home care being provided?

MR. D'ENTREMONT: I know that our nurse policy manager, our nurse person within the department, has been working quite closely with the district on the training options, making sure we continue to have that one step up on the LPN and VON training programs so we can try to attract those individuals to the Valley. But I also think it has a lot to do with making people - again I talk a lot about societal changes, but we have to understand that our society will change a fair amount over the next number of years, especially when it comes to care of seniors because our seniors numbers will rise dramatically.

We need to continue to work within our school systems in making communities aware of the option of being a continuing care assistant, being an LPN, an RN and their needs. I know there has been some specific strategies focused at DHA 3, yet we haven't found that final solution that would alleviate some of the pressure we're seeing, especially in home care.

MR. GLAVINE: To the minister, there is some talk now in the Greenwood-Kingston area because of the transitional population in the Air Force, there are many people without a family doctor. There is talk about a community clinic being developed in Greenwood and I would expect it would probably be the base doctors and perhaps nurses, nurse practitioners and other health care providers that would staff that facility. I'm wondering, would that come under the auspices of the province, in terms of such a set up?

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MR. D'ENTREMONT: Greenwood gives us a bit of a problem because there are a lot of those personnel and their families that would be able to receive services through the Armed Forces directly. But, once you go beyond those primary services, they do fall within the purview of the Department of Health in order to receive those secondary and tertiary services that would be at a regional hospital or here in Halifax.

We have been working quite closely on a number of initiatives with the Armed Forces, whether it be here in Halifax or in Greenwood and some other sites. Maybe what we could do is bring that issue forward again and we can discuss this one to see what maybe the proposal might be from the community and from the Armed Forces community to see what their requests would really be, and how we could basically share the services that they do have, with maybe some expanded services, which would be nurse practitioners, which we could fund through the DHA. So I know there can be some pieces that we could work together on but it would also require having the Department of National Defence or the Armed Forces to work with us as well, on this issue.

MR. GLAVINE: Thank you, Mr. Chairman, I'm pleased with that response from the minister. It certainly opens the door for discussions and the possibility of executing a plan for a much needed service with Armed Forces personnel.

Just one further question to finish up with and then my colleague for Digby-Annapolis has a couple of questions to the minister. One of the areas that, again, in many parts of the province we hear of nurses putting in a considerable amount of overtime, and certainly demands in some of our hospitals that there are nursing shortages. I've heard of cases in the last few weeks of nurses doing 30 to 36 hours of overtime and of course, it's a pretty demanding occupation to be putting in that kind of overtime.

I'm just wondering if there has been any consideration by the department perhaps about structuring the RN program? Not in any way challenging the degree nursing program, but some type of mentorship and longer clinical experience in the hospital? You know, my wife, who was an RN, now retired, talks about how much time nurses in the nursing schools put in on the floors. That was pretty cost effective, for the province. I'm just wondering if that can be both a cost saver and that valuable clinical experience too in fact perhaps even put out, again, a better quality of nurse. Not in any way to diminish the training they get now, but again, one of those enhancements when you have that wide experience in the hospital?

MR. D'ENTREMONT: Mr. Chairman, I will take the opportunity at this point to thank our RNs for the service they provide to our system every day. It is a tremendous amount of work that they provide, working those 12-hour shifts, providing the patient care. We need to find sometimes, I think, better utilization of these very important professionals and see how they can work more in tandem with some of those other professionals that we're talking about. A better working relationship with those LPNs, better working relationship in the long-term care, with CCAs, or whatever that level of worker is as well.

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The nursing strategy is one that is a living document as well that we continue to update as time goes on. We have had some tremendous success through it. We have attracted and kept over 250-odd nurses in the province, as they've graduated through their programs at the various sites around the province. Of course, Kentville has a number of seats or positions for the clinical experience for nurses who are either at the Dalhousie program, the Yarmouth site of the Dalhousie program, through, I believe, Antigonish as well. Of course, we're also in negotiations right now with Cape Breton University on bringing that to a full program rather than the satellite site of the Antigonish program.

We retain, at this point, over 80 per cent of our new graduates, which I think is a good number. We would like to see it better. Six years ago we were only retaining 50 per cent of our nurses. So I think we've made some great steps, but again, it's a living document and we'll continue to update it and try other strategies in order to retain nurses in our system. Again, Mr. Chairman, we need to find that balance between the competencies and the scope of practice of the RN, and how that works in concert with the scope of practice of other professionals, like LPNs.

MR. CHAIRMAN: The honourable member for Digby-Annapolis. You have about 11 minutes.

MR. HAROLD THERIAULT: Mr. Chairman, I won't keep the minister too long. We don't need him in the ER tonight, after all the hours you've put in, so we'll soon let you out of here, that's for sure.

I want to talk about Digby a little bit. As you know, down in Dibgy our shortage of doctors is growing and it's going to grow. We've got six doctors there now and we're expecting probably before this year is up three more to leave. We've very concerned about that. I've had questions put to me, information put to me too, about Cuban doctors. My daughter, just this past year, this winter, was down in Cuba and had to go visit a doctor. I've been down there a few times myself, I've never been that unlucky, but she said she was lucky to be able to meet one of these doctors. He spoke four different languages and was very, very thorough, did a wonderful job, and she thought he was great.

[7:00 p.m.]

Cuba, as of August 2005, had 66,567 doctors. They made a little deal with Venezuela a while back for a little bit of oil and gave them 20,000 doctors. They're still putting them out down there, day after day after day, doctors and school teachers, and they're not doing too much. It's a shame because those young doctors, if they don't practice, I guess, you know, you lose it after awhile - use it or lose it.

Here we are in Digby with no doctors and all these doctors down in Cuba, wonderful people, I've been down there quite a few times myself, and wonderful people, smart people. They're all well educated and speak many languages. Some people said it could be a

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language barrier, but I don't believe that. Anyone I met down there could speak very fluently in many languages. Anyway, has this country, or even this province, or the minister himself, looked into getting doctors from the Country of Cuba? Has that been done or been looked at?

MR. D'ENTREMONT: Mr. Chairman, maybe what I should do is take a bit of time and go on a road trip with the member for Digby-Annapolis. Maybe that would be a good thing to do right now but, quite seriously, I don't think there has been any specific programming through our department or even through the Department of Immigration to target Cuba as a possibility for getting those positions. The challenge I think would be, as well, that I don't know how freely the residents of Cuba can actually travel to other jurisdictions because it is a communist state, let's not forget that one. Cuba, it is an interesting thing that I learned when I had an opportunity to visit there, I was not a Health Minister at that time nor was I anywhere near this House, but I had learned at that point that there's actually probably one doctor per 100 people in Cuba. They pump out an awful lot of physicians in that state.

What we could do though and what we continue to do with foreign trained doctors is through agreement with Immigration, they are working with the department and other departments to coordinate shortening the time it takes to get credentials in Canada, depending on what you've trained, it could be an engineer, it could be a physician, it could be something else that we need here in the country. Also what we can do is maybe through the program that we have through the College of Physicians and Surgeons, called the CAP Program which reviews the credentials of the doctor, okay, so they would come to us and we would put them through sort of a battery of tests to see what their competencies are. We would then provide them with sufficient training to give them their Nova Scotia credentials.

We've had a fair amount of success with that, and I know Alan has some CAP assessment programs, but through the two cohorts at this point we've had the retention of a huge number of physicians. What we're finding though is that we had felt, and other jurisdictions had felt, that there was a fair amount of these foreign-trained doctors in different jurisdictions, they could be in Toronto, they could be somewhere else. They can come to our province, get that training and we are hoping they are going to stay, right? But we are finding we are not getting the uptake as we thought it was so we are actually dropping the numbers down to something like 30 people or 30 physicians per cohort that would end up going through the system and getting the mentoring from other physicians or through the CAP mentoring program that we have working out of the Yarmouth hospital.

I would say maybe there is an opportunity that we should be looking at, which would be states or countries like Cuba to see if there is an opportunity to basically take some of those physicians. I just wonder sometimes, especially dealing with Cuba, we have a good relationship with Cuba on receiving some of our ambulances. I don't know how that return would be on taking people, in this case physicians, away from that country. But it's something we could look at anyway.

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MR. THERIAULT: In the meantime, you know, we have a shortage of doctors and I guess it sounds like, from that answer, we will be awhile before we get any out of Cuba. In the meantime, we are going to have three less doctors in the Digby area and especially in the emergency room. We have the emergency room shut down now nearly every weekend and my phone rings steady and I get a lot of feedback. We have a nurse practitioner on Long Island down there and the people down there think the world of her. I think probably they think more of her than the doctors do of her because there are so many of those people on that island don't come off that island anymore to see the doctor.

Maybe that is part of the problem, I don't know, but we don't look at a nurse practitioner as taking over any doctor's position. We look at a nurse practitioner put in that emergency room in Digby to help the doctors. We believe, and the people down there believe, and 99 per cent of them believe that a nurse practitioner would work fine in that ER while we are looking for doctors. Is that something that the minister is going to look into for us in the Digby area?

MR. D'ENTREMONT: Mr. Chairman, yes, that is definitely something that we are going to look at for Digby. I know I have committed to a meeting with the community to work with the medic group and the councils to see if there are some things that we can do collaboratively in trying to figure out a way to get more service out of the Digby emergency room.

The challenge I think we have there is that even if we did bring in a nurse practitioner, that nurse practitioner has to work in collaboration with a physician. So we really have to figure out a way in order for them to work collaboratively or in concert with.

(Interruption) Three minutes to go, yes. Thank you very much, to the member for Glace Bay. You are really watching the clock and I thank him for that.

Mr. Chairman, I think that what we really need to do, as well, is try to use the model that we have in Long Island because the approach is so different. The two contrasts, we have two contrasts in your riding. We have the primary health care model, which is working so well in Long Island and Brier Island and in part of Digby Neck. Then you have the old version which is the ER, wait until you are sick and hurt before you go, right? What we really need to do is continue to work in communities so that we have less people showing up in ERs for minor things and we use ERs for what they are designed for, which is to see patients who are acute.

So I don't necessarily want to use up our nurse practitioners in putting them in the wrong setting because I think they can do a world of good working in our communities, providing that primary health care that the people in Long Island have come to appreciate and embrace. Really, what we should do is get the member for Digby-Annapolis and maybe some community members from Long Island to do a commercial supporting primary health care and nurse practitioners in our community, because I know they do it so well there. Maybe I will leave the last comment to you.

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MR. THERIAULT: I would do that because the people, the feedback I get down there about this nurse practitioner is something else. If you're not there to witness this and hear it, this woman will go out and do house calls and she'll stay with them for a half an hour - they love it. Especially the elderly people, they can't get over this, they haven't had this. There used to be a doctor down there 30, 40 years ago that did this and they feel this has come back to them. And, very cost efficient, I might add. I guess it is, it's a great thing.

If I can help you any way in promoting this, I certainly will. Thank you very much.

MR. D'ENTREMONT: Thank you for the 30 seconds of close up. Maybe what we can do is look forward to the questions on Thursday. I know the NDP will be starting it off, I believe, with some questions. I also look forward to maybe responding to some questions on another department which is under my purview, which is the Office of Acadian Affairs. I know the member for Halifax Fairview has said he would maybe like to have a bit of that debate in French so we'll see how we make out with that one.

I thank the member for Digby-Annapolis as well as the member for Kings West for their questions this evening.

MR. CHAIRMAN: Order, please. The time has expired for debate in Committee on Supply.

The honourable Deputy Government House Leader.

MR. PATRICK DUNN: Mr. Chairman, I move the committee do now rise to report progress and beg leave to sit again on a future day.

MR. CHAIRMAN: Is it agreed?

It is agreed.

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

The motion is carried.

[The committee adjourned at 7:10 p.m.]